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122 Cards in this Set
- Front
- Back
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Histoplasmosis
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Pneumonia - Mississippi and Ohio river valleys, bird or bat droppings (caves)
Macrophages filled with Histoplasma, dimorphic |
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Blastomycosis
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Inflammatory lung disease -> skin, bone, forms granulomatous nodules
Mississippi River and central america, broad-base budding |
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Coccidioidomycosis
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Pneumonia (cavitary, hemoptysis can mimic TB), meningitis -> disseminated
Southwestern united states, california spherule filled with endospores |
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paracoccidiomycosis
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budding yeast with captain's wheel
Latin America |
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Tenia versicolor
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damaged melanocytes and hypopigmented/hyperpgmented patches
Malassezia furfur |
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Tineae
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pedis (foot), cruris (groin), corporis (ringworm), capitis (head, scalp)
not dimorphic- dermatophytes - Microsporum, Thrichphyton, Epidermophyton - KOH prep, Wood's lamp |
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Candida albicans
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oral/esophageal thrush in immunocompromised, vulvovaginitis (diabetes), diaper rash, endocarditis (IV drugs), disseminated
pseudohyphae and budding yeast 20C, germ tubes at 37C tx: amphoteticin B/nyastatin for disseminated |
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Aspergillus fumigatus
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allergic bronchopulmonary aspergillosis with asthma/CF, lung cavities after TB,"", some produce aflatoxins ->HCC, invasive/disseminated
not dimorphic *Acute angle branching in Aspergillus* |
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Cryptococcus neoformans
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cryptococcal meningitis, pneumonia if inhaled
heavily encapsulated yeast, stains with India ink, soild, pigeon droppings |
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Mucor and Rhizopus spp.
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ketoacidotic diabetics, leukemia patients
fungi proliferate in blood vessel walls, penetrate cribiform plate -> enter brain -> rhinocerebral, frontal lobe abscesses headache, facial pain, black necrotic eschar on face greater 45 degree branching, no septae |
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Pneumocystis jiroveci
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diffuse interstitial pneumonia, inhaled, important for immunosuppression,
methenamine silver stain -> yeast AIDS defining illness, prophylaxis CD4 <200 tx: TMP-SMX, pentamidine, dapsone |
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Sporothrix schenckii
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dimorphic, cigar-shaped budding yeast, lives on vegetation, travels through skin lymphatics as red streaks without systemic illness
"rose gardener's" disease tx: itraconazole or potassium iodide |
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Giardia lamblia
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giardiasis, bloating, flatulence, foul-smelling, fatty diarrhea, after camping
doesn't invade gut mucosa trophozites or cysts |
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Entamoeba histolytica
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bloody diarrhea, liver abscess (red/brown), RUQ pain
metroniadazole and iodoquinol (must treat both live and cysts) |
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Cryptosporidium
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severe diarrhea in AIDS, mild watery in competent
cysts on acid-fast stain |
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Toxoplasma gondii
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ring-enhancing brain lesions on CT/MRI in HIV patients
congenital toxoplasmosis - hydrocephalus, chorioretinitis, calcifications - "wet, ret, white" crosses placenta, cat feces |
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Trypanosoma gambiense, rhodesiense
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African sleeping sickness: enlarged lymph nodes, recurring fever, somnolence, coma
Tsetse fly, painful bite |
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Plasmodium
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malaria: fever, headache, anemia, splenomegaly
P. vivax/ovale -48hr cycle, dormant in liver P. falciparum- severe, irregular/daily fever, RBCs occlude capillaries in brain, kidneys, lungs (most common form) P. malariae -72-hr cycle transmitted by Anopheles mosquito tx: chloroquine (blocks malaria heme polymerase) -mefloquine if resistant vivax/ovale - primaquine for dorm liver form (hypnozoite) |
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Babesia
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fever, hemolytic anemia -NE USA
Ixodes tick (same as Borrelia burgdorferi, Lyme disease) Maltese cross tx: quinine, clindamycin |
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Trypanosoma cruzi
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Chagas' disease: dilated cardiomyopathy, megacolon, megaesophagus
predominantly in South America, reduviid bug- painless "kissing bug" |
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Leishmania donovani
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visceral: spiking fevers, hepatosplenomegaly, pancytopenia
sandfly transmits macrophages containing "amastigotes" |
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Trichomonas vaginalis
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vaginitis: foul-smelling, greenish discharge, itching, burning
motile trophozoites with flagellum metronidazole and prophylaxis for partner |
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Enterobius vermicularis
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pinworm- anal pruritus
tx: bendazoles, pyrantel pamoate |
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Ascaris lumbricoides
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eggs in feces, intestinal infection
bendazoles |
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Trichinella spiralis
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undercooked meat (pork)- larva encyst in muscle causing inflammation, periorbital edema
bendazoles |
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Strongyloides stercoralis
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intestinal infections; vomiting, diarrhea, anemia- immunocompromised
bendazoles |
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Ancylostoma duodenale, Necator americanus
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larvae penetrate skin of feet, intestinal infection causes anemia
bendazoles |
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Dracunculus medinensis
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drinking water, skin inflammation and ulcerated
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Onchocerca volvulus
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transmitted by female blackflies- hyperpigmented skind, river blindness
can produce allergic rection to microfiliria IVERmectin for rIVER blindenss |
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Loa loa
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transmitted by deer fly
swelling in skin, worm crawling in conjunctiva |
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Wuchereria bancrofti
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female mosquito transmitts: blockage of lymphatics -> elephantiasis
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Toxocara canis
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food contaminated with eggs: granulomas (eyes) and visceral larva migrans
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Taenia solium
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pork tapeworm,
ingestion of eggs cause cysticercosis and neurocysticercosis -> "swisschees" lesions in brain praziquantel, bendazoles for neuro |
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Diphyllobothrium latum
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fish tapeworm, raw freshwater fish
B12 deficiency, anemia tx: praziquantel |
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Echinococcus granulosus
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eggs in dog feces -> cysts in liver
anaphylaxis if antigens are released from cysts during surgery (EtOH for prophylaxis) tx: |
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Schistosoma
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snails are hosts, granulomas, fibrosis, inflammation of spleen/liver
S. haematobium can lead to squamous cell carcinoma of the bladder- hematuria |
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Clonorchis sinensis
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undercooked fish, inflammation of biliary tract -> pigmented gallstones, cholangiocarcinoma
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Paragonimum westrmami
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undercooked crab meat, inflammation and secondary bacterial infection of lung -> hemoptysis
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Live attenuated vaccines
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Smallpox, yellow fever, chickenpox, Sabin's polio virus, MMR
induce humoral and cell-mediated immunity but can become virulent |
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Killed vaccines
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Rabies, influenza, Salk Polio, HepA
can get recombinant HepB, HPV only induce humoral immunity- require boosters |
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Naked viral genomes
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lack outer envelope
CPR -PAPP PAPP = Parvovirus, adenovirus, papilloma, polyoma = all DNA -except Poxvirus CPR = Calicivirus, Picornavirus, reovirus = naked RNA viruses |
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DNA virus characteristics
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HHAPPPPy viruses -Hepadna, Herpes, Adeno, Pox, Parvo, Papilloma, Polyoma
Parvo virus only single stranded Papilloma, polyoma, hepadna - non-linear Pox only nonicosahedral Pox only replicate in nucleus |
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Herpesviruses
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HSV-1, HSV-2, VZV, EBV, CMV, HHV-6, HHV-8
CMV - immunosuppressed patients, congenital hearing loss, seizures, petechial rash, "owl eye inclusions" negative monospot |
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HSV-1
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enveloped, DS linear DNA
oral lesions, in neonate born to positive mother - temporal lobe encephalitis, keratoconjunctivitis - latent in neural ganglia (especially trigeminal) Tzanck test- multinucleated giant cells |
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HSV-2
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enveloped, DS linear DNA
genital, latent in neural ganglia (especially sacral)- can cause temporal encephalitis, lesions Tzanck test- multinucleated giant cells |
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VZV
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enveloped, DS linear DNA
chickenpox, shingles - dorsal root ganglia, can cause encephatlitis, pneumonia |
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EBV
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enveloped, DS linear DNA
mononucleosis (pharyngitis, organomegaly, lymphadenopathy, atypical lymphocytes, splenomegaly, monospot test), Burkitt's lymphoma, Hodgkin's lymphoma, nasopharyngeal carcinoma latent in B cells |
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CMV
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enveloped, DS linear DNA
congenital infection: hearing loss, seizures, petechial rash, "owl eye inclusions" mono, pneumonia negative monospot latent in mononuclear cells |
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HHV-6
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roseola- high fevers that can cause seizures, followed by diffuse macular rash
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HHV-8
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Kaposi's sarcoma in HIV patients- papular nodules- dark colors
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Hepadnavirus
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enveloped, DS-paritial circular virus
Hep B acute hepatitis 20% remain chronic - ground glass inclusions contains a reverse transcriptase but is not a retrovirus blood/sexual transmission hepaDNAvirus |
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Adenovirus
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non-enveloped, linear dsDNA
febrile pharyngitis - sore throat, acute hemorrhagic cystitis pneumonia conjunctivitis "pink eye" can be transmitted in water |
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Parvovirus
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non-enveloped, SS DNA virus, linear negative sense
B19- aplastic crisis in sickle cell disease "slapped cheeks" rash in children = erythema infectiosum (fifth disease) RBC destruction in fetal infection can lead to hydrops fetalis and death pure RBC aplasia and RA-like symptoms in adults |
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Papillomavirus
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nonenveloped, circular dsDNA
HPV- warts 6,11 and cervical cancer in 16, 18 |
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polyomavirus
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nonenveloped, circular dsDNA virus
JC- progressive multifocal leukoencephalopathy in HIV BK virus- transplant patients, targets kidney |
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Poxvirus
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enveloped, linear dsDNA virus
smallpox vaccinia- cowpox *molluscum contagiosum* flesh-colored dome lesions with central dimple |
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RNA virus characterics
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all are single-stranded except Reo
most are enveloped only are CPR -Calici, Pico, Reo negative sense require RNA-dependent RNA polymerase as part of mature virus |
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Reoviruses
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nonenveloped, linear dsRNA
coltavirus -Colorado tick fever rotavirus- #1 cause of fatal diarrhea in kids |
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Picornaviruses
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nonenveloped, ss+RNA
Poliovirus- polio-Salk/Sabin vaccines Echovirus - aseptic meningitis Rhinovirus "common cold" Coxsackievirus - aseptic meningitis; herpangina- febrile pharyngitis, hand, foot, mouth disease, myocarditis HAV- acute viral hepatitis- fecal/oral pico RNA -small RNA virus |
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Flaviviruses
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nonenveloped, ss+RNA,
HepC- blood-borne transmission, can be chronic with cirrhosis, carcinoma, carrier state Yellow fever- Aedes mosquito, black vomit, jaundice Dengue- break bone fever - spreading into US St. Louis encephalitis West Nile |
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Togaviruses
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enveloped, ss+RNA,
Rubella Eastern equine encephalitis Western equine encephalitis |
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Orthomyxoviruses
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enveloped, linear ss-RNA with 8 segments
influenza virus replicates in nucleus |
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Paramyxoviruses
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enveloped, linear ss-RNA nonsegmented
express f protein that causes host cells to fuse Parainfluenza- croup RSV - bronchiolitis in babies Rubeola |
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Bunyavirusis
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enveloped, circular ss-RNA with 3 segments
California encephalitis Sandfly/Rift Valley fevers Crimean-Congo hemorrhagic fever *Hantavirus - hemorrhagic fever, pneumonia |
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mnemonic for +RNA viruses
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naked (CPR) yellow (Flavi) togas (togaviruses) with croonas (coronaviruses) are retro (retroviruses)
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INfluenza viruses
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orthomyxoviruses, eneveloped ss-RNA
contain hemogglutin -promotes viral entry neuraminidase - promotes progeny release genetic shift/drift |
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Rubella virus
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togavirus, German (3-day measles) measles
fever, postauricular adenopathy, lymphadenopathy, arthralgias, truncal rash that starts at head and moves down, does not include hands and feet |
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Rubeola virus (measles)
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paramyxovirus - measles
Koplic spots - red spots with blue white center on buccal mucosa descending maculopapular rash that includes hands and feet Subacute sclerosing panencephalitis years later (rare) *3 C's Cough, Coryza, Conjunctivitis* |
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Mumps virus
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paramyxovirus, enveloped, linear nonsegmented ss-RNA
Parotitis, orchitis, aseptic meningitis |
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Rabies virus
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fever, malaise -> agitation, photophobia, hydrophobia -> paralysis, coma -> death
bat, raccoon, skunk bite retrograde travel to CNS on nerve axons Negri bodies, cytoplamsic inclusions- especially Purkinje cells |
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HepA
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RNA picornavirus, fecal oral transmission
often symptomatic but may be acute hepatitis |
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HepB
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DNA hepadnavirus
sexual, blood, maternal-fetal transmission acute infection typically resolves although up to 20% may persist not a retrovirus but has a reverse transcriptase may act as an oncogene and increase risk for HCC |
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HepC
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RNA flavivrus, primarily blood-borne transmission, may be sexually transmitted
increases HCC risk due to chronic inflammation |
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HepD
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RNA delta virus
blood, sexual, maternal-fetal transmission Defective virus that depends on HbsAG as an envelope coinfection has a better prognosis than a superinfection |
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HepE
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RNA hepevirus
fecal-oral transmission high mortality in pregnant women |
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Anti-HAVAb (IgM)
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active HepA infection
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Anti-HAVAb (IgG)
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prior infection or vaccination against infection
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HBsAg
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antigen of surface of HepB, indicates HepB infection
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Anti-HBsAg
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indicates immunity to hepatitis B
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HBcAg
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antigen associted with core of HBV
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Anti-HBcAg
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IgM = acute/recent infection
IgG - chronic disease during window period will be only positive serologic marker as the amount of HBsAg and anti-HBsAg will be approximately equal and will have cancelled eachother out |
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HBeAg
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indicates active HepB infection -> high transmissibility
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Anti-HBeAg
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indicates high transmissibility
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HIV
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diploid genome
3 structural genes 1. env (gp120, gp 41) envelope proteins gp120 attaches to host T cell via complement receptor CCR5, gp41 facilitate fusion and entry 2. gag p24 - capsid protein 3. pol reverse transcriptase CCR5 mutation: homozygous HIV immune, heterozygote slower course |
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HIV diagnosis
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ELISA- sensitive, high false+, rule out test -> if negative then negative
positive ELISA is confirmed with Western blot - blots gp120, gp41, p24 -> 2/3 required for diagnosis HIV PCR/viral load tests are effective but cost money AIDS <200 CD4 and an AIDS defining illness |
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Dermatologic findings in HIV+ patients
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C. albicans
Bartonella henselae - superficial vascular proliferation -> neutrophilic inflammtion |
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Encephalopathy in HIV patients
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JC virus reactivation - demyelination CD4 <200
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HIV dementia
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directly associated with HIV, must look for other causes
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Kaposi's sarcoma
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superficial neoplastic proliferation of vasculature -> lymphocytic inflammation
caused by HHV-8, must be distinguished from B. henselae |
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Lymphomas in HIV
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Non-Hodgkin;s - EBV-associated
Primary CNS lymphoma -only in AIDS, focal or multiple lesions, associated with EBV |
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Prions
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conversion of normal protein (PrPc) to beta-pleated form (PrPSC) -> PrPSC facilitates conversion of PrPc and can be transmitted
accumulation results in spongifrom encephalopathy, dementia, ataxia, death sporadic (Creutzfeldt-Jakob disease, inherited, or acquired |
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bacteria causing bloody diarrhea and their sources
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Campylobacter - spoiled chicken, grow at 42C
Salmonella -chicken, eggs Shigella Enterohemorrhagic E. coli, undercooked beef |
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Watery diarrhea and sources
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Vibrio cholerae - seafood
C. perfringens - reheated meat Clostridium botulinum -honey in babies, spoiled canned food Bacillus cereus - reheated rice |
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Causes of pneumonia in neonates
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Group B strep, E. coli
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Pneumonia in kids
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Viruses, mycoplasma, Chlamydia trachomatis (infancy to 3 years), Streptococcus pneumoniae
C. pneumoniae |
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Pneumonia in adults
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S. pneumoniae, H. influenzae, anaerobes, viruses, Mycoplasma
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Pneumonia in elderly
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S. pneumoniae, influenza virus, anaerobes, H. Influenzae, G- rods
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Atypical pneumonia
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All have atypical characteristics
Mycoplasma - sterols Legionella- charcoal Chlamydia - intracellular |
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Typical pneumonias
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S. pneumoniae
H. influenzae S. aureus |
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Meningitis in newborns
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Group B strep
E. coli Listeria |
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Meningitis in kids
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H. influenzae typed B
S. pneumo Neisseria meningitidis |
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meningitis 6-60 years
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S. pneumo
N. meningitidis #1 in teens |
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meningitis in 6- yrs +
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S. pneumo
Listeria |
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Top 3 causes of UTI
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E. coli - green metallic sheen on EMB agar
Staphylococcus saprophyticus - sexually active women Klebsiella pneumoniae -large mucoid capsule |
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Maternal-fetal infections
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ToRCHeS
Toxoplasma gondii - cat feces - hydrocephalus, chorioretinitis, intracranial calcifications "wet, ret, white" Rubella - patent ductus arteriosus, cataracts, deafness -blueberry muffin rash CMV - hearing loss, seizures, petechial rash HIV - recurrent infections, chronic diarrhea HSV2 - temporal encephalitis, herpetic lesions Syphilis- stillbirths, hydrops fetalis - notched teeth, saber shins, CN VIII deafness |
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Guessing with pus, empyema, abscess
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S. aureus
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Guessing with pediatric infections
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H. influenzae
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Guessing with pneumonia in CF, burn infections
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Pseudomonas aeruginosa
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Guessing with branching rods in oral infections, sulfur granules
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Actinomyces israelii
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Guessing with traumatic open wound
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S. aureus
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Guessing with dog/cat bite
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Pasteurella multocida
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Guessing with currant jelly sputum
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Klebsiella
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Guessing with Positive PAS stain
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Tropheryma whippeli
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Guessing with sepsis/meningitis in newborn
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Group B strep
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Guessing with health care provide
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HepB
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Guessing with fungal infection in diabetic
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Mucor or Rhizopus spp.
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Guessing with asplenic patient
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SHiN infections S. pneumo, H. influenzae type B, N. meningitidis
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Guessing with chronic granulomatous disese
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catalase+ microbes
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Guessing with neutropenic patients
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C. albicans, Aspergillus
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Guessing with bilateral Bell's palsy
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Borrelia burgdorferi (Lyme disease)
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Peniciliin
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G = IV, V = oral, bactericidal
1. Bind penicillin-binding proteins, membrane proteins to enter cell 2. block transpeptidase corss-linking of peptidoglycan 3. activate autolytic enzymes gram positive organism and syphilis hypersensitivity reaction, hemolytic anemia |
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Methicillin, nafcillin, dicloxacillin
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prevent cross-linking of peptidoglycan- resistant to pencillinase because of bulkier R group
S. aureus |
