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18 Cards in this Set

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60 y/o man from Arizona is in ICU with pulm edema, respiratory distress, and hypotension which progresses to shock. Hx of contact with deer mice. What is the virus/diagnosis?
HANTAVIRUS PULMONARY SYNDROME
how common is this virus & what are the man's chances of survival
rare & 50%
76 year old woman presents with respiratory distress and low O2 sats. She reports that a week ago she returned from china. On the plane she sat next to a man who was coughing heavily. 4 days later she developed a cough, high fever, and diarrhea. She assumed she had the flu until it progressed rapidly to extreme difficulty breathing. Seriologic testing shows what pathogen?
SARS- CoV
a ss RNA corona virus
8 year old boy with a seizure disorder is in ICU for aspiration pneumonia. Suddenly he begins coughing up copious amounts of a foul-smelling sputum. What type of cx should you order?

Aerobic cx grows staph aurous & anerobic cx grows fusoform spp. X-ray is performed and shows cavity formation and permant lung damage. To what is this due?
anaerobic & aeorobic on sputum

Lung abscess/necrotizing pneumonia
76 year old pneumonia patient is not improving. X-ray shows fluid in the plura. Aspiration of pleural fluid is cultured which shows a G+ cocci (Staphylococcus aureus) [most common] or gram-negative bacilli (Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli) [less common] Patient is treated with Antibiotics and puss drainage. What is the diagnosis?

or

76 year is having complications after his pneumocentis. X-ray shows fluid in the plura. Aspiration of pleural fluid is cultured which shows a G+ cocci (Staphylococcus aureus) [most common] or gram-negative bacilli (Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli) [less common] Patient is treated with Antibiotics and puss drainage. What is the diagnosis?
EMPYEMA (purulent inflammatory exudate of the pleural cavity)
45 year old migrant field worker presents with chronic cough. X-ray shows destructive lesions. Sputum culture easily grows a filamentous branching organism that stains gram positive and acid fast positive. What is it?
Is this organism a fungus?
Nocardia asteroides
No
56 year old brittish man , Bernie McPlaquemouth, is admitted to the hospital for chronic pneumonitis that has been getting progressively worse. He is also showing symptoms of pericarditis. He reports respiratory symptoms began about 3 months ago after he got in a bar fight and aspirated one of his front teeth. On close examination his sputum is yellowish in color with granules when granules are crushed & cultured they grow fastideous anaerobic filamentous gram + rods. That do not stain acid fast. X-ray shows cavitary lung damage similar to tuberculosis. It also shows infiltration of the infection into the vertebrae. IV pennicillin is started. What is the organism?
Is this organism a fungus.
Actinomyces israelii
No
24 year old female presents with white plaques on the back of her throat after being on a broad spectrum antibiotic. Fungus culture quickly grows out a G+ organism. What is the organism?
It is dimorphic, in its pathogenic state what form does it take?
Candida spp.
psudohyphal
17 year old male with history of asthma becomes symptomatic. He has developed a productive cough with eosinophilia. Culture & microscopic examination shows a filamentous fungi with Y & V shaped branching hiphae. What is the organism?
Is this organism monomorphic or dimorphic?
What is the danger in an immunocompromized patient?
Aspergillosis

monomorphic

fungus ball in the lung
55 year old male spelunker from the Mississipi river valley, presents with fever, chills, headache, cough, chest pain, weakness, & fatigue. X-ray shows tuburculosis like granulomas. Fungal culture grows what organism?
Histoplasmosis
Explain how chronic cavitary disease in histoplasmosis mimics tuberculosis.
Inhalation of spores reach broncholes/alveoli and germinate into yeast. Yeast is phagocytosed by macrophages. Accumulation of infected macrophages & other cells result in an infiltrate at infected site. Infected macrophages migrate to spleen & liver. 9-15 days onset of aquired immunity causes vasculitis, tissue necrosis, & caseation at the site of infiltrate.
Does a positive histoplasmosis skin test indicate current infection.
No, just exposure.
Philapeno woman who works in the dust fields of the San Juaquine Valley presents with flu like symptoms that progresses to pneumonia. Culture grows spherules.
What fungus do you suspect?- What test is an alternate to the culture which is dangerous because of it's high risk for spread of infection.
Coccidioides immitis

Complement fixation,
What is the life cycle of Coccidiodes immites
It exists in soil in the MYCELIAL PHASE and matures. Alternate cells along a hyphae become barrel shaped and are easily fragmented & become airborne. In the host the spores swell, become spherical and develop a thick wall. This structure is called a SPHERULE which is the diagnostic feature of a culture. The spherule contains as many as 800 ENDOSPORES which are released and turn into new sperules.
30 year old male brazilian agricultural worker with a history of alcoholism presents with chronic progressive lung disease. Sputum fungal culture on a KOH mount grows out a dimorphic fungus in a characteristic “pilot wheel” pattern. What is the organism? What is its morphology in soil? In tissue?
Paracoccidioides brasiliensis
mycelial in soil
yeast form in tissue
45 year farmer in Mississippi river value presents with fever, chills, headache, cough, chest pain, weakness, & fatigue. Fungus culture grows dimorphic budding yeast with a broad base & thick wall that appears refractile under the microscope. What is the organism?
Blastomyces dermatitidis
50 year old male with AIDS presents with abrupt fever, cough and tachypnea.
Or 3 month old infant presents with slight fever insidious onset of dyspnea, & cyanosis. What is the most likely diagnosis? What is the treatment?
Pneumocystosis carinii

tmp-smz
16 year old boy with contact to pigeon droppings has a mild respiratory infection and a week later develops meningitis. LP is performed and negative staining of CSF with India ink shows yeast cells with a wide capsule. IV treatment with amhotericin B & 5-Fluorocytosine is began. What was the organism?
In what patient population is this organism particularly dangerous
Cryptococcus neoformans

patients with AIDS or immunocompromized.