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23 Cards in this Set
- Front
- Back
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18 year old navy recruit presents with fever, headache, and positive kernigs test. He is the 10th case in the past week that has occurred at the base
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patient has menningitis, most likely due to Neisseria meningitidis based on the crowded condititions.
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32 year old man renal transplant patient who is immunosupressed has a positive India Ink prep
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cryptococcal meningitis
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Bilateral opthalmia neonatorum during first week
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N. gonnorrhoeae transmitted on way through cervix.
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Corneal transplant, brain instrumentation
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can transmit prions of Cruetzfield Jakob disease.
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Diabetic ketoacidosis
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mucormycosis in frontal lobes, ketoacidosis accelertes the growth of the fungus.
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MCC of meningitis after 18 years old
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Strep pneumoniae
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Rubeola
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causes subacute sclerosing panencephalitis - slow virus disease.
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Papovavirus infection
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viral agent of progressive multifocal leukodystrophy, a slow virus disease
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"Bubbles and Holes" spongiform change in the brain
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describes C-J disease
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Interleukins
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IL-1 (produced by macrophages, fever of inflamation, acute phase reactant synthesis of proteins in liver, osteoclast activator, stimulates B cell production and antubody production) IL-2 (produced by CD4 T Helper cells, primarily a T cell growth factor promotes Bcell/NK cell proliferation) IL-3 (produced by T cells and thymic epithelial cells, stimulates pluripotential stem cell marrow, increases hematopoeisis) IL-4 (produced by activated T cells, mainly promotes growth of B cells, switch of IgM synthesis in B cells to IgE synthesis in Type 1 hypersensitivity reactions) IL-5 (produced by T cells and mast cells, promotes growth of eiosinophils, promotes IgE synthesis) IL-6 (produced by T cells, macrophages, endothelial cells, fibroblasts, epithelial cells, primarily stimulates synthesis of acute phase reactants in the liver in acute inflamation) IL-12 (produced by macrophages, promotes growth of CD8 T cells, promotes differentiation of CD4 T Helper cells into TH1 and TH2 classes, promotes production of y-interferon, enhances NK activity)
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y-interferon
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produced by CD4 T Helper cells and NK cells, activates macrophages to kill microbial pathogens, antiviral activity - induces class I and II antigens, increases production of IL-2 and IL-12 by CD4 T Helper cells
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Granulocyte colony stimulating factor (G-CSF)
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produced by fibroblasts, stimulates neutrophil development in the bone marrow
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Granulocyte/Macrophage colony stimultating factor (GM-CSF)
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produced by macrophages and T cells, stimulates neutrophil and monocyte development in the bone marrow
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B cells
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10-20% of total lymphocyte count, markers - intracytoplasmic mew heavy chains: pre B cell, surface mew and delta heavy chains: mature B cell and antigen recognition site, function in antibody synthesis, surface receptors IgG Fc receptor, CD21 for EBV, Testing B cell count Flow cytometry. (Imunoglobullin concentration: order of decreasing concentration IgG, IgA, IgM, IgD, and IgE, detect isohemagglutinins, mitogen stimulation pokeweed)
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T cells
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60-70% of total lymphocyte count, markers monoclonal ab marker studies for cluster designation types, immature T cells have nuclear enzyme terminal deoxynucleotidyl transferase (tdT) on their surface, funtions type IV hypersensitivity cytokines regulate B cells, defense against intracellular pathogens (e.g. TB, protozoa), testing mitogen assays: functioning T cells are specifically activated by phytohemagglutinin and concanavalin A, skin tests to evealuate cellular immunity: Candida is the main antigen used, absence of an immune indicates anergy or a lack of cellular immunity (e.g. AIDS)
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AIDS epidemiology
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gp 120 viral envelope protein of virus attaches to CD4 molecule of T Helper cells and other cells -monocytes/macrophages/dendritic cells /microglial cells (CNS macrophage), astrocytes. p24 core protein surrounds viral genomic RNA - only increased during intial infection and when pt develops AIDS. 2 seperate peaks, CD4 T helper cell is lysed by the virus usually by direct HIV cytotoxicity, reverse transcriptase converts genomic RNA into proviral double stranded DNA - integrated into host cells DNA with virally encoded integrase enzyme, after transcription HIV messenger RNA is translated into various proteins. env encodes gp120/gp41, pol encoded reverse transcriptase/integrase, gag encodes p24 core antigen, viral core consists of genomic RNA surrounded by an inner membrane composed of p24 antigen - assembled near the host cell's plasma membrane, budding of the progeny virion through the host cell membrane is where the viral core acquires the External envelope to become a mature HIV virion.
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Mode of HIV transmission in the united states in descending order
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receptive anal intercourse between men, vaginal intercourse male to female: infected semen has more surface area to infect. female to male : less surface area in male urethra to infect
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Positive enzyme immunoabsorbent assay (EIA) test for HIV in a newborn
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due to transplacental transmission of the IgG antibody from the infected mother, document HIV infection of the newborn by detection of HIV RNA by PCR and p24 antigen capture assay
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AIDS testing with enzyme immunoabsorbent assay (EIA) test
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intitial screening test, detects anti gp120 antibody. sensitivity 99.5-99.8%, poor specificity due to low prevalence of HIV positivity in the general population.
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AIDS testing with western blot
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confirimatory test for intermediate or positive EIA, poditivewestern blot - predence of p24 and gp41 antibodies and either gp120 or gp160 antibodiess. combined positive predicitive value of a positive EIA/western blot is 99.5%
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AIDS tests for monitoring immune status
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CD4 T Helper count, HIV RNA by PCR - best overall test to monitor viral burden
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Non-AIDS defining infections
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oral thrush, oral hairy leukoplakia (EBV glossitis), shingles (h. zoster), molluscum contagiosum (poxvirus)
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Diagnosis of AIDS
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HIV positive plus - CD4 T Helper cell count <200 cells/ul. specific malignancies: e.g. Kaposis sarcoma. specific infections: e.g. P. carinii pneumonia (MC AIDS defining disease)
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