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27 Cards in this Set
- Front
- Back
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Pneumocystis (carinii) jiroveci
(histoy) |
First discovered c 1900 in institutionalized patients/debilitated infant. The introduction of transplants and AIDS fortified pneumocystis' role in immunocompromized hosts
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Pneumocystis and AIDS patients
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W/out prophylaxis, majority will develop pneumocystis pneumonia
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P. carinii vs. jiroveci
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Carinii = rat pathogen
Jiroveci = human pathogen |
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Pneumocystis jiroveci
(acquisition) |
Ubiquitous fungus. Vast majority of children are serotype positive before kindergarten. Suspected airborn pathogen, transient carriage, but continual exposure
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Pneumocystis and host immunity
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Humoral immunity < cell-mediated immunity
Direct correlation between T-cell count and developing illness in AIDS patients |
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Pathophysiology of pneumocystis infection
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"Foamy," eosinophilic exudate resulting in hypoxemia (broader A-a gap) and impaired CO2 diffusion capacity
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Pneumocystic infections
(clinical manifestations) |
Debilitated infants: interstitual plasma cell pneumonia (insidious onset)
Immunocompromized adults: pneumonia (shortness of breath, dry-cough, dyspnea w/exertion) Late stage AIDS w/aerosolized vs. systemic prophylaxis: extrapulmonary pneumocytosis |
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Pneumocystic infections
(diagnosis) |
Chest X-ray (diffuse, bilateral INTERSTITIAL pneumonia - but may possibly look normal!); blood-gases; sputum stains (immunofluorescence esp.)
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Pneumocystic infections
(treatment) |
Trimethoprim/sulfmethoxazole
AIDS patients: prophylaxis if CD4 < 200 |
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Candida
(microobiology) |
Budding, oval/round yeasts
No special growth requirements ~150 species, but ~10 significant (important in susceptibility/pathogenicity) |
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Candida
(epidemiology) |
Ubiquitous in environoment
Generally endogenous source (some nosocomial infections) |
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Candida
(virulence factors) |
(1) Adherence, i.e. to fibronectin, epithelia (oral and vaginal)/endothelial surfaces, and prosthetic devices
(2) extracellular proteases (enable invasion of epithelium) |
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Candida
(susceptible patient populations) |
Immunocompromized, altered flora (i.e. broad antibiotic use), prosthetic devices
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Candida infections
(mucus membranes) |
Oral candidiasis (thrush, erythmatous, leukoplakia, chronic atrophic), esophagitis, vaginitis
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Thrush
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Pseudomembraneouos oral candidiasis
Curd-like patches on tongue and oral mucosa |
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Erythematous Oral Candidiasis
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Acute atrophic candiasis
Red patches |
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Chronic atrophic candidiasis
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Oral candidiasis
Denture/angular cheilitis |
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Cheilitis
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Inflammation of lips
Radiates from angles of mouth |
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Cutaneous Candidiasis Infections
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Chronic mucocutaneous candidiasis, paronychia, onychomycosis, intertrigo
"yeasts cause COPIous cutaneouos infections" |
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Chronic Mucocutaneous Candidiasis
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Failure of T cells to respond to candida antigen
(presents infancy, early childhood) |
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Paronychia
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Cutaneouos yeast infection due to frequent immersion of hands in water (i.e. dishwashers)
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Onychomycosis
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Direct (yeast) infection of finger/toe-nails
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Intertrigo
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Yeast infection of warm, close-proximity skin (i.e. under breasts)
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Deep organ Candida infections
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Rare, but possible
CNS (due to dissemination) Pneumonia (direct inoculation or dissemination) Endocarditis (IV drug use, prosthetic devices) |
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Candida in urine
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Indwelling urinary catheter
Cystitis (from previous urinary catheter) Upper urinary tract infection (hematogenous or ascending spread) |
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Candida infections
(diagnosis) |
CULTURE body fluids, then stain
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Candida infections
(therapy) |
Amphotericin B and fluconazole
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