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Micro Block 4

Micro Block 4

by codyhedge9, Apr. 2011

Subjects: 4 block micro

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159 Cards in this Set

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	Superficial Mycoses Diseases and Etiologic Agents: 1) Tinea Versicolor 2) Tinea Nigra 3) Black Piedra 4) White Piedra	Superficial Mycoses: 1) Tinea Versicolor - Malassezia spp. (mainly M. globosa) 2) Tinea Nigra - Hortaea weneckii 3) Black Piedra - Piedriaia hortae 4) White Piedra - Trichosporon spp.
	Classic *RING-SHAPED* lesions (originally thought to be worms (tinea) hence "ringworm") 5-15% of infected persons will develop chronic, recurring infection Filamentous fungi (moulds) that possess Keratinolytic Enzymes that allow parasitization of ALL fully keratinized tissues of the body (hair, skin, nails) Do NOT usually penetrate beneath Epidermal Layer of Skin	Cutaneous Mycoses caused by Dermatophytes Infections Three Genera: 1) Microsporum 2) Trichophyton 3) Epidermophyton
	Fungal growth and sporulation WITHIN Hair Shaft (ENDOthrix Infection) Effects Hair/Scalp Common in US Causes *"BLACK DOT"*	Trichophyton causing a Tinea Capitis (hair and scalp) fungal infection
	Fungal growth and sporulation WITHIN Hair Shaft (ENDOthrix Infection) Most common in Europe, North Africa, Middle East Effects Hair/Scalp	Trichophyton causing a Tinea Capitis (hair and scalp) fungal infection
	Fungal growth and sporulation WITHIN Hair Shaft (ENDOthrix Infection) Effects Hair/Scalp Cause of *FAVUS* - looks like a crusted piece of honeycomb on Scalp, see *SCUTULA(Crusting)* with PERMANENT Loss of Hair and Scarring	Trichophyton causing a Tinea Capitis (hair and scalp) fungal infection
	Fungal growth and sporulation AROUND Hair Shaft (ECTOthrix Infection) Effects Hair/Scalp Anthrophilic (prefers human host) Causes *EPIDEMIC TINEA CAPITIS*	Microsporum causing a Tinea Capitis (hair and scalp) fungal infection
	Fungal growth and sporulation AROUND Hair Shaft (ECTOthrix Infection) Effects Hair/Scalp Zoophilic (prefers animal host) Can cause Localized Outbreaks May be acquired from Dogs and Cats	Microsporum causing a Tinea Capitis (hair and scalp) fungal infection
	Fungal growth and sporulation AROUND Hair Shaft (ECTOthrix Infection) Effects Hair/Scalp and or Beard Zoophilic (prefers animal host) Contracted from Dogs and Cattle	Trichophyton causing a Tinea Capitis (hair and scalp) OR a Tinea Barbae (beard) fungal infection
	Fungal growth and sporulation AROUND Hair Shaft (ECTOthrix Infection) Effects Beard Zoophilic (prefers animal host) Contracted from Cattle	Trichophyton causing a Tinea Barbae (beard) fungal infection
	Cause of KERION (Suppurative Folliculitis) - Raised, Spongy Lesions This HONEYCOMB is Severely PAINFUL Inflammatory Reaction with Deep Suppurative Lesions on the Scalp.	Trichophyton spp.
	Tinea Corporis (aka Tinea Circinata) - Smooth Skin	1) Microsporum 2) Trichiphyton
	Tinea Cruris - "JOCK ITCH", "JOCK-ROT"	Groin, Perineal, and Perianal Areas = Epidermophyton May Extend over Buttocks and Waist = Trichophyton
	Tinea Pedis - "ATHLETES FOOT"	Trichophyton
	Tinea Unguium - "Onychomycosis" - *NAILS*	Trichophyton
	Dermatophyte Test Media	DERmatophytes turn media RED due to Alkaline by-products Non-Dermatophytes turn media YELLOW
	Acquisition of infection through Traumatic Implantation of Soil Fungus, often due to *ROSE THORN, SPLINTER* or similar types of puncture wounds Lesions begin as Painless Papules, usually 1-3 weeks after inoculation, and spread DISTALLY along LYMPHATIC CHANNELS	Sporotrichosis causing a Lymphocutaneous Disease (a subcutaneous mycoses) Can also cause Disseminated Disease if acquired via Inhalation
	Dimorphic Fungi Mold Phase (25 C) consists of Septate Hyphae, turning *WHITE TO BLACK* with age, with delicate Conidiophores bearing *PYRIFORM (pear-shaped) CONIDIA in ROSETTE CLUSTERS* Tissue Phase (37 C) consists of Elongated, *CIGAR-SHAPED YEASTS. RARELY seen in histological sections of tissue. Yeast forms surrounded by EOSINOPHILIC HALO*	Sporothrix schenckii Etiologic Agent causing a Sporotrichosis, Subcutaneous Mycoses Halo = Antigen/Antibody Complex
	Localized, Chronic Infection of the Skin and Subcutaneous Tissues acquired by Implantation of Soil Organisms Lesions are usually PAINLESS and *"CAULIFLOWER-LIKE"* Caused by a group of SLOW Growing, *DEMATIACEOUS (BLACK) Fungi BROWN-SEGMENTED HYPHAL** Forms seen in Infected TIssue	Chromomycosis causing a Subcutaneous Mycoses
	Acquired from Soil Transplantation Lesions involve Skin, Subcutaneous Tissue, Fascia, and Bone Associated with formation of GRANULOMAS and ABSCESSES that eventually drain by formation of SINUS TRACTS Once called "*MADURA FOOT"* or *MADURA MYCOSIS* May see *"GRAINS"* in Sinus Tract drainage that represent compact microcolonies of the Pathogen	Mycetoma causing Subcutaneous Mycoses Includes both Actinomycetoma (caused by Bacteria) and Eumycetoma (caused by Fungi) Eumycotic (Fungal) Myceytoma: 1) Pseudallescheria boydii 2) Madurella mycetomatis Actinomycotic (Bacterial) Mycetoma: 1) Nocardia spp. 2) Streptomyces spp. 3) Actinomadura spp.
	Pigmented Irregular Hyphal Forms in Tissue Infection may be Superficial, Subcutaneous or Deeply Invasive depending on Fungus and Immune Status Subcutaneous Disease presents with *SOLITARY CYST-LIKE LESIONS* Secondary to Traumatic Implantation of Contaminated Soil or Wood Splinters	Phaeohyphomycosis Heterogeneous array of fungal infections caused by various Dematiaceous (Black) Fungi commonly found in Environment Common Etiologic Agents: 1) Wangiella 2) Exophiala 3) Bipolaris
	Dimorphic Fungi Growth Conditions	25-30 C = Grows as MOULD (Environmental or Saprophytic Phase) --> Enter via Respiratory Tract 35-37 C = Grows as YEAST (Tissue or Parasitic Phase) --> NOT a necessary component of their life cycle! --> NOT Transmissible!
	Sexual Spores	ZAB Zygospores Ascospores Basidiospores
	Asexual Spores	CS Conidia Sporangiospores (Exclusive to Zygomycetes)
	Diagnostic Test for Yeasts	Carbohydrate Assimilation and Fermentation
	Scotch Tape Preparation	Used to examine MOULDS under a microscope, especially structures associated with sporulation.
	What provides SPECIFIC Immunity to Fungal Infections?	Cell-Mediated Immunity (T-Cells)!!! Humoral (Antibody) plays a MINOR role
	Common in soils of the Lower Sonoran Life Zone Prevalent in Southwestern US (Southern Cali, Arizona, Nevada, New Mexico, West Texas), as well as parts of Mexico, Central and South America Mould Phase: White to tan fluffy colony whose hyphae will fragment into *BARREL SHAPED ARTHROCONIDIA* separated by Disjunctor Cells. Perturbations in Environmental Conditions (Rainfall, Wind, Earthquakes) may affect the Concentration and Spread of Arthroconidia in the Atmosphere. Tissue Phase: Formation of MULTINUCLEATED SPHERULES. Repeated internal cleavage products produces Endospores. 60% of cases may be Asymptomatic 35% have Mild Flu-like illness with Fever, Chest Pain and Arthralgia First Presenting Symptom of Infection = Allergic Manfestations (erythema nodosum, eythema multiforme) Extrapulmonary Disease is rare (<5%) but serious and may involve CNS, Skin, Pericardium Antibody Response is NOT PROTECTIVE	Coccidioides spp. infection causing Coccidioidomycosis aka San Joaquin Valley Fever aka Desert Rheumatism C. immitis (San Joaquin Valley CA) C. posadasii (Texas, AZ, Outside US)
	Endemic to Mississippi River Valley and Parts of South-Central US (including East Texas), also found in parts of Mexico and Central America Prospers in soils laden with *BIRD and BAT GUANO* --> **SPELUNKERS* BEWARE!!! Typically a Self-Limiting Pulmonary Disease (Cough, SOB) Minority of patients will develop Progressive Pulmonary Disease and/or Disseminated HISTOPLASMOSIS (Immunosuppressed/AIDS) Disseminated infection can involve ANY organ system, typically bone marrow, spleen, skin, GI, CNS. Mould Phase: Microconidia (infectious) and *TUBERCULATED MACROCONIDIA* (diagnostic) Tissue Phase: Small Oval Yeast Cell Mediated Response causes GRANULOMA FORMATION (like TB)	Histoplasma capsulatum causing Histoplasmosis (Darling's Disease)
	Endemic in Mississippi and Ohio River Valleys, Middle-Eastern Seaboard, also in parts of Africa. Chronic infection of the Skin and Bones. Lesions characterized by MICROABSCESS FORMATION, PAPULOPUSTULAR NODULES, and CRUSTY VERRUCOUS GRANULOMAS of the Hands, Face, and Mucocutaneous Areas. If systemic, can involve CNS or Urogenital System. Mould Phase: Septate hyphae, white colony, OVAL MICROCONIDIA Tissue Phase: Large, THICK-WALLED YEAST with BROAD-BASED BUD	Blastomyces dermatitidis infection causing North American Blastomycosis (Gilchrist's Disease)
	Found in Soil of Subtropical Sylvatic Regions of Central and South America Chronic Granulomatous Disease Begins as a Pulmonary Infection and disseminates to form Ulcerative Granulomata of Buccal, Nasal, and occasionally GI Mucosa Lymph Node involvement is common, with extension to cutaneous tissue. Systemic involvement of multiple organ systems is RARE. Mould Phase: Septate hyphae, white colony, Oval Microconidia. Tissue Phase: THIN-Walled Yeast with Multiple Buds arranged in a "SHIP'S WHEEL" Configuration	Paracoccidioides brasiliensis infection causing Paracoccidioidomycosis aka South American Blastomycosis
	Found in Soil and *BAMBOO RATS. Most disease in HIV Patients* in *THAILAND* and *SOUTHERN CHINA* Prominent Mycotic Disease in HIV-Infected individuals of Southeast Asia Disseminated disease which may mimic TB, Leishmaniasis or Histoplasmosis Skin lesions reflect dissemination, may mimic Molluscum Contagiosum-like lesions of face and trunk. Mould Phase: Filamentous hyphae with Sporulating Structures. May have RED PIGMENT. Tissue Phase: Yeast-like organism that divides by fission and shows Transverse Septation.	Penicilliosis marneffei Infection! P. marneffei is the ONLY species of Penicillium that is a dimorphic fungus!
	Commonly infected sites include Urogenital Tract (Cystitis, Vaginitis, Urethritis), Oropharynx (Oral Thrush, Esophagitis), Skin, CV Cutaneous infection can occur with breakdowns in skin integrity from Burns, Chronic Moisture and Maceration (Dishwashers, Bartenders, Intertriginous Areas of the Obese) Common in IV drug abusers. GERM TUBE!!!	Opportunistic Candida albicans infection! Endogenous Fungi of Enteric System! Associated with CMC
	Occurs in Children with certain *GENETIC DEFECTS* in Leukocyte Function (primarily T Cells) Recurrent Severe, Debilitating Ulcerative Lesions of the Skin and Mucocutaneous Areas but WITHOUT Dissemination to Internal Organs	Chronic Mucocutaneous Candidiasis (CMC) caused by Candida albicans
	Virulence Factors of Candida albicans	1) Can grow at HIGH Temperatures 2) Can ADHERE to Cell Surfaces 3) Can produce PROTEASES
	Endocarditis in I.V. Drug Abusers Species found on skin and introduced into blood stream at sites of innoculation	Candida tropicalis and Candida parapsilosis infections
	Major reservoir for fungus is *PIGEONS* (however, no disease seen in them) Virulence Trait = *POLYSACCHARIDE CAPSULE, thus appearing as a SMOOTH, MOIST COLONIES* Chronic, Subacute, or (rarely) Acute Pulmonary, Systemic, or Meningitic Infection Primary infection is usually SUBCLINICAL Serious, life threatening disease in patients with impaired immune response (particularly T Lymphocytes in AIDS, Lymphoma) Fungus has a predilection for the CNS Produces *BLASTOSPORES ONLY*	Cryptococcus neoformans infection Diagnostic Test = Latex Agglutination for detection of Cryptococcal Polysaccharide in CSF and Serum
	Monomorphic Moulds ubiquitous to most environments. Mycelium consist of Septate Hyaline Hyphae with *45 ANGLE BRANCHING* May produce a spectrum of diseases including: 1) Fungus ball in patients with preexisting cavities in lungs (TB or Sarcoidosis) 2) Allergic Bronchopulmonary Hypersensitivity Response WITHOUT Tissue Invasion 3) Parenchymal invasion with hyphal progression along vascular pathways. 4) Disseminated Disease 5) Mycotoxicoses (Ingestion of food containing toxins) Conidiophores with Terminal Vesicle and Phialides produce Chains of Conidia	Aspergillus Infection causing Aspergillosis
	Differentiating between the 3 Zygomycetes (RAM) 1) Rhizopus spp. 2) Absidia spp. 3) Mucor spp.	1) Rhizopus spp. = Rhizoids DIRECTLY OPPOSITE Sporangia 2) Absidia spp. = Rhizoids BETWEEN TWO Sporangia (Internodal) 3) Mucor spp. = NO Rhizoids
	Often found as common *BREAD MOULDS* White colony mould, turns dark upon sporulation. Hyaline, NON-SEPTATE HYPHAE with *90 ANGLE BRANCHING* Sporangia and Sporangiospores. Can be EXTREMELY ACUTE AND FULMINANT Several Clinical Presentations: 1) *RHINOCEREBRAL INFECTION* (most common) - Rapidly Progressive infection of *SINUSES, ORBITS and BRAIN*, with Infarction and Necrosis. 2) Associated with KETOACIDOTIC DIABETES 3) Thoracic Infection 4) Abdominal, Gastric Infection 5) Skin Infection (Burn Patients)	Zygomycosis aka Mucormycosis caused by Zygomycete (Rhizopus, Absidia, Mucor) Infection
	Hallmark of Infection = *INTERSTITIAL PNEUOMONITIS and PLASMA CELL INFILTRATION* Subclinical infection probably common. Pulmonary infection associated with clinical conditions of debilitation, secondary to Immunosuppression and more recently AIDS	Pneumocystis jiroveci (formerly carinii)
	Usually seen as *BLUE-GREEN* Colony Produces Conidiophores with *SECONDARY BRANCHES* called *METULAE*	Penicillium spp. causing a Hyalohyphomycoses Infection Whorled Phialides that bear Conidia in chains are known as "Penicillus"
	*WHITE TO PINK* Colony, forms *BANANA-SHAPED CONIDIA* Causes Eye, Skin and Nail Infections Occasionally Disseminates	Fusarium spp. causing a Hyalohyphomycoses Infection
	Corneal and Nail Infections, Rare Cause of Mycetoma White Cottony Colony Delicate Tapering Conidiophores with OBLONG Conidia Occuring in Clumps at Terminal Ends	Acremonium spp. causing a Hyalohyphomycoses Infection
	Definitive Host vs Intermediate Host	Definitive Host: -Helminth - ADULT Stage -Protozoan - SEXUAL Stage Intermediate Host: -Helminth - LARVAL Stage -Protozoan - ASEXUAL Stage
	Usually exposed via Fecal-Oral Route, generally via contaminated Water and/or Food. Diarrhea, Cramping, Abdominal Pain, *BLOODY STOOLS* Localized Necrosis in Large Intestine (due to CYTOTOXIN production) Necrosis can provide a route of entry to bloodstream (extraintestinal) with subsequent Liver Involvement with Abscess Formaton. Symptoms include Fever, Hepatomegaly, Leukocystosis and is More common in *MALES*.	Entamoeba histolytica Infection causing Amebiasis, Amebic Dysentery, and possibly Extraintestinal Amebiasis
	Travelers to RUSSIA Usually exposed via Fecal-Oral Route, generally via contaminated Water and/or Food. *RESISTANT TO CHLORINE* levels used in Water Treatment Plans Usually asymptomatic. Symptoms include *MALODOROUS (STINKY)*, Watery Diarrhea, Cramping and Distention, Epigastric Pain. Sometimes accompanied by Low-Grade Fever. Severe cases can entail significant Weight Loss Limited Tissue Destruction. Reduced absorption of some nutrients due to Epithelial Turnover.	Giardia lamblia aka Giardia duodenalis causing Giardiasis
	Common in travelers to ST. PETERSBURG (Russia) Usually exposed via Fecal-Oral Route, generally via contaminated Water and/or Food. *RESISTANT TO CHLORINE* levels used in Water Treatment Plans 80% are Symptomatic! Profuse, Watery Diarrhea, Cramping. Less common are Fever (rarely), Nausea, Anorexia. Symptoms usually abate after 1-2 weeks. Dehydration is a serious concern in Immunocomprimised patients and can be life-threatening. Mild and self limited Tissue Destruction in Immunocompetent individuals Dx via *MODIFIED ACID-FAST STAIN*	Cryptosporidium (C parvum most common) causing Cryptosporidiosis Unlike other Intestinal Protozoa, Crypto Oocysts do NOT stain well! Solution: Modified Acid-Fast Stain!
	Rare in US, some outbreaks have occurred in Institutional Settings Reservoir = *PIGS* Symptoms resembles Amebiasis - Diarrhea, Abdominal Pain, Nausea, Anorexia Cyst are large and round with a *DARK, CRESCENT-SHAPED MACRONUCLEUS*	Balantidium coli causing Balantidiasis
	Exposure is mostly by *SEXUAL CONTACT* Symptoms include Homogenous, *WATERY VAGINAL DISCHARGE*. Irritation and Inflammation can occur. Can cause Urethritis in Men. Pathology is generally Mild. 50% have Colpitis Macularis ("STRAWBERRY CERVIX") - Patchy, Erythematous Lesions of the Cervix. Women have an Increased Risk for Pre-Term or Low Birth Weight Deliveries	Trichomonas vaginalis causing Trichomoniasis
	Definitive Host: *DOMESTIC CAT* Intermediate Hosts: Many Mammals and Birds, including Humans Transmission by ingestion of Oocysts from material contaminated with *CAT FECES* 80-90% Asymptomatic Symptoms include Cervical Lymphadenopathy, Headaches, *NIGHT SWEATS*, CHORIORETINITIS (Reflect a Preference of the Organism for cells of the CNS, Eye, Lungs, and Lymphoid System) Tissue Cysts can persist indefinitely.	Toxoplasma gondii causing Acute Toxoplasmosis
	Definitive Host: *DOMESTIC CAT* Intermediate Hosts: Many Mammals and Birds, including Humans Transmission by ingestion of Oocysts from material contaminated with *CAT FECES* *AIDS-RELATED* Symptoms include *ALTERED MENTAL STATUS, CHORIORETINITIES, SEIZURES, Sensory Abnormalities, HEMIPARESIS, COMA* Often results from REACTIVATION of Latent Infections rather than new exposure.	Toxoplasma gondii causing Toxoplasmic Encephalitis
	Affects *INFANTS* Symptoms include Severe Neurological Abnormalities including: 1) *CEREBRAL CALCIFICATIONS* 2) *HYDROCEPHALY or MICROCEPHALY* 3) *CHORIORETINITIS* 4) *NEUROMUSCULAR DEFECTS* Spontaneous Abortion or Miscarriage can Occur.	Toxoplasma gondii causing Acute Congenital Toxoplasmosis Affects infants born to Toxoplasmosis-infected Mothers Exposure at Early Gestational Ages = More Severe Symptoms
	Typically acquired while *SWIMMING IN FRESH WATER* contaminated with the organisms Rare, but Extremely Serious. Mortality ~95%. Symptoms include: 1) Headaches (potentially severe) 2) Mental-Status Changes 3) *ALTERATIONS IN TASTE/SMELL* 4) *SENSITIVITY TO LIGHT* 5) Diffuse HEMORRHAGE and Necrosis of BRAIN tissue	Naegleria flowerli OR Acanthamoeba spp causing Primary Amebic Meningoencephalitis (PAM) Progression is SLOWER with Acanthamoeba
	Typically acquired while *SWIMMING IN FRESH WATER* contaminated with the organisms *CORNEAL ULCERS* resulting from Trauma or *CONTACT LENS* Use GRANULOMATOUS SKIN LESIONS!	Acanthamoeba spp causing Amebic Keratitis
	Infection through bite of a *FEMALE ANOPHELES MOSQUITO* carrying the organism (transfusion transmission also occurs) Most often in Subsaharan Africa, also in Most Tropical Countries. *CYCLICAL FEVER* with Peaks and Troughs of Fever space 24-72 Hours Apart PAROXISMS (a sudden attack or recurrence of symptoms) and Chills are Common. Myalgia, Malaise, Fatigue, Nausea/Diarrhea, Hepatomegaly/Splenomegaly, Anemia due to lysis of RBCs = *PANCYTOPENIA* = Drops in ALL blood cellular components Neurological Symptoms/Altered Mental Status - Headaches, Confusion, Lethargy, Coma (usually by only one species). Organ Failure caused by Anemia, Reduced O2 Delivery, Occlusion of Capillary Beds. *BLACKWATER FEVER* - Dark Urine from Excretion of Hemoglobin (caused by Kidney Malfunctions)	Plasmodium infection aka Malaria Resistant Women in Endemic Areas can become SUSCEPTIBLE during Pregnancy!
	Unique, Darkly Staining Organelle (the *KINETOPLAST) Vector: TSETE FLY* 3 Phases: 1) Acute Phase: Ulceration at the Bite Site (Chancre) 2) Systemic Phase: -Fever (Intermittent, but UNRESPONSIVE to Antimalarials), Myalgia, Arthralgia. -ENLARGEMENT OF POSTERIOR CERVICAL LYMPH NODES = WINTERBOTTOM'S SIGN or a More Generalized Lymphadenopathy 3) CNS Involvement: *LETHARGY, TREMORS, Headaches, WASTING SYNDROME, Meningoencephalitis, ATAXIA, or PERSONALITY CHANGES* Becomes increasingly pronounced extending to Coma and Death within a few months or a few years.	Trypanosoma brucei causing African Trypanosomiasis aka African Sleeping Sickness Subspecies gambiensis (West) = Winterbottom's Sign, Coma/Death in 2-5 Years Subspecies rhodensiensis (East) = Generalized Lymphadenopathy, Coma/Death in 9-12 Months
	Vector: *REDUVIID* aka *"KISSING BUG"* Transmitted when feces from infected bugs contaminate bites. Endemic to CENTRAL AND SOUTH AMERICA Inflamed Lesion (Chagoma) may occur at bite site. Three Stages: 1) Acute Phase: Fever, Lymphadenopathy, Hepato/Splenomegaly, Subcutaneous Edema and Rash. Few may develop acute myocarditis or meningoencephalitis. 2) Indeterminant/Asymptomatic Chronic Phase: Occurs in 20-40% of those infected. Little or No signs of infection. May or May Not progress to stage 3. 3) Symptomatic Chronic Phase: *CARDIAC ENLARGEMENT* with Heart Enlargement and *DEFECTS IN CONDUCTION*. Arrythmias, blockages and thromboembolisms can occur. Involvement of Esophagus or Colon is also possible. Most DEATH occurs in this phase!	Trypanosoma cruzi causing American Trypanosomiasis aka Chagas' Disease
	What is one notable difference between T. brucei and T. cruzi?	T. cruzi has an "Amastigote" Phase which penetrates tissues and divides intracellularly by fission. This stage can be a source of reinfection!
	Vector = SANDFLY Reservoir = Several Rodent Species RED PAPULE at the bite site 2 weeks to 2 months after infection. Lesion ULCERATES and becomes CRUSTED and HYPERPIGMENTED. Ulcers are PAINLESS, but may ITCH INTENSELY	Leishmania major, braziliensis, mexicanii, or tropica causing Cutaneous Leishmaniasis aka Oriental Sore aka Delhi or Aleppo Boil aka Uta or Chiclero Ulcer
	Vector = SANDFLY Reservoir = Several Rodent Species Red Papule at the bite site 2 weeks to 2 months after infection. Lesion Ulcerates and becomes Crusted and Hyperpigmented. Ulcers are PAINLESS, but may Itch Intensely Can *METASTASIZE to MUCOSAL SURFACES*, including the Nasopharynx. Severe disease can cause Substantial Damage to these tissues, necessitating Reconstructive Surgery.	Leishmania braziliensis causing Mucocutaneous Leishmaniasis aka Espundia
	Vector = SANDFLY Reservoir = Several Rodent Species Mostly occurs in SOUTH ASIA, *BRAZIL, SUDAN* Infected bites are usually UNAPPARENT. Primary symptoms include Fever and Chills, Hepatosplenomegaly, Pancytopenia, Renal Dysfunction, Hypergammaglobulinemia 80--90% of Untreated Symptomatic Infections lead to DEATH within 2 Years.	Leishmania donovani causing Visceral Leishmaniasis aka Kala-azar or Dumdum Fever
	Vector: TICK Reservoir: VOLES and Other Small Mammals Endemic to NORTHEASTERN SEABOARD Malaise, Fever, Chills, Weakness. Severe cases may develop Hepatosplenomegaly, Anemia and Renal Failure. *SPLENECTOMY* Significantly Raises Susceptibility and Likelihood of Severe Disease! Blood Film reveals Erythrocytic Cycle similar to Plasmodium. Difference is that here it is LARGER and DARKER and sometimes forms an X-SHAPE = MALTESE CROSS	Babesia microti causing Babesiosis
	Common infection mostly in Children. Crowded conditions help spread the disease (day care centers, hospitals, etc.) *PERIANAL ITCHING* due to irritation from the laid eggs.	Enterobius vermicularis (Pinworms, Nematodes) causing Enterobiasis
	Extremely Common. Symptoms are rare in adults, but more common in children. No known animal reservoir Large! In children, can *EXACERBATE MALNUTRITION* by an unclear mechanism. Abdominal Pain and/or Obstructions of the Gut in severe cases. During Pulmonary Migration, a Pneuomonitis can occur (Loeffler's Syndrome) with Coughing, Dyspnea, and Eosinophilia. Rarely, aberrant migration can take organisms to bile duct, liver or gall bladder, causing substantial tissue damage.	Ascaris lumbricoides causing Ascariasis (Nematode) The largest nematode which affects humans! Ascaris suum is a related Pig Parasite causing Zoonotic Infections in Humans.
	Worldwide carriage, in US mostly in the *SOUTHEAST US* Most carriers are asymptomatic with pathology more common in Children. Abdominal Pain and Secondary Bacterial Infections can occur if organism Penetrates Mucosa. High burdens can produce Diarrhea, Weight Loss, and , occasionally, APPENDICITIS. Eggs are Oval, Slightly YELLOWISH (bile-stained), with *THICK WHITE CAPS ON BOTH ENDS*	Trichuris trichiura (Whipworms, Nematodes) causing Trichuriasis
	Very common in Tropical and Subtropical Climates Infection comes from contact with Soil contaminated with Feces. A few Zoonotic Species can infect Humans High burdens can cause *HYPOCHROMIC ANEMIA*, with potential DEVELOPMENTAL RETARDATION in Malnourished Children. Other symptoms are generally Mild (or undetectable) and include Abdominal Pain, Diarrhea, Malnutrition, Loeffler's Syndrome, and Rash at Penetration Site	Ancyclostoma duodenale (Old World Hookworms, Nematodes) or Necator americanus (New World Hookworms, Nematodes) causing Ancyclostomiasis
	Endemic in some Tropical Areas, such as West Africa, CARIBBEAN, SE Asia Small Endemic foci in the RURAL SE US Often Asymptomatic, but can cause Loeffler's Syndrome (Pneumonitis) during the Lung Phase Heavy Burdens can cause Occlusion of the Bile or Pancreatic Ducts, Malabsorption, *BLOODY DIARRHEA, Epigastric Pain Symptoms sometimes MISTAKEN FOR PEPTIC ULCERS, but Peripheral Eosinophilia is a clue to proper diagnosis Repeated Cycles of AUTOINFECTION* can cause *HYPERINFECTION SYNDROME* which can become Life Threatening if the host is Immunocomprimised, especially Hematological Malignancy or Corticosteroid Treatment. Organism can migrate to most Organ Systems, with substantial pathology. Mortality is very high.	Strongyloides stercoralis (Threadworms, Nematode) causing Strongylodiasis
	Worldwide in association with *MEAT PRODUCTS, most Particularly PORK* Agent carried by many Meat-Eating Mammals. Carnivorous Animals (including humans) Eat Raw or Undercooked Meats containing Encysted Larvae Can form *CYSTS IN STRIATED MUSCLES* (Nurse Cells) Can be asymptomatic (depending on number ingested), Fever, Adnominal Pain, Myalgia, Marked Eosinophilia with Increasing Severity *SPLINTER HEMORRHAGES* sometimes seen Under the Nails Lethal Infections usually combine Myocarditis, Encephalitis, and Pneumonitis Dx: Clinical Signs + Eosinophilia = Clues Muscle Biopsies NOT Fecal Samples, they are NOT informative!	Trichenella spiralis (Nematode) causing Trichinosis
	Worldwide disease associated with contact with *DOGS AND CATS* Humans are ACCIDENTAL HOSTS Mostly Asymptomatic. Heavy Burnders, particularly in Young Children, can cause Cough, Rash, Anorexia, Hepatosplenomegaly, and Pneumonitis. Less commonly, CNS involvement is seen and rare deaths can occur from Meningoencephalitis. Can produce *RED EYE* and *VISUAL IMPAIRMENTS* sometimes mistaken for RETINOBLASTOMA	Toxocara canis and, more rarely, Toxocara cati (Nematodes) causing Toxocariasis aka Visceral Larval Migrans Ocular Larval Migrans causes symptoms in Eyes
	Extraintestinal infections Vectors: AEDES, ANOPHELES, CULEX MOSQUITOES (None Endemic to US) Infect the Lymphatic System causing Lymphadenopathy and RECURRENT FEVER, causing ENLARGEMENT OF TISSUES and susceptibility to other Bacterial Infections. Extreme, Chronic manifestation is *ELEPHANTITIS*	Lymphatic Filariasis (Threadlike Nematodes) Can be caused by: 1) Wuchereria bancrofti - Bancroft's Filariasis, Endemic to Tropical Areas 2) Brugia malayi, Brugia timori - Brugian or Malayan Filariasis, Endemic to SE Asia
	Extraintestinal Infection Endemic to Africa Vector: BLACKFLY Tissue Preference for *SKIN AND EYES* Dermatitis, Skin Nodules, Ocular Lesions. Eye involvement progresses from Conjunctivitis to Keratitis and causes *BLINDNESS* in 5%	Onchocerca volvulus (Filariasis, Nematodes) causing Onchocerciasis aka River Blindness
	Extraintestinal Infection Confined to 4 Countries in Sub-Saharan Africa - *SUDAN, ETHIOPIA, GHANA, MALI* Vector: COPEPODS (Water Fleas) *EXCRUCIATING AND DEBILITATING PAIN* due to *MIGRATION* of Organisms in Subcutaneous Tissue After about 1 year, organism migrates to a *LOWER EXTREMITY* (usually) and a BLISTER forms	Dracunculus medinensis aka the "Guinea Worm" (Filariasis, Nematode) causing Dracunculiasis
	Extraintestinal Infection Endemic ONLY in *AFRICAN RAIN FOREST* Vector: *CHRYSOPS FLY* Organisms MIGRATE particularly through MUSCLE, Subcutaneous Tissue, and the EYE "CALABAR SWELLINGS" on Extremities	Loa loa (Filariasis, Nematode) causing Loaisis
	Mostly Affects Dogs with potential Fatal Heart Infections. Can be transmitted to Humans via a Mosquito Bite, where it causes a *"COIN LESION" IN THE LUNG*	Dirofilaria immitis (Filariasis, Nematode) aka Dog Heartworm
	Vector: SNAILS Tropical Areas including Mexico and the Caribbean. Many are Asymptomatic. Acute Infection (Katayama's Fever) includes Fever, Cough, Abdominal Pain, Diarrhea, Hepatosplenomegaly, Eosinophilia. Rash can appear at site of Skin Penetration. Liver Granulomas can be seen. 1 species can cause Urinary Frequency, Hematuria, Bacteriuria. Chronic Infection Symptoms arise from Immunological Responses to deposited Eggs with Granulomatous Inflammatory Responses, Fibrosis, and Obstruction. SWIMMER'S ITCH - Skin Rash associated with larval penetration. More common in species that do NOT normally infect humans. These species CANNOT reproduce in humans. Common worldwide. In US it is most prevalent in *GREAT LAKES REGION*	Schistosoma, the Blood Fluke (Trematode) causing Schistosomiasis aka Snail Fever aka Bilharziasis
	Schistosoma Species Blood Site Preference and Egg Shape: 1) S. mansoni: 2) S. japonicum: 3) S. hematobium:	1) S. mansoni: Inferior Mesenteric Veins; Ovoid with Lateral Spine (Dagger) 2) S. japonicum: Superior Mesenteric Veins; Ovoid and Smaller/Rounder and LACK a Spine 3) S. hematobium: Urinary Plexus and Veins; Terminal Spine (Syringe Tip)
	Ingested in Contaminated Water, *AQUATIC PLANTS* (Especially *WATER CHESTNUTS*), or Fresh Water Fish Endemic to Asia, Africa and Latin America Symptoms arise from Organism MIGRATION in LUNG, including Cough and Fever Destruction of Lung Tissue produces "RUSTY SPUTUM" Color and Necrosis is susceptible to Secondary Bacterial Infections. Bronchitis and Pleural Effusions can result. Rarely, migrating worms can invade the CNS causing SEIZURES, VISUAL DEFECTS, Motor Weakness	Paragonimus westermani - the Lung Fluke (Trematode)
	Endemic to SE Asia Symptoms are associated with Heavy Burdens and include Abdominal Pain, Diarrhea, Malabsorption, and in severe cases, Intestinal Obstruction	Fasciolopsis buski, the Giant Intestinal Fluke (Trematode)
	Endemic Worldwide Symptoms include Hepatomegaly, *RIGHT UPPER QUADRANT PAIN*, Chills and Fever, Eosinophilia. Hepatitis and Biliary Obstruction CAN result.	Fasciola hepatica, the Liver Fluke (Trematode)
	Endemic to SE Asia Freshwater Fish are Intermediate Host, Infection via UNDERCOOKED FISH Usually Asymptomatic Severe Infections can cause Fever, Diarrhea, Hepatomegaly, Epigastric Pain, Jaundice	Opisthorchis sinesis, the Chinese Liver Fluke (Trematode) Archaically called Clonorchis sinensis
	Ingestion of Larval Cysterceri in Contaminated Meat (Pork or Beef) Typically Asymptomatic, other than Vague Abdominal Discomfort and Complaints of Chronic Indigestions Proglottid Segments in Feces	Taenia solium (Pork) or Taenia saginata (Beef) Tapeworm Infection
	Oncospheres (Embryos) develop in Stomach of Human which then Migrate to the MUSCLES Inflammation following invasion into tissues causes Pathology. In brain, symptoms include HYDROCEPHALY, MENINGITIS, NERVE DAMAGE, SEIZURES EYE INFECTIONS are also common with LOSS OF VISUAL ACUITY. CALCIFIED NODES	Taenia solium (Pork Tapeworm) causing Cysticercosis Due to Ingestion of Eggs, rather than the Cysticerci (Larva), leading to Hatching in the Stomach, a process that normally occurs in the PIG!
	Worldwide. Very Rare in North America, primarily in North and West (*UPPER PLAINS, ALASKA, PRARIE PROVINCES) Hosts: Canids, which include FOXES, WOLVES*, and occasionally Domesticated Dogs. Oncospheres migrate to various body sites and develop into a Cyst that Fills with SCOLICES and Grows Slowly. Cysts can grow Very Large, up to Liters in Volume. Symptoms can mimic a Slow Growing Tumor and Pressure resulting can cause Pathology dependent on the organ involved: -Liver: Hepatitis or Jaundice -Lung: Difficulty Breathing	Echinococcus (Tapeworm) infection causing Hydatidosis aka Echinococcosis
	Found Worldwide Obtained from eating Raw or Undercooked Fish (which had eaten Small Fresh Water CRUSTACEANS) Usually Asymptomatic, but typical Vague GI complains can occur. *VITAMIN B12 DEFICIENCY* is occasionally seen. Dx: Oval, *BILE-STAINED OPERCULATED EGGS*	Diphyllobothrium latum, The Fish Tapeworm Largest Parasite of Humans!!! Up to 10 Meters!
	Worldwide, Common in N. America Intermediate Hosts: *RATS AND BEETLES* Small Autoinfection can Occur Generally Asymptomatic. High burden causes Vague Symptoms of Abdominal Pain, Diarrhea, Headache and Nausea	Hymenolepsis nana - the Dwarf Tapeworm The Most Common Tapeworm in N. America!!!
	Distributed Worldwide, Rare in Humans. Primarily infects RODENTS. Intermediate Host: BEETLES Human transmission via Consuming Contaminated Mealworms in *GRAIN* Mostly Asymptomatic, High burden causes Vague Symptoms of Abdominal Pain, Diarrhea, Headache and Nausea	Hymenolepsis diminuta - the Rat Tapeworm Longer than H. nana
	Vesicles that Rupture and result in HONEY-COLORED Crusting	IMPETIGO 1) Streptococcus pyogenes 2) Staphylococcus aureus
	Well-Demarcated, Brownish-Red Macular Patches on Inner Thighs, Crural Region, Scrotum Toe Web Lesions appear as Maceration Wood's Lamp: CORAL-RED FLUORESCENCE	ERYTHRASMA 1) Corynebacerium minutissimum
	Well-Demarcated Erythematous Patch with Edema, Pain, Fever Face and Legs Most Common Sites Rapidly Spreading	ERYSIPELAS 1) Streptococcus pyogenes
	Subcutaneous tissue; Redness, Warmth, Induration, Pain, Fever Red Streaking is characteristic of Ascending Lymphangitis	CELLULITIS 1) Staphylococcus aureus 2) Streptococcus pyogenes 3) Young Children with Facial Cellulitis: Haemophilus influenza 4) Diabetics and Debilitated Patients: S. aureus, Enterobacteriaceae, Anaerobes
	Inflammation of Hair Follicles; Seen in areas of Friction	FOLLICUITIS 1) S. aureus 2) Hot Tubs: Pseudomonas aeruginosa 3) HIV: Eosinophilic Pustular Folliculitis 4) Pityrosporum ovale caused by Yeast 5) Gram Negative Folliculitis caused by Klebsiella or Enterobacter species due to Antibiotic Acne Therapy
	Tender and Painful Red Subcutaneous Nodule Becomes Fluctuant (like a WATER-FILLED BALLOON) May drain spontaneously with Pus	FURUNCLE 1) S. aureus
	MULTILOCULATED Subcutaneous Nodules Appear in areas of Friction or Minor Trauma May Ooze Puz or Weep	CARBUNCLE 1) S. aureus
	Large Flaccid Blisters at site of Infection Most common in Newborns and Children Bullae form in response to Epidermolytic Toxin A	BULLOUS IMPETIGO 1) Staphylococcus aureus 2) Streptococcus pyogenes
	Flaccid, Ill-Defined Bullae Nikolsky Sign - Gentle Stroking of Skin causes Skin to Separate at the Epidermis *SANDPAPER-Like Rash PERIORAL CRUSTING* Widespread Desquamation	STAPHYLOCOCCAL SCALDED SKIN SYNDROME (SSSS) 1) Epidermolytic Toxin A and B by S. aureus Infection from Skin, Throat, Nose, Mouth, Umbilicus, or GI Tract - NOT in the Bullae
	Localized collection of PUS Walled Off by deposition of Fibrin Thrombi Indurated Fluctuant Nodule	PERIRECTAL/PERIANAL ABSCESSES 1) Bacteroides fragilis (most common) 2) Proteus 3) Escherichia coli 4) Bacteroides 5) Streptococcus
	Red Linear Streaks Extending Towards the Local Lymph Nodes	LYMPHANGITIS 1) Streptococcus pyogenes (Most Common) 2) Staphylococcus aureus 3) Pseudomonas
	Deep Infection that Spreads Rapidly through Muscle Plains with Destruction of Muscles, Vasculature and Nerves	NECROTIZING FASCIITIS 1) Type 1: Polymicrobial 2) Type 2: Streptococcus pyogenes 3) Type 3: Gas Gangrene or Clostridial myonecrosis
	Petechiae Stellate Purpura Hemorrhagic Bullae	ACUTE MENINGOCOCCEMIA 1) Neisseria meningitides Carried in Nasopharynx, transmitted via Respiratory Secretions
	Fever, Rash, Hypotension, Constitutional Symptoms, Multi-Organ Involvement MUCOUS MEMBRANES: Red Eyes, Mouth, Vagina Cutaneous: *DIFFUSE* Erythema, *STRAWBERRY TONGUE, Desquamation of Palms and Soles FEMALES ONLY* Severe Pain is RARE	STAPHYLOCOCCAL TOXIC SHOCK SYNDROME (TSS) 1) S. aureus Predisposing Factors: Tampons and Nasal Packs
	Fever, Rash, Hypotension, Constitutional Symptoms, Multi-Organ Involvement Cutaneous: *LOCALIZED* Erythema More Common than Generalized, *STRAWBERRY TONGUE, Possible Desquamation SEVERE PAIN* Associated w/ Bacteriema and Mortality	STREPTOCOCCAL TOXIC SHOCK SYNDROME (TSS) 1) Streptococcus pyogenes Predisposing Factors: Cuts and Burns
	More common in hot, humid climates or in those who sweat heavily, so it may recur each summer. HYPO OR HYPERPIGMENTED Macules and Patches on the CHEST AND BACK. They may be mildly itchy. Microscopy shows *"SPAGHETTI AND MEATBALLS"* "Cigar-Butt" Hyphae Wood's Light: *COPPERY-ORANGE FLUORESCENCE*	Malassezia furfur causing Tinea versicolor Benign, superficial cutaneous fungal infection.
	Headache, Nuchal Rigidity, Photophobia Increased # WBC in CSF (Pleocytosis)	MENINGITIS Can be Bacterial/Viral/Fungal in Origin Bacterial Causes Dependent on Age: <1 month old: Streptococcus pyogenes, Listeria monocytogenes 1-2 years old: Streptococcus pneumoniae, Neisseria meningitidis 2-18 years old: Neisseria meningitidis, Streptococcus pneumoniae 19-59 years old: Streptococcus pneumoniae, Neisseria meningitidis >60 years old: Streptococcus pneumoniae, Listeria monocytogenes Listeria seen in Extremes of Age: Very Young/Very Old - People concerned most with this because it can be spread by close human contact.
	Bacterial vs Viral vs Fungal CSF Profiles in Meningitis	Bacterial/Fungal: -Protein/Pressure Increased -Glucose Decreased -PMN Infiltrate = Bacteria -Lymphocyte Infiltrate = Fungal Viral: -Protein/Pressure/Glucose Approximately Normal -Lymphocyte Infiltrate
	Fever, Headache, Altered Level of Consciousness, Focal or Diffuse Neurological Signs, Confusion	ENCEPHALITIS Bacterial: Rickettsia & Ehrlichia Viral: HERPES SIMPLEX, Varicella Zoster, West Nile, HIV, Enterovirus, Influenza Fungal: Cryptococcus
	IV Drug User presents to ER with Fever, Right Hemiparesis for 1 Week. Papilledema 3/6 Holosytstolic Murmur Splenomegaly Skin Abnormalities including Splinter Hemorrhages on Nails, Osler's Nodes (painful, red tender lesions on hands/feet), Janeway Lesions (like Osler's but NOT tender)	Brain Abscess affecting Middle Cerebral Artery causing ENDOCARDITIS Immune Complexes deposit on Heart Valves
	Causes of Extradural Abscess and Subdural Empyema	Streptococcus and Staphylococcus
	Caffeic Acid Agar (Birdseed) Culture	Cryptococcus neoformans
	Rales vs Rhonchi	Rales = Fluid in Alveoli (CANNOT clear via cough) Rhonchi = Fluid in Bronchial Tree (CAN clear via cough)
	"Typical" Pneumonia: Cough, Rusty Sputum, Fever, Chest Pain Elderly, Alcoholics, Immunocompromised (ex. Splenectomy), Children, Closed Populations Sputum Stain: GRAM POSITIVE DIPLOCOCCI --> *LANCET SHAPED* Often associated with Bacteremia	Streptococcus pneumoniae Treatment: Penicillin!
	Prominent cough and Yellow Sputum production Associated with Otitis, Sinusitis, Epiglottitis Frequently in Alcoholics, SMOKERS, COPD, Children Sputum Stain: GRAM NEGATIVE COCCOBACILLI Associated with Pleural Effusions and Rapidly Progressive Empyema (Pus in Pleural Cavity) Chocolate Agar: GROWTH Sheep Blood Agar: NO GROWTH	Haemophilus influenza Treatment: Cephalosporins (Beta-Lactamase provides Penicillin resistance) If Sputum were Gram Negative Cocci and everything else was similar, it would be Moraxella catarrhalis
	Natural Habitat = Water Inhalation of Aerosolized organisms from ACs or Water Sources SMOKERS, Diabetics, Immunosuppressed, Cancer Patients, those with Chronic Illness Productive Cough, Fever, GI Symptoms, Altered Mental Status Chest X Ray: Bilateral Interstitial Infiltrates Sputum Stain: WBC's BUT NO ORGANISMS Charcoal Yeast Extract Agar: GROWTH	Legionella pneumophilia Treatment: Erythromycin, Rifampin, Tetracyclines
	Typically in younger adult population (less than 30 years old) Cough, Fever, Sore Throat Systemic Signs are frequent, including Lymphadenopathy, Muscle Aches, Chills and *BULLOUS MYRINGITIS* = Bleb on Tympanic Membrane producing EARACHE Chest X Ray: Bronchopneumonia Sputum Stain: MIXED BACTERIA	Mycoplasma pneumoniae Treatment: Empiric-Tetracyclines or Macrolides
	Pneumonia Usually Occur in EPIDEMICS Chest X Ray: Bilateral Interstitial Infiltrates System symptoms frequent and include Fever, Chills, Muscle Ache, Cough	Viral Pneumonia! Causes: 1) Influenza A or B 2) CMV 3) Adenovirus (*no treatment) 4) RSV 5) Parainfluenza
	Pneumonia associated with Septic Pulmonary Emboli in INJECTION DRUG USERS Sputum Stain: GRAM POSITIVE COCCI IN CLUSTERS Bacteremia may result in SKIN LESIONS Chest X Ray: Cavitation, Pleural Effusions, MULTIPLE NODULES (Hematogenous)	Staphylococcus aureus
	Pneumonia associated with Oral Colonization in setting of Chronic Illnesses Frequently in Alcoholics, Diabetics, Debilitated Nursing Home Patients, Cystic Fibrosis Chest X Ray: Cavitation, Pleural Effusions	Enteric Gram Negative (Enterobacteriaceae) Pneumonias! Alcoholics = Klebsiella Cystic Fibrosis = Pseudomonas
	Pneumonia associated with Aspiration from Oral Cavity Frequently in those with Altered Consciousness, Swallowing Disorders, POOR DENTITIA (homeless), Chronic Obstructive Lesions in the Lung FOUL SMELLING SPUTUM Sputum Stain: Mixed Morphology Chest X Ray: Cavitation	Anaerobic Pneumonias!
	Distinguishing Plasmodium Species: 1) P. falciparum 2) P. vivax 3) P. ovale 4) P. malariae	1) P. falciparum: 24 Hr Periodicity 2) P. vivax: 48 Hr Periodicity 3) P. ovale: Not Regular Periodicity (sometimes 48 Hr) 4) P. malariae: 72 Hr Periodicity. P. falciparum is Most Severe, has Neurological Symptoms, and has CRESCENT SHAPED GAMETOCYTES P. vivax and P. ovale Infect YOUNG RBCs, RBCs are Enlarged, have Schuffner's Dots, "HYPNOZOITE LIVER STAGES" P. malariae Infects OLD RBC's
	What is a major difference between the two Free Living Amoebae, Naegleria flowerli and Acanthamoeba spp.?	Naegleria flowerli has 3 forms: 1) Cyst 2) Trophozoite 3) Flagellated Acanthamoeba spp. have only 2: 1) Cyst 2) Trophozoite NO FLAGELLATED FORM!
	Food Poisoning due to Preformed Toxins:	Require a relatively LOW dose! 1) Staphylococcus aureus: -Heat Stable Toxin -Vomiting WITHOUT Fever 2) Clostridium perfringens: -Watery Diarrhea WITHOUT Vomiting 3) Bacillus cereus: -Heat Stable Toxin OR a Different Toxin -Depending on Toxin type, can mimic either of the two above
	Agents causing Dysentery (Bloody/Mucoid Stools)	Bacterial (5) ________________ Aerobic Gram Neg Curved Rod: 1) Campylobacter ANaerobic Gram Neg Rod (Enterobacteriaceae): 2) EHEC (STEC) 3) Shigella 4) Salmonella ANaerobic Gram Pos Rod: 5) Clostridium Protozoal (1) __________________ 1) Entameba histolytica
	"Hypnozoite" Liver Stages	Plasmodium vivax and ovale Dormant Stages, UNRESPONSIVE to most drugs Solution: Give them PRIMAQUINE in combination with the primary antimalarial!
	Which skin disorders can you NOT use Penicillin for?	1) Carbuncle 2) Furuncle 3) Folliculitis 4) Perirectal/Perianal Abscesses 5) Erythrasma 6) Necrotizing Fascitis 7) TSS
	Dealing with Meningitis as a Medical Emergency	Start with: Blood Cultures, Empiric Antimicrobial Treatment w/ Dexamethason, Neuroimaging If Neuroimaging Negative, LUMBAR PUNCTURE immediately, Gram Stain and Culture, Cell Count and Protein
	Screening/Confirming Syphilis	Screening: RPR, VDRL Confirming: FTA-ABS, TP-PA
	What causes Neonatal Conjunctivitis?	Chlamydia in pregnancy
	Which STDs have Culture and Nucleic Amplification Assays (NAATs) as Diagnostic Tests?	Chlamydia and Gonorrhea
	Disinfectants which are TOXIC to Humans:	1) Chlorine 2) Hexachlorophene 3) Chlorhexidine (less toxic than Hexa) 4) Glutaraldehyde
	Modalities for Sterilization:	1) Heat 2) Gas 3) Cold Sterilization 4) UV Light 5) Ionizing Radiation 6) Filtration (Bacteria, NOT Viruses)
	New Modalities for Disinfection: 1) Surfacine 2) Superoxidized Water	1) Surfacine - Transfers silver and kills bacterial cells 2) Superoxidized Water - Hypochlorous Acid and Chlorine Radicals which are NOT toxic to biological tissues
	Alcohols as Antiseptics	Kill most everything Fast Optimum Concentration = 60-90% NO Persistent Activity
	Iodine Compounds as Antiseptics	Kill most everything (slightly less effective against Fungi) Intermediate Speed of Action Causes Skin Burns - Too Irritating for Hand Hygiene
	Iodophors as Antiseptics	Kill most everything (Slightly less effective at killing Mycobacteria and Viruses than Iodine) Intermediate Speed Less Irritating than Iodine Acceptance Varies
	Phenol Derivatives as Antiseptics	Kill most everything (Most effective at killing Gram + Bac, everything else is decreased) Intermediate Speed Activity Neutralized by Non-Ionic Surfactants!
	What does Sterilization NOT kill?	Prions!
	Major cause of diarrhea in Children and TRAVELERS in Endemic Regions Virulence related to colonization FIMBRIAE and Heat Labile (LT) and Heat Stable (ST) Enterotoxins	Enterotoxigenic E. coli (ETEC)
	Cattle, Raw Milk, Dairy Products, Apple Juice, Vegetables, Drinking and Wading Water Bloody Diarrhea, Fever Minimal 60% in US 0157:H7 Antibiotics potentially harmful ---> Hemolytic Uremic Syndrome (HUS)	Enterohemorrhagic E. coli (EHEC) aka Shigatoxin-Producing E. coli (STEC)
	Major cause of *PERSISTENT DIARRHEA* in Children in Tropics, Travelers’ Diarrhea and Patients with AIDS-associated Chronic Diarrhea Intestinal (HEp-2 cells) Attachment and Damage *STACKED BRICK APPEARANCE*	Enteroaggregative E. coli (EAEC)
	Receipt of Antibiotics, Proton Pump Inhibitors or Chemotherapy plus Host Co-Morbidity & Genetics Spore-Forming! Diagnosis: Culture of Organism or test for Toxins A/B in Stools	Clostridium difficile
	Viral Gastroenteritis Causes:	Rotavirus - Affects Infants, detected via ELISA Noravirus - Affects Older Children and Adults, detected by RT-PCR
	Low Dose vs Intermediate Dose vs High Dose GI Infections	Low Dose: 1) Shigella 2) EHEC 3) Giardia and Cryptosporidium parvum 4) Norwalk Virus Intermediate: 1) Salmonella 2) Campylobacter High Dose: 1) Vibrio cholerae 2) ETEC
	Category A Agents (6)	1)* Bacillus anthracis (Anthrax) 2) * Clostridium botulinum (Botulism) 3)* Francisella tularensis (Tularemia) 4) Yersinia pestis (Plague - pneumonic) --> Droplet Spread 5) Variola Major (Smallpox) --> Airborne + Contact Spread 6) Viral Hemorrhagic Fever (Ebola, Marburg) --> Droplet + Contact Spread * = NO Person-to-Person Spread!
	Rates of Infection =	Number Infected/ 100,000 Persons at Risk
	Incidence rate in a population during a specified time (i.e., during an outbreak)	Attack Rate
	Proportion of persons in a defined population who are affected at any ONE TIME.	Prevalence If based on frequency at a moment in time = Point Prevalence
	Number of NEW events occurring in a given population in a unit of time.	Incidence
	The constant or usual presence of an infection or disease in a community	Endemic
	When an unusual number of cases of a disease occur in a given time period and geographic area as compared to an established occurrence of the disorder	Epidemic or Outbreak
	The primary case of an illness in a family, institution or community that may serve as a source of infection to others	Index Case
	Proportion of individuals who develop infection within an appropriate incubation period after exposure to primary case divided by number exposed	Secondary Attack Rate
	Multiplication of a microorganism in a host, characteristically accompanied by an immune response. It may or may not occur with clinical illness	Infection
	Number of Death of a specific disease divided by total number of cases	Case-Fatality Rate
	Most Definitive and Expensive Study Group is followed over time prospectively Possible to identify group of persons negative for a disease in the past who is followed to the present or beyond	Cohort Study
	Retrospective Study of persons already ill with the disease and compare their characteristics with a control group without the disease for presence or absence of certain risk factors	Case-Control Study
	Examination of Occurrence of Disease or Risk Factor in a population at a point in time	Cross-Section or Prevalence Study
	Systematic Testing of Blood Sample for presence of Antibodies, Antigens, Genetic Markers, Cell-Mediated Immunity which is used to: 1) ID past/current prevalence of an infectious agent in a community 2) ID incidence of infection by Seroconversion or rise in samples obtained at different times 3) Reveal ratio of Subclinical vs Clinical Infections when combined with Clinical Data 4) Determine the need for Immunization Programs and evaluate their effectiveness MORE WIDELY USED IN VIRAL than bacterial!!!!	Serological Epidemiology MORE WIDELY USED IN VIRAL than bacterial!!!!
	Acute versus Chronic Gastroenteritis	Acute: less than 2 weeks duration Chronic: Greater than 2 weeks duration
	Causes of CHRONIC Gastroenteritis (> 2 Weeks)	Parasitic: 1) Giardia 2) Cryptosporidium 3) Cyclospora Disaccharide Deficiency EAEC Occasionally: Shigella Salmonella Campylobacter Yersinia
	Plasmodium Life Cycle:	Sporozoites Injected by Mosquito --> Invade Hepatocytes of Liver --> Asexual Production there produces Merozoites which are then released into Blood Stream--> Merozoites invade Erythrocytes and undergo a Trophic Period to become a Ring form Trophozoite--> Enlarges to become a Schizont --> Merozoites then bud off of the Schizont and are released following Rupture of the Erythrocyte Some Merozoites differentiate into Gametocytes which are sexually competent. These are taken up into Mosquitos and reproduce in the foregut, resulting in a zygote. Meiosis then occurs, reforming Sporozoites.

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