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365 Cards in this Set
- Front
- Back
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ARD
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No fever, Virus, URT, supportive care
|
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RHinovirus
|
Pirocna, +RNA, Hands, canyon hypothesis ICAM1
|
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Adenovirus Adult Pharyngitis
|
Winter Adults
|
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Pharyngoconjuntival fever
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adenovirus, unilateral conjuntivitis, swimmingpool
|
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Pertusus like syndrom
|
adenovirus 4&7, young adult, college dorm
|
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Adenovirus
|
DSDNA, 20 capsid, 4&7
Lytic and latent Dense inclusions, fecal oral route PCR |
|
|
Picovir
|
Rhinovirus binds to canyon pocket
don't give because could kill/rhinovirus can't kill |
|
|
ICAM-1
|
rhinovirus/canyon hypothesis
-binds deep in capsomere and stiumulated by interferon |
|
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3C protease inhibitor
|
Hinovirus
Prevents maturation of virus |
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BIRR4
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Nasal spray- bind viral receptor (mimics ICAM)
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Most fequent caus of pharyngitis in winter
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adenovirus
|
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Adenovirus physical charactristics
|
dsDNA, 20 capsid, Dense inclusion "A Dense O VIrus"
|
|
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Adenovirus liytic vs atent infection
|
lytic - respiratory and enteric
Latent-lymphoid tissue |
|
|
adneovirus transmission
|
fecal oral ,
aerosol, fomite EYES! |
|
|
HI neutralization assay
|
Ag Detection adenovirus
or PCR or rapid tests |
|
|
Tell me about cells to cancer
|
non permissive cells are "transformed" into cancer cells by DNA viruses (Adenovirus)
|
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Antigen type 4&7
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Adenovirus
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Rhinovirus immunity
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18months
|
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Nuclear dense inclusions
|
Adenovirus
|
|
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ssRNA +
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Rhinovirus
Coronavirus |
|
|
envoleoped caspid flu
|
Corona
PIV, RSV Influenza virus Hantavirus |
|
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Helical RNA symetry
|
Corona,
RSV INfluenza |
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crown like surface projections
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corona virus
|
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corona virus epidemiology
|
epi cells at resp tract
|
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Virus that like strangely low temps
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Rhino 33
|
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Civic Cats and Bats
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Sars- New corona virus
|
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SARS Dx
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PCR or Pt Antibody
|
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Human reservoir only
|
TB
Adenovirus Pertussis Strep Pyogenes Chalmidophile Phenumonia |
|
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RSV adult vs child
|
URTI vs
LRTI |
|
|
More severe RSV subtype
|
A
this one also predominates |
|
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fever, hoarsness, barking cough
|
Croup
|
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Steeple sign
|
Croup
|
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Paramyxoviruses
|
PIV, RSV- croup associated
|
|
|
confined to URT or
non-specific URTI |
Para influenza virus
|
|
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ssRNA-
|
PIV, RSV
Hantavirus |
|
|
PIV physical characterisitcs
|
NONsegmented - RNA
H&N on same peplomere |
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H&N on same peplomere
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PIV
|
|
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Syncitia formation
|
PIV, RSV
Paramyxoviruses |
|
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PIV infection method
|
Droplets to respiratory tract
|
|
|
Cause otitis media
|
PIV
Strep Pneumoniae Haemophilus influenzae A, B Moraxella Catarahallis |
|
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PIV dx
|
RT-PCR
takes longer than elisa |
|
|
Syncitia defintion
|
multinucleated giant cell
|
|
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PIV types
|
1,2 - alternating epidemiolgoy
3- endemic 4- new |
|
|
RSV risk increases
|
children born in april-september, daycare, crowd, NOT breast fed
|
|
|
Children narrowing and plugging of bronchi and bronchioles, fever, cough
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RSV
|
|
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RSV transmission
|
fomites, direct contact
|
|
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This virus lacks hemaglutanin and neuraminidase
|
RSV
INfluenza B |
|
|
RSV dx
|
Elisa (faster)
4xincrease in serum Abs |
|
|
Ribavirin
|
Tx RSV in sever cases- inhaler
|
|
|
RSV immuniztation
|
no vaccine-
passive RSV Ig to premies |
|
|
FLU in 1918
1957 1968 |
1, 2, 3
H1N1 H2N2 H3N2 |
|
|
Winter pandemics
|
Flu A virus
|
|
|
Cytokine Storm
|
H5N1 flu
SpeA from Strep Pyogenes Scarlet fever |
|
|
Cause of severe flu pulmonary disease
|
Primary- viral pneumonina compromising mucociliary elevator- promotes bacterial adhesion
secondary- bacterial pneumonia |
|
|
Flu's ominous sign
|
after a few days of getting better a pt has a returned fever
|
|
|
Reyes syndrom
|
viral infection <15yrs
W/ Aspriin (CNS and Liver damage) Pepto bismol |
|
|
Guillan Barre
|
NV tissue demylelination disease
young adult/elderly within 2 weeks of getting vaccine |
|
|
Flu in nursery homes
|
underlying disease
Lack of response to vaccine |
|
|
Novel flu
|
H1N1 2009
|
|
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Spanish flu
|
1918 H1N1 killed young and not sick very quickly
|
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Influenza virus physical properties
|
SEGMENTED
ssRNA, Helical Capsid H&N |
|
|
Segmented virus
|
INfluenza
|
|
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Type B influenza H&N
|
NONE
|
|
|
Flu pandemics
|
shift in type A
change in H |
|
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Flu Dx
|
Rapid test and clinical findings
|
|
|
Fluzone
|
>65 vaccine, high dose
|
|
|
FLumist
|
live attenuated non preggo
sniffer vaccine |
|
|
M2 inhibitors
|
Aman/ Rimantidine
Halt hemaglluitinin structureal change Stops uncoating/opsonization Only old type A H1N1 |
|
|
Neruaminidase inhibition
|
works on both A,B
causes viral aggregation at the cell and inhibits further virus spread. must be givine within 48hrs of symptoms |
|
|
FLu drug "sensitive to all"
|
Zanamavir
|
|
|
Sensitive to novel H1N1 & B
|
Oseltamivir - give during H1N! outbreak
|
|
|
Otalgia and ottorhea
|
otitis externa
bacterial- P.Arugenosa A. Aureus |
|
|
Gram - B
|
Arugenosa, Klebsiella, Legionella,
Coxiella Burnetti |
|
|
Gram- C
|
H. Influenzae
M. Catarrhalis, Bortadella Purtussis C. Pneumonia C. Psittaci Fransicella Tularensis |
|
|
Gram +
|
S. Aureus
S. Pneumonia |
|
|
Otitis externa factor
|
Moisture, objects, trauma, chronic skin condition
|
|
|
Look at what in woodlamp?
|
Pyoveridn from Psuedomonas Aurugenosa
|
|
|
Ottits externa Tx
|
Topical Local
Fever? Think systemic Analgesic |
|
|
P. Aurugenosa Morphology
|
Gram-B
Encapsulated Aroobic, oxidase positive, pyocyanin/verdin |
|
|
S. Aureus Morphology
|
Positive everything
B hemolysis ferment mannitol Encapsulated coccus |
|
|
Optichin sensitive
|
S. Aureus
S. Pneumoniae |
|
|
Otitis Media Bacteria
|
Middle ear inflammation
H INfluenzae S. Pneumonia Morexella Catarrhal8s CatNIP |
|
|
Otitis Media Tx
|
Amoxicillin with clavulonic acid
Tympanosotomy if chronci |
|
|
Lancelet Diplo
|
strep penumonia
|
|
|
Hi influenzae morphology
|
G- B
non-typable Not capsulated= NOT type B |
|
|
Moraxella catarralis
|
G- diplococcus
Oxidase +, Blactamase producer nonfermenter of Carbon |
|
|
alpha hemolytic
|
Strep pneumoniae
|
|
|
Beta hemolytic
|
S. Aureus
|
|
|
sinusitis cause
|
S. Pneumoniae,
H. Influenzae M. Catarrhalis Same as inner ear just in nose |
|
|
AB exotoxin
|
Dyptheria
A-Attach B-bind (lysogenic) |
|
|
skin papule develops to an ulcer
|
Cutaneous Diptheria
|
|
|
Grayish Pseudomembrane
|
dyptheria
fibrin and bacteria and RBCs/WBCs and Necrotic Epi- Bull Neck |
|
|
Bull Neck
|
Dyptheria, CHinese Bull- ELEK(test)
|
|
|
Systemic dypthewria
|
Myocarditis and Demyelination
|
|
|
Demyelination diseases
|
Systemic dyptheria and guillan Barre
|
|
|
Baccilus w/ metachromatic granules
|
volatin cgranules within
corynebacterium diptheriae |
|
|
Volutin
|
Inorganic phosphage
|
|
|
Clubbed shaped bacillis
|
Dyptheria
|
|
|
CHinese Letter
|
Dyptheria
Chinese Bull Elek |
|
|
Dyptheria Exotoxin Mechanism
|
Binds heparin binding EGF receptor- inactivates EF2, inhibits pretein synthesis, cell dies
(INcreases when Iron is low) |
|
|
Inhibits EF-2
|
binding EGF
Dyptheria and P. Aurugenosa |
|
|
Black colonies on Tellurite
|
Dyptheria Gram + chinese club
|
|
|
Dyptheria on blood agar
|
not hemolytic so rules out hemolytic streap
|
|
|
ELEK test
|
Immunodiffusion- zone of equivalence
immune compelx function -lines shape X= toxogenic |
|
|
immune comlex formation (ELEk)
|
Binds toxin, not cells
|
|
|
Dyptheria Tx 3 stops
|
1- antitoxin from CDC
2- Erythromycin 3-Vaccinate |
|
|
Pertussis causes/spread
|
strictly human
cough/resp droplets |
|
|
Pertussis 4 stages
|
1-incubation
2- catarrhal- URTI 3- Paroxysmal whoop 4- Convolescence or secondary infection |
|
|
Pertussis Catarhaliss
|
G- CoccoBac
LPS/ Adhesins/Exotoxins |
|
|
Pertactin (P69)
|
Whooping cough Pertussis
Agglutinogen- promotes attahcment of bacteria to host |
|
|
filamentous hemaglutin FHA
|
Finalmentous attachment of bacteria to ciliated epi cells
|
|
|
Pertussis Adhesions
|
P69, FHA
Fimbriae |
|
|
Pertusis Exotoxin (basic)
|
AB exo, Adenylate cyclase toxin, Dermonectotic toxin, tracheal cytotoxin
|
|
|
AB exotoxin
|
Pertussis
Inactivates Gi, increases cAMP, increase secretions, adhesion |
|
|
Adenylate cyclase toxin
|
chemotaxis pertussis
|
|
|
Tracheal cytotoxin
|
pertussis
IL1- ciliostasis |
|
|
Dermonecrotic toxin
|
Pertussis Vaso COnstriction
|
|
|
Lymphblastic leukocytosis
|
pertusis
inhibits leukocyte extravasation |
|
|
Pertussis Dx
|
Presumptive
Difinitive- culture on Bordet G/Regan Lowe, PCR |
|
|
Pertusis Tx
|
DOC Macrolides (mycin) then
immunize with Tdap/Dtap |
|
|
Common cold Rhinitis
|
40% viral URT
30% bac Strep Pyogenes |
|
|
Acute Rhiitis
|
follow sinusites (usually viral)
|
|
|
chronic sinusitis
|
unresolved acute sinusitis, suppurative, usually anaerobe polymicrobial bacteria
|
|
|
usually anaerobe polymicrobial bacteria
|
chronic sinusitis
|
|
|
Acute pharyngitis
|
both bacterial (GAS
and viral (common cold syndrome) |
|
|
Common cold syndrome
|
Acute pharyngitis
bacterial and viral infection |
|
|
Eppiglotitis
|
No viral causes
Acute- HIB (vaccinate) S. Pneumoniea (mild case) |
|
|
Laryngitis
|
Primarily viruses and Bordatella Pertussis
|
|
|
Strep Genus factoids
|
fastidious (BAP)
Mesophile, little bit of a capnophile no cat, no movement + |
|
|
Strep pyogenes "recall"
|
Lancfield A; B hemolytic; acute haryngitis, skin infections
|
|
|
Strep pneumoniae "recall"
|
NO lancfield
ahemolytic pneumonia, meningitis otitis media in children |
|
|
Typical vs atypical
onset |
Sudden vs Gradual
|
|
|
Typical vs atypical
Temp |
>103, <103
|
|
|
Typical vs atypical Chills shakes
|
common vs rare
|
|
|
Typical vs atypical
cough |
productive vs non
|
|
|
Typical vs atypical
pleurisy |
frequent vs rare
|
|
|
Typical vs atypical
CXR |
Consolidation vs patchy
|
|
|
Typical vs atypical
TX |
BLactam vs Unresponsive to Blactam
|
|
|
Typical vs atypical
other symptoms |
Chest pain, SOB vs BODY ahces, diarrhea, ab pain
|
|
|
Myocarditis
|
systemic dyptheria, SPyogenes- Rheumatic fever
|
|
|
GABHS
|
Group A beta hemolytic strep
|
|
|
Strep P normal flora site
|
Oropharynx
|
|
|
string of pearls
|
strep pyogenes GABHS
|
|
|
Strep pyogenes 3 paths 2 subpaths
|
pyogenic inflammation
Scarlet Fever Immunologic disease -poststreptococcal AGN - Rheumatic fever |
|
|
Strep P Transmission
|
skin- resp droplets
|
|
|
Pyogenic inflamation small children
|
sub acute nasopharynx/discharge
cervical lymphadenopathy |
|
|
pyogenic inflammation in adults
|
acute strep throat
|
|
|
Strep throat 4 signs
|
FAPP
Fever>101 Anterior cervical lymphadenopathy Palatal Petichiae Purulent exudate |
|
|
Ant Cervical Lymphadenopahty
|
Strep Pyogenes inflammation
|
|
|
Palatal Petichiae
|
Strep throat S. Pyogenes inflammation
|
|
|
Strep symptoms w/ rhinorrhea and cough
|
think viral
|
|
|
Lysogenized strep causes increased what?
|
increases SpeA exotoxin in children Scarlet fever (cytokine storm)
|
|
|
Punctate erythematic rash not on face
|
Scarlet fever, SpeA exotoxin, S. Pyogenes, Scarlet Fever
Lysogenized |
|
|
Sand Paper skin
|
Strep P scarlet fever, lysogenized
speA |
|
|
Desquamation of extremities
|
Scarlet fever, SpeA exotoxin, S. Pyogenes, Scarlet Fever
Lysogenized |
|
|
circumoral pallor and strawberry tong
|
Scarlet fever, SpeA exotoxin, S. Pyogenes, Scarlet Fever
Lysogenized |
|
|
Petichial lesions in flexor folds
|
Thomson sign, Pastia Lines
Scarlet fever, SpeA exotoxin, S. Pyogenes, Scarlet Fever Lysogenized |
|
|
Post Strep AGN
|
post cutaneous strep infection,
M Protein, Type III Puffy face, hematouriea from deposition |
|
|
Type III hypersensitivity
|
immune mediated
|
|
|
Puffy face
|
Post strep AGN III
Protein M- nephroglomerular damage |
|
|
Nehpritogenic M protein
|
Post strep AGN, IGMantibodies cross react with host cell,
|
|
|
Strep P envolope contents
|
M protein
Protein F LTA Capsule |
|
|
Protein F
|
Strep P
binds fibronectin |
|
|
LTA
|
step P
Attaches epithelium |
|
|
Strep Pyogenes Capsule function
|
inhibits phagocytosis
|
|
|
Strep P 5 enzymes
|
Streptolysin O/S,
Hyaluronidase Streptodornase Streptokinase/Fibrinolysin |
|
|
Streptolysin O
|
oxygen labile, destroys RBC and WBC, hemolysis in deep cuts
ANTIGENIC |
|
|
Streptolysin S
|
Oxygen Stable, Destroys RBC and WBC surface colonies
NOT ANTIGENIC |
|
|
Streptordornase
|
Degrades DNA, reduces viscosity of purulent exudate
|
|
|
Streptokinase/fibrinolysi
|
break down fibrin clot
|
|
|
Strep P toxins
|
SpeA- superantigen
causes TSS and Scarlet fever |
|
|
Rheumatic fever
|
Strep pyogenes
young fever, myocarditis, joint swelling, chorea, subq nodules 1-4weeks post GABHS infection in young people |
|
|
Type II sensitivity
|
Rheumatic fever- ab mediated cytotoxic
|
|
|
Aschoff bodies
|
Perivascular granulomas- replaced with scar tissue
Rheumatic fever S. Pyogenes |
|
|
Damage to L heart valve
|
S. Pyogenes Rheumatic Fever
most serious problem |
|
|
Jones criterion
|
There is no room for specculation
S-subQ P-Polyarthritis joint swelling E-erythema C-Cardiomegaly, myocarditis C-Chorea of extremities |
|
|
RADT
|
Strep P test-
detects group A ag - results must be confirmed by culture -specific not sensitive |
|
|
SPIN
|
SNOUut
|
|
|
ASO
|
Strep P serological test
|
|
|
Strep P DOC
|
Penicillin VK,
Erythromycin up to 9 days post (to stop RF and AGN) |
|
|
CAPneumonia
|
all ages/places
consolidation/inflammation of lungs |
|
|
Typical CAP bacteria
|
S. Pneumonia
Hemaophilus influenzae S. Aureus K. Pneumonia |
|
|
Atypical CAP bacteri
|
legioinalla,
mycoplasma clamydia zoo and non-zoo |
|
|
Strep CAP
|
Meningitis
Optichin Pneumonia Sinusitis |
|
|
Strep CAP resevoir
|
asymptomatic carriers
|
|
|
Strep CAP virulence factors
|
Cap PAP HyPi
Capsule Pneumolysis Autolysin Peptidoglycan Pili Hydrogen Peroxide |
|
|
Strep CAP capsule
|
inhibits phagocytosis- surface proteins prevent c3 opsoniization of bacteria
interferees with compliment |
|
|
Pneumolysis
|
Strep CAP
forms transmembrane pores resulting in host cell lysis activates compliment |
|
|
Autolysin
|
StrepCAP
Causes lysis of pneumococccal and release of pneumolysin and neuraminidase response to antibiotic therapy |
|
|
Peptidoglycan Teichoic Acid
|
Strep CAP
immunomodulator causes increased response and adhesion "overwhemed repsonse" |
|
|
Activates TNF in Strep CAP
|
PILI
|
|
|
Hydrogen Peroxide to lyse host cells
|
Strep CAP
|
|
|
Lyse w/ bile
|
Strep Pneumoniae
|
|
|
Hemoptysis
|
Strep Pneumonia CAP
|
|
|
Strep CAP Tx
|
Penicillin G and Blactam
Fluoroquinlalone |
|
|
Strep CAP vaccine
|
23 valent for old people
16 valent "conjuigate" for young uns |
|
|
H. INfluneza B CAP target
|
infants and young hildren and debilitated folks
|
|
|
H Influenza virulenc and cap
|
virulent w or w/o capsule
|
|
|
Chocolate Agar
|
HIB
need GFs |
|
|
Factor X
|
Hemin
GF for HIB |
|
|
Factor V
|
HIB
GF for growth like NAD |
|
|
HIB Hemolysis
|
NONE
|
|
|
Encapsulated bacteria
|
S Pneumonina
S Pyogenes P Aurgenosa S Aureus |
|
|
HIB 4 virulence factors
|
PRP
Neuraminidase IgA protease Fimbrieae LOS |
|
|
PRP
|
HIB virulence factor
polyribosomal phosphate capsule resistangt to phagocytosis by PMNs _BIG DEAL |
|
|
LOS
|
HIB virulence factor
Lipooligosac outer membrane ptrotein similar to LPS |
|
|
Latex particle agglutination test
|
HIB
LAT test or PCR |
|
|
HIB tx
|
Blactams
amoxicillin w/ clavulonic acid |
|
|
HIB vaccine
|
DO IT!
W/ pertussis dip/tetanus |
|
|
Klebsiella morphology
|
G- B
non motile thick slimy grody goopy capsule normal in maouth skin, intestines |
|
|
LRT and Currant Jelly
|
Klebsiella
alcoholics diabetics and homeless or any combination thereof |
|
|
Klebsiella Virulence factor
|
Polysaccharide capsule prevents MAC/Phagocytosis
Adhesins |
|
|
lung cavitation w/ pleuritic pain
|
Klebsiella
|
|
|
Klebsiella colonization
|
Rapid necrotic destruction of alveolar spaces, inflammation and hemmorhage in lungs
|
|
|
Klebsiella diagnossi
|
Jelly
cavitation |
|
|
Klebsiella Tx
|
50% will died
DOC- Aminoglycocsides 3gen cephalosporins, fluoroquinalone |
|
|
Legionella Spread
|
Aerosols, protozoans, Cl resistance, Intracellular
Charcoal yeast, pontiac |
|
|
Legionalle transmission
|
aerosol, water, no person to person
|
|
|
pontiac fever
|
Firebird baby!
I don't feel so good Not like pneumonia |
|
|
Legionairres disease
|
Severe acute pneumonia
Fibrourulent necrotizing pneumonia death of alveolar macrophages from shock or respiratory failure dry cough |
|
|
fibrourulent necrotizing pneumonia
|
Legioneirres
|
|
|
Serogroup 1
|
Legionella
|
|
|
Opsonized by C3b and survives intracellularly
|
Bastard Legionella does
|
|
|
Legionella Dx
|
buffered charcoal yeast xtract
selective growing |
|
|
Legionella Tx
|
Cell mediated immunity
Levofloxacin |
|
|
Mycoplasma Pneumoniae CAP
|
most common atypical CAP
crackles, non-productive cough tracheobronchitis, pharyngitis, relapse common |
|
|
Mycoplasma Pneumoniae Morph
|
smallest
no wall fried egg |
|
|
Fried egg appearance
|
mycoplasma pneumoniae
|
|
|
P1 adhesion protein
|
Mycoplasma pneumoniae
Ciliostatis, epithelial damage decrease adherance to epithelium release H202 and O2 for damage |
|
|
Mycoplasma Pneumoniae DX
|
CXR,
Cold agglutination for IgM @4C Elisa titer>32 |
|
|
M. Pneumoniae DOC
|
Azithromycin
"Macrolides, DOxycycline" |
|
|
Clap pneumonia transmission
|
humans only droplet p2p
|
|
|
Clap P CAP
|
atypical,
INterstitial infiltrates Brohncitis Sinusitis PBS non-productive cough UNILATERAL LOBE =severe |
|
|
MOMP
|
Major outer membrane protein
Chlamydophila/Chlamydia Cross linked disulfide bonds |
|
|
Elementary body
|
INFECTIOUS clamydia/pila
enters cell through receptor mediated endocytosisd convers to RB |
|
|
Reticular BOdy
|
Replicative chlamidya/pila
cause direct cell destruction and infilmmation splits via binary fission |
|
|
Clamydia/pila primary defense
|
PMN
|
|
|
Chlamydia Trachomatis CAP
|
atypical CAP
STD Mother to child 3-12wks post birth Stocatto cough, AFEBRILE, Eiosinophelia, bilateral conjunctivitis |
|
|
Chlamiydia Bilateral vs unilateral lung involvment
|
Bi- Chlamydia Pneumonia
uni- Chlam Trach |
|
|
Nuclear inclusions vs cytoplasmic inclusions
|
Adenovirus vs Chlamydia/pila
|
|
|
MIF assay
|
Chlamydia/pila test for IGM/IGG
IgM>16 or IgG> 512 |
|
|
Chlamydia Trachosoma DOC
|
Macrolides
|
|
|
3 zoonotic bacterial pneumonia
|
chalmydia psittaci
Francisella Tularensis Coxiella Burnetti |
|
|
Parrot Fever
|
Psittaci/Ornithosis
Heatache and Atypical pnemonia |
|
|
Chlamydophila Psittaci progression
|
spread to lung to RES- into macros- disseminates to the rest of the body.
causes chronic organ inflammation, focal necrosis, hemmorhage, cyanosis |
|
|
Cyanosis and hypoxia
|
Chlamydophila psittaci
atypical CAM organ damage |
|
|
Chlamydiopila Psittaci DOC
|
Doxycycline
|
|
|
Franciscella tularensis Transmission
|
low dose, inhalation, animals
|
|
|
Pnumonia Tularemia
|
Multiple necrotizing granulomas-x-ray patch
hilar lymph nodes enlargment, hematogenously spread |
|
|
Tularemia Morphology
|
G- coocobac
B lactamase Fastidious, facultative intracellular pathogen |
|
|
THis sucka aint got no flagella or PILI
CAP |
Tularensis
|
|
|
Reportable diseases
|
Tularemia
TB SARS Diptheria Coxiealla Burnetti |
|
|
Tularensis Dx
|
CXR
titer >160 Thayer Martin Agar- specialized |
|
|
Tularensis DOC
|
Streptomycin
|
|
|
Thayer Martin Agar
|
Tularensis
|
|
|
Tularensis Vaccine
|
available for high risk,
live attenuated decrease morbidity if not anything else |
|
|
where do you find Burnetti?
|
in alveolar macrophages
|
|
|
high fever, granulomas in liver
|
coxiella burnetti
|
|
|
Burnetti serology
|
Abs to phase II (IgG)>
Phase I (IgM) |
|
|
Small cell variangt
|
SCV Burnetti
infectous form resistant to environment |
|
|
Large cell variant
|
LCV vegetative form
infected cells obligate intracellular parasites In phagolysosome Coxiella Burnetti |
|
|
Cox Burnetti Phase I vs II
|
I- Wild Resists Homo, VIrulent
II- deletion mutant- HOMO- killed easily |
|
|
Cox Burnettin infection route
|
unpastuized milk, ticks, inhalation
|
|
|
milk/tick infection
|
Coxiella Burnetti
|
|
|
coxiella find IgA/G to phase I
|
Chronic
|
|
|
Coxiella find IgM to I and II
|
Acute
or just IgG to phase II |
|
|
Coxiella BUrnetti DOC
|
doxycycline
|
|
|
infection 72 hours post hospital
|
psuedomonas, Staph Aureus,
G- predominate |
|
|
Nosocomial Symptoms
|
Cough (productive) not always w/fever
|
|
|
Iatrogenic nosocomial Pneumonia
|
post pathogene on medical personnel, invasive procedure, antibiotic dump
|
|
|
Organizational Nosocomial pneumonia
|
nurses, contaminated air, water, staff, high pt/staff ratio
|
|
|
Nosocomial infection Tx
|
Tx for P aurugenosa
this covers all G- bacteria |
|
|
Contaminated Hot tubs/ contacts
|
P. Aureuginosa
HOW DO YOU SPELL THIS BEAST? |
|
|
common infection in Burn Pt/ CF
|
P. Areuginosa
|
|
|
Source of P. Aureuginosa motility
|
single flagella
|
|
|
Psudomonas Aurugenosa Virulence factors
|
Exotoxin A
Elastase Alginate Pillia LPS (DIC, sepsis) |
|
|
P. Aeruginosa Exotoxin A
|
inhibits EF2
|
|
|
LasA, LasB
|
P. Aeruginosa elastases
synnergistically increase elastolytic activity |
|
|
Algninate
|
P. Aeruginosa
SLime layer inhibits the mucociliary escalator |
|
|
P. Aeruginosa necrotizing pneumonia sx
|
Toxicity and cyanosis
Empyema |
|
|
Pseudomonas Aeruginosa Tx
|
Succeptibility test
4th gen ceph and fluoroquinalone |
|
|
Staphylocidal defect of PMN
|
chronic granulomatous disease, severe diabetic decompensation, presence of foreign body
Staph Aureus |
|
|
Can be ingested in food /droplets
|
Staph Aureus
|
|
|
Panton Valentin Luekocyidn
|
Staph Aureus
Leukocyte destruction and tissue necrossis associated with sever necrotic hemmorrageic pneumonia NOT NOSOCOMIAL |
|
|
TSS-T1
|
Staph Aurues toxin
|
|
|
S. Aureus toxins
|
Tss1,
enterotoxin PVL |
|
|
S. Aureus Virulence Factors
|
Capsule
Protein A CLumping Facotr Coagulase Staphylothrobin Hyaluronidase, Nuclease, Lipase Catalase Staphykinase |
|
|
S. Aureus survival Factor
|
Penicillinase
Blactamase |
|
|
What bac is Bhemolytic and positive everything plus yellow mannitol
|
S Aureus
|
|
|
Empyema
|
Ps. Aeruginosa,
S. Aureus |
|
|
MRSA Tx
VRSA? |
Linezolid
Trimethoprim/Sulfamethoxazole |
|
|
S. Aureus Protiein A
|
Bind FC component of IgG
interferes with compliment/activation |
|
|
A. Aureus Clumping factor
|
Bacterial aggreagaion
Fibrinogen to fibrin |
|
|
Staphylothrombin
|
S. Aureus
Clot maker fibrinogen to fibrin |
|
|
Staphylokinase
|
dissolves fibrin clot
S. Aureus |
|
|
Vanco is bad for?
|
S. Aureus
VRSA |
|
|
Staph Aureus Inhalation Pneumonia
|
CAP= post onset of flu
Local consolidation patchy multiple abcesses Tricuspid vegitation !! Miliary sub Q nodules |
|
|
S. Aureus Aspiration [pneumonia
|
Hospital Acquired via aspiration or intubation
|
|
|
Hematongeouns S. Aureus pneumonia
|
relase of infected thrombus from venous system
|
|
|
Pasteurization kills most
|
Mycobacteria
|
|
|
Mycobacteria infected adult vis child
|
adult- 2ndary, latent
child- 1ary, hematogenous if immunocompromised |
|
|
mycobacteria virulence factors
|
built on mycolic acid and mycocide
Sulfatides Cord Factor WaxD Wax D + COrd factor |
|
|
Mycolic acid
|
mycobacterium dehydration resistance
|
|
|
Mycocide
|
2 mycolic acids, 1 disaccharide
|
|
|
Cord factor
|
mycobacteria
MA-DS-MA sandwich parralel growth/cord of cells Only in virulent strains inhibits PMN migration Damages host mito INduces TNF and promotes Phag by macros |
|
|
Sulfatides
|
Myucosides that cord factor + sulfates (?)
inhibit phagolysosomes during intgracellular growht (keep them alive) |
|
|
Wax D
|
adjuvant
enhanves ab to form an ag activate CMI and delayed hypersensitivity rxn IV Mycobacteria |
|
|
Wax D+ Cord Factor
|
Granuloma FOrmation
jMycobacterium |
|
|
LAM
|
mycobateria virulence factor
interfere w/ mac activation by INFg Suppress T cell formation |
|
|
MTB 1ary infection
|
lower lobes
enter inactivated alveolar macrophages- disseminate |
|
|
GHON complex
|
Mycobacteria
Ghon focus and perihilar lymph node fibrotic/calcified granuloma evident 2-6wks post infection Type IV rxn |
|
|
MTB 2ary infection
|
Upper lobes
individuals with decreased immune system ncecrossis- liquifies- discharge TB baciili into bronchi- progresssive TB/Pneuonia |
|
|
Potts disease
|
MTB to vertebrae
|
|
|
Miliary TB
|
multiple small granulomas all over the body- loss of organ function
|
|
|
INduration
|
Mycobacteria
Fibrin deposition triggered by macros and monocytes |
|
|
micobacteria Tx
|
RIPES
Rifampin Isoniazid PZA Ethambatol Streptomycin |
|
|
Old TB vaccine
|
BCG < 3 leaves scar.
|
|
|
no glycocalyx, no necotizing enxyms, no exotoxins, no endotoxins
|
Mycobacterium
|
|
|
Contain Mycolic acid
|
Corynebacteria
Nocardia TB |
|
|
MAC
|
mycobacterium Avium Complex
|
|
|
MAC morph
|
saprophitic Acid fast ubiquitious
inhalation or ingestion |
|
|
Not killed by water tx with Cl_
|
MAC, legionella
|
|
|
DMAC
|
advanced aids
increased CD4 URQ pain, diarrhea Organs enlarge with dissemination |
|
|
MAC/DMAC immunocompromized vs compitent
|
compromized- 95% avium
compitent- cellulare 40% |
|
|
Lady Windemere disease
|
MAC superinfection b/ c suppressed cough.
Break down elastin formation of solitary pulmonary module |
|
|
MAC infection
|
REsp/GI colonization? infect resting macrophates, spread to submucosa to lymph nodes, lytmphadenitis in children
|
|
|
MAC DX
|
Id bacterium
+ if in sterile site CXR |
|
|
MAC TX
|
3 drugs
Clarithromycin, ethambutol, rifabutin |
|
|
DMAC TX
|
cd<50- Azithromycin
CD4>50- Clarithromycin |
|
|
Nocardia Asteroides morphology
|
G+ weak acid fast
AEROBIC catalase + Orange/white blob with aerial hyphea |
|
|
Nocardosis
|
pulm AND disseminated
pulmonary disease |
|
|
Nocardia greatest risk
|
T-cell deficiencies (leukemia and aids)
Chronic Pulm Diseases |
|
|
Bronchopulm infection spread
|
NOT from direct inhalation of droplets
from colonization and aspiration |
|
|
Cavitation in pleura
|
Asteroids and Klebsiella
|
|
|
Asteroids in immunocompromised individuals
|
can spreads to CNS or sub Q
|
|
|
Asteroids DOC
|
sulfonamides
6mo-1year |
|
|
Fever and thrombocytopenia
|
HPS aka HCPS
|
|
|
Hantavirus Morphology
|
Spherical, enveloped, surface glycoproteins
-ssRNA Segmented L (rna dep rna pol) M (Gn, Gc) S |
|
|
Hantavirus pathogenesis
|
Bind B3 integrin, incrase vegF, increase permeability, decrease platelet activity (thrombocytopenia)
Macrophages increase proinflammatory cytokines |
|
|
Beta1 vs Beta3 integrin binding
|
Hantavirus
1- nonvirulent 3- pahogenic |
|
|
How does hantavirus Evade the immune system?
|
Avoid RIG1 that activates the IFN and inflammation)
TLR sees it but no rxn |
|
|
Boxcar Spores and +ROD
|
Anthrax
|
|
|
Anthrax spore vs germ
|
spore= dec T,O2
germ= incT, CO2 |
|
|
Anthrax virulence factors
|
on plasmid
Edema toxin Lethal toxin Crazy Pleural Effusions |
|
|
Edemal Toxin
|
EF+ PA
|
|
|
Lethal Toxin
|
LF+PA
|
|
|
EF, LF, PA
|
EF- calmodulin dependent adenylate cylcase-> increase CAMP)
LF- zinc MMP cleaves MAPks -> disrupt signal PA- Protective antigen |
|
|
Anthrax Tx
|
Drain/support
Prevent- vaccinate high risk Ab and 3 dose vaccine |
|
|
Anthrax 3 phases
|
Incubation 1-2 wks
Initial Phase- mediastinal widening Subsequent phase- Dyspnea, stridor, cyanosis, death 24-36hrs |
|
|
Anthrax labs
|
gamma lysis
malachite green spore fluro Ab Test |
|
|
DL-17
|
Anthrax
important in mice? |
|
|
LT
|
Anthrax Cytotoxic?
|
|
|
Anthrax ID50
|
10000 spores
|
|
|
Anthrax human transmission
|
ANdes
|
|
|
G+
|
Anthrax
Dyptheria Staph Aureus Strep Pneumonea |
|
|
Strep Pneumoniae
Presumptive vs Confirmed |
optichin vs quellung rxn
|
|
|
has fimbriae
|
pertussis, H. Influenzae
|
|
|
king of CAP
|
Strep Pneumoniae
|
|
|
Penicillin Bad
|
Legionella b/c of B lactamases
|
|
|
Titer 128 vs 32
|
128- leggionalla
32- mycoplasma |
|
|
Hospital sink
|
Klebsiella
|
|
|
zinc
|
MMPs
Zycam |
|
|
Fried Egg
|
MycoPneumoniea with a little Zpepper
|
|
|
Chlamydida DOC
|
Pneumonia- DoxyMAc
Trach- MAC Psitticia- Doxy |
|
|
inhibit phagolysozome function
|
francisella tularensis,
legioneres disease |
