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40 Cards in this Set
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- Back
Histoplasmosis
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Bird/bat feces; demolition, construction, caves
Snowstorm CXR, coin-lesions, yeast in tissue Acute or chronic pulmonary (emphesema), disseminated w/ HIV/AIDS Ohio/Miss River Valley, opportunistic infxn Itraconazole, Amph B in tx failures |
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Blastomycosis
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Inhale microconidia, dogs & men w/ prostate infxn
Broad-based budding, serology T-cell response granulomas, acute pulmonary: weight loss, cavitations; pulmonary disseminated: bones, joints, prostate, CNS; chronic cutaneous A-antigen Large and inhibit phagocytosis Itraconazole, Amph B in tx failures |
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Coccidiomycosis
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Inhaled arthroconidia
Serology, Accuprobe, hazardous to culture Pulmonary infxn + erythema nodosum, tender nodules on anterior legs, joint pain Southwest US, Mexico Fluconazole, Amph B in tx failures |
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Candidiasis
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Inhalation, dirty hands
Culture invalid w/ catheter Superficial, oral, vaginal, invasive Normal flora Broad spectrum Abx, transplant, immunosuppressed Amph B, Fluconzaole (recent shift in pathogen distribution), Caspofungin/Micafungin |
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Cryptococcus
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Pigeon poop
India ink of CSF, latex agglutination, culture Pulmonary infxn, disseminated infxn includes meningitis, skin, osteomyelitis Encapsulated No mold form (monomorphic) Amph B + flucytosine; then Fluconazole; maintenance tx in HIV/AIDS pts |
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Pneumocystosis
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Diffuse perihilar infiltrates in CXR
Bronchioalveolar lavage No serology Alveolitis, pneumonia (PCP) – adheres to Type I pneumocytes No ergosterol can’t use normal antifungals Bactrim |
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Penicilliosis
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Mold w/ red pigment & brush shaped conidiophore
Fission yeast (no budding) SE Asia (Thailand) Bamboo rat Molluscum Contagiousum-like lesions on forehead/face and upper trunk Microscopy or Culture (dangerous) or serology Amph B; maintenance w/ fluconazole or itraconazole |
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Aspergillosis
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Mold infects lungs
Death rates in untreated high-risk = 80-90% Avoid contact w/ foods, flowers, plants + use HEPA filter Ubiquitous in evironment Neutropenia, GVHD, steroid use = major risk factor Becomes disseminated in immunocompromised brain, heart, kidney, liver CT: halo (early), air crescent (advanced) Acute angle branching Culture: commonly contaminated Antigen detection: galactomannan (cell wall) – false + w/ certain therapies Amph B, Voriconazole (new best tx) |
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Zygomycosis
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Sporadic
incidence w/ use of Voriconazole Ubiquitous in environment – common contaminant Inhalation, ingestion or traumatic implantation Rhinocerebral infxn (30-50% cases) – black discharge from nose (death w/in hours) Pulmonary infxn – GVHD, neutropenic cancer pts Cutaneous infxn – necrotizing fasciitis (must use aggressive surgical debridement + meds) IV drug abusers – cerebral infxn Broad, non-septate hyphae w/ wide angled branching High dose Amph B |
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Sporotrichosis
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Dimorphic: mycelia in environment (daisy clusters with dark center), yeast at 37˚ (cigar-shaped)
N America, African gold mines (splinters) Traumatic implantation – rose bushes, sphagnum mosses 75% lymphocutaneous w/ cording effect Fixed cutaneous mimics squamous cell carcinoma w/ pseudoepitheliomatous hyperplasia Extracutaneous: bones, joints, meningitis in rose gardners Tx: potassium iodide, Amph B, Itraconazole capsules |
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Chromoblatomycosis
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Chronic, indolent granulomas of feet/legs
Dimorphic black molds Sclerotic bodies (non-budding) = copper pennies Decaying wood, plants Traumatic implantation (men get it more due to their occupational exposures) Culture: gray mouse fur mold Surgical resection for early lesions; Itraconazole for advanced |
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Mycetoma
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Pseudallescheria boydii = soil saprophyte
Triad: tumefaction, granules, draining sinus tracts Does not spread to other organs Ascospores (sexual reproduction) Surgical resection for early lesions; Itraconazole for advanced Resistant to Amph B |
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Dermatophytosis
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Trichophyton tonsurans: black-dot ringworm, endothrix growth, hair breaks off at scalp
Microsporum canis: multiseptate macroconidia (canoe shaped), Woods lamp positive, ectothrix 4-6 y/o day care/school issue Communicable Keratinases determine pathogenicity 4 clinical signs: inflammation, active borders, pruritis, scaling, (alopecia in tinea capitis) Oral griseofulvin, itraconazole for tinea capitis |
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Tinea versicolor
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Malassezia spp
Meatball and Spaghetti Budding yeast Tan people have pale spots (hypopigmentation), pale people have dark spots (hyperpigmentation) Tend to occur on upper trunk/back Swimmers with lotions Tx w/ selenium sulfide lotion |
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Anthrax
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Bacillus anthracis: aerobic, gram positive bacillus
Skin innoculation or spore inhalation Virulence: protective antigen, lethal toxin, edema toxin, capsule NO person to person spread = no respiratory isolation needed Cutaneous: 20% untx pts die Pruritic papule + necrotic black eschar + ulceration Pulmonary: 80-90% untx pts die (1-42 days incubation) Nonproductive cough Hemorrhagic mediastinitis, pulmonary edema, septicemia, respiratory distress, shock, death Tx: cipro, doxycycline + 1 of 2 other antimicrobials for 60 days (75 for prophylaxis) |
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Plague
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Yersinia pestis: aerobic, gram negative bacillus
Resist intracellular killing spread to regional lymph nodes Virulence: F1 surface antigen Rodents, rat fleas 4 Corners, SoCal Bubonic: 2-8 day incubation Tender bubo, sudden onset chills, fever, headache No bubo = septicemic plague (25%) Pneumonic: 2-3 day incubation Cough + bloody sputum (productive cough) ARDS, DIC, shock, multiorgan failure Person to person spread = requires respiratory isolation Tx: Streptomycin or gentamycin, chloramphenicol for meningitis |
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Cryptosporiosis
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Oocyst ingested (chlorine resistant)
Contaminated water, swimming pools, food Summer outbreaks Watery diarrhea ~12 days (>7 days think parasite) AIDS: former defining illness, major weight loss, pre-HAART was never cleared Stool sample – acid fast stain, immunoflourescence, antigen detection 70% population seropositive No good tx Reduce risk: boiled/filtered water, limited exposure to animals, feces |
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Toxoplasmosis
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Oocyst infectious in humans, herbivores
Cats, undercooked meat Cysts maintained for life potential for reactivation AIDS defining illness w/ Toxo encephalitis causing lots of morbidity/mortality Transplacental infection: 1st trimester is worst: abortion, stillbirth, hydrocephalus Serology: new infection with both IgG (ever infected) & IgM (acute infxn) Bactrim |
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Giardiasis
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Flagellated protozoa
Ventral disc mediates attachment Cyst resistant to environmental degradation – ingested form Endemic in daycare Fecal contamination of water or food, person to person spread (fomites) Protracted diarrhea Malabsorption syndrome + lactose intolerance beyond duration of infxn Recurrent infxn common b/c trophozoites have highly variable surface antigens Stool exam: cysts in stool, trophozoites in diarrhea ELISA |
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Ascaris
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Helminth
Egg infective once larvae develop inside ingested release larvae into gut Larvae enter circulation liver lung coughed up and swallowed grow to adulthood in gut Eosinophilia Asthma-like complaints, pneumonitis Intestinal obstruction = medical emergency Stool exam: female worms release 200,000 eggs/day Serology: not useful Tx: Mebendazole, albendazole; target microtubules No immunity b/c antibodies only target the migrating larvae, adult worms too large |
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Visceral larva migrans
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Toxocara & Toxacaris (Ascarids of our pets)
Eggs hatch and migrate but don’t receive signals to grow to adults Granulomas Kids eat the eggs (PICA, just kids, dirty hands from pets) Hepatomegaly Extreme eosinophilia IgE Serology (stool worthless b/c the larvae are not excreted) Get puppies dewormed several times |
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Ocular larva migrans
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Granulomas
Misdiagnosed as retinoblastoma Can cause cataracts, retinal damage, blindness |
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Trichuris trichuria (whipworm)
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Egg develops on ground & once larvae develop inside it’s infective
No tissue migration period (it goes straight to the intestines) Survive 5-15 years Rectal prolapse (pathognomonic) Bone marrow suppression/anemia/anorexia due to TNF (major nutritional impairment) Stool exam: football shaped eggs Mebendazole, Albendazole |
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Human hookworm
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Ancylostoma or Necator
Cuticular teeth/plates anchor worms to small intestine Blood feeders anemia Eggs hatch on the ground larvae sense heat/CO2 penetrate skin Carried up respiratory tree coughed up and swallowed Cutaneous larval migrans erythematous rxn + pruritis (characteristic tracks on skin) Stool exam Mebendazole, Albendazole |
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Strongyloides stercoralis
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No parasitic male worms – females undergo parthogenesis
Larva penetrate skin (then go to lungs, cough and swallow, etc) Assoc w/ HTLV-1 IFN TH2 response SE Asia (US Veterans) Autoinfection: life-long infection (>20% mortality), w/ steroids Sxs: abdominal pain, diarrhea, urticaria, larval tracks Serology Ivermectin |
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Enterobius vermicularis (pinworm)
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Female lives in cecum, crawls out to perianal skin and lays eggs (mature in hours)
Daycare/Fomites Perianal dermatitis irritable behavior, bed-wetting Scotch tape test Mebendazole, Albendazole (give 2 doses 1 month apart) – treat entire cohort |
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Schistosoma mansoni
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Fluke/Trematode
Adult worms exist as pairs (male has a groove that the female lives in) S. japonicum: intestinal pathology S. haematobium: hematuria, bladder cancer in Africa Fresh water contamination Snails release cercaria stage vasculature liver retrograde migration to mesenteric veins Granulomas: TH2 driven, eosinophilia, chronic infxn usuallly downregulates size via IL-10/TGF- Hepatic Fibrosis (5%): absence of immune downregulation Schistosomal/Cercarial Dermatitis: swimmers itch w/ exposure to marine estuaries/birds Stool exam (Sm/Sj) or urine exam (Sh) HIV: accelerated by schistosoma, excretion of eggs = more in liver, control of granulomas |
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Taenia Saginata – tapeworm
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Undercooked beef
Invade capillaries & muscle – benign Cysticercus stage (head of scolex tape worm) consumed attaches to intestinal wall 10 meters long! Stool exam: proglottids (motile pumpkin seeds) |
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Taenia Solium – tapeworm
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Like T. saginata (above)
Pigs – undercooked measly pork Cysts in muscle Neurocysticercosis – inflammatory response to cysts in brain epilepsy Stool exam: proglottids Tx: corticosteroids (treat carriers); sanitations, condemn infected pork, pig vax in development |
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Echinococcus granulosis – tapeworm
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Shepherds: close contact with dogs (harbor adult worms)
Hyatidosis: cyst in liver filled with solices (lots of tapeworm heads) = hydatid sand Cyst rupture anaphylaxis PAIR: percutaneous aspiration, injection, reaspiration of cyst |
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Wuchereria bancrofiti – filiariasis
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Mosquito (larvae)
Female worm lives in lymphatics produces microfilaria that circulate in blood at night Lymphatic filariasis: leading cause of disability worldwide + risk of 2˚ infxn Urogenital disease: acute hydrocele after adult worm death in spermatic cord lymph Microfilaria downregulate immune response more of a TH2 response Tropical Pulmonary Eosinophilia Annual mass tx, salt Skin hygeine and exercise |
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Onchocerciasis
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Adult worms in subcutaneous nodules
Microfilaria migrate through skin Black Fly Ocular Damage (punctate ketatitis, sclerotization) & Retinal damage blindness Leopard skin: pruritis, severe itching, depigmentation Hanging groin: elasticity of skin Immunosuppression vaccine response Serology or skin scraping Ivermectin |
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Guinea worm
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Female worm causes an ulcer emerges & person puts their leg in freshwater uterus bursts
Copepods eat the larvae Unfiltered water No effective drugs, prevent 2˚ infxns Wind the worm out on a stick – don’t break it off or else |
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Trichenila spiralis
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Larvae in pig undercooked meat
Wild game: especially bear, cougar Larvae encyst in muscles (intracellular) Inflammatory response eosinophilia, IgE Periorbital edema Muscle biopsy or serology |
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Entameoba histolytica
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E. disbar is non-pathogenic twin
Virulence: Gal/GalNac Lectin mediates binding to intestinal mucins & inhibit complement 5 F’s: fingers, feces, food, fomites, flies Cyst: impervious to environmental insult Perforin homology RUQ pain, fever, anorexia, abscess (liver, skin, brain – liquefactive necrosis) Stool exam: ingested RBCs in trophozoites Serology + in 70% of invasive intestinal infxn, 95% extraintestinal infxn |
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Cyclospora
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Oocyst in stool
Importation of exotic foods Raspberries Bactrim |
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Trichomonas
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Flagellated
STD Frothy discharge in 50% women Low birth-weight babies Tx. Metronidazole (some resistance) |
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Leishmania
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Sand Fly – promastigote stage in fly’s gut causes it to regurgitate into human tissue
US troops in Middle East Dogs are urban reservoir Cutaneous: painful ulcer at inoculation site scar Mucocutaneous: progression from cutaneous, highly TH2 response, prob w/ 2˚ infxn Visceral: HIV related; spleen, liver, bone marrow anemia, pancytopenia, weight loss Serology Blocks superoxide dismutase production (Gp63) |
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Chaga’s Disase
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Trypanosoma cruzi
Kissing bug/Reduviid Raccoons & opossums in US Bug excretes infective stage onto skin auto-innoculation by scratching Chagoma: unilateral periorbital edema Cardiac: acute tachyarrhythmias & chronic dilated cardiomyopathy death Mega syndrome: myenteric plexus invasion dilation & stasis of esophagus & colon death Concern: transfusions & transplants US blood supply will be screened for trypomastigotes (2007) Probably not due to autoimmune response |
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African Sleeping Sickness
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Trypanosomiasis
Tsetse fly (salivary gland) Chancre dissemination into bloodstream lymphatics CNS Enlarged cervical lymph nodes (Winterbottom’s sign) 50% fatality w/o tx; 10-15% w/ tx Waves of parasitemia: constantly changing antigenic presentation Hypergammaglobulinemia Uses IFN- as a growth factor CDC has tx – toxic |