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138 Cards in this Set
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Most common agent of SKIN infections: Cellulitis, Oomphalitis (around umbilicus of newborn), Mastitis, Panniculitis (around abdomen), Folliculitis, Carbuncle (small nodule), Furuncle (hair in middle of carbuncle), Ballintitis (head of penis), Fasciatis (compartment syndrome)
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Staphylococcus AUREUS
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5 P's of Compartment syndrome and what's the most common agent?
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Pain (occurs 1st), Paloer, Poikilothermia, Paresthesia (tingling, pricking), Pulselessness (occurs last). MCC->Staph AUREUS
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What are the cases of STREP PYogeNES? (LINES)
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LYMphangitis(red streaks); ImpetiGO (if bullous->Staph aureus' elastase); Necrotising FASCitis that leads to compartment syndrome; ERYSepelas (raised edges, no blanching vs cellulitis); SCARLET fever (sand paper rash, strawberry tongue, rash on PALMS and SOLES)
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How did bacteria pick up nasty traits?
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TRANSDUCTION!
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What is mcc of shunt infections and central lines?
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STAPH epidermidis. Think "epidermis"- that's where it is abandant. Was there an invasive skin penetration?
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How does bleach work on ANAErobes?
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it introduces O2 to bacteria. Same principle with Oxy 10 for Propinibacterium Acne, a g+ ANAErobe
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Clues for ANERObes?
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Air/fluid levels
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What does ProPIOnibacterium Acne have affinity to?
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Progesterone (females>males; may be caused by birth control pills; acne 2 weeks prior to menses due to increase in progesterone; more common in pregnancy) and Propionic acid in sebaceous glands
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What kind of bugs does clindamycin treat?
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ANAErobes
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How do we treat Acne?
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expose to oxygen (Oxy 10, abrasive pads); Clindamycin (anti anaerobe), Erythromycin (macrolide), Minocycline (broad spectrum tetracycline); BIG GUNS: Retin-A previtamin A that stimulates skin to grow, thuc pushing bacteria to exposure SE: photosensitivity, hyperlipidemia b/c absorbed in the ileum, fat soluble->teratogenic!
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Strep PYOGENES- has no capsule resides in the back of the throat. MCC of what?
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RheuMATIC FEveR.
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What are the Jones criteria? What dz do they help diagnose and what bug causes that dz?
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JONES criteria. RHEUmatic FEveR. Subcu nodules; POLY-ARTH-RITIS; Erythema MARGINATUS (superficial lesions with clear margins; Chorea (Syderham); CARDI-TIS (as bug is aspirated from back of throat it gets into lung, then from the lung affects mitral valve-> '"fish mouth appearance" in mitraL steNosis
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What other serious condition besides RF may Strep PYOGENES cause?
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GlomeruloNEPHRITIS. Strain 12 of the bug
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What is the #1 way to paralyze cilia and what can it lead to?
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VIRUS! Cilia don't sweep up and out->infection sets in.
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What are the bugs that have an IgA PROTEASE that fights IgA?
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StreP PNEUMOnia, H.inFLUenza, Neisseria (catarrhalis, meningitis, gonorrhea)
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What facultative anaerobes populate GUMS?
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Peptostreptococcus; Peptococcus; Fusobacterium (fused at the edges and tapered at the ends)->Vincent Angina (painful ulcers in the back of throat) and Trench mouth (oozing from the gums)
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If you see Sulfur granules and Fistula tracts, what is the pathogen?
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Actinomyces- facultative anaerobes
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MCC of bacterial endocarditis?
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Strep VIRIDANS
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Pathogen that is responsible for dental caries (ferments glu and produces lactic acid-> bad teeth)
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Strep MUTANS
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What UREASE + organism is DUODENAL gastritis associated with?
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H.pylori. Dx: breath test. Triple or quadruple therapy. PPI and H2 blockers. Abics- Amox, Tetracycline/Metronidazole. Bismuth-suffocates the bug
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If E. coli produces vit K (co-factor for clotting factors 10, 9, 7, 2 (1972), protein C&S->measure PT (this is why broad spectrum drugs can cause bleeding), where would it make sense for the bug to mostly be?
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Small intestine where it also makes Folate(B9)-repair, synthesize, methilate DNA, Biotin(B7), Panthotenic acid (B5)-metabolism and synthesis of carbohydrates, proteins, and fats; helps absorb B12 in ileum
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What are the Big Mama ANAErobes? How do we treat them?
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Clostridium melanogosepticum, STREP boVis, Bacteroides fragilis. Tx with CLINDAmycin, ceFOXitin, METROnidazole
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Proteus and Klebsiella
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respectively: P-2nd in line for UTI vs K-3rd in line for UTI, mc in alcoholics and homeless, "current jelly sputum, likes FISSURES of the LUNGS->pneumoniae
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What's the bug associated with holiday ham?
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Clostridium perfringens
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3 main causes of sepsis in a newborn?
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GBS, E.coli and Lysteria. Find in rectum of mother
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cocci in clusters with gold pigment
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Staph AUREUS
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what does CATALASE do? what does B-lactamase do? Lipase? Elastase? Collagenase?
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catalase- breaks down Hydrogen peroxide. Beta lactamase- beta lactam drugs. Lipase- breaks down fat, thus folliculitis, panniculitis, mastitis. Elastase- bullous emphysema. Collagenase- skin and bones (Osteomyolitis- Salmonella is 2nd MCC), Type II (connective tissue)- fasciatis, Septic Arthritis (Gonorrhea #2) and folliculitis, Type III (endothelium)- vasculitis in arteries, Type IV (basement membrane)-Scalded Skin, Kidney, Lung
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MCC of acute endocarditis and death for burn unit pnts in the FIRST week?
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Staph aureus
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Toxins of Staph AUREUS
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EXFOLiatin->Staph Scalded Skin Syndrome (Nikolsky sign, sloughing off); Lecithinase->subcu fat infections; Erythrodermic toxin-> just like Strep pyogenese for Scarlet Fever.
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Triad of Toxic Shock Syndrome
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High Fever, Hypotension, Bright red rach over body, palms and soles. Often associated with menses (retained tampon in vagina) Menses?->Click and move! Enterotoxin- custard pie
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Tnx of Staph infections
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1st Generation Cephalosporins (Cefazolin · Cephalexin · Cephapirin · Cephradine.) Vancomycin- best but $$$. Also macrolides (azythromycin, erythromycin), quinolones (floxacins) and Chloramphenicol (broad spectrum like tetracyclins)
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Which Staph has a white pigment? Which one without a pigment?
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Both CATALASE +.... Staph epidermidis-white. Saprophyticus- none (frequent in UTIs: 5-10 yo-playing with themselves, and 18-24 yo-sex with uncircumcised penis)
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Types of hemolysis for cocci in CHAINS - STREP!!!
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beta "best" clear- complete hemolysis (by Streptokinase-the clot buster, but use tPA if pnt recently recovered from Strep b/c now pnt has antibodies to streptokinase and the procedure won't work!); alpha "almost" green hemolysis; gamma "none" red hemolysis
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Group A: Strep pyogenes-> GAS
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GAS is beta-hemolytic. #1 throat infection-> only GAS causes RHEUMATIC Fever
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Group B: Strep agalactiae-> GBS
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GBS is beta hemolytic (similar to GAS, but unlike Strep pneumo->alfa); #1 Cause of Neonatal sepsis
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Which Strep is alfa-hemolytic (green pigment)? What can it cause? Who is in danger?
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Strep pneumo (Pneumococcus). Post Strep Glomerulonephritis PSGN Strain 12. Encapsulated-> danger to aspleenic, SC, CF and DM. Give immunizations to >65yo and SC who are >2yo
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Group D! Strep viridians (mutans, saguis, salivarius) Alfa-hemolytic (green pigment) #1 cause of SBE-subacute bacterial endocarditis
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septic emboli to brain->MYCOTIC aneurysm; ROTH spots->emboli to retina; Oslers nodes->emboli to palms&soles, fingers&toes-painful; splinter hemorrhages->nail bed; Janeway lesions->septic emboli to toes-painless
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Treatment of SBE
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Amoxicillin 3g 2 hrs before surgery and 1.5g 6 hrs after the surgery
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What bug is gamma-hemolytic (red pigment) in NITRITE negative UTI? Treatment?
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ENTEROCOCCUS (Faecalis, Faeceum) Rx: Vanc
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Vancomycin. MOA. Bugs to fight?
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Cell wall inhibitor that inhibits a phospholipid carrier. Irreversible -non competitive! MRSA, Strep epidermidis, Enterococcus; SE ototoxic, nephrotosic, Red Man syndrome- not an allergic rxn, but histamine release.
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Causes of Meningitis
*0-2mo *2mo-10yrs *10-21yrs *21yrs-up |
GBS, E.coli, Lysteria;
Strep pneumo, Neisseria; Neisseria; Strep pneumo; |
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Bugs with preformed toxins?
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Bacillus anthrax, Bacillus cerius, Staph aureus
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Why do spores cause such bad rxn on our body?
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Composed of Ca2+ dicholinate,they have a poly D-glutamate membrane (D-amino acids), while we have L-amino acids. They hate heat-> STERILIZE!
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Two types of Bacilli and what's their deal?
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ANTHRAX (Skin->malignant pustule and Pulmonary->"Woolsorters Dz" lung necrosis, i.e. drown in own blood, fav of germ warfare) and CEREUS (toxin preformed and symptoms are seen 8 hrs after ingestion)
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Name B. anthrax toxin's factors
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EDEMA Factor
Protector Factor Lethal Factor (if you hear any of these in the stem->click and move) |
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What strict ANAErobe causes gas gangrene (Dry and Wet)?
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Clostridium PERFRINGENS
Dry- necrotic skin; Wet-as bld rushes to necrotic areas it'll introduce emboli into circulation which are likely to lodge in the R ventricle->put pnt on L side and tap on the right side to prevent Gas Embolus. Immediate amputation; Gastroenteritis (holiday ham/turkey) when reheated->immediate diarrhea! |
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Treatment of C.Diff
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stop antibiotics that have been given. Then introduce new abx: Metronidazole(MOA-promotes prodcnt of free radicals; SE:dysguzia, disulfiram rxn, contraindicated in G6PD pnts) and Vancomycin
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What is associated with Dirty wounds? and MOA of its toxin (similar to Strychnine)
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C. tetani. Inject anti-immunoglobulin right into the wound. Toxin inhibits GLYCINE (inhibitory fnx in spinal cord), which will disinhibit contractions, thus respiratory failure possible). Lock Jaw and Risus Sardonicus(abn sustained spasm of facial muscles)
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MOA of C. BOTULINUM->Botulism (dark caramel syrups, honey/molasses<- preformed toxin vs ingested spores)
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Toxin inhibits presynaptic release of Ach->flaccid paralysis (floppy baby)->diaphragm won't work->respiratory failure(can't breath in, restrictive profile of labs). Give ANTI-toxin first, then abx
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A curved rod that is gram + (Tnx with Vanc)
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Listeria MONOcytogenes (monocytosis!) curved like Vibrio, Campilobacter and H.pylori. T-cells and MONOCYTES will be involved->GRANULOMA! Gastroenteritis in adults (migrant workers): cabbage, spoiled milk, hot dogs
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MCC of Epiglotitis?
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Hib (Nemophilus Influenza type B, i.e. ENCAPSULATED, which makes it pathogenic, while 80%-other types are not) Gram -
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PAINFUL genital lesions. What are the agents?
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Hemophilus DUCREYI->Cahncroid, ulceration w/central necrosis(black scar in the middle); Herpes (HSV7); LGV lymphogranuloma venerum -dz of lymphatics by Chlamydia trachomatis; Granuloma inguinale- ulcern in inguinal area by Calymmatobacterium granulomatis-Donovan bodies seen. Very rare in teh US.
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What is the largest encapsulated bacteria (requires MAC complex to fight it) that releases toxin without dying at the same time?
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Neisseria MENINGITIDES
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Gram neg diplococci that have more endotoxin than anyone else. MOA of Lipid A endotoxin. What is the prophylaxis for close contact?
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Early vasculitis-> Purpura(palpable), Petechiae (dots) and Ecchymoses(bruise like). Think DIC;
DIC may cause adrenal hemorrhage->Waterhouse-Fredriechson SYNDROME! (low Na/high K =electrolite imbalance->tnx w/PREDNISONE or CORTISOL) RIFAMPIN for close contacts. |
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MCC of STD that is 90% asymptomatic? Symptomatic?
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Chlamydia (an intracellular parasite) vs Gonorrhea "the drips" (in women +perihepatitis Fits-Hugh-Curtis SYNDROME->fallopian tube affected and pus drops next to liver)
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What allows N. gonorrhea be disseminated? Tenosynovitis?
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Pilli->"walks up the epithelium into the bladder and blood stream." N.gonorrhea loves to attack the tendons and ligaments->joints of wrists and ankles.
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Treatment of N.gonorrhea (must also treat for Chlamydia at the same time-Azythromycin 1g x1)
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ceTRIaxone 250 mg IMx1
ceFIXeme 400 mg IMx1 ceFOXatin 250 IMx1 and quinolones |
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Neisseria is Catalase + and contains IgA, i.e. survives on mucous membrane. What's the implication?
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N. "cattar"alis ("mucous") trasmitted with oral sex
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MCC of UTI in all ages? MCC of Traveler's diarrhea?
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E.coli. Also all SM.intestine problems: iliocystitis, ascending cholangitis (alk phosph is elevated), appndx, etc
Traveler's diarrhea- EIEC (enteroinvasive e.coli) |
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What kind of bug is similar to Vibrio cholera as ADP ribosylates Gs->turns ON, ON->up cAMP
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ETEC (enterotoxigenic e.coli)
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What type of e.coli likes medium size arteries in GI/Renal->epidemic HUS?
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0157:H7- lives in cow's anus. Raw hamburger-mcc
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UTI infections in likelihood of etiologic agents
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1.E.coli
2.Proteus mirabilis (+struvite stones) Rx->Norfloxacin 3.Klebsiella (currant jelly, fissures of lungs) |
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Gram neg that attack immunocompromised:
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Serratia MASCECENTS (+mltiple cerebral ABSCESS);
Pseaudomonas AERUGINOSA (same enzymes as Staph->green pigment->same populations affected: CF, DM, Burn pnt, Neutropenic). If Staph- tnx 1 abx, if Pseudomonas-2 abx |
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Pseudomonas becomes a MCC. QUINOLONES (Cipro-FLOXACIN) take care of Pseudomonas and Staph together.
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Malignant otitis externa- NOT swimmers ear. This one can kill quickly. Very tender ear if pulled on exam. Hospitalize->ICU->IV abx.
Burn pnts on 2nd week of hospital stay; Whirlpool FOLLICULITIS-butt crack:) and soles of feet meet water first->infection |
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House of "ella". What are the bugs? Gram neg that like to get into the cell. Cause granulomatous change (with T-cells and Macrophages)
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BordatELLA pertussis=Whooping cough (NO ENDOtoxin, YES EXOtoxin; ADP ribosilates Gi->turns OFF, OFF->Gs remains ON; prodromal catarrhal and paroxysmal stages) DTaP vaccine available. Rx: ERYTHROmycin (macrolides) CBC: WBCs up->lymphocytosis)
BrucELLA: spiking undulating FEVER for 7days. Risk: veterinarian (placenta of an aborted animal) PasturELLA multocida: dog/cat bites. Bug in the saliva. Rx: AMOXicillin ShigELLA: GI dysentery-day care. Naurotoxin causes seizures. SalmonELLA: encapsulated. Hides in anus of chickens. Do NOT treat->or it'll hide in gallbladder->carrier state. Thus treatment=public health risk. S.sonnei-mc in America, S.dysentery-mc worldwide, S.typhi=Typhoid fever (triad: high fever, heart block, rose spots)=intestines are on fire. Rx CIPROfloxacin FrancisELLA: fever, red eye, swollen glands. Rx: Streptomycin BartonELLA hensleae: swollen lymph nodes, Silver stain in the lymph nodes |
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5 buggs/diseases that can cause heart block
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1.SalmonELLA-Typhoid fever
2.Lyme dz- borrelia burgd. 3.-Legionella 4.Diphtheria-cornibacterium diphtherriae, rare in the US 5.Chagas |
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Rice water diarrhea by a gram negative bug. Etiology and mechanism
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VIBRIO CHOLERA: similar to ETEC (enterotoxigenic E.coli)->turns On, ON by ribosylating Gs
Other vibrio bugs: Vibrio PARAHEMOLYTICUS - raw fish (sushi) Vibrio VUNIFICUS- oyeters |
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What is the bug that mimics an acute appendicitis but in actuality causes acute ileitis?
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Yersinia entercolitica
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What bugs/conditions are associated with Reiter's syndrome-can't see, can't pee, can't climb the tree- in post infectious arthritis?
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Yersinia entercolitica
ShigELLA Chlamydia Inflammatory Bowel Disease -IBD |
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Where do we see HLA 27?
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Ankylosing spondylitis-fusion of lumbar spine in middle aged men. Death from aortic dilation)
Reite'r Syndrome Psoriasis (oval silvery plaques on extensor surfaces, usu on back of forearm, relates to rapidly dividing cells and possible uric acid stones) |
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Comma shaped bugs
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Vibrio cholera
H.pylori Campylobacter Lysteria |
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What are ATYPICAL bugs (not real bacteria)? Why are they called so and what treatment is necessary?
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MTB
Chlamydia Ureaplasma Mycoplasma pneumoniae Legionella Treat with Macrolides, Quinolones and Tetracycline. PNC won't work because there is no cell WALL! |
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MCC of infertility in women, ectopic pregnancy, pelvic inflammatory disease, cervicitis. #1 cause of neonatal blindness (vs congenital blindness-CMV).
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Chlamydia. Treated with ERYTHROmycin ointment, AZYTHROmycin 1gm.
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Staccato coughing? What's the bug?
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Chlamydia. Atypical pneumonia. common in 0-2mo old child. INTERSTITIAL pneumonia. Non-productive cough. Xray-ground glass appearance, reticulonodular. Since we are dealing with a parasite->eosinophila (no other atypicals have that feature)->blood smear shows Tcells and Macrophages. Also see in Alzheimer's-neurofibrillary tangles in hippocampus and CAD (coronary artery dz)-in atherosclerotic plaque.
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What is a urease positive and atypical bug?
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Urease pos- Pseudomonas, cryptococcus, proteus, H.pylori and ureaplasma. And atypical->UREAPLASMA, an agent of non-gonococcal urethritis
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CXR finding in an ATYPICAL pneumonia
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ground glass appearance, reticulonodular pattern, interstitial pattern
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Walking pneumonia- Mycoplasma. Ages 10-30.
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MYCOLIC acid in membrane- not a true bacteria. As it spends too much time in blood our body is forced to make Ab to it-> CRYOGLOBULINemia=cold agglutinins (IgM) (detect by using Strep Salivarius Ag, i.e. that Ag=cold aglutinins IgM)
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MCC of atypical pneumonia after 40 years of age?
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Legionella pneumophila. Loves standing water in heating and AC ducts- tall buildings. Legionnair's dz=full blown pnemonia. CHARCOAL yeast agar extract to culture the bug. +Heart block.
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MTB -Mycobacterium Tuberculosis. Atypical bacteria due to what feature?
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MYCOLIC acid with peptidoglycan wall. Rx INH (inhibits peptidoglycan wall)SE: pulls B6 (used by transaminases), inhibits P450 (like Macrolides and quinolines), hepatitis, myocitis, Drug induced lupus
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First thought when Na is down and K is up= disbalance on CBC?
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Adrenal failure
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Mobilizing T cells and Mapha's around a specific site. What's your thought?
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a granuloma formation
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Positive PPD test (if come in contact with someone who has TB->10% risk of contracting and developing it. After 1 year of INH prophylaxis ->1% risk)
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15 mm induration with no risk factors
10 mm - health care workers, 3rd world countries, overcrowding, institutional facilities 5 mm- AIDS patients |
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Positive PPD with Sx and without Sx. What to do?
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Sx->treat. No Sx-> CXR. Treatments 4 rx (INH, Rifampin, Ethambutal, Pyrizinamide) for 4 mo. Then continue INH and Rifampin for the rest of the year.
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What is one of the mc bug if CD4<100?
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Mycobacterium AVIUM Intracellulare
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Триппер=Сифилис. Painless CHANCRE. Treponema Pallidum. Spiral shaped, flipping motility. What are the rules of 6?
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Classic painless chancre disappears in 6 wks. 6 wks later a rash will develop involving the palms and soles (like Scarlet fever or TSS). Neuropathy will appear 6 years later-> neurosyphylis
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Dorsal columns are attacked by this bug->tabes dorsalis, wide gate
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Spirochetes (Treponema Pallidum of Syphilis)
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Edinger-Westphal nucleus attaked. What is obvious?
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Reactive vision in Syphilis (Treponema Pallidum spirochete) (coordination b/w CN III-IV) Accomodates but not reacts. Argyll-Robertson pupil. Test:dark field microscopy (most specific). Blood test: FTA-ABS (IgM antibody test->IgM will bind if it is present)
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TORCH in neonatal infections
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Toxoplasmosis->multiple ring enhanced lesions in the PARIETAL lobe (cat exposure). Other. Rubella->cataracts, hearing loss, autism, :blueberry muffin" rash, PDA. CMV->Central calcifications, #1 cause of CONGENITAL blindness. Herpes->TEMPORAL lobe ENCEPHALITIS.
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Screening for Syphilis: VDRL and RPR.
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Both tests are sensitive but not specific (unlike FTA-ABS and Dark field microscopy).
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Treatment of Syphilis
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1'- penicillin (procaine) 1.2 mln x1
2'-penicillin 2.4 mln x1->each buttock 3'-penicillin 2.4 mln 1/wk for 3 wks |
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Proximal aorta ONLY with obliterative arteritis - tree bark appearance of blood vessels
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Syphilitic aortitis
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Lyme disease. Etiologic agent and treatment.
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Borrelia burgdorferi by Ixodes tick. Rx Penicillin and Tetracyclin.Switch from IgM to IgG at 2 months.
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Weils dz in a sewage worker
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Leptospirosis Interogens. Attacks liver and kidney (in rat urine). Treat with Penicillin.
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Sulfa drugs MOA? Cover Gram + except for Staph AUREUS. Simple gram - (E.coli, H.infuenza)
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inhibit FOLATE SE: Megaloblastic anemia (also photosensitivity, allergic rxn, G6PD incompatibility, hemolytic anemia, interstitial nephritis)
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Anti-FUNGAL agents MOA (Nystatin, Tinactin, Micatin, Myconazole)
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Bind ERGOSTEROL, make hole in membrane and cells swell up and die.
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Amphoteracin-B MOA
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Also binds to ergosterol, but often "mistakenly" goes after cholesterol. SE: HYPERkalemia (if systemic toxicity), HYPOkalemia (if renal toxicity- losing K) and Renal failure.
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Which antifungal xBBB (crosses BldBrainBarrier)?
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Fluconazole. 1 dose PO treats candidiasis (Diflucan)
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An antifungal GRISEOFULVIN MOA
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fat soluble drug that inhibits microtubules= (-)Mitosis
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Cutaneous fungus that is common on the back, in the shape of an upside down x-mass tree. Likes pigment. Common in black and Hispanics- see pigment changes. Treatment?
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Tinea Versicolor. Rx: Griseofulvin (best for capitis and versicolor) or Selsin blue.
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SYSTEMIC fungi?
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Candidiasis, Histo (pigeons/bats, lives w/in Macrophages), Blasto (Pigeons, borad based buds->cavitary lesions) Coccidio (SouthWest- dry), Apergillus (Moldy hay/basement, fungus ball), Cryptococcus (AIDS pnts w/HA and meningitis, stains w/Indian ink), Rhizo/Mucor (Diabetic w/smth growing out of nostrils), Sporothrix (rose bush)
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Systemic fungi that can cause Bad vasculitis (invades blood vessels) eg. Churg-Strauss<-necrotising vasculitis or idiopathic
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Aspergillus (mimics asthma due to fibers-> PIE=pulmonary infiltrate with eosinophilia)
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A cause of a nitrite NEGATIVE UTI?
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Enterococcus
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Liver FLUKES affecting barefoot wanderers/swimmers who venture where the snails carrying this fluke are
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SCHISTOSOMIASIS Mansoni->liver, up to liver CA; S. Hematobium->bladder CA
Tnx for liver flukes- PRAZIQUANTEL |
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What FLUKE is it likely to be if alk phosph is elevated (Biliary tract affected/gallbladder)
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Clinorchis SINENSIS/OPTHorchis. Tnx for liver flukes- PRAZIQUANTEL
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Hook worm that "hooks" into rectum and causes tenesmus (feel like need to poop) and prolapse. Tnx?
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Trichuris TRICHURUM- Whip worm
All hook worms: NEAT ASs (Necator, Enterobium, Ancylostoma duodenale, Trich Trichura, Ascaris lumbricoides, Strongyloides) Rx: MEBENDAZOLE (paralyzes microtubules) |
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What's a pin worm? Tnx general and specific?
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ENterobius Vermicularis. Mebendazole, but Pyrantel Pamaoate is more specific. Thiobendazole-tnx for Strongyloides.
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Parasites associated with Loeffler's Syndrome (part of the life cycle occurs in heart and lungs)
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NASA: Necator americanus
Anchylostoma duodenale Schistomiasis Strongyloides Ascaris lumbricoides Pulmonary infiltrates and severe eosinophilia. Loeffler's Syndrome=endocarditis and pneumonitis |
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Flat worms- will curl around the intestine. Name them. Tnx?
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D.Latum-like B12; Taenia solium->larvae from Cysticercus (humans-intermediate hosts), likes to swimin aqueous humor of eye; Taenia Saginatum-w/raw beef; Trichinella Spiralis-raw bear meat->tunnels in muscle->myositis.
Rx: Hyclosamine and Niclosamine (Nicle-hycle that inhibit oxidative phospharylation=ATP plummets down) |
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Protozoa of Brain
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Naeglaria FOWLERI- swimming in still water->penetrates thru cribriform plate->fulminant meningo encephalitis;
Toxoplasmosis-cat little, PARIETAL lobe enhanced lesions Rx:Pyremethamine/Sulfadiazine; Trypanosoma Rhodienese->tse-tse fly GABA connection, African sleeping sickness |
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Protozoa of Cornea
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Acanthomoeba-contact lenses, will eat thru cornea;
Erlichiosis-dog licking face, "puncture" wound next to eye |
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Protozoa of Heart
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Trypanasoma Cruzi: CHAGAS dz. Eats ganglia and causes heart block. ReDUUVID bug-SOUTH America
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Protozoa of Lung
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Pneumocystis Carinii. CD4<200; Silver stains (along with Legionella) Tnx: BACTRIM (SMX-TMP)
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Protozoa of GI
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Giardia->gastroenteritis. Fresh well water. Hiking in mountains. Rx: METRONIDAZOLE;
Entamoeba Histolytica-multiple liver abscess. NEVER do surgery. METRONIDAZOLE 8wks; Microsporidium-mcc of diarrhea in AIDS. Cryptosporidium-very watery diarrhea Rx CYPROfloxacin (2nd gen fluoroquinolone) |
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Protozoa of GU
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Trichomonas: #3 mcc of Vaginitis, frothy green discharge. Rx Metronidazole 2gx1. Treat the partner too (#1-CANDIDA-white cheesy curdy discharge; #2-GARDNERELLA-fishy odor, clue cells)
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Protozoa of Skin
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Leschmaniasis- by sand flies. L.Donavini-skin and nostrils; L.Rhodiensis aka Kala-Azar. likes to be systemic (in bld)->attacks organs.
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Protozoa of Lymphatics
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Wucheria Bacrofti->elephantitis. No treatment
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Protozoa of Blood
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Babesiosis-just like malaria but on the East Coast (carried by Ixodes tick, just like Lyme dz) Rx anti-malarial
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Protozoa of Blood (other than Babesiosis) Prophylaxis: 2wks before go, all the time while gone, 4 wks after returned.
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Plasmidium:
Malaria-mc strain worldwide. Fever q3rd day i.e.QUARTIAN. TERTIAN, i.e. fever every other day-the rest of strains: FFFalciparum-most FFFatal, hemolysis mature RBC Vivax-likes reticulocytes (young RBCs) Ovale-likes mature RBCs. Goes to LIVER |
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Treatment for Palsmodium (malaria, vivax, falciparum, ovale)
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PRIMAQUINE-best liver penetration-give for vivax and ovale. Chloraquine-mostly RBCs. Quinine. Mefloquine oxidizes RBC membrane->hemolytic anemia esp in G6PD
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Purpura, Ecchymosis, Petechia. Bld test shows high platelets, eosinophilia, hypochromic anemia. What parasite?
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Rickettsia. Likes to invade bld vessels -> vasculitis-> bleed or clot.
RMSF Tick (deer) rash on palms and soles. Centripital=from periphery to torso). R.Typhi-ENdemic, flea. R.Prowzekii-EPidemic, lice- rach from axilla going outwards. |
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Viruses. General Characteristics in behavior: Invasion (by contact 90%)
Adhesion (tropism to certain cells) Penetration (via ENDOCYTOSIS, only HIV injects RNA) Uncoating (Rx at this stage most effective) Replication Assembly Lysogeny |
AAAAmantidine for Infuenza AAAAA. Inhibits uncoating of the virus. SE: affects Rapidly dividing cells. Rimantidine for PROPHYLAXIS.
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What antiviral is also used in Parkinson's. MOA?
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AAAmantadine (anti Influenza AAAA). PRomotes release of Dopamine (DA)
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MC location for VZV (Herpes Zoster)?
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Opthalmic division of V1 and T4 level of the nipple. If pnt is >40yo, must do ELISA for HIV/CA.
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When to perform ELISA vs PCR, Southern/Northern Blots?
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While at Invasion and Adhesion stages- ELISA works! After Adhesion and Invasion virus is hidden -Eclipse, and ca no longer be detected by ELISA, but PCR and the Blots: Penetration, Uncoating, Replication. Viremic and symptomatic (pnt deteriorates) at Assembly and Lysogeny.
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MC viral agents of encephalitis-Bad HA and Ataxia?
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#1 is Togavirus- ends in "equine", the more "e's", the more lethal. Mosquito carrier. Self limiting. Will go away.
#2 is HSV Temporal lobe=hemorrhagic |
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What is elevated in viral and fungal meningitis? MCC of aseptic meningitis with diarrhea?
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lymphosytes and monocytes (not neutrophils!) Sugar is normal
ENTEROVIRUS! no diarrhea->Adult-Adenovirus. Kid-Rotavirus. |
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Common cold->sinusitis, otitis, bronchitis, pneumonia
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Rhinovirus- only sniffles. If more symptoms (like sore throat, cough)->Corona-summer/spring or Adeno-fall/winter (cryoglobulinemia)!
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Mumps and complications in males and females
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affects parotids (swell in front of ear)
Oophoritis (females), Orchitis (males), Pancreatitis-both |
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Rubeola->MEASLES
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Koplic spots-buccal mucosa 1 day before rash.
3C's cough, corrhiza (thick nasal discharge), conjunctivitis Rash- MORBILLIFORM i.e. blotchy Complications: otitis media and pneumonia. May progress to rapid demyelinating dz=Subacute Sclerosing PanEncephalitis SSPE (kid w/HA who can't walk)-rare |
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Rubella=German Measles
1st trimester (must abort-90% deformed) Cataracts, Deafness, Autism, Blueberry muffin rash, PDA due to immturity |
No 3C's. Swollen lymphnodes behind ears and neck (postauricular and occipital)
Multinucleated giant cells with eosinophilic cytoplasmic and nuclear inclusions |
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VariCella=Chicken pox
Most infectious 2 days b4 rash breaks out and 3 days after it has broken out. |
lesions come in 4 waves: red macules-dots, clear vesicle-dome, pustule, scab->no longer infectious (7days to scar over).
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#1 cause of aplastic anemia
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5th Disease (Parvovirus B19) Erythema infectiousum- slapped cheek dz.
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only illness where rash comes 24 hrs after the fever subsides!
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RoseOL-LA-LA (no complications or treatment) Exanthem subitum (Subito piano)
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Pityriasis Rosea HSV VII
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mimics Excema. Herald patch, Xmas tree pattern. Circular dry patches all over the skin. Self limiting.
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Fleshy colored papules with central umbilicus that can be sexually transmitted
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Molluscum contagiosum (Poxvirus)
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Hand, Foot and Mouth (HFM) dz
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little red dots on palms and soles. Painful- kid won't drink or breastfeed. Dehydration is a common complication
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Mucocutaneous lymph node dz-Kawasaki.
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Strawberyr tongue (only other one is Scarlet Fever), RED lips, RED eyes, RED rash on palms and soles (peeling). Swollen lymph nodes-cervical chain. FEVER 102' for 3-5 days.
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What is the biggest complication with Kawasaki?
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Coronary aneurysm within 6 mo. So, do ECHO q month for 6mo and every 6-12 mo after that. Tnx: IgG immediately->block antibodies to decrease coronary aneurysm.
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