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176 Cards in this Set
- Front
- Back
p24 protein
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HIV capsid protein
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What type of genome does HIV have?
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diploid genome (2 molecules of RNA)
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GP41 and GP120
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envelope proteins of HIV
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What does reverse transcriptase do?
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synthesizes dsDNA from RNA, dsDNA integrates into host genome
seen in HIV |
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What does the HIV virus bind to ?
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CXCR4 and CD4 on T cells; binds CCR5 and CD4 on macrophages
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homogenous CCR5 for HIV means what? What does heterozygous mean?
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Homozygous CCR5 mutation = immunity
Heterozygous CCR5 mutation = slower course |
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How to diagnose HIV?
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ELISA used first (high sensitivity, but lots of false positives and low threshold) if positive then use Western blot assay (specific, high false negative rate and high threshold)
ELISA/Western blot - look for antibodies to viral proteins |
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What test is used to monitor the effect of drug therapy on viral load?
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HIV PCR/viral load - increasing popularity
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How do you get an AIDS diagnosis?
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CD4+ count less than or equal to 200 (normal is 500-1500)
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ELISA/Western blot usually what during the first 1-2 months of infection?
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falsely negative
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ELISA/Western blot usually what for babies born to HIV positive women?
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Falsely positive - b/c anti-gp120 crosses the placenta
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What are the 4 stages of HIV infection?
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1. fluelike (acute)
2. feeling fine (latent) 3. Falling count 4. Final crisis *during latent phase, virus replicates in lymph nodes |
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Opportunistic infections in brain in HIV patients?
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crypotococcal meningitits, toxoplasmosis, CMV encephalitis, AIDS dementia, PML (JC virus)
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Opportunistic infections in eyes in HIV patient?
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CMV retinitis
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Opportunistic infection in Mouth and Throat in HIV patient?
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Thrush (candida albicans), HSV, CMV, oral hairy leukoplakkia (EBV)
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Opportunisitic infectinon in lungs in HIV patient?
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PCP, TB, histoplasmosis
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Opportunisitic infection in GI in HIV patient?
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Crypto, Mycobacterium avium-intracellulare complex, CMV colitis, non-Hodgkin's lymphoma (EBV), isospora bellli
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Opportunisitic infection in skin in HIV
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Shingles (VZV), Kaposi sarcoma (HHV-8)
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Opportunistic infection in genitals in HIV
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Genital warts, herpes, cervical cancer (HPV)
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Oral thrush, tinea pedis, reactivation of VZV, reactivation of TB, H. influenzae, S. pneumoniae, salmonella increased risk when?
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<400 CD4+ count
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Reactivation of HSV, crypto, Isospora, disseminated coddidio, PCP increased risk when?
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<200 CD4+ count
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Candidal esophagitis, toxoplasmosis, histoplasmosis increased risk when?
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<100 CD4+ count
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CMV retinitis and esophagitis, disseminated M. avium-intracellulare, cryptococal menintitis increased risk when?
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<50 CD4+ count
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What are the 4 neoplasms associated with HIV?
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1. Kaposi's sarcoma (HHV-8)
2. Invasive cervical carcinoma (HPV) 3. Primary CNS lymphoma 4. Non-hodgkin's lymphoma |
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When does HIV encephalopathy occur?
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late in the course of HIV infection - virus gains CNS access via infected macrophages
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Microglial nodules with multinucleated giant cells seen in what?
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HIV encephalitis
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Prions what is the problem?
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misfolding of B-pleated sheets - change from PrPc (protein) to PrPsc (beta pleated form), it is transmissable
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What does PrPsc do?
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resists degredation and facilitates conversion of PrPc (normal) to PrPsc (abnormal)
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Accumulation of PrPsc causes what?
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Spongiform encephalopathy, dementia, ataxia and death - can be sporatic (Creutzfeldt-Jakob disease - rapidly progressing dementia), inherited (Gerstmann-Straussler-Scheinker syndrome) or acquired (kuru)
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What is normal flora on the skin?
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S. epidermidis
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What is normal flora in the nose?
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S. epidermadis; colonized by S. aureus
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Normal flora on oropharynx?
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viridans group streptococci
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Normal flora on dental plaque?
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S. mutans
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Normal flora in colon?
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Bacteroides fragilis > E.coli
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Normal flora in vagina?
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Lactobacillus, colonized by E.coli and group B strep
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Which babies have no flora?
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neonates delivered by cesarean section - but are rapidly colonized after birth
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Bug in contaminated seafood
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V.vulnificus (can also cause wound infections from contact with contaminated water/shellfish
V. parahaemolyticus |
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bug in reheated rice?
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B. cereus
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Bug in meats, mayo, custard. Preformed toxin
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S. aureus
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Bug in reheated meat dishes
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C. perfringens
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Bug in improperly canned foods (bulging cans)
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C. botulinum
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Bug in undercooked meat
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E. coli 1057:H7
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Bug in poultry, meat and eggs
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Salmonella
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What food poisoning starts quickly and ends quickly?
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B. cereus, S. auerus
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bugs that cause bloody diarrhea
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"YESS CCEE"
Campylobacter, Salmonella, Shigella, EHEC, EIEC, Yersinia, C. difficile (watery and bloody) , Entamoeba histolytica |
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bugs that cause watery diarrhea?
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ETEC, Vibrio cholerae, C. perfringens, Protozoa (giardia, cryptosporidium, viruses (rota, adeno, norwalk)
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comma-shaped organisms
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V. cholerae - rice water diarrhea
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pseudomembranous colitis
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C. difficile
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Bug that has low infective dose?
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Shigella! VERY infectious!
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Most common cause of meningitis in neonate <4 weeks?
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#1 Group B strep
#2 E.coli |
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Bug in improperly canned foods (bulging cans)
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C. botulinum
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Bug in undercooked meat
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E. coli 1057:H7
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Bug in poultry, meat and eggs
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Salmonella
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What food poisoning starts quickly and ends quickly?
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B. cereus, S. auerus
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bugs that cause bloody diarrhea
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"YESS CCEE"
Campylobacter, Salmonella, Shigella, EHEC, EIEC, Yersinia, C. difficile (watery and bloody) , Entamoeba histolytica |
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bugs that cause watery diarrhea?
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ETEC, Vibrio cholerae, C. perfringens, Protozoa (giardia, cryptosporidium, viruses (rota, adeno, norwalk)
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comma-shaped organisms
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V. cholerae - rice water diarrhea
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pseudomembranous colitis
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C. difficile
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Bug that has low infective dose?
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Shigella! VERY infectious!
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Most common cause of pneumonia in neonate <4 weeks?
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#1 Group B strep
#2 E.coli |
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Most common cause of pneumonia in children (4 wk to 18 yr)
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RSV, Mycoplasma, Chlamydia pneumoniae, Strep pneumoniae
"Runts May Cough Sputum" |
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Most common cause of pneumonia in adults (18-40 yrs)
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Mycoplasma, C. pneumoniae, S. pneumoniae
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Most common cause of pneumonia in adults (40-65)?
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S. pneumonia, H. influenzae, Anaerobes, Viruses, Mycoplasma
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Most common cause of pneumonia in elderly
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S. pneumonaie, viruses, anaerobes, h. influenzae, gram negative rods
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causes of nosocomial pneumonia
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Staph, enteric gram - rods
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causes of ICH pneumonia
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Staph, enteric gram - rods, fungi, viruses, PCP (with HIV)
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causes of aspiration pneumonia
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Anaerobes
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Causes of pnuemonia in alcoholic/IV drug user
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S. pneumonaie, Klebsiella, Staph
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Causes of pneumonia in CF patient?
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pseudamonas
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Cause of postviral pneumonia?
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staph, H. influenzae
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Cause of atypical pneumonia?
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Mycoplasma, legionella, chlamydia
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Cause of meningitis in Newborn (0-6 mo)?
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Group B strep, E. coli, listeria
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Cause of meningitits in children (6 mo - 6 yrs)?
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Strep. pneumoniae, Neisseria menintitis, H. influenzae type B, enteroviruss
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Cause of meningitidis in 6-60 yrs?
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N. meningititis, enteroviruss, S. pneumoniae, HSV
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Cause of meningititdis in 60 +?
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S. pneumoniae, Gram negative rods, listera
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What are the viral causes of meningititis?
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enteroviruses (coxsackievirus), HSV, HIV, West nile virus, VZV
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What are the cause of meningitis in HIV?
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Cryptococcus, CMV, toxoplasmosis (brain abscess), JC virus (PML)
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Why has incidence of H. influenzae decreased recently?
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It has decreased with the introduction of H. influenzae vaccine in the last 10-15 years
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In CSF: increased pressure, increased PMN's, increased protein, decreased sugar
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Bacterial cause of meningitis
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In CSF: increased pressure, increased lymphocytes, increased protein, decreased sugar?
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fungal/TB cause of meningitis
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CSF: increased/normal pressure, increased lymphocytes, normal suar
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Viral cause
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What causes osteomyelitis in most people?
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S. auerus
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What causes osteomyelitis in sexually active people?
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Neisseria gonorhoeae (rare), septic arthritis more common
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What causes osteomyelitis in diabetics/drug users?
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Pseudomonas aeruginosa
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What causes osteomyelitis in sickle cell patients?
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Salmonella
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What causes osteomyelitis in prosthetic replacements?
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S. aureus, S. epidermidis
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What causes osteomyelitis in vertebral column?
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Mycobacterium tuberculosis (Pott's disease)
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What causes osteromyelitis in cat and dog bites and scratches?
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Pasturella multicida
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Who most commonly gets osteomyelitis?
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children - elevated CRP and ESR is classic but nonspecific
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dysuria, frequency, urgency, suprapubic pain, WBC in urine (not casts!)
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UTI - usually by ascention of microbes from urethra to bladder
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UTI can occur in what babies and elderly adults?
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male infants with congenital defects, vesicoureteral reflex
elderly - from enlarged prostate |
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fever, chills, flank pain, CVA tenderness, hematuria, WBC cast seen in what?
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pyelonephritis - ascension of UTI from bladder to kidney
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Who most commonly gets UTI's
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women - 10x more common - urethra is shorter!
other predisposing factors: obstruction, kidney surgery, cathertirization, GU malformation, diabetes, pregnancy |
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Diagnostic markers of UTI
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positive leukocyte esterase test = bacterial UTI
positive nitrate test = gram negative bacterial UTI |
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UTI bugs
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SSEEK PP
Serratia marcescens - some strains produce a red pigment; often nosocomial and drug resistant Staphylococcus saprophyticus: second leading cause of community acquired UTI in sexually active women E. coli: most common cause of UTI, colonies show metallic sheen on EMB agar Enterobacter cloacae - often nosocomial and drug resistant Klebsiella pneumoniae: large mucoid capsule and viscous colonies Proteus mirablis: motility causes swarming on agar; produces urease; associated with stuvite stones Pseudomonas aeruginosa: blue-green pigment and fruity odor; usually nosocomial and drug resistant |
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what bug is it that in some strains there is a red pigment?
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Serratia marcescens
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What is the second leading cause of UTi's in sexually active women?
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S. saprophyticus
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colonies show metallic sheen on EMB agar
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E. coli - leading cause of UTI's
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motility causes swarming on agar; produces urease... what bug?
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proteus mirabilis
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What are the infections that can pass from mother to fetus? What are nonspecific signs of these infections?
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Hepatosplenomegaly, jaundice, thrombocytopenia, and growth retardation
ToRCHeS Toxoplasma Rubella CMV HSV, HIV Syphilis |
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How do pregnant moms get toxoplasmosis gondii? What are signs of this in mom?
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Aerosolized cat feces or ingestion of undercooked meat
*mom is usually asymptomatic; rarely gets lymphadenopathy |
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chorioretinitis, hydocephalus and intracranial calcifications in baby
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toxoplasmosis infection from mom
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How is rubella trasmitted? What are mom's symptoms?
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Respiratory droplets
mom has rash, lymphadenopathy, arthritis |
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PDA (or pulmonary artery hypoplasia), cataracts, and deafness + or - blueberry muffin rash
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Rubella in baby from mom
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How is CMV transmitted to mom and what are her symptoms?
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From sexual contact or organ transplant
symptoms: usually asymptomatic; mononucleosis like illness |
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How do Moms get HIV what are her symptoms?
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sexual contact
symptoms: variable presentation depending on CD4+ levels |
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hearing loss, seizures in a baby
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CMV from mom
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recurrent infections, chronic diarrhea in newborn
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HIV infection from mom
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How do moms get HSV, what are her symptoms?
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from skin or mucous membrane contact
symptoms; usually asymptomatic; or can have herpetic (vesicular) lesions |
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encephalitis; vesicular lesions in baby
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HSV from mom (vesicular lesions are herpetic)
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How does mom get syphilis and what are her symptoms?
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from sexual contact
symptoms: chancre (primary), rash (secondary), cardiac/neurologic disease (tertiary) |
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stillbrith, hydrops fetalis, if child survives presents with facial abrnomalties (notched teeth, saddle nose, short maxilla), saber shins
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Congenital syphilis from mom
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post auricualar lymphadenoapthy, rash that beings at head and moves down
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rubella virus: german measles
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cough, coryza, conjunctivitis then rash that starts at head and moves down
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Measles virus: rubeola, measles
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Rash begins on trunk and spreads to face and extremities with lesions of different ages
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VZV: chickenpox
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Macular rash over body appears after several days of high fever
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HHV-6: roseola
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rash on face later appears over body in reticular, lace like pattern (can cause hydrops fetalis in pregnant mother)
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Parvovirus B19: erythema infectiosum
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Erythematous, sandpaper like rash with fever and sore throat
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Strep pyogenes: scarlet fever
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vesicular rash on palms and soles; ulcers in oral mucosa
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coxsackievirus type A: hand-foot-mouth disease
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Painful genital ulcer, inguinal adeonpathy
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Haemophilus ducreyi
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strawberry colored mucosa, vaginitis
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Trichomoniasis caused by trichomonas vaginalis
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Genital warts, koilocytes (dysplastic squamous cells in potentially precancerous lesions)
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Condylomata acuminata: HPV6 and 11
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Noninflammatory, malodorus discharge (fishy smell), positive whiff test, clue cells
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gardnerella vaginalis
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ulcers, lymphadenopathy, rectal strictures
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lymphogranuloma venereum from C. trachomatis (L1-L3)
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Urethritis, cervicitis, conjunctitivs, Reiter's syndrome, PID
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Chlamydia: C. trachomatis (D-K)
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Top bugs that cause PID
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Chlamydia trachomatis (subactue, often undiagnosed), Neisseria gonorrhoeae (acute, high fever)
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What is the most common STD in the USA?
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Chlamydia
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Cervical motion tenderness (chandelier sign), purulent cervical discharge
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PID
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What can PID cause?
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slpingitis, endometritis, hydrosalpinx, tubo-ovarian abscess, Fitz-hugh-curtis syndrome (infection of the liver capsule with violin string adhesions of parietal peritoneum to liver)
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Fitz-hugh-curtis syndrome
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associated with PID - inflammation of liver capsule: violin string adhesions of parietal peritonuem to liver
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Salpingitis is a risk factor for what?
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ectopic pregnancy, infertility, chronic pelvic pain and adhesions
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What other STD's can cause PID (less common)?
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Gardnerella (clue cells) and Trichomonas (corkscrew motility on wet prep)
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2 most common causes of nosocomial infections?
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E.coli (UTI) and S. aureus (wound infection)
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In the newborn nursery at risk for what nosocomial infections?
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CMV, RSV
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Urinary catheterization puts you at risk for what nosocomial infections?
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E.coli, Proteus mirabilis
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Respiratory therapy equipment puts you at risk for what nosocomial infections?
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Psudomonas aeruginosa
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If you work in renal dialysis unit at risk for what nosocomial infection?
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HBV
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If hyperalimentation (over eat) at risk for what nosocomial infection?
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canidida albicans
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If water aerosols at risk for what nosocomial infection?
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Legionella
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Symptoms: low-grade fevers, cough, hepatosplenomegaly
Lab: oval yeast cells within macrophages |
Histoplasma capsulatum (causes only pulmonary symptoms in immunocompetent hosts)
*this is what you see in HIV patient |
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Symptoms: fluffly white cottage-cheese lesions in HIV patient in buccal mucosa
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C. albicans (thrush)
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Symptoms: superficial vascular proliferation in HIV patient
Biopsy: reveals neutrophilic inflammation |
Bartonella henselae (causes bacillary angiomatosis)
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Symptom: superficial neoplastic proliferation of vasculature in HIV patient
Biopsy: lymphocytic inflammation |
HHV-8 (Kaposi's sarcoma)
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Symptom: chronic, watery diarrhea, HIV patient
Lab: Acid-fast cysts seen in stool |
Cryptosporidium spp.
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Meningitis in HIV patient
lab: india ink stain reveals narrow-based buds |
Cryptococcus neoformans (can also cause encephalitis)
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Encephalopathy in HIV patient
*from reactivation of latent virus; results in demyelination |
JC virus (cause of PML)
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Abscess in HIV patient
ring enhancing lesions on imaging |
toxoplasmosis gondii
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Retitinits in HIV patient
cotton-wool spots on funduscopic exam |
CMV
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Hairy leukoplakia on lateral tongue in HIV patient
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EBV in HIV patient
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Non-Hodgkin's lymphoma (large cell type) on oropharynx (waldeyer's ring) in HIV patient
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EBV
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Squamous cell carcinoma in anus or cervix in HIV patient
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HPV
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interstitial pneumonia
biopsy: cells with intranuclear and cytoplasmic inclusions bodies in HIV patient |
CMV
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pleuritic pain, hemoptysis, inflitrates on imaging in HIV patient
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invasive aspergillosis
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Pneumonia with CD4<200 in HIV patient
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Pneumocystis jiroveci
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TB like disease in HIV patient CD4<50
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Mycobacterium avium-intracellulare
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Bugs affecting unimmunized kids?
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Rubella virus, Measles virus, H. influenzae type B, poliovirus, Corynebacterium dphtheriae,
|
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bug that infects unimmunized kids that colonizes nasopharynx what does it cause?
|
meningitis: H. influenzae type B
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bug that infectes unimmunized kids that can lead to myalgia and paralysis what is it? what can it cause?
|
Poliovirus can cause meningitis
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bug that causes paryngitis and elaborates toxin that causes necrosis in cardiac and CNS tissue
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Corynebactierium diphtehriae - can infect unimmunized children
grayish pseudomembranes - can obstruct pathway |
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epiglottitis cause in unimmunized children
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H. influenzae - fever with dysphagi, drooling, problems breathing - cherry red epiglottis
*can cause epiglottitis in fully immunized children |
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pus, empyema, abscells
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S. aureus
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pediatic infection
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H. influenzae (including epiglottitis)
|
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pneumonia in CF patient or burn infection
|
pseudomonas aeruginosa
|
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branching rods in oral infection, sulfur granules
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actinomyces israelii
|
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Traumatic open wound
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C. perfringens
|
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Surgical wound
|
S. aureus
|
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Dog or cat bite
|
pasturella multicida
|
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Currant jelly sputum
|
Klebsiella
|
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Positive PAS stain
|
Tropheryma whippelii (whipples disease)
|
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Sepsis/meningitis in newborn
|
Group B strep
|
|
health care provider infection?
|
HBV from needle stick
|
|
fungal infection in diabetic
|
mucor or rhizopus spp.
|
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Asplenic patient
|
problem with encapsulated bacteria
SHiN S. pneumonia, H. influenzae, N. meningitidis |
|
CGD
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problem with catalase + organisms: S. aureus, Nocardia spp. Serratia marcescens, Psudomonas cepacia, Aspergillus spp.
|
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neutropenic patient
|
candida albicans (systemic)
|
|
bilateral bell's palsy
|
Borrelia burgdorferi (Lyme disease)
|