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176 Cards in this Set

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p24 protein
HIV capsid protein
What type of genome does HIV have?
diploid genome (2 molecules of RNA)
GP41 and GP120
envelope proteins of HIV
What does reverse transcriptase do?
synthesizes dsDNA from RNA, dsDNA integrates into host genome
seen in HIV
What does the HIV virus bind to ?
CXCR4 and CD4 on T cells; binds CCR5 and CD4 on macrophages
homogenous CCR5 for HIV means what? What does heterozygous mean?
Homozygous CCR5 mutation = immunity
Heterozygous CCR5 mutation = slower course
How to diagnose HIV?
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
What test is used to monitor the effect of drug therapy on viral load?
HIV PCR/viral load - increasing popularity
How do you get an AIDS diagnosis?
CD4+ count less than or equal to 200 (normal is 500-1500)
ELISA/Western blot usually what during the first 1-2 months of infection?
falsely negative
ELISA/Western blot usually what for babies born to HIV positive women?
Falsely positive - b/c anti-gp120 crosses the placenta
What are the 4 stages of HIV infection?
1. fluelike (acute)
2. feeling fine (latent)
3. Falling count
4. Final crisis
*during latent phase, virus replicates in lymph nodes
Opportunistic infections in brain in HIV patients?
crypotococcal meningitits, toxoplasmosis, CMV encephalitis, AIDS dementia, PML (JC virus)
Opportunistic infections in eyes in HIV patient?
CMV retinitis
Opportunistic infection in Mouth and Throat in HIV patient?
Thrush (candida albicans), HSV, CMV, oral hairy leukoplakkia (EBV)
Opportunisitic infectinon in lungs in HIV patient?
PCP, TB, histoplasmosis
Opportunisitic infection in GI in HIV patient?
Crypto, Mycobacterium avium-intracellulare complex, CMV colitis, non-Hodgkin's lymphoma (EBV), isospora bellli
Opportunisitic infection in skin in HIV
Shingles (VZV), Kaposi sarcoma (HHV-8)
Opportunistic infection in genitals in HIV
Genital warts, herpes, cervical cancer (HPV)
Oral thrush, tinea pedis, reactivation of VZV, reactivation of TB, H. influenzae, S. pneumoniae, salmonella increased risk when?
<400 CD4+ count
Reactivation of HSV, crypto, Isospora, disseminated coddidio, PCP increased risk when?
<200 CD4+ count
Candidal esophagitis, toxoplasmosis, histoplasmosis increased risk when?
<100 CD4+ count
CMV retinitis and esophagitis, disseminated M. avium-intracellulare, cryptococal menintitis increased risk when?
<50 CD4+ count
What are the 4 neoplasms associated with HIV?
1. Kaposi's sarcoma (HHV-8)
2. Invasive cervical carcinoma (HPV)
3. Primary CNS lymphoma
4. Non-hodgkin's lymphoma
When does HIV encephalopathy occur?
late in the course of HIV infection - virus gains CNS access via infected macrophages
Microglial nodules with multinucleated giant cells seen in what?
HIV encephalitis
Prions what is the problem?
misfolding of B-pleated sheets - change from PrPc (protein) to PrPsc (beta pleated form), it is transmissable
What does PrPsc do?
resists degredation and facilitates conversion of PrPc (normal) to PrPsc (abnormal)
Accumulation of PrPsc causes what?
Spongiform encephalopathy, dementia, ataxia and death - can be sporatic (Creutzfeldt-Jakob disease - rapidly progressing dementia), inherited (Gerstmann-Straussler-Scheinker syndrome) or acquired (kuru)
What is normal flora on the skin?
S. epidermidis
What is normal flora in the nose?
S. epidermadis; colonized by S. aureus
Normal flora on oropharynx?
viridans group streptococci
Normal flora on dental plaque?
S. mutans
Normal flora in colon?
Bacteroides fragilis > E.coli
Normal flora in vagina?
Lactobacillus, colonized by E.coli and group B strep
Which babies have no flora?
neonates delivered by cesarean section - but are rapidly colonized after birth
Bug in contaminated seafood
V.vulnificus (can also cause wound infections from contact with contaminated water/shellfish
V. parahaemolyticus
bug in reheated rice?
B. cereus
Bug in meats, mayo, custard. Preformed toxin
S. aureus
Bug in reheated meat dishes
C. perfringens
Bug in improperly canned foods (bulging cans)
C. botulinum
Bug in undercooked meat
E. coli 1057:H7
Bug in poultry, meat and eggs
Salmonella
What food poisoning starts quickly and ends quickly?
B. cereus, S. auerus
bugs that cause bloody diarrhea
"YESS CCEE"
Campylobacter, Salmonella, Shigella, EHEC, EIEC, Yersinia, C. difficile (watery and bloody) , Entamoeba histolytica
bugs that cause watery diarrhea?
ETEC, Vibrio cholerae, C. perfringens, Protozoa (giardia, cryptosporidium, viruses (rota, adeno, norwalk)
comma-shaped organisms
V. cholerae - rice water diarrhea
pseudomembranous colitis
C. difficile
Bug that has low infective dose?
Shigella! VERY infectious!
Most common cause of meningitis in neonate <4 weeks?
#1 Group B strep
#2 E.coli
Bug in improperly canned foods (bulging cans)
C. botulinum
Bug in undercooked meat
E. coli 1057:H7
Bug in poultry, meat and eggs
Salmonella
What food poisoning starts quickly and ends quickly?
B. cereus, S. auerus
bugs that cause bloody diarrhea
"YESS CCEE"
Campylobacter, Salmonella, Shigella, EHEC, EIEC, Yersinia, C. difficile (watery and bloody) , Entamoeba histolytica
bugs that cause watery diarrhea?
ETEC, Vibrio cholerae, C. perfringens, Protozoa (giardia, cryptosporidium, viruses (rota, adeno, norwalk)
comma-shaped organisms
V. cholerae - rice water diarrhea
pseudomembranous colitis
C. difficile
Bug that has low infective dose?
Shigella! VERY infectious!
Most common cause of pneumonia in neonate <4 weeks?
#1 Group B strep
#2 E.coli
Most common cause of pneumonia in children (4 wk to 18 yr)
RSV, Mycoplasma, Chlamydia pneumoniae, Strep pneumoniae

"Runts May Cough Sputum"
Most common cause of pneumonia in adults (18-40 yrs)
Mycoplasma, C. pneumoniae, S. pneumoniae
Most common cause of pneumonia in adults (40-65)?
S. pneumonia, H. influenzae, Anaerobes, Viruses, Mycoplasma
Most common cause of pneumonia in elderly
S. pneumonaie, viruses, anaerobes, h. influenzae, gram negative rods
causes of nosocomial pneumonia
Staph, enteric gram - rods
causes of ICH pneumonia
Staph, enteric gram - rods, fungi, viruses, PCP (with HIV)
causes of aspiration pneumonia
Anaerobes
Causes of pnuemonia in alcoholic/IV drug user
S. pneumonaie, Klebsiella, Staph
Causes of pneumonia in CF patient?
pseudamonas
Cause of postviral pneumonia?
staph, H. influenzae
Cause of atypical pneumonia?
Mycoplasma, legionella, chlamydia
Cause of meningitis in Newborn (0-6 mo)?
Group B strep, E. coli, listeria
Cause of meningitits in children (6 mo - 6 yrs)?
Strep. pneumoniae, Neisseria menintitis, H. influenzae type B, enteroviruss
Cause of meningitidis in 6-60 yrs?
N. meningititis, enteroviruss, S. pneumoniae, HSV
Cause of meningititdis in 60 +?
S. pneumoniae, Gram negative rods, listera
What are the viral causes of meningititis?
enteroviruses (coxsackievirus), HSV, HIV, West nile virus, VZV
What are the cause of meningitis in HIV?
Cryptococcus, CMV, toxoplasmosis (brain abscess), JC virus (PML)
Why has incidence of H. influenzae decreased recently?
It has decreased with the introduction of H. influenzae vaccine in the last 10-15 years
In CSF: increased pressure, increased PMN's, increased protein, decreased sugar
Bacterial cause of meningitis
In CSF: increased pressure, increased lymphocytes, increased protein, decreased sugar?
fungal/TB cause of meningitis
CSF: increased/normal pressure, increased lymphocytes, normal suar
Viral cause
What causes osteomyelitis in most people?
S. auerus
What causes osteomyelitis in sexually active people?
Neisseria gonorhoeae (rare), septic arthritis more common
What causes osteomyelitis in diabetics/drug users?
Pseudomonas aeruginosa
What causes osteomyelitis in sickle cell patients?
Salmonella
What causes osteomyelitis in prosthetic replacements?
S. aureus, S. epidermidis
What causes osteomyelitis in vertebral column?
Mycobacterium tuberculosis (Pott's disease)
What causes osteromyelitis in cat and dog bites and scratches?
Pasturella multicida
Who most commonly gets osteomyelitis?
children - elevated CRP and ESR is classic but nonspecific
dysuria, frequency, urgency, suprapubic pain, WBC in urine (not casts!)
UTI - usually by ascention of microbes from urethra to bladder
UTI can occur in what babies and elderly adults?
male infants with congenital defects, vesicoureteral reflex
elderly - from enlarged prostate
fever, chills, flank pain, CVA tenderness, hematuria, WBC cast seen in what?
pyelonephritis - ascension of UTI from bladder to kidney
Who most commonly gets UTI's
women - 10x more common - urethra is shorter!
other predisposing factors: obstruction, kidney surgery, cathertirization, GU malformation, diabetes, pregnancy
Diagnostic markers of UTI
positive leukocyte esterase test = bacterial UTI
positive nitrate test = gram negative bacterial UTI
UTI bugs
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
what bug is it that in some strains there is a red pigment?
Serratia marcescens
What is the second leading cause of UTi's in sexually active women?
S. saprophyticus
colonies show metallic sheen on EMB agar
E. coli - leading cause of UTI's
motility causes swarming on agar; produces urease... what bug?
proteus mirabilis
What are the infections that can pass from mother to fetus? What are nonspecific signs of these infections?
Hepatosplenomegaly, jaundice, thrombocytopenia, and growth retardation
ToRCHeS
Toxoplasma
Rubella
CMV
HSV, HIV
Syphilis
How do pregnant moms get toxoplasmosis gondii? What are signs of this in mom?
Aerosolized cat feces or ingestion of undercooked meat
*mom is usually asymptomatic; rarely gets lymphadenopathy
chorioretinitis, hydocephalus and intracranial calcifications in baby
toxoplasmosis infection from mom
How is rubella trasmitted? What are mom's symptoms?
Respiratory droplets
mom has rash, lymphadenopathy, arthritis
PDA (or pulmonary artery hypoplasia), cataracts, and deafness + or - blueberry muffin rash
Rubella in baby from mom
How is CMV transmitted to mom and what are her symptoms?
From sexual contact or organ transplant
symptoms: usually asymptomatic; mononucleosis like illness
How do Moms get HIV what are her symptoms?
sexual contact
symptoms: variable presentation depending on CD4+ levels
hearing loss, seizures in a baby
CMV from mom
recurrent infections, chronic diarrhea in newborn
HIV infection from mom
How do moms get HSV, what are her symptoms?
from skin or mucous membrane contact
symptoms; usually asymptomatic; or can have herpetic (vesicular) lesions
encephalitis; vesicular lesions in baby
HSV from mom (vesicular lesions are herpetic)
How does mom get syphilis and what are her symptoms?
from sexual contact
symptoms: chancre (primary), rash (secondary), cardiac/neurologic disease (tertiary)
stillbrith, hydrops fetalis, if child survives presents with facial abrnomalties (notched teeth, saddle nose, short maxilla), saber shins
Congenital syphilis from mom
post auricualar lymphadenoapthy, rash that beings at head and moves down
rubella virus: german measles
cough, coryza, conjunctivitis then rash that starts at head and moves down
Measles virus: rubeola, measles
Rash begins on trunk and spreads to face and extremities with lesions of different ages
VZV: chickenpox
Macular rash over body appears after several days of high fever
HHV-6: roseola
rash on face later appears over body in reticular, lace like pattern (can cause hydrops fetalis in pregnant mother)
Parvovirus B19: erythema infectiosum
Erythematous, sandpaper like rash with fever and sore throat
Strep pyogenes: scarlet fever
vesicular rash on palms and soles; ulcers in oral mucosa
coxsackievirus type A: hand-foot-mouth disease
Painful genital ulcer, inguinal adeonpathy
Haemophilus ducreyi
strawberry colored mucosa, vaginitis
Trichomoniasis caused by trichomonas vaginalis
Genital warts, koilocytes (dysplastic squamous cells in potentially precancerous lesions)
Condylomata acuminata: HPV6 and 11
Noninflammatory, malodorus discharge (fishy smell), positive whiff test, clue cells
gardnerella vaginalis
ulcers, lymphadenopathy, rectal strictures
lymphogranuloma venereum from C. trachomatis (L1-L3)
Urethritis, cervicitis, conjunctitivs, Reiter's syndrome, PID
Chlamydia: C. trachomatis (D-K)
Top bugs that cause PID
Chlamydia trachomatis (subactue, often undiagnosed), Neisseria gonorrhoeae (acute, high fever)
What is the most common STD in the USA?
Chlamydia
Cervical motion tenderness (chandelier sign), purulent cervical discharge
PID
What can PID cause?
slpingitis, endometritis, hydrosalpinx, tubo-ovarian abscess, Fitz-hugh-curtis syndrome (infection of the liver capsule with violin string adhesions of parietal peritoneum to liver)
Fitz-hugh-curtis syndrome
associated with PID - inflammation of liver capsule: violin string adhesions of parietal peritonuem to liver
Salpingitis is a risk factor for what?
ectopic pregnancy, infertility, chronic pelvic pain and adhesions
What other STD's can cause PID (less common)?
Gardnerella (clue cells) and Trichomonas (corkscrew motility on wet prep)
2 most common causes of nosocomial infections?
E.coli (UTI) and S. aureus (wound infection)
In the newborn nursery at risk for what nosocomial infections?
CMV, RSV
Urinary catheterization puts you at risk for what nosocomial infections?
E.coli, Proteus mirabilis
Respiratory therapy equipment puts you at risk for what nosocomial infections?
Psudomonas aeruginosa
If you work in renal dialysis unit at risk for what nosocomial infection?
HBV
If hyperalimentation (over eat) at risk for what nosocomial infection?
canidida albicans
If water aerosols at risk for what nosocomial infection?
Legionella
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
Symptoms: fluffly white cottage-cheese lesions in HIV patient in buccal mucosa
C. albicans (thrush)
Symptoms: superficial vascular proliferation in HIV patient
Biopsy: reveals neutrophilic inflammation
Bartonella henselae (causes bacillary angiomatosis)
Symptom: superficial neoplastic proliferation of vasculature in HIV patient
Biopsy: lymphocytic inflammation
HHV-8 (Kaposi's sarcoma)
Symptom: chronic, watery diarrhea, HIV patient
Lab: Acid-fast cysts seen in stool
Cryptosporidium spp.
Meningitis in HIV patient
lab: india ink stain reveals narrow-based buds
Cryptococcus neoformans (can also cause encephalitis)
Encephalopathy in HIV patient
*from reactivation of latent virus; results in demyelination
JC virus (cause of PML)
Abscess in HIV patient
ring enhancing lesions on imaging
toxoplasmosis gondii
Retitinits in HIV patient
cotton-wool spots on funduscopic exam
CMV
Hairy leukoplakia on lateral tongue in HIV patient
EBV in HIV patient
Non-Hodgkin's lymphoma (large cell type) on oropharynx (waldeyer's ring) in HIV patient
EBV
Squamous cell carcinoma in anus or cervix in HIV patient
HPV
interstitial pneumonia
biopsy: cells with intranuclear and cytoplasmic inclusions bodies in HIV patient
CMV
pleuritic pain, hemoptysis, inflitrates on imaging in HIV patient
invasive aspergillosis
Pneumonia with CD4<200 in HIV patient
Pneumocystis jiroveci
TB like disease in HIV patient CD4<50
Mycobacterium avium-intracellulare
Bugs affecting unimmunized kids?
Rubella virus, Measles virus, H. influenzae type B, poliovirus, Corynebacterium dphtheriae,
bug that infects unimmunized kids that colonizes nasopharynx what does it cause?
meningitis: H. influenzae type B
bug that infectes unimmunized kids that can lead to myalgia and paralysis what is it? what can it cause?
Poliovirus can cause meningitis
bug that causes paryngitis and elaborates toxin that causes necrosis in cardiac and CNS tissue
Corynebactierium diphtehriae - can infect unimmunized children
grayish pseudomembranes - can obstruct pathway
epiglottitis cause in unimmunized children
H. influenzae - fever with dysphagi, drooling, problems breathing - cherry red epiglottis
*can cause epiglottitis in fully immunized children
pus, empyema, abscells
S. aureus
pediatic infection
H. influenzae (including epiglottitis)
pneumonia in CF patient or burn infection
pseudomonas aeruginosa
branching rods in oral infection, sulfur granules
actinomyces israelii
Traumatic open wound
C. perfringens
Surgical wound
S. aureus
Dog or cat bite
pasturella multicida
Currant jelly sputum
Klebsiella
Positive PAS stain
Tropheryma whippelii (whipples disease)
Sepsis/meningitis in newborn
Group B strep
health care provider infection?
HBV from needle stick
fungal infection in diabetic
mucor or rhizopus spp.
Asplenic patient
problem with encapsulated bacteria
SHiN
S. pneumonia, H. influenzae, N. meningitidis
CGD
problem with catalase + organisms: S. aureus, Nocardia spp. Serratia marcescens, Psudomonas cepacia, Aspergillus spp.
neutropenic patient
candida albicans (systemic)
bilateral bell's palsy
Borrelia burgdorferi (Lyme disease)