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99 Cards in this Set

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IFN alpha
anti-viral

produced by leukocytes
involved in innate immune response

rIFN-alpha used to treat anogenital warts (HPV 6 & 11)
HPV 6 & 11
causes anogenital & laryngeal warts
(condyloma acuminata, flat warts of cervix, laryngeal papillomas)

can progress to Recurrent Respiratory Papillomatosis if in throat (high risk in kids born to mothers with anogenital papillomas)

Tx: iquiminod cream, rIFN-alpha

most common STD
(but does NOT cause cancer)
HPV 16 & 18
associated with cervical lesions that have oncogenic potential to become cervical carcinoma

First identified opportunistic infection specific to female→ affects many HIV + women

Pap smear screen + hybrid capture nucleic acid assay for DNA of the 13 most important high risk HPVs
Papovaviridae:

features & members
naked icosahedral
supercoiled DNA (like bacterial plasmids)

Think O:
warts
circular, dbl stranded DNA
cervix (cancer)

3 members:
PA: human PApilloma virus
PO: POlyoma
VA: simiam vacuolating virus (doesn't infect humans)
Parvoviridae
naked icosahedral
smallest icosahedral virus with only one strand of DNA→ “simple as a Par-ONE golf course”

childhood dz called erythema infectiosum (Fifth Disease)
fever & slapped face rash
Diseases caused by Polyoma Virus
BK Polyoma: mild childhood ix, usu. asymptomatic
(ubiquitous as Burger King)

JC Polyoma: opportunistic ix in AIDS px
PML = progressive multifocal encephalopathy

Merkel Cell Polyoma virus--> Merkel cell carcinoma (aggreisve neuroectodermal skin Ca)
HPV vaccine
Quadrivalent: protects against 4 strains of HPV
HPV 16 & 18 (cervical ca)
HPV 6 & 11 (ST warts)

VLPs express L1 major capsid protein (immunogenic) but don't contain DNA

3 doses
Chickenpox vs. Smallpox
Chickenpox
Herpesviridae Varicella Zoster virus
asynchronous
superficial lesions
centripetal spread (prominent on chest)


Smallpox
Orthopoxviridae
synchronous lesions
deep lesions
centrifugal spread (prominent on face, palms, also affecting internal organs)
Major congenital virus infection
CMV
Major Neonatal viral infections
HSV-2
VZV
Neonatal Herpes
results from a primary infection of the mother towards the end of pregnancy

verious serious neonatal dz
antiviral tx for
Herpes encephalitis (HSV 1 or 2, primary or secondary ix)
&
Neonal Herpes (HSV-2)
IV acyclovir
antiviral tx for Herpes Labialis
(2ary ix with HSV-1)
penciclovir
antiviral tx for Ocular Herpes
(manifestation of 1ary ix with HSV-1)
topical trifluridine/ triflurothymidine
Antiviral Tx for Recurrent Genital Herpes
(1ary or 2ary manifestation of HSV-2 ix)
Prodrug form of acyclovir (valacyclovir) or famciclovir
Sexually Transmitted Anogenital Lesions
anogenital warts = HPV 6 & 11
anogenital warts with potential to become cervical cancer = HPV 16 & 18
HPV viruses may resolve on their own

herpetic lesions = HSV-2 (chronic virus with latent periods; often recurrent sx)
What are the only licensed vaccines against human herpes viruses?
Varicella (1ary VZV) & Zoster (2ary VZV)
both live attenuated

given at 12 months to prevent varicella (chickenpox)
to ppl over 60 yrs to prevent/reduce severity of zoster (shingles)
A mother gets varicella late in her pregnancy. What is the risk? What do you do?
risk that neonate will have neonatal VZV
(b/c this is a non-immune person at high risk of serious 1ary ix with VZV)

Tx/prophylaxis = VSV IgG +/- acyclovir
Tx for Zoster
zoster = 2ary ix with VZV

give oral famciclovir or valacyclovir
CMV Tx
Gancyclovir, Valganciclovir

Alternative drugs: Foscarnet, Cidofovir

Passive immunization with CMVIg in some cases
Sx of ix with Rotavirus vs. Norovirus
Rotavirus
affects infants & young kids
diarrhea +/- vomiting
oro-fecal transmission
(naked icosahedral virus with strange wintertime peak)

Norovirus
older kids, adults
vomiting +/- diarrhea
oro-fecal transmission via contaminated water (cruise ships, Katrina)
acute HBV Tx
Lamuvidine = nucleoside analog (NRTI)

targets DNA dependent DNA Polymerase
acute HBC Tx
Ribavirin

targets viral protease

administer along with IFN-alpha
presence of anti-HBc alone
indicates infection, NOT immunization
+ Ab capture ELISA for HBs antigen
current infection
HBsAg & anti-HDV Ig = ?
chronic infection with HBV & HDV
Tx for chronic HCV
Ribaviring & pegylated IFN gamma

PCR to monitor viral load (=effectiveness of tx, not infectivity)
Tx for chronic HBV
Lamivudine (NRTI) +/- pegylated IFN gamma

monitor therapy with PCR to detect viral load (not a test for infectivity)
What causes "anhovy pastelike abscess in the liver?"
hematogenous spread of Entamoeba histolytica from the GI
What causes flask shaped necrotic ulcers in the GI tract?
Entamoeba histolytica

Look for trophozoites (motile form) or cysts in stool
What is the cause of the most common diarrheal disease in the USA?
Giardia lamblia

transmitted by contaminated H2O
not killed by chlorine
You find a protozoa in the duodenum of a patient. What is it?
Giardia lamblia = only portozoa that resides in duodenum
Red kite-shaped intraluminal organisms
Giardia lamblia
only intestinal protozoan that doesn't produce cysts
Dientomoeba fragilis
Woman c/o itchy vag. Strawberry red mucosa with frothy exudates.
Trichomonas vaginalis = sexually transmitted protozoan
Pt with abdominla pain, diarrhea. Find acid-fast oocytes in stool & organisms in brush border on ilal mucosa on biopsy.
Cryptosporidium parvum

= protozoan transmitted by fecal contamination of food or water
chlorine won't kill it
pneumocysis is categorized as what type of organism
fungus

formerly classified as a protozoan b/c:
has trophozoite & cyst stages when it reproduces within a host
(cannot be grown in vitro--> so dx involves broncheolar lavage)
Responds to antibiotics
(also treat with HART tx b/c host will be immunocompromised, probably AIDS patient)
Pneumocystis pneumonia hits what patients?
immunocompromised patients
Pneumocystis carinii causes disease in whom?
in animals--NOT in people

pneumocystis jirovecii cauess dz in humans
CXR reveals honeycomb infiltrates. Foamy film showing attack of fibrous, interstitial tissue.
pneumonia caused by Pneumocystis jiroveci

immunocompromised host
What is the leading cause of pneumonia in AIDS patients?
Pneumocystis jirovecii
How do you detect Pneumocystis microscopically?
Special stains:
fluorescence
modified Ganza
capaflor
GMS
Which dermatophyte has no microconidia?
Epidermophyton (macroconidia only)
Keratinase
enzyme secreted by dermatophytes

allows breakdown of keratin for nutrients
Which dermatophytes produce arthrospores & why are they significant?
all of them: epidermophyton, microsporum, trichophyton

these are the most infectious thing produced by dermatophytes
Dermatophyte hyphae growth inside hair shaft, eventually breaking off hair to leave a black dot
endothrix pattern of growth
Exctothrix pattern of dermatophyte growth
fungal hyphae grow on outer surface of hair
Hyphal growth inside hair shaft with production of air bubbles.

Produces yellow, thick crusts.
Favus pattern of dermatophyte growth

most aggressive type of scalp hair infection
What is tinea capitis?
dermatophyte infection of scalp hair & skin
What is tinea cruris?
dermatophyte infection of the groin

= jock itch
What is tinea unguium?
onychomycosis = infection of nails, usually by dermatophytes
What is White Piedra & what causes it?
Hair infection, usually in pubic, beard or scalp areas

caused by Trichosporon, a NON-DERMATOPHYTE, dimorphic yeast that is normal flora

Creates white to light brown fungal nodules on the hair shaft that are easily removed
Pt with black or dark brown fungal nodules on their hair shafts that adhere firmly. What is the infection called & what causes it?
Black piedra = ix
caused by the NON-DERMATOPHYTE, Piedraia hortae
What is an important yeast pathogen that is very similar to Candida?
Trichosporon

normal flora that causes OPPORTUNISTIC infections, including:
white piedra (hair), onychoymcosis, cutaneous lesions, & disseminated infections such as endocarditis or meningitis

resistant to treatment

not a dermatophyte (don't confuse with Trichophyton)
What is Tinea corporis & what causes it?
ringworm

classic lesion with central clearing

on trunk, arms, legs

caused by dermatophytes (not worms), frequently of the Trichophyton variety
What causes granulomatous subcutaneous mycosis with draining sinus tracts extruding pigmented grains or granules?
Mycetoma spp.

esp. Mycetoma pseudoallescheria, white grain, hyaline fungus

there are also back grain, demitaceous mycetoma spp.

indolent & invasive
usually involves the feet, but spreads to underlying muscle & bone

Note that filamentous bacteria may cause comparable infections called Actinomycetoma, esp. Nocardia spp.
Subcutaneous mycosis with cigar shaped YEAST cells. When cultured & grown at 25 C, they form filamentous fungi with hyaline hyphae.
Sporothrix Schenckii
Subcutaneous mycosis wiht sclerotic bodies (aka Medlar bodies or muriform cells) inside the lesions.
Chromoblastomycosis.

cauliflower-like warty lesions
Phaeohyphomycosis spp.
Exophiala, Wangiella, PHialophora

cause cystic subcutaneous lesions wiht overlying verrucuous lesions.

fungi seem mycelial inside lesions

may disseminate to brain

inhalation of spres causes respiratory dz
Rose handler's diseaes
subcutaneous mycosis caused by Sporthrix spp (aka Sporotrichosis)
Cauliflower or wartlike lesions
Chromoblastomycosis
Lobomycosis
lesions between skin and subcutanous tissue

nodular lesions that become verrucoid ulcerative with satellite lesions

no growth on any agar media
Bacteria associated with IBD & diarrhea in kids 1-5 yo.
ETBF = enterotoxin producing Bacteroides fragilis

an anaerobic pathogen
gram + cocci in human infection
Peptostreptococcus
HUS
hemolytic uremic syndrome = life threatening complication of dz marked by hemolytic anemia & renal failure

associated with EHEC when shiga-like toxin enters bloodstream & destroys renal endothelial and glomerular cells
Example of local infection with systemic toxemia.
watery diarrhea followed by bloody diarrhea. no pus in stool. no fever.
EHEC = Enterohemorrhagic E. coli

shiga toxin producing

bacteria remain adhered to intestinal wall, toxin enters bloodstream
Example of Local infection with Systemic Toxemia
bloody diarrhea + fever and pus in stool
dysentery caused by Shigella spp.
Kid 5yo or younger gets EHEC. What is a potential complication?
HUS
Traveler's Diarrhea
Enterotoxigenic E. Coli

may be as severe as cholera
pathogenesis same as cholera
rapid lactose fermenters
Escherichia
Lactose non-fermenters
Shigella
Salmonella
Contaminant of caesar salad, hollandaise sauce, ice cream
Salmonella (Typhimurium, Enteritidis, etc.)

causes gastroenteritis after 12-48 hr incubation period
Reiter's Syndrome
pt can't see, can't pee, can't bend the knee

autoimmune rxn triggered by infections (usu. genital or enteric ix)

Sx: inflammatory arthritis, cunjunctivits or uveitis, & urethritis

associated with Salmonella, Shigella, Yersinia, Campylobacter
2 Typhoid vaccines
live attenuated S. Typhi strain Ty 21a

Purified Vi capsular polysaccharide
2 cholera vaccines
oral live, attenuated strain of V. cholerae

killed cells + toxin B subunit
Guillain-Barre Syndrome
autoimmune disorder of the PNS causing flaccid paralysis, often triggered by an antecedent infection

Campylobacter = most common etiology (can also trigger Reiter's Syndrome)
3 enetric gram negative bacilli that are curved or spiral shaped rods
Vibrio
Campylobacter
Helicobacter

Vibrio related to E. coli & other Enterobacteriaceae

Campylobacter & Helicobacter more distant taxonomically
3 bacteria transmitted transplacentally & the infections they cause in utero
LISTERIA MONOCYTOGENES causes listeriosis

Treponema pallidum -- congenital syphilis

Borrelia burgdorferi -- Lyme dz
Listeriosis in neonates
with 2 days of birth: transplacental transmission
septicemia, pneumonia, meningitis
> 80% mortality

later onset, 1-2 weeks postpartum = acquired soon after birth via ingestion or from birth canal or from hospital
bloodstream invasion causes meningitis
K1 capsule
antiphagocytic capsule on E. Coli that is necessary for tissue invasion

common in E. coli isolates involved in disseminated infections
vaccine for prevention of Hep A
inactivated HAV produced in human cells in culture
capsule expressed by Salmonella typhi that facilitates its survival in transit b/w macrophages in the human boodstream.
Vi
Listeria-caused nosocomial infection
neonatal meningitis
most common bacteria in gut
Bacteroides
HIV + pt with chorioretinitis. How do you treat it?
gancilovir
nonbloody diarrhea

stand up or sit down? (dz of decision)
Staph. aureus

onset within a few hours due to preformed exotoxin release
cause of mono
Epsetin-barr virus
fluorescent dermatophyte
microsporum
roseola (aka exanthem subitum) is cuased by what?
HHV-6

it is "sixth disease"
Which is worse: TSS caused by Staph or Strep?
Strep! This is a systemic dz wtih systemic toxemia.

TSS caused by Staph is a local infection with systemic toxemia.
Tx for primary HSV infection
acyclovir
Tx for herpes labialis
topical penciclovir
treatment for ocular HSV
trifluridine (topical)
valacyclovir/famcyclovir

treatment for what?
tx of long-term herpes to prevent recurrent infections

"He has genital herpes. She doesn't. He takes once a day Valtrex to help keep it that way."

also used to treat shingles
name the HACEK bacteria
H = Haemophilus
A = actinobacillus
C = cardiobacterium
E = eikenella
K = klingella
component of E coli likely responsible for sepsis sx
lipid a
Does E coli require O2?

Campylobacter?
E coli is a facultative anaerobe

Campylobacter is a microaerophile
fungus in the SW
blasto
beta hemolytic catalase negative bacteria
strep pyogenes