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99 Cards in this Set
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IFN alpha
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anti-viral
produced by leukocytes involved in innate immune response rIFN-alpha used to treat anogenital warts (HPV 6 & 11) |
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HPV 6 & 11
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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) |
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HPV 16 & 18
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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 |
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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) |
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Parvoviridae
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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 |
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Diseases caused by Polyoma Virus
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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) |
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HPV vaccine
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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 |
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Chickenpox vs. Smallpox
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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) |
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Major congenital virus infection
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CMV
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Major Neonatal viral infections
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HSV-2
VZV |
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Neonatal Herpes
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results from a primary infection of the mother towards the end of pregnancy
verious serious neonatal dz |
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antiviral tx for
Herpes encephalitis (HSV 1 or 2, primary or secondary ix) & Neonal Herpes (HSV-2) |
IV acyclovir
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antiviral tx for Herpes Labialis
(2ary ix with HSV-1) |
penciclovir
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antiviral tx for Ocular Herpes
(manifestation of 1ary ix with HSV-1) |
topical trifluridine/ triflurothymidine
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Antiviral Tx for Recurrent Genital Herpes
(1ary or 2ary manifestation of HSV-2 ix) |
Prodrug form of acyclovir (valacyclovir) or famciclovir
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Sexually Transmitted Anogenital Lesions
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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) |
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What are the only licensed vaccines against human herpes viruses?
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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) |
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A mother gets varicella late in her pregnancy. What is the risk? What do you do?
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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 |
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Tx for Zoster
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zoster = 2ary ix with VZV
give oral famciclovir or valacyclovir |
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CMV Tx
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Gancyclovir, Valganciclovir
Alternative drugs: Foscarnet, Cidofovir Passive immunization with CMVIg in some cases |
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Sx of ix with Rotavirus vs. Norovirus
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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) |
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acute HBV Tx
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Lamuvidine = nucleoside analog (NRTI)
targets DNA dependent DNA Polymerase |
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acute HBC Tx
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Ribavirin
targets viral protease administer along with IFN-alpha |
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presence of anti-HBc alone
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indicates infection, NOT immunization
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+ Ab capture ELISA for HBs antigen
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current infection
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HBsAg & anti-HDV Ig = ?
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chronic infection with HBV & HDV
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Tx for chronic HCV
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Ribaviring & pegylated IFN gamma
PCR to monitor viral load (=effectiveness of tx, not infectivity) |
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Tx for chronic HBV
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Lamivudine (NRTI) +/- pegylated IFN gamma
monitor therapy with PCR to detect viral load (not a test for infectivity) |
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What causes "anhovy pastelike abscess in the liver?"
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hematogenous spread of Entamoeba histolytica from the GI
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What causes flask shaped necrotic ulcers in the GI tract?
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Entamoeba histolytica
Look for trophozoites (motile form) or cysts in stool |
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What is the cause of the most common diarrheal disease in the USA?
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Giardia lamblia
transmitted by contaminated H2O not killed by chlorine |
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You find a protozoa in the duodenum of a patient. What is it?
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Giardia lamblia = only portozoa that resides in duodenum
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Red kite-shaped intraluminal organisms
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Giardia lamblia
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only intestinal protozoan that doesn't produce cysts
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Dientomoeba fragilis
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Woman c/o itchy vag. Strawberry red mucosa with frothy exudates.
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Trichomonas vaginalis = sexually transmitted protozoan
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Pt with abdominla pain, diarrhea. Find acid-fast oocytes in stool & organisms in brush border on ilal mucosa on biopsy.
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Cryptosporidium parvum
= protozoan transmitted by fecal contamination of food or water chlorine won't kill it |
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pneumocysis is categorized as what type of organism
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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) |
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Pneumocystis pneumonia hits what patients?
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immunocompromised patients
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Pneumocystis carinii causes disease in whom?
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in animals--NOT in people
pneumocystis jirovecii cauess dz in humans |
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CXR reveals honeycomb infiltrates. Foamy film showing attack of fibrous, interstitial tissue.
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pneumonia caused by Pneumocystis jiroveci
immunocompromised host |
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What is the leading cause of pneumonia in AIDS patients?
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Pneumocystis jirovecii
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How do you detect Pneumocystis microscopically?
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Special stains:
fluorescence modified Ganza capaflor GMS |
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Which dermatophyte has no microconidia?
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Epidermophyton (macroconidia only)
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Keratinase
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enzyme secreted by dermatophytes
allows breakdown of keratin for nutrients |
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Which dermatophytes produce arthrospores & why are they significant?
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all of them: epidermophyton, microsporum, trichophyton
these are the most infectious thing produced by dermatophytes |
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Dermatophyte hyphae growth inside hair shaft, eventually breaking off hair to leave a black dot
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endothrix pattern of growth
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Exctothrix pattern of dermatophyte growth
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fungal hyphae grow on outer surface of hair
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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 |
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What is tinea capitis?
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dermatophyte infection of scalp hair & skin
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What is tinea cruris?
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dermatophyte infection of the groin
= jock itch |
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What is tinea unguium?
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onychomycosis = infection of nails, usually by dermatophytes
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What is White Piedra & what causes it?
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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 |
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Pt with black or dark brown fungal nodules on their hair shafts that adhere firmly. What is the infection called & what causes it?
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Black piedra = ix
caused by the NON-DERMATOPHYTE, Piedraia hortae |
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What is an important yeast pathogen that is very similar to Candida?
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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) |
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What is Tinea corporis & what causes it?
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ringworm
classic lesion with central clearing on trunk, arms, legs caused by dermatophytes (not worms), frequently of the Trichophyton variety |
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What causes granulomatous subcutaneous mycosis with draining sinus tracts extruding pigmented grains or granules?
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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. |
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Subcutaneous mycosis with cigar shaped YEAST cells. When cultured & grown at 25 C, they form filamentous fungi with hyaline hyphae.
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Sporothrix Schenckii
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Subcutaneous mycosis wiht sclerotic bodies (aka Medlar bodies or muriform cells) inside the lesions.
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Chromoblastomycosis.
cauliflower-like warty lesions |
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Phaeohyphomycosis spp.
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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 |
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Rose handler's diseaes
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subcutaneous mycosis caused by Sporthrix spp (aka Sporotrichosis)
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Cauliflower or wartlike lesions
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Chromoblastomycosis
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Lobomycosis
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lesions between skin and subcutanous tissue
nodular lesions that become verrucoid ulcerative with satellite lesions no growth on any agar media |
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Bacteria associated with IBD & diarrhea in kids 1-5 yo.
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ETBF = enterotoxin producing Bacteroides fragilis
an anaerobic pathogen |
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gram + cocci in human infection
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Peptostreptococcus
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HUS
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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. |
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watery diarrhea followed by bloody diarrhea. no pus in stool. no fever.
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EHEC = Enterohemorrhagic E. coli
shiga toxin producing bacteria remain adhered to intestinal wall, toxin enters bloodstream Example of Local infection with Systemic Toxemia |
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bloody diarrhea + fever and pus in stool
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dysentery caused by Shigella spp.
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Kid 5yo or younger gets EHEC. What is a potential complication?
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HUS
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Traveler's Diarrhea
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Enterotoxigenic E. Coli
may be as severe as cholera pathogenesis same as cholera |
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rapid lactose fermenters
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Escherichia
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Lactose non-fermenters
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Shigella
Salmonella |
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Contaminant of caesar salad, hollandaise sauce, ice cream
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Salmonella (Typhimurium, Enteritidis, etc.)
causes gastroenteritis after 12-48 hr incubation period |
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Reiter's Syndrome
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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 |
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2 Typhoid vaccines
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live attenuated S. Typhi strain Ty 21a
Purified Vi capsular polysaccharide |
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2 cholera vaccines
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oral live, attenuated strain of V. cholerae
killed cells + toxin B subunit |
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Guillain-Barre Syndrome
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autoimmune disorder of the PNS causing flaccid paralysis, often triggered by an antecedent infection
Campylobacter = most common etiology (can also trigger Reiter's Syndrome) |
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3 enetric gram negative bacilli that are curved or spiral shaped rods
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Vibrio
Campylobacter Helicobacter Vibrio related to E. coli & other Enterobacteriaceae Campylobacter & Helicobacter more distant taxonomically |
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3 bacteria transmitted transplacentally & the infections they cause in utero
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LISTERIA MONOCYTOGENES causes listeriosis
Treponema pallidum -- congenital syphilis Borrelia burgdorferi -- Lyme dz |
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Listeriosis in neonates
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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 |
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K1 capsule
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antiphagocytic capsule on E. Coli that is necessary for tissue invasion
common in E. coli isolates involved in disseminated infections |
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vaccine for prevention of Hep A
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inactivated HAV produced in human cells in culture
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capsule expressed by Salmonella typhi that facilitates its survival in transit b/w macrophages in the human boodstream.
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Vi
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Listeria-caused nosocomial infection
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neonatal meningitis
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most common bacteria in gut
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Bacteroides
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HIV + pt with chorioretinitis. How do you treat it?
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gancilovir
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nonbloody diarrhea
stand up or sit down? (dz of decision) |
Staph. aureus
onset within a few hours due to preformed exotoxin release |
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cause of mono
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Epsetin-barr virus
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fluorescent dermatophyte
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microsporum
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roseola (aka exanthem subitum) is cuased by what?
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HHV-6
it is "sixth disease" |
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Which is worse: TSS caused by Staph or Strep?
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Strep! This is a systemic dz wtih systemic toxemia.
TSS caused by Staph is a local infection with systemic toxemia. |
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Tx for primary HSV infection
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acyclovir
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Tx for herpes labialis
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topical penciclovir
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treatment for ocular HSV
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trifluridine (topical)
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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 |
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name the HACEK bacteria
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H = Haemophilus
A = actinobacillus C = cardiobacterium E = eikenella K = klingella |
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component of E coli likely responsible for sepsis sx
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lipid a
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Does E coli require O2?
Campylobacter? |
E coli is a facultative anaerobe
Campylobacter is a microaerophile |
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fungus in the SW
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blasto
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beta hemolytic catalase negative bacteria
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strep pyogenes
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