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60 Cards in this Set
- Front
- Back
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Major causes of URTI
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Rhinitis - Mainly viruses
Pharyngitis/Tonsilitis - Virus (or 3 bacterial types) Peritonsilar/Retropharyngeal abscess - Mainly bacterial |
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Rhinitis
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Fever
Inflammatory edema of nasal mucosa Increased mucus secretion Nasal Obstruction |
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Pharyngitis/Tonsilitis
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Sore throat
Red, swollen pharynx Exudates or petechial hemorrhagic spots Vesicle and ulcers on the pharyngeal mucosa Pseudomembranes Enlarged tender anterior cervical lymph nodes |
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Stomatitis
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Multiple ulcers on oral mucosa extending to tongue and lips
Oral thrush in Candidiasis |
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Aphthous Stomatitis
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Single or multiple painful ulcers w/ irregular margin in the oral cavity
Recur in relation to stress, menses, local trauma and other non-specific stimuli |
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Noma or cancrum oris
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Severe gangrenous stomatitis progressing beyond the mucus membrane to involve soft tissue, skin, and sometimes bone
Occurs in malnutrition and immunocompromised conditions Etiological agents: Fusobacterium, Bacteroides, P. aeruginosa |
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Peritonsillar and Retrotonsilar abscesses
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Local pain
Fever Tonsillar asymmetry with one tonsil unusually displaced medially by the abscess Involvement of adjacent structures May rupture into pharynx Arises from complications in tonsillitis |
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Retropharyngeal or lateral pharyngeal abscesses
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Infants and children under 5 are most commonly affected
Complication of pharyngitis or perforation of pharyngeal wall Characterized by pain, dysphagia, change in phonation, extended neck Widening of space between cervical spine and posterior pharyngeal wall |
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General principles of management
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Viral - Symptomatic treatment
Bacterial S. Pyogenes - Penicillin C. Diphtheria - Antitoxin N. Gonorheae - Antibiotics Candidiasis - Antifungal Vincent's Angina - Systemic penicillin Apthous Stomatitis - no specific treatment Abscesses - Antimicrobials and/or surgical drainage |
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Common causes of MRTI
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Epiglottitis - Mostly BACTERIAL
Laryngitis - Mostly VIRAL |
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Epiglottitis
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Throat/neck pain
Fever Inspiratory stridor Muffled phonation or aphonia Dysphagia Acute airway obstruction |
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Laryngitis/Croup
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Localized to subglottic laryngeal structure
PARAINFLUENZA is the most common cause Fever Inspiratory stridor Hoarse phonation Harsh, barking cough Chest pain (Characteristic symptom) Aphonia |
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Bronchitis/Tracheobronchitis
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Ensues from extension of URTI
Cough Fever Sputum production Bubbling rhonchi |
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Chronic Bronchitis
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Not virally induced
Results from long-standing damage to bronchial epithelium Lack functional integrity Susceptible to infections Recurrent infection makes damage worse and increases susceptibility |
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Acute Bronchitis
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B. Pertusis is major bacteriologic consideration
Serology important for mycoplasma and Chlamydia |
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Major causes of LRTI
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Acute Pneumonia - S. Pneumonia
Chronic Pneumonia - Coccidio, Histo, Blasto, Crypto Lung abscess & Empynema - Usually bacterial |
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Acute Pneumonia
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Malaise
Fever Chill Cough Production of purulent sputum Dyspnea Rapid breathing Cyanosis Chest pain |
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Chronic pneumonia
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Slow insidious onset
Fever Chill Malaise Cough Loss of appetite Loss of weight Sleeplessness Night sweats Sputum production Dyspnea Chest pain |
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Empyema
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Purulent infection of the pleural space that develops
Contiguous spread from an infected lung Extension of an abdominal through the diaphragm Liver abscess |
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Lung Abscess
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Fever
Cough Foul smelling sputum |
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Streptococcal pyogenes
(Strep throat) |
Virulence factors
M-protein: breakdown of C3b opsonin Hyaluronic acid capsule: Inhibits phagocytosis -ase: breakdown tissue & spread infection Gram + cocci Sore throat Fever, malaise, headache Redness of throat White purulent patches on tonsils Enlarged cervical lymph nodes Penicillin is the first drug of choice |
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Strep pyogenes
(Scarlet Fever) |
Gram + cocci
Fever, lethargy, sore throat, sandpaper-like rash Strawberry tongue Pastia line (dark lines in creases) Children commonly affected Penicillin is the drug of choice |
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Acute rheumatic fever
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Complication of untreated S. pyogenes
Usually begins 3 weeks post-infection Fever, Joint pain, Chest pain, Nodules under the skin, Rash, Chorea JONES criteria (joints, heart, neuro, erythema, skin) Renal complications from acute glomerulonephritis 10 day course of penicillin (may need to give for 5 years or until 18) |
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Pneumococcal pneumonia
(Strep pneumonia) |
Gram + diplococci
VERY THICK CAPSULE (major virulence factor) Pneumolysin (virulence factor antigenically related to streptolysin O) Normal flora of URT Runny nose, congestion of chest, cough, fever, chest pain, sputum production, shallow and rapid breathing, dusky coloring Distinguished from S. viridans with Optochin test Penicillin, Macrolides, Sulphamethoxazole, Ketolides |
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Diphtheria
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ETI: Corynebacterium diphtheria (Gram + rod)
Non-motile, non-spore forming, "Chinese letter" formation Tinsdale agar used for growing (selective/differential K+ telluride medium) Humans primary reservoir Characteristic pseudomembrane on the tonsils VF: Exotoxin that inhibits protein synthesis of EF2 (A-B complex) Dx: Entirely clinical Immunization w/ toxoid Drugs: Penicillin or Erythromycin |
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H. Influenza pneumonia
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ETI: H. influenza (Gram - coccobacilli)
Labs: Chocolate agar (Hematin (factor X) and NAD (factor V)) VF: Type b capsule called polyribitol phosphate (PRP) Children 2> CNS infection Children >2 Resp infection Person to Person transmission Only capsule strains are invasive NO EXOTOXINS RAPID PROGRESSION is HALLMARK Tx: Conjugated vaccine, 3rd generation cephalosporin |
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Whooping cough
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ETI: B. Pertussis (Gram - rod)
Encapsulated and strictly aerobic LAB: BG agar EPI: classically kids disease, no seasonal pattern 3 stages: Catarrhal (most communicable), Paroxysmal, Convalescent VF: Pertussis toxin (AB toxin), Adenylate toxin, Tracheal toxin Paroxysmal cough leading to inspiratory whoop Tx: Vaccination, Erythromycin/Clathromycin |
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TB
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ETI: Mycobacterium tuberculosis (Acid fast rod)
Strictly aerobic, non-spore forming Mycolic acid and LAM are the lipid constituents EPI: Non-white, poor, elderly are most common. Outside US 7x more likely LAB: PPD test (Mantoeux) type IV hypersensitivity Causes granulomas w/ caseous necrosis, Gohn's complex (Initial lung infection plus lymphatic lesion) Can be dormant and reactivated Tx: 2 months of INH, Rifampin, Pyrazinamide, Ethambutol 4 months of just INH and Rifampin Irregular intake of drugs can cause resistant strains |
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Mycobacterium kansasii
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Urban people affected more
Photochromogenic (turns yellow in light) TB-like symptoms: Cavitary pulmonary disease, cervical lymphadenitis, and skin infections (MOST COMMON) PPD + May require surgical intervention |
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Mycobacterium avium-intracellulare Complex
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Disseminated infection MOST COMMON systemic bacterial infection in AIDS patients
Sx: Progressive weight loss, Intermittent fever, Chills, Night sweats, Diarrhea Prognosis is grave |
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Mycobacterium scrofulaceum
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Common cause of granulomatous cervical lymphadenitis in young children
Manifests as 1+ cervical lymph nodes w/ little or no pain PPD - Surgical excision |
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Diphtheria
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ETI: Corynebacterium diphtheria (Gram + rod)
Non-motile, non-spore forming, "Chinese letter" formation Tinsdale agar used for growing (selective/differential K+ telluride medium) Humans primary reservoir Characteristic pseudomembrane on the tonsils VF: Exotoxin that inhibits protein synthesis of EF2 (A-B complex) Dx: Entirely clinical Immunization w/ toxoid Drugs: Penicillin or Erythromycin |
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H. Influenza pneumonia
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ETI: H. influenza (Gram - coccobacilli)
Labs: Chocolate agar (Hematin (factor X) and NAD (factor V)) VF: Type b capsule called polyribitol phosphate (PRP) Children 2> CNS infection Children >2 Resp infection Person to Person transmission Only capsule strains are invasive NO EXOTOXINS RAPID PROGRESSION is HALLMARK Tx: Conjugated vaccine, 3rd generation cephalosporin |
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Whooping cough
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ETI: B. Pertussis (Gram - rod)
Encapsulated and strictly aerobic LAB: BG agar EPI: classically kids disease, no seasonal pattern 3 stages: Catarrhal (most communicable), Paroxysmal, Convalescent VF: Pertussis toxin (AB toxin), Adenylate toxin, Tracheal toxin Paroxysmal cough leading to inspiratory whoop Tx: Vaccination, Erythromycin/Clathromycin |
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TB
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ETI: Mycobacterium tuberculosis (Acid fast rod)
Strictly aerobic, non-spore forming Mycolic acid and LAM are the lipid constituents EPI: Non-white, poor, elderly are most common. Outside US 7x more likely LAB: PPD test (Mantoeux) type IV hypersensitivity Causes granulomas w/ caseous necrosis, Gohn's complex (Initial lung infection plus lymphatic lesion) Can be dormant and reactivated Tx: 2 months of INH, Rifampin, Pyrazinamide, Ethambutol 4 months of just INH and Rifampin Irregular intake of drugs can cause resistant strains |
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Mycobacterium kansasii
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Urban people affected more
Photochromogenic (turns yellow in light) TB-like symptoms: Cavitary pulmonary disease, cervical lymphadenitis, and skin infections (MOST COMMON) PPD + May require surgical intervention |
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Mycobacterium avium-intracellulare Complex
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Disseminated infection MOST COMMON systemic bacterial infection in AIDS patients
Sx: Progressive weight loss, Intermittent fever, Chills, Night sweats, Diarrhea Prognosis is grave |
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Mycobacterium scrofulaceum
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Common cause of granulomatous cervical lymphadenitis in young children
Manifests as 1+ cervical lymph nodes w/ little or no pain PPD - Surgical excision |
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Legionnaires Disease
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ETI: Legionella pneumonia (Gram -)
LAB: BCYE EPI: Immunocompromised NO person-to-person transmission (water systems of buildings) Infection confined to lungs VF: Porin and Macrophage invasion potentiator (to get into macrophages) Tx: Erythromycin Cell mediated immunity most important |
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Mycoplasmal pneumonia
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ETI: Mycoplasma pneumonia (Irregular shape because the lack cell wall)
LAB: Eaton's agar (Characteristic "fried egg" appearance in medium) EPI: Most common 5-15 yrs old Also known as "WALKING Pneumonia" Infectious for up to 4 months after Tx: Erythromycin and Tetracyclin (Azithromycin and quinolones also effective) |
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Klebsiella Pneumonia
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ETI: Klebsiella pneumonia (Gram - rod)
LAB: pink colonies on MacConkey agar (lactose fermentation) EPI: ALCOHOLICS and DIABETICS Often antimicrobial resistant because of transposons (transpose genes) Sx: RED GELATINOUS SPUTUM VF: Capsule Lung can be permanently damaged Tx: Resistant to PCN, must use Ciprofloxacin (Quinolones) |
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Pseudomonas
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ETI: Pseudomonas aeruginosa (Gram - rod)
Aerobic, non-spore forming, motile, facultative anerobe Produces colorful water soluble pigments VF: Exotoxin A- Inhibition of protein synthesis by inhibiting EF2, Exoenzyme S- ADP-ribosylates several intracellular proteins including the cytoskeleton filament vimentin, Elastase- Acts on elastin and collagen EPI: CF, Leukemia, Burns LAB: Hemolytic colonies on blood agar, FRUITY ODOR Tx: B-lactams (3rd generation cephlasporins, Carbapenem, Monobactams), Quinolones, Vaccine for high risk patients |
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Chlamydia pneumonia
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ETI: Chlamydia pneumonia
3 species (trachomatis, psittaci, pneumonia) Person-to-person secretions Most are asymptomatic (WALKING PNEUMONIA) LRTI involve a single lobe of the lung Can grow in smooth muscle cells and cause ATHEROSCLEROSIS Tx: Antibiotics for 10 days |
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Chlamydia psittaci
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ETI: Chlamydia psittai
EPI: People who handle birds Transmitted through respiratory secretions or dust from bird droppings Alveolar walls thicken d/t edema and cellular infiltration Tx: Macrolide and Tetracycline |
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Anthrax
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ETI: Bacillus anthracis (Long chains of rods)
Non-motile, Non-hemolytic, Spore forming, Saphrophyte LAB:Characteristic colony is rough, uneven surfaces that look like "Medusa head" EPI:Humans become infected through inhalation VF: poly-D-glutamyly capsule (invasive stage), pXO2 anthrax toxin (toxigenic stage) pXO1 toxin has 3 components: Factor I (edema factor), Factor II (protective antigen) used to make vaccine, Factor III (lethal factor) Tx: Vaccine for livestock, Rx: Penicillin, resistant strains get doxycycline or fluoroquinolone |
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Pneumonic plague
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ETI: Yersinia pestis (Gram - coccobacillary)
LAB: Bipolar staining "safety pin" Zoonotic: Xenopsylla cheopis VF: Yop (Inhibit 3 things: phagocytosis, production of inflammatory cytokines and chemokines, and platelet aggregation), PAI, F1 capsular protein, Plasminogen activating protease Rx: Streptomycin (DRUG of CHOICE) |
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Nocardia
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ETI: Nocardia astroides (Gram + rods) strictly aerobic
Form branched hyphae in tissue and culture LAB: Appear as Gram - with intracellular Gram + beads, Gives the smell of "WET DIRT" EPI: NOT person-to-person, Immunocompromised highly susceptible VF: No known virulence factor Rx: Sulfonamides |
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Rhodococcus
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ETI: Rhodococcus (Acid-fast)
LAB: Salmon-pink colonies on chocolate agar Opportunistic pathogen (facultative intracellular pathogen of macrophages) Radiology: Bilateral cavitation Rx: Systemic - Vancomycin, Imipenem, Aminoglycosides, Ciprofloxacin, Rifampin, Erythromycin. Localized - Erythromycin, Rifampin, Ciprofloxican |
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Rhinovirus
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ETI: Picornavirus (SS + RNA) non-enveloped
Attack ICAM-1 receptors INNATE and ADAPTIVE play important role EPI: Humas are only source of infection, Children more susceptible, Stress from any source doubles the chances of getting it Prevention: Wash hands Tx: Symptomatic |
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Adenovirus Pharyngitis
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ETI: Adenovirus (DS DNA) non-enveloped
EPI: Schoolchildren at anytime of year Route: Inhaled, Fecal-oral, Fomites Pharyngoconjunctival fever (CLASSICALLY associated w/ Adenovirus) VF: E3 (helps to evade MHC-1 molecules), E1A protein (increase epithelial susceptibility to TNF), Adenovirus death protein (efficient lysis of infected cells) Common Serotypes: 7a (pneumonia and PC fever), 19 (perussis-like illnessand conjuctivitis), 11 (hemorrhagic cystisis), 40/41 (gastroenteritis) Tx: Mostly self-limiting |
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Coronavirus
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ETI: Enveloped RNA virus
Petal/club shaped spike projecting from surface 3 types: 1 (common cold), 2 (enteric), 3 (SARS) transmitted rapidly through droplets |
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Influenza
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ETI: Orthomyxovirus (SS linear RNA) 8 SEGMENTS
VF: Neuraminidase (destroys receptor), Hemaglutinin (binds receptors) 3 Major Strains: A is most severe Pigs are "mixing vessel" because they contain both avian and human receptors Antigenic Drift - minor changes based on random mutations (Gradual) Antigenic Shift - Reassorment of viral genome (Sudden) Unusual manifestations: Reyes Syndrome - fatty infiltration of liver and cerebral edema Dx: Hemadsorption inhibition (infected cells) and Hemagglutination (extracellular virus) inhibition Tx: Vaccines Rx: Amantidine, Rimantidine, Zanamivir (neuraminidase inhibitor) |
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Parainfluenza
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ETI: Paramyxovirus (SS - RNA) Unsegemented
EPI: Causes serious disease in children Types: 1 (Major cause of CROUP) occurs in fall, 3 (Major cause of severe respiratory disease in infants) occurs in any season |
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Respiratory Syncytial Virus (RSV)
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ETI: Paramyovirus (SS - RNA) Unsegmented
VF: Virion is enveloped in F (fusion protein), G (Glycosylated) EPI: Infants/young children, peaks in mid-winter Rx: Palivizumab (monoclonal antibody) |
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Hantavirus
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ETI: Bunyavirus (SS - RNA) enveloped, 3 segments
EPI: Person to person transfer is rare, Inhaled dust and feces from rodents Large amounts of plasma leak into lungs and patients suffocate Radiology: Kerley B lines, pulmonary vascular congestion LAB: Large atypical lymphocytes combined w/ bandemia and dropping platelet count Management: Early aggressive intensive care, Early use of inotropic, Early ventilation, Careful monitoring |
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Pneumocystosis
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ETI: Pneumocystis jiroveci (carinii) member of Ascomycota
Structure: Cell walls lack ERGOSTEROL EPI: Immunocompromised patients LAB: Bronchoalveolar lavage and methenamine stain Rx: TSX Cell mediated immunity, macrophages, and CD4 T-cells are most important |
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Coccidioidomycosis
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ETI: Coccidioides immitis (Dimorphic fungi)
Fungus is found in a thick-walled spherical form in tissues EPI: Found in farmers in the southwest United States Rx: Amphotericin B and Flucanozole |
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Histoplasmosis
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ETI: Histoplasma capsulatum (Dimorphic fungi)
Tiny yeast that grows in macrophages Does not have capsule EPI: Mississippi and Ohio rivers Most cases are asymptomatic LAB: Typical conidia and dimorphism Tx: Amphotericin B and Itraconazole |
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Aspergillosis
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ETI: Aspergillosis fumigatus
LAB: Rapidly growing mold w/ branching hyphae, and characteristic conidia on conidiophore EPI: Pre-existing pulmonary disease or immunosuppression Rx: Amphotericin B and Itraconzole |
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Gram + and Gram - Cocci
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