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108 Cards in this Set
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Systemic mycoses
4 fungi and where are they endemic |
1. histoplasmosis - Mississippi and Ohio River Valley
2. Blastomycosis - East of Mississippi and Central America Coccidioidomycosis - California, SW USA Paracoccidioidomycosis - Rural Latin America |
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Systemic mycoses
what disease do they all cause |
pneumonia, can disseminate
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Systemic mycoses
What are the forms of each fungi in soil and in the body |
dimorphic
mold in cold (20C), yeast in heat (37C) cocci is a spherule (not yeast) in tissue |
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Systemic mycoses
What disease can these infections mimic What is one differentiating factor |
can mimic TB (form granulomas)
Different from TB because no person-person transmission |
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Systemic mcoses
treatment for a local infection treatment for a systemic infection |
local = fluconazole or ketoconazole
systemic = amphotericin B |
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Patient from Ohio has pneumonia
you take a blood smear and see tiny organisms in macrophages that are smaller than RBCs dx? where did the disease come from? |
Histoplasmosis
"Histo Hides in macrophages" Comes from bird or bat droppings |
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Patient from Central America has pneumonia
-blood smear with broad based buds that are about the same size as RBCs dx? what can happen to this disease if it progresses? |
Blastomycosis
Can disseminate to skin and bones, form granulomatous nodules |
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After an earthquake, patients from California come in with pneumonia. Blood smear shows spherules filled with endospores, which are much bigger than RBCs
dx? Why do earthquakes increase the incidence? |
Coccidioidomycosis
Earthquakes throw dust up in the air |
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Mycoses associated with the San Joaquin valley or desert
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Coccidioidomycosis
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Patient from Latin America has pneumonia
-blood smear shows budding yeast with captain's wheel appearance (much larger than RBCs) dx? |
Paracoccidioidomycosis
PARAcoccidio PARAsails with the CAPTAIN'S WHEEL all the way to LATIN AMERICA |
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Patient has hypo/hyperpigmented patches on skin
KOH prep reveals "spaghetti and meatball" appearance a. disease - path b. organism c. treatment |
a. tinea versicolor - degradation of lipids --> acids that damage melanocytes
b. malassezia furfur - cutaneous mycoses c .topical miconazole, selenium sulfide (dandruff shampoo) |
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General symptom of cutaneous mucoses
what type of organisms cause these how would you diagnose |
Pruritic, red rings with central clearing
dermatophytes Mold hyphae on KOH prep |
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Tinea pedis, cruris (groin), corporis (ringworm), capitis
caused by what type of organisms? are these dimorphic? what do you see on KOH prep? |
dermatophytes
not dimorphic see mold hyphae on KOH |
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microsporum
Trichophyton Epidermophyton where do these infect? how do you treat |
dermatophytes, infect horny layer (1 layer deeper than cutaneous)
treat with topical azoles |
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microsporum
reservoir treat |
pets
topical azoles |
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Organism stains with silver stain, shows branched budding pseudohyphae at 20degrees
germ tube at 37 degrees dx. treat? |
candida
nystatin for superficial amphotericin B for serious systemic |
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candida infection - what can it cause
a. immunocompromised b. women taking antibiotics c. IVDU d. skin infections e. dissemination |
a. oral/esophageal thrush
b. vaginitis c. endocarditis d. diaper rash, chronic mucocutaneous candidiasis e. disseminated candidiasis (any organ) |
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What is one method for checking for disseminated candidiasis
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check retina for white, fluffy patches around red retina
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3 types of aspergillosis infection
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allergic bronchopulmonary aspergilosis (inhalation)
lung cavity aspergilloma invasive (immunocompromised) |
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Under microscope, you see mold with septate hyphae branching at 45 degrees
what organism? is it dimorphic? |
aspergillus
not dimorphic |
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patient has high IgE, bronchospasm, lots of eosinophils
sample produces mold that branches at acute angles dx? how did it get there/ |
allergic bronchopulmonary aspergillosis
inhalation of spores |
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toxin of aspergillus
what is it assocated with |
aflatoxin
associated with liver cancer |
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AIDS patient has meningitis
biopsy reveals soap bubble lesions dx. where is it found? |
cryptococcus
found in soil, pigeon droppings |
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under microscope, you see yeast with wide capsular halo, narrow-based unequal budding
a. dx --> what does it cause b. is it dimorphic c. how do you stain |
cryptococcus (meningitis in AIDS)
b. no c. India ink (for capsule) |
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fungus that grows on sabouraud's
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cryptococcus
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best method for diagnosing cryptococcus
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latex agglutination for capsular antigens
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Patient has headache, facial pain, black necrotic eschar on face, CN involvment
CT shows rhinocerebral and frontal lobe abscess what fungal infection? what would you expect to see under a microscope? |
mucormycosis
see nonseptate hyphae branching at obtuse angles |
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who is most at risk for mucormycosis infection
how does it proceed |
diabetic ketoacidotic or leukemic patients
fungi proliferates in blood vessels (high ketones and glucose) --> penetrates cribriform plate --> enters brain causes frontal and rhinocerebral abscesses |
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Most common opportunistic infection in AIDS patients
what does it look like under microscope |
Pneumocystis jiroveci
saucer shaped yeast form |
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AIDS patient has
-fever -non productive cough -Shortness of breath most likely diagnosis? when you do a biopsy, what stain should you use? How should you treat? |
Pneumocystitis jiroveci
Methenamine silver stain - see saucer shaped yeast Treat with TMP-SMX, pentamidine, dapsone |
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If your CD4 drops below 200 (HIV), what prophylaxis should you use to prevent opportunistic pneumonia
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Start prophylaxis TMP-SMX to prevent pneumocystis jirovecia infection
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Gardner is pricked by a thorn, gets ulcerative nodules along arm
organism? pathophys? treat? |
sporothrix schenckii
nodules follow path of draining lymhatics (ascending lymphangitis) treat with itraconazole or potassium iodide "plant a rose in a POT" (POTassium iodide) |
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cigar shaped yeast with unequal budding
typically seen in infections of gardners |
sporothrix schenckii
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Patient went camping, now has
-bloating -flatulence -fatty, foul-smelling stool the stool contains trophozoites or cysts that are pear shaped with an owl's eye nucleus (double nucleus) dx? how is it transmitted? treat? |
giardia lamblia infection
passed through cysts in water treat with metronidazole |
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Patient has bloody diarrhea (dysentary)
-liver abscess (reddish-brown) -RUQ pain histology shows flask shaped ulcers a. dx b. pathophysiology c. how do you diagnose definitively d. treat |
a. entamoeba histolytica
b. organism erodes intestinal mucosa c. serology, stool sample -see cysts with 4 nuclei or RBCs in the cytoplasm of trophozoite d. metronidazole or iodoquinol |
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AIDS patient has severe diarrhea
-stool sample shows acid fast cysts dx? |
cryptosporidium infection
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3 protozoa that cause GI infections
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Giardia
Entamoeba histolytica Cryptosporidium |
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3 protozoa that cause CNS infections
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-Toxoplasma gondii
-Naegleria fowleri -Trypanosoma brucei/gambiense/rhodesiense |
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2 protozoa that cause visceral infections
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Trypanosoma cruzi
Leishmania donovani |
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2 protozoa that cause hematologic infections
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Plasmodium (vivax/ovale/faciparum/malariae)
Babesia |
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1 protozoa that causes STD
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Trichomonas vaginalis
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difference between protozoa and helminths/worms
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protozoa = 1 cell
helminths/worms = multicellular |
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Type of organism and where do these all infect
-Enterobius vermicularis -Ascaris lumbricoides (roundworm) -Trichinella spiralis -Strongyloides stercoralis -Ancylosoma duodenale, Necator americanus |
Nematodes (roundworms) - intestine
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Type of organism and where do these all infect
-Dracunculus medinensis -Onchocerca volvulus -Loa loa -Wucheria bancrofti -toxocara canis |
Nematodes (roundworm) - tissue
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Type of organism
-taenia solium -Diphyllobothrium latum -Echinococcus granulosus |
Cestodes (tapeworm)
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Type of organism
-Schistosoma -Chonorchis sinensis -Paragonimus westermani |
Trematodes (flukes)
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Baby is born with
-chorioretinitis = vision loss, cotton patches on red retina -Hydrocephalus -Intracranial calcifications dx? How did the baby get this? |
Toxoplasma gondii
Cysts from meat or cats crossed placenta into baby |
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HIV patient has a brain abscess
-ring enhancing on CT/MRI -patient ate some bad meat dx? how do you diagnose? treat? |
toxoplasma gondii
serology, biopsy sulfadiazine + pyrimethamine |
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Most common CNS infection in HIV patients
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Toxoplasma gondii
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Patient swam in freshwater lake, now has nuchal rigidity, fever, headache, focal defecits
dx? how do you diagnose? course? |
meningoencephalitis from Naegleria fowleri
diagnose by finding ameoba in CSF death in 1 week |
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naelgleria fowleri
type of organism where do you get it from how do you treat |
amoeba
freshwater --> enters through cribriform plate no treatment (amphotericin has been effective for a few survivors) |
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Organism is transmitted by Tsetse fly, causes African Sleeping sickness
how do you diagnose? treat? |
Trypanosoma brucei
diagnose = blood smear treat: Suramin (blood-born disease), Melarsoprol for CNS penetration "it SURe is nice to sleep; MELAtonin helps with sleep" |
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Patient bitten by a fly gets
-enlarged LN -recurring fever progresses to somnolence, coma what disease? what treatment? |
African sleeping sickness due to Trypanosoma brucei
Blood symptoms = suramin CNS symptoms = melarsoprol |
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Patient lives in S. America, comes in with arrhythmias and lack of bowel movements
-on imaging you see cardiomyopathy, megaesophagus, megacolon what do you suspect? how do you proceed? how do you treat? |
Chagas disease from Trypanosoma cruzi
Do blood smear to see motile typomastigotes Nifurtimox |
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Organism that causes Chagas Disease
How is it transmitted |
Trypanosoma cruzi
Reduviid bug (kissing bug) |
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Patient has spiking fevers, hepatosplenomegaly, pancytopenia
on blood smear, you see amastigotes in macrophages (organisms lacking flagella) what is the organism? transmission? Treat? |
Visceral leishmaniasis from leishmania donovani
transmitted by sandfly treat with sodium stibogluconate |
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how does leismania donovani cause pancytopenia and splenoegaly?
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Invades reticuloendothelial cells (phagocytes) --> build up in spleen --> splenomegaly --> pancytopenia
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Patient bitten by mosquito, now experiences massive fever, headache, drenching sweats, anemia, and splenomegaly every
a. 48 hours b. daily c. 72 hours what are the organisms |
a. Plasmodium vivax/ovale
b. P. falciparum c. P. malariae |
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patient suffers from tertian malaria
how often do symptoms come? what is the organism? how do you treat? |
every 48 hours
Plasmodium vivax/ovale Treat with chloroquine, mefloquine if resistent add primaquine for dormant forms in liver |
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patient suffers from daily cycles of fever, drenching sweats, anemia, splenomegaly after being bitten by a fly in Africa
what should you see in blood smear in RBCs |
Plasmodium flaciparum
RBC shizont (cell with thousands of nuclei) with merozoites (membrane surrounding nuclei) RBC with trophozoite ring |
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Plasmodium vivax/ovale
how can they cause relapsing malaria throughout one's life how do you prevent |
dormant form in liver
preent with primaquine |
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what is cerebral malaria?
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P. falciparum --> RBCs with parasite occlude capillaries in brain
also kidneys and lungs |
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Organism associated with maltese cross and ring forms in RBC
how is it transmitted |
Babesia
Ixodes tick (like lyme disease) |
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Patient lives in NE USA
presents with -fever and hemolytic anemia blood smear reveals maltese cross formation dx. treat? |
bebesia infection
quinine, clindamycin |
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Sexually active female has foul smelling green discharge from vagina, with itching and burning
2 things on differential how can you differentiate |
gardnerella vaginalis = gram neg
trichomonas vaginalis = flagellated protozoan on wet mount |
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Patient has vaginitis caused by flagellated protozoan
how is it transmitted? How do you treat? |
sexual contact
metronidazole |
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After eating some food, you get abdominal pain, diarrhea, fever, and massive anal itching
how do you diagnose? how do you treat? |
Enterobius vermicularis
do scotch tape test treat with bendazoles or pyrantel pamoate "worms are BENDy, so treat with meBENDazole" |
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What is one nematode infection that does NOT cause an increase in eosinophils
why? |
Enterobius
because it stays in the intestine, does not spread |
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Patient from the tropics gets
-cough, pulmonary infiltrate -diarrhea, fever see eggs in feces dx? treat? |
Ascaris lumbricoides (roundworm)
treat with endazoles or pyrantel pamoate |
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Patient ate pork, now has fever, muscle ache, periorbital edema
muscle biopsy reveals encysted larva dx? treat? |
trichinella spiralis
bendazoles |
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Patient gets rash from soil penetrating skin between toes, gets vomiting, diarrhea, anemia
see larva in feces, NO EGGS dx? treat? |
strongyloides stercorals - larva in soil penetrates skin
bendazoles or ivermectin |
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Patient diarrhea, abdominal pain, wt. loss, and rash on skin of feet after soil gets in
+cough, pulm infiltrate see eggs in feces get Fe deficient anemia dx. path. treat. |
anclysotma duodenale, necatar americanus (hookworms)
enter skin via soil, to lungs, swallowed to GI, sucks blood from intestinal wall bendazoles or pyranted pamoate |
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How are tissue nematodes spread
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arthropods
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Patient gets guinea worm from drinking water --> skin inflammation and ulceration
organism treat |
dracunuculus medinensis
Niridazole |
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Pateint living near a river is bitten by a blackfly gets hyperpigmented skin --> lizard skin
becomes blind what is the organism? what is going on? what is one other clinical manifestation of this infection? |
onchocerca volvulus
black skin nodules and River blindness can also have an allergic reaction to microfilaria |
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Patient has black skin areas and blindness after being bitten by a female black fly
treat? |
onchocerca volvulus
IVERmectin (for rIVER blindness) |
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Patient has swelling skin and you can see a worm crawling in the conjunctiva
dx? how is it transmitted? treat? |
Loa loa
transmitted by deerfly, horsefly, or mangofly diethylcarbamazine |
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Patient in Africa gets huge swelling of legs and genitals
what is one nematode that can cause this and how? treat? |
wuchereria bancrofti --> blocks lymphatics --> elephantiasis
treat by diethylcarbamazine |
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Patient eats food, gets granulomas and visceral larva migrans
blindness as well dx? how did it transmit? treat? |
toxocara canis
food contaminated with eggs diethylcarbamazine |
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3 organisms treated with diethycarbamezine
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loa loa
wuchereria bancrofti toxocara canis |
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Patient ate pork, now has seizures, obstructive hydrocephalus, focal neuro
CT shows swiss cheese lesions dx? what do you see on blood sample? treat? |
neurocysteicerosis secondary to taenia solium
high eosinophils praziquantel, bendazoles for neurocysterosis |
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Ingestion of larvae in raw freshwater fish
causes vitamin B12 deficiency --> anemia dx. treat. |
diphyllobothrium latum
praziquantel |
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Cestode that causes hydatid cyst in liver
what happens if cysts releases it's antigens treat? |
echinococcus granulosus
anaphylaxis if cyst is released treat with bendazoles, ethanol before surgical removal to kill daughter cysts |
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1. dermatitis - swimmer's itch
2. fever, hives, cough, wt. loss, eosinophilia 3. chronic fibrosis around spleen and liver organism? host? treatment |
schistosoma
snails praziquantel |
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chronic infection with schistosoma haematobium can lead to what?
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squamous cell carcinoma of the bladder
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patient eats undercooked fish, now gets inflamed biliary tract --> pigmented gallstones, cholangiocarcinoma
dx? treat? |
clonorchis sinensis
praziquantel |
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patient eats undercooked crab meat, gets inflammation, hemoptysis
dx. treat |
paragnimus westermani
praziquantel |
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Ingested nematodes
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if you EAT these, you will get sick
Enterobius Ascaris Trichinella |
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Nematodes that enter by coming in through skin
common symptoms |
these get into your feet from the SANd
Strongyloides Ancylostoma Nectar all cause rash where they enter, anemia, intestinal infection |
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Parasites
Brain cysts, seizures |
Taenia solium (cysticercosis)
Cestode |
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Parasites
Liver cysts |
Echiococcus granulosus
Cestode |
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Parasites
B12 deficiency |
Diphyllobothrium latum
Cestode |
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Parasites
Biliary tract disease, cholangiocarcinoma |
Clonorchis sinensis
Trematode |
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Parasites
Hemoptysis |
Paragonimus westermani
Trematode |
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Parasites
Portal HTN |
Schistosoma mansoni
Trematode |
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Parasites
Hematuria, Bladder cancer (sq. cell carcinoma) |
Schistosoma haematobium
trematode |
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Parasites
Microcytic anemia |
Ancylosoma, Necator
Nematode |
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Parasites
Perianal pruritis |
Enterobius
Nematode |
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Causative agent
Typhoid fever |
salmonella typhi (bact)
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Causative agent
Typhus a. epidemic b. endemic c. scrub |
bacteria
a. Rickettsia prowazekii b. Rickettsia typhi c. Rickettsia tsutsugamushi |
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Causative agent
bacterial STD, trachoma |
Bacteria
Chlamydia trachomatis |
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Causative agent
a. syphillis b. yaws |
spirochete
a. treponema pallidum b. treponema pertenue |
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Protozoan cause of vaginitis
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Trichomonas vaginalis
STD, protozoa |
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Chagas' disease or African sleeping sickness
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protozoan
Trypanosoma Cruzi |
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TORCH infections
What do these cause? |
Toxoplasmosis
Other Rubella CMV HSV perinatal infections --> go to fetus |
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Nematode in undercooked meat
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Trichinella spiralis
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Tapeworm larvae in pork or eggs (neurocystercercosis) in food/water contaminated with human feces
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Taenia solium
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Disease if you eat Taenia solium larvae in undercooked pork
Disease if you eat Taenia solium eggs |
Intstinal infection
neurocysticercosis |
