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187 Cards in this Set
- Front
- Back
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In older kids (age 5-15) ___ is the most common etiology for Pharyngitis, followed by the ____
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Streptococcus pyogene (Group A streptococcus), Mycoplasma pneumoniae
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Which two bacterial causes of Laryngitis are highly contagious
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Moraxella catarrhalis, Mycobacterium tuberculosis
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Which two fungi is common for allergic fungal sinusitis
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Aspergillus or Bipolaris
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The most common causes of otitis media are ___ and nontypable ___
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Streptococcus pneumoniae, Haemophilus influenzae
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3 bugs that are the major causes of atypical pneumonia
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Mycoplasma, Chlamydia and Legionella
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Walking pneumonia
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Mycoplasma pneumonia
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Patients with ___ can present with pneumonia with depressed cell-mediated immunity (generally owing to use of corticosteriods) and may manifest with fever, cough, and cavities or nodules in the lung (TB-like illness)
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Nocardia asteroides
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Adenovirus Shape?
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____ is a nonenveloped, double-stranded, linear DNA virus with an icosahedral nucleocapsid
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Where does Adenovirus replicates?
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nucleus of host cell
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How does Adenovirus survive outside enviroment?
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unusually stable to chemical or physical agents and adverse pH conditions
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Which serotypes of Adenovirus cause ARDS?
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4 and 7
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Which serotypes of Adenovirus cause Epidemic keratoconjunctivitis?
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8,19,37
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Which serotypes of Adenovirus cause Gastroenteritis?
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40 and 41
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Which serotypes of Adenovirus cause Acute hemorrhagic cystitis?
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11 and 21
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Tx of Adenovirus
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no specific antiviral therapy
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What are the alpha-herpesviruses?
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HSV-1, HSV-2 and VZV
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What are the beta-herpesviruses?
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CMV and HHV-6 and 7
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What are the gamma-herpesviruses?
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EBV and KSHV
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EBV has a oncogenic virus form that has tropism for ___ and is associated with ___ in Africa and ___ in Asia
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B lymphocyte, Burkitt lymphoma, nasopharyngeal carcinoma
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What serves as the basis of serologic diagnosis for Monospot test?
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heterophile antibodies for EBV
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Streptococcus pyogenes are __ negative and ___ sensitive in a diagnostic disc susceptibilty test
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catalase, bacitracin
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S. pyogenes is commonly known as ___ for the presence of the cell surface ___
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GABHS (group A B-hemolytic streptococcus), group A carbohydrate antigen
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Large ___ transmit S.pyogenes from person to person
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Respiratory droplets
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What is the major virulence factor of S.pyogenes and how does it work?
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M protein, antiphagocytic effect by interfering with opsonization via alternative complement pathway
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Tx of S.pyogenes
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Cephalosporins (PCN) for ten days to prevent ARF
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What are the 3 main other clinical features of the URI due to Streptococcus pyogenes
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Abscess (pyogenic complication), Scarlet fever (toxigenic complication), ARF and RHD (immunologic complication)
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Small, club-shaped Gram-positive bacteria with metachromatic granules. Noncapsulated, nonspore forming, nonmotile bacteria that grow on potassium tellurite. Catalase +
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Corynebacterium diphtheriae (diphtheria)
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A modified plate test on immunoprecipitation on agar can be performed to detect the toxigenic strain of ____
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Corynebacterium diphtheriae (diphtheria)
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How is C.diphtheriae transmitted
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Via exposure to upper respiratory droplets and direct contact with skin lesions
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The ____ of C. diphtheriae inhibits protein synthesis intracellulary by ADP-ribosylation of elongation factor 2
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A fragment
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After infection with C. diphtheriae, dense necrotic coagulum of organisms, epitherlial cells, fibrin, leukocytes, and erythrocytes forms, advances , and becomes a ____
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gray-brown adherent pseudomembrane
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Tx of C. diphtheriae
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diphtheria antitoxin to neutralize the effect of circulating exotoxin. Plus erythromycin. ThenDTP vaccine
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Family for Mumps the genome type
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Paramyxoviridae, nonsegmented, negative sense, single stranded RNA
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The appearance of ____ suggests a paramyxovirus
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multinucleated giant cells
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How is Mumps virus transmitted?
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Via exposure to respiratory secretions and direct contact with saliva
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The mumps virus infects and multiplies primarily in the __________
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epithelial cells of the oropharynx
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Postviremic invasion from the mumps virus occurs in the ___ and ____
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parotid and submaxillary glands
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Affected glands from the mumps virus show edema and necrosis with ____ and _____
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perivascular mononuclear and lymphocytic infiltrates
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Tx for Mumps Virus
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Management is supportive with analgesic for pain
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Preventation of Mumps virus
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Vaccine with Mumps-Measles-Rubella (MMR) consists of a live, attenuated viruses
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Paramyxovirus that has an enveloped virion with nonsegmented, negative sense, single stranded RNA genome.
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Parainfluenza Virus (PIV)
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What does the envelope of PIV contain
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hemagglutinin (H) and fusion protein (F)
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PIV infected cells produce ____ and can be detected by ____
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syncytica (cell-to-cell fusion), heme absorption.
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Transmission of PIV
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inhalation of infected respiratory droplets
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Why does PIV lead to hoarseness and the characteristic bark-like cough
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edema of vocal cords and subglottic larynax
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PIV causes mainly inflammatory changes in the ____
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superficial mucous membrane
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Tx of PIV
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no antivirals. Humidification, epinephrine via nebulizer, and glucocorticoids
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____ are small, nonmotile, aerobic Gram-negative rods. They are nutritionally fastidious bacteria requiring special growth medium for isolation
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Bordetella pertussis
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Transmission of B. pertussis
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respiratory route through contact with respiratory droplets
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How does B. Pertussis irreversibly inactivates the Gi-protein complex.
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Pertussis toxin via ADP ribosylations
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In a B. Pertussis infection, what is the result of ADP ribosylation
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prolonged stimulation of adenyl cyclase and aconsequent rise in cAMP which increases protein kinases activity
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Other then Pertussis toxin from B. Pertissus, what are the other two toxin and how do they work
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tracheal cytotoxin (a peptidoglycan fragment that kills ciliated cells) and hemolysin (which kills mucosal epithetial cells)
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Tx for Bordetella pertussis
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Supportive care, which includes suctioning to remove mucus and the use of pressurized oxygen. Macrolide (erthromycin)
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Prevention of B. Pertussis
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Acellular pertussis vaccine in combination with diphteria and tetanus tocoids (DTaP)
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_____ species are small, Gram-negative coccobacillary rods
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Haemophilus
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What is the difference in Para and non-para designated Haemophilus
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para require V factor (nicotinamide adnine dinucleotide) but not X factor (heme) for growth. Non para(H. Influenzae) needs either X and V or X only
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____ has a polyribitol phosphate capsule and in the past was the major (invasive) pathogen
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H. influenzae type b (Hib)
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Group 2 (unencapsulated) H. influenzae strains are referred to as ___
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nontypable H. influenzae (NTHi)
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Which H. Influenzae causes Otitis media/sinusitis
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NTHi and other non-type b
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Which H. Influenzae causes Epiglottitis
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Hib
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Which H. Influenzae causes Meningitis
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Hib
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Which H. Influenzae causes pneumonia primarily affecting children younger then 2 and unvaccinated? What about developing countries?
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Hib. 2. NTHi
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Transmission of H. Influenzae
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direct contact with respiratory droplets from a nasopharyngeal carrier
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In H.Influenzae, ___ allows these organism to colonize the respiratory mucosa
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IgA protease
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NTHi can cause AECB which is a condition associated with ____ sufficient to cause cough for 3months to 2 years or more
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excessive tracheobronial muscus production
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Tx of H. Influenzae
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Antibiotics such as macrolides (clarithromycin and azithromycin) and cephalosporins. For Hib, need 3rd gen cephalosporin such as cefotaxime or ceftriaxone
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Prevention for H. Influenzae
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none for NTHi. Hib vaccine (dramatic reduction in invasive disease in children (down meningitis)
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___ are Gram-positive, lancet-shaped diplococci. Catalase negative and optochin sensitive
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Streptococcus pneumoniae
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Growth of S. pneumoniae on conventional sheep blood agar yields _____
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Alpha-hemolytic colonies
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Which streptococci are alpha-hemolytic but Optochin resistant?
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Viridans
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What structure in the outer layer gives S.pneumoniae their 23 serotypes?
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capsular polysaccharide (CPS)
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____ is the most common cause of community-acquired pneumonia (CAP)
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S. pneumoniae
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5 multifactorial pathogenesis of Streptococcus Pneumoniae
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1. Upper airway colonization 2. aspiration into lower airway 3. failure of normal host defense 4. bacterial proliferation 5. inflammatory response (lung pathology)
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S. pneumoniae generate ___ that degrades IgA antibodies and favors mucosal colonization
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IgA protease
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S. pneumoniae's ___, a major virulence factor, has antiphagocytic properties
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polysaccharide capsule
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Pathology of lobar pneumonia progresses in the following four steps
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1. Congestion 2. Red hepatization 3. Gray hepatization 4. Resolution
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Pneumococcal pneumonia is a classic airspace infection, with ___ spreading rapidly within a lobe and through the pore of Kohn, until the entire lobe is consolidated
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intra-alveolar exudates
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Tx for Streptococcus pneumoniae (pneumococcal pneumonia)
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PCN. For CAP use 3rd gen cephalosporin (cefotaxime or ceftriaxone ) plus a macrolide or newer quinolone (levofloxacin or gatifloxiacin)
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Most common cause of meningitis in adults (19-65)
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S. Pneumoniae
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S. pneumoniae can cause what condition that is very common in young chilidren
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Acute otitis media
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Family is Entero-bacteriaceae. Short-plump, Gram-negative bacili. Lactose-fermenting, urease-positive, indole-negative. Non-motile and nonflagellated (no H antigen)
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Klebsiella pneumoniae
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Major virulence factor and is antiphagocytic for K. pneumoniae
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Prominent polysaccharide capsule (K antigen, 77 types)
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___ is associated with impaired host defenses in alcoholics
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K. Pneumoniae
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K. Pneumoniae possess a complex acidic ___ as the main determinant of virulence
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capsular polysaccharide (CPS)
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In K. Pneumoniae, what does CPS do?
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inhibits complement components, C3b, and causes antigenic mimicry. No MAC
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___ from bronchioles into adjacent alveoli that occur following Klebsiella infection of the lung causes bronchopneumonai (patchy opacity on CxR)
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Acute inflammatory infiltrates
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In K. Pneumoniae, what causes the blood-tinged sputum, what about cavity formation?
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1. endothelium damage 2. necrotic destruction of alveolar space
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Tx of Klebsiella pneumoniae. Problem with Tx
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Extended-spectrum PCN (piperacillin and ticarcillin), aminoglycosides, quinolones. Extended-spectrum Blactamases is increasing in Klebsiella
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___ are frequently involved in infection associated with respiratory tract manipulations
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Klebsielleae
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___ are the smallest free-living, self-replicating (.2 to 2um in diameter). Wall-less and do not react to Gram strain. 3-layer outer membrane contain cholesterol
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Mycoplasma pneumonia
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What are the 4 most important characteristics of atypical pneumonia
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1. nonproductive cough 2. variable CxR (patchy, diffuse) 3. no bacteria on smear 4. no response to B-lactam antibiotics
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Test for Mycoplasma pneumonia
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Microorganism-specific IgG antibody
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M. pneumoniae accounts for __ of community-acquired lower respiratory tract infections in adults
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15-20%
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Transmission of Mycoplasma pneumoniae
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person to person. Inhalation of aerosol particles or contact with respiratory secretions.
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What is the general risk group for Mycoplasma Pneumonia
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5-20 years (school age children to young adults). Crowded military and institutional setting
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M. Pneumoniae adherence leads to ___ resulting in a prolonged cough
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inhibition of ciliary movement
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M. Pneumoniae stimulates T and B lymphocytes, inducing the formation of ___
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IgM autoantibodies
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___, detected by agglutination of type O Rh-negative erythrocytes at 4C, may be present in the acute serum of M. Pneumoniae patients
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Cold Agglutinin
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Tx of Mycoplasma Pneumoniae
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erthromycin or doxycycline
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What extrapulmonary syndrome can M. Pneumonia cause
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Stevens-Johnson syndrome- rash in large areas of the body. Erythema multiforme
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___ are motile, flagellated, pleomorphic rods. Stain faintly with Gram Strain
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Legionella pneumonphila (legionellosis)
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Nutritionally fastidious, aerobic pathogen grows slowly in 3-7 days on selective (buffered charcoal yeast extracts) agar medium
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Legionella pneumonphila (legionellosis)
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Can Legionella pneumonphila (legionellosis) be transmitted person to person
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NO
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Main risk factors for Legionella pneumonphila (legionellosis)
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>50y/o, SMOKER, alcoholics, patients with COPD and malignancy, immunocompromised
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What in Legionella pneumonphila (legionellosis) allows it to penetrate the muscus layer in the lower respiratory epithelum
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Flagellated organism
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How does lung tissue get damage from a Legionella pneumonphila (legionellosis) infection
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cytokines and other reactive mediators form PMNs and T cells. Leads to patchy, diffuse infiltrates on CxR
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Tx for Legionella pneumonphila (legionellosis)
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Macrolide (erthromycin, azithromycin or CLARITHROMYCIN), newer quinolone (Levofloxacin or gatifloxacin) or doxycycline
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What are 2 consequences of Legionella pneumonphila (legionellosis) infection
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Legionnaires disease and Pontiac fever
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acute-onset, flu-like, non-pneumonaic illness, occurring within a few hours to two days from Legionella pneumonphila (legionellosis)
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Pontiac Disease
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___ has a single-stranded RNA genome with 8-segments pieces coding for 10 proteins. RNA has negative polarity
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Influenza virus
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___ occurs due to genetic reassortment that results in a complete change in the configuration of specific epitope on the surface of the influenza viron
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Antigenic Shift
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___ occurs when a point mutation results in a change in the configuration of a specific epitope
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Antigenic drift
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Transmission of Influenza Virus
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person to person from coughing and sneezing
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Influenza replicates in ___ cells and in other epithelial cells
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mucus-secreting ciliated
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___ liberated from damaged infiltrating leukocytes cause systemic symptoms of influenza
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Cytokines
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Tx of Influenza Virus. Difference in A and B
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Amantadine or Rimantadine (only for type A NOT type B). Neuraminidase inhibitors (Zanamivir and Oseltamivir) for both A and B
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___ is interstitial in location, with diffuse patchy inflammation localized to interstitial areas at alveolar walls
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Influenza viral pneumonia
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___ is a rare, often fatal childhood hepatoencephalopathy associated with ASA use in predominantly influenza B
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Reye Syndrome
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___is a member of the Paramyxoviridae family and include genus Pneumovirus. Enveloped, negative sense, single stranded RNA (nonsegmented)
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Respiratory syncytial virus (RSV) (bronchiolitis)
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Peak months for RSV. Age group most affect
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January and February. 2-6 months old
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___ is a result of inflammation of the terminal bronchioles, necrosis, and sloughing of the epithelial cells lining the bronchioles. Results in ___
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Bronchiolitis. Wheezing and hyperinflation
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Tx for RSV
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no specific antiviral therapy (Ribavirin was initially shown to be good, but not now)
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___ are acid-fast (reactive to auramine O fluorescence and Kinyoun acid-fast stains). Cell wall is 60% lipids and has long chain fatty acids called mycolic acis
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Mycobacterium tuberculosis
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What does M. tuberculosis grow on
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Lowenstein-Jensen agar
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Why does M. Tuberculosis grow in a parallel and serpentine pattern
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cord factor (6,6 trehalose dimycolate)
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Mycobacteria are __ that cause disease in oxygenated tissue such as the upper lobe of lungs
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obligate aerobes
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What is the hallmark of tuberculosis
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Granulomas
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What can be seen in a CxR that indicates a primary infection by Mycobacterium TB
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TB granulomas
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Key Th1 cytokines for controlling TB include __, __ and __
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IL-12, gamma-interferon and TNF
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The ___ of TB infections are latent.
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majority 90%
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Tx of Mycobacterium tuberculosis
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isoniazid (INH), rifampin (RIF), pyrazinamide (PZA) and ethambutol (EMB)
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In some high risk patients, untreated Mycobacterium TB infections disseminates to invade skeletal tissues, usually involving the midthoraic vertebral bodies, causing ___
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osteomyelitis (Pott disease)
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Has thin hyphae of even diameter (2 to 4um) that branch at V-shaped 45 degree angles. Not dimorphic
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Aspergillus fumigatus
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Transmission of Aspergillus fumigatus
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Inhalation of airborne conidia (spores)
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How does A. Fumigatus colonize the lower respiratory airways
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Adhesins
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Defect in phagocytosis of neutrophils owing to lack of NADPH oxidase activity
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chronic granulomatous disease
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How does A. Fumigatus cause endothelial damage causing hemoptysis
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Fungal hydrolases (serine protease or phospholipase) and toxic molecules (hemolysin)
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Tx of Aspergillus fumigatus
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Amphotericin B, Voriconazole
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Dimorphic Fungus. Mold form in soil but yeast in humans at 37C.Yeast is thin oval shape
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Histoplasma capsulatum
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H. capsulatum is endemic where?
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central and eastern US along Ohio and Mississippi river valleys
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H. Capsulatum grows in soil contaminated with __
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bat or bird droppings
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In H.capsulatum, when do the microconidia transform in the yeast
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after they bind to CD2/CD18 family of integrins and are engulfed by both neutrophils and macrophages
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Tx for Histoplasma capsulatum
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Self limited, Itraconazole for less severe manifestations in immunocompetent individuals. Amphotericin B for disseminated
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Dimorphic fungus that grows at room temp on Sabouraud agar as a white fluffy mold. Large yeast forms (10-12um) with broad-base budding
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Blastomyces dermatitidis (blastmycosis)
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Blastomycosis endemic in __
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Southeastern region of the US (states east of the Mississippi River)
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The tissue response to B. Dermatitidis is a combo of __ and __
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suppurative and granulomatous inflammation
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How does B. Dermatitidis show on the skin
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microabscesses in the papillary dermis. Often as verrucous skin lesions with pustular features
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Tx for Blastomyces dermatitidis
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Itraconazole. Amphotericin B if brain lesions
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Dimorphic fungus. In soil grows as mold with branching septate hyphae. Fragmented hyphae is called arthroconidia
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Coccidioides immitis (coccidioidomycosis)
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C immitis arthroconidia can reach the alveoli and transform into ___
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thick-walled, nonbudding spherules (can produces thousands of endospores)
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C. immitis is endemic in ___, ___
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southwestern US states, California (San Joaquin Valley = valley fever)
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C. immitis dissemination to skin causes characteristic ___ lesions
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erythema nodosum
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Tx of Coccidioides immitis
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Fluconazole or itraconazole for 3-6 months. Amphotericin B is required for severe pneumonia
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___ are filamentous (beaded) bacteria belonging to aerobic actinomycetes. Weakly Gram-postive and weakly postive on acid-fast stain. Grows slowly on antibiotic containing media
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Nocardia asteroides
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Who are high risk for getting Nocardia asteroides
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pt receiving cytotoxic or immunosuppressive drugs and pt with AIDS
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major mode of acquisition for Nocardia asteroides (nocariosis)
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Inhalation of contaminated dust from soil
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Nocardiosis skin inoculation presenting as chronic subcutaneous infection, characterized either by slow extenson along lymphatics or destruction of deeper tissues
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Madura Foot
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Lung pathology of Nocardiosis
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inflammatory endobronchial masses or diffuse pneumonitis and abscess. Can have CNS involvement
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TX of Norcardia asteroides
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Sulfonamides (trimethoprim/sulfamethoxazole)
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___ are filamentous, Gram-positive bacteria. Long, branching filaments that resemble hyphae of fungi. Nonspore forming. Non-acid fast and anaerobic
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Actinomyces israelii (thoracic actinomycosis)
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In Actinomyces israelii infected tissues, the organism often forms dense masses known as ___
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sulfur granules
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___ colonies form sulfur granules from a draining sinus are diagnostic of Actinomyces israelii
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Molar tooth
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Transmission of Actinomyces israelii
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Endogenous. Person with poor oral hygiene. Women who use IUD
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How does Actinomyces israelii cause infection
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Requires synergistic presence of other commensals.
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Tx of Actinomyces Israelii
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Iv PCN G followed by oral amoxicillin for 6-12 months
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Small (1-4um) trophic form and the 5-8um cyst, which has a thick cell wall and contains up to eight intracystic sporozoites
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Pneumocystis jiroveci (Pneumocystis pneumonia)
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P. jiroveci adhere avidly to __ and __ to type I pneymocytes
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fibronectin and glycoproteins
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How does HIV help P. jiroveci
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alters the mannose receptor-mediated binding and phagocytosis
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What is the histopathology characteristic of P. jiroveci
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foamy exudates developing in the alveoli and interstitial pathology (radiology reveals bilateral ground glass appearance)
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How does P. Jiroveci cause a ventilation/perfusion mismatch
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increased phospholipase activity and a deficiency of surfactant secrection by type II cells
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Tx for Pneumoncystis jiroveci
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TMP-SMX
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___ is a Gram-negative rod in the family of Psudomonadaceae. Actively motile single polar flagellum. Strictly aerobic bacteria are also nonfermentative and oxidase positive
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Pseudomonas aeruginosa
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P. aeruginosa strains are pigmented due to a ___
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water-souble pigment, pyocyanin (blue pus)
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P aeruginosa isolates obtained from respirtory secretions of CF patients have a ___ appearance, which is due to ___
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mucoid, alginate capsule
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Transmission of Pseudomonas aeruginosa
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ingestion of, or contact with, contaminated water or ice, aerosolization of contaminated liquids. Tomatoes.
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Early in life, the trachea becomes colonized with P. aeruginosa, mediated by __ and __ . The receptor is __
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Flagell and Pili. Sialic acid
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P. aeruginosa surface bound __ also serves as an adhesion for glycolipids on respiratory epithelial cells
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exoenzyme S
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What three secreted products does P. aeruginosa release that damages lung tissue
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elastase, exotoxin A and phospholipases.
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What does Exotoxin A do
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causes ADP-ribosylation of EF-2, resulting in inhibition of protein synthesis and ultimate cell death
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Tx of Psudomonas aeruginosa
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extended-spectrum PCN (piperacillin), cephalosporin (ceftazidime) or a carbapenem (imipenem)
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Gram-positive cocci, irregular grapelife clusters. Nonmotile, nonspore forming, and catalase positive.
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Staphylococcus Aureus
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The ability to ___ continues to be the most widely used and generally accepted criterion for id of S. Aureus.
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clot plasma (coagulase activity)
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Human ___ are the reservoir of S. Aureus
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nasal carriers, also on skin surface
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S. Aureus can cause pneumonia by either ____ or via the ____
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aspiration mode (after influenze) or hematogenous mode (illicit IV drug use)
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In patients with influenza, the virus destroys ___ allowing S. aureus to colonize in the lungs.
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ciliary defense
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the hallmark of staphylococcal infection is the __
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abscess
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Tx of Staphylococcus aureus
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IV antistaphylococcal PCN (NAFCILLIN) or vancomycin
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