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239 Cards in this Set
- Front
- Back
- 3rd side (hint)
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The ______________________ is the most commonly affected system.
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Respiratory System
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The respiratory is divided into 2 parts...
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upper and lower; based on structures and functions in each part.
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What is included in the upper respiratory tract, how severe are infections?
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Nasal cavity, sinuses, pharynx and larynx; infections fairly common and nothing more than an irritation
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What is included in the lower respiratory system, how severe are infections?
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Lungs and bronchi; infections are more dangerous and can be difficult to treat.
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Lower respiratory tract is essentially a ____________ environment.
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sterile
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How can water be a source of respiratory infections?
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LEGIONELLOSIS inhaled by WATER vapor/droplets
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FUNGI
victims most dangerous |
Especially for immunocompromised patients.
ASPERGILLUS (birds and mammals fungus) & PNEUMOCYTOSIS carinii |
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What pathogen is specific for the lung?
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Legionella
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What pathogen can infect multiple sites?
*what can travel from your pharynx to just about everywhere else in your laryngo/oro/naso-pharynx? |
STREPTOCOCCUS
as in STREP THROAT... middle ear infections, sinusitis, pneumonia |
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What are the 4 frequent sites of infection? MMNN
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Middle ear
Mastoid cavity Nasal sinuses Nasopharynx |
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What organ is the most important part of the respiratory tract and what can disable it?
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MUCO-CILIARY ESCALATOR
smoking, huffing and other exogenous agents |
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What can affect the diaphragm giving a common misdiagnosis of acid reflux?
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Hiatal hernia
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What is atypical pneumonia?
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Walking pneumonia
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What are 4 types of upper respiratory tract infections?
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1. Otitis media, mastoiditis and sinusitis 2. Pharyngitis 3. Scarlet fever 4. Diphtheria
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The middle ear, mastoid cavity and sinuses are connected to the _____________.
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Nasopharynx
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Sinus and Eustachean tube have __________ epithelial cells.
How does a virus invade? |
CILIATED
VIRUS destroys the ciliated cells allowing bacteria to invade. |
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Why is mastoiditis dangerous?
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Its proximity to the CNS and large blood vessels.
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CLASSIC Pharynx presentation?
Gram +/-? How is the bacteria soooo strong? |
Strep PYOGENES! (strep throat POSITIVELY sucks)
spherical Gram + M-PROTEINS (inhibit phagocytosis). PYOGENIC TOXINS (pharyngitis). |
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Group ___ streptococci can cause abscesses on the tonils.
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A
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SCARLET FEVER & TSS are caused by STREP __________ - both have pus pockets in throat as sx
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PYOGENES for scarlet and toxic shock because endotoxins go TOXIC!
Why? Because the toxins created by the bacteria-causing pustules go septic. PYOGENIC = PUS |
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SCARLET FEVER is caused by Group ____ streptococcus (which one is nasty and gives you pustules, infection, sepsis, shock?)
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Group A streptococci (STREP PYOGENES = PUS)
*(children under 18 y/o |
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symptoms of SCARLET fever initially and duration...
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RED/SCARLET RASH,
tiny bumps on chest and abdomen that can spread all over body and appear redder in armpits and groin. Lasts 2-5 days |
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SCARLET FEVER is caused by Strep PYOGENES (PUS)...describe the throat, body and fever (don't forget- 'fever' is in the name)!
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Very sore throat with yellow or white papules (PUS=PYOGENES)
Fever of 101F or higher (scarlet FEVER) Lymphadenopathy in neck Headache, body aches and nausea |
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DIPTHERIA bacteria
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is CORNY and stops protein synthesis
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~~~~~DIPTHERIA~~~~
Localized infection. PRESENTATION? |
PSEUDOMEMBRANE
severe pharyngitis George Washington |
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___________ can make diphtheria life threatening, why?
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Toxemia; can involve multiple organ systems and can cause acute myocarditis
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How is diphtheria transmitted? (3)
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Droplet aerosol, direct contact with skin, fomites (lesser degree)
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What are local effects of diphtheria?
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Epithelial cell necrosis Inflammation
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What is the diphtheria pseudomembrane made up of?
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fibrin, leukocytes, cell debris; size varies from small and localized to extensive an extensive membrane can cover the trachea
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Diphtheria can also be _________ causing acute _________.
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systemic; myocarditis
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How long does diphtheria take to incubate, how does it present and where can the pseudomembrane develop?
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2-4 days; pharyngitis or tonsillitis with fever, sore throat and malaise; On tonsils, uvula, soft palate or pharyngeal walls
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What is the difference in complicated and uncomplicated cases of diphtheria?
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Complicated cases are due to respiratory obstruction can result in suffocation. Uncomplicated cases resolve spontaneously.
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RHINOVIRUS elements
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50% are PICORNA viruses
My rhino loves picorna half the time. NON-enveloped, SINGLE-stranded, RNA |
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What does rhinovirus mostly cause and when is infection seen?
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Mild upper respiratory infections, known as the common cold. Seen throughout the year but major outbreaks in spring and early fall.
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What is the pathogenesis of rhinovirus?
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Incubation period is 2-3 days, acute symptoms can last 3-7 days. Infection is usually mild
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There are ___ TYPES of PARA-influenza.
They belong to the __________ group of single-stranded ENVELOPED ____ viruses. They contain ____and ____ spikes, but they are NOT TRUE influenza. |
4 types
PARA-MYXOVIRUS group single-stranded enveloped RNA viruses Contain H and N spikes but not true influenza. |
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INFLUENZA vs. PARA-influenza
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Parainfluenza replicates in the cytoplasm, it is faster, little mutation and not seasonal.
Influenza replicates IN the nucleus, SLOW & SEASONAL |
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Parainfluenza is a serious problem for what age groups and why?
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infants and small children; only transitory immunity to reinfection, infection becomes milder as the child ages.
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Once a cute croup of coughing kids went to school and...
TYPE 1 PARA-influenza onset and progression |
Onset may be abrupt.
1-3 days to involve the lower respiratory tract. Illness lasts b/w 4 and 21 days usually 7-10 |
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TYPE 1 PARA-influenza
*ONCE there was a cute croup of coughing kids in school Cause? When do outbreaks happen? |
ACUTE CROUP (laryngotracheitis) in children.
Once there was a cute croup of coughing kids in school Severe upper respiratory illness in all age groups. Outbreaks in fall: "back to school croup" |
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TYPE 3 PARA-influenza
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SEVERE LOWER RESPIRATORY INFECTIONS IN CHILDREN
Bronchitis and pneumonia in children under 1. Infections can occur throughout the year. 50% of all children are exposed in 1st year of life. |
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What are the 9 bacterial infections of the lower respiratory tract?
Quigley, Psit and Inhale the Perfume! Merry Ladies Beck & Call! |
Quigley, Psit and Inhale the Perfume!
Merry Ladies Beck & Call! Q-fever Psittacosis Inhalation anthrax Pertussus Mycobacterium pn. Legionella pn. Bacterial pn. Chlamydial pn. |
Bacterial Chlamydial Mycoplasma Legionella -4 pneumonias
TB Pertussus Inhalation anthrax Q-fever Psittacosis (ornithosis) Quigley, Psit and Inhale the Perfume! Merry Ladies Beck & Call! |
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SERIOUSLY evil LOWER respiratory infection...
Where do you get them (2 places)? Cause? |
BACTERIAL pneumonia
COMMUNITY ACQUIRED & NOCOSOMIAL (hospital) Variety of organisms |
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How long after HOSPITAL ADMISSION does (nocosomial) BACTERIAL pneumonia catch?
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48 hours after hospital admission.
S. AUREUS about your BACTERIAL pneumonia. What a NEGATIVE experience. |
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COMMUNITY-ACQUIRED pneumonia
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LOBAR pneumonia w/ PURULENT INFECTED SPUTUM
*just want you want the community to share - big, hocking infected loogies with lung lobe pain fever, chest pain |
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What is atypical pneumonia? What is its common name?
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DRY COUGH WALKING
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BACTERIAL pneumonia evil cause
*think: where does staph live? Where does strep live? Which one can go south into your lower respiratory? |
STREPTOCOCCUS PNEUMONIAE (Beta hemolytic)
Strep throat becomes bacterial pneumonia |
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What causes chlamydial pneumonia, when and where is it found, how spread and what can it cause?
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Chlamydia pneumoniae, throughout the year and world, spread person-to-person, infects the elderly and can cause both community acquired and nosocomial infections.
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CHLAMYDIAL pneumonia person has sx?
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DRY COUGH PHARYNGITIS (unlike chlamydia of the you-know-what!)
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MYCOPLASMA pneumonia presentation
MY COP WALKS THE BEAT |
WALKING PNEUMONIA!
Initial pharyngitis lasts 1-3 weeks replaced by persistent cough lasting weeks. |
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MYCOPLASMA PNEUMONIA.
Quigley, Psit and Inhale the Perfume~ ToBe @ Merry Ladies Beck & Call! |
NO CELL WALL!
DROPLET TRANSMISSION <100 pathogens TEMPERATE-URES above Mason-Dixon line |
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What is the incubation period of mycoplasma pneumonia, how is it onset and what areas are affected?
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b/w 2 and 15 days; insidious onset, fever, HA and malaise for 2-4 days then respiratory symptoms; trachea, bronchi, and bronchioles may extend to alveoli
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How long can MYCOPLASMA pneumonia be shed in upper respiratory secretions?
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2-8 days before symptoms appear, up to 14 FUCKING WEEKS after symptoms subside.
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MYCOPLASMA pneumonia
MY COP WALKS THE BEAT |
MY COP WALKS THE BEAT!
WALKING PNEUMONIA TRACHEO-BRONCHITIS fever, cough, HA and malaise; sometimes sore throat and otitis media (<10 y/o) |
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How many people are infected with TB, what has had a role in its increase?
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1.7 BILLION PEOPLE SERVED!
AIDS and HIV (increase efficiency of transmission cycle) poverty and poor socioeconomic conditions are breeding grounds. |
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What are some initial symptoms for TB?
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fever, fatigue, weight loss, chest pain, shortness of breath, congestion with coughing.
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What causes TB and what are some features?
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mycobacterium tuberculosis;
rod-shaped bacillus, acid-fast staining, non-spore forming, produces mycolic acid (waxy) protects from antibiotics and host defenses |
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What are the 2 types of TB?
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Primary: follows initial exposure to the pathogen.
Secondary (latent): can occur years later |
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Primary TB occurs when and what happens once in alveoli?
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When host encounters pathogen for 1st time. Localized inflammatory response develops, phagocytosis of bacilli by macrophages and PMNs
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You must Kill Bill the first time - THE PRIMARY TUBERCULOSIS PATHOGEN.
If you don't, where does he go in the body? What does the body do in response? If Kill Bill Primary TB gets you inside, he makes ___________ |
Primary TB RIDES the WBCs to regional LYMPH nodes and continue to divide intracellularly.
CELL-MEDIATED immune response begins. If primary lesion not contained, TUBERCLES (GET IT?) form anywhere |
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PRIMARY TB TUBERCLES
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Aggregates of enlarged MACROPHAGES filled with bacteria.
Can be surrounded by fibroblasts and lymphocytes, center of tubercle can undergo CASEOUS necrosis that may CALCIFY making readily visible on x-rays. |
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Most primary TB infections become __________ and __________.
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quiescent and asymptomatic
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Once ol' Kill Bill - PRIMARY TB rides the WBC's to your local lymph system, cell-mediated immune response kicks in. He puts TUBERCLES of TUBERCULOSIS anywhere he wants. Widespread tubercles everywhere finally blow their wads and end up in the jackpot, your _________.
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LUNGS
*MILIARY is the word for widespread *TB MENINGITIS happens, too. Great. |
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What can secondary TB be due to?
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ITSELF
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What happens if recurrence of secondary TB occurs?
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APICES OF LUNGS
,occurs w/in 2 years of primary infection, can evolve decades later when innate resistance is diminished. |
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TB drugs!!!! (3)
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INH
PZA RFP + ethambutol |
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DOT means what and what is it used for?
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Directly observed therapy; to prevent multi-drug resistant TB
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Directly observed therapy is administered by whom, why and what does it help prevent?
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By a health care worker who administers, observes and documents that patient received medication; prevents spread of TB and occurrence of multi-drug resistant TB
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What is another name for Pertussis, how is it spread and how contagious is it?
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WHOOPING COUGH
airborne droplets from ppl in early stages; highly contagious, infects 80-100% of exposed susceptible individuals, spreads rapidly in schools, hospitals, just about anywhere |
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What causes pertussis and what are symptoms similar to?
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BORDETELLA PERTUSSIS
GRAM NEGATIVE RESERVOIR IS HUMANS SIMILAR TO HAVING A COLD |
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Who has the highest mortality rate with pertussis, when did immunization begin and who is showing infections now?
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Infants under 1 y/o;
1940s; 10-20 y/o b/c of not being immunized. |
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What causes pertussis and what cells does it like?
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Bordetella Pertussis; ciliated bronchial epithelium
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BORDETELLA P E R T U S S I S
attaches to the T R A C H E A and destroys C I L I A T E D CELLS with a __________________ that destroys invaded cells. |
TRACHEAL TOXIN -specifically trachea!!
If Bordatella only likes cilia, then we know it won't go any further. No lung cells or deep body cells. 7-10 days. Out. |
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THREE STAGES OF PERTUSSIS
The cat paradox is a con! Come here, puss. which is most catching? |
CATARRHAL (most catching)
PAROXYSMAL CONVALESCENT |
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How long does the Catarrhal stage of pertussis last and what happens with it?
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1-2 weeks; persistent runny nose, sneezing, malaise, and anorexia.
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PAROXSYMAL PERTUSSIS STAGE
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SUDDEN CLASSIC WHOOPING SOUND!!!
2-4 WEEKS ENLARGED LYMPHOCYTES |
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What occurs in the convalescent stage of pertussis?
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Frequency and severity of coughing and other symptoms gradually decrease.
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PERTUSSIS COMPLICATIONS
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STREPTOCOCCUS PNEUMONAE SUPERINFECTION
, convulsions, subconjunctival and cerebral bleeding and anoxia |
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INHALATION ANTHRAX PRODUCES ___________PNEUMONIA
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FULMINATE pneumonia
(90% mortality); suddenly and with great severity, leads to respiratory failure and death |
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Anthrax is primarily a disease of _________, how is it acquired?
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herbivores; From spores found in pastures if inhaled can occur in respiratory tract.
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Who gets infected with inhalation anthrax and how does it present?
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BLACK BOIL disease in UNHEALTHY PEOPLE
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INHALATION ANTHRAX
germ? spore, cyst, capsule, envelope, what? |
BACILLIS ANTHRACIS
+ +++++++ROD (think Anthrax w/ a sideways cross for the X) SPORES! (the worst) ANTIPHAGOCYTIC CAPSULE; |
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The pathogenesis of inhalation anthraX is because of?
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powerful eXotoxin
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What are symptoms of pulmonary anthrax and what follows?
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1-5 days of non-specific malaise, mild fever, nonproductive cough; progressive respiratory distress and cyanosis, rapid and massive spread to the CNS and bloodstream is followed by death.
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What causes Legionella pneumonia?
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LEGONELLA PNEUMOPHILA
=====gram NEGATIVE======= cannot be grown under normal lab conditons |
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LEGIONELLA LIKES...
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FRESH WATER - IT IS TRANSMITTED BY WATER ONLY
ACANTHAMOEBA |
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Who is affected by legionella and at what percentage?
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Unhealthy/immunocompromised; less than 5% of population.
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LEGIONELLA
parasite type? exudate? |
FACULTATIVE INTRACELLULAR PARASITE
that attacks the lungs producing a necrotizing multifocal pneumonia; fibrin, PMNs and RBCs |
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What happens after LEGIONELLA enters the alveoli?
IT BUILDS A SHIELD FOR IT'S LEGION... |
INFECT DUST CELLS
produce endocytic vessel (A DOME OF PROTECTION)that continue replication and PREVENT FUSION OF VESICLE W/ LYSOSOME |
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How does a doctor see legionella is present and how does it look?
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BRONCHIAL LE'VAGE
COILED morphology |
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What does legionella cause and how does it progress?
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SEVERE TOXIC PNEUMONIA
SEEN ON X-RAY begins w/ myalgia and HA followed by rising fever, chills, chest pain, vomiting and diarrhea, confusion and delirium, infiltrates seen in lung on x-ray can cause hepatic dysfunction. |
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Serious cases of legionella progress in how many days and how does it end? What is the mortality rate?
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3-6 days, shock or respiratory failure; 15% can be as high as 50% in hospital outbreaks
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Q-FEVER
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UNGULATE RESERVOIRS for Q
CAROL BURNETT HAD A NEGATIVE GRAMMA a gram-neg, spore forming, grows well in animal placentas. |
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How does transmission of Q fever occur?
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UNGULATES ARE COWS, REMEMBER:
Can be transmitted by inhalation during animal births and by ingestion of unpasteurized milk. |
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What is the pathogenesis of Q fever?
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Begins 9-20 days after inhalation, abrupt onset of chills, fever and HA, can also be a mild hacking cough and some cases show abnormal liver function.
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PSITTACOSIS
A bird pissed at the zoo and I breathed it in, too. |
ZOONOTIC pneumonia;
INHALATION OF BIRD PISS/feces of CHALMYDIA psittaci |
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How does Psittacosis present?
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Acute infection of the lower respiratory tract, acute fever, HA, malaise, myalgia, dry cough and bilateral pneumonia; Systemic complications include BIRD PISS FEVER TO:
MYOCARDITIS ENDOCARDITIS HEPATITIS |
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75-80% of all acute respiratory infections are _______ in origin. How many do each person have per year and how does incidence vary?
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VIRAL (acute respiratory infections are VIRAL)
3-4 a year kids mostly |
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CAUSES of majority of ACUTE VIRAL RESPIRATORY infections of LOWER respiratory?
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RSVP INFLUENZA!
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INFLUENZA is an _____________; which means what?
"It's perfect for mailing!" |
ORTHOMYOX- VIRUS "It's perfect for mailing!"
virions are surrounded by an envelope |
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How is the genome of influenza shaped and what are the serotypes?
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Single-stranded RNA in 8 segments; 3 major serotypes A, B and C. Differences are based on how the antigens are associated with the nucleoprotein.
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HUMAN INFLUENZA + _________ VIRUS (from BIRDS) = PATHOGEN FROM HELL
USES BIRD RESERVOIR, HUMAN HOST |
AVIAN ---ESPECIALLY AQUATIC BIRDS
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What is the primary manifestation of influenza, since when have outbreaks been described and what is most common method of spread?
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RESPIRATORY
DROPLET 1500's, |
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How often does a major outbreak of influenza occur, how long does it last, how many affected what groups show high illness rates?
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every 2-3 years; 3-6 weeks; up to 10% affected, exceed 30% in school aged children and residents of closed institutions.
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With influenza viral destruction of tissues causes ______ and respriatory epithelium takes how long to be restored?
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Inflammation; 2-10 weeks
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What can result in superinfection by influenza bacteria?
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Impaired phagocytic and chemotactic responsses.
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ACUTE INFLUENZA SYNDROME
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~2 days, symptoms in a few hours: fever, MYALGIA, HA and occasional shaking chills. Maximum severity appears in 6-12 hours NON-PRODUCTIVE COUGH.
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ACUTE PNEUMONIA CAN KILL YOU. HOW?
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3-5 days; usually followed by improvement but a progressive infection can develop. This affects the TRACHEOBRONCHIAL TREE and lungs, lethal pneumonia can occur.
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What is a serious complication of influenza, what does it involve and when can it occur? How is it identified?
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IF THEY SUDDENLY GET WORSE DURING CONVALESCENT STAGE
LUNGS FOR SUPERINFECTION |
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What 3 bacteria are common causes of influenza superinfection?
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Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus
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In what 3 ways can influenza cause death?
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UNDERLYING DISEASE
SUPERINFECTION DIRECT RAPID PROGRESSION (OVERWHELMENT/ASPHYXIA) |
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What are the 2 approaches to influenza treatment and what is the best?
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Symptomatic care and anticipation of potential complications; rest and fluid intake, conservative use of analgesics for myalgia and HA, cough suppressants.
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When are amantidine and rimantadine useful for influenza treatment?
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Only if the infection is diagnosed w/in 12-24 hours.
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How was Respiratory SYN-CYT-IAL Virus (RSV) named?
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SYN-CYT-IAL
to SYNthesize or bring together cells to form CYToplam |
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When do community outbreaks of RSV occur, how long do they last and who can it involve?
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Annually in late fall to early spring; 8-12 weeks; 50% of families with small children
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MAJOR CAUSE OF NOSOCOMIAL INFECTIONS
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RSV
that big old lung plug of fibrin and mucuous because of giant ass synctial cells of CYTOPLASM coagulating in the bronchi from infants for up to 7 days shedding Wash hands No respiratory infected people in hospital DUH! |
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Where does RSV have major pathological consequences and what does it cause?
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Bronchi, bronchioles and alveoli; Necrosis, interstitial mononuclear cell infiltration and inflammation, can result in the plugging of small airways with mucus, necrotic cells and fibrin.
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What is the incubation time of RSV, what are the clinical signs?
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2-4 days followed by onset of rhinitis and severity peaks w/in 3 days; hyperexpansion, hypoxia, hypercapnia, pulmonary collapse
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How long do acute signs of RSV last, who is the infection mild with and with whom is it fatal and why?
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10-14 days;
older children and adults; infants, fatality rate is 1% but in compromised children can get up to 15% |
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What does the Hantavirus cause, what is the most common type and what are infections associated with?
GOTCHA HANDS FULL WITH THAT NO-NAME RAT VIRUS |
HANTA:
FULMINATE repiratory/SIN NOMBRE/RODENTS GOTCHA HANDS FULL WITH THAT NO-NAME RAT VIRUS |
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How is Hantavirus transmitted?
GOTCHA HANDS FULL OF THEM NO-NAME RAT DROPPINGS |
Via dried rodent excreta: by inhalation, conjunctival route, direct contact through breaks in skin.
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What 2 factors govern the incidence and spread of fungal infection?
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UBIQUITY & ADAPTIVE IMMUNE RESPONSE
Ubiquity of the infectious organisms: found in soil, resident flora and The adaptive immune response: usually keeps infections under control, immunocompromised at greater risk. |
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Pneumocystis pneumonia is common in what population and what is it caused by?
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AIDS patients; Pneumocystis (carinii) jiroveci: never grown in culture and info. comes from clinical info. from patients.
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What are the principal manifestations of Pneumocystis pneumonia infection?
WHY DOES FUNGUS PRODUCE A DRY COUGH? |
Progressive dyspnea, TRACHEAL PNEUMONIA, eventual cyanosis and hypoxia, nonproductive cough in 50% of patients
FUNGUS CANNOT BE EXPRESSED AS LIQUID (FUNGUS BALLS) |
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What do x-rays show in pneumocystis pneumonia and what does it cause?
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Alveolar infiltrates spreading out from the hila, causes decreased O2 capability, decreased saturation of arterial blood, decreased vital capacity, death occurs through progressive asphyxiation. (Can become systemic with lesions in other areas)
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What causes blastomycosis, where can the spores enter, what and who does it affect?
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blastomyces DERMATIDIS (SKIN & BONES & GU SYSTEM);
ENTERS VIA LUNGS MEN 20-40 respiratory system; lungs but can spread through blood and affect other parts and men b/w 20 and 40 |
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Blastomycosis infection of the lungs is _________. What are other symptoms?
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gradual; fever, chills and drenching sweats develop, chest pain, difficulty breathing and cough may also develop, can sometimes heal w/o treatment.
BLASTS W/ MYCOSIS: SKIN & BONES & GENITOURINARY |
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BLASTOMYCOSIS (3) areas of affect
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SKIN/BONES/GENITOURINARY = BLASTED W/ MYCOSIS
SKIN: warty patches develop surrounded by tinY painless abscesses BONES painful swellings GENITOURINARY tract: prostatitis or painful swelling of epididymis |
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HISTOPLASMOSIS __________ (kind of covering: envelope or capsule?)
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Histoplasma capsulatum;
BAT/BIRD GUANO-CONTAMINATED SOIL |
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How does transmission of histoplasmosis occur and what are symptoms? think CONures
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INHALE CONIDA (MICROCONIDA if alveolar)
small enough to reach bronchioles and alveoli and b/c of size referred to as microconidia. Most cases asymptomatic but some present w/ fever and mild cough. |
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A majority of HISTOPLASMOSIS (BIRD/BAT GUANO IN SOIL) cases never go further than ________ formation, what can severe cases develop?
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TUBERCLE
chills, malaise, chest pain and extensive LUNG infiltration. |
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What causes coccidioidomycosis, what is the symptomatic form known as and what is it restricted to?
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Coccidioides IMMITIS
VALLEY FEVER certain geographical areas (generally western U.S.). |
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Over half of people infected with coccidioidomycosis show no signs of infection, how do those with valley fever present?
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malaise, cough, chest pain, fever and athralgia; all signs occur 1-3 weeks after infection begins and can last up to 6 weeks.
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What percentage of patients infected with coccidioidomycosis (Caughtcha dying in the desert) experience pulmonary symptoms,
disseminated form is seen with whom and what else can it cause? |
10%;
pt's with AIDS and on immunosuppressive therapy; coccidioidal meningitis |
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Aspergillosis is typically seen in whom and shows a rapid progression to what?
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The immunocompromised, leukemia or AIDS, bone marrow transplants and pt's with pulmonary disease; death.
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What causes apergillosis, how is it dispersed and where is it seen more frequently?
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Aspergillus; inhalation of resistant C0NIDA nosocomial infections associated with AC systems.
CONIDA: HISTOPLASMOSIS & ASPERGILLUS |
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ASPERGILLUS IN LUNG TISSUES CAUSES...
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penetration of blood vessels which causes HEMOPTYSIS AND ACUTE PNEUMONIA
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MORTALITY RATE FOR ASPERGILLOSIS FUNGAL INFECTION OF LUNGS
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100%
multifocal pulmonary infiltrates and high fever; grave; 100% |
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Infections in the blood easily become _______ and these infections can do what?
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systemic; can have devastating effects on the patient
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What are the 4 classifications of blood infections?
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1. Bacteremia 2. Viremia 3. Fungemia 4. Parasitemia
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What 2 syndromes from pathogenic organisms growing in the blood can occur?
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1. Sepsis 2. Septic shock
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INTRAVASCULAR INFECTIONS...
CAUSED BY? |
BACTERIA, sometimes FUNGI, damage to HEART
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What are 3 types of intravascular infections?
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1. Endocarditis: infection of the heart 2. Thrombophlebitis: infection of the veins 3. Endoarteritis: infection of the arteries
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What does infectious endocarditis affect?
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Heart valves and can also develop on the septa of the heart and cardiac shunts.
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With infectious endocarditis, circulating pathogens adhere to the fibrin and platelets, what can occur as a result? (3)
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Mature vegetation protects the pathogens from host defense, also helps keep out antibiotics. Causes alterations in cardiac endothelium -> obstructs blood flow and increases turbulence. Turbulence can cause parts of vegetation to fall off -> embolus
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TRANSIENT bacteremia is common after some medical procedures which is usually what and why?
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Of no clinical importance, organisms involved have low levels of virulence but can colonize the HEART VALVE if endothelium altered.
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What organisms are associated with infectious ENDOCARDITIS?
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Streptococcus viridians Enterococci Other streptococci Coagulase NEGATIVE staphylococcus
GRAM NEGATIVE BACILLI (<-result from medical procedure all rest normal flora) |
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IV LINE & CATHETER INFECTI0N
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BACTEREMIA - SKIN BACTERIA THAT GETS IN BLOOD VIA INTRAVENOUS PUNCTURE OR CATHETER
increase the chance of endocarditis and distal infections. |
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What species are commonly involved in IV and catheter bacteremia?
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S. epidermis OKAY,
S. aureus BAD, Cornyebacterium DIPTHERIA |
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If IV fluid becomes contaminated what is involved?
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NEGATIVE RODS
such as PSEUDOMONAS (BURN VICTIM PATHOGEN) |
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What do most bacteremias result from, where do the organisms move from there?
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An extravascular infection; from infected tissue to lymphatics most are caught here but w/ overwhelming numbers some make it into the blood.
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What are the 3 most common sources of bacteremia with extravascular infection?
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1. UTIs 2. Respiratory infections 3. Skin infections
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Sepsis and septic shock result from what?
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Progression of bacteremia. Gram-positive and gram-negative bacteria can be responsible, fungi, protozoa and viruses can also be the cause.
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What is sepsis?
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An infection which causes a host response including fever, chills and tachycardia (increased HR).
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What are 5 bacterial infections of the blood?
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1. Plague 2. Tularemia 3. Brucellosis 4. Lyme disease 5. Relapsing fever
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How is plague transmitted to humans, what makes it distinct and how does it spread?
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Vector transmission, most explosively virulent bacterial infection and spreads from lymph nodes to blood where it can move on to the lungs. AKA pneumonic plague
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What bacterium causes the plague?
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Yersinia pestis
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In what 2 forms does plague exist?
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Sylvatic: seen in wild rodents Urban: seen in cities Urban form more infectious b/c more potential hosts
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Bite of the infected flea causes ____________ which is normally not ____________. What form is?
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Bubonic plague; contagious. Bacteremia can spread to lungs where pneumonic form develops and this is very contagious.
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What is the pathogenesis of plague?
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Bacteria multiply rapidly in lymph nodes, producing a bubo (swelling) and from there bacteria can rapidly spread to the blood.
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What is the incubation period of plague and w/o treatment what can patients develop?
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2-7 days,
BACTERICEMIA LUNGS...SHOCK...DEATH |
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What is tularemia?
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FRANK CELLA'S HUNTING TRIP = TULAREMIA
ULCER > SEROSA > PAINLESS GRANULOMAS LOW INFECTIOUS DOSE ...GOOD BIOTERRORISM WEAPON WILD ANIMAL INFECTION |
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TULAREMIA caused by?
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FRANK CELLA'S HUNTING TRIP
that is fastidious and can take up to 10 days to incubate. BIOWEAPON |
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Tularemia has a _______ ID50. FRANK CELLA'S HUNTING TRIP = TULAREMIA
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SMALL INFECTIOUS DOSE NEEDED - THAT'S WHY IT WOULD MAKE A GOOD BIOTERRORISM WEAPON; inhalation, tick bite, ingestion of contaminated meat or water or direct contact with abrasion or cut.
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Where can tularemia be found?
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NORTHERN HEMISPHERE
FRANK CELLA'S HUNTING TRIP= TULAREMAI |
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What forms at an infection site with tularemia?
FRANK CELLA'S HUNTING TRIP = TULAREMIA |
ULCER > SEROSA > GRANULOMAS (good bioterrorism weapon)
, organisms move into organs of the mononuclear phagocytic (likes serosal tissue) system and form granulomas |
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What occurs with ulceroglandular tularemia?
FRANK CELLA'S HUNTING TRIP = TULAREMIA |
Causes localized papule at inoculation site, becomes ulcerated and necrotic, leads to swelling of regional lymph nodes and very painful.
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What is oculoglandular tularemia?
FRANK CELLA'S HUNTING TRIP = TULAREMIA (ULCERS>SEROSA>GRANULOMAS...DEATH...SMALL INFECTIOUS DOSE) |
Infection acquired through the eyes that produces a painful and purulent conjunctivitis.
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HOW DOES FRANK CELLA THE HUNTER DEVELOP TYPHOID TULAREMIA?
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BY EATING A BEAR!!! Ingesting a large number of Francisella bacilli, presents with symptoms similar to typhoid fever
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BRUCELLOSIS can last for YEARS!!!!
fever 102 degrees and? |
ZOONOTIC -UNPASTEURIZED MILK & RAW FOOD
REPRODUCTIVE TRACT CYCLING NIGHT SWEATS |
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How is brucellosis transmitted and what type of illness does it produce?
BRUCELLOSIS IS UNDULATING UNGULATE FEVER |
Occupational contact or ingesting contaminated animal products; chronic illness in humans that can last for weeks or months and causes fever, night sweats and weight loss. Has a cyclic pattern of symptoms (undulant fever).
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How does brucella enter the host?
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cuts in the skin, contact with mucous membranes, inhalation and ingestion.
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What are symptoms of brucellosis?
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Malaise, chills and fever occur for 7-21 days after infection with drenching night sweats; Nocturnal fevers can last for weeks, months or years other symptoms include HA, body aches and weight loss.
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What type of tick transmits lyme disease and what causes it?
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Ixodes tick; spirochete Borrelia burgdorferi which is gram-neg. has similar properties to Treponema pallidum.
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B. burgdorferi has at least __ subspecies that are localized how?
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10; geographically
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Lyme disease is ENDEMIC in what areas and what is the primary RESERVOIR for B. burgdorferi?
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U.S. and Canada and temperate areas of Europe and Asia;
MICE!!!! |
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How does B. burgdorferi LYME'S DISEASE go through its life cycle?
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DEER - MICE - TICK - DEER
DEER host final stages, fall from deer & lay eggs in soil, eggs hatch and larvae seek out MICE for blood meals, BACTERIUM OF BERGDORFI picked up from mice and remains w/ TICK larvae mature and parasitize deer. |
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How is acute lyme disease characterized?
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Fever, migratory bull's eye rash, muscular and joint pain, often meningeal irritation
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How is chronic lyme disease characterized?
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MENINGIOENCEPHALITIS
MYOCARDITIS DISABLING recurrent !ARTHRITIS (LARGE JOINTS, KNEES) |
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Both acute and chronic forms of lyme disease are highly __________ and lyme is rarely ________.
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variable; fatal Involve multiple body systems, s/s have overlapping patterns that come and go. If untreated source of chronic ill health.
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When the ring of the bull's eye from lyme disease expands it forms what and is accompanied by what?
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erythema migrans lesion, accompanied by fever, myalgia, HA and joint pain. If untreated skin lesions can disappear while the other symptoms can persist for months.
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When does the secondary infection stage begin with lyme disease and what is involved?
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Days, weeks or months later. CNS involvement can give meningitis, Bell's palsy and peripheral n. destruction. Cardiovascular involvement can lead to myocarditis and heart enlargement.
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When can neurologic and cardiovascular symptoms associated with lyme disease resolve?
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spontaneously in a matter of weeks
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How soon can arthritic symptoms arise with lyme disease and what does it mark?
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Weeks to years after initial onset of the infection. Marks continuing stage of lyme disease.
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Arthritic symptoms with lyme disease occur in 2/3 of what patients and what occurs?
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UNTREATED LYME'S GET ARTHRITIS
involves LARGE JOINTS = KNEE and serious cases can cause erosion of bone. Chronic involvement of the CNS can affect memory, mood and sleep. |
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What causes relapsing fever and how is it transmitted?
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RELAPSING FEVER,
BORRELIA NOT BOUGHT AT BERGDORFF'S, TICKS AND LICE |
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What do the 2 forms of relapsing fever depend on?
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Whether the vector was a tick or a louse and the type of Borrelia species involved.
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What form of relapsing fever is seen in epidemics?
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LOUSE-BORNE RELAPSING FEVER
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How does relapsing fever present, when do symptoms disappear and relapse?
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Fever, HA, myalgia and weakness. Disappear in about 1 week and return a few days later.
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During relapse of relapsing fever what can be found in patients blood and b/w relapses what occurs?
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RELAPSING FEVER = SPIROCHETES
HIDE WHEN NO SYMPTOMS |
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How many relapses does tick-borne relapsing fever have?
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2; fatalities are rare.
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How many relapses does louse-borne relapsing fever have?
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as many as 10; fatalities can reach 40% if untreated, death usually d/t myocarditis, cerebral hemorrhage or liver failure.
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What causes rickettsial infections of the blood?
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Rickettsia are coccobacilli that have charac. of both bacteria and viruses.
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What characteristics of bacteria and viruses do rickettsia have?
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divide by binary fission, very small, gram-neg but stain poorly, are obligate intracellular parasites
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What do rickettsial infections of the blood cause and most have what type of reservoir?
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Cause spotted fevers and typhus-related illnesses, fevers typically accompanied by vasculitis. Most have animal reservoirs transmitted by arthropod vectors, spread through vector's life cycle.
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What is epidermic typhus a classic example of?
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Rickettsial infection, most common in U.S. is RMSF
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What characterizes rickettsial infections of the blood?
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fever, rash and muscle aches. Both types may be fatal as a result of vascular collapse.
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What is the ediologic agent in rocky mountain spotted fever?
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Rickettsia rickettsii
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What does rocky mountain spotted fever cause and what are the vectors?
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acute febrile illness that occurs in association w/ exposure to wooded areas infested w/ ticks. The vectors are ticks but different vectors in different geographic locations.
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What is the incubation time for rocky mountain spotted fever what symptoms occur and what is the most characteristic feature?
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2-6 days; fever, HA, myalgia and mental confusion. Rash appears on soles, palms, wrists and ankles then moves towards trunk. Rash most charac. feature develops on 3rd day and appearance makes distinguishable from viral infection
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What particular muscle can tenderness become extreme in RMSF and what complications can occur if untreated?
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calf muscles; disseminated vascular collapse, renal and heart failure -> death.
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What are the 2 most important types of typhus?
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Epidemic and endemic
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What causes epidemic typhus and how is it transmitted?
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Rickettsia prowazekii; the human louse
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When does rickettsia circulate with epidemic typhus?
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During acute febrile illness, lice feeds on infected human and becomes infected and then Rickettsia increases
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What does a louse do while feeding (epidemic typhus) and how does this get into bite wounds?
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defecates; rubbed into bite when scratched
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How does a rash form with epidemic typhus and what are complications?
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Begins on trunk and moves into extremities; myocarditis and CNS dysfunction.
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What causes endemic typhus, where is the primary infection and how is it transmitted to humans?
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Rickettsia typhi; rodent to rodent; transmitted by rat flea.
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What is the etiologic agent of infectious mononucleosis and Burkitt's lymphoma and what does it have an affinity for?
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Epstein-Barr virus; B lymphocytes (infection non-productive) and epithelial cells (infection productive)
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How is Epstein-Barr virus transmitted and what is it associated with?
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Repeated contact; salivary glands.
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What are the symptoms of infectious mononucleosis?
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Fever, malaise, pharyngitis, tender lymphadenitis and splenomegaly, persists for days to weeks.
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What are complications of Epstein-Barr virus and where is Burkitt's lymphoma common?
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Laryngeal obstruction (from swelling glands), meningitis, encephalitis, hemolytic anemia, thrombocytopenia and splenic rupture
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What are arboviruses and how are they classified?
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Arthropod borne: carried and transported by insects; fever infections: dengue and yellow fever
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How are arboviruses transmitted and what is a feature of arbovirus infection?
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By mosquitoes; transient viremia
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What are the 3 manifestations depending on the arbovirus target and what do all of them produce?
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CNS, major organs particularly the liver, small blood vessels (capillary networks); produce a cellualr necrosis which instigates inflammation and leads to fever
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Why is yellow fever called that, what else can be affected and what is the major complication?
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First sign is jaundice b/c fever causes necrosis of hepatocytes which can lead to urinary symptoms d/t destroying of renal tubules, brain and heart by destroying myocardium; hemorrhage.
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What are clinical symptoms associated with yellow fever?
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Abrupt onset of fever, chills, HA and hemorrhaging which can become severe causing bradycardia and shock
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How does Dengue fever present?
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Fever, rash, severe pain in back, head, muscles and joints. Severe infections can lead to shock, pleural effusion, hemorrhage and death.
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What are the only 2 filoviruses that infect humans?
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Marburg and Ebola
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Ebola is very ___________ and can be transmitted how?
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contagious; person-to-person with a 90% mortality rate
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Where has Marburg virus been seen and what is the mortality rate?
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nosocomial settings; 25% mortality
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What are 5 parasitic infections of the blood?
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Malaria, toxoplasmosis, schistosomiasis, trypanosomiasis, filariasis
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What is Chagas' disease?
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American form of trypanosomiasis caused by the flagellate protozoan Trypanosoma cruzi.
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How is Chagas' disease disseminated, what is the vector and how does it spread?
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In fecal material of the transmitting vector; reduvid (kissing) bug that feeds on sleeping hosts in evening hours; spread from the site by circulating in host's blood.
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Where is Chagas' disease found, how many are affected, amount of deaths each year and leading cause of what infection?
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Central America to southern Argentina; 16 and 18 million ppl; causes 50K deaths each year, accounts for 25% of all deaths b/w 25-44 y/o; leading cause of heart infection
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Why is reduvid called the kissing bug and who/what can be infected?
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Preferentially bites near lips and eyes; most in children but dogs, cats, rats and opossums can become reservoirs.
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In Chagas' disease what accumulates at the bite site and what is the result?
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Neutrophils, lymphocytes and tissue fluids that results in the formation of a local chancre called a chagoma
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What does dissemination of parasite in the host with Chagas' disease cause which can lead to what?
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Febrile illness; persists for up to 3 months, causes widespread organ damage, any cells can be infected. Heart, skeletal muscle and glial nerve are the most susceptible.
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Who shows chronic forms of Chagas' disease and it usually results in what?
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only in adults; coronary dysfunction
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What do filaroidea inhabit and what does this cause?
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lymphatic systems; acute inflammatory response, chronic lymphatic blockade and swelling of extremities and genitalia = elephantiasis
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What 2 parasites are commonly involved in Filariasis and what are they?
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Wuchereria bancrofti and Brugia malayi; both are threadlike worms that lie coiled up in the lymph vessels for decades.
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In filariasis the females of the parasite produce what and what do these do?
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large numbers of fertile eggs; once laid, embryos uncoil to their full length: microfilariae. The shell of each egg elongates to become a flexible sheath.
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In what location do filariasis infections mostly occur and where is the pathology confined?
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120 million people infected with either parasite in Africa, Latin America, Pacific Islands and Asia;Humans only known vertebrate hosts, pathology confined to lymphatic system.
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What are the 2 types of infection with filariasis?
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Acute and chronic
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The acute form of filariasis is caused by presence of molting adolescent and dying adult worms that stimulate what?
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Dilatation of the lymphatics, hyperplastic changes to the vessel endothelium, cause infiltration of lymphocytes, plasma cells, and eosinophils -> Forms a granuloma, fibrosis, permanent lymphatic blockade.
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What do repeated acute filariasis cause and this leads to what?
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Massive lymphatic blockade; Skin and subcutaneous tissues fill w/ edematous fluids, bacterial and fungal superinfections can now occur that contribute to further tissue damage
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When do chronic forms of filariasis develop and what are major characteristics?
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10-15 years after onset of first acute attack, incidence and severity increase w/ age, chronic lymphangitis, thickened lymphatic trunk, chronic lymphadema and elephantiasis.
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People with chronic filariasis experience what for how long?
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Filarial fevers andlymphadenitis for 8-12 months; fevers are usually low-grade and accompanied by chills and myalgia.
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Where is lymphadenitis first noted with filariasis?
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First noted in femoral areas as an enlarged, red, tender lump; inflammation spreads down the lymph. channel of the leg, vessels become enlarged and tender and the overlying skin becomes red and edematous.
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What can repeated infections of filariasis cause?
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Permanent lymphatic obstruction -> edema, ascites, pleural and joint effusion; Persistent lymphadenopathy can cause lymphatic channels to rupture causing formation of abscesses
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