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49 Cards in this Set
- Front
- Back
PNA in immunocomp host:
1. cause |
1. genetic: t-cell def -> prone to mycobacT, herpes, listeria
-b-cell def -> prone to S. aureus & E. coli - combined def 2. acquired: immunosupp (ie transplant pt or pt w/ leukemia) - or AIDS: prone to pneumocystic jirovecci |
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PNA in immunocomp host:
morphology |
-alveoli filled w/ cell debris, foamy exudates & organisms appearing as small bubbles
- interstitium filled w/ plasma cells and lymphocytes |
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PNA in immunocomp host:
1. dx |
- silver stain of trans-trach aspiration, and trans-bronch lung biopsy and culture
- will demonstrate fungus as round 5 micro m structure w/ central dimple |
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PNA in immunocomp host:
mucormycosis, zygomycosis, phycomycosis |
widespread distribution in plants, soil, food, bread mold
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the types of infxns caused by the parasites (mucomycosis, zygomycosis, phycomycosis)
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1. subQ
2. rhino-cerebral 3. fungal arteritis which causes thrombosis 4. pulm mucormycosis - often in neutropenic (can cause sepsis) 5. fungus invasion of arterial wall - demonstration of non-septate hyphae in tissue biopsy |
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nosocomial infxns
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- acquired while in hosp
- # is continuously growing, important to remind pt who want to be admitted longer that its not always beneficial due to infxns |
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atypical PNA:
typical v atypical |
1. alveolar involvement - edema, fibrin, PMNs, bacT = TYPICAL
2. interstitial involvement - edema, mononuc cells, fibroblasts = ATYPICAL |
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viral interstitial PNA:
1. bugs 2. CXR |
1. CMV, HSV, measles, RSV, flu and coronavirus (SARS)
2. interstitial opacities starting from hilus |
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viral interstitial PNA:
morphology |
- bronchiolitis and interstitial inflamm
- interstitial pna: inflam rxn is mainly in interstitium while alveoli remain clear - severe cases may be a/w formation of hyaline memb lining the alveoli --type I cells damaged & generate intra-alveolar edema - plugs of mucus, fibrin & dead cells determine focal lung atelectasis |
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atypical influenza PNA
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- acute self limiting infxn
- necrosis in ciliated epi & extension into lungs - 1-2% mortality rate - should get vaccine |
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atypical SARS pna
1. what 2. who 3. when 4. CXR |
1. 30% URT infxn, "cold-like" type
2. infants or young children 3. winter/spring outbreaks --can progress to PNA or hemorr --diffuse alveolar damage, multinuc giant cells = **why so many people die --5% mortality 4. interstitial opacities starting from hilus - rarely patchy and confluent |
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atypical PNA - mycoplasma (walking PNA)
1. bug 2. labs |
1. M. pneumonia
2. rising titer of cold agglutinins (causes agglutination of RBC at 4-6* C) |
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atypical PNA - mycoplasma (walking PNA)
1. transmission 2. morphology |
1. aerosols & droplet - mostly in close quarters like dorms & ships
2. bronchiolitis & erosion of bronchial epi w/ interstitial PNA - empty alveolar space - inflamm infiltration is thickening the alv walls -> intra-septal accumulation of lympho and plasma cells (mononuc) |
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atypical PNA - mycoplasma (walking PNA)
1. s/sx 2. complications |
1. fev/ha/malaise/sore throat/ nasal symp/chestp/ear ache
--may cause false + for syph 2. myocarditis, miringitis (eardrum infxn) --also stevens johnson synd: peri-orificial ecto-dermatitis |
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chronic PNA includes what bacT infxns?
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1. histoplasma capsulatum - Histoplasmosis
2. cryptococcus neoformans - cryptococcosis 3. coccidiioides immitis - coccidiomycosis 4. blastomyces dermatiditis - N. american blastomycosis 5. paracoccidioides brasiliensis - S. american blastomycosis (paracoccidiomycosis) 6. aspergillus niger or aspergillus fumigatus - Aspergillosis |
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histoplasmosis capsulatum:
1. general 2. where |
1. dimorphic fungus (yeast & mold)
2. grows on soil contaminated w/. bird or bat droppings --dangerous for kids who play in soil near birds --found: ohio-mississippi valley, W mexico, S. america |
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histoplasmosis capsulatum:
1. micro 2. complications |
1. lung granuloma w/ epithelioid cells & other organs have focal accumulations of macrophages filled w/ histoplasmosis
2. disseminated histoplasmosis, or more aggressive clinical forms resemble TB |
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histoplasmosis capsulatum:
1. gross 2. dx |
1. encapsulated fibro-caseous nodule
2. demonstration of H. capsulatum in smears or lymph node biopsy b/c the skin tests for histoplasmosis is often false |
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cryptococcosis:
1. bug 2. morphology |
1. cryptococcus neoformans - encapsulated yeast that live in both plants & animals
- ds results from human inhalation of spores from pigeon droppings 2. lung lesions range from small to large granulomatous nodules, or consolidation or cavitation |
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cryptococcosis:
1. complications |
1. fungal meningitis
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coccidiomycosis
1. bug 2. where |
1. coccidiodes immitis - dimorphic fungus; endospores called arthroconidia
2. mold in soil of SW and W US - "valley fever" b/c dry, windy weather |
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coccidiomycosis
1. affects |
1. lungs - focal pneumonitis or scattered focus of consolidation (resemble tubercles)
-- rarely disseminated via blood stream to skin, meninges, bone, liver and sleep |
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coccidiomycosis
1. who 2. dx |
1. certain racial groups (Filipinos), immunocomp
2. organism found in sputum |
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N. American blastomycosis
1. bug 2. where 3. affects |
1. blastomyces dermatiditis - dimorphis fungus; round/oval yeast w/ thick contoured wall
- mold in warm moist soil w/ decaying 2. US, mississippi, ohio rivers, great lakes 3. pulm and skin |
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S. American blastomycosis = paracoccidiomycosis
1. bug 2. affects |
1. paracoccidiodes brasiliensis - dimorphic fungus, external buds from soil
2. lungs, skin, lymph nodes |
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aspergillus niger or A. fumigates
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Aspergillosis
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invasive aspergillosis
1. general 2. gross 3. fulminant course |
1. opportunistic infxn in immunocompromised
2. multifocal areas of consolidation, occasionally cavities, occlusion & thrombosis 3. death |
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aspergilloma
1. general 2. CXR |
1. "fungus balls" - fungus grows in pre-existing cavities
2. large mass separated from wall by air w/in a cavity |
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allergic bronchomulmonary aspergillosis (ABPA):
1. general |
- immunologic rxn to Aspergillus
- transient pulm infiltrates on CXR - eosinophilia of blood and sputum - skin sensitivity & serum precipitins, inc serum IgE |
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ABPA:
1. gross 2. micro 3. clinical 4. tx |
1. central bronchiectasis, involving segmental bronchi
2. mucous plugs & infiltrates of eosinophils, Charcot-Leyden crystals 3. similar to asthma - wheeze, cough, chestp, mucous plugs 4. cortisone |
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1* pulm TB
- why is it coming back? - patho of tubercle formation |
- prevalence of AIDS
- tuberculous bacilli (bacilli of Koch = BK) are phagocytozed by macrophages |
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1* pulm TB
- what do macrophages secrete to produce a response in TB |
1. IL-6: acute phase protein response
2. MHC class 11: Ag presentation to T-cell 3. proteinases & cathepsins - tissue destruction 4. IL-10: limits inflamm response 5. proinflamm cytokine secretion (eg TNF) and adhesion molecule expressions: granuloma formation |
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Ghon focus
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subpleural lesion found in middle zone of lung, about 1 cm gray-white granuloma
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in 1* pulm TB, hilar lymph nodes are
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enlarged and caseous
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Ghon 1* complex =
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ghon focus + lymphadenopathy
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tubercle
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infective granuloma of TB - different from sarcoidosis
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different types of tubercles
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1. central: BK and cessation
2. pericentral: epithelioid cells, multi-nuc langhans giant cells, lymphocytic infiltration 3. peripheral: fibroblasts |
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what are epitheloid ang iant cells formed from?
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histiocytes or macrophages
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1* pulm TB:
1. clinical course 2. CXR 3. special test 4. evolution |
1. asymp or fever w/ nonprod cough
2. patchy infiltrate; hilar adenopathy 3. PPD test + 4. most cases heals w/ fibrosis and calcification |
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2* TB
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- infxn in previously sensitized individuals which can be from
1. reactivation in 1* ds 2. reinfxn w/ exogenous BK |
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2* TB:
1. gross 2. clinical 3. cxr 4. healing |
1. Simon's foci
2. cough, malaise, fatigue, night sweats, hemoptysis 3. coin lesions & tuverculous PNA 4. variable w/ possible cavitation, fibro-calcific scar and pleural adhesions |
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Simon's foci
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dense spherical nodules or excavated, cavitary lesions in apical regions of 1 or both lobes
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how are Simon foci seen on CXR
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coin lesions
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patterns of TB spread
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1. cavitary fibro-caseous TB
2. direct extension to pleura-pleurisy 3. through bronchial lumen & trachea to other parts of lungs - also along natural passages (gut, ureter) 4. endobronchial & endotrach TB -> laryngeal TB -> intestinal TB (may lead to each of these) 5. through blood stream -> miliary TB (whole body or isolated organ TB), can also cause TB meningitis 6. miliary TB |
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cavitary fibro-caseous TB
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caseous focus can erode into bronchiole which is evacuated through cough (hemoptysis), but the fibrous wall remins to form a cavity
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miliary TB
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- tubercules scattered throughout all parenchyma of lung or other
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miliary TB:
1. spread via 2. causes 3. can also spread to |
1. lymphatics
2. causes focal eroding into pulm artery which localizes miliary TB in lung 3. pulm vein which disseminates TB throughout body |
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miliary TB:
1. morphology 2. complications |
1. yellow-white consolidated foci showing typical structure of tubercle
2. interstitial lung fibrosis, pachipleuritis, mayloidosis |
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dx of TB
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- isolation of acid fast staining bacilli from body fluids (sputum is most imp)
- biopsy - in order to identify acid fast bacilli - TB skin test: may test + if born or raised in diff country or if you've had vaccine |