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829 Cards in this Set

  • Front
  • Back
3 main roles of Ig binding to bacteria
- opsonization - neutralization - complement activation
A defect in phagocytosis of neutrophils owing to lack of NADPH oxidase activity or similar enzymes is indicative of what immune deficiency disease?
Chronic granulomatous disease, which presents with marked susceptibility to S. aureus, E.coli, Aspergillus. Diagnosis confirmed with neg nitroblue tetrazolium dye reduction test.
After exposure to what 4 things are preformed (passive) antibodies given?
Tetanus toxin, Botulinum toxin, HBV, or Rabies.
All nucleated cells have what class of MHC proteins?
class I MHC proteins
Anaphylaxis, asthma, hives, or local wheal and flare are possible manifestations of which type of hypersensitivity?
Type I
Anti-gliadin autoantibodies are associated with what disease?
Celiac disease
Anti-inflammatory cytokines
IL-10&TGF-b
Anti-Scl-70 autoantibodies are associated with what disease?
diffuse Scleroderma
Ataxia-telangiectasia
AR, df. in DNA repair. hypersensitivity to ionizing radiation. Manifestations : cerebellar ataxia, oculocutanoeous telangiectasias, repeated sinopulmonary infxn, inc. malignancy
Autoimmune hemolytic anemia, Rh disease (erythroblastosis fetalis), Goodpasture's syndrome, Rheumatic fever, Graves disease, and bullous pemphigoid are examples of what kind of hypersensitivity reaction?
type II hypersensitivity
Class I major histocompatibilty complex consists of 脰
1 polypeptide, with B2-microglobulin
Class II major histocompatibilty complex consists of 脰
2 polypeptides, an alpha and a Beta chain
Cytotoxic T cells have CD(?), which binds to class (?) MHC on virus-infected cells.
CD8 binds to class I MHC
def. in C3
pyogenic sinus and resp. infxn. in childhood, esp H.inf
def. in C6-C9
Neisseria bacteremia
Define acute transplant rejection.
Cell-mediated due to cytotoxic T lymphocytes reacting against foreign MHCs. Occurs weeks after transplantation.
Define adjuvant.
Adjuvants are nonspecific stimulators of the immune response but are not immunogenic by themselves.
Define Anergy?
Self-reactive T cells become nonreactive without co-stimulatory molecule. Bcells also become anergic but tolerance is less complete than in Tcells
Define chronic transplant rejection.
Antibody-mediated vascular damage (fibrinoid necrosis)--irreversible. Occurs months to years after transplantation.
Define Graft-versus-Host Disease
grafted immunocompetent Tcells proliferate in the irradiated immunocompromised host and reject cells with foreign proteins, resulting in severe organ dysfunction
Define hyperacute transplant rejection.
Antibody-mediated due to the presence of preformed anti-donor antibodies in the transplant recipient. Occurs within minutes after transplantation.
Define Ig allotype (polymorphism).
Ig epitope that differs among members of the same species (on light or heavy chain)
Define Ig idiotype.
Ig epitope determine by the antigen-binging site (specific for a given antigen-binding site), Hypervariable region is unique
Define Ig isotype.
Ig epitope common to a single class of Ig (5 classes, determined by the heavy chain-IgG,IgA,etc.)
Does IgA fix complement?
No
Give 3 examples of possibly causes for SCID?
(1) failure to synthesize class II MHC antigens (2) defective IL-2 receptors (3) adenosine deaminase deficiency
Goodpasture's syndrome is associated with what kind of autoantibodies?
anti-basement membrane antibodies.
Helper T cells have CD(?) which binds to class (?) MHC on antigen-presenting cells.
CD4 binds to class II MHC
How does Bruton's agammaglobulinemia usually present?
Recurrent bacterial infections in boys after about 6 months of age, when levels of maternal IgG antibody decline
How is active immunity acquired?
Active immunity is induced after exposure to foreign antigens. There is a slow onset with long-lasting protection.
How is passive immunity acquired?
by receiving preformed antibodies from another host. Antibodies have a short life span, but the immunity has a rapid onset.
I-cell dz.
def. in N-Ac-glucosamine phosphotransferase in Golgi apparatus.
IL-4 promotes the growth of B cells and the synthesis of what 2 immunoglobulins?
IgE and IgG
In what immune deficiency is there a failure of gamma-interferron production by helper T cells and neutrophils fail to respond to chemotactic stimuli?
Job's syndrome
In what T-cell deficiency do the thymus and parathyroids fail to develop owing to failure of development of the 3rd and 4th pharyngeal pouches?
Thymic aplasia (DiGeorge syndrome)
Job's syndrome is associated with high levels of what immunoglobulin?
IgE
MHC I Ag loading occurs in __(1?)__ while MHC II Ag loading occurs in __(2?)__?
(1) in rER (viral antigens) (2) in acidified endosomes.
Primary biliary cirrhosis has what kind of autoantibodies?
anti-mitochondrial antibodies
Role of TH1 cells?
produce IL-2 (activate Tc cells and further stimulate TH1 cell) and gamma-interferon (activate macrophages)
Role of TH2 cells?
produce IL-4 and IL-5 (help B cells make Ab)
Sensitized T lymphocytes encounter antigen and then release lymphokines which leads to macrophage activation' in what hypersensitivity reaction?
Type IV
TB skin test, Transplant rejection, and contact dermatitis are examples of what type of hypersensitivity reaction?
Type IV
The 3 kinds of MHC class I genes are脰
A, B, and C
The 3 kinds of MHC class II genes are脰
DP, DQ, DR
The Fc portion of immunoglobulins are at the __?__ terminal.
The carboxy terminal
What 2 cytokines are secreted by macrophages?
IL-1 and TNF-a
What 2 kinds of autoantibodies are specific for SLE?
Anti-dsDNA and anti-Smith
What 3 cytokines are classified as 'acute phase cytokines'?
IL-1, IL-6, and TNF-alpha
What 3 ways do interferons interfere with viral protein synthesis?
(1) alpha and beta interferons induce production of a second protein that inhibits viral protein synthesis by degrading viral mRNA (2) gamma interferons increase MHC class I expression and antigen presentation in all cells (3) activates NK cells to kill virus-infected cells.
What affect do the acute phase cytokines (IL-1,IL-6,TNF-alpha) have on Bcells?
Bcell mobilization and antibody production
What affect do the acute phase cytokines (IL-1,IL-6,TNF-alpha) have on fat and muscle?
mobilization of energy reserves to raise body temperature
What affect do the acute phase cytokines (IL-1,IL-6,TNF-alpha) have on neutrophils?
Neutrophil mobilization and phagocytosis
What affect do the acute phase cytokines (IL-1,IL-6,TNF-alpha) have on Tcells?
Tcell mobilization and cytotoxic response
What affect do the acute phase cytokines (IL-1,IL-6,TNF-alpha) have on the bone marrow?
Incr. Production of Colony stim. Factor (CS) which leads to leukocytosis
What affect do the acute phase cytokines (IL-1,IL-6,TNF-alpha) have on the hypothalamus?
increase body temperature
What affect do the acute phase cytokines (IL-1,IL-6,TNF-alpha) have on the liver?
acute phase proteins (eg C-reactive protein) which activates complement and opsonization
What antibody isotype can cross the placenta, fix complement, opsonized bacteria, and neutralize bacterial toxins and viruses?
IgG
What are 3 types of antigen-presenting cells?
macrophages, B cells, and dendritic cells
What are some examples of Immune Complex?
PAN, immune complex GN, SLE, rheumatoid arthritis
What are the four steps in Th activation?
(1)Foreign body is phagocytosed by APC (2)Foreign antigen is presented on MHC II and recognized by TCR on Th cell (3)Co-stimulatory signal is given by interaction of B7 and CD28 (4)Th cell activated to produce IL-2 and gamma-interferon
What are the main symptoms of serum sickness and at what period of time following Ag exposure?
fever, urticaria, arthralgias, proteinuria, lymphadenopathy 5-10 days after Ag exposure
What are the major symptoms of graft-vs.-host disease?
maculopapular rash, jaundice, hepatosplenomegaly, and diarrhea.
What are the two steps in Tc activation?
(1)endogenously synthesized (viral or self) proteins are presented on MHC I and recognized by TCR on Tc cell (2)IL-2 from Th cell activates Tc cell to kill virus-infected cell
What B- and T- cell deficiency, assoc. with IgA deficiency, presents with cerebellar problems (ataxia) and spider angiomas (telangiectasia)?
ataxia-telangiectasia
What causes the tissue damage associated with Serum sickness?
formation of immune complexes of foreign particles and Abs that deposit in membranes where they fix complement (leads to tissue damage)
What cell secretes gamma-interferon and what does it stimulate?
Secreted by helper Tcells, stimulates macrophages
What cell secretes IL-1 and what does it stimulate?
Secreted by macrophages, stimulates Tcell, Bcells, neutrophils, fibroblasts, and epithelial cells to grow, differentiate, or synthesize specific products. IL-1 is an endogenous pyrogen
What cell secretes IL-2 and what does it stimulate?
Secreted by helper Tcells, stimulates the growth of helper and cytotoxic Tcells
What cell secretes IL-3 and what does it stimulate?
Secreted by activated Tcells, stimulates bone marrow (similar function to GM-CSF)
What cell secretes IL-4 and what does it stimulate?
Secreted by helper Tcells, stimulates growth of Bcells and enhances IgE and IgG production
What cell secretes IL-5 and what does it stimulate?
Secreted by helper Tcells, stimulates synthesis of IgA and production and activation of eosinophils
What cell secretes TNF-alpha and what does it stimulate?
Secreted by macrophages, stimulates IL-2 receptor synthesis by helper Tcells and inc Bcell proliferation, attracts and activates neutrophils
What cell secretes TNF-beta and what does it stimulate?
Secreted by activated T lymphocytes, function similar to TNF-alpha
What cell surface proteins do all cells (except mature red cells) have?
MHC I
What cell surface proteins do Bcells have?
IgM,B7,CD19,CD20
What cell surface proteins do Cytotoxic Tcells have?
CD8,TCR,CD3
What cell surface proteins do Helper Tcells have?
CD4,TCR,CD3,CD28
What cell surface proteins do Macrophages have?
MHCII,CD14
What cell surface proteins do NK cells have?
Receptors for MHC I,CD16 CD56
What class of MHC proteins are the main determinants of organ rejection?
class II MHC
What complement component can cause opsonization?
C3b
What complement components can cause anaphylaxis?
C3a and C5a
What complement components can cause viral neutralization?
C1,C2,C3,C4
What components of the alternative complement pathway make the C3 convertase?
C3b, Bb
What components of the alternative complement pathway make the C5 convertase?
C3b, Bb, and C3b+C3a
What components of the classic complement pathway make the C3 convertase?
C4b, C2b
What components of the classic complement pathway make the C5 convertase?
C3a+C4b, 2b, and 3b
What components of the complement pathway are deficient in Neisseria sepsis?
The MAC complex--(C5b, C6, C7, C8, C9)
What condition presents with disseminated mycobacterial infections?
IL-12 receptor deficiency
What cytokines attract and activate neutrophils?
TNF-alpha and TNF-beta
What disease is associated with a X-linked defect in a tyrosine-kinase gene associated with low levels of all classes of immunoglobulins?
Bruton's agammaglobulinemia
What disease is associated with anti-epithelial cell autoantibodies?
Pemphigus vulgaris
What disease is associated with anti-microsomal autoantibodies?
Hashimoto's thyroiditis
What does a deficiency of C6-C8 cause (in the complement cascade)?
Neisseria bacteremia
What does a deficiency of C1 esterase inhibitor cause (in the complement cascade)?
hereditary angioedema because of overactive complement
What does a deficiency of C3 cause (in the complement cascade)?
can lead to severe, recurrent pyogenic sinus and respiratory tract infections.
What does deficiency of decay-accelerating factor (DAF) in the complement cascade cause?
leads to paroxysmal nocturnal hemoglobinuria (PNH)
What does IL-8 do?
major chemotactic factor for neutrophils
What does Job's syndrome classically present with?
recurrent 'cold' (noninflamed) staphylococcal abscesses, eczema, and high levels of IgE
What does TNF-alpha stimulate dendritic cells to do during the acute phase response?
TNF-alpha stimulates their migration to lymph nodes and their maturation for the initiation of the adaptive immune response.
What elements of the complement cascade make the Membrane Attack Complex (MAC)?
C5b, C6, C7, C8, and C9
What Ig is found in secretions as a monomer or a dimer?
IgA
What Ig is found in secretions as a monomer or a pentamer?
IgM
What Ig levels do you see with Hyper-IgM Syndrome?
High levels: IgM- Very Low levels: IgG,IgA,IgE
What immune deficiency disease has an autosomal-recessive defect in phagocytosis that results from microtubular and lysosomal defects of phagocytic cells?
Chediak-Higashi disease, which presents with recurrent pyogenic infections of staph and strep
What immune deficiency is associated with elevated IgA levels, normal IgE levels, and low IgM levels?
Wiskott-Aldrich syndrome
What immune deficiency presents with tetany owing to hypocalcemia, congenital defects of the heart and great vessels, and recurrent viral, fungal, and protozoal infections?
Thymic aplasia (DiGeorge syndrome), a T-cell deficiency syndrome
What immunoglobulin fixes complement but does not cross the placenta and has an antigen receptor on the surface of Bcells?
IgM
What immunoglobulin isotype has the lowest concentration in serum?
IgE
What immunoglobulin isotype is involved in type-I hypersensitivity reactions by inducing the release of mediators from mast cells and basophils when exposed to allergen?
IgE
What immunoglobulin isotype is produced in the primary response to an antigen and is on the surface of B cells?
IgM
What immunoglobulin isotype mediates immunity to worms?
IgE
What immunoglobulin isotype prevents the attachment of bacteria and viruses to mucous membranes?
IgA
What immunoglobulins bind and activate the classic complement pathway?
IgG and IgM (the Fc portion)
What interleukin induces naive helper T-cells to become TH1 cells?
IL-12
What interleukin induces naive helper T-cells to become TH2 cells?
IL-4
What interleukin stimulates the growth of both helper and cytotoxic T-cells?
IL-2
What is an example of Arthus Reaction?
hypersensitivity pneumonitis caused by thermophilic actinomycetes
What is an Immune Complex?
Antigen-antibody complexes that activate complement, which attracts neutrophils (3 things stuck together antigen-antibody-complement)
What is Chronic Mucocutaneous Candidiasis?
T-cell dysfunction specifically against Candida albicans presenting with skin and mucous membrane Candida infections.
What is important about the CD3 complex?
It is a cluster of polypeptides associated with a T-cell receptor and is important in signal transduction.
What is the cellular process that causes type I hypersensitivity?
Ag cross-links IgE on presensitized mast cells and basophils, triggering the release of vasoactive amines (histamine). Reaction occurs rapidly after antigen exposure to preformed antibody.
What is the cellular process that causes type II hypersensitivity?
IgM, IgG bind to Ag on 'enemy' cell, leading to lysis (by complement) or phagocytosis (its cytotoxic).
What is the main antibody in the secondary immune response?
IgG
What is the most abundant immunoglobulin isotype?
IgG
What is the most common selective immunoglobulin deficiency?
Selective IgA deficiency that presents with sinus and lung infections
What is the rise in temperature during the acute phase response help do (3 things?)
(1) increase specific immune response (2) increase antigen processing (3) decrease viral and bacterial replication
What is the triad of symptoms seen with Wiskott-Aldrich syndrome?
recurrent pyogenic infections, eczema, and Thrombocytopenic Purpura
What kind of autoantibodies are associated with CREST/Scleroderma?
anti-centromere antibodies
What kind of autoantibodies are associated with Vasculitis?
anti-neutrophil antibodies
What kind of autoantibodies are known as rheumatoid factor?
anti-IgG antibodies
What kind of immunity (antibody-mediated or cell mediated) is involved in allergies?
both: antibody-mediated immunity (B cells)-hay fever, cell mediated immunity (T cells)-poison oak
What kind of immunity (antibody-mediated or cell mediated) is involved in autoimmunity?
antibody-mediated immunity (B cells)
What kind of immunity (antibody-mediated or cell mediated) is involved in graft and tumor rejection?
cell mediated immunity (T cells)
What kind of immunity (antibody-mediated or cell mediated) is involved in host defense against infection (opsonize bacteria, neutralize toxins and viruses)?
antibody-mediated immunity (B cells)
What kind of immunity (antibody-mediated or cell mediated) is involved in host defense against infection (TB, virus-infected cells, and fungi)?
cell mediated immunity (T cells)
What kind of immunity (antibody-mediated or cell mediated) is involved in regulation of antibody response (help and suppression)?
cell mediated immunity (T cells)
What kind of transplant rejection is reversible with immunosuppressants such as cyclosporin and OKT3?
acute transplant rejection
What kinds of adjuvants are included in human vaccines?
aluminum hydroxide or lipid adjuvants
What kinds of cells have class II MHC proteins?
antigen-presenting cells (e.g. macrophages, Bcells, and dendritic cells)
What symptoms characterize the Arthus reaction and what causes them?
edema, necrosis, and activation of complement due to the Ag-Ab complexes that form in the skin following intradermal injection of Ag.
What syndrome has a defect in CD40 ligand on CD4 T helper cells that leads to inability to class switch, presents early in life with severe pyogenic infections?
Hyper-IgM Syndrome
What syndrome has a defect in LFA-1 adhesion proteins on phagocytes and presents early in life with severe pyogenic infections?
Leukocyte Adhesion Deficiency Syndrome
What type of cell secretes IL-3?
activated T-cells
What type of cells does gamma interferon stimulate?
macrophages
What type of Hypersensitivity is Type I?
Anaphylactic and Atopic
What type of Hypersensitivity is Type II?
Cytotoxic
What type of Hypersensitivity is Type III?
Immune Complex, Serum Sickness, Arthus Reaction
What type of Hypersensitivity is Type IV?
Delayed (cell-mediated) Type
What type of hypersensitivity reaction is the Arthus reaction?
type III
What usually causes Serum Sickness
Drugs
Where does the alternative complement pathway occur?
On microbial surfaces (nonspecific activators eg. endotoxin)
Where does the classic complement pathway occur?
antigen-antibody complexes (IgG,IgM)
Where is the defect in SCID?
the defect is in early stem-cell differentiation, leading to B- and T-cell deficiency
Which immunoglobulin has an unknown function and is found on the surface of many Bcells and in serum?
IgD
Which interleukin causes fever?
IL-1
Which interleukin enhances the synthesis of IgA?
IL-5
Which interleukin stimulates the production and activation of eosinophils?
IL-5
Which interleukin supports the growth and differentiation of bone marrow stem cells?
IL-3
Which is the only type of cell-mediated hypersensitivity reaction, and thus not transferable by serum?
Type IV
Wiskott-Aldrich syndrome is a defect in the ability to mount what immune response?
an IgM response to capsular polysaccharides of bacteria.
With what disease are anti-histone autoantibodies associated?
drug-induced lupus
With what disease are anti-nuclear antibodies associated?
systemic lupus (SLE)
Name 5 species of bacteria that are transmitted to humans from animals.(Acronym: BBugs From Your Pet.)
Borrelia burgdorferi - Brucella spp. - Francisella tularensis - Yersinia pestis - Pasteurella multocida
(T/F) The outer membrane for G+ and the cell membrane for G- act as major surface antigens.
FALSE: they DO act a major surface antigens BUT the outer mb for G- and the cell membrane for G+
All Rickettsiae (except one genus) are transmitted by what type of vector?
arthropod (Coxiella is atypical: transmitted by aerosol and causes pneumonia)
Are endotoxins heat stable?
yes, stable at 100C for 1 hr.
Are endotoxins secreted from cells?
NO
Are endotoxins used as antigens in vaccines?
no, they don't produce protective immune response
Are exotoxins heat stable?
no, destroyed rapidly at 60C (exception: Staphylococcal enterotoxin)
Are exotoxins secreted from cells?
YES
Are exotoxins used as antigens in vaccines?
Yes, TOXOIDS are used as vaccines
Are G(-) bugs resistant to Pen G? to ampicillin? to vancomycin?
G- bugs are resistant to PenG but may be susceptible to pen. derivative like ampicillin. The G- outer mb inhibits entry of PenG and vancomycin.
Are Strep. pneumoniae sensitve to optochin? Are Viridans strep.?
Strep. pneumoniae is optochin-Sensitive - Viridans streptococci is optochin-Resistant
Are Strep. pyogenes Bacitracin-sensitive?>
YES.
Are Viridans strep. alpha, beta, or non-hemolytic?
alpha
Bartonella henselae
cat-scratch dz. & bacillary angiomatosis(aids pt.), endocarditis
Because of drug resistance, what in an alternate treatment combination for leprosy?
rifampin with dapsone and clofazimine
Besides the rash, what other body systems are affected by Lyme disease? (3)
joints -CNS -heart
C.diffficile toxin
"toxin A: enterotoxin(mucosal inflammation, loss of water, mucosal death)
toxin B: cytotoxin (loss of cytoskeleton integrity, cell death)"
Describe lab-findings for Pseudomonas aeruginosa.
Aerobic, G(-) rod. - Non-lactose fermenting - Oxidase positive - Produces pyocyanin (blue-green pigment)
Describe the chemical composition of peptidoglycan.
Sugar backbone with cross-linked peptide side chains.
Describe the disease associated with M. avium-intracellulare.
often resistant to multiple drugs; causes disseminated disease in AIDS.
Describe the H. flu vaccine. When is it given?
contains type b capsulare polysaccharide conjugated to diphtheria toxoid or other protein. -Given b/t 2m and 18m.
Describe the major components of a G- cell wall.
inner and outer lipid bilayer membranes- thin layer of peptidoglycan- periplasmic space- contains lipopolysaccharide, lipoprotein and phospholipid
Describe the major components of a G+ cell wall.
one lipid bilayer membrane- thick layer of peptidoglycan- contains teichoic acid
Describe the process of conjugation.
DNA transfer from one bacterium to another.
Describe the process of transduction.
DNA transfer by a virus from one cell to another
Describe the process of transformation.
purified DNA is taken up by a cell
Describe the typical findings with diarrhea caused by enterotoxigenic E. coli. (3)
1) Ferments lactose 2) watery diarrhea 3) no fever/leukocytosis
Describe the typical findings with Vibro cholerae. (3)
1) Comma-shaped organisms 2) rice-water stools 3) no fever/leukocytosis
Do Streptococcus pneumonia have catalase? Do Viridans Strep. have catalase?
No. both are catalase neg.
Does endotoxin induce an antigenic response?
no, not well
Does exotoxin induce and antigenic response?
Yes, induces high-titer antibodies called antitoxins
ecthyma gangrenosum
Pseudomonas in i.comprimised pt.
Enterococci are hardier than nonenterococcal group D bacteria. What lab conditions can they grow in?
6.5% NaCl (used as lab test)
Following primary infection with TB, if preallergic lymphatic or hematogenous dissemination occurs, what follows?
#NAME?
Following primary infection with TB, if severe bacteremia occurs, what follows?
Miliary tuberculosis and possibly death
Following primary infection with TB, if the lesion heals by fibrosis, what is the result?
Immunity and hypersensitivity---> tuberculin positive
Following primary infection with TB, under what conditions would the lesion likely progress to lung disease?
HIV, malnutrition. This progressive lung disease can rarely lead to death.
Following primary infection with TB, what are 4 possible courses the disease could take?
1) Heals by fibrosis 2) Progressive lung disease 3) Severe bacteremia 4) Preallergic lymphatic or hematogenous dissemination
Give 3 classic examples of bacteria with antigen variation.
(1) Salmonella (2 flagellar variants) (2) Borrelia (relapsing fever) (3) Neisseria gonorrhoeae (pilus protein)
Give 3 examples of obligate anaerobes.
Clostridium - Bacteroides - Actinomyces
Give 3 types of infection Pseudomonas aeruginosa is commonly responsible for.
1) burn wound infection 2) nosocomial pneumonia 3) pneumonia with cystic fibrosis
Give 4 examples of encapsulated bacteria.
1) Strep. pneumoniae (Pneumococcus 2) Haemophilus influenza (especially b) 3) Neisseria memingitidis 4) Klebsiella pneumoniae
Give two general functions of peptidoglycan
Gives rigid support- protects against osmotic pressure
H. flu causes what? (4)
Epiglottitis -Meningitis -Otitis media -Pneumonia (haEMOPhilus)
How are Borrelia visualized?
using aniline dyes (Wright's or Giemsa stain) in light microscopy
How are Group A and Group B Strep primarily differentiated?
Group A are Bacitracin sensitive- Group B are Bacitracin resistant
How are Mycobacteria visualized in the lab?
all Mycobacterium are acid-fast, stain =Ziehl-Neelson
How are the pathogenic Neisseria species differentiated?
on the basis of sugar fermentation
How are the species of Streptococcus primarily differentiated?
on the basis of their HEMOLYTIC capabilities
How are Treponema visualized?
by dark-field microscopy
How can secondary tuberculosis in the lung occur?(2)
1) Reinfection of partially immune hypersensitized hosts (usu. adults) =exogenous source 2) Reactivation of dormant tubercle bacilli in immunocompromised or debilitated hosts =endogenous source
How can you remember that Viridans strep are resistant to optochin?
they live in the mouth and are not afraid of the (opto-)CHIN
How does primary syphilis present?
with a painless chancre (localized disease; 2-10 wks).
How does secondary syphilis present?
disseminated disease (1-3m later) with constitutional symptoms, maculopapular rash, condylomata lata (genital lesions)
How does tertiary syphilis present?
gummas (granulomas), aortitis, neurosyphilis (tabes dorsalis), Argyll-Robertson pupil
How does the rash with typhus differ from the rash with RMSF?
typhus: maculopapillary rash BEGINS ON TRUNCK, moves peripherally -RMSF: macules progressing to petichiae BEGIN ON HANDS &FFET and move inward.
How is Brucellosis/Undulant fever transmitted?
dairy products, contact with animals
How is Cellulitis transmitted?
Animal bite; cats, dogs
How is H. flu transmitted?
aerosol
How is Legionnaires' disease diagnosed in lab?
Gram neg rod. Use silver stain (doesn't Gram stain well) -culture with charcoal yeast extract with iron and cysteine.
How is Legionnaires' disease transmitted?
aeresol transmission from envirnomental water source habitat (NO human-to-human transmission).
How is Lyme disease transmitted?
Tick bite; Ixodes ticks that live of deer and mice
How is Shigella spread?
food, fingers, feces, and flies'
How is the Plague transmitted?
Flea bite; rodents, especially prairie dogs
How is Tuleremia transmitted?
Tick bite; rabbits, deer
Is Bacillus anthracis G+ or G-? What is its morphology?
It is a G+, spore-forming rod
Is there an animal reservoir for leprosy?
Yes, armadillos in the US
List 5 findings associated with rheumatic fever. (Hint: PECCS)
Polyarthritis - Erythema marginatum -Chorea - Carditis - Subcutaneous nodules
List the 'ABCDEFG' of diphtheria.
ADP ribosylation -Beta-prophage -Corynebacterium - Diphtheria - Elongation Factor 2 - Granules
List the four phases of the bacterial growth curve.
Lag phase- log (exponential) phase- stationary phase- death phase
Name 2 alpha-hemolytic bacteria.
Strep. pneumoniae - Viridans streptococci
Name 2 bugs that cause diarrhea but NOT fever and leukocytosis?
E. coli and Vibro cholerae
Name 2 disease processes that can be caused by enterococci.
1) UTI 2) subacute endocarditis
Name 2 G- rods that are considered slow lactose fermenters.
Citrobacter and Serratia
Name 2 species of enterococci.
Enterococcus faecalis -Enterococcus faecium
Name 2 symptoms of diphtheria.
pseudomembraneous pharyngitis (grayish white membrane)- lymphadenopathy
Name 3 G- rods that are considered fast lactose fermenters.
1) Klebsiella 2) E. coli 3) Enterobacter
Name 3 G- rods which are lactose nonfermenters and Oxidase(-)?
Shigella, Salmonella, Proteus
Name 3 spore forming bacteria.
Bacillus anthracis - Clostridium perfringens - C. tetani
Name 4 bacteria that use IgA protease to colonize mucosal surfaces.
1) Strep. pneumoniae 2) Neisseria meningitidis 3) Neisseria gonorrhea 4) H. flu
Name 4 beta-hemolytic bacteria.
1) Staph. aureus 2) Strep. pyogenes (GAS) 3) Strep. agalactiae (GBS) 4) Listeria monocytogenes
Name 4 genus of bacteria that are G- 'coccoid' rods.
1) H. flu 2) Pasteruella 3) Brucella 4) Bordetella pertussis
Name 4 lactose-fermenting enteric bacteria.
E. coli -Klebsiella -Enterobacter Citrobacter (think Lactose is EKE for first three listed)
Name 5 bugs that cause watery diarrhea.
1) Vibrio cholerae 2) enterotoxigenic E. coli 3) viruses (rotavirus) 4) protozoa (Cryptosporidium and (5) Giardia)
Name 6 bacteria that don't Gram's stain well?
Treponema - Rickettsia - Mycobacteria - Mycoplasma - Legionella pneumophila - Chlamydia
Name 6 bugs that cause bloody diarrhea.
1) Salmonella 2) Shigella 3) Campylobacter jejuni 4) enterohemorrhagic/enteroinvasive E.coli 5) Yersinia enterocilitica 6) Entamoeba histolytica (a protozoan)
Name 7 facultative intracellular bacteria.
1) Mycobacterium 2) Brucella 3) Francisella 4) Listeria 5) Yersinia 6) Legionella 7) Salmonella
Name four genus of bacteria that are G+ rods.
1) Clostridium (an anaerobe) 2) Coynebacterium 3) Listeria 4) Bacillus
Name seven G+ bacteria species that make exotoxins.
1) Corynebacterium diphtheriae 2) Clostridium tetani 3) Clostridium botulinum 4) Clostridium perfringens 5) Bacillus anthracis 6) Staph. aureus 7) Strep. pyogenes
Name three diseases caused by exotoxins.
Tetanus- botulism- diptheria
Name three G- bacteria species that make exotoxins.
1) E. coli 2) Vibrio cholerae 3) Bordetella pertussis
Name three genera of spirochetes.
Borrelia (big size) - Leptospira -Treponema (think: BLT; B is big)
Name three Lactose-fermenting enterics.
Eschericia, Klebsiella, Enterobacter
Name two diseases caused by endotoxins.
Meningococcemia- sepsis by G(-) rods
Name two lab tests used to detect syphilis?
VDRL and FTA-ABS
Name two non-lactose fermenting bacteria that invade intestinal mucosa and can cause bloody diarrhea.
Salmonella and Shigella
Name two obligate intracellular bacteria.
Rickettsia and Chlamydia (Hint: 'stay inside when its Really Cold.')
Name two type of Strep that exhibit alpha hemolysis?
S. pneumoniae - Viridans strep. (e.g. S. mutans)
Name two types of Strep. that are non-hemolytic (gamma hemolysis).
Enterococcus (E. faecalis) and Peptostreptococcus (anaerobe)
Name two types of Strep. that exhibit beta hemolysis.
Group A Strep. (S. pyogenes) and Group B Strep. (S. agalactiae)
pt. w/ CGD is risk infxn for
S.aureus, Pseudomonas, Serratia, Nocardia, Aspergillus
RMSF is endemic to what part of the US?
the East Coast (in spite of the name)
Spore are formed by certain species of what type of bacteria?
Gram+ rods, usually in soil; form spores only when nutrients are limited
T/F Chlamydia are obligate intracellular parasites that cause mucosal infections.
TRUE
T/F Chlamys means cloak.
TRUE (intracellular)
T/F Enterobacteriaceae are oxidase negative and are glucose fermenters.
TRUE
T/F H. pylori infection is a risk factor for peptic ulcer and gastric carcinoma.
TRUE
T/F Penicillin is not an effective treatment against Mycoplasma pneumoniae.
TRUE Mycoplama are naturally resistant b/c they have no cell wall.
T/F Pseudomonas produces both endotoxin and exotoxin.
TRUE: endotoxin---> fever, shock -exotoxin---> inactivates EF-2
T/F Rickettsiae are obligate intracellular parasites and need CoA and NAD.
TRUE
T/F Some enterococci are resistant to PenG.
FALSE: ALL enterococci are naturally resistant to Pen/cephlosporins.
T/F Spores have no metabolic activity.
TRUE
T/F: S. aureus food poisoning is due to the ingestion of bacteria that rapidly secrete toxin once they enter the GI tract.
FALSE: rapid onset of S. aureus food poisoning is due to injestion of PREFORMED toxin
Teichoic acid induces what two cytokines?
TNF and IL-1
The Weil-Felix reaction usually tests positive for what two diseases? Negative for what? Cross reacts with what?
Positive: typhus and RMSF -Negative: Q fever -Cross-reacts: with Proteus antigen
Think COFFEe for Enterobacteriaceae. What does that stand for?
Capsular -O-antigen -Flagellar antigen -Ferment glucose -Enterobacteriaceae
What's a pneumonic for remembering 4 obligate aerobes?
Nagging Pests Must Breath (=Norcardia - Pserudomonas aeruginosa - Mycobacterium tuberculosis - Bacillus
What (6) infections can Pseudomonas aeruginosa cause?
burn-wound infections -Pneumonia (esp. in cystic fibrosis) -Sepsis (black skin lesions) -External Otitis (swimmer's ear) - UTI -hot tub folliculitis
What 2 bugs can cause bloody diarrhea, fever, and leukocytosis, but do not ferment lactose?
Salmonella and Shigella
What animals carry Lyme disease?
The Ixodes tick transmits it. - Deer are required for tick life cycle. - Mice are important reservoirs.
What anitbody class is necessary for an immune response to encapsulated bacteria?
IgG2.
What are 2 disease processes caused by Viridans strep and what species are responsible?
1) dental caries: Strep. mutans 2) subacute bacterial endocarditis: Strep. sanguis
What are 2 options for triple thearpy treatment of H. pylori?
(1) bismuth (Pepto-Bismal), metronidazole, and tetracyclin or amoxicillin. OR (2) metronidazole, omeprazole, and clarithromycin (#2 is more expensive)
What are 3 advantages/differences between VDRL and FTA-ABS?
FTA-ABS is 1) more specific 2) positive earlier in disease 3) remains positive longer than VDRL
What are 3 disease processes caused by Strep. pyogenes?
1) Pyogenic--pharyngitis, cellulitis, skin infection 2) Toxigenic--scarlet fever, TSS 3) Immunologic--rheumatic fever, acute glomerulonephritis
What are 4 biological false positives for VDRL?
1) Viruses (mono, hepatitis) 2) Drugs 3) Rheumatic fever and rheumatic arthritis 4) Lupus and leprosy (=VDRL)
What are 4 clinical symptoms of 'walking' pneumonia?
1) insidious onset 2) headache 3) nonproductive cough 4) diffuse interstitial infiltrate
What are 4 clinical symptoms of TB?
1) fever 2) night sweats 3) weight loss 4) hemoptysis
What are 5 areas that can be affected by extrapulmonary TB?
1) CNS (parenchmal tuberculoma or meningitis) 2) Vertebral body (Pott's disease) 3) Lymphadenitis 4) Renal 5) GI
What are the culture requirement for H. flu?
culture on chocolate agar with factor V (NAD) and X (hematin). [Think: 'Child has 'flu'; mom goes to five (V) and dime (X) store to buy chocolate.']
What are the effects of erythrogenic toxin?
it is a superantigen- it causes rash of Scarlet fever
What are the effects of streptolysin O?
it is a hemolysin- it is the antigen for ASO-antibody found in rheumatic fever
What are the effects of the exotoxin secreted by Bacillus anthracis? (1)
one toxin in the toxin complex is an adenylate cyclase
What are the effects of the exotoxin secreted by Bordetella pertussis? (3)
Stimulates adenylate cyclase by ADP ribosylation - causes whooping cough- inhibits chemokine receptor, causing lymphocytosis
What are the effects of the exotoxin secreted by Clostridium botulinum?
blocks release of acetylcholine: causes anticholenergic symptoms, CNS paralysis; can cause 'floppy baby'
What are the effects of the exotoxin secreted by Clostridium perfringens?
alpha toxin is a lecithinase- causes gas gangrene- get a double zone of hemolysis on blood agar
What are the effects of the exotoxin secreted by Clostridium tetani?
blocks release of the inhibitory NT glycine; causes 'lockjaw'
What are the effects of the exotoxin secreted by Corynebacterium diphtheria? (3)
1) inactivates EF-2 by ADP ribosylation 2) pharyngitis 3) 'pseudomembrane' in throat
What are the effects of the exotoxin secreted by E. coli? (2)
this heat labile toxin stimulates adenylate cyclase by ADP ribosylation of G protein - causes watery diarrhea
What are the effects of the exotoxin secreted by Staph. aureus?
superantigen; induces IL-1 and IL-2 synthesis in Toxic Shock Syndrome; also causes food poisoning
What are the effects of the exotoxin secreted by Vibro cholerae? (3)
Stimulates adenylate cyclase by ADP ribosylation of G protein - increases pumping of Cl- and H2O into gut - causes voluminous rice-water diarrhea
What are the general clinical effects of endotoxin?(2)
fever, shock
What are the lab findings with Chlamydia?
cytoplasmic inclusions on Giemsa fluorescent or antibody-stained smear
What are the symptoms of RMSF? (3)
1) rash on palms and soles (migrating to wrists, ankles, then trunck) 2) headache 3) fever
What are the three stages of Lyme disease?
1) erythema chronicum migrans, flu-like symptoms 2) neurologic and cardiac manefestations 3) autoimmune migratory polyarthritis
What are the two forms of chlamydia?
1) Elementary body (small, dense): Enters cell via endocytosis 2) Initial or Reticulate body: Replicates in the cell by fission
What are the two forms of leprosy (or Hansen's disease)?
1) lepromatous- failed cell-mediated immunity, worse 2) tuberculoid- self-limited.
What are three primary/general effects of endotoxin (especially lipid A)?
1) Acivates macrophages 2) Activates completment (alt. pathway) 3) Activates Hageman factor
What are two drugs that could be used to treat 'walking' pneumonia?
tetracycline or erythromycin
What are two drugs that could treat Chlamydia?
erythromycin or tetracycline
What are two exotoxins secreted by Strep. pyogenes?
Erythrogenic toxin and streptolysin O
What are two functions of the pilus/fimbrae?
A Glycoprotein that mediates adherence of bacteria to the cell surface- sex pilus forms attachment b/t 2 bacteria during conjugation
What are two lab findings associated with 'walking' pneumonia?
1) X-ray looks worse than patient 2)High titer of cold agglutinins (IgM)
What are two species of Gram (-) cocci and how are they differentiated?
1) Neisseria memingitidis: maltose, glucose fermenter 2) Neisseria gonorrhoeae: glucose fementer (non maltose)
What are usually associated with pseudomembraneous colitis?
Clostridium difficile; it kills enterocytes, usu. is overgrowth secondary to antibiotic use (esp. clindamycin or ampicillin)
What bacteria are G+, spore-forming, obligate anaerobic bacilli?
Clostridia
What bacteria causes a malignant pustule (painless ulcer); black skin lesions that are vesicular papules covered by a black eschar?
Bacillus anthracis
What bacteria exhibits a 'tumbling' motility, is found in unpasteurized milk, and causes meningitis in newborns?
Listeria monocytogenes
What bacteria is catalase(-) and bacitracin-resistant?
Strep. agalactiae
What bacteria is catalase(-) and bacitracin-sensitive?
Strep. pyogenes
What bacteria is catalase+ and coagulase+?
Staph. aureus
What bacteria produces a blue-green pigment?
Pseudomonas aeruginosa
What bacteria produces a red pigment?
Serratia marcescens ('maraschino cherries are red')
What bacteria produces a yellow pigment?
Staph. aureus (Aureus= gold in Latin)
What bacteria produces alpha-toxin, a hemolytic lecithinase that causes myonecrosis or gas gangrene?
Clostridium perfringens
What bacterium causes Cellulitis?
Pasteurella multocida
What bacterium causes leprosy?
Mycobacterium leprae
What bacterium causes Lyme disease?
Borrelia burgdorferi
What bacterium causes the Plague?
Yersinia pestis
What bacterium causes Tularemia?
Francisella tularensis
What bacterium causes Undulant fever?
Brucella spp. (a.k.a. Brucellosis)
What bug causes atypical 'walking' pneumonia?
Mycoplasma pneumoniae
What bug causes gastroenteritis and up to 90% of duodenal ulcers?
Helicobacter pylori
What bug causes Legionnaire's disease?
Legionella pneumophila
What bug is associated with burn wound infections?
Pseudomonas aeruginosa
What bug is comma- or S-shaped and grows at 42C, and causes bloody diarrhea with fever and leukocytosis?
Campylobacter jejuni
What bug that causes diarrhea is usually transmitted from pet feces (e.g. puppies)?
Yersinia enterocolitica
What causes tetanus? (give bacteria and disease process)
Clostridium tetani: exotoxin produced blocks glycine release (inhibitory NT) from Renshaw cells in spinal cord
What causes the flu?
NOT H. flu -it is caused by influenza virus
What chemical is found in the core of spores?
dipicolinic acid
What coccobacillus causes vaginosis: greenish vaginal discharge with a fishy smell; nonpainful?
Gardnerella vaginalis
What culture requirements do Fungi have?
Sabouraud's agar
What culture requirements do Lactose-fermenting enterics have?
MacConkey's agar (make pink colonies)
What culture requirements does B. pertussis have?
Bordet-Gengou (potato) agar
What culture requirements does C. diphtheriae have?
Tellurite agar
What culture requirements does H. flu have?
chocolate agar with factors V (NAD) and X (hematin)
What culture requirements does Legionella pneumophia have?
Charcol yeast extract agar buffered with increased iron and cysteine
What culture requirements does N. gonorrhea have?
Thayer-Martin (VCN) media
What disease does Bordetella perussis cause? How?
Whooping cough: toxin permanently disables Gi-protein in respiratory mucosa (turns the 'off' off);ciliated epithelial cells are killed; mucosal cells are overactive.
What disease does Vibrio cholerae cause? How?
Cholera: toxin permanently activates Gs-protein in intestinal mucosa (turns the 'on' on) causing rice-water diarrhea
What disease is caused by Borrelia?
Lyme Disease
What disease is caused by Clostridium botulinum? What pathophys. does it cause?
Botulism: associated with contaminated canned food and honey, produces a preformed, heat-labile toxin that inhibits ACh release---> flaccid paralysis.
What diseases (2) are caused by Treponema?
Syphilis (T. pallidum) -yaws (T. pertenue; not an STD)
What diseases can be caused by Staph. aureus?
Inflammatory disease: skin infections, organ abcess, pneumonia - Toxin-mediated disease: Toxic Shock Syn., scalded skin syndrome (exfoliative toxin), rapid onset food poisoning (enterotoxins)
What do Chlamydia trachomatis serotypes A, B, and C cause?
chronic infection, cause blindness in Africa (ABC= Africa / Blindness / Chronic
What do Chlamydia trachomatis serotypes D-K cause? (3)
urethritis/ PID - neonatal pneumonia -neonatal conjuctivitis
What do Chlamydia trachomatis serotypes L1,L2, and L3 cause?
lymphogranuloma venereum (acute lymphadentis: positive Frei test)
What do RMSF, syphilis, and coxsackievirus A infection have in common?
rash on palm and sole is seen in each (coxsackievirus A =hand, foot, and mouth disease)
What does catalase do? Which bacteria have it?
it degrades H2O2, an antimicrobial product of PMNs.- Staphlococci make catalase; Strep. do NOT.
What does the H-antigen represent?
H: flagellar antigen, found on motile species
What does the K-antigen represent?
K: capsular, relates to virulence
What does the O-antigen represent?
O-antigen is the polysaccharide of endotoxin (found on all species)
What does VDRL detect? (It detects non-specific antibody that reacts with what?)
detects antibody that reacts with beef cardiolipin
What drug of choice is used to treat Norcardia? Actinomyces? (Acronym: SNAP)
Sulfa for Norcarida, Actinomyces gets Penicillin
What enteric bacterial infection may be prolonged with antibiotic treatment?
Salmonellosis
What enzyme allows H. pylori to creat an alkaline environment?
urease (cleaves urea to ammonia); used in urease breath test
What family includes E. coli, Salmonella, Klebsiella, Enterobacter, Serratia, and Proteus?
Enterobacteriaceae
What family of bacteria uses the O-, K-, and H-antigen nomenclature?
Enterobacteriaceae
What function does the capsule serve? (2: one for the bacterium, one other)
1) antiphagocytic 2) antigen in vaccines (Pneumovax, H. flu b, meningococcal vaccines)
What G- rod is a lactose nonfermenter and is Oxidase+ ?
Pseudomonas
What G+ anaerobe causes oral/facial abscesses with 'sulfur granules' that may drain through sinus tracts in skin?
Acinomyces israelii
What G+ and also weakly acid fast aorobe found in soil causes pulmonary infections in immunocompromised patients?
Norcardia asteroides
What general type of bacteria are normal flora in GI tract but pathogenic elsewhere?
Anaerobes
What general type of bacteria grow pink colonies on MacConkey's agar?
Lactose-fermenting enteric bacteria
What is a function of the plasma membrane in bacterial cells.
site of oxidative and transport enzymes
What is a Ghon complex and in whom does it occur?
Occurs in Primary TB (usually a child) -Ghon complex= draining Hilar nodes and Ghon focus, exudative parenchymal lesion (usu. in LOWER lobes of lung)
What is a lab diagnosis of diphtheria based on?
G+ rods with metachromatic granules; grows on tellurite agar. (Coryne=club shaped)
What is a major difference between Salmonella and Shigella observable in the lab?
Salmonella are motile; Shigella are nonmotile
What is a positive Quellung reaction?
if encapsulated bug is present, capsule SWELLS when specific anticapsular antisera are added.
What is a toxoid?
exotoxin treated with formaldehyde (or acid or heat); retains antigenicity but looses toxicity
What is an acronym for remembering 6 bacteria that don't Gram's stain well?
TRMMLC: These Rascals May Microscopically Lack Color
What is meant by alpha, beta, and gamma hemolysis?
On a Blood agar plate: Beta= complete; clear - alpha= partial; green - gamma= no hemolysis; red
What is notable about Chlamydia psittaci?
has an avian reservoir
What is one reason M. leparae infects skin and superficial nerves?
It likes cool temperatures
What is the chemical composition of a glycocalix?
polysaccharide
What is the chemical composition of bacterial ribosomes?
RNA and protein in 30S and 50S subunits
What is the chemical composition of endotoxin?
Lipopolysaccharide
What is the chemical composition of exotoxin?
polypeptide
What is the chemical composition of spores?
keratin-like coat- dipicolinic acid
What is the classic symptom of Lyme Disease?
erythema chronicum migrans, an expanding 'bull's eys' red rash with central clearing.
What is the classic triad of symptoms associated with Rickettsiae?
1) headache 2) fever 3) rash (vasiculitis)
What is the common manifestation of secondary TB?
Fibrocaseous cavitary lesion usu. in APICIES of lung
What is the common site of infection for Mycobacterium tuberculosis?
the apicies of the lung (which have the highest PO2)
What is the DOC for treatment of most rickettsial infections?
tetracycline
What is the DOC to treat Lyme Disease?
tetracycline
What is the DOC to treat syphilis?
Penicillin G
What is the drug of choice (D.O.C.) to treat Gardnerella vaginalis?
Metronidazole
What is the drug of choice for H. flu meningitis? What Drug for prophylaxis in close-contacts?
Treat meningitis with CEFTRIAXONE; Rifampin for prophylaxis.
What is the drug of choice for Legionaires' disease?
Erythromycin
What is the funciton and chemical composition of the flagellum?
for motility- made of protein
What is the function of a glycocalix?
mediates adherence to surfaces, especially foreign surfaces (i.e. catheters)
What is the function of spores?
provides resistance to dehydration, heat, and chemicals
What is the major chemical composition of the capsule?
Polysaccharide (*except Bacillus anthracis, which contains D-Glutamate)
What is the major function of the capsule?
antiphagocytic
What is the mode of action of endotoxin?
includes TNF and IL-1
What is the morphology of H. flu?
Small G(-) (coccobacillary) rod
What is the morphology of H. pylori?
Gram (-) rod
What is the nature of the DNA transferred in conjugation?
Chromosomal or plasmid
What is the nature of the DNA transferred in transduction?
Any gene in generalized transduction; only certain genes in specialized transduction
What is the nature of the DNA transferred in transformation?
Any DNA
What is the periplasm? Where is it found?
the space between the inner and outer cell membranes found in G(-) bacteria.
What is the primary drug used to treat leprosy?
dapsone (toxicity is hemolysis and methemoglobinemia)
What is the primary test to subcatergorize G- rods?
are they Lactose Fermenters?
What is the recommended treatment for Pseudomonas aeruginosa infection?
aminoglycoside plus extended-spectrum penicillin (e.g. piperacillin or ticarcillin)
What is the source of endotoxins?
cell wall of most G- bacteria (think N-dotoxin=gram Negative)
What is the source of exotoxins?
certain species of some G+ and G- bacteria
What is the source of infection and the bacterium that causes endemic typhus?
R. typhi; from fleas
What is the source of infection and the bacterium that causes epidemic typhus?
R. prowazekii; from human body louse
What is the source of infection and the bacterium that causes Q fever?
Coxiella burnetii; from inhaled aerosols
What is the source of infection and the bacterium that causes Rocky Mountain Spotted Fever?
Rickettsia rickettsii; from tick bite
What is the toxin responsible for TSS is Staph. aureus?
TSST-1; it is a superantigen that binds to class II MHC and T-cell receptors---> polyclonal T-cell activation
What is the unique chemical component of Gram (-) cell membranes?
Lipopolysaccharide
What is the unique chemical component of Gram + cell membranes?
Teichoic acid
What is the unique component found in Mycoplasma bacterial membranes?
cholesterol
What is the unique feature of Chlamydiae cell walls?
its peptidoglycan wall lacks muramic acid
What is used to stain Legionella?
Use silver stain.
What is woolsorter's disease?
inhalation anthrax; can cause life-threatening pneumonia
What lab test assays for antirickettsial antibodies?
Weil-Felix reaction
What Lancefield Antigen Group are enterococci in?
Group D
What Lancefield Antigen Group are Viridans strep in?
They are non-typeable. They do not have a C-carbohydrate on their cell wall to be classified by.
What level of disinfection is required to kill spores?
autoclaving; they are highly resistant to destruction by heat and chemicals
What populations are most likely to get Mycoplasma pneumoniae infection?
patients younger than age 30 - military recruits - prisons
What rickettsial disease is atypical in that it has no rash, no vector, negative Weil-Felix reaction, and its causative organism can survive outside for a long time?
Q fever (Coxiella burnetii)
What species are associated with food poisoning in contaminated seafood?
Vibrio parahaemolytica and Virbrio vulnificus
What species causes diphtheria?
Corynebacterium diptheriae
What species is associated with food poisoning in improperly canned foods (bulging cans)?
Clostridium botulinum
What species is associated with food poisoning in meats, mayonnaise, and custard?
Staphylococcus aureus (this food poisoining usu. starts quickly and ends quickly)
What species is associated with food poisoning in poultry, meat, and eggs?
Salmonella
What species is associated with food poisoning in reheated meat dishes?
Clostridium perfringens
What species is associated with food poisoning in reheated rice?
Bacillus cereus ('Food poisoning from reheated rice? Be serious!')
What species is associated with food poisoning in undercooked meat and unpasteurized juices?
E. coli 0157-H7
What species is Group A Strep?
S. pyogenes
What species is Group B Strep?
S. agalactiae
What species of Mycobacteria causes pulmonary, TB-like symptoms?
M. kansasii
What stain is amyloid and gives an apple-green birefringence in polarized light?
Congo red
What stain is used for acid fast bacteria?
Ziehl-Neelsen
What stain is used for Borrelia, Plasmodium, trypanosomes, and Chlamydia?
Giemsa's
What stain is used for Cryptococcus neoformans?
India ink
What stains gylcogen, mucopolysaccharides and is used to diagnose Whipple's disease?
PAS (periodic acid Schiff)
What strain of Haemophilus influenza causes most invasive disease?
capsular type b
What symptoms are associated with M. scrofulaceum
cervical lymphadenitis in kids
What test differentiates Viridans from S. pneumoniae?
Viridans are resistant to optochin; S. pneu. are sensitive to optochin
What test distinguishes Staph. and Strep?
Staph. are Catalase (+) and are in clusters - Strep. are Catalase (-) and are in chains
What test distinguishes Staph. aureus from Staph. epidermidis and Staph. saprophyticus?
S. aureus is Coagulase (+) - S. epidermidis and S. saprophyticus are Coagulase (-)
What two bugs secrete exotoxins that act via ADP ribosylation of G-proteins, permanently activating adenyl cyclase (resulting in increased cAMP)?
Vibrio cholerae - Bordetella pertussis
What two genera of G+ rods form long branching filaments resembling fungi?
Acinomyces and Nocardia
What two things distinguish S. pneumoniae from Viridans Strep.?
S. pneumoniae: have Capsule (+Quellung); Optochin Sensitive - Viridans strep: No capsule; Optochin Resistant
What type of bacteria are difficult to culture, produce gas in tissue (CO2 and H2), and are generally foul-smelling?
Anaerobes
What type of bacteria is associated with rusty sputum, sepsis in sickle cell, and splenectomy?
Pneumococcus
What type of E. coli are associated with bloody diarrhea?
enterohemmoragic/ enteroinvasive E. coli
What type of enzymes allows certain bacteria to colonize mucosal surfaces?
IgA proteases
What type of immunologic response is elicited by a Salmonella infection?
monocyte response
What types of infection can chlamydia cause? (4)
arthritis - conjunctivitis - pneumonia - nongonococcal urethritis
What virulence factor of Staph. aureus binds Fc-IgG, inhibiting complement fixation and phagocytosis?
Protein A
What virulence factor of Strep. pyogenes also serves as an antigen to which the host makes antibodies?
M-protein
What will likely be visible under the microscope in the case of Gardnerella vaginallis infection?
Clue cell, or vaginal epithelial cells covered with bacteria
When endotoxin activates complement, what are the secondary effects?
C3a: hypotension, edema - C5a: neutrophil chemotaxis
When endotoxin activates Hageman factor, what are the secondary effects?
coagulation cascade: DIC
When endotoxin activates macrophages, what 3 cytokines are released and what are the secondary effects?
IL-1--fever - TNF--fever, hemmoragic tissue necrosis - Nitic oxide--hypotension, shock
Where are the genes for endotoxin located?
on the bacterial chromosome
Where are the genes for exotoxin located?
on a plasmid or in a bacteriophage
Where are the spores of Clostridium botulinum found?
canned food- honey
Where are Viridans strep. found (reservoir)?
normal flora of oropharynx
Where are when is Lyme disease common?
common in northeast US in summer months
Where is LPS found?
in the outer membrane of G (-) cell walls
Which disease/toxin causes lymphocytosis? (Cholera or Pertussis)
Pertussis toxin: by inhibiting chemokine receptors
Which has a higher toxicity: exotoxin or endotoxin?
EXOTOXIN: fatal dose is ~1ug! (for endotoxin, fatal dose is hundreds of micrograms)
Which has an animal reservoir? (Salmonella or Shigella)
Salmonella: poultry, meat, eggs
Which is more specific for syphilis: VDRL or FTA-ABS?
FTA-ABS is more specific
Which is more virulent? (Salmonella or Shigella)
Shigella is more virulent (10^1 organisms vs. Salmonella 10^5 organisms)
Which is motile? (Salmonella or Shigella)
Salmonella (think: salmon swim)
Which species of chlamydia causes an atypical pneumonia? How is it transmitted?
C. pneumonia -transmitted via aerosol
Which species of chlamydia causes urethritis?
C. trachomatis
Which two species of chlamydia infect only humans?
C. trachomatis -C. pneumoniae
Which type of Neisseria ferment Glucose only?
Gonococci (Glucose= Gonococci)
Which type of Neisseria ferment maltose and glucose?
Meningococci (MaltoseGlucose= MeninGococci)
Which types of transfer can eukaryotic cells do?
only transformation
Which types of transfer can prokaryotic cells do?
all 3: conjugation, transduction, and transformation
Why are anaerobes susceptible to oxygen?
they lack catalase and/or oxidase and are susceptible to oxidative damage
Why does TB usually infect the upper lobes of the lung?
M.tuberculosis is an aerobe; there is more oxygen at the apicies
Why don't Mycobacteria Gram's stain well?
high lipid content cell wall requires acid-fast stain
Why don't Mycoplasma Gram's stain well?
no cell wall
Why don't Rickettsia, Chlamydia, and Legionella Gram's stain well?
they are intracellular (Legionella is Mainly intracellular)
Why don't Treponema Gram's stain well?
too thin to be visualized (use darkfield microscopy and antibody staining)
Why must rickettsia and chlamydia always be intracellular?
they can't make their own ATP
Are most fungal spores asexual?
yes
Are most P. Carinii infections symptomatic?
no, most of are asymptomatic
Are the above mentioned systemic mycoses dimorphic?
yes, (histoplasmosis, Paracoccidioidomycosis, Blastomycosis) except coccioidomycosis which is a spherule in tissue
Aspiration pneumonia is usually caused by脰
Anaerobes
Atypical pneumonia is usually caused by脰
Mycoplasma Pneumoniae (walking pneumonia), Legionella, Chlamydia pneumoniae
Bug Hints: Branching rods in oral infection =
Actinomyces israelii
Bug Hints: Currant jelly sputum =
Klebsiella
Bug Hints: Dog or cat bite =
Pasteurella multocida
Bug Hints: Pediatric Infection =
H. influenzae (including epiglottitis)
Bug Hints: Pneumonia in CS, burn infection =
P. aeruginosa
Bug Hints: Pus, Empyema, Abscess =
S. aureus
Bug Hints: Sepsis/Meningitis in Newborn =
Group B strep
Bug Hints: Surgical wound =
S. aureus
Bug Hints: Traumatic open wound =
Clostridium perfringens
How do the S. Schenckii yeast appear in the pus?
Cigar-shaped budding yeast
How do you diagnose cryptosporidium?
cysts on acid fast stain
How do you diagnose giardiasis?
Trophozoites or cysts in stool
How do you get P. Carinii?
Inhalation
How do you treat systemic mycoses (fungus)?
fluconazole or ketoconazole for local infection, amphotericin B for systemic infection
How do you Tx S. Schenckii?
Itraconazole or Potassium Iodide
How does Aspergillus appear microscopically?
Mold with septate hyphae that branch at a V-shaped (45 degree angle), rare Fruiting Bodies, they are NOT dimorphic
How does Mucor species appear microscopically?
It is a mold with irregular nonseptate hyphae branching at wide angles>90 degrees
How does Paracocciodioidomycosis appear histologically?
Captain's wheel' appearance (like on a sailboat)
How is Clonorchis sinensis transmitted and what disease results?
undercooked fish; causes inflammation of the biliary tract
How is Schistosoma transmitted and what disease results?
snails are host; cercariae penetrate skin of humans; causes granulomas, fibrosis, and inflammation of the spleen and liver
How is Ancylostoma Duodenale (Hookworm) transmitted and what disease results?
Larvae penetrate skin of feet; intestinal infection can cause anemia
How is Ascaris Lumbricoides (Giant roundworm) transmitted and what disease results?
Eggs are visible in feces; intestinal infection
How is cryptosporidium transmitted?
Cysts in Water
How is Dracunculus medinensis transmitted and what disease results?
In drinking water; sink inflammation and ulceration
How is E. Histolytica transmitted?
Cysts in Water
How is Echinococcus Granulosis transmitted and what disease results?
Eggs in dog feces cause cysts in liver; causes anaphylaxis if echinococcal antigens released from cysts
How is Enterobius Vermicularis (Pinworm) transmitted and what disease results?
food contaminated with eggs; intestinal infections; causes anal pruritus (don't scratch your bum and suck your thumb)
How is giardia transmitted?
Cysts in Water
How is Loa loa transmitted and what disease results?
Transmitted by deer fly; causes swelling the in the skin (can see worm crawling in conjunctiva)
How is malaria dx?
Blood smear
How is malaria transmitted?
mosquito (Anopheles)
How is Onchocerca volvulus transmitted and what disease results?
transmitted by female blackflies; causes river blindness
How is Paragonimus Westermani transmitted and what disease results?
Undercooked crab meat; causes inflammation and secondary bacterial infection of the lung
How is Sporothrix schenckii appear under the scope?
Dimorphic fugus that lives on vegetation
How is Strongyloides Stercoralis transmitted and what disease results?
larvae in soil penetrate the skin; intestinal infection
How is T. Solium transmitted and what disease results?
undercooked pork tapeworm; causes mass lesions in the brain, cysticercosis
How is T. Vaginalis transmitted?
sexually
How is Toxo transmitted?
cysts in meat or cat feces
How is Toxocara Canis transmitted and what disease results?
food contaminated with eggs; causes granulomas (if in retina=blindness)
How is Trichinella Spiralis transmitted and what disease results?
undercooked meat, usually pork; inflammation of muscle, periorbital edema
How is Wuchereria Bancrofti transmitted and what disease results?
female mosquito; causes blockage of lymphatic vessels (elephantiasis)
In what cells do you find histoplasmosis?
macrophages
Incidence of what cause of mengitis has decreased with a vaccine?
Incidence of H. influenze meningitis has decreased greatly with introduction of H. influenzae vaccine in the last 10-15 years
Is Pneumocystis Carinii (PCP) a yeast?
Yes, but originally classified as a Protozoa
Microscopically how does Candida appear?
budding yeast with pseudohyphae, germ tube formation at 37 degrees C)
Most osteomyelitis occurs in what age group?
children
Name 3 Trematodes (Flukes) .
Schistosoma, Clonorchis sinensis, Paragonimus Westermani
Name 4 opportunistic fungal infections.
Candida Albicans, Aspergillus fumigatus, Cryptococcus Neoformans, Mucor and Rhizopus species
Name 4 systemic mycoses.
Coccidiomycosis, Histoplasmosis, Paracoccidioidomycosis, Blastomycosis
Name two asexual spores transmitted by inhalation.
Histoplasmosis and Coccidiodomycosis
Name two Cestodes (Tapeworms) .
Taenia Solium, and Echinococcus Granulosus
Neonatal pneumonia is usually caused by脰
Group B streptococci, E. coli
Nosocomial pneumonia is usually caused by脰
Staphylococcus, gram-negative rods
PID includes what disorders in the body?
salpingitis, endometritis, hydrosalpinx, tubo-ovarian abscess
PID is likely caused by what two organisms?What are the characteristics of the disease caused by each organism?
#NAME?
Pneumonia in immunocompromised patients is caused by脰
Staphylococcus, gram-negative rods, fungi, viruses, Pnemumocystis carinii (with HIV)
Pneumonia in the alcoholic/IV drug user is usually caused by脰
S. pneumoniae, Klebsiella, Staphylococcus
Postviral pneumonia is usually caused by脰
Staphylococcus, H. influenzae
Salpingitis is a risk factor for脰
#NAME?
UTIs are found in men in which 2 age groups?
Babies with congenital defects and Elderly with enlarged prostates
UTIs are mostly caused how?
by ascending infections
What's the likely cause of osteomyelitis in a pt where you have no other information?
S. aureus
What 2 pathogens likely cause nosocomial infections associated with urinary catherization?
E. coli, Proteus mirabilis
What 2 pathogens likely cause nosocomial infections in the newborn nursery?
CMV, RSV
What 7 organisms are associated with UTIs?
- Serratia marcescens- Staphylococcus saprophyticus- E. coli- Enterobacter cloacae- Klebsiella pneumoniae- Proteus mirabilis- Pseudomonas aeruginosa[HINT: SSEEKS PP]
What abnormal lab result is often seen in osteomyelitis patients?
elevated ESR
What agar is used to culture for systemic mycoses?
Sabouraud's Agar
What are 4 clinical findings of Pyelonephritis?
#NAME?
What are 4 clinical findings of UTIs?
#NAME?
What are Conidia?
asexual fungal spores (ex. Blastoconidia, and arthroconidia)
What are some common Candida infections?
THRUSH in throat of Immunocompromised pts (neonates, patients on steroids, diabetics and AIDS pts) , endocarditis in IV drug users, vaginitis (high pH, Diabetes, post-antibiotic) , diaper rash, disseminated candidiasis (to any organ)
What are some infections caused by cryptococcus?
Cryptococcal meningitis, cryptococcosis
What are the 2 most common causes of nosocomial infections?
E. coli causes UTI- S. aureus causes wound infection
What are the 3 most common causes of UTI in young ambulatory women?
1. E. coli (50-80%)2. Staphylococcus saprophyticus (10-30%)3. Klebsiella (8-10%)
What are the 4 B's of Blastomycosis?
Big, Broad-Based, Budding
What are the common causes of hospital-acquired UTIs?
#NAME?
What are the common causes of meningitis in 6-60y/o?
#NAME?
What are the common causes of meningitis in 60+ y/o?
#NAME?
What are the common causes of meningitis in children (6mo-6y/o)?
#NAME?
What are the common causes of meningitis in HIV pts?
#NAME?
What are the common causes of meningitis in newborns (0-6mos)?
#NAME?
What are the common causes of osteomyelitis in those with prosthetic replacements?
S. aureus and S. epidermidis
What are the common causes of pneumonia in adults 18-40 y/o?
#NAME?
What are the common causes of pneumonia in adults 40-65 y/o?
#NAME?
What are the common causes of pneumonia in children (6wk-18yrs)?
#NAME?
What are the CSF finings in bacterial meningitis (pressure, cell type, protein and sugar levels)?
#NAME?
What are the CSF finings in fungal/TB meningitis (pressure, cell type, protein and sugar levels)?
#NAME?
What are the CSF finings in viral meningitis (pressure, cell type, protein and sugar levels)?
#NAME?
What are the diseases caused by Cryptosporidium?
Severe diarrhea in AIDS, Mild disease (watery diarrhea) in non-HIV
What are the diseases caused by Toxoplasma?
Brain Abscess in HIV and birth defects
What are the dominant normal florae in the colon?
Bacteroides fragilis > E. coli
What are the dominant normal florae in the vagina?
Lactobacillus, colonized by E. coli and group B strep
What are the infections caused by Aspergillus?
Ear fungus, Lung cavity Aspergilloma ('fungus ball') , invasive aspergillosis.
What are the predisposing factors of UTIs?
#NAME?
What can systemic mycoses mimic?
TB (granuloma formation)
What disease are caused by Entamoeba Histolytica?
Amebiasis: bloody diarrhea, dysentery, liver abscess, RUQ pain
What disease does Mucor species cause?
Mucormycosis
What disease does Pneumocystis carinii cause?
Pneumocystis Carinii Pneumonia
What disease does Sporothrix Schenckii cause?
Sporotrichosis
What disease does Trypanosoma Cruzi cause?
Chaga's Disease (heart disease)
What disease is caused by Giardia Lamblia?
Giardiasis: bloating, flatulence, foul-smelling diarrhea
What disease is caused by Leishmanina donovani?
Visceral Leishmaniasis (Kala-azar)
What disease is caused by P. Carinii?
Diffuse interstitial pneumonia in HIV
What disease is caused by the plasmodium species (vivax, ovale, malariae, falciparum) ?
MALARIA: cyclic fever, headache, anemia, splenomegaly
What disease is caused by Trypanosma Gambiense and Rhodesiense?
African Sleeping sickness
What disesase does Trichomonas Vaginalis cause?
Vaginitis: foul-smeilling, greenish discharge; itching and burning
What do you tx P. Carinii with?
TMP-SMZ, pentamidine, dapsone
What do you use to culture cryptococcus?
Sabouraud's Agar
What do you use to Diagnose E. Histolytica?
Serology and/or trophozoites or cysts in stool
What do you use to stain Cryptococcus?
India Ink
What do you use to tx cryptosporidium?
nothing
What do you use to Tx Giardiasis?
Metronidazole
What do you use to tx T. Vaginalis?
Metronidazole
What do you used to dx P. Carinii?
Lung biopsy or lavage, methenamine silver stain
What do you used to Tx Candida Albicans?
Nystatin for superficial infection, Amphotericin B for systemic infection
What does dimorphic mean?
fungi that are mold in the soil (low temp) and yeast in tissue (higher/body temp 37 C)
What form is cryptococcus and where do you find it?
heavily encapsulated yeast (not dimorphic), found in soil and pigeon droppings
What infections are dangerous in pregnancy?
Toxoplasma, Rubella, CMV, HSV/HIV, Syphilis[HINT: ToRCHeS]
What is chandelier sign?
Cervical motion tenderness associated with Pelvic Inflammatory Disease (PID)
What is diagnositic for L. donovani?
Macrophages containg amastigotes
What is diagnositic of T. Vaginalis?
Trophozoites on wet mount
What is histoplasmosis associated with?
bird or bat droppings
What is the 2nd leading cause of community-acquired UTI in sexually active women?
Staphylococcus saprophyticus
What is the characterisitc of Trichomonas on a slide?
motile on wet prep
What is the common cause of osteomyelitis in IV drug users?
Pseudomonas aeruginosa
What is the common cause of osteomyelitis in most people?
S. aureus
What is the common cause of osteomyelitis in sickle cell pts?
Salmonella
What is the common cause of osteomyelitis in the sexually active?
N. gonorrhoeae (rare), septic arthritis more common
What is the common cause of osteomyelitis in the vertebra?
M. tuberculosis
What is the dominant normal flora contributes to dental plaque?
Streptococcus mutans
What is the dominant normal flora in the nose?
S. aureus
What is the dominant normal flora in the oropharynx?
viridans streptococci
What is the dominant normal flora on the skin?
S. epidermidis
What is the most common STD in the U.S.?
Chlamydia trachomatis causes 3-4 million cases per year
What is the progression of S. Schenckii infection?
traumatic introduction into the skin, typically by a thorn ('rose gardner's' disease) , causes local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis) . Little systemic illness.
What is the vector for L. donovani?
Sandfly
What is the vector for T. Cruzi?
Reduviid Bug
What is the vector for T. Gambiense and Rhodesiense?
Tstese fly
What is used to dx African sleeping sickness?
Blood smear
What is used to dx T. Cruzii?
blood smear
What is used to dx toxoplasma?
serology and biopsy
What is used to treat D. Medinensis?
Niridazole
What is used to Treat E. Histolytica?
Metronidazole and Iodoquinol
What is used to tx african sleeping sickness?
Suramin for bloodborne disease or melarsoprol for CNS penetration
What is used to tx Ancylostoma duodenale?
Mebendazole/pyrantel pamoate
What is used to tx Ascaris Lumbricoides?
Mebendazole/pyrantel pamoate
What is used to tx Clonorhis sinensis?
Praziquantel
What is used to tx E. Granulosus?
Albendazole
What is used to tx E. Vermicularis?
Mebendazole/pyrantel pamoate
What is used to tx L. Donovani?
Sodium Stibogluconate
What is used to tx Loa loa?
diethylcarbamazine
What is used to tx malaria?
Chloroquine ( primaquine for vivax, ovale), sulfadoxine + pyrimethamine, mefloquine, quinine
What is used to tx Onchocerca Volvulus?
Ivermectin
What is used to tx Paragonimus Wetermani?
Praziquantel
What is used to tx S. Stercoralis?
Ivermectin/thiabendazole
What is used to tx schistosoma?
Praziquantel
What is used to tx T. Cruzii?
Nifurtimox
What is used to tx T. Spiralis?
Thiabendazole
What is used to tx taenia solium infection?
Praziquantel/niclosamide; albendazole for cysticercosis
What is used to tx Toxocara Canis?
diethylcarbamazine
What is used to tx toxoplasma?
sulfadiazine + pyrimethamine
What is used to tx Wuchereria. Bancrofti?
diethylcarbamazine
What organism can you presume is causing a nosocomial infection if respiratory equipment or burns are involved?
Psudomonas aeruginosa
What organism is the leading cause of UTI and shows a metallic sheen on EMB agar?
E. coli
What parasites have antigen variation?
trypanosomes (programmed rearrangement)
What pathogen is associated with hyperalimentation?
Candida albicans
What pathogen is associated with water (ie. aerosols)?
Legionella
What pathogen likely causes nosocomial infections from respiratory therapy equipment?
Pseudomonas aeruginosa
What pathogen likely causes nosocomial infections in the renal dialysis unit?
HBV
What patient population is susceptible to Mucor disease?
Ketoacidotic diabetic patients and Leukemic patients
What population does not have any flora?
Neonates delivered by cesarean section have no flora but are rapidly colonized after birth
What ratio is UTIs found more in women vs. men? Why?
10 to 1 because women have short urethrae more likely to be colonized by fecal flora
What stain do you use for lung tissue when you are detecting P. Carinii (PCP)?
silver
What state predisposes you to P. Carinii infection?
Immunosuppression
What STD is associated with Argyll-Robertson pupil?
3' Syphilis
What STD is associated with clue cells?
Garnerella
What STD is associated with Genital warts and loilocytes? What is the causative agent?
- Condylomata acuminata- HPV 6 and 11
What STD is associated with jaundice? What is the causative agent?
#NAME?
What STD is associated with opportunistic infections, Kaposi's sarcoma, lymphoma? What is the causative agent?
#NAME?
What STD is associated with painful penile, vulvar or cervical ulcers? What's the causative agent?
#NAME?
What STD is associated with painful ulcers, lymphadenopathy, rectal strictures? What is the causative agent?
#NAME?
What STD is associated with urethritis, cervicitis, conjuntivitis, Reiter's syndrome, Pelvic Inflammatory Disease (PID)? What is the causative agent?
Chlamydia- Chlamydia trachomatis
What STD is associated with vaginitis? What is the causative agent?
#NAME?
What STD is characterized by painful genital ulcer? What is the causative agent?
#NAME?
What STD is likely in a patient with a painless chancre? What causes it?
- 1' Syphilis- Treponema pallidum
What STD is likely in a patient with fever, lymphadenopathy, skin rashes, condylomata lata? What causes it?
- 2' Syphilis- Treponema pallidum
What STD is likely in a patient with gummas, tabes dorsalis, general paresis, aortitis, Argyll-Robertson pupil? What causes it?
- 3' Syphilis- Treponema pallidum
What STD is likely in a patient with urethritis, cervicitis, PID, prostatitus, epididymitis, arthritis? What organism causes it?
#NAME?
What test can be used to detect polysaccharide capsular antigen of Cryptococcus?
latex agglutination test
What types of infections can Candida Albicans cause?
systemic or superficial fungal infections
What UTI-causing organism has a bue-green pigment, fruity odor and is usually nosocomial and drug-resistant?
Pseudomonas aeruginosa
What UTI-causing organism is characterized by a large mucoid capsule and viscous colonies?
Klebsiella pneumoniae
What UTI-causing organism is mobile, causing 'swarming' on agar and also produces urease and is associated with struvite stones?
Proteus mirabilis
What UTI-causing organism is often nosocomial and drug-resistant?
Enterobacter cloacae
What UTI-causing organism sometimes produces a red pigment, is often nosocomial and drug-resistant?
Serratia marcescens
When do you start prophylaxis in HIV patients?
when the CD4 drops below 200 cells/mL
Where do the mucor and rhizopus species fungi proliferate?
in the walls of blood vessels and cause infarction of distal tissue
Where is Blastomycosis endemic?
States east of the Mississippi River and Central America
Where is Coccidioidomycosis endemic?
Southwest US, California (San Joaquin Valley or destert (desert bumps) 'Valley fever')
Where is Histoplasmosis endemic?
Mississippi and Ohio River valleys
Where is Paracoccioidomycosis endemic?
Rural Latin America
(T or F) Viral nucleic acids with same structure as host are infective alone; others require special enzymes (contained in intact virion.)
same
All viruses are haploid except _________?(1)
Retroviruses, which have two identical ssRNA molecules (diploid).
Bites from what 3 animals are more prone to rabies infection than a bite from a dog?
Bat, Raccoon, and Skunk
Define complementation?
When one of 2 viruses that infects the cell has a mutation that results in a nonfunctional protein. The nonmutated virus 'complements' the mutated one by making a functional protein that serves both viruses.
Define genetic drift.
Minor changes based on random mutations.
Define genetic shift.
Reassortment of viral genome(such as when human flu A virus recombines with swin flu A virus.)
Define phenotypic mixing?
When virus A acquires virus B coat proteins and acts like virus B buts its progeny will have virus A genome and coat.
Define reassortment?
#NAME?
Define recombination?
Exchange of genes between 2 chromosomes by crossing over within regions of significant base sequence homology.
Describe its incubation period and whether or not it has a carrier.
"Short incubation period (3 weeks)- No carriers
Long incubation (3 months)- has carriers"
Describe the general concept of bacterial super infection which can occur with influenza infection?
A life-threatening illness where a bacterial infection is superimposed on an existing viral infection.
Describe the genetic and physical properties of influenza virus?
#NAME?
Describe the migration of rabies within the CNS.
It migrates in a retrograde fashion within the CNS up nerve axons.
Describe the physical shape and duration of incubation for rabies.
-Bullet-shaped capsid (illus. in book)-long incubation period (wks. - 3 months)
Describe the technique and purpose for performing a Tzanck test?
assay for herpes-make a smear of an opened skin vesicle to detect multinucleated giant cells
Does HDV have carriers?
Yes
dz. process of HSV
cyclical
Explain the concept of a slow virus infection.
Virus exists in patient for months to years before it manifests as clinical disease.
HCV is a common form of hepatitis in what US population?
IV drug users
How does a Monospot test work?
It detects heterophil antibodies by agglutination to sheep RBC's
How is RNA translated and processed in picornaviruses?
RNA is translated into one long polypeptide that is cleaved by proteases into many small proteins.
How many segments and what sense is the RNA genome of influenza viruses?
-8 segments-negative sense
How may serotypes do paramyxoviruses have except parainfluenza which has ___?
1- 4- RSV also has 2 serotypes
Into what class RNA or DNA do all segmented viruses fall?
RNA
Killed vaccines induce what type of immunity?
Humoral, with no possibility of the virus reverting to virulence
Live attenuated vaccines induce what type of immunity?
Humoral and Cellular-with a risk of the virus reverting to virulence
Mneumonic for Hep A
Hep A: Asymptomatic (usually)
Mneumonic for rotavirus symptoms: ROTA
Right Out The Anus
Mneumonic: Hep D
Hep D: Defective, Dependent on HBV
Mneumonic: Hep E
Hep E: Enteric, Expectant mothers, Epidemics
Mneumonic: Hep B
Hep B: Blood-borne
Mneumonic: picoRNAvirus
pico = 'small' RNA viruses
Name 2 common bacterial infections in AIDS pts.
TB, M. avium (intracellulare complex)
Name 2 common protozoan infections in AIDS pts.
Toxoplasmosis, cryptosporidiosis
Name 3 members of the arborvirus family.
Flavivirus, Togavirus, and Bunyavirus
Name 3 possible sequelae of measles infection?
-SSPE- encephalitis- giant cell pneumonia (rare;found in immunocompromised persons)
Name 4 common fungal infections in AIDS pts.
Thrush (Candida ablicans)- cryptococcosis (cryptococcal meningitis)- histoplasmosis- Pneumocystis pneumonia
Name 4 common viral infections in AIDS pts.
HSV- VZV- CMV- PML(progressive multifocal leukoencephalopathy-JC virus)
Name 4 herpesviruses using the mneumonic:Get herpes in a CHEVrolet.
CMV-HSV-EBV-VZV
Name 4 main segmented viruses using the mneumonic BOAR.
#NAME?
Name eveloped DNA viruses (3).
#NAME?
Name naked DNA viruses (3). PAP
-Parvo-Adeno-Papova'You need to be naked for a PAP smear.'
Name the 3 naked RNA virusesNaked
#NAME?
Name the characteristic cytoplasmic inclusions seen in neurons infected with rabies virus.
Negri bodies
Name the DNA viruses using the mneumonic'HHAPPPy viruses.'
#NAME?
Name the illness caused by rabies and 2 primary symptoms.
Fatal encephalitis with seizures and hydrophobia.
Name the members of the PaRaMyxovirus using the letters in bold (4 viruses).
#NAME?
Name the recombinant vaccine available (1).
HBV (antigen = recombinant HBsAg)
Name the RNA enveloped viruses (9).
#NAME?
Name the RNA nucleocapsid viruses (3).
#NAME?
Name the vaccines that are killed (4).
#NAME?
Name the vaccines that are live attenuated (6).
#NAME?
Of these 3 markers (HBsAg, HBsAb, HBcAg), which ones are positive in each of the 4 phases below:(acute disease, window phase, complete recovery, chronic carrier).
Acute: HBsAg, HBcAg- Window: HBcAg- Complete Recovery: HBsAb, HBcAg- Chronic Carrier: HBsAg, HBcAg
On HIV, what is gp41 and gp120?
envelope protein
On HIV, what is p24? (illus. p. 205)
rectangular nucleocapsid protein
Roughly, what are the time periods for acute, latent, and immunodeficient stages of HIV?
Acute: 1-3 months, Latent: 3 months-3years, Immunodefic: 3 yrs.-death
Use the mneumonic PERCH to name members of the Picornavirus family.
#NAME?
What 2 antigens are used to classify influenza?
Neuraminadase, Hemagglutinin
What age group is the primary target of paramyxoviruses?
children
What antiviral treatment is approved for influenza A (especially prophylaxis) but not for influenza B & C
Amantadine and Rimantadine
What antiviral treatment is approved for influenza A and B?
Zanamivir and Oseltamivir
What are Councilman bodies and what are they pathomneumonic for?
acidophilic inclusions seen in the liver of those with yellow fever
What are the 3 C's of measles?
-Cough- Coryza (acute rhinitis)- Conjunctivitis; Be sure to look for Koplik spots
What are the 4 C's of HCV.
Chronic, Cirrhosis, Carcinoma, Carriers
What are the 4 most common diseases caused by prions?
Creutzfeldt-Jakob disease (CJD: rapid progressive dementia)- kuru-scrapie(sheep)- 'mad cow disease'
What are the causes of SSPE and PML in immunocompromised pts.
#NAME?
What are the classic symptoms of yellow fever?
high fever- black vomitous- jaundice
What are the common diseases (1) and routes of transmission(1) for HHV-8?
Kaposi's sarcoma (HIV pts.)- sexual contact
What are the common diseases (2) and routes of transmission(2) for EBV?
infectious mononucleosis, Burkitt's lymphoma- resp. secretions, saliva
What are the common diseases (2) and routes of transmission(2) for HSV-2?
herpes genitalis, neonatal herpes- sexual contact, perinatal
What are the common diseases (3) and routes of transmission(1) for VZV?
varicella zoster (shingles)- encephalitis-pneumonia
What are the common diseases (3) and routes of transmission(2) for HSV-1?
gingivostomatitis, keratoconjunctivitis, temporal lobe encephalitis, herpes labialis- respiratory secretions and saliva
What are the common diseases (3) and routes of transmission(6) for CMV?
congenital infection, mononucleosis, pneumonia- congenital, transfusion, sexual contact, saliva, urine, transplant
What are the general characteristics of a prion?
infectious agent that does not contain RNA or DNA, consists only of protein
What are the primary symptoms of the mumps virus? (MOP)
#NAME?
What are two classic illness caused by arborviruses?
-dengue fever (break-bone fever)- Yellow fever
What general form of encephalopathies do prions present as?
spongiform encephalopathies
What genetic property does segmentation afford viruses and how does this play into flu epidemics?
#NAME?
What group has a high mortality rate from HEV?
pregnant women
What hematologic finding is characteristic of mono?
abnormal circulating cytotoxic T cells (atypical lymphocytes)
What is HBcAb, and what does it indicate?
Antibody to HBcAg; IgM HBcAb indicates recent disease
What is HBcAg?
Antigen associated with core of HBV
What is HBeAb, and what does it indicate?
Antibody to e antigen; indicates low transmissibility
What is HBeAg, and what does it indicate?
it is a 2nd different antigen marker of HBV core; indicates transmissibility (HBeAg=Beware)
What is HBsAb, and what does it do?
Antibody to HBsAg; provides immunity to hepatitis B
What is HBsAg, and what does it indicate?
Antigen found on surface of HBV; continued presence indicates carrier state
What is IgM HAVAb, and what is it used to detect?
IgM antibody to HAV; best test to detect active hepatitis A
What is meant by the 'window period' in HBV infection, and what is positive in this period?
It is the period between disappearance of HBsAg and appearance of Anti-HBs; HBcAb is pos. during this period.
What is the classic vector for arborvirus?
Arthropods (mosquitos, ticks, etc.)ARBOR=Arthropod Borne
What is the function of reverse transcriptase in HIV?
synthesize dsDNA from RNA for integration into host genome.
What is the major mode of protection from influenza virus?
Killed viral vaccine which is reformulated each year and is given to those in high risk of infection (elderly, health-workers, etc.)
What is the method behind ELISA/Western blot and during what period of HIV infection are they often negative?
look for abs to viral proteins; false negatives common in first 1-2 months of infection
What is the mneumonic for remembering the Tzanck smear?
Tzanck heavens I don't have herpes.
What is the only DNA virus that is not double stranded?
Parvoviridae (ssDNA)
What is the only RNA virus that has dsRNA?
Reoviridae has dsRNA
What is the viral cause of the common cold?
-Rhinovirus, 100+ serotypes-Rhino has a Runny nose.
What neurologic infection can picornaviruses (except rhinoviruses and hepatitis A viruses) cause?
Aseptic Meningitis
What physical finding is diagnostic for measles?
Koplik spots(bluish-gray spots on buccal mucosa)
What population should not receive a live vaccine?
Those who are immunocompromised and their close contacts.
What reproductive complication can mumps cause?
sterility; especially after puberty
What shape are all the DNA viruses? Which virus (1) is the exception?
#NAME?
What test is used to make the presumptive dx of HIV, and then, which test confirms the dx?
ELISA (sensitive w/ high false + and low threshold);Western blot (specific, high false - rate with high threshold)
What tests are gaining popularity for monitoring drug tx efficacy in HIV?
PCR/viral load tests that measure viral RNA in the blood
What type of genome does HIV have?
diploid RNA
What type of nucleic acid structure does rotavirus have?
segmented dsRNA (a reovirus)
What type of transcription occurs and what type of polymerase does HBV possess?
Reverse transcription- the virion contains an DNA-dependent DNA polymerase
What type of virus is HAV and how is it transmitted?
RNA picornavirus- fecal-oral route
What type of virus is HBV and how is it transmitted?
DNA hepadnavirus- parenteral, sexual, and maternal-fetal routes
What type of virus is HCV and how is it transmitted?
RNA flavivirus- via blood and resembles HBV in its course and severity
What type of virus is HDV and what is special about its envelope?
delta agent, it is a defective virus-requires HBsAg as its envelope
What type of virus is HEV and how is it transmitted?
RNA calicivirus- enteric transmission; causes water-borne epidemics
What variant of dengue fever is found in Southeast Asia?
hemorrhagic shock syndrome
What virus causes and what are the classic symptoms of mononucleosis?
EBV- fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (esp. posterior auricular nodes)
What virus causes yellow (=flavi) fever, and what is its vector and reservoirs (2)?
flavivirus- Aedes mosquitos- monkey or human reservoir
What virus is the most common global cause of infantile gastroenteritis and acute diarrhea during winter (in the US).
Rotavirus
Where do enveloped viruses acquire their envelopes, and what virus is the exception to this rule?
#NAME?
Where in the cell do DNA viruses replicate, and which virus is the exception to this rule?
-Nucleus- exception: poxvirus in cytoplasm (carries DNA-dependent RNA polymerase)
Where in the cell do RNA viruses replicate, and what 2 viruses are the exception to this rule?
#NAME?
Which marker tests are appropriate for each phase of hepatitis infection:Incubation, Prodrome/acute illness, Early Convalescence, Late Convalescence.
HBsAg- HBsAg (Anti-HBc)- Anti-HBc- Anti-HBs (anti-HBc)
Which two DNA viruses don't have a linear genome?(they're circular)
Papovaviruses and Hepadnaviruses
Which two hepatitis viruses follow the fecal-oral route?
A and E; 'The vowels hit your bowels.'
Which two hepatitis viruses predispose to hepatocellular carcinoma?
HBV and HCV
Why is mono called the 'kissing disease?'
Peak incidence occurs during peak kissing years 15-20 yo-(saliva transmission)