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12 Cards in this Set

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describe the physical structure/etiology of clostridium. what are some key words to know here?
these are anerobic, gram positive, spore formers. similar to anthrax, minus the anerobic part. sometimes can be gram negative later in life (perfinges is like this).

"box car" shaped = clostridium perfinges
why are we studying clostridium during our cancer block?
There are several categories of clostridium infections. When you're talking about those which present as non-supprative, rapidly progressing tissue necrosis (Rhabdomyolysis), there are two possible causes.

those that DON'T have to do with trauma are "spontaneous" and are caused mostly by Clostridium SEPTICUM.

in 80% of these non-trauma types are secondary to colon cancer of a lymphoproliferative disorder (usually cancer), so until proven otherwise, assume cancer's going on if you see this.
what are the symptoms of a clostridium infection? how does it cause disease?
remember that perfinges is our traditional causer of "gas gangrene."


so, rhabdomyolysis secondary to trauma is likely caused by perfinges.

if it's sporadic or the patient has cancer, it's septicium. Note that disease is mostly driven by TOXINS, of which the enzyme LECITHINASE, is probably the worst (digests muscles).

if it's sporadic, sudden onset of pain, discoloration, edema, bullae, crepidence (from gas), probably clostridium. CPK in the urine's going to be high, myoglobin, brown/red colored urine.
what mutation causes the sickle cell disease?
GLU to VAL at the 6th position of the beta chain of hemoglobin. It's a protection against malaria.
what disease is mentioned as being particularly bad in sickle cell patients? why?
SCA patients are at particular risk for infection by capsuled bacteria, especially PNEUMOCOCCAL infections. Couple reasons - pneumococcal infections depend on the ALTERNATIVE COMPLEMENT PATHWAY for clearance, and SCA people are deficient in it. Also, once bacteremic, depend on your spleen to filter everything out.

SCA People are asplenic (eventually gets covered with fibrin and totally useless).

so they get lots of meningitis, very dangerous.

decreased C3b and C5b activation.

also, klebsiella, H. influenzae, and salmonella.
what are the major causes of meningitis for different age groups?
neonates = E. coli and strep agalactia

infants = strep. pneumo and h. influenza (before vaccine)

kids/adolescents/young adults: nisseria

elderly: strep pneumo/lysteria
EBV infection - what can serology tell you about the state of infection/different possible diseases?
if active infection is going on, you should have VCA-IgM (this is viral capsid antigen), set it apart. Also have VCA-IgG, EA, but no EBNA.

Subclinical will have some kind of VCA, rest is hard to predict.

if you have CANCER, expect to have VCA-IgG plus EBNA and one of the EA's.

if it's Burkitt's, have VCA IgG, EAR, and EBNA

if it's nasopharyngeal cancer, have VCA-IgG, EA-D, and EBNA.

so really look at the IgG and the kind of EA that's present (R = buRkitt's, D=nasopharyngeal).

also, past infection = NO VCA IgM, but should have VCA IgG and EBNA IgG.
what are the tests for mono?
there's the Paul-Bunnell heterophilic antibody, so can test for it (heterophil antibody test) - note that you need to remove Forssman antibodies first by using guinea pig cells, then aglutinate it.

also the MONOSPOT test - one step, no removal of fossman antibodies.

don't forget that mono will have lots of DOWNY cells.
how does the body try and fight off EBV? What's most important?
interferon production

NK cells

CD8 cells

ADCC

Ab's.



the CD8 killer T cell response is most important - but remember that the virus is going to crank up production of suppressor T cells, which is why you get that huge T cell proliferation.
what does it mean if you have mono symptoms but come up negative on the heterophil test?
50% chance that you still have mono, just a false negative. the other 50% are likely to have mono-like syndrome from CMV or TOXO infection.
what malignancies are associated with EBV? give details on them.
burkitt's lymphoma, nasopharyngeal cancer, hodgkin's, T-cell lymphomas, and CNS lymphomas (IN AIDS PATIENTS).

Post transplant lymphoproliferative disorders.

Burkitt's is IN KIDS and involves the jaw.

nasopharyngeal cancer = men in southern china.
post transplant lymphoproliferative disorders - what's possible, outcomes, etc?
can be polymorphous B cell proliferation, b cell lymphoma, or lymphoblastic lymphoma.

sometimes going lighter on the cyclosporin makes them regress.