Usmle First Aid Microbiology

Front 1

Differentiation between coagulase negative Staphylococci

Back 1

NO StRESs with ur staph (staff)

Novobiocin

Saprophyticus --> Resistant

Epidermidis --> Sensitive

Front 2

Differentiation between alpha hemolytic (green) Streptococci

Back 2

OVRPS (overpass)

Optochin:

Viridans --> Resistant

Pneumoniae --> Sensitive

Front 3

Differentiation between beta hemolytic (clear) Streptococci

Back 3

B-BRAS

Bacitracin

group B (agalacticae) --> Resistent

group A (pyogenes) --> Sensitive

Front 4

alpha hemolytic bacteria

Back 4

gram positive cocci

partial reduction of hemoglobin -> green brownish colour

Strep. pneumoniae (catalase- optochin sensitve)

Viridans Strep (S mutans/S mitis) (catalase - optochin resistent)

OVRPS (overpass)

Front 5

Beta hemolytic bacteria

Back 5

gram positive cocci

complete lysis of RBCs --> clear area surrounding them:

Staphylococcus areus (catalase and coagulase positive)

Streptococcus pyogenes --> group A (catalase negative and bacitracin sensitive)

Streptococcus agalacticae --> group B (catalase negative and bacitracin resistent)

Front 6

Staphylococcus areus

Back 6

gram positive / beta hemolytic / catalase positive / coagulase positve

-colonizes in nares,axilla and groin

-causes:

--> inflammatory disease (skin inf., organ abscesses, pneumonia(often with influenza), endokarditis,septic arthitis and osteomyelitis)

--> Toxin mediated disease ( toxic shock syndrome (TSST-1), scalded skin syndrome (exofoliative toxin), rapid onset food poisening (enterotoxins))

Front 7

MRSA

Back 7

MRSA (methicillin resistant S areus infection --> important cause of serious nosocmial infections, resistant to methilicin and nafcilin because of altered peniciliin binding protein)

Front 8

Staphylococcal toxic shock syndrome (TSS)

Back 8

fever, vomiting, rash, desquamation, shock, end-organ failure.

-->high AST, high ALT, high bilirubin

--> prolonged use of use of vaginal tampons and nasal packing

Front 9

Food poisoning with Staph areus

Back 9

ingestion of a preformed toxin

short inkubation period (2-6 h)

--> nonbloody diarrhea and emesis

Enterotoxin --> heat-stable --> not killed by cooking

Front 10

TSST-1

Back 10

superantigen that binds to MHC 2 and T-cell receptor resulting in polyclonal T-cell activation

Front 11

Staphylococcus epidermidis

Back 11

gram positive, catalase positve, coagulase negative, urease positive

does not ferment mannitol (vs S areus)

normal flora to skin, contaminates blood cultures

infects prosthetic devices, IV catheters, producing biofilm

Front 12

Staphylococcus saprophyticus

Back 12

gram positive, catalase positive, coagulase negative, urease positive, Novobiocin resistent

saprophyte = organism that lives on dead organic material

normal flora = female genital tract, perineum

second most common cause of uncomplicated UTI in young women

most common is E coli

Front 13

Streptococcus pneumoniae

Back 13

gram positive, alpha hemolysis, Optochin sensitve (OVRPS), encapsulated, IgA Protease (SHiN)

Most common cause of:

-Meningitis

-Ottitis media (children)

-Bacterial pneumonia

-Sinusitis

"rusty" sputum, Sepsis in patients with sickle cell disease, asplenic patients

no capsule --> no virulence

Front 14

Viridans group streptococci

Back 14

gram positive, alpha hemolytic

normal flora of the orophyarynx that causes dental caries (S mutans and mitis) and subacute bacterial endokarditis at damaged heart valves (S sanguinis)

Resistant to optochin (vs S pneumoniae) OVRPS

S sangiunis makes dextrans, which bind to fibrin-platelate aggregates of damaged heart valves

Viridans live in mouth, theyre afraid of the chin (Optochin)

Front 15

Streptococcus pyogenes (group A streptococci)

Back 15

gram positive cocci in chains, group A, PYR (pyrrolidonyl arylamidase) positve, hyaluronic acid capsule inhibits phagocytosis, Antibodies to M protein--> better defence but can give rise to rheumatic fever

cause:

--> Pyogenic : pharynitis, cellulitis, impetigo(honey-crusted-lesions), erysepelas

-->Toxigenic : scarlet fever, toxic shock-like syndrome, necrotizing fasciitis

-->Immunologic: rheumatic fever, glomerulonephritis

Front 16

Criteria of rheumatic fever

Back 16

-J<3ONES (mojor criteria)

Joints - arthitis

<3 - Carditis

Nodules - subcutaneous

Erythrema marginatum

Sydemham chorea

Pharyngitis can result in rheumatic "phever" and glomerulonephritis.

Impetigo usually precedes glomerulonephritis

Front 17

Scarlet fever (Scharlach)

Back 17

blanching, sandpaper like body rash, strawberry tongue, circumoral pallor in the setting of group A streptococcal pharyngitis (erythrogeniy toxin positive)

Front 18

Streptococcus agalacticae (group B)

Back 18

gram positive, bacitracin resistant (B-BRAS), beta-hemolytic, colonizes vagina

causes:

pneumonia / meningitis / sepsis in babies(B for Babies)

produces CAMP factor --> enlarges area of hemolysis of S areus

Screen pregnant women (35-37 weeks of gestation --> rectal vaginal swab)

--> if positive --> intrapartum Penicillin prohylaxis

Front 19

Enterococci

Back 19

gram positive cocci

Enterococci (E faecalis and E faecium) are normal colonic flora that are penicillum G resistant and cause UTI, biliary tract infections and subacute endocarditis (after GI/GU procedures)

catalase negative, PYR positive, variable hemolysis

Front 20

Steptococcus bovis

Back 20

gram positive cocci, colonizes gut

S gallolyticus (S bovis biotyp 1) can cause bacteremia and subacute endocarditis and is associated with colon cancer

Bovis in the blood = cancer in the colon

Front 21

VRE (vancomycin resistant enterococci)

Back 21

important cause of nosocomial infections

Front 22

ASO titer or anti-DNase B antibodies

Back 22

recent streptococcus pyogenes infection

Front 23

Bacillus anthracis

Back 23

gram positive, spore forming rod, anthrax toxin

only bacterium with polypeptide capsule (D-glutamate)

Colonies show halo projections --> medusa head

Front 24

Cutaneus anthrax

Back 24

cutaneus manifestation of Bacillus anthrax

painless papule surrounded by vesicles --> ulcer with black eschar (painless, necrotic)

--> uncommonly progresses to bacteremia and death

Front 25

Pulmonary anthrax

Back 25

pulmonary maifestation of Bacillus anthrax

inhalation of spores --> flu-like symptoms that rapidly progress to fever, pulmonary hemorrhage, mediastinitis and shock

known as woolsorters disease (Weberhusten)

Front 26

Bacillus cereus

Back 26

gram positiv rod / causes food poisening

reheated rice syndrome

Spores survive cooking rice. Keeping rice warm leads to germination of spores and enterotoxin formation.

Emetic type --> seen with rice and pasta:

-nausea and vomiting within 1-5 h

-caused by cereulide (preformed toxin)

Diarrheal type

-nonbloody diarrhea and GI pain within 8-18 h

Front 27

Clostridia with exotoxins

Back 27

gram positive, spore forming, obligate anaerobic rod

C tetani

C botulinum

C perfringens

C difficile

Front 28

Clostridium tetani

Back 28

gram positive, spore forming, obligate anaerobic rod

produces tetanospasmin (causing tetanus).

-cleaves SNARE protein

-therefore blocks release of neurotransmitters

-blocks release of inhibitory neurotransmitters GABA and glycine in Renshaw cells (spinal cord)

prevent tetanus with vaccine

treat with antitoxin (+/- booster), diazepam (for muscle spasms) and wound debridement

Front 29

tetanus

Back 29

caused by Clostridium tetani

spastic paralysis,

trismus(lockjaw)

risus sardonicus (raised eyebrows and open grin)

opsthotonus (spasm of spinal extensors)

Front 30

Clostridium botulinum

Back 30

gram positive, spore forming, obligate anaerobic rod

produces heat-labile toxin that inhibits ACh release at the neuromuscular junction causing botulism.

adults --> ingestion of preformed toxins

babies--> ingestion of spores(e.g. in honey) leads to floppy baby sndrome.

treat with antitoxin

Front 31

botulism

Back 31

4 Ds

Diplopia

Dysarthria

Dysphagia

Dyspnea

Botulinum is from bottles of food, juice, and honey

flaccid descending paralysis

Front 32

Local Botox injections

Back 32

toxin of clostridium botulinum

used to treat

-dystonia

-achalasia

-muscle spasms

-cosmetic reduction of wrinkles

Front 33

Clostridium perfringens

Back 33

gram positive, spore forming, obligate anaerobic rod

produces alpha toxin (lecithinase = phosphlipase)

that can cause myonecrosis (gas gangrene) and hemolysis

Spores can survive in undercooked food, when ingested bacteria release heat labile enterotoxin --> food poisoning

Front 34

Clostridium difficile

Back 34

gram positive, spore forming, obligate anaerobic rod

produces 2 toxins:

Toxin A:

enterotoxin that binds to brush border of gut and alters fluid secretion

Toxin B:

cytotoxin that disrupts cytoskeleton via actin depolymerization

both toxins lead to diarrhea--> pseudomembranous colitis

often secondary to antibiotic use (esp. clindamycin/ampicillin) and often with PPI (Proton pump inhibitor use)

Dgx: detecting one of both toxins in stool / PCR

Front 35

Corynebacterium diphteriae

Back 35

gram positive rod, transmitted via respiratory droplets, grows on cystein-tellurite aga

causes:

diphteria via exotoxin encoded by beta-prophage: potent exotoxin inhibits protein synthesis via ADP-ribosylation of EF-2

Symptoms : pseudomembranous pharyngitis (grayish-white plaques) with lymphadenopathy, myocarditis and arrythmia

Lab diagnosis: gram positive rods with metachromatic (blue and red) granules and positive Elek(test for diphteria toxin on aga) test for toxins

ABCDEFG:

ADP-ribosylation

Beta-prophage

Corynebacterium
Diphteriae
Elongation Factor 2
Granules

Front 36

Listeria monocytogenes

Back 36

gram positive, facultative intracellular bug

aquired by ingestion of unpasteurized dairy products and cold deli meats

placental transmission or vaginal transmission during birth.

grows well at refigeration temperatures (4-10C)

= cold enrichment

Forms rocket tails (red on pic) via actin polymerization that allow intracellular movement and cell-to-cell spread across cell membranes --> avoiding antibody

causes:

amnionitis, septicemia and spontanous abortion

immunocompromized: meningits

healthy: gastroenteritis

neonatal: meningitis, granulomatosis infantiseptica

treatment: ampicillin

Front 37

Nocardia

Back 37

gram positive and forms long branching filaments resembling fungi

-aerobic (vs. Actinomyces anaerobic)

-weak acid fast (vs Actinomyces not)

-found in soil

causes :

pulmonary infections in immunocompromized (can mimic TB with negative TBB)

cutaneus infection after trauma in immuncompetent

can spread to CNS

Treat with Sulfonamide (TMX-SMX)

SNAP Sulfonamides- Nocardia -- Actinomyces - Penicillin

Front 38

Actinomyces

Back 38

gram positive and forms long branching filaments resembling fungi

-anaerob (vs Nocardia aerob)

-not acid fast ( vs Nocardia weak acid fast)

-found in oral, reproductive and GI flora

causes:

oral/ facial abscesses that drain through sinus tracts, often with dental caries/extraction, forms yellow sulfur granules that cause PID(pelvic inflammatory disease)

with IUD(intrauterin device)

treat with penicillin

SNAP Sulfonamides- Nocardia -- Actinomyces - Penicillin

Front 39

Primary and secondary tuberculosis

Back 39

primary tuberculosis

-->Hilar nodes + Ghon focus (usually mid an lower lobes) = Ghon complex

90% healing by fibrosis Calcification (tuberculin positive)

--> after that reactivation can occur (secondary tuberculosis) = Fibrocaseous cavity lesion (usually upper lobes)

-->sec. tuberculosis can lead to locolaized destructive disease (Ceasation in cavity in the lund plus caesation in e.g. kidney)

-->can also progress to bacteremia and miliary tuberculosis

10% of primary tuberculosis lead to progressive primary tuberculosis (AIDS, malnutrition) --> leads to progressive lung disease --> bacteremia

--> progresses to Miliary tuberculosis:

caseous necrosis in Meninges, Vertebrae (Pott disease), Lymph nodes, Lungs, Spleen, Adrenal gland, Joints and long bones

Front 40

PPD(Mantoux test) test in tuberculosis

Back 40

PPD positve --> if current or past exposure

PPD negative --> if no infection and in sarcoidosis or HIV infection (especially with low CD4 count)

Interferon-gamma- release assaey (IGRA) has fewer false positves from BCG vaccination

Front 41

Pathology of tuberculosis

Back 41

Caseating granulomas with central necrosis and Langerhans giant cells are charecteristic of secondary tuberculosis

Front 42

Mycobacteria

Back 42

All mycoacteria are acid-fast (pink rods)

Mycobacterium tuberculosis

-->TB often resistent to multiple drugs

M avium - intracellulare

-->causes disseminated non-TB disease in AIDS often resistent to multiple drugs. Prophylaxis with azithromycin when CD4 count <50 cells/mm³

M scrofulaceum

--> cervical lymphadenitis in children

M marinum

--> hand infection in aquarium handlers

Front 43

Tuberculosis symptoms plus virulence

Back 43

fever, night sweats, weight loss, cough, hemoptysis

Cord factor creates (connects mycobacteria) a "serpentine cord" in virulent strains of M tuberculosis

--> activates macrophages --> promoting granuloma formation

--> induces release of TNF alpha

Sulfatides (surface glycolipids) inhibit phagolysomal fusion

Front 44

Leprosy (Hansen disease)

Back 44

Mycobacterium tuberculosis

acid-fast bacillus, like cool Temperature (-->infects skin and superficial nerves- glove and stocking loss of sensation) and cannot be grown in vitro

Diagnosed via skin biospsy or tissue PCR.

Reservoir in USA --> Armadillos (Gürteltiere)

Hansen disease has 2 forms:

--> lepromatous (can be lethal)

presents diffusely over the skin with leonine (lion-like) facies and is communicable, characterized by low cell-mediated immunity with humeral Th2 response

-->tuberculoid

limited to a few hypesthetic, hairless skin plaques, characterized by high cell-mediated immunity with a largely Th1-type immune response

Treatment: dapsone and rifampin (tuberculoid form) clofazimine is added for lepromatous form

Front 45

Lactose-fermenting enteric bacteria bacteria

Back 45

Lactose is key

Test with McConKEES

--> pink colonies on McConkey agar

Klebsiella, E coli, Enterobacter and Serratia

E Coli produces Beta-Galactosidase which bracks down lactose into glucose and galactose

Front 46

Neisseria

Back 46

gram negative diplococci

metabolize glucose and produce IgA proteases.

contain LPS(Lipopolysacharids) with strong endotoxins

N gonorrhoeae is often intracellular (within neutrophils)

MeninGococci ferment Maltose and Glusose

Gonococci ferment Glucose

Front 47

Neiseria gonorrheo

Back 47

No LPS (vs Meningococci)

No Maltose fermentation (vs Meningococci)

No Vaccine due to antgenetic variatition (vs Meningococci)

sexually and perinatal transmission

Causes gonorrhea, septic arthritis, neonatal conjunctivitis (2-5 days after birth), pelvic inflammatory disease (PID) and Fitz-Hugh-Curtis Syndrome

Saver sex (condoms), erythromycion ointment prevents neonatal blindness

Treatment:

ceftriaxone + (azithromycin or doxycylin) for possible chlamydial coinfection

Front 48

Neisseria meningitis

Back 48

Polysacharid capsule (vs gonnococci)

Maltose fermentation (vs gonnococci)

Vaccine (type B vaccine not widely available)

Transmitted via respiratory or oral scretions

causes:

meningococcemia with petechial hemorrhages and gangrene of toes, meningitis, Waterhouse-Friederichsen syndrome(adrenal insufficiency, fever, DIC, shock)

Rifampin, ciprofloxacin or ceftriaxone for prophylaxis in close contacts

Treatment:

ceftriaxone or penicillin G

Front 49

Hemophilus influenzae

Back 49

small gram negative rod

aerosol transmission

Nontypeable (nonencapsuled) strain are the most common cause of mucosal infections (ottitis media, conjunctivitis, bronchitis) since vaccines also for invasive infections !

produces IgA proteases

vaccines --> type b = capsular polysacharide

give between

Culture on chocelate agar (Factor V(Nad+) and X(hematin))

can also be grown with S areus --> hemolysis provides blood factors

hemophilus = loves blood

HaEMOPhilus causes:

Epiglottits (endoscopic: "cherry red"/ Xray--> thumb sign)

Meningitis

Otitis media

Pneumonia

Treatment:

Haemophilus

amoxicillin +/- clavunate for mucosal infections

ceftrixone for meningitis

rifampin = prophylaxis for close contacts

Front 50

Bordetella pertussis

Keuchhusten

Back 50

gram negative, aerobic, coccobacillus

virulence factors include pertussis toxin (disables Gi) and tracheal cytotoxin

3 cilinical stages

-catarrhal = low grade fever, coryzae(rhinitis)

-paroxysmal = paroxysm of intense cough followed by a inspiratory "whoop" = whooping cough/ posttussive vomiting

-convalescent = gradual recovery of chronic cough

prevention : Tdap and DTaP vaccines

can be mistaken as viral infection due to lymphocytic infiltrate

Front 51

Legionella pneumophila

Back 51

gram negative rod

gram stains poorly

--> use silver stains

-->grow on charcoal medium(with iron and cystein)

"French legionnaire with his silver helmet, sitting around a campfire(charcoal) with his iron dagger...he is no sissy(cystein)"

aerosol transmission from enviromental water source habitat (hot water tanks/ Air conditioner)

treatment macrolide or quinolone

Front 52

Legionnaires disease

Back 52

due to Legionella pneumophila infection

severe pneumonia ( unilateral and lobar)

fever

GI and CNS symptoms

Common in smokers and in chronic lung disease

Front 53

Pontiac fever

Back 53

due to Legionella pneumophila infection

flu-like syndrome

Front 54

Pseudomonas aeroginosa

-stain

-morphology

-toxins

Back 54

aerobic, motile, gram negatve rod. Non-lactose fermenting, oxidase postive.

produces pyocyanine = blue-green pigment

grape like odor

produces :

exotoxin --> fever shock

exotoxin A --> inactivates EF 2

phospholipase C --> gedrade cell membranes

pyocyanin --> generate ROS

Mucoid polydacharide capsule may contribute to chronic pneumonia in cystic fibrosis due to biofilm formation

frequently found in water --> hot tub folliculitis

Front 55

What causes Pseudomanas aeroginosa ?

seen with ?

Treatment?

Back 55

PSEUDOMONAS

Pneumonia, pyocyanin

Sepsis

Ecthyma gangrenosum

UTI

Diabetes, drug use (seen with)

Osteomyelitis

Mucoid Polysacharide Capsule

Ottitius externa (swimmers ear)

Nosocomial infections (catheters, equipment)

Exotoxin A

Skin infections (hot tub folliculitis)

Treatment:

CAMPFIRE

Carbapenems

Aminoglykosides

Monobactams

Polymyxins (polymyxin B, colistin)

Flouroquinoles (ciprofloxacin, levofloxcin)

ThIRd and fourth generation cephalosporins (ceftazidim, cefepime)

Extended-spectrum penicillins (piperacillin, cefepime, ticarcillin)

Front 56

Ecthyma gangrenosom

Back 56

seen in infection with pseudomonas aeroginosa

rapidly progressing, necrotic cutaneus lesion caused by pseudomonas bacteremia

typically seen in immunocompromised patients

Front 57

Escherichia coli

Back 57

gram negative rod

E coli virlulence factors include:

fimbriae - cystitis and pyelonephritis --> P-Pili

K-capsule - pneumonia, neonatal meningitis

LPS endotoxin - septic shock

Front 58

EIEC

Back 58

Toxin and Mechanism:

invades intestinal mucosa and causes necrosis and inflammation

Presentation:

Invasive, dysentery. Clinical manifestation similar to Shigella (bloody diarrhea)

Front 59

ETEC

Back 59

"Montezumas revenche" (-->cAMP)

Toxin and Mechanism:

Prduces heat -labile and heat-stable enteroToxins, No inflammation or invasion

Presentation:

Travelers diarrhea (watery)

Front 60

EPEC

Back 60

Toxin and Mechanism:

no toxin produced, adheres to apical surface, flattens villi, prevents absorption

Presentation:

Diarrhea, usulally in children (Pediatrics)

Front 61

EHEC

Back 61

Toxin and Mechanism:

O157:H7 = most common serotype in the US

Often transmitted via undercooked meat, raw leafy vegetables

Shiga-like toxin causes

hemolytic-uremic syndrome:

TRIAD:

-anemia

-thrombocytopenia

-acute renal failure (due to microthrombi in damaged endothelium)

--> mechanical hemolysis (schistocytes in peripheral blood smear), platelate consumption and low renal blood flow

Presentation:

Dysentry (toxins alone causes necrosis and inflammation)

Does not ferment sorbitol

H

Hemorrhagic

Hamburgers

Helolytic-uremic syndrome

Front 62

Helicobacter pylori

Back 62

curved , flagellated= motile, gram negative rod

triple positive

catalase

oxidase

urease

breath test and fecal antigen test

Urease produces ammonia creating--> alkaline enviroment which helps H pylori survive acidic mucosa

colonizen manly antrum of stomach (near the pylorus)

causes:

gastritis

peptic ulcer disease (espiacally duodenal)

gastric adenocarcinoma

MALT lymphoma

triple therapy:

Amoxicillin (metronidazole if penicillin allergy)

Clarithromycin

Proton Pump inhibitor

Antibiotics Cure Pylori

Front 63

Spriochetes general

Back 63

spiral-shaped bacteria with axial filaments

Borrelia (big size)

Leptospira

Treponem

BLT

Borrelia are big

dye with aniniline dyes (Wright or giemsa)

can be seen in light microscopy

Treponema is visualized in dark-field microscopy or direct flourescent antibody (DFA) microscopy

Front 64

Leptospiro interrogans

Back 64

Spirochete with hook-shaped ends found in water contaminated with animal urine

Leptospirosis:

flu-like symptoms

myalgia (espiacally on calves)

jaundice

photophobia

cojunctival suffusion (erythrema / exsudate)

--> prevalent among surfers in tropics (hawaii)

Weil disease: (icterohemorrhagic leptospirosis)

severe form with jaundice and azotemia(high levels of nitrogen containing compounds)

kidney dysfunction

fever

hemorrhage

anemia

Front 65

Lyme disease

Back 65

Borrelia bugdorferi which is transmitted by Ixodes deer tick (also vector for Anaplasma spp and protozoa Babesia)

natural reservoir is the mouse (importent in tick cycle)

Northeastern USA

3 Stages

Stage 1:

erythema migrans (bulls eye = pathognomonic)

flu-like symptoms

Stage 2:

early dissemenated

secondary lesions

AV block

facial nerve palsy (Bell)

migratory myalgias / transient arthitis

Stage 3:

late dissemenated

encephalopathies

chronic athritis

A key lyme pie to the FACE

Facial nerve plalsy

Arthritis

Cardiac block

Erythrema marginatum

Treatment:

doxycycline (1st line)

amoxicillin

cefuroxime in pregnant women and children

Front 66

Syphilis

Back 66

caused by spirochete treponema pallidum

primary

secondary

tertiary

congenital

Front 67

Primary Syphilis

Back 67

localized painless chancre

if available use dark-field microscopy to visualize treponems in fluid from chancre

VDRL positive in 80 %

Front 68

secondary syphilis

Back 68

disseminated disease with constitutional symptoms

maculopapular rash (palms and soles)

Condylomata lata (smooth moist, painless, wart-like white lesions on genitals)

lymphadenopathy

patchy hair loss

--> dark field microscopy

testing : VDRL(nonspecific) + confirm diagnosis with specific test (FTA-ABS)

FTA-ABS = Fluoreszenz-Treponema-Antikörper-Absorption-Test

Secondary Syphilis = Systemic

latent syphilis may follow = positive serology no symptoms

Front 69

tertiary syphilis

Back 69

Gummas (chronic granulomas)

aortitis (vasa vasorum destruction)

neurosyphilis (tabes dorsalis, "general paresis")

Argyll Robertson pupil (prostutes pupil)

Signs:

broad based ataxia

positive Romberg

Charcot joint

stroke without hypertension

For neurosyphilis:

spinal fluid test with VRDL, FTA-ABS, PCR

Front 70

congenital syphilis

Back 70

facial abnormalities:

rhagades (linear scars at angle of mouth)

snuffles (nasal discharge)

saddle nose

notched Hutchison teeth

mulburry molars

short maxilla

saber chins

CN 3 deafness

to prevent :

treat mother early in pregnancy

placental transmission usaully occurs after the first trimester

Front 71

VDRL test

false positive

Back 71

VDRL detects nonspecific antibodies that react with beef cardiolipin

inexpensive, widely available test for syphilis

false positve with

VDRL

Viral infection

Drugs

Rheumatic fever

Lupus and Leprosy

Front 72

Jarisch-Herxheimer reaction

Back 72

flu-like syndrome (fever,chills,headache,myalgia)

after antibiotics are started --> lysis of bacteria (usually spirochetes)--> release of the endotxins

Front 73

Zoonotic bacteria - Zoonosis

Back 73

infectious disease transmitted between animal and humans

Front 74

Anaplasma spp.

Back 74

Disease:

Anaplasmosis

Transmission and source:

Ixodes ticks (live on deer and mice)

Front 75

Bartonella spp.

Back 75

Disease:
Cat scratch disease (lymphadenopathy mostly in children)
bacillary angiomatosis

Transmission and source:
Cat scratch

Front 76

Borrelia recurrentis

Back 76

Borrelia recurrentis

Disease:

Relapsing fever

Transmission and source:

louse (recurrent due to variable surface anigens)

Front 77

Brucella spp.

Back 77

Disease:

Brucellosis / undulant fever

Transmission and source:

unpasteurized dairy

undulierend = wellenförmig verlaufend

Front 78

Chlamydophila psittaci

Back 78

Disease:

Psittacosis

Transmission and source:

Parrots or other birds

Front 79

Francisella tularensis

Back 79

Disease:

Tularemia

Transmission and source:

Ticks, rabbits, deer flies

Front 80

Pasteurella multocida

Back 80

Disease:

Cellulitis, osteomyelitis

Transmission and source:

Animal bite, cats, dogs

Front 81

Yersinia pestis

Back 81

Disease:

Plague

first in lymphatics (see picture)

can then lead to sepsis

Transmission and source:

Fleas (rats and prairie dogs are reservoirs)

Front 82

Gardenella vaginalis

Back 82

pleomorphic, gram-variable rod involved in bacterial vaginosis

gray vaginal discharge with a fishy smell

nonpainfull

associated with sexual activity but not transmitted

Clue cells = vaginal epithelia cells covered with gardnella vaginalis

Bacteria have strippled appearance along outer margin

Treatment:

metronidazole or clindamycin

Amine whiff test- discharge + KOH --> more fishy smell

I dont have no clue why it smells like fish in the vagina garden!

Front 83

Treatment of Ricketsial diseases and vector born illnesses

Back 83

doxycycline

cave: during pregnancy alternative in chloramphenicol

Front 84

Rockymountain spotted fever

Back 84

Reckettsia ricketsii

vector = tick

despite name disease is primarily in the south atlantic states (esp North Carolina)

rash starts at wrists and ankles and then spreads to trunk, palms and soles

classical triad:

headache

fever

rash (vasculitis)

Front 85

Palms and soles rash associated diseases

Back 85

Coxsackievirus A infection

Rocky mountain spottet fever

Secondary Syphilis

you drive CARSS using your palms and soles

Front 86

Typhus (german = Fleckfieber!!!)

Back 86

Endemic (fleas) - R typhi

Epidemic (human body louse) - R prowazekii

Rash starts centrally and spreads out

sparing palm and soles!!!

Rickettsii on the wRist, Typhus on the Trunk

Front 87

Ehrlichiosis

Back 87

Ehrlichia, vector is tick

Monocytes with morulae (mulberry like inclusions) in cytoplasm

MEGA berry

Monocytes = Ehrlichiosis

Granulocytes= Anaplasmosis

Front 88

Anaplasmosis

Back 88

Anaplasma, vector is tick.

Granulocytes with morulae in cytoplasm

Front 89

Q fever

Back 89

Coxiella burnetii, no athropod vector

spores inhaled as aerosols from cattle/sheep amniotic fluid

presents as pneumonia

common cause of culture negative endocarditis

Q fever is Queer because it has no rash or vector and its causative organsim can survive outside in its endospore form.

Front 90

Chlamydiae

forms during infection

Back 90

Clamydiae cannot make their own ATP --> obligat intracellular organism that cause mucosalinfections

2 forms

Elementary body (small,dense)

--> Enfectious and Enters cell via Endocytosis

--> transforms into reticulate body

Reticulate body Replicates in cell by fission

-->Reorganizes into elementary bodies

Front 91

Chlamydia trachomatis

Back 91

causes reactive arthritis (Reiter syndrome)

follicular conjunctivitis

nongonoccal urethritis

PID

Front 92

Chlamydophila pneumoniae

Chlamydophila psittaci

Back 92

cause:

atypical pneumonia

transmitted by aerosol

Ch. psittaci - has an avian reservoir (parrots)

Front 93

Diagnosis Treatment of Chlamydial infections

Back 93

Lab diagnsosis:

PCR

nucleic amplification test

Cytoplasmic inclusion bodies =reticulate bodies (pic) seen on Giemsa or flourescent antibodystained smear

treatment:

azithromycin (only one time treatment)

or doxycycline (+ ceftriaxone for possible gonoccocal infection)

Front 94

Chlamydia trachomatis serotypes:

Types A,B,C

Back 94

Chronic infection

cause blindness due to follicular conjunctivitis in Africa

ABC = Africa, Blindness, Chronic infection

Front 95

Chlamydia trachomatis serotypes:

Types D-K

Back 95

Urethritis/ PID

ectopic pregnancy

neonatal pneumonia (staccato cough) with eosinophila

neonatal conjunctivitis

neonatal disease can be aquired during passage through the birthcanal

Front 96

Chlamydia trachomatis serotypes:

Types L1, L2 and L3

Back 96

Lymphogranoloma venerum

small, painless, ulcers on genitals

--> swollen, painful ingiunal lymph nodes that ulcerate (budoes)

treat with doxycycline

Front 97

Mycoplasma pneumoniae

Back 97

Classic cause of a atypical pneumonia

--> insidious(schleichend) onset, headache, nonproductive cough, patchy or diffuse infiltration

X-Ray looks worse than patient

high titer of cold agglutinins (IgM) which lyse RBC

Grow on eaton agar

treatment:

macrolides, doxycycline or flouroquinoles

penicilline is not effective because mycoplasma have no cell wall!

mostly in patients <30 years

frequent outbreaks in military recruits or prisons

Mycoplasma get cold without a coat (cell wall)

Front 98

Fungi that can cause pneumonia and can dissemenate

Back 98

all are yeast except Coccidiodes

Histoplasmosis

Blastomycosis

Coccidiodomycosis

Paracoccidiomycosis

Front 99

Difference between mold and yeast

Back 99

mold --> cold (20C)

yeast --> heat (37C)

mold (Schimmel) is type of fungus that grows in multicellular filaments called hyphe. These tubular branches have multiple, genetically identical nuclei yet form a single organism.

yeast is a type of fungus that grows as a single cell

Front 100

Systemic mycosis

Back 100

can form granulomas (like TB)

cannot be transmitted person-to-person
(unlike TB)

treatment --> Amphotericin B

Front 101

Treatment of local mycosis

Back 101

fluconazole

itaraconazole

Front 102

Histoplasmosis

Back 102

Endemic lacation:

Mississippi and Ohio River Valleys

Pathologic features:

Macrophage filled with histoplasma (smaller than RBC)

unique signs / symptoms:

Palatal/ tongue ulcers, splenomegaly

notes:

Histo hides (within macrophages)

Bird (starlings=star) or bat droppings

Dgx: urine/ serum antigen

Front 103

Blastomycosis

Back 103

Endemic lacation:

Eastern and Central US

Pathologic features:

broad-based budding of Blastomycosis (same size as RBC)

unique signs / symptoms:

Inflammatory lung disease, can dissemenate to skin/bone

Verrucous (warzig) skin lesions can stimulate SCC (squamous cell carcinoma)

Forms granulomatous nodules

notes:

Blasto buds broadly

Front 104

Coccidioidomycosis

Back 104

Endemic lacation:

Southwestern US, California

Pathologic features:

Spherule (much larger than RBC) filled with endospores

unique signs / symptoms:

dissemenates to skin / bone

Erythrema nodosum (desert bumps)

Erythrema multiforme

Athralgia (destert rheumatism)

can cause meningitis

Front 105

Paracoccidiomycosis

Back 105

Endemic lacation:

Latin America

Pathologic features:

Budding yeast of Paracoccidiodes with "Captains wheel" formation (much larger than RBC)

unique signs / symptoms:

similar to coccidiomycosis

males > femalae

notes:

Paracoccidio parasails with captains wheel all the way to Latin america

Front 106

Cutaneous mycosis

Back 106

caused by Tinea (dermatophytes)

Dermatophytes:

Microsporum, Trichophyton, Epidermophyton

branching septate hyphae visible on KOH with fungal blue stain

associated with pruitus

Front 107

Tinea capitis

Back 107

occurs on head, scalp.

associated lymphadenopathy, alopcia, scaling (Schuppung)

Front 108

Tinea corporis

Back 108

Occurs on torso

Erythromatous scaling rings ("ringworm") and central clearing

Can be aquired from contact with an infected cat or dog.

Front 109

Tinea cruris

Back 109

Occurs in ingiunal area

Often does not show the central clearing seen in tinea corporis

Front 110

Tinea pedis

Back 110

Three varieties:

interdigital; most common

moccasin

vesicular type

Front 111

Tinea unguium

Back 111

Onychomycosis

occurs on nails

Front 112

Tinea (pityriasis) versicolor

Back 112

caused by Malassezia spp. (Pityrosporum spp), a yeast-like fungus (NOT a dermatophyte)

Pathogenesis:

degradation of lipids produces acid that damage melanocytes and cause hypopigmented, hyperpigmented and/ or pink patches.

less pruitic than dermatophytes

can occur any time of the year but more common in the summer (hot, humid weather)

"Spaghetti and meatballs" appearance in microscopy

Treatment :

selenium sulfide, topical and/or oral antifungal medications

Front 113

Candida albicans

Back 113

alba = white, dimorphic, forms pseudohyphae and budding yeast at 20C and germ tubes at 37 C

causes:

systemic or superficial fungal infection

oral and esophageal thrush in immunocompromised (AIDS, neonates, steroids, diabetes)

vulvovaginitis (diabetes, use of anibiotics)

diaper rash

endocarditis (IV drug users)

dissemenated candidiasis (neutropenic patients)

chronic mucocutaneous candidiasis

Treatment:

oral fluconazole/ topical azole for vagina

nystatin,fluconazole or caspofungin for oral/esophageal

fluconazole, caspofungin, amphotericin B for systemic

Front 114

Aspergillus fumigatus

Back 114

Septate hyphae that branch at 45 degree Acute Angle

produce conida in radiating chains at end of conidiophore

Causes:

invasive aspergillosis in immunocompromised and patient with chronic granulomatous disease

Aspergillom in pre-excisting lung cavities (after TB)

Aflatoxin (associated with hepatocellular carcinoma)

Front 115

Allergic bronchopulmonary aspergillosis (ABPA)

Back 115

caused by aspergillus fumigatus

hypersensitivity response associated with asthma and cystic fibrosis

may cause bronchiectasis and eosinophilia

Front 116

Opportunistic fungal infections

Back 116

C albicans

Cryptococcus neoformans

Aspergillus fumigatus

Mucor and Rhizopus spp.

Pneumocystis jirovecii

CCAMP

Front 117

Cryptococcus neoformans

Back 117

5-10 mircometer with narrow budding

heavily encapsulated yeast

not dimorphic (vs Candida albicans)

found in soil and pigeon droppings

Acquired through inhalation with hematogenous dissemination to meninges

Culture on Sabouraund agar

stain with india ink (clear halo pic1) and mucicarmine (red inner capsule pic2)

Latex agglutination test detects polysaccharide capsular antigen and is more specific

causes:

cryptococcosis

cryptoccocal meningitis

cryptoccocal encephalitis (soap bubble lesions in brain)

primarily in immunocomprodmised

treatment:

amphotericin B + flucytosine followed by fluconazole for miningitis

Front 118

Mucor and Rhizopus spp.

Back 118

irregular, broad, nonseptated hyphae branching at wide angles

Mucormycosis

Causes:

disease mostly in ketoacidic diabetic and neutropnic patients (eg leukemia)

fungi proliferate in blood vessel endothelium --> penetrate cibriform plate --> enter brain --> rhinocerebral and frontal lobe abscess

-cavernous sinus thrombosis

-headache

-facial pain

-black necrotic eschar

-canial nerve involvement

treatment:

amphotericin B

surgical debridement

Front 119

Pneumocystis jirovecii

Back 119

yeast like fungus, inhaled

most infections are asympomatic

causes:

Pneumocystis pneumonia (PCP) often in AIDS

--> diffuse interstitial pneumonia

-->diffuse bilateral ground glass opacities on CXR/CT

-->diagnosed by biopsie or lavage

-->disc shaped yeast seen on methamine silver stain of lung tissue

treatment:

TMP-SMX, pentamidine, dapsone(prophylaxis only), atovaquone

start prophylaxis when CD 4 count is under 200 cells/mm3 in HIV patients

Front 120

Spirothrix schenkii

Back 120

Sporotrichosis, dimorphic, cigar shaped budding yeast that grows in branchin hyphae with rosettes of conidia

lives on vegetation

When spores traumatically introduced into the skin, typically by thorn (rose gardeners disease)

--> postule or ulcer

with nodules along draining lymphatics (ascending lymphangitis)

dissemenated disease possible in immunocomprimised host

treatment --> itraconazole or potassium iodide

Think of a rose gardener who smokes a cigar and pot

Front 121

Protozoa that cause GI infections

Back 121

Giardia lamblia

Entamoeba histolytica

Cryptosporidium

"Cryptic Gi Entaboeba"

Front 122

giardia lamblia

Back 122

Disease:

Giardiasis

--> bloating, flatulence, foul-smelling, fatty diarrhea (often seen in campers and hikers)

"fat-rich Ghirardelli chocolates for fatty stools Giardia"

Transmission:

Cysts in water

Diagnosis:

Multinucleated trophozoites or cysts in stool

antigen detection

Treatment:

Metronidazole

Front 123

Entamoeba histolytica

Back 123

Disease:

Amebiasis

--> bloody diarrhea(dysentry), liver abscesses (anchovy paste exudate =Sardellenbutter), RUQ pain, histology shows flask-shaped ulcer

Transmission:

Cysts in water

Diagnosis:

Serology and/or trophozoites ( with engulfed RBCs in the cytoplasm)

or cysts with up to 4 nuclei in stool

Entamoeba Eats Erythrocytes

antigen detection

Treatment:

Metronidazole;

paromomycin or idioquinol for asymptomatic cyst passers

Front 124

Cryptosporidium

Back 124

Disease:

severe diarrhea in AIDS

mild disease (watery diarrhea) in immunocompetent

Transmission:

Oocytes in water

Diagnosis:

Oocytes on acid-fast stain

anitgen detection

Treatment:

Prevention (by filtering city water supplies)

nitazoxanide in immunocompetent hosts

Front 125

Protozoa that cause CNS infections

Back 125

Toxoplasma gondii

Naegleria fowleri

Trypanosoma brucei

TNT blows up you head (CNS)

Front 126

Toxoplasma gondii

Back 126

Disease:

Congenital toxoplasmosis=

trias

-chorioretinitis

-hydrocephalus

-intracranial calcifications

-->reactivation in AIDS --> brain abscesses usually seen as multiple ring-enhancing lesions in MRI

(the heroin adicct in trainspotting dies because of his cat that gives him toxoplasmosis!)

Transmission:

Cysts in meat (most common)

Oocytes in cat feces

crosses placenta (pregnant women should avoid cats!)

Diagnosis:

Serology, biopsy (tachyzoit)

Treatment:

Sulfadiazine + pyrimethamine

Front 127

Naegleria fowleri

Back 127

Disease:

rapidly fatal miningoencephalitis

Transmission:

Swimming in freshwater lakes

("Nalgene bottle filled with fresh water containing Naegleria")

enters via Cibriform plate

Diagnosis:

Amaebas in spinal fluid

Treatment:

Amphoericin B has been effective for a few survivors

Front 128

Trypanosoma brucei

Back 128

Disease:

African sleeping sickness

-->enlarged lymph nodes

-->recurring fever (due to antgenetic variation)

-->somnolence

-->coma

2 subspecies : T rhodiense / T gambiense

Transmission:

Tsetse fly (painful bite)

Diagnosis:

Trypomastigote in blood smear

Treatment:

Suramine for bloodborne disease

Melarsoprol for CNS penetration

"I sure am mellow when Im sleeping; remember melatonin helps with sleep"

Front 129

Protozoa that cause hematologic infections

Back 129

Plasmodium (vivax/ovale, falciparum, malariae)

Babesia

Plasm-babe like plasma(blood)

Front 130

Plasmodium

Back 130

Disease

Malaria

--> fever, headache, anemia, splenopmegaly

Transmission

Anopheles mosquito

Diagnosis

Blood smear

trophozoite ring (A in pic)form within RBC

schizont containing merocoites

red granules (Schüffner stippling) (B in Pic)throughout RBC cytoplasma seen with P vivax/ovale

Treatment:

Chloroquine (for sensitive species)

--> blocks plasmodium heme polymerase

if resistant --> mefloquine / atovaquone / proguanil

if life threatening --> IV quinidine or artesunate

P vivax/oval --> add primaquine for hypnozoite

Front 131

Plasmodium spp

Back 131

cause malaria

P vivax/oval

48 h cycle (tertian; includes fever in first day, third day thus fevers are actually 48 h apart)

dormant --> hypnocyte in liver

P falciparum

severe irregular fever patterns

parasitized RBCs occlude capillaries in brain

--> cerebral malaria

kidneys, lungs

P malariae

72 h cycle (quartan)

Front 132

Babesia

Back 132

Disease:

Babesiosis

--> fever and hemolytic anemia

-->predominantly in northeastern US

-->asplenia ( higher risk of severity of disease)

Transmission:

Ixodes tick (same as Borrelia burgdoferi of Lyme)

Diagnosis:

Blood smear --> ring form

--> Maltese cross

PCR

Treatment:

Atovaquone + Azithromycin

Front 133

Protozoa that cause visceral infections

Back 133

Trypanosoma cruzi

Leishmania donovani

"tripin on an leishmania"

Front 134

Trypanosoma cruzi

Back 134

Disease:

Chagas disease

-->dilated cardiomyopathy with apical athrophy

-->megacolon

-->megaesophagus

-->predominatly in south america

unilateral periorbital swelling (Romanas sign) is characteristic in acute stage

Transmission:

rebuviid bug (kissing bug) feces

deposited in a painless bite (much like a kiss)

Diagnosis:

Trypomastigote in blood smear

Treatment:

Benznidazole or nifurtimox

"Cruzin in my Benz, with a fur(pelz) coat on"

Front 135

Leishmania donovani

Back 135

Disease:

Visceral leishmaniasis (kala- azar)

--> spiking fevers / hepatosplenomegaly / pancytopenia

Cutaneus leishmaniases

--> skin ulcers

Transmission:

Sandfly

Diagnosis:

Macrophages containing amastigotes

Treatment:

Amphotericin B

sodium stibogluconate

Front 136

Trichomonas vaginalis

Back 136

Sexually transmitted infection

Disease:

Vaginitis

--> foul-smelling, greenish discharge, itching and burning, do not confuse with Gardenella vaginalis

Transmission:

sexual

Diagnosis:

Trophozoites (motile) on wet mount

"strawberry cervix"

Treatment:

Metronidazole for patient and partner (prophylaxis)

Front 137

ingested nematodes

Back 137

Enterobius, Ascaris, Toxocara, Trichinella

Youll get sick if you EATT these!

Front 138

Cutaneous infectious nematodes

Back 138

Strongyloides, Ancylostoma, Necator

These get into your feet from the SANd

Front 139

Infectious via bites - nematodes

Back 139

Loa loa, Onchocerca volvulus, Wucheria bancrofti

Lay LOW to avoid getting bitten.

Front 140

Immune response to helminths

Back 140

Eosinophils act by type I and type II hypersensitivty reactions

Type I --> neutralization of histamines and leukotrienes

Type II --> eosinophils attach to surface of helminths via Ig E --> release cytokines contained in their granules

Front 141

Nematodes (roundworms) causing intestinal disease

Back 141

Enterobius vermicularis

Ascaris lumbricoides

Strongyloides lumbricoides

Ancylostoma duodenale

Necator americanus

Trichinella spiralis

Trichuris trichuria

NAASTTE (=nasty) worms

Front 142

Nematodes (roundworms) causing tissue infections

Back 142

Toxocara canis
Onchocerca volvulus
Loa Loa
Wucheria bancrofti

LOW T

Front 143

Enterobius vermicularis

Back 143

Disease:

anal pruitus ( diagnosed by tape test)

Transmission:

fecal-oral

Treatment:

Pyrantel pamoate or bendazole

"worms are bendy"

Front 144

Ascaris lumbricoides (giant round worm)

Back 144

Disease:

obstruction of ileocecal valve, biliary obstruction, intestinal perforation, migrates from nose/mouth

Transmission:

fecal-oral, knobby coated, oval eggs seen in feces under microscope

Treatment:

Bendozale

Front 145

Stringyloides stercoralis (threadworm)

Back 145

disease:

vomiting, diarrhea, epigastric pain (my mimic peptic ulcer)

transmission:

larvae in soil penetrate skin

rhabditiform larvae seen in feces under microsscope

treatment:

Ivermectin or bendazoles

Front 146

Ancylostoma duodenale, Necator americanus

(hookworms)

Back 146

disease:

causes anemia by sucking blood from intestinal wall

cutaneous larva migrans:

-->pruitic, serpiginous rash from walking barefoot on contaminated beach

transmission:

larvae penetrate skin

treatment:

bendazoles or pyrantel pamoate

Front 147

Trichinella spiralis

Back 147

disease:

larvae enter bloodstream, encyst in striated muscle --> muscle inflammation

Trichinosis:

fever, vomiting, nausea, periorbital edema, myalgia

transmission:

undercooked meat (especially pork --> Trichinienschau !

fecal-oral (less likely)

treatment:

bendazoles

Front 148

Trichuris trichiura (whipworm)

Back 148

disease:

asymptomatic

loose stools/anemia

rectal prolapse in children

transmission:

fecal-oral

treatment:

bendazoles

Front 149

Toxocara canis

Back 149

disease:

visceral larva migrans:

nematodes migrate to blood through intestinal wall --> inflammation and damage

often affects heart (myocarditis), liver, eyes (visual impairment, blindness) and CNS (seizure, coma)

transmission:

fecal-oral

treatment:

Bendazoles

Front 150

Onchocerca volvulus

Back 150

disease:

skin changes, loss of elastic fibers and river blindeness

allergic reaction to microfiliaria possible

transmission:

female blackfly

"black flies, black skin nodules, black sight"

treatment:

Ivermectin (Ivermectin for river blindness)

Front 151

Loa loa

Back 151

disease:

swelling in skin

worn in conjuctiva

transmission:

deer fly, horse fly, mango fly

treatment:

diethylcarbamazine

Front 152

Wuchereria bancrofti

Back 152

Lymphatic filariasis (elephantiais)

-->worms invade lymph nodes--> inflammation --> lymphedema

symptoms onset after 9 mo - 1yr

transmission:

female mosquito

treatment:

diethylcarbamazepine

Front 153

Cestodes = tapeworms

Back 153

taenia solium

echinococus granulosus

diphyllobotrium latum

TED is on tape

Front 154

taenia solium - intestinal tapeworm disease

Back 154

ingestion of larvae encysted in undercooked pork

treatment:

Praziquantel

Front 155

taenia solium - Cysticercosis, neurocysticercosis

Back 155

ingestion of eggs in food contaminated with human feces

common under homeless

leads to epilepitc seizures

treatment:

praziquantel, albendazole for neurocysticercosis

Front 156

diphyllobothrium latum

Back 156

disease:

Vit B 12 defiency (tapeworm competes for B12 in intestine)

--> megaloblastic anemia

transmission:

ingestion of larvae in raw freshwater fish

treatment:

praziquantel

Front 157

Echinococcus granulosus

Back 157

disease:

hyadatid cysts (eggshell calcification) in liver

cyst ruptures can cause anaphylaxis

transmission:

ingestion of eggs in food contaminated with dog feces

sheep are an intermediate host

treatment:

albenazole

Front 158

Trematodes (flukes)

Back 158

Schistosoma

Clonorchis sinensis

Clon that Schist

Front 159

Schistosoma

Back 159

causes infection in visceral infections

transmission:

snails are host

cercariae penetrate skin of humans

treatment:

praziquantel

Front 160

Schistosoma mansoni

Back 160

Liver and spleen enlargement, fibrosis, inflammation, portal hypertension

egg with lateral spine

treatment:

praziquantel

Front 161

Schistosoma haematobium

Back 161

chronic infection with S haematobium can lead to squamous cell carcinoma of the bladder

--> SCC --> painless hematuria

and pulmonary heypertension

egg with terminal spine

treament:

praziquantel

Front 162

Clonorchis sinensis

Back 162

biliary tract inflammation

--> pigmented gallstones

associated with cholangiocarcinoma

transmission:

undercooked fish

treatment:

praziquantel

Front 163

Ectoparasites

Back 163

A parasite, such as a flea, that lives on the exterior of another organism.

Front 164

Sarcoptes scabiei

Back 164

mite(milbe) burrow(buddeln) into stratum corneum and cause scabies

--> pruitus (worse at night)

-->serpinginous burrows (lines) in webspace of hands and feet

common in children, crowded population (jails, nursing homes)

transmission through skin-to-skin contact or via fomites (keimträger)

treatment:

permethin cream (insecticites)

washing/drying all clothing/bedding

treat close contact

Front 165

Pediculus humanus

Phtirus pubis

Back 165

blood sucking lice that cause intense pruitus with associated excoriations, commonly on scalp an neck (head lice) or waistband and axilla (body lice)

can transmit

rickettsia prowazekii (epidemic typhus)

borrelia recurrentis (relapsing fever)

bartonella quintana (trench fever)

treatment:

pyrethroids (insecticides)

malathion

ivermectin lotion

nit combing(kämmen)

children with head lice can be treated at home without interrupting school attendance

Front 166

viral structures - general features

Back 166

naked virus with icosahedral capsid

envoloped virus with icosahedral capsid

enveloped virus with helical capsid

Front 167

viral genetics - recombinatio

Back 167

exchange of 2 gene between 2 chromosomes by crossing over within regions of significant base homology

Front 168

Viral genetics - Reassortment

Back 168

when viruses with segmented genome exchange genetic material

genome has e.g. 8 sperate parts

-->mechanism in genetic shift

Front 169

Viral genetics - complementation

Back 169

when 1 of 2 viruses that infect the cell has a mutation that results in a nonfunctional protein, the nonmutated virus "complements" the mutated

e.g. hepatitis D requirer the presence of Hep B to supply HBsAg for coating the Hep D virus

Front 170

Viral genetics - phenotypic mixing

Back 170

occurs with simultanous infection of a cell with 2 viruses by virus A and B

-->A can be coated with B surface antigens

tropism changed

Front 171

Viral vaccines - live attenuated vaccines

Back 171

MMR, Yellow fever, Rotavirus, Influenza (intranasal), Chickenpox (VZV), Smallpox, Sabin polio virus

"Music and LYRICSS are best ejoyed Live"

MMR = measles, mumps, rubella

(mumps,masern,röteln)

--> can be given to HIV positive patient without signs of immunedefiency

Front 172

Viral- vaccines - killed

Back 172

killed

Rabies, Influenza (injected), Salk Polio and HAV vaccines

Killed inactivated vaccines induce only humoral immunity but are stable

SalK = Killed

RIP Always

Front 173

Viral vaccines - subunit

Back 173

HBV (Antigen = HBsAg)

HPV (types 6, 11, 16, 18)

Front 174

DNA viral genomes

Back 174

all DNA viruses exept parvoviridae are dsDNA

all DNA viruses are linear except papilloma-,polyoma-, and hepadnaviruses (circular)

All are dsDNA (like our cells) except "part-of-a-virus"(parvovirus) is ssDNA

parvus = small

Front 175

RNA genomes

Back 175

All RNA viruses except Reoviridae are ssRNA

positive stranded RNA viruses:

I went to a retro (retrovirus) toga (togavirus) party, where I drank flavored (flavivirus) Corona (coronavirus) and ate hippie (hepevirus) California (calicivirus) pickles (piconavirus)

all are ssRNA except "repeato-virus"

Front 176

Naked viral genome invectivity

Back 176

purified nucleic acids of most dsDNA (except poxviruses and HBV) and posisitve stranded ssRNA (=mRNA) viruses are infectious

naked nucleic acids of negative strand ssRNA and dsRNA are not infectious. They requirer polymerase to complete the virion.

Front 177

Viral repilication

DNA

RNA

Back 177

DNA: all replicate in the nucleus (except poxvirus)

"pox is out of the box"

RNA: all replicate in the cytoplasm (except influenza virus and retrovirus)

Front 178

Viral envelopes

Back 178

Naked: (only covered by capsid)

Papillomavirus, Adenovirus, Parvovirus, Polyomavirus, Calicivirus, Picornavirus, Reovirus, Hepvirus

"Give PAPP smears and CPR to a naked hippie"

Generally, enveloped viruses acquire their envelopes from plasma membrane when they exit from cell

Exceptions include herpesvirus, which acquire envelopes from nuclear memebrane

DNA = PAPP

RNA = CPR and hepevirus

Front 179

DNA viruses

Back 179

HAH PPPP

Herpesvirus

Hepadnavirus

Adenovirus

Poxvirues

Papillomavirus

Polyovirus

Parvovirus

Front 180

Poxvirus

Back 180

DS an linear (largest dna virus)

Smallpox eradicated world wide by use of liveattenuated vaccines

Cowpox (milkmaid bilsters)

Molluscum contagiosum : flesh-colored papule with central umbilication

Front 181

structure of Hepadnavirus

Back 181

partially DS and ciruclar

not a retrovirus but has a reverse transcriptase

Front 182

Adenovirus

Back 182

no envelope (PAPP)

DS and lieat DNA

causes:

febrile pharyngitis

-->sore throat

-->acute hemorrhagic cystitis

-->pneumonia

-->Conjuctivitis "pink eye"

Front 183

Papillomavirus

Back 183

No capsule

dsDNA - circular

HPV- warts (serotypes 1,2,6,11)

CIN (cervical intraepithelial neoplasm)

cervical cancer (mostly 16, 18)

Front 184

Polyomavirus

Back 184

no capsule

ds DNA circular

JC virus

-->progressive multifocal leukencephalopathy

BK virus

-->transplant patient, commonly targets kidney

JC : Junky Cerebrum

BK: Bad Kidney

Front 185

Parvovirus

Back 185

no capsule

ssDNA and linear

parvo = small --> smallest dna virus

B19 virus

--> aplastic crisis in sickle cell disease

-->"slapped cheek" rash in children

-->erythrema infectiosum of fith disease

RBC destruction in fetus leads to hydrops fetalis and death, in adults leads to pure RBC aplasia and rheumatoid arthritis-like symtoms

Front 186

Herpesviruses all

Back 186

HSV

1 - labialis

2 - genitalis

3 - Varicella Zoster virus

4 - Ebstein-Barr virus

5 - Cytomegalie virus

6 - HSV 6

7 - HSV 7

8 - Kaposi Sarkom

Front 187

HSV 1

Back 187

route of transmission:

respiratory, secretions, saliva

clinical significance:

gingivostomatitis

keratovonjunctivitis

herpes labialis

herpetic withlow on finger

temporal lobe encephalitis

esophagitis

erythrema multiforme

most common cause of sporadic encephalitis

--> altered mental status, seizure and/or aphasia

Front 188

HSV 2

Back 188

route of transmission:

sexual contact

perinatal

clinic:

herpes genitalis

neonatal herpes

latent in sacral ganglia

viral meningitis more common with HSV 2 than with HSV 1

Front 189

HHV 3 - Varicella Zoster virus

Back 189

route of infection:

respiratory secretions

clinic:

Varicella-zoster (chickenpox, shingles)

encephalitis

pneumonia

most common complication of shingles is pneumonia

latent in dorsal root or trigeminal ganglia

CN V1 involvement can cause herpes zoster ophthalmicus

Front 190

HHV 4 - Ebstein-Barr virus

Back 190

route of infection:

respiratory secretion

--> "kissing disease" (teens, young adults")

clinic

Mononucleosis:

fever, hepatosplenomegaly,pharyngitis, and lymphadenopathy (post. cervical lymph nodes)

--> avoid contact sports --> splenic rupture

--> can lead to lymphoma, nasopharyngeal carcinoma (esp. in asian adults)

infects B cells through CD 21

Atypical lymphocytes on peripheral blood smear --> cytotoxic T cells

positive monospot test --> heterophile antibodies detected by agglutination of sheep RBCs

Front 191

HHV 5 - Cytomegalievirus

Back 191

route of transmission:

congenital transfusion

sexual contact

saliva

urine

transplant

clinic:

Mononucleosis (negative monospot) in immunocompetent patients

infections in immunocompromized

especially pneumonia in transplant patients

esophagitis

AIDS retinitis ("sightomegalovirus")

-->hemorrhage, cotton-wool exudates, vision loss

congenital CMV

infected cells have characteristic "owl eye" inclusions

Front 192

Human herpes virus 6 and 7

Back 192

route of transmission:

saliva

clinic:

roseola infantum (exathem subitum)

--> high fevers for several days that can cause seizures

-->followed by diffuse macular rash

Roseola: fever first, Rosie (cheeks) later

HHV 7 less common cause for roseola

Front 193

HHV 8

Back 193

route of infection:

sexual contact

clinic:

Kaposi sarcoma (neoplasm of endothelial cells)

seen in HIV/AIDS and transplant patients

Dark/ violaceous plaques or nodules

representing vascular proliferations

can also affect GI and lungs

Front 194

HSV identification

Back 194

Viral culture for skin/genitalia

CSF PCR for herpes encephalitis

Tzanck test

-->a smear of an opened skin vesicle to detect multinucleated giant cells commonly seen in HSV 1/2 and VZV infection

PCR of skin lesions is currently test of choice

Intranuclear cowdry A inclusions also seen in HSV 1/2 and VZV

"Tzanck heaven I dont have herpes"

Front 195

CMV virus receptor

Back 195

Integrins (heparan sulfate)

Front 196

EBV virus receptor

Back 196

CD 21

Front 197

HIV receptors

Back 197

CD 4, CXCR4 , CCR5

Front 198

Parvovirus B19 receptor

Back 198

P antigen in RBCs

Front 199

Rabies virus receptor

Back 199

Nicotinic AChR

Front 200

Rhinovirus receptor

Back 200

ICAM-1

Front 201

Hepatitis

Back 201

signs and symptoms:

episodes of fever

jaundice

ALT high, AST high

Naked viruses (HAV/HEV) --> no envlope --> not destroyed by the gut

HBV DNA polymerase --> DNA and RNA dependent activities

upon entry in nucleus --> polymerase completes the partial dsDNA

host RNA polymerase transcribes mRNA from viral DNA to make viral proteins

the DNA-polymerase then reverse transcribe viral RNA to DNA, which is in the genome of the virus

HCV lacks 3´-5´ exonuclease acticvity --> no proofreading ability -->variation in anigenic structures of HCV envelope proteins

Antibodie production lacks behind the antigenetic variation of the HCV virus

Front 202

What is the only DNA hepatitis virus ?

Back 202

HBV

Front 203

Which hepatitis viruses have to risk for HCC?

Back 203

HAV and HEV

Front 204

HAV

Back 204

RNA picornavirus

transmission:

fecal oral (shellfish, travelers, day care)

incubation:

short

clinical course:

Asymptomatic, Acute

"picornavirus pico symptoms"

prognosis:

good

HCC risk:

no

Liver biopsy:

Hepaocyte swelling, monocyte infiltration, councilman bodies

no carrier state

(Alone)

Front 205

HBV

Back 205

DNA hepadnavirus

transmission:

parenteral (Blood)

sexual (Baby-making)

perinatal (Birthing)

incubation:

long

clinic:

initially like serum sickness (fever, arthralgia, rash)

may progress to carcinoma

prognosis:

adults --> full resolution

neonates --> worse prognosis

HCC risk

yes

liver biopsy

granular eosinophilic

"ground glass" appearance

cytotoxic T-Cells mediate damage

carrier state = common

Front 206

HCV

Back 206

RNA flavivirus (fla vi ce)

transmission:

primarily blood (IVDU, posttransfusion)

incubation:

long

clinical course:

May progress to Cirrhosis or Carcinoma

Prognosis:

chronic

HCC risk:

yes

Liverbiopsy

Lymphoid aggregates (A in pic) with focal areas of macrovesicular steatosis(fatty degeneration B in Pic)

Carrier state very common

Front 207

HDV

Back 207

RNA deltavirus

transmission:

perenteral, sexual, perinatal (same as HBV)

incubation

superinfection (HDV after HBV) = short

coinfection (HDV and HBV) = long

clinic:

same as B

prognosis:

superinfection --> worse prognosis

HCC risk

yes

Liver biospsy

same as B

Defective virus

Depends on B

Front 208

HEV

Back 208

RNA hepevirus

transmission

fecal oral (esp. waterborne)

incubation:

short

clinical course:
Fulminant hepatitis in Expectant women (pregnant)

prognosis

gigh mortalility in pregnant women

HCC risk

no

Liver biopsy

patchy necrosis

Enteric, Epidemic

no carrier state

Front 209

Extra hepatic manifestation of HBV

Back 209

Hematologic:

Aplastic anemia (think of parvovirus B 19)

renal:

membranous GN --> membranoproliferative GN

vascular:

polyarteritis nodosa

Front 210

extrahepatic manifestation of HCV

Back 210

hematologic:

essential mixed cryoglobulinemia

-->cryoglobulins = blood proteins which dissolve from blood when its cold in the laboratory

--> thicken blood --> clots, vasculitis

high risk of B Cell NHL (non-hodgin lymphoma)

autoimmune hemolytic anemia

renal

membranoproliferative GN --> membranous

vascular

leukocytoclastic vasculitis

dermatologic

sporadic porphyria cutanea tarda

lichen planus

endocrine

high risk diabetes mellitus

autoimmune hypothyreodism

Front 211

Reoviruses

Back 211

No envelope (PCR Hippie)

dsRNA linear (10-12 segments)

Icosahedral (double)

important Geni:

Coltivirus --> Colorado tick fever

Rotavirus

-->most importan cause of infantile gastroenteritis

-->acute diarrhea in US during the winter

-->especially in daycareunits (kindergarten)

--> villous destruction with atrophy leads to less absorption on Na+ and loss of K+

ROTAvirus = Right Out The Anus

Front 212

Picornavirusn

Back 212

ssRNA

no capsule

icoshedral

important geni:

Poliovirus

-->polio-Salk/Sabin vaccine - IPV(inactivated polio vaccine)/OPV

Echovirus--> asepic meningitis

Rhinovirus

-->common cold >100 serotypes

-->acid-labile-->destroyed by stomach acid

-->does not infect GI (unlike other piconoviri)

Coxsackivirus

--> aseptic meningitis, herpangina (mouth blisters fever), hand, foot mouth, disease, myocarditis, pericarditis

HAV --> hepatitis

PERCH

Front 213

Hepevirus

Back 213

no capsule

ssRNA +linear

icosahedral

-->HEV

Front 214

Caliciviruses

Back 214

no capsule

ssRNA +linear

icohedral

Norovirus

-->gastroenteritis

Front 215

Flaviviruses

Back 215

capsulated

ssRNA +linear

icosahedral

HCV

Yellow fever -->1

Dengue --> 1

St louis encephalitis -->1

West nile virus -->1

1=(arbovirus, arthropod borne (mosquitos ticks)

Zika virus

commonly transmitted by aedes mosquito
causes:
-conjunctivitis
-low-grade pyrexia
-myalgia

can lead to congenital microcephaly

diagnosed via RT-PCR

sexual or vertical transmission

supportive care

Front 216

Togaviruses

Back 216

capsulated

ssRNA + linear

icosahedral

Wester and Eastern equine encephalitis

(arbovirus, arthropod borne (mosquitos ticks) )

Chikungunya virus

Rubella

-->German 3 day measels

-->fever, postauricular lymphadenopathy, arthralgia, fine, confluent rash

-->rash starts on face and spreadsn centrifugally to involve trunk and extremities

--> mild in children

-->serious congenital infection (ToRCHeS)

-->congenital rubella:

---->blueberry muffin appearance because of extramedullary hematopoesis

Front 217

Retrovirus

Back 217

capsulated

ssRNA + linear (2 copies)

Icosahedral (HTLV)

complex and conical (HIV)

have reverse transcriptase

HTLV --> T-cell leukemia

HIV-->AIDS

Front 218

Coronavirus

Back 218

capsulated

ssRNA +linear

helical

common cold

SARS (Severe acute respiratory syndrome)

MERS (Middle East respiratory syndrome)

Front 219

Orthomyxovirus

Back 219

capsulated

ssRNA -linear (8 segments)

helical

Influenza virus

-->hemagglutinin (binds sialic acid and promotes entry)

-->neuramidase (promotes progeny virion release)

--> both are antigens

--> high risk of bacterial superinfection--> S aureus, S pneumoniae, H influenzae

vaccine with killed virus most frequently used

live attenuated vaccine contains temperature sensitive mutant that replicates in the nose but not in the lung

intranasal

Front 220

Genetic shift

antigenic shift

Back 220

causes pandemics

reassortments of viral genome segments

e.g. human flu A and swine flu A fuse

Front 221

Genetic drift

antigentic drift

Back 221

causes epidemics

minor (antigenetic drift) changes based on random mutation in hemagglutin or neuramidase genes

Front 222

Paramyxoviruses

Back 222

capsuled

ssRNA -linear

nonsegmented

helical

PaRaMyxovirus

-->Parainfluenza -->croup

-->RSV --> bronchiolitis in babies, Rx- Ribavirin

-->Measles, Mumps

Front 223

Croup (acute laryngotracheobronchitis)

Back 223

caused by parainfluenza virus

-->hemglutinin (sialic acid)

-->neuramidase

-->seal like barking cough and inspiratory stridor

-->narrowing of upper trachea and subglottis

---->charecterisitc sign on X-Ray

-->severe croup can lead to pulsus paradoxus secondary to airway obstruction

Front 224

Measles (rubeola) virus

Back 224

paramyxovirus

presentation:

-prodromal

-fever

-cough

-coryza

-conjuctivis

-->Koplik spots

-->1-2 days later --> macupapular rash

----> starts at head/neck spread down

Lymphadenitis with Warthin-Finkeldy giant cells (fused lymphocytes) + paracortical hyperplasia

SSPE - subacute sclerosing panencephalitis occuring years later

encephalitis (1:2000)

rarely pneumonia in immunsupressed

Vit A supplementation

--> can reduce morbidity and mortality

Front 225

Mumps virus

Back 225

paramyxovirus

uncommon due to MMR vaccine

symptoms:

Parotitis

Orchititis (inflammation of testes)

aseptic Meningitis

Pancreatitis

-->can cause sterility

makes your parotid glands and testes as big as POM-Poms

Front 226

Rhabdoviruses

Back 226

encapsuled

ssRNA -linear

helical

Rabies:

bullet-shaped virus

clinic:

long incubation period (weeks to months) before symptom onset

-->postexposure immunization (passive and active) + wound cleaning

travels to CNS by migrating in a retrograde fashion (via dynein motors)

-->fever, photophobia, hydrophobia, hypersalvation --> paralysis, coma --> death

Patho:

Negri bodies commonly found in Purkinje cells of cerebellum and hippocampal neurons

infection via:

bat, racoon and skunk bite

Front 227

Filovirus

Back 227

encapsuled

ssRNA -linear

helical

Marburg hemorrhagic fever often fatal!

Ebola

-->Filovirus that targets endothilial cells,phagocytes, hepatocytes

-->incubation period of up to 21 days

-->abrupt flu-like symptoms

-->diarrhea/vomiting, high fever, myalgia

-->can progress to DIC, diffuse hemorrhage, shock

-->dgx -> RT-PCR within 48 h

--> high mortality rate

-->transmission via body fluids (incl. dead bodies, primates)

-->supportive care

-->strict isolation

Front 228

Delta virus

Back 228

encapsuled

ssRNA -circular

HDV (defective virus)

Front 229

Anit-HAV (Ig M)

Back 229

IgM antibody to HAV

best to detect acute hepatitis A

Front 230

Anit-HAV (Ig G)

Back 230

antigbody indcates prior HAV infection

or prior vaccination

Front 231

HBsAg

Back 231

Antigen found on surface of HBV infection

-->indicates HBsAg infection

Front 232

Anti-HBs

Back 232

Antibody to HBsAg

-->inducate immunity to hepatitis B due to vaccination or recovery from infection

Front 233

HBcAg

Back 233

Antigen assiciated with core of HBV

Front 234

Anti-HBc

Back 234

Antibody to HBcAg

IgM --> acute / reinfection

IgG --> prior exposure or chronic infection

IgM anti-HBc may be the sole + marker of infection during window period

Front 235

HBeAg

Back 235

secreted by infected Hepatocyte into circulation

not part of mature HBV viron

indicates active viral replication and therefore high transmissibility and poorer prognosis

Front 236

Anti-HBe

Back 236

Antibody to HBeAg

indicates low transmissibility

Front 237

serum values during HBV

Back 237

Front 238

Acute HBV

Back 238

HBsAg

HBeAg

Anti-HBc -> IgM

Front 239

Window

Back 239

Anit-HBeAg

Anti-HBc --> IgM

Front 240

Chronic HBV (high infectivity)

Back 240

HBsAg

HBeAg

Anti-HBc --> IgG

Front 241

Chronic HBV (low infectivity)

Back 241

HBsAg

Anti-HBeAg

AntiHBc --> IgG

Front 242

Recovery HBV serum markers

Back 242

Anti-HBs

Anti-HBe

Anit-HBc --> IgG

Front 243

Immunized

Back 243

Anti-HBs

Front 244

HIV structure

Back 244

Diploid genome (2 molecules of RNA)

3 structural genes:

-env

-gag

-pol

reverse transcriptase synthesizes dsDNA from genomic RNA

dsDNA integrates into host genome

virus binds CD 4 as well as acoreceptor:

-->CCR5 on macrophages (early infection)

-->CXCR4 on T cells (late infection)

CCR5 homozygote mutation --> immunity

CCR5 heterocygite mutaion --> slower course

Front 245

env structural HIV gene

Back 245

env (gp120 and gp 41)

-->formed by cleavage of gp 160 to form envope glycoprotein

-->gp 120 - attachement to host CD 4 receptor

Front 246

gag (HIV)

Back 246

p24 and p17

capsid and matrix proteins

respectivly

Front 247

pol

Back 247

reverse transbriptase

aspartate

integrase

Front 248

HIV diagnosis

Back 248

presumptive diagnosis made with ELISA (rule out)

(sensitive, high false positive rate)

positive ELISA confirmed a Western blot assay (rule in) (specific, low false postive rate)

ELISA/Western blot look for the antibodies to the viral proteins these test are often falsely negative

often falsely positive in the first 1-2 months of babies born to HIV infected mothers (anti-gp120 crosses plazenta)

--> use PCR to detect viral load

viral load test determine the amount of viral RNA in the plasma

-->high viral load associated with poor prognosis

Front 249

Time course of untreated HIV infection

Back 249

<400 CD 4 cells --> moderate immunocomprise

<200 CD4 cells --> AIDS defining illness emerge

four stages of infection:

flu-like

feeling fine

falling count

final crisis

Front 250

AIDS diagnosis

Back 250

<200 CD4+ cells/mm3

(normal 500-1500 CD4 cells/mm3)

HIV + with AIDS defining condition (Pneumocystis pneumonia)

or CD percentage <14 %

Front 251

HIV CD4 count under 500 diseases

Back 251

Candida albicans

EBV

Bartonella henselae

HHV-8

HPV

Front 252

HIV cell count under 200 diseases

Back 252

Histoplasma capsulatum

HIV

JC virus (reactivation)

Pneumocystis jirovecii

Front 253

Prions

Back 253

prion diseases caused by conversion of normal (predominantly alpha-helical) protein termed prion protein (PrPc) to a beta pleated form (PrPsc)

PrPsc is tranmissible via CNS-related tissue (iatrogenic CJD) or food contaminated by BSE-infected animal products

accumulation of PrPsc results in spongiform encephalopathy and dementia, ataxia and death

Front 254

Creuzfeld-Jakob disease

Back 254

rapidly progeressive dementia, typically sporadic

caused by prions

Front 255

Bovine spongiform encephalotpathy

Back 255

mad cow disease

cause by prions

Front 256

Kuru

Back 256

acquired prion disease
in tribal population practicing cannibalism

Front 257

Normal flora oropharynx

Back 257

Viridans streptococci

Front 258

Dental plaque bacteria

Back 258

S mutans

Front 259

Colon flora

Back 259

B fragilis > E coli

Front 260

Vagina

Back 260

Lactobacillus, E coli, group B streptococci

Front 261

bugs causing bloody diarrhea

Back 261

Campylobacter jejuni

E histolytica

ETEC

EIEC

Salmonella

Shigella

Y enterocolitca

Front 262

bugs causing watery dierrhea

Back 262

C difficile

C perfringens

Enterotoxigenic E coli

Protozoa

V cholera

Viruses

Front 263

Common cause of pneumonia

Neonates

Back 263

group B streptocci

E coli

Front 264

Common cause of pneumonia

children

Back 264

Viruses (RSV)

Mycoplasma

C trachomatis (infants - 3yr)

C pneumonia (school-aged children)

S pneumoniae

Runts(zwerge) May Cough Chunky Sputum

Front 265

Common cause of pneumonia

adults (18 - 40)

Back 265

Mycoplasma

C pneumoniae

S pneumoniae

Viruses ( eg influenza)

Front 266

Common cause of pneumonia

adults (40-65)

Back 266

S pneumoniae

H influenzae

Anaerobes

Viruses

Mycoplasm

Front 267

Elderly

Back 267

S pneumoniae

Influenza virus

Anaerobes

H influenzae

Gram nagtive rods

Front 268

Common cause of pneumonia

Alcoholics

Back 268

KlebsiellA

anaerobs usaully due to aspiration

Front 269

Common cause of pneumonia

IV drug users

Back 269

S pneumonie

S areus

Front 270

Aspiration

Back 270

anaerobes

Front 271

Common cause of pneumonia

atypical

Back 271

Mycoplasma

legionella

Chlamydia

Front 272

Common cause of pneumonia

Cystic fibrosis

Back 272

Pseudomonas

S aureus

S pneumoniae

Burkholderia cepacia

Front 273

Common cause of pneumonia

immunocompromised

Back 273

S aureus,

enteric gram negative rods

fungi+viruses

Pjirocecii (with HIV)

Front 274

Common cause of pneumonia

nosocomial

Back 274

S aureus

Pseudomonas

enteric gram negative rods

Front 275

Common cause of pneumonia

postviral

Back 275

S pneumonia

S aureus

H influenzae

Front 276

Common cause of meningitis

newborn

Back 276

Group B streptococci

E coli

Listeria

Front 277

Common cause of meningitis

children

Back 277

S pneumoniae

N meningitidis

H influezae type B

EnterovirusesCommon cause of meningitis

Front 278

Common cause of meningitis

6 - 60 years

Back 278

S pneumoniae

N meningitidis

Enteroviruses

HSV

Front 279

Common cause of meningitis

60 +

Back 279

S pneumoniae

Gram nagtive rods

Listeria

Front 280

Treatment of bacterial meningtitis

Back 280

Ceftriaxone + vancomycin

Listeria --> ampicilin

Front 281

viral meingitis - which viruses ?

Back 281

Enteroviruses (especially coxsackie)

HSV-2 (HSV-1 --> encephalitis)

HIV

West-nile virus

VZV

Front 282

Meningitis in HIV

Back 282

Cryptococcus spp

Front 283

CSF findings in meningitis

bacterial

Back 283

opening pressure --> high

cell type --> high polymorphnuclear neutrophils (PMN)

Protein --> high

Glucose --> low (used by bacteria)

Front 284

CSF findings in meningitis

fungal/TB

Back 284

Opening pressure --> high

Cell types --> high lymphocytes

Protein --> high

Glucose --> low

Front 285

CSF findings in meningitis

viral

Back 285

opening pressure --> normal - high

celltype --> high lymphocytes

Protein --> normal - high

Glucose --> normal

Front 286

Infection causing brain abscess

Back 286

most common : viridans streptococci / S aureus

--> dental procedures

multiple lesion --> bacterimia

single lesions --> contiguous sites

ottitis media and mastoiditis --> temporal lobe and cerebellum

sinusitis or dental infection --> frontal lobe

Tocoplasmosis in AIDS

Front 287

Osteomyelitis - diagnosis

Back 287

elevated C-reactive protein
Ery sedimentation rate are non-specific

MRI best for detecting

Front 288

Osteomyelitis which bug with no other information ?

Back 288

S areus --> most comon

Front 289

Osteomyelitis which bug with sexually active?

Back 289

Neisseria gonorrhoeae (rare)

more septic arthritis

Front 290

Osteomyelitis which bug with sickle cell disease?

Back 290

Salmonella

S aureus

Front 291

Osteomyelitis which bug with prosthetic joint replacement?

Back 291

S aureus

S epidermis

Front 292

Osteomyelitis which bug with vertebral involvement?

Back 292

S aureus

Mycobacterium tuberculosis (Potts disease)

Front 293

Osteomyelitis which bug with cat and dog bites?

Back 293

Pasteurella multocida

Front 294

Osteomyelitis which bug withIV drug users?

Back 294

Pseudomonas, Candida, S auerus

Front 295

UTI - cystitis - symptoms

Back 295

dysuria

frequency

urgency

suprapubic pain

WBC (but no casts) in urine

due to ascending bugs from urethra to bladder

^

Front 296

UTI - pyelonephritis - symptoms

Back 296

fever

chills

flank pain

costovertebral angle tenderness

hematuria

WBC casts

due to ascending bugs to kidney

Front 297

Causes for UTI

Back 297

1 E coli

2 Staphylococcus saprophyticus (sexually active women)

3 Klebsiella pneumoniae

Serratia marcescens (red pigment, nosocomial)

Enterococcus (nosocomial)

Proteus mirabilis (swarming on agar, struvite stones)

Pseudomonas aeroginosa (blue-gree pigment, fruity odor)

Front 298

Diagnostoc markers for UTI bugs

Back 298

+ Leukocytes esterase --> evidence of WBC

+Nitrite test = reduction of urinary nitrates by bacterial species (E coli)

+ urease test = urease producing bugs (S saprophyticus, Proteus, Klebsiella)

Front 299

Bacterial vaginosis

Back 299

Signs and symptoms:

No inflammation

thin white discharge with fishy odor

Lab findings:

Clue cells

pH>4.5

Treatment:

Metronidazole

Front 300

Trichomonas vaginitis

Back 300

signs and symptoms:

Inflammation (strawberry cervix)

frothy yellow-green, foul smelling discharge

lab findings:

motile trichonads

pH>4.5

treatment

Metronidazole

tret sexual partners

Front 301

Candida vulvovaginitis

Back 301

signs and symptoms:

inflammation

thick, white (cottage cheese) discharge

lab findings:

pseudohyphae

pH = normal = 4.0-4.5

treatment

-azoles

Front 302

ToRCHeS infections

Back 302

Toxoplasmosis gondii

Rubella

Cytomegalovirus

HIV

Herpes simplex virus 2

Syphilis

Front 303

Neonatal toxoplasmosis

Back 303

cat feces + ingestion of undercooked meat

classical triad :

chorioretinitis

hydrocephalus

intrcranial calcifications

+/- blueberry muffin

Front 304

Neonatal Rubella

Back 304

respiratory droplets

classical triad :

abnormalities of:

eye(cataract)

ear(deafness)

heart (PDA)

+/- blueberry muffin

I (eye) <3 ruby (rubella) earrings

Front 305

neonatal cytomegalovirus

Back 305

sexual transmission/ organ transplant

Hearing loss

seizure

petechial rush

blueberry muffin rash

perivetricular calcification

Front 306

neonatal HIV

Back 306

sexual contact, needlestick

recurrent infections, chrionic diarrhea

Front 307

neonatal Herpes simplex virus 2

Back 307

Skin mucous contact

Meningoencephalitis

herpetic skin lesions

Front 308

neonatal Syphilis

Back 308

sexual contact

often stillbirth

hydrops fetalis

if child survives :

notched teeth

saddle nose

short maxilla

saber chins

CN 3 deafness

Front 309

Canroid - STD

Back 309

Hemophilus ducreyi

"its so painful you do cry"

painful genital ulcer with exudate

inguinal adenopathy

Front 310

Chlamydia - STD

Back 310

Chlamydia trachomatis (D-K)

Urethritits

cervicitis

epididymitis

conjunctivitis

reactive arthritis

PID

Front 311

Condylomata acuminata STD

Back 311

HPV 6 and 11

genital warts
koilocytes (infected epithelial cells)

Front 312

Genital herpes STD

Back 312

HSV - 2, less commonly HSV-1

painful, vulvar or cervical vesicles and ulcers

can cause systemic symptoms:

fever, headache, myalgia

Front 313

Gonorrhea STD

Back 313

Neisseria gonorrhoae

Urthritis

cervititis

PID

prostatis

epididymitis

arthritis

creamy purulent discharge

Front 314

Granuloma inguinale (Donovanosis)

Back 314

Klebsiella (Calymmatobacterium) granulomatis

cytoplasmic Donocan bodies

(bipolar staining in micrsopy)

symptoms:

painless, beefy red ulcer that bleeds readily on contact

Front 315

Syphilis - STD

Back 315

Treponema pallidum

primary:

painless chancre

secondary:

fever

lymphadenopathy

skin rashes

condylomata lata

tertiary:

gummas

tabes dorsalis

gernal paresis

aortitis

Argyll Robertson pupil

Front 316

Pelvic inflammatory disease PID

Back 316

mainly by:

Chlamydia trachomatis (subacute, often undiagnosed)

Neisseria gonorrheae

STD

Cervical motion tenderness (chandeliers sign)

--> if u push against the cervix it causes pain

purulent cervical discharge

lower abdominal pain

may lead to:

salpingitis (risk of ectopic pregnancy)

endometritis

hydrosalpinx

tubo-ovarian abscess

can lead to Fitz-Hugh syndrome:

infection of the liver capsule

-->violin string adhesions of peritoneum to liver

Front 317

most common nosocomial infection

Back 317

E coli --> UTI

S aureus --> wound infection

Front 318

Nosocomial infections after antibiotic use

Back 318

C difficile

--> watery diarrhea, leukocytosis

Front 319

Nosocomial infections due to aspiration

Back 319

Polymicrobal

gram - bacteria often anaerobe

"Anaerobes cant breathe freah air"

Clostridium (g+)

Bacteriodes

Fusobacterium

Actinomyces (g+)

right lower lobe infiltrate

or right upper/middle lobe (patient recumbant) = liegend

malodorous sputum

Front 320

Nosocomial infectionsdue to decubitus/surgical wounds/ drains

Back 320

S auereus (MRSA)

S epidermidis (long term)

Enterobacter

Erythema, induration, tenderness, drainage

Front 321

Nosocomial infectionsdue to mechenical ventilation

Back 321

late onset:

P aeroginosa

Klebsiella

Acinetobacter

S aureus

New infiltrate on CXR

high sputum production

sweet odor (P aeroginosa)

Front 322

Nosocomial infections due to renal dialysis, needle stick

Back 322

HBV, HCV

Front 323

Nosocomial infections due to Urinary catherization

Back 323

E coli

Klebsialla

Proteus

Dysuria

Leukocytosis

flank pain

costovertebral tenderness

Front 324

Nosocomial infections via water aerosols

Back 324

Legionella

signs of pneumonia

GI symptoms (nausea, vomiting)

neurologic problems

Front 325

Rash beginning on head and moving down

postauricular lymphadenopathy

Back 325

Rubella virus

Front 326

Rash beginning at head and moving down

preceded by cough, coryza, conjunctivitis and Koplik spots in buccal mucosa

Back 326

Measels virus

Front 327

Meningitis due to bug which colonizes oropharynx

Back 327

H influezae type B

Front 328

Meningitis due to bug which can also lead to myalgia and paralysis

Back 328

Poliovirus

Front 329

Pharyngitis with grayish oropharyngeal pseudomembranes

painful throat

Back 329

Crynebacterium diphteriae

elaboartates toxin that causes necrosisinpharynx, cardiac and CNS tissue

Front 330

Penicillin G / V

Back 330

beta lactam antibiotic

Penicillin G(IV and IM) V(oral)

Mechanism:

D-Ala-D-Ala sructural analog

bind penicillin binding protein (transpeptidase)

-->block cross-linking of peptidioglykan in cell wall

--> activate autolytic enzymes

Clinical use:

mostly gram + (S pneumoniae, S pyogenes, Actinomyces)

also for gram - cocci (N meningitidis) and spirochetes (T pallidum)

bacteriocidal for the above

penicillinase sensitive

advers effect:

hypersensitivity reactions

direct Coombs + hemolytic anemia

resistance

penicillinase in bacteria (beta-lactamase)

--> cleaves beta lactam ring

Front 331

Penicillinase-sensitive penicillines

Back 331

Amoxicillin, ampicillin, aminopenicillin

mechanism:

same as penicillin

wider spectrum

combinate with clavulanic acid for destructionprotection

AMinoPenicillins are AMPed-up penicillin

AmOxicillin has greater Oral bioavailability than ampicillin

clinical use:

extended spectrum:

H influenzae, H pylori, E coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella

ampicillin/ amoxicillin HHELPSS kill enterococci

adverse effects

hypersensitivity reactions

rash

pseudomemebranous colitis

Front 332

Penicillinase-resistant penicillins

Back 332

Dicloxacillin, nafcillin, oxacillin

mechanism:

same as penicillin

narrow spectrum

penicillinase resistant because of bulky R group blocks access of beta lactamase

clinical use:

S areus (exept MRSA, altered penicillin binding protein)

Naf for staph

adverse effects:

hypersensitivity reactions

intestinal nephritis

Front 333

Antipseudomal penicillins

Back 333

Piperacillin, tircacillin

mechanism:

same as penicillin

extended spectrum

clinical use:

Pseudomonas spp

gram - rods

susceptible to penicillinase

adverse effects:

hypersensitivity reactions

Front 334

beta-lactamase inhibitors

Back 334

Clavulanic acid

Avibactam

Sulbactam

Tazobactam

CAST (gips)

Front 335

Cepaholosporins

Back 335

mechanism:

beta-lactam drugs --> inhibition of cell wall seynthesis

organisms not covered by 1st-4th generation are LAME:

Listeria

Atypicals (Chlamydia, Mycoplasma)

MRSA

Enterococci

Adverse effects

hypersensitivity

autoimmune hemolytic anemia

disulfiram like reaction

Vit K defiency

increase nephrotoxitiy of aminoglykosides

Front 336

Cephalosporins 1st generation

Back 336

cefazolin , cephalexin

--> for gram + cocci

Proteus mirabilis

E coli

Klebsiella penumoniae

-->PEcK

Cefazolin used prior to surgery to prevent S aureus infection

Front 337

Cephalosporins 2nd generation

Back 337

cefaclor, cefoxitin, cefuroxime

fake fox fur (Pelz)

--> gram + cocci

H influenzae

Enterobacter aerogenes

Neisseria spp

Serratia marcescens

Proteus mirabilis

E coli

Klebsiella pneumoniae

HENS PEcK

Front 338

3rd generation cephalosporins

Back 338

ceftriaxine, cefotaxime, cefpodoxime, ceftazidime

serious gram - infections resistant to other beta lactams

can cross blood brain barrier

Ceftriaxone --> meningitis, gonorrhea,dissemenated Lyme disease

Ceftazidime- Pseudomonas

Front 339

4th generation cephalosporins

Back 339

cefepime

gram - organisms with activity against Pseudomonas and gram +

Front 340

5th generation cephalosporins

Back 340

Ceftaroline

broad gram + and gram -

unlike 1st-4th generation:

Listeria

MRSA

Enterococcus faecalis

dos not cover pseudomonas

Front 341

Carbapenems

Back 341

Imipenem, meropenem, ertapenem, doripenem

broad spectrum beta-lactam antibiotic

beta-lactamase resistant

alway give imipenem with cilastin

--> inhibits renal tubule dehydropeptidase 1

imipenem, "the kill is lastin´ with cilastin"

adverse effects

GI stress

skin rash

CNS toxicity (seizures) at high plasma levels

Front 342

Monobactams

Back 342

Aztreonam

less susceptible to beta-lactamases

binds to penicillin binding protein 3

synergistic with aminoglycosides

clinical use:

gram - rods only

can be given to penicillin allergic who cannot tolerate aminoglykosides

adverse effects:

usually nontoxic

occasional GI upset

Front 343

Vancomycin

Back 343

mechanism:

inhibits cell wall formation by binding to D-ala D-ala portion of cell wall percoursors

bactericidal against most bacteria (bacteriostatic against C difficile)

beta lactamase resistant

clinical use:

gram + bugs only

--> including MRSA, S epidermidis, Enterococcus species, C difficile (oral)

adverse effects:

well tolerated - but NOT trouble free

Nephrotoxicity

Ototoxicity

Thrombophlebitis

-->red flushing --> red-man sydrome

-->preventable with antihistaminic and slow infusion rate

resistance:

aminoacid modification of D-Ala-D-Ala to D-Ala-D-Lac

"Pay back 2 D-Alas for vandalizing (vancomycin)"

Front 344

Which antibiotics bind to the 30 S subunit of the ribosome?

Back 344

Aminoglykosides (bactericidal)

-->Streptomycin in picture

Tetracyclin (bacteriostatic)

buy AT 30

Front 345

Which antibiotics bind to the 50 S subunit of the ribosome?

Back 345

C = Chloramphenicol, Clindamycin (bacteriostatic)

E = Erythromycin (macrolides, bacteriostatic)

L = Linezolid (variable)

CCEL at 50

Front 346

Aminoglykosides

Back 346

Gentamycin

Neomycin

Amikacin

Tobramycin

Streptomycin

"Mean (Aminoglycosides) GNATS caNNOT kill anaerobes"

mechanism:

inhibiting the initiation complex through binding at 30 S subunit

can cause misreading

require O2 for uptake --> ineffective against anaerobs

clinincal use:

severe gram - rod infections

synergistic with beta-lactam inhibitors

Neomycin for bowl surgery

adverse effects:

caNNOT

Nephrotoxicity

Neuromuscular blockade

Ototoxicity (especially with loop diuretics)

Teratogen

resistance:

bacterial tranferase enzymes --> methylation,phosphorylation or adenylation

Front 347

Tetracyclines

Back 347

tetracycline, doxycycline, minocycline

mechanism:

bacteriostatic

bind to 30 S and prevent aminoacyl-tRNA

limited CNS penetration

Doxycyclin is fecally eliminated

--> can be used in patients with renal failure

do not take with milk (Ca2+), antacids(Ca2+/Mg2+) or iron containing preparations

-->divalent cations inhibit uptake in the gut

clinical use:

Borrelia bugdorferi

M pneumoniae

--> accumalates intracellulary --> effective against Rickettsia and Chlamydia

Doxycyclin effective for MRSA

adverse effects:

GI-distress

discoloration of teeth

inhibition of bone growth in children

photosensitvity

contraindicated in pregnancy

resistance:

less uptake or more efflux out of bacteria by plasmid-encoded transport pumps

Front 348

Glycylcyclines

Back 348

Tigecycline

mechanism:

tetracycline derivate

binds to 30 S subunit

bacteriostatic

clinical use:

broad-spectrum antibiotic

gram -

gram +

Multiresistant bugs causeing deep tissue penetration --> MRSA, VRE

"use the Tiger (tigecyclin) for deep bites (deep tissue) by resistant bugs (MRSA,VRE)"

adverse effects:

GI

nausea

vomiting

Front 349

Chloramphenicol

Back 349

mechanism:

blocks peptidyltransferase at 50 S subunit

bacteriostatic

clinical use:

Meningitis (H influezae, N meningitis, S pneumoniae)

Rocky mountain spotted fever (Ricketsia rickettsii)

high tox --> low cost --> only used in developing countries

adverse effects:

Anemia (dose dependent)

Aplastic anemia (dose dependent)

gray baby sndrome (lack of UDP-glucuronyltranferase)

resistance:

plasmid encoded acetyltranferase

--> drug inactivation

Front 350

Clindamycin

Back 350

mechanism:

block peptide transfer (translocation) at 50 S

bacteriostatic

clinical use:

anaerobic infections (Bacteroides (normal GI flora, Clostridium perfringens)

aspiration pneumonia

lung abscess

oral infections

also effective against group A streptoccal infections

-->treat anaerobic infection above the diaphragm vs metronidazol -->below the diaphragm

adverse effects:

Pseudomembranous colitis

fever

diarrhea

Front 351

Oxazolidones

Back 351

Linezolid

mechanism:

binding to 50 S subunit

prevents formation of the initiation complex

clinical use:

gram + species --> MRSA and VRE

adverse effects

Bone marrow suppression (thrombocytopenia)

peripheral neuropathy

serotonin sydrome

resistance:

point muattion of rRNA

Front 352

Macrolides

Back 352

Azithromycin, Clarithromycin, Crythromycin

"MACE"

mechanism:

blocks translocation ("macroslides")

bind to the 23S rRNA of the ribosomal 50 S subunit

clinical use

atypical pneumonias (Mycoplasma, Chlamydia, Legionella)

STDs (Chlamydia)

gram + cocci (streptococcal infection if penicillin allergy)

B pertussi

adverse effects:

MACRO:

gastrointsetinal Motility issues

Arrythmia (prolonged QT interval)

acute Cholestatic hepatitis

Rash

eOsinophilia

increases theophilline and oral anticoagulants concentration

Clarithromycin and erythromycin inhibit cytochrom P-450

resistance:

Methylation of 23S rRNA at binding site

Front 353

Sulfonamides

Back 353

Sulfamethazole (SMX), sulfisoxazole, sulfadiazine

mechanism

inhibit dihydropteroate synthase

--> inhibiting folate synthesis

bacteriostatic

(bacteriocidal if combined with trimethoprim)

clinical use

gram +

gram -

Nocardia

SMX fo simple UTI

adverse effects:

hypersensitivity

hemolylsis if G6PD

nephrotoxicity (tubointestitial nephritis)

photosensitivity

Steven-Johnson syndrome

kernicterus in infants

displaces drugs from albumin (warfarin)

resistance:

altered enzyme (dihydroperoate synthase)

less uptake

increased PABA synthesis

Front 354

Dapsone

Back 354

mechanism

inhibtion of dihydropreroate synthase

clinical use:

Leprosy (lepromatous and tuberculoid)

Pneumocystis jirovecii prophylaxis

adverse effects:

hemolysis if G6PD deficient

Front 355

Trimethoprim

Back 355

mechanism:

inhibits bacterial dihydrofolate reductase

bacteriostatic

clinical use:

use in combination with sulfonamides (TMP-SMX)

Combination used for:

UTIs

Shigella

Salmonella

Pneumocystis jirovecii pneumonia

-->treatment and prophylaxis

toxoplasmosis prophylaxis

adverse effects:

megaloblastic anemia

leukopenia

granulocytopenia

-->give folinic acid

TMP Treats Marrow Poorly

Front 356

Flouroquinoles

Back 356

Ciprofloxacin, norfloxacin, levofloxacin, oflofloxacin,moxifloxacin, gemifloxacin, enoxacin

mechansim:

inhibits topoisomerase II (DNA gyrase) and topoisomerase IV

bactericidal

must not be taken with antacida

clinical use

gram - rods of urinary and GI (incl. Pseudomonas)

some gram +

otitis externa

adverse effects

GI upset

superinfections

skin rashes

headache

dizziness

contraindicated in pregnant women, nursing mothers, children under 18 (cartilage damage)

cause tendonitis and may cause tendon rupture in >60 yr old patients

Ciproflaxacin inhibits P450

resistance:

Chromosome encoded mutation in DNA gyrase

plasmid-mediated resistance

efflux pumps

Flouroquinolones hurt attachements to your bones

Front 357

Daptomycin

Back 357

mechanism:

Lipopeptide that disrupts cell membranes of gram + cocci

-->creating transmembrane channels

clinical use:

S aureus skin infections (especially MRSA)

bacteremia

endocarditis

VRE

not used for pneumonia

--> inactivated by surfactant

adverse effects:

Myopathy

rhabdomyolysis

Front 358

Metronidazole

Back 358

mechanism:

forms free radicals in bacteria --> damage DNA

bactericidal

antiprotozoal

clinical use

Gardia

Entamoaba

Trichomonas

Gardenella vaginalis

Anaerobes (bacteroides, C difficile)

can be used instead of amoxicillin (if penicillin allergy) for H Pylori

GET GAP on the Metro with Metronidazole!

adverse effects:

disulfiram like reacions (flushing, tachycadria,hypotension) with alcohol

headache

metallic tast

Front 359

M tuberculosis

-prophylaxis

-treatment

Back 359

M tuberculosis

prophylaxis --> Isonoazid

treatment--> Rifampin, Isoniazd, Pyrazinamide, Ethambutol

RIPE (reif) for treatment

Front 360

M avium - intrcellulare

-prophylaxis

-treatment

Back 360

M avium- intracellulare

Prophylaxis:

Azithromycine, rifabutin

Tretament:

Azithromycin or clarithromycin

Ethambutol

can add rifabutin or ciprofloxacine

Avium -intraCellulaRe

--> Azithromycin, Clarithromycin, Rifabutin

Front 361

M leprae - treatment

Back 361

long-term treatment with dapsone and rifampin

add clofazime for lepromatous form

dap the rif on the clo if u have lepro

Front 362

Rifamycins

Back 362

Rifampin, rifabutin

mechanism

inhibit DNA-dependent RNA polymerase

clinical use

Mycobacterium tuberculosis

delay resistance to dapsone when used for leprosy

meningococcal prophylaxis

chemoprophylaxis in children with H influezae type B

adverse effects:

minor hepatoxicity

drug interactions!

orange body fluids

Rifabutin favored in HIV patients

-->less interactions with P450 than rifampin

resistance:

mutation in RNA polymerase

monotherapy leads to rapid resistance

Rifampins 4 R´s

RNA polymerase inhibitor

Ramps up microsomal caytochrom P-450

Red/orange body fluids

Rapid resistance if used alone

Rifampin ramps up cytochrom P450, but rifabutin does not.

Front 363

Isoniaizid

Back 363

mechanism:

inhibits sythesis of mycolic acid

-->bacterial peroxidase (gene= KatG) needed for activation of INH

clinical use:

Mycobacterium tuberculosis

can be used alone for the prophylaxis of TB

can be used for monotherapy for latent TB

adverse effects:

Hepatotoxicity

P450 inhibition

drug-induced SLE
Vit B6 defiency (-->neuropathy, sideroblastic anemia)

-->administer with Vit B6

Resistance:

Mutations leading to underexpression of KatG

INH

"Injures Neurons and Hepatocytes"

Front 364

Pyrazinamide

Back 364

mechanism:

unkown

prodrug--> has to be converted to pyrazinoic acid

works best at acidic pH --> in phagolysosome

clinical use:

Mycobacterium tuberculosis

adverse effects:

Hyperuricemia

Hepatotoxity

Front 365

Ethambutol

Back 365

mechanism

inhibits carbohydrate polymerisation of mycobacterium cell wall blocking aminoacyltranferase

clinical use:

Mycobacterium tuberculosis

adverse effect:

Optic neuropathy (red-green blindness)

"eyethambutol"

Front 366

Streptomycin

Back 366

mechanism

interferes with 30S component of ribosome

clinical use :

Mycobacterium tuberculosis

adverse effect:

tinnitus, vertigo,ataxia,nephrotoxicity

Front 367

High risk for endocarditis and undergoing surgical or dental procedure

Which prophylaxis?

Back 367

Amoxicillin

Front 368

Exposure to gonorrhea

Which prophylaxis?

Back 368

Ceftriaxone

Front 369

History of recurrent UTIs

Which prophylaxis?

Back 369

TMP-SMX

Front 370

Exposure to meningococcal infection

Which prophylaxis?

Back 370

Ceftriaxone, ciprofloxacin, or rifampin

Front 371

Pregnant woman carrying group B strep

Which prophylaxis?

Back 371

intrapartum Penicillin G or ampicillin

Front 372

Prevention of gonococcal cojunctivitis in newborn

Which prophylaxis?

Back 372

Erythromycin ointment on eyes

Front 373

Prevention of postsurgical infection due to S aureus

Which prophylaxis?

Back 373

Cefazolin

Front 374

Prophylaxis of strep pharyngitis in child with prior rheumatic fever

Which prophylaxis?

Back 374

Benzathine penicillin G or oral penicillin V

Front 375

Exposure to syphillis

Which prophylaxis?

Back 375

Benzathine penicillin G

Front 376

HIV CD4<200 cells/mm

Which prophylaxis?

Back 376

TMP-SMX for

Pneumocystis pneumonia

Front 377

HIV CD4<100 cells/mm

Which prophylaxis?

Back 377

TMP-SMX for

Pneumocystis pneumonia

Toxoplasmosis

Front 378

HIV CD4<50 cells/mm

Which prophylaxis?

Back 378

Azithromycin or clarithromycin for

Mycobacterium avium complex

Front 379

Treatment of MRSA

Back 379

vancomycin

daptomycin

linezolid

tigecyclin

ceftaroline

doxycycline

Front 380

VRE

Back 380

linezolid

streptogramins(quinupristin, dalfopristin)

Front 381

Multidrug-resistant P aeroginosa

Multidrug-resistant Acinobacter baumanii

Back 381

Polymyxins B and E(colistin)

Front 382

Amphotericin B

Back 382

mechanism:

binds ergosterol; forms membrane pores that allow leakage of electrolytes

clinical use

serious systemic mycosis

Cryptococcus (Amphotericin B with flucytosine for cryptococcal mengingitis)

Blastomycosis

Histoplasma

Candida

Mucor

intrathecally for fungal meningitis

supplement K+ and Mg2+ bacause of altered renal tubule permeability

Adverse

Fever/Chills (shake and bake)

hypotension

nephrotoxicity

arrythmia

anemia

IV

phlebitis ("amphoterrible")

hydration --> lower nephrotoxicity

Liposomal amphotericin --> lower toxicity

Front 383

Nystatin

Back 383

mechanism

same as amphotericin B. topical use only too toxic for system use

clinical use:

"Swish and swallow" for oral candidiasis (thrush)

topical for diaper rash or vaginal candidiasi

Front 384

Flucytosine

Back 384

mechanism:

inhibits DNA and RNA biosynthesis by conversion to 5-floururacil by cytosine deaminase

clinical use

systemic fungal infections

-->espiacially in cryptococcal meningitis in combination with amphotericin B

adverse effects:

bone marrow suppression

Front 385

Azoles

Back 385

Clotrimazole, fluconazole, itraconazole, ketoconazole, miconazole, vorinconazole, isvuconazole

mechanism:

inhibits fungal sterol (ergotserol) synthesis by inhibiting the cytochrom P450 (14alpha demethylase) that converts lanosterol to ergosterol

clinical use:

local and less serious systemic mycoses

Fluconazole for chronic supression of cryptococcal meningitis

Itraconazole for Blastomyces, Coccidiodes, Histoplasma

Clothrimazole and miconazole fot topical fungal infections

Voriconazole for Aspergillus

Isavuconazole for serious Aspergillus and Mucoral infections

adverse effect:

Testosterone synthesis ihibited

(gynecomastia, esp. with ketoconazole)

liver dysfunction (cytochrom P 450 inhibition)

Front 386

Terbinafine

Back 386

mechanisms:

inhibits the fungal enzyme squalene epoxidase

clinical use:

Dermatophytoses

-->especially onychomycosis --> fungal infection of finger and toe nails

adverse effects:

GI upset

headaches

hepatotoxicity taste disturbance

Front 387

Echinocandins

Back 387

Anidulafungin, caspofungin, micofungin

mechanism:

inhibit cells wall synthesis by inhibiting synthesis of beta-glucan

clinical use:

invasive aspergillosis, Candida

adverse effects:

GI upset

flushing by histamine release

Front 388

Antifungal drugs overview

Back 388

Front 389

Griseofulvin

Back 389

mechanism:

interferes with microtubule function

-->disrupts mitosis

deposits in creatine rich tissue

clinical use:

oral treatment of superficial infections

-->inhibits growth of dermatophytes (tinea,ringworm)

adverse effects:

teratogenic

carcingenic

confusion

headaches

disulfiram-like-reactions

high cytochrom P450 and warfarin metabolism

Microtubules get constructed very poorly

Mebendazole

grisovulvin

colchicine

vinblastin, vincristin

paclitaxel

Front 390

What do treat with Pyrimethamine?

Back 390

Toxoplasmosis

Toxoplasma gondii is a coccidian protozoan parasite that commonly causes subclinical infection or mild lymphadenopathy in normal persons yet produces severe opportunistic infections in infants in utero and patients with AIDS, both of whom lack intact cell-mediated immune systems.

Front 391

What do you treat with suramin and melarsorpol?

Back 391

Trypanosoma brucei

--> African sleeping sickness

-->enlarged lymph nodes, recurring fever, somnolence, coma

Front 392

What do you treat with nifurtimox ?

Back 392

Trypanosmoma cruzi

--> chagas disease

Front 393

What do you treat with sodium stibogluconate ?

Back 393

leishmaniasis

caused by Leishmania donovani

-visceral leishmaniasis (fever,hepatosplenomegaly, pancytopenia)

-cutaneous leishmaniasis (skin ulcers)

Front 394

Anti-mite / louse therapy

Back 394

PML --> Pesty Mites and Lice

with

PML --> Permethrin, Malathion, Lindane

because they

NAG --> Na, AChE, GABA blockade

used to treat Scabies (Sarcoptes scabiei) and lice (Pediculus and Pthirus)

Front 395

Chloroquine

Back 395

mechanism

blocks detoxification of heme into hemozoin

-->heme accumulates in plasmodia --> toxic

clinical use:

treatment of all plasmodial spp despite from plasmodium falciparum

P falciparum --> resistance via efflux pump --> less toxic heme in cell

adverse effects:

Retinopathy

pruitus (espiacally in dark-skinned persons)

Front 396

Treatment of plasmodium flaciparum

Back 396

artemether/ lumefantrine

atovaquone / proguanil

for live-threatening malaria

-->quinidine

Front 397

Oseltamivir, zanamivir

Back 397

mechanism:

inhibit influenza neuramidase --> less release of progeny virus

clinical use

treatment and prevention --> influenza A and B

treatment as to be started 48 hours within onset of symptoms

Front 398

Acyclovir

famiclovir

valacyclovir

Back 398

mechanism:

Guanosine analogs

--> monophosphorylated by HSV and VZV thymidine kinase

-->inhibits viral DNA polymerase

clinical use:

HSV and VZV

HSV

-->mucocutaneous and genital lesions as well as encephalitis

Valacyclovir = prodrug of acyclovir with better oral bioavailability

herpes zoster --> famciclovir

adverse effects:

obstructive crystalline nephropathy and acute renal failure if not adquatly hyfrated

resistance

mutated thymidine kinase

Front 399

Ganciclovir

Back 399

mechanism:

Guanosine analog

5´-monophosphate formed by CMV viral kinase

inhibits viral DNA polymerase

clinical use:

CMV in immunocompromised

Valganciclovir --> prodrug of ganciclovir with better oral bioavailibility

adverse effects:

bone marrow supression (leukopenia, neutropenia, thrombocytopenia)

renal toxicity

resistance:

mutated viral kinase

Front 400

Forscanet

Back 400

mechanism

viral DNA/RNA polymerase inhibitor

binds to pyrophosphate-binding site

clinical use:

CMV retinitis when ganciclovir fails

adverse effects:

Nephrotoxicity

electrolyte abnormalities

--> can lead so seizures

resistance:

mutated DNA polymerase

Foscarnet = pyrofosphate analog

Front 401

Cidofovir

Back 401

mechanism:

inhibits DNA polymerase

clinical use:

CMV retinits

adverse effects:

nephrotox

--> coadminister with probenicid and IV saline to lower toxicity

Front 402

Indication for antiretrocirla therapy

HAART

highly active antiretroviral therapy

Back 402

Strongest indication --> AIDS defining illness

low-CD-4 count (<500 cells/mm3)

high viral count

Front 403

antiretroviral regime

Back 403

2 NRTIs

+

integrase inhibitor

Front 404

Nucleoside Reverse Transcriptase Inhibitors

NRTI

Name of the drugs?

Back 404

Abacavir

Didanosine

Emtricitabine

Lamivudine

Stavudine

Tenofovir

Zidovudine

Tenofovir = nucleoTide

all others are nucleosides

NucleoSide = base + (deoxy)ribose (Sugar)

NucleoTide = base + (deoxy)ribose + phosphaTe

all need to be phosphorylated to be active

Ziduvudine can be used for prophylaxis during pregnancy

Front 405

Nucleoside Reverse Transcriptase Inhibitors

NRTIs

mechanism

toxicity

Back 405

Abacavir,Didanosine,Emtricitabine,Lamivudine,Stavudine,Tenofovir,Zidovudine

mechanism:

competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain (lack of 3´OH group)

toxicity:

bone marrow suppression

--> can be reversed with G-CSF and erythropoietin

peripheral neuropathy

lactic acidosis (nucleosides)

anemia (ZDV)

pancreatitis (didanosine)

HLA-B*5701 mutation --> contraindication for Abacavir because of high risk of hypersensitivity

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Non-Nucleoside Reverse Transcriptase Inhibitors

NNRTIs

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Delavirdine

Efavirenz

Nevirapine

mechanism:

binds to reverse transcriptase at different side than NRTIs

Toxicity:

Rash

hepatoxicity

Efavirenz: vivid dreams + CNS symptoms

Delavirdine + efavirenz contraindicated in pregnancy

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Protease inhibitors

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Atazanavir, Darunavir, Fosamprenavir, Ininavir, Lopinavir, Ritonavir, Saquinavir

mechanism

assembly of virions depends on HIV-1 protease (pol gene)

-->cleaves the polypeptide products of HIV mRNA into their functional parts

-->protease inhibitors prevent the maturation of a new functional virus

Ritonavir can increased concentration through inhibition of cyp 450

navir (never) tease a protease

adverse effects:

Hyperglycemia, GI intolerance (nausea, diarrhea), lipodystrophie (Cushing-like syndrome)

Nephropathy, hematuria, thrombocytopenia

--> indinavir

Rifampin (anti-TB) reduces concentration of protease inhibitors

--> use rifabutin instead

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Integrase inhibitors

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Raltegravir, Elvitegravir, Dolutegravir

mechanism:

inhibits integration of HIV genome into host chromosome by inhibiting HIV protease

toxicity

increases creatine kinase

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Enfuviritide

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HIV drug

Fusion inhibitor

mechanism:

binds gp41 --> inhibiting viral entry

toxicity

skin reactions at injection sites

Enfuviritide inhibits fusion

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Maraviroc

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HIV drug

Fusion inhibitor

mechanism:

binds CCR-5 on surface of T-cells/monocytes

-->inhibiting interaction with gp120

Maraviroc inhibits docking

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therapeutic use of IFN-alpha

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chr Hep B/C

Kaposi sarcoma

hairy cell leukemia

condylomata lata

renal cell carcinoma

malignant melanoma

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therapeutic use of IFN beta

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multiple sclerosis

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IFN gamma

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chronic granulomatous disease

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Ribavirin

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Hep C drug

mechanism

inhibits synthesis of guanine nucleotide synthesis

--> inhibiting ionosine monophosphate dehydrogenase

clinical use

chr HCV, can be used for RSV in children

adverse effects

hemolytic anemia, severe teratogen

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Sofosbovir

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chr Hep C therapy

inhibits HCV RNA-dependent RNA-polymerase

acting as a chain terminator

clinical use

chr. HCV in combination with ribavirin, simeprevir, ledipasvir (NS5A inhibitor)

+/- interferon alpha

not as a monotherapy !

adverse effects:

fatigue

headache

nausea

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Simeprevir

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chr Hep C drug

mechanism

HCV protease inhibitor

prevents viral replication

clinical use

in combination with ledipasvir (NS5A inhibitor)

not as a monotherapy

adverse effects:

photosensitivity reactions

rash

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Antibiotics to avoid in pregnancy

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Countless SAFe Moms Take Really Good Care

Clarithromycin, Sulfonamides, Aminoglycosides, Fluroquinolones, Metronidazole, Tetracyclines, Ribavirin, Griseofulvin, Chloramphenicol

Clarithromycin

embryotoxic

Sulfonamides

kernicterus

Aminoglycosides

ototoxicity

Fluoroquinolones

cartilage damage

Metronidazole

mutagenesis

Tetracyclines

discolored teeth, inhibition of bone growth

Ribavirin

teratogenic

Griseofulvin

teratogenic

Chloramphenicol

gray baby

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Vibrio cholerae

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gram negative, flagellated, comma shaped , axidase positive

grows in alkaline media

endemic in developing countries

produces rice-water diarrhea via enterotoxin that permanently activates Gs --> cAMP

sensitve to stomach acid

transmitted by contaminated water or shellfish

--> prompt rehydration is necessary

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Chagas disease

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dilated cardiomyopathy with apical atrophy

megacolon

megaesophagus

predominantly in south america

Romanas sign (unilateral swelling if eye)

Due to infection with Trypanosoma cruzi

Reduviid bug (kissing bug) feces depositi in bite

--> Trypomastigote in blood smear

treatment:

Benznidazole or Nifurtimox

"Cruzin with my benz with a fur coat on"

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Indulin test

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positive --> E coli

negative --> Enterobacter cloacis