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46 Cards in this Set
- Front
- Back
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what are the four protozoan common opportunistic infections in AIDS?
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Toxoplasmosis
isospora belli infection crytosporodiosis leishmania species |
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what are the four fungal common opportunistic infections in AIDS?
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Pneumocystosis
cryptococcosis candidiasis histoplasmosis (disseminated) |
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what are the three bacterial common opportunistic infections in AIDS?
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disseminated M. TB
MAC salmonella |
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what are the four viral common opportunistic infections in AIDS?
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-persistent mucocutaneous HSV
-cytomegalovirus retinitis, gastrointestinal or disseminated infection -varicella zoster (persistent or disseminated) -progressive multifocal leukoencephalopathy |
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HIV positive pt presents to your clinic with confusion and memory issues. You do a MRI of the brain and you notice multiple lesions appearing like white sclerotic plaque all over the brain. dx
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progressive multifocal leukoencephalopathy caused by JC virus
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a 25 week pregnant HIV positive women presents to the ER complaining of vaginal bleeding and abdominal pain. You inspect her cervix and notice that it is fully dilated and the placenta is sliding out as you inspect. She mentioned that she travelled to a different state for a hawaiian themed wedding and regularly takes her prenatal vitamins. Why is she experiencing these sxs?
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She had toxoplasmosis gondii d/t the undercooked pork meat that she ate and she gave her child Congenital toxoplasmosis which lead to her inevitable abortion.
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what are some delayed manifestations of congenital toxoplasmosis?
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choiroretinitis occuring from reactivation of latent infection during the 2nd or 3rd decade of life.
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____ of AIDS patients or pts receiving immunosuppressive therapy for various reasons develop _________ encephalitis (90% of these cases are fatal)
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50%; toxoplasma
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what can you see on an MRI that is diagnostic for toxoplasmosis gondii? what is the primary method of diagnosis for this pathogen?
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ring enhancing lesion; serology and increase in IgG ab
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what is the best way to tx toxoplasma? what do you give to pregnant women?
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atovaquone b/c it is effective against both cyst and trophozoites. preggers give spiramycin
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what readily stains cryptosporidium parvum? how do you diagnose their oocysts?
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readily stained w/ Giemsa and hematoxylin-eosin.
Oocysts are AFB positive d/t their cell walls |
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how does cryptosporidium cause watery diarrhea?
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it attaches to the epithelium preventing absorption of nutrients
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what is the purpose of a thin-walled oocyst of crytposporidium?
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to autoinfect and repeat the whole cycle
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microgamets are ____ (Female or male)
Macrogamets are _____ (Female or male) how do they reproduce? (for cryptosporidium) |
micro-male
macro- femal reproduce- binary fission |
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what is the definitive phase of protozoans? intermediate?
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definitive: sexual stage
intermediate: asexual stage |
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Miwaukee + intractable diarrhea + HIV positive:
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Cryptococcus Parvum
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what would you see on pathology for a pt suffering from cryptosporidiosis? how do you improve cryptosporidiosis?
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mild to moderate villous atrophy, crypt enlargement located more heavily in the jejunum but involving the whole GI.
improve-- improve the CD4 count, there is no tx. |
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what is the difference between an immunocompetent pt contracting cryptosporidiosis parvum and a immocompromised pt?
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immunocompromised pt will present w/ severe intractable diarrhea. This will be a chronic illness for them until the CD4+ count improves.
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how do you diagnosis cryptosporidiosis parvum?
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recovery and identification of the oocysts in the stool by acid fast staining. It can also be stained w/ immunoflourescent ab.
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HIV positive pt presents w/ night sweats, hemoptysis and diarrhea. PPD tests is negative. dx
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MAC
- does not respond to traditional M TB drugs and is usually disseminated (not lung) |
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how do you diagnose MAC?
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blood culture
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HIV positive pt presents w/ hemoptysis, night sweats, cavity lesion on CT. PPD test is positive and the pathogen forms yellow-pigemented colonies in the presence of light. dx
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M. Kansasii
tx: INH, rifampin and ethambutol for a prolonged period of time. |
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what makes PCP different from other fungi? how do you detect it?
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no ergosterol in the cell wall
detected via silver methanamine staine |
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Pt presents 10 days after getting a new pancreas with dusky color of skin and mucus membrane, shortness of breath and non-productive cough. You do a sputum sample and no growth is evident. why is that?
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PCP is an alveolar pathogen which makes sputum useless for testing and PCP only grows in living creatures.
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why does death by PCP usually occur from respiratory failure?
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d/t everytime the pt suffers from pneumoniae there is inflammation and a residual damage. The residual damage builds up and perfusion at the level of alveolar membrane decreases. Over a period of time, it will become so thick that perfusion will become inadequate and they will suffer from chronic respiratory failure.
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HIV positive pts presents to your ER complaining of shortness of breath and a nonproductive cough. On CXR you see interstitial linear opacities w/ hazy ground glass appearance. dx
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PCP
tx: Trimethoprim-sulphamethoxazole (TSX) |
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what 4 stains can be used for PCP? how do you detect PCP?
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Confirmation:
silver methanamine for trophozoites and PCP: wright giemsa pap stain detect: via BAL |
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HIV positive pt presents to your ER in an unconscious state. You do a spinal tap and diagnose the pt with meningeal encephalitis. dx
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cryptococcus neoforman.
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describe the capsule of cryptococcus neoformans.
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it is a complex polymer of polysaccharide which means that it is Thymus independent which means it doesn't require T cell help to induce a response. but the limitations is that there are no memory cells produced. You only get IgM which will not induce a memory response.
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what is the only pathogen that has a protein capsule?
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bacillus anthracis
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what can you stain cryptococcus neoformans with? what media(s) can it grow on?
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India Ink- negative stain. super sensitive, not specific
media: glucose agar, blood agar, chocolate agar, potato dextrose agar |
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An HIV pt who works as a bridge builder in San Francisco presents with Fever, dementia and a few recent seizures. dx and tx
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C. neoformans
tx: amphoterecin B until culture negative and in combo with (generally) fluconazole (forever) |
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what is produced by C. neoformans that protects itself against oxidative injury of phagocytes?
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Melanin
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what are the four pathogens that you do CSF latex agglutination for?
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S. pneumonia, H. influ, Neisseria meningititis, C. Neoformans
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what are you detecting in the latex agglutinating of the CSF in C. neoformans?
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Detection of GXM polysaccharide antigen
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what is the #1 cause of in utero infections in the US?
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CMV
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A newborn is presented to your office with jaundice, hepatomegaly, microcephaly and thrombocytopenic purpura. DX
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Blueberry muffin baby caused by CMV
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A bone marrow transplant pt presents with pneumonia. what is the most likely cause?
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CMV
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Histology shows: basophilic intranuclear inclusion bodies surrounded by a clear halo. dx
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CMV
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what four fluids can CMV be isolated from?
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urine, saliva, semen, and cervical secretions
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Immunocompromised pts suffer severe forms of CMV and suffer from what other illnesses?
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pneumoniae
chorioretinitis Gastroenteritis Neurologic disorders |
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what complication of CMV is evident in immunocompromised individuals as opposed to immunocompetent?
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CMV retinitis
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how do you diagnose CMV? how do you tx it? what does each tx do?
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serology
tx: Gancyclovir (inhibit DNA polymerase, bone marrow suppresion) Foscarnet (inhibit DNA polymerase, nephrotoxic) - 2nd line Cidofovir (nucleotide analog and nephrotoxic)- retinitis |
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at what CD4+ count do you start to see pts with histoplasmosis and coccidioidomycosis infections?
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<200 This is when you start prophylaxis
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at what CD4+ count do you start to see pts exhibiting cryptococcosis, cryptosporidiosis, HSV, and candidal esophagitis?
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<100- start prophylaxis
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what can cause macrocytosis in HIV infected pts? Anemia? Neutropenia?
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macrocytosis: AZT (medication)
Anemia: only AZT neutropenia: AZT |
