Z Infectous Diseases From Pathoogy Block 9

Front 1

Most common cause of suppurative infections of skin, joints and bones

Back 1

Staphylococcus aureus

Front 2

Most common cause of infectious endocarditis

Back 2

Staphylococcus aureus

Front 3

Staphylococcus aureus Protein A

Back 3

blocks the complement activation by binding to the Fe receptor of IgG

Front 4

blocks the complement activation by binding to the Fe receptor of IgG

Back 4

Staphylococcus aureus Protein A

Front 5

Coagulase-Negative Staphylcocci

Back 5

S. epidermidis,
S. hominis
S. saprophyticus

Front 6

Major causes of infections associated with medical devices, neutropenic, immunocompromized patients

Back 6

S. epidermidis, S. hominis

Front 7

Fibrious coat on implanted medical devices Polysaccaride gel (“slime”)

Back 7

S. epidermidis, S. hominis

Front 8

Encapsulated gram-positive diplococcus The capsule prevents the activation of the alternate complement pathway

Back 8

Staphylococcus pneumoniae

Front 9

Staphylococcus pneumoniae and vaccine

Back 9

> 80 antigenically distinctive serotypes Antibodies against one serotype does not protect from the other serotypes Vaccine

Front 10

Splenectomy favors what with strep pneumo

Back 10

S. pneumoniae (Pnemococcus)

Front 11

Leading cause of neonatal pneumonia, sepsis, meningitis

Back 11

Staphylococcus agalactiae

Front 12

Cytotoxin kills ciliated cells Produces lymphycytosis with ‘atypical’ lymphocytes Toxins inhibits bacterial phagocytosis (by blocking adenyl cyclase)

Back 12

Bordetella pertussis

Front 13

Bordetella pertussis
phases

Back 13

Catarrhal stage (1 week):
Paroxysmal stage (2-3 weeks):
Convalescent phase (several weeks):

Front 14

name the stage of pertussis

Similar to common viral upper respiratory

Back 14

Catarrhal stage (1st week)

Front 15

name the stage of pertussis
Paroxismal cough with inspiratory whoop, vomiting

Back 15

Paroxysmal stage (2-3 weeks):

Front 16

name the stage of pertussis
Paroxysms gradually decrease

Back 16

Convalescent phase (several weeks

Front 17

invasive bacteremias, meningitis, epiglotitis

Back 17

Haemophilus influenzae

Front 18

Haemophilus influenzae
Encapsulated strains

Back 18

type b): Invasive

Front 19

Haemophilus influenzae
wrt enzyme

Back 19

Elaborates IgA protease for survival in the respiratory tract

Front 20

Pneumonia (adults with IgG deficiencies)

Back 20

Haemophilus influenzae

Front 21

Humans are the only resevoir (asymptomatic carriers) Almost always spread by sexual contact Perinatal transmission (opthalmia neonatorum)

Back 21

Neisseria gonorrhoeae

Front 22

Neisseria gonorrhoeae
enzyme

Back 22

Pili contain a protease which digests IgA antibodies

Front 23

Neisseria gonorrhoeae
how it attaches

Back 23

to the epithelial cells or urethra and endocervix by pili

Front 24

Neisseria gonorrhoeae - Clinical Features
men

Back 24

urethritis, epididimitis, proctitis

Front 25

Neisseria gonorrhoeae - Clinical Features
women

Back 25

Endocervicitis, endometritis, salpingitis, pelvic inflammatory disease, Fitz-Hughes- Curtis syndrome (peritonitis, peripepatitis, subdiaphragmatic abcess),

Front 26

Neisseria gonorrhoeae - Clinical Features
neonates

Back 26

Neonates: conjunctivits

Front 27

Hemophilus ducrei
structure and clinical picture

Back 27

Small, Gram-negative bacillus On Gram stain: clusters of parallel bacilli in chains (school of fish)

Chancroid: painful genital ulcerations with lymphadenopathy

Front 28

Hemophilus ducrei
where

Back 28

Most common in tropics and subtropics

Front 29

Enters through minute breaks in the skin Local raised lesions which eventually ulcerate Macrophages transport the bacteria to the lymphnodes Supporative lymphadenitis (bubo)

Back 29

Hemophilus ducrei

Front 30

Calymmatobacterium granulomatis
structure and clinical pic

Back 30

Small, Gram-negative, encapsulated, bacillus

Granuloma inguinale: chronic superficial ulceration of the genitalia, inguinal and
perianal regions

Front 31

Granuloma inguinale: chronic superficial ulceration of the genitalia, inguinal and perianal regions

Back 31

Calymmatobacterium granulomatis

Front 32

Macrophages phagocytize (Donovan bodies)

Back 32

Calymmatobacterium granulomatis

Front 33

Gram-negative, aerobic, facultatively anerobic rod Glucose and lactose fermenter

Back 33

Escherichia Coli

Front 34

Typhoid Fever caused by

Back 34

Salmonella typhi

Front 35

Typhoid Fever
Chronic carriers

Back 35

Chronic carriers (gallstones, food handlers, Typhoid Mary)

Front 36

Humans are the only resevoir Chronic carriers (gallstones, food handlers, ) Shellfish

Back 36

Typhoid Fever due to Salmonella typhi

Front 37

Endemic in rivers’ deltas (India, Bangladesh, Louisiana)

Back 37

Vibrio Cholerae

Front 38

Shellfish, plankton may serve as natural reservoir
Epidemics which ‘disappear’ spontaneously

Back 38

Vibrio Cholerae

Front 39

Abdominal pain of the right lower quadrant mimics appendicitis

Back 39

Yersinia entercolitica

Front 40

arrives to the alveoli, replicates within the alveolar macrophages in the phagosomes (inhibits the fusion of the phagosomes with the lysosomes).

Back 40

Legionella pneumophila

Front 41

rapidly progressive, fever, myalgias, patchy distribution. Mortality rate 15%

Back 41

Legionella pneumophila

Front 42

Most frequent hospital acquired pathogen

Back 42

Pseudomonas aeruginosa

Front 43

Ecthyma gangrenosum: nodular, necrotic lesions of the skin with localized hemorrhagic infarctions.

Back 43

Pseudomonas aeruginosa

Front 44

Elastase has been associated with ability to penetrate blood vessels.

Back 44

Pseudomonas aeruginosa

Front 45

Pseudomonas pseudomallei

Back 45

high fever, pneumonia, splenomegaly, hepatomegaly, diarrhea, septicemia

Front 46

high fever, pneumonia, splenomegaly, hepatomegaly, diarrhea, septicemia

Back 46

Pseudomonas pseudomallei

Front 47

Necrotizing enterocolitis (pigbel), with perforation and peritonitis

Back 47

Clostridium perfringens type C

Front 48

Clostridium perfringens A

Back 48

self limited (24 hours) diarrhea

Gas gangrene (clostridial myonecrosis)

Front 49

Clostridium perfringens D

Back 49

self limited (24 hours) diarrhea

Front 50

Clostridium perfringens C

Back 50

Necrotizing enterocolitis (pigbel), with perforation and peritonitis

Gas gangrene (clostridial myonecrosis)

Front 51

sudden onset of high fever, chills, aches, pains, prostration, profound sweating, lymphadenopathy, hepato and splenomegaly. Death may be sudden.

Back 51

Acute (malignant) Brucellosis

Front 52

influenza-type symptoms which recur and relapse, night sweats

Back 52

Recurrent Brucellosis (undulant fever, Malta fever

Front 53

Inoculation site, usually skin, focal ulceration Spread to the regional lymphnodes Dissemination through the bloodstream Survives within macrophages until they are activated by a cell mediated immune response

Back 53

Francisella tularensis

Front 54

flu-like illness, abortion, premature delivery, sepsis may follow delivery

Back 54

Listeria monocytogenes

Front 55

transplacental infection in the third trimester, symptoms appear in the first week after delivery. Papular cutaneous lesions and mucosal nodules in the posterior pharynx (granulomatosis infantiseptica), CNS involvement, hepato- splenomegaly, diarrhea

Back 55

Neonatal listeriosis

Front 56

second and third week after delivery. Infected passing through the colonized birth canal-meningitis

Back 56

Late onset listeriosis

Front 57

necrotizing, suppurative stellate abscesses, granulomatous lymphadenitis

Back 57

Cat-Scratch Disease
Bartonella (Rochalimea) henselae

Front 58

Chronic pneumonia: immunocompetent patients

Back 58

Nocardia Species

Front 59

Symptoms mimic tuberculosis Pulmonary infection may spread (30%) to CNS, skin and other organs

Back 59

Nocardia Species

Front 60

Anaerobic to aerobic, gram-positive, filamentous bacterium Commensal of mouth, throat, gastrointestinal tract and vagina

Back 60

Actinomycosis

Front 61

dental extraction, injury, abscesses, draining sinuses, sulfur granules

Back 61

Cervicofacial actinomycosis (lumpy jaw):

Front 62

most frequently secondary to aspiration of orophryngeal contents.

Back 62

Thoracic actinomycosis

Front 63

Suppurative abscesses with spheroid actinomycotic granules of filamentous bacterial colonies bordered by club-like projections of Splendore-Hoeppli material

Back 63

Actinomycosis

Front 64

Most common sexually transmitted disease in the developed world

Back 64

Chlamydia trachomatis -

Front 65

Elementary Body (EB

Back 65

metabolically inert

Front 66

Reticulate body (RB):

Back 66

metabolically active

Front 67

Obligate intracellular pathogen with biphasic developmental cycle

Back 67

Chlamydia trachomatis

Front 68

Acquired Immune Deficiency Syndrome (AIDS)
occurs when

Back 68

CD4 < 200 or an AIDS defining
illness is diagnosed

Front 69

what IL help B cells make antibodies

Back 69

IL-4 and IL-5

Front 70

what IL activates CD4 and CD8 cells (cytotoxic T cells),

Back 70

2

Front 71

what activates macrophages

Back 71

gamma interferon

Front 72

infections when
CD4 Lymphocytes 250-500

Back 72

Pneumococcal pneumonia
Pulmonary tuberculosis
Herpes Zoster
Oral candidiasis

Front 73

infections when
CD4 Lymphocytes <200

Back 73

Pneumocystis carinii pneumonia (PCP)

Disseminated histoplasmosis
Toxoplasmosis
Kaposi’s Sarcoma
Cervical cancer

Front 74

infections when
CD4 Lymphocytes <100

Back 74

Cryptococcal meningitis
Esophageal candidiasis

Front 75

infections when
CD4 < 50

Back 75

Mycobacterium-avium complex (MAC)
Cytomegalovirus (CMV)

Front 76

84% of persons with HIV will have positive cultures for

Back 76

Candida: don’t culture.

Front 77

White vertical stripes or plaques with vertical folds on the lateral border of the tongue, less common buccal mucosa or dorsum of tongue.

Back 77

Oral hairy Leukoplakia (OHL).

Front 78

Almost pathognomonic of HIV infection..
Reactivation of Epstein Barr virus, usually asymptomatic, not progressive and not premalignant.

Back 78

Oral hairy Leukoplakia (OHL).

Front 79

Cytomegalovirus (CMV) Disease
when seen in AIDS

Back 79

CD4 almost always < 50.

Front 80

Initial complaint is often unilateral decrease in visual acuity, floaters or visual field defects.

Back 80

Cytomegalovirus (CMV) Disease

Front 81

Aids and pneumovax

Back 81

Pneumovax is recommended for CD4 >200 and also may be effective with CD4 <200. (Some would revaccinate if CD4 rises to >200).

Revaccination is recommended every 5 years.

Front 82

PCP and AIDS
when seen

Back 82

Almost all cases occur with CD4 count < 200.

Front 83

the most common opportunistic infection and cause of death among AIDS patients

Back 83

PCP

Front 84

PCP - Clinical

Back 84

Fever, non-productive cough.

Dyspnea on exertion (DOE).

Front 85

Decreased DLCO. Abnormal Gallium Scan

Back 85

PCP

Front 86

PCP - Diagnosis

Back 86

Bronchoscopy with bronchoalveolar lavage (BAL) is 90% sensitive

Front 87

May cause fever and rash (up to 30%) and severe hyperkalemia.

Back 87

PCP - Therapy
Trimethoprim-Sulphamethoxazole (TMP-SMZ; Bactrim/Septra

Front 88

Prophylaxis for PCP is indicated for:

Back 88

CD4 < 200

Oropharyngeal candidiasis

Front 89

PCP prophylaxis is considered for

Back 89

CD4% < 14
AIDS –defining illness

Front 90

AIDS -
Most Common Pathogens Causing Chronic Diarrhea

Back 90

Microsporidia
Cytomegalovirus
Cryptosporidia
Mycobacterium avium complex

Front 91

AIDS -
Direct smears of unconcentrated stool with
Weber’s modified trichrome has resulted in a significant yield

Back 91

Microsporidiosis: Diagnosis

Front 92

coccidian protozoal parasites that infect enterocytes of the small intestine

Back 92

Cryptosporidiosis

Front 93

AIDS -
Cryptosporidia: Clinical Syndrome

Back 93

Chronic Diarrhea
Cholera – like disease
Transient Diarrhea
Relapsing Illness

Front 94

AIDS -
HIV and Cryptosporidiosis
wrt cd4

Back 94

HIV infected patients with CD4 counts > 200 cells/mm³ usually have self limited infections.

Patients with CD4 counts < 100 cells/mm³ have chronic diarrhea with wasting.

Front 95

AIDS -
Mycobacterium avium Complex
wrt cd4

Back 95

Almost all have a CD4 <50.

Front 96

AIDS -
Symptoms include fever, night sweats, weight loss, and abdominal pain (associated with mesenteric adenopathy).

Back 96

Mycobacterium avium Complex

Front 97

AIDS -
Suggestive lab and PE findings: severe anemia, elevated alkaline phosphatase and hepatomegaly.

Back 97

Mycobacterium avium Complex

Front 98

AIDS -
Cytomegalovirus Colitis
wrt cd4

Back 98

CD4 count < 50 cells/mm3

Front 99

AIDS -
Cytomegalovirus Colitis
symps

Back 99

Chronic watery diarrhea
Abdominal pain
fever

Front 100

AIDS -
Perianal HSV
when is it aids defining

Back 100

AIDS defining illness when ulcer lasts > 30 days.

Front 101

AIDS -
Presents as a painful tongue, may be chronic.
On physical exam, there are linear or cross hatched fissures of the tongue.

Back 101

Herpetic Glossitis

Front 102

AIDS -
Most common cause of meningitis in AIDS patients

Back 102

Cryptococcal

Front 103

AIDS -
Cryptococcal disease
wrt cd4

Back 103

CD4 almost always < 100

Front 104

AIDS -
Cryptococcal Disease
onset

Back 104

Subacute onset over 2-4 weeks with fever, malaise, headache, confusion.

Front 105

AIDS -
Serologic tests are based on detection of the polysaccharide antigen by latex agglutination.

Back 105

Cryptococcosis - Diagnosis

Front 106

AIDS -
Rapid diagnosis of meningitis can be made with

Back 106

India ink preparation; (+) in 75%.
Cryptococcosis - Diagnosis

Front 107

AIDS -
lesions usually multiple, basal ganglia and gray-white junction, usually with ring enhancement

Back 107

Toxoplasmosis

Front 108

AIDS -
Toxoplasmosis
wrt cd4

Back 108

CD4 < 100

Front 109

AIDS -
Fever, weight loss, hepatosplenomegaly, and pancytopenia.

AIDS patients may present with a fulminating syndrome – shock, adult respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC).

Back 109

Disseminated Histoplasmosis

Front 110

AIDS -
Urine and blood polysaccharide antigen detection by radioimmunoassay.

Direct stains of buffy coat and tissue.

Back 110

Histoplasmosis - Diagnosis

Front 111

AIDS -
Initially may be flat, but become nodular and may become infiltrating plaques.
Purple to dark brown or black.
Anywhere on the skin, but especially the face (tip of the nose), chest, genitals and oral mucosa

Back 111

Kaposi’s Sarcoma

Front 112

AIDS -
Immunizations for HIV

Back 112

Pneumovax all patients,

Hepatitis B all patients with negative HepBcAb

Influenza all patients annually.
Hepatitis A

Front 113

Immunizations for HIV
ones to avoid

Back 113

Avoid live virus vaccines (MMR, Varicella, Yellow Fever, Smallpox

Front 114

Flask-shaped ulcers form in the large intestine.
There is inflammation, hemorrhage, secondary bacterial infection

Back 114

Entamoeba histolytica

Front 115

A normally free-living organism that opportunistically colonizes the nasal passages and then passes to the brain

Back 115

: Naegleria fowleri

Front 116

Patients have frontal headache, sore throat, fever, blocked nose with altered sense of smell, stiff neck, Kernig's sign., and purulent cerebrospinal fluid containing RBCs

Back 116

: Naegleria fowleri

Front 117

Sudden onset, foul smelling watery diarrhea,
abdominal cramps, flatulence, steatorrhea

Back 117

Giardia lamblia

Front 118

Females are usually asymptomatic or have a mild watery discharge. Occasionally females have vaginitis, itching, burning, painful urination. Males may have urethritis, prostatitis.

Back 118

Trichomonas vaginalis

Front 119

Abdominal pain, tenesmus, nausea, watery stool with blood and pus, intestinal ulcers, secondary bacterial infections.

Back 119

Balantidiasis

Front 120

A mild disease in healthy individuals: self limiting mild entercolitis, watery diarrhea with blood. Symptoms last about ten days, no treatment required. Severe disease occurs in immunocompromized individuals such as AIDS patients. These persons may have up to 50 stools/day, great fluid loss, and symptoms for months to years.

Back 120

. Cryptosporosis

Front 121

Early headache, muscle pain, anorexia, nausea, photophobia, vomiting. Chills, fever, malarial rigors from erythrocytes rupturing. Paroxysms occur every 48 hours.

Back 121

P. vivax

Front 122

: Paroxysms every 72 hours

Back 122

. P. malariae

Front 123

Paroxysms approximately every 36-48 hours (much less timely). Nausea, vomiting, diarrhea. The most likely malaria to be fatal

Back 123

. P. falciparum

Front 124

. There are early chills and fever, enlarged liver and spleen, weight loss, emaciation, and kidney damage. Untreated patients may have: a) a fulminating, debilitating disease with death in a few weeks or

Back 124

: Leishmania donovani

Front 125

There is a red papule at bite site, pruritis, ulceration. The ulcer becomes hard and crusted with a serous exudate. Secondary bacterial infections occur and the ulcer may heal on its own but leaves a disfiguring scar.

Back 125

: Leishmania tropica

Front 126

Incubation period of a few weeks to a few months, then formation of a papule. Same pathology as L. tropica but also involves mucus membrane destruction. There is edema, secondary bacterial infections and disfigurement of lips, nose, mouth, and tongue.

Back 126

: Leishmania braziliense

Front 127

. Winterbottom's sign is swelling of the posterior cervical lymph nodes. CNS involvement leads to a chronic disease of lethargy, tremors, meningoencephalitis, mental retardation

Back 127

: Trypanosoma gambiense

Front 128

African
Shorter incubation period than for
Acute disease occurs more rapidly including fever, rigors. mylagia. Disease progresses to a fulminating rapidly fatal illness.

Back 128

: Trypanosoma rhodisiense

Front 129

Hosts are often asymptomatic. Severe perianal pruritis is a
reaction to worm secretions.

Back 129

Enterobius vermicularis

Front 130

Ingestion of few eggs usually results in no symptoms. However, one worm can block the bile duct or perforate the small intestine. Lung migration produces pneumonitis and lobar consolidation

Back 130

Ascaris lumbricoides

Front 131

Pathology is from larvae in tissues. Larvae may invade any tissue causing bleeding, necrosis, granulomas, eosinophilia. Patients may be asymptomatic, have eosinophilia only, or have serious disease

Back 131

: Toxocara canis and cati

Front 132

. Symptom severity is directly related to the worm burden. Patients with small numbers of worms are asymptomatic. Large numbers of worms produce abdominal pain and distension, bloody diarrhea

Back 132

Trichuris trichiura

Front 133

. Larvae skin penetration causes an allergic reaction and rash. Larvae migration through lungs causes pneumonitis. Adults in the small intestine suck blood

Back 133

Ancylostomiasis (hookworm infection)

Ancylostoma dudenale

Front 134

Worms ub the skin cause a severe erythematous, vesicular reaction. Scratching in response to severe pruritis can lead to secondary bacterial infections.

Back 134

Ancylostona braziliense,
Ancylostoma caninum

Front 135

Pneumonitis from migrating larvae. Intestinal infections are usually asymptomatic. Heavy infections involve inflammation and ulceration of bilary and pancreatic ducts,

Back 135

Strongyloidiasis

Front 136

. Symptoms depend on worm burden and location in the host. Mild (few migrating larvae) infections produce flu-like symptoms, slight fever, mild diarrhea. More extensive migration yields persistent fever, gastrointestinal distress, eosinophilia, muscle pain, periorbital edema

Back 136

: Trichinella spiralis

Front 137

Patients are often asymptomatic even when they have many microfilariae. In acute disease there is fever, chills, febrile attacks, lymphangitis, lymphadenitis, enlarged lymph nodes, occasional abscess formation. Acute disease is an inflammatory response to molting adolescents and dying and dead adults. Disease involves extremities, scrotum, testes. Obstruction of lymph flow is from adult worms

Back 137

: Wucheria bancrofti

Front 138

Vector is Simulium, the black fly. Once injected larvae enter the subcutaneous tissue These migrate to the skin, eye, body tissue.

Back 138

Onchocerca volvulus

Front 139

The fresh water cercaria larval stage penetrates the host's skin, makes a lung migration, goes to the liver

Back 139

Schistosoma

Front 140

Worm is located in the mesenteric veins of the small intestine

Back 140

Schistosoma japonicum

Front 141

This trematode is located in the venules of the bladder prostate, and uterus

Back 141

Schistosoma hematobium

Front 142

Cerebral cysticercosis causes hydrocephaly, meningitis, cranial nerve damage, seizures, hyperactive reflexes, visual defects. Ocular cysticercosis produces loss of visual accuity and visual field defect.

Back 142

T. solium cyst

Front 143

At 45 feet, this is the largest tapeworm

Back 143

: Diphyllobothrium latum

Front 144

. Vitamin B12 deficiency results from worm's absorption of this nutrient.

Back 144

Diphyllobothrium latum

Front 145

. First symptoms often are from mechanical pressure on organs. usually the liver and lungs. In the liver there is pressure on bile ducts and blood vessels, pain, biliary rupture. In the lungs there is cough, dyspnea, chest pain. Cyst rupture, either from surgery or physical trauma, leads to fever, uticaria, anaphylactic shock, possibly death

Back 145

. Echinococcus granulosus