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466 Cards in this Set
- Front
- Back
Microorganisms associated with birds - Fungi, Bacteria, Viruses
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Fungi:
histo (also with bats) Crypto (pigeons) Bacteria: Chlamydia psittaci (parrots, etc) Viruses: H5N1 - Avian influenzae West Nile Virus |
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Characteristics/mechanism of infection: Giardia lamblia
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owl eyes, four pairs flagella
MC protozoan infection in US. adheres to mucosa, secretes molecules that induce mucosal inflammatory response |
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Sx: Giardia lamblia
Infects whom? |
bloating, flatulence, foul-smelling diarrhea, campers/hikers
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Transmission: Giardia lamblia
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Transmission - cysts in water (beaver fever)
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Dx: Giardia lamblia
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Dx: Trophozoites/cysts in stool
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Tx: Giardia lamblia
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Metronidazole (GET GAP on the Metro)
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Characteristics: Trichomonas vaginalis
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triangular, flagellated
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Sx/Dx: Trichomonas vaginalis
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vaginitis - foul-smelling, greenish discharge, itching and burning.
Strawberry cervix Causes alkaline pH Trophozoites (motile) on wet mount |
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Transmission: Trichomonas vaginalis
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sexual
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Tx: Trichomonas vaginalis
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metronidazole (GET GAP on the Metro)
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Sx: Trypanosoma cruzi
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Chagas' dz. Dilated cardiomyopathy, megacolon, megaesophagus, achalasia, swelling of eye (Romana's sign). 'Makes everything bigger'
Predominantly S. America |
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Transmission: Trypanosoma cruzi
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Reduviid bug (kissing bug). Found in thatched roofs of huts
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Dx: Trypanosoma cruzi
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Blood smear
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Tx: Trypanosoma cruzi
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Nifurtimox
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Characteristics/Sx: Trypanosoma brucei - gambiense and rhodesiense
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west and east African sleeping sickness (slow and fast onset, respectively), enlarged lymph nodes, recurring fever (due to Ag variation), somnolence, coma
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Transmission: Sleeping sickness
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Tsetse fly
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Dx: Sleeping sickness
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Blood smear
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Tx: Sleeping Sickness
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Blood-borne - SURamin + pentamidine
CNS penetration - MELArsoprol 'It SURe is nice to get sleep. MELAtonin helps with sleep' |
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Sx: Leishmania donovani
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Visceral Leishmaniasis (kala-azar) - spiking fevers, HS-megaly, pancytopenia
Cutaneous Leishmaniasis - big pustules on skin |
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Transmission: Leishmania donovani
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Sandfly
Reservoir = dogs |
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Dx: Leishmaniasis
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Macrophages containing amastigotes
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Tx: Leishmaniasis
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Sodium stibogluconate
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Life cycle: Plasmodia
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Sporozoite --> early/late schizonts --> merozoite
Sporozoite - acquired from anopheles mosquito. Early/late - Reproduce intracellularly (hepatocytes + RBCs) Merozoites - cause cell lysis Trophozoites in RBCs look like diamond ring. Falciparum - also has cresent-shaped gametocytes in blood |
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Sx: Plasmodia
Unique characteristics of each? Which are MC? Which lead to relapsing Malaria? |
Malaria - cyclic fever (response to merozoites that rupture out of RBCs), headache, anemia, splenomegaly
Falciparum - severe cerebral malaria P. vivax and P. ovale have dominant forms in liver (hypnozoites) that lead to relapsing malaria Vivax and falciparum are MC forms |
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Tx: Malaria (4 options)
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First choice
1: Chloroquine + primaquine - prevents relapse of vivax/ovale. Also used as prophylaxis If resistant: 2: sulfadoxine + pyrimethamine 3: mefloquine (alone) 4: quinine (not approved for restless leg syndrome) + doxycycline |
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Ixodes tick is involved in the transmission of...
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Babesia and Borrelia burgdorferi (lyme)
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Characteristics: Babesia
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Ixodes carrier, maltese cross and ring forms, NE USA
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Sx: Babesiosis
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Fever, hemolytic anemia
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Dx: Babesiosis
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Blood smear, no RBC pigment, Maltese cross
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Tx: Babesiosis
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Quinine
Clindamycin |
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Cryptosporidium is especially dangerous in whom?
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AIDS patients - causes severe diarrhea. Mild, watery diarrhea in non-IC
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Transmission/Dx/Tx: Cryptosporidium
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Transmission: Cysts in water
Dx: Cysts on acid-fast stain Tx: none needed |
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Characteristics: Toxoplasma gondii
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crescent-shaped, T in ToRCHeS
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Toxoplasma transmission in utero, manifestations (Classic triad)
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Via placenta. 'classic triad' = chorioretinitis, intracranial calcifications, hydrocephalus. May be asymptomatic at birth.
Pregnant women should avoid cats, not change cat litter. |
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ToRCHeS
What else is transmitted via placenta or birth canal? |
transmitted in utero or during vaginal birth:
Toxoplasma gondii Rubella CMV HIV Herpes virus 2 Syphilis Also, Listeria, E. coli and GBS can be acquired placentally or from birth canal, as can GC and Chlamydia |
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Transmission: Toxoplasma gondii
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Cysts in raw meat (e.g. stake tartar) or cat feces. Pregnant women should avoid cats, not change cat litter.
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Sx: Toxoplasma gondii
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Brain abscess (which would cause ring-enhancing lesions) or brain lesions in HIV pts.
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Tx: Toxoplasma gondii
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Sulfadiazine + pyrimethamine
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Sx: Entamoeba histolytica
What bacterium has similar organ effects? |
Amebiasis: bloody diarrhea (dysentery), liver abscess (leptospira also affects liver), RUQ pain
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Transmission: Entamoeba histolytica
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Cysts in water
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Dx: Entamoeba histolytica
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Ingested RBCs in cytoplasm of entamoeba
Serology Trophozoites/cysts in stool |
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Tx: Entamoeba histolytica
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Iodoquinol and metronidazole
GET GAP on the Metro |
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Dysentery
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Amebic - Entamoeba histolytica
Bacterial - Shigella Both have watery diarrhea for few days, followed by severe, potentially life-threatening, potentially bloody diarrhea |
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Sx: Naegleria fowleri
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Rapidly fatal meningoencephalitis
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Transmission: Naegleria fowleri
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Swimming in freshwater lakes - enter via cribriform plate
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Dx: Naegleria fowleri
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Amoebas in CSF
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Nematodes and their routes of infection
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EAT SANd
-Ingested- Enterobius Ascaris Trichinella -Cutaneous (feet)- Strongyloides Ancylostoma Necator Get these from not wearing SHoes: Strongyloides, Hookworms (Ancylostoma/Necator) |
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Enterobius vermicularis
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Pinworm (little white worms)
Food contaminated with eggs (Eat sand) intestinal infection, anal pruritis. Scotch tape test MC helminth in US children |
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Helminth that causes Eosinophilic pneumonitis (Loeffler's Syndrome)
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Ascaris Lumbricoides (giant roundworm)
Eat eggs --> intestinal infection/invasion --> blood --> ALVEOLI --> cough up --> swallow --> excrete in feces |
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Ascaris Lumbricoides
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Giant roundworm
Eat eggs --> intestinal infection/invasion --> blood --> ALVEOLI --> cough up --> swallow --> excrete in feces Causes eosinophilic pneumonitis Eggs visible in feces 1/3 of world infected |
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Tx: Enterobius vermicularis (pinworm) or Ascaris lumbricoides (giant roundworm) or Ancylostoma duodenale or Necator americanus (hookworms)
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Mebendazole (Worms BEND) or pyrantel pamoate
same for all |
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Trichinella spiralis
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undercooked meat, usually pork; inflammation of muscle (larvae encyst in muscle), periorbital edema
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Tx: Trichinella spiralis
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Thiabendazole
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Strongyloides stercoralis
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Larvae penetrate SKIN of feet --> blood --> alveoli --> cough, swallow --> intestinal infection
Causes vomiting, diarrhea, anemia |
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Tx: Strongyloides stercoralis
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Ivermectin
Thiabendazole |
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Ancylostoma duodenale, Necator americanus (hookworms)
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larvae penetrate skin of feet --> intestinal infection --> possibly anemia (suck blood through intestinal walls)
One of MCC of IDA worldwide |
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Nematodes (roundworms)
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Include enterobius, ascaris, trichinella, strongyloides, ancylostoma
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Cestodes (tapeworms)
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Include Taenia, Dipyllobothrium, Echinococcus
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Trematodes (flukes)
Egs. and Tx |
Include Schistosoma, Clonorchis, Paragonimus
All treated with Praziquantel |
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Taenia solium
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Ingestion of encysted larvae from undercooked pork
Egg ingestion --> cysticercosis (larvael form in muscles --> myositis) or neurocystiscercosis (mass lesions in brain, swiss cheese appearance, seizures) |
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Tx: Taenia solium
Intestinal worms/cysticercosis? Neurocysticercosis? |
Cysticercosis - Praziquantel
Neurocysticercosis - Albendazole |
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Diphyllobothrium latum
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larvae in freshwater fish
Causes B12 deficiency, resulting in megaloblastic anemia |
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Tx: Diphyllobothrium latum
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Praziquantel
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Echinococcus granulosus
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Eggs in dog feces (also found in sheep. Both animals in tapeworm life cycle) - ingested - cysts in liver. Causes anaphylaxis if Ags released from cysts
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Tx: Echinococcus granulosus
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Albendazole
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Schistosoma
Hosts/transmission/Dz/course |
Hosts: Freshwater snails
Penetrate skin Cause granulomas, fibrosis, Inflammation of spleen (Splenomegaly), liver (Portal HTN) Swimmer's itch - starts 24 hrs after infection, lasts week Hematuria - #1 in DDx of 3rd world pt. with hematuria |
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Schistosoma haemotobium
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can lead to squamous cell carcinoma of the bladder (MC predisposing factor in 3rd world)
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Schistosoma mansoni epidemiology
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seen in Caribbean/PR
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Tx: Schistosomes
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Praziquantel (as with all Trematodes - flukes)
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Clonorchis sinensis
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undercooked fish, causes inflammation of biliary tract --> pigmented gallstones. Associated with cholangiocarcinoma
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Tx: Pediculosis capitis/pediculosis pubis
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lice - malathion, pyrethrin, permethrine
crabs - pyrimethamine, pyrethrin, malathion Lindane not first line because of neurotoxicity |
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Tx: Roundworms
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Go with a BEND drug
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Brain cysts, seizures (helminth)
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Taenia solium
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Liver cysts (helminth)
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Echinococcus granulosa
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B12 deficiency (helminth)
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Diphyllobothrium latum
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Biliary tract dz. (helminth)
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Clonorchis sinensis
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Helminth that causes Hemoptysis
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Paragonimus westermani (undercooked crab meat, causes inflammation and secondary bacterial infection of lung)
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Portal HTN (helminth)
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Schistosoma mansoni
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Hematuria, bladder cancer (helminth)
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Schistosoma haematobium (3rd world)
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Microcytic anemia (helminths)
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Ancylostoma, Necator
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Perianal pruritis (helminths)
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Enterobius
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Scotch tape test
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Enterobius
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Eosinophilic pneumonitis
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Ascaris lumbricoides
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Myositis, periorbital edema (helminth)
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Trichinella spiralis
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Can't break cysts or will cause anaphylaxis
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Echinococcus granulosus
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Eggs from dog feces
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Echinococcus granulosus
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Snails are host
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Schistosoma
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Splenomegaly and Portal HTN (helminth)
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Schistosoma
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Undercooked fish (helminths)
And diseases |
Clonorchis sinensis (biliary tract, cholangiocarcinoma)
Diphyllobothrium latum (B12 deficiency) |
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Biliary tract inflammation, pigmented gallstones, cholangiocarcinoma association
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Clonorchis sinensis
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Gram+ve
Cocci Catalase+ Coagulase+ |
Staph aureus
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Gram+ve
Cocci Catalase+ Coagulase- Novobiocin sensitive |
Staph epidermidis
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Gram+ve
Cocci Catalase+ Coagulase- Novobiocin resistant |
Staph saprophyticus
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Gram+ve
Cocci Catalase- No hemolysis |
Enterococcus (E. faecalis)
Peptostreptococcus (anaerobe) |
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Gram+ve
Cocci Catalase- alpha (partial - green) hemolysis + Quellung Optochin sensitive, bile soluble |
diplococci
Strep pneumonia |
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Gram+ve
Cocci Catalase- alpha (partial - green) hemolysis - Quellung Optochin resistant bile insoluble |
-Quellung = No capsule
Viridans strep e.g. Strep mutans |
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Gram+ve
Cocci Catalase- beta (complete - clear) hemolysis Bacitracin sensitive |
GABHS Pyogenes
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Gram+ve
Cocci Catalase- beta (complete - clear) hemolysis Bacitracin resistant |
GBS B for Babies
Strep agalactiae |
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Gram+ve
Rods |
Spore-forming
Clostridium (anaerobe), Bacillus Corynebacterium Listeria |
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Gram+ve
Branching filaments |
Nocardia
Actinomyces |
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S. aureus virulence factor
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Protein A
binds Fc-IgG, inhibiting complement/opsonization/phagocytosis |
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TSST
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superantigen in S. aureus
Binds MHC II and T-cell receptor --> polyclonal T-cell activation. Toxin-mediated disease - ingestion of preformed toxins leads to rapid on/off food poisoning (enterotoxins - e.g. mayo that's been sitting out). Also toxin-mediated: scalded skin syndrome |
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Inflammatory disease - skin infections, organ abscesses, pneumonia
(bacterial) |
S. aureus
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Acute bacterial endocarditis, osteomyelitis (bacterial)
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S. aureus (salmonella in SCD pts)
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MRSA resistance
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altered penicillin binding protein
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Staph epidermidis
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Infects prosthetic devices and catheters (insertion can cause bacteremia). Cause of endocarditis (in-dwelling catheter). Contaminates cultures
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Strep pneumoniae
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Strep pneumoniae is Most OPtochin Sensitive. MCC of:
Meningitis Otitis media (children) Pneumonia Sinusitis |
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Encapsulated bacterium, IgA protease
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Strep pneumonia - this is why it infects airways. capsule is primary virulence factor
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Subacute endocarditis
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Strep viridans, Strep epidermiditis, Enterococci
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Mastitis
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Staph aureus - continued milk movement necessary to clear infection - not harmful to baby
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Rusty sputum
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Strep pneumonia
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Sepsis in SCD/splenectomy pts.
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Strep pneumonia
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Normal flora of mouth.
E.g. that cause dental caries. E.g. that cause endocarditis (when...) |
Strep viridans. Sanguis - causes endocarditis (if turbulent heart flow problem exists - requires prophylaxis). Mutans - dental caries.
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Protein in S. pyogenes that causes autoimmune problems
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M Protein (helps evade immune response)--> rheumatic fever
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Detection of recent strep pyogenes infection
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ASO titer detects recent strep pyogenes infection
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Strep Pyogenes infections
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Pyogenic - pharyngitis (don't have to treat in adults), cellulitis, impetigo
Toxigenic - scarlet fever, TSS Immunologic - rheumatic fever, acute glomerulonepritis Subcutaneous nodules Polyarthritis Erythema marginatum Chorea (Sydenham's) Carditis |
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Able to hide within blood clots before re-emerging and infecting
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S. aureus
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Cause skin infections: folliculitis, cellulitis, impetigo
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S. aureus
S. pyogenes |
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Exotoxins - S. aureus
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alpha toxin - hemolysis
beta toxin - sphingomyelinase Proteins A, B and C of gamma toxin - hemolysin and leukocidin These give it ability to hide within blood clots, hiding from immune system before re-emerging and infecting Enterotoxins A-E - food poisoning TSST-1 - TSS (fever, rash, shock) Epidormolytic/exfoliative toxins - Scalded skin syndrome |
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Toxins - S. pyogenes
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Streptolysin O/S - hemolysis
Erythrogenic/Pyrogenic - Skin rash (sandpaper-like)/fever of scarlet fever |
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Diptheria toxin
Similar to? Does what? |
Inactivates EF-2
Lethal - interferes with protein synthesis in heart/nerve cells Similar to Pseudomonas exotoxin A |
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Vibrio cholerae exotoxin
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ADP ribosylation of Gs --> stimulates adenylyl cyclase --> increased pumping of Cl into gut, decreased Na absorption. Water follows.
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cAMP inducing toxins
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Cholera (E. coli labile toxin pretty much same thing) turns the 'on' on (Gs)
Anthrax toxins includes edema factor, a bacterial adenylate cyclase, as is Pertussis toxin --> increased cAMP (note: cholera, E. coli ADP ribosylate to increase cAMP, while anthrax edema factor and pertussis toxins are adenylate cyclases) |
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Clostridium perfringens toxin
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alpha toxin
gas gangrene double zone of hemolysis on blood agar |
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C. tetani toxin
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blocks release of GABA and gly
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C. botulinum toxin
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blocks Ach release, causing anticholinergic Sx (dry as a bone, hot as a hare...), CNS paralysis. Can't give honey to <1yr baby.
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Shiga toxin
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also produced by O157:H7
cleaves host cell rRNA (inactivates 60S ribosome) Enhances cytokine release, causing HUS |
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O157:H7 toxin is like which other toxin? What does it do?
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Same as shiga toxin
cleaves host cell rRNA (inactivates 60S ribosome) Enhances cytokine release, causing HUS |
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E. coli Heat Labile/Stable toxin
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Labile/Stable - stimulate Adenylate/Guanylate cyclase, both causing watery diarrhea.
Labile like Air, stable like Ground |
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Pertussis toxin
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Increases cAMP b/c toxin is an adenylate cyclase, causes whooping cough. Inhibits chemokine receptor, causing lymphocytosis
|
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Bacteria that secrete enterotoxins
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Staph aureus, E. coli, Vibrio cholerae, Salmonella/Shigella
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Obligate intracellular bacteria
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Rickettsiae, Chlamydia - can't make own ATP
'stay inside because it is Really Cold' Legionella also hard to stain because often inside cells. |
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Gram stain limitations
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Treponema (too thin - dark field, fluorescent Ab)
Ricketssia (intracellular) Mycobacteria (high-lipid content cell wall - acid fast stain - mycolic acid) Mycoplasma - no cell wall Legionella (primarily intracellular - silver stain) Chlamydia (intracellular - lacks muramic acid in cell wall) |
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Giemsa stain
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Borrelia, Plasmodium, trypanosomes, Chlamydia
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PAS (periodic acid-Schiff)
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stains glycogen, mucopolysaccharides, used to Dx Whipple's dz.
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Ziehl-Neelson
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Acid-fast bacteria
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India ink
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Cryptococcus
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Silver stain
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Fungi, Legionella, Pneumocystis
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Chocolate agar w/ factors V (NAD) and X (hematin)
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H. influenzae
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Thayer-Martin media
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N. gonorrhoeae
|
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Lowenstein's-Jensen agar
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M. tb - takes 2 weeks. Do acid-fast stain and start treating
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Eaton's agar
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M. pneumoniae
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Pink Colonies on MacConkey's agar
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Lactose-fermenting enterics.
Has bile salts, crystal violet to inhibit gram+ves. Lactose + neutral red taken up --> pink. If don't take up lactose, white colonies. |
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Pigment producing bacteria
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S. aureus - yellow
Pseudomonas - blue-green Serratia marcescens - red (maraschino cherries) |
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IgA protease in bacteria
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S. pneumoniae, H. influenzae, Neisseria
All these cause meningitis Give Pneumovax to all pts. >65, asplenic, resp. dz. (e.g. asthma), HIV+ IgA protease cleaves IgA dimer, allowing mucosal binding and penetration |
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Endotoxin
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Gram-ve cell wall comonent - LPS. heat stable
Lipid A especially causes downstream effects (shock, DIC, edema, fever) |
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Strep agalactiae
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GBS
Pneumonia, meningitis, sepsis (all mainly in babies) 25% of women have as normal vaginal flora. Prophylaxis during labor if + |
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DDx: Neonatal sepsis/meningitis
|
GBS, listeria, E. coli
|
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Lancefield groups (Strep)
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based on differences in C carbohydrate on bacterial cell walls
|
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Enterococci
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gram+ve bacteria (vs. Enterobacter - gram-ve)
Include E faecalis and E. faecium PCN G resistant, cause UTI and subacute endocarditis Can grow in 6.5% NaCl Include VRE - nosocomial infections Group D (along with non-enterococcal group D strep, e.g. bovis) |
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Strep bovis
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non-enterococcal Group D strep
Highly assoc. with colon cancer |
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Diphtheria
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Corynebacterium diphtheriae
Exotoxin - inhibits protein synthesis via ADP ribosylation of EF-2 Pseudomembranous pharyngitis with lymphadenopathy Gram+ve rods with metachromatic granules |
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Diphtheria ABCDEFG
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ADP ribosylation
Beta-prophage (encodes toxin) Corynebacterium Diptheriae Elongation Factor 2 Granules |
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Tx: Diphtheria
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antitoxin, PCN + vaccination
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Spore formation
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Only certain gram+ve rods
When nutrients are limited (at end of stationary phase) Highly resistant to destruction by heat/chemicals Have dipicolinic acid in core No metabolic activity Must autoclave to kill Prevalent in people who work with soil |
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Spore former e.g.s (and sources)
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Bunch of Cs and Bs
Soil: Clostridium perfringens Clostridium tetani Bacillus anthracis B. cereus (reheated rice) C. botulinum (honey, canned food) Coxiella burnetii |
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Obligate aerobe
|
Nocardia, Pseudomonas aeruginosa, Mycobacterium tb, Bacillus
|
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Pseudomonas aeruginosa seen in which infections?
|
burn wounds, nosocomial pneumonia, pneumonias in CF pts., hot tub folliculitis
|
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Obligate anaerobes
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Clostridium, Bacteroides, Actinomyces
Lack catalase and/or SOD Foul-smelling (short-chain fatty acids), difficult to culture, produce gas (CO2 adn H2) Normal flora of GI |
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What can't you treat Obligate anaerobes with?
|
Can't treat with aminO2glycosides because they need O2 to get into bacteria
|
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Quellung reaction
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Positive in encapsulated bacteria - capsule swells when anti-capsular antisera added
|
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Bacterial capsules
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Capsule is antiphagocytic virulence factor
Serves as Ag in vaccines - Pneumovax, HiB, meningococcal vaccines. Conjugation with protein increases immuno response and T-cell dependent response |
|
Encapsulated bacteria
|
Strep pneumonia
Klebsiella pneumonia H. influenzae (esp. B serotype) Neisseria meningitidis Susceptibility in asplenic pts and in C3 deficiency |
|
Urease-positive bacteria
|
UTI-causers:
Proteus mirabilis Klebsiella pneumoniae Ureaplasma H. Pylori |
|
Lysogeny
Genes for these 5 bacterial toxins encoded in a lysogenic phage |
ABCDE
shigA-like toxin Botulinum toxin (certain strains) Cholera Diphtheria Erythrogenic toxin of S. pyogenes |
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Tetanus
|
Clostridium tetani (tennis-racket shaped)
Blocks GABA release and also gly rlelease from Renshaw cells in SC. can infect neonates via colonization of umbilical stump, though vaccination of mother is protective via IgG |
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Botulinum toxin acts where, does what?
|
inhibits Ach release - flaccid paralysis
|
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C. perfringens toxin
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lecithinase - can cause myonecrosis (gas gangrene) and hemolysis
|
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C. difficile toxin
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Enterotoxin - causes diarrhea by acting as chemoattractant for neutrophils, which release cytokines leading to mucosal inflammation and GI fluid loss
cytotoxin - exotoxin that kills enterocytes by depolymerizing actin filaments, causing cell death, followed by pseudomembranous colitis Dx - C-dif toxin in stool |
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Tx: C. dif
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Metronidazole or
Vancomycin |
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Anthrax
|
obligate aerobe
B. anthracis only bacterium with protein capsule (contains D-glutamate) |
|
Malignant pustule (painless ulcer)
can progress to bacteremia and death |
Contact anthrax infection
Black skin lesions - vesicular papules covered by black eschar |
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Wool sorter's disease - inhalation of spores from contaminated wool
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Inhaled anthrax infection
flu-like symptoms that rapidly progress to fever, pulmonary hemorrhage, mediastinitis, shock. |
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Acquired by ingestion of unpasteurized milk/cheese and deli meats or by vaginal transmission during birth
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Listeria monocytogenes
|
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Form 'actin rockets' by which they move from cell to cell
|
Listeria monocytogenes
|
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Only gram+ve with endotoxin
|
Listeria monocytogenes
|
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Tumbling motility
|
Listeria monocytogenes
|
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Dz: Listeria monocytogenes
|
Can cause amnionitis, septicemia, spontaneous abortion in pregnancy
Granulomatosis infantiseptica, neonatal meningitis, meningitis in IC pts., mild gastroenteritis in healthy pts. |
|
Actinomyces vs. Nocardia
Shared characteristics |
Both gram+ve rods forming long branching filaments resembling fungi
|
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Actinomyces vs. Nocardia
|
A. israelii - oral/facial abscesses that may drain through sinus tracts (with yellow 'sulfur granules') in skin
Nocardia asteroides - weakly acid-fast aerobe in soil, causes pulmonary infection in IC pts. |
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Tx: Actinomyces vs. Nocardia
|
SNAP:
Sulfa for Nocardia Actinomyces use Penicillin |
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Primary Tb
|
Nonimmune host (usually child) gets it --> Ghon focus (Tb granulomas - usually lower lobes). + hilar nodes = Ghon complex
|
|
Primary Tb possible effects
|
heals by fibrosis --> immunity and HPY --> Tb+
progressive lung dz. (HIV/malnutrition) --> death (rare) Severe bacteremia --> miliary Tb --> death Preallergic lymphatic or hema- dissemination --> dormant Tb bacilli in several organs --> reactivation in adult life |
|
Secondary Tb
|
Reinfection (partially immune hypersensitized host, usually host) or reactivation
Fibrocaseous cavitary lesion, usually upper lobes |
|
Extrapulmonary Tb infects what, causing what?
|
CNS (parenchymal tuberculoma or meningitis)
Vertebral body (Pott's dz) Lymphadenitis Renal GI |
|
Meaning of PPD+
|
current infection, past exposure, BCG vaccinated
|
|
Meaning of PPD-
|
no infection or
Anergic (steroids, malnutrition, IC, sarcoidosis, elderly) |
|
Mycobacterium infection
|
all acid-fast
IL-12 receptor deficiency predisposes Don't pick up gram stain Lowenstein-Jensen culture for Tb, but takes two weeks, so do acid stain and don't wait for culture to start prophylaxis |
|
Sx: M. kansasii
|
pulmonary Tb-like Sx
|
|
M. avium-intracellulare
|
often resistant to multiple drugs, causes disseminated disease in AIDS
AIDS-defining |
|
MAI Prophylaxis
|
CD4 < 100 : azithromycin
CD4 < 75 : clarithromycin |
|
M. marinium
|
mycobacterium
skin infections associated with aquatic activities, even from changing aquarium with a cut. Can even cause septic arthritis and osteomyelitis |
|
M. leprae
What kind? Gram stain? What dz? Mechanism of disease? |
Mycobacterium
Doesn't gram stain Leprosy (Hansen's disease) Infects skin and superficial nerves --> nerve death --> unnoticed injuries --> appendage loss |
|
Armadillo reservoir
|
Hansen's disease
also in foot pads of mice |
|
Mycobacterium leprae characteristics
|
acid-fast bacillus that likes cool temperatures (infects skin, superficial nerves [Schwann Cells]), cannot be grown in vitro
|
|
Loss of eyebrows, nasal collapse, Lumpy earlobe, leonine facies, cutaneous hypopigmentation in plaques (often accompanied by hair loss)
|
lepromatous leprosy
|
|
Nasal collapse/deformity
|
Leprosy
Syphilis (saddle nose deformity) FAS (short, upturned nose with loss of bridge) Yaws (treponema pertenue) - destruction of nasal bone and cartilage after five years |
|
Lepromatous leprosy
|
worse of two types. Failed cell-mediated immunity. Lethal.
Loss of eyebrows, nasal collapse, Lumpy earlobe, leonine facies |
|
Tuberculoid leprosy
|
self-limited
|
|
Tx (primary): Leprosy
|
Long-term dapsone
6 mos - 2 years Toxicity - hemolysis, methemoglobinemia |
|
Tx (alternative): Leprosy
|
Rifampin
Clofazimine/Dapsone combination |
|
Gram-ve (pink)
cocci glu- |
Moraxella catarrhalis (ear infections)
|
|
gram-ve (pink)
cocci glu+ maltose fermenter |
N. meningitidis
|
|
gram-ve (pink)
cocci glu+ maltose non-fermenter |
N. gonorrhoeae
|
|
gram-ve (pink)
coccoid rods |
Haemophilus influenzae
Pasteurella (animal bites) Brucella Bordetella pertussis |
|
gram-ve (pink)
Rods Lac+ (pink on MacConkey) Fast fermenting |
Klebsiella
E. coli Enterobacter |
|
gram-ve (pink)
Rods Lac+ (pink on MacConkey) Slow fermenting |
Citrobacter
Serratia Others |
|
gram-ve (pink)
Rods Lac- (White on MacConkey) Oxidase- |
Shigella
Salmonella Proteus |
|
gram-ve (pink)
Rods Lac- (White on MacConkey) Oxidase+ |
Pseudomonas
likes air, obligate aerobe |
|
Gram-ve bacteria and PCN
|
gram-ves resistant to PCN G and Vanco (outer membrane layer inhibits entry), but may be susceptible to PCN derivates (e.g. ampicillin)
|
|
Neisseria infections
|
absence of MAC (C6,7,8) = prone to these infections
Both glu+, IgA protease producers, gram-ve diplococci |
|
N. gonorrhoeae
|
No polysaccharide capsule
Maltose- No vaccine or lasting immunity because of frequent Ag variation STI Causes gonorrhea (all these also caused by chlamydia): septic arthritis, neonatal conjunctivitis, PID (ascending infection. urethritis --> cervicitis --> endometritis --> sapingitis --> liver capsule (Fitz-hugh Curtis Syndrome). Epididymitis in males |
|
N. meningococci
|
Polysaccharide capsule
Maltose- Vaccine Respiratory and oral secretions Causes meningococcemia and meningitis, Waterhouse-Friderichsen syndrome (adrenal hemorrhage, shock, sepsis, adrenocortical insufficiency) |
|
Haemophilus influenzae
|
Epiglottitis, meningitis, otitis media, pneumonia
Small gram-ve (coccobacillary) rod Aerosol transmission Most invasive dz. caused by B capsule IgA protease |
|
Epiglottitis - 2-7 y/o, pharyngitis, drooling, sniffing dog position (to extend airway), omega sign (swollen epiglottis) on laryngoscopy
|
Haemophilus influenzae
|
|
Tx: Haemophilus influenzae meningitis
|
ceftriaxone
(same for GC meningitis) |
|
Haemophilus influenzae prophylaxis
|
Rifampin - for close contacts
|
|
HiB vaccine
|
capsular polyribosyl-ribitol-phosphate (PRP) polysaccharide conjugated to Diphtheria toxoid or other protein to improve immune system recognition and promote class-switching
Given between 2-18 months |
|
Legionella pneumophila - dz.
|
Legionnaire's disease - severe pneumonia. Pontiac disease - mild influenza
Dx: Urinary Ag test Atypical pneumonia. Sx not as bad as CXR implies |
|
Aerosol transmission from environmental water source habitat, no person-to-person transmission
|
Legionella pneumophila
|
|
Atypical pneumonia
|
Sx not as bad as CXR implies
Treat all with macrolides - azithro/erythromycin |
|
Charcoal yeast extract with iron and cysteine
|
Legionella pneumophila culture
|
|
Infects CF pts, IC pts, ventilator (ICU) pts
|
Pseudomonas aeruginosa
|
|
Pseudomonas aeruginosa dz.
|
burn victims, UTIs, sepsis (black lesions) with high mortality, endocarditis (IVDA), corneal infections (contact lens wearers), diabetic osteomyelitis, hot tub folliculitis. water source. endotoxin (fever, shock), exotoxin A (inactivates EF-2)
|
|
Pseudomonas aeruginosa characteristics
|
obligate aerobe, blue-green pigment (pyocyanin), gram-ve rod, lac-, oxidase+, grapelike odor
|
|
Tx: Pseudomonas aeruginosa
|
aminO2glycoside plus extended spectrum penicillin (e.g. piperacillin, ticarcillin) to avoid high mortality sepsis
|
|
Enterobacteraciae family
|
E. coli, Salmonella, Shigella, Klebsiella, Enterobacter, Serratia, Proteus
All have somatic O Ag (polysaccharide of endotoxin), capsular (K) Ag related to virulence, flagellar (H) Ag in motile species. All glu+ and Oxidase- |
|
Tx: Enterobacteriaciae
|
meropenem or
imepenem with cilastatin |
|
Tx: Enterobacteriaciae
|
meropenem or
imepenem with cilastatin |
|
Klebsiella
|
Aspiration pneumonia in diabetics, alcoholics, Red currant jelly sputum, mucoid sputum, nosocomial UTIs
Upper lung cavitations |
|
Salmonella and Shigella:
Characteristics Pathology |
Both lac-, invade intestinal mucosa and can cause bloody diarrhea. Both never normal flora, always pathogenic.
|
|
Salmonella vs. Shigella
|
Salmonella have flagella, disseminate hematogenously, produce H2S, Sx may be prolonged by AB Tx. Typically monocytic response.
Shigella more virulent (10 vs. 100,000 organisms). Immotile, but can propel selves within cell with actin polymerization |
|
Shigella
|
bacterial dysentery - watery diarrhea for 1-2 days, then gets painful, bloody and mucusy with wall invasion. Invade by entering M cells of Peyer's patches, escape phagosome, spread laterally to other epithelial cells, release shiga-toxin, a subunit of which inhibits 60S, blocking protein production and leading to cell death.
|
|
Shigella flexneri
|
Reiter's syndrome - can't see, can't pee, can't climb a tree
|
|
Salmonella enteritidis
|
MCC of food associated diarrhea in developed countries - poultry, eggs, AB Tx can prolong carrier state
|
|
Salmonella Typhi
|
typhoid fever - fever, diarrhea, headache, rose spots on abdomen, can remain in gallbladder chronicaly. Mimics appendicitis because of abdominal pain and fever
|
|
Yersinia enterocolitica
|
Usually transmitted from pet feces (e.g. puppies), contaminated milk or pork. Outbreaks in day-care centers. Mimics Crohn's or appendicitis
|
|
H. pylori characteristics
|
gram-ve rod, urease+ (thus urease breath test)
|
|
Tx: H. pylori
|
Triple therapy
1. bismuth, metronidazole and either tetracyclin or amoxicillin 2. (more costly) metronidazole, omeprazole, clarithromycin |
|
Animal associated bacteria:
Cat Scratch Dz. - cat/dog bites - cat feces - Animal urine - Rat bites - |
Cat Scratch Dz. - Bartonella henselae
cat/dog bites - Pasteurella multocida cat feces - Toxoplasma Animal urine - Leptospira Rat bites - Spirillum minus |
|
Spirochetes characteristics, examples, visualization
|
spiral shaped with axial filaments
Borellia (big) - light microscopy Leptospira Treponema - dark field |
|
E. coli is the MCC of what?
|
diarrhea, UTI, neonatal meningitis/sepsis/pneumonia
|
|
ETEC
|
enteroToxogenic E. coli - Traveler's diarrhea.
Similar to cholera - rice-water diarrhea, no invasion, no bloody diarrhea, no fever Tx: TMP-SMX or fluoroquinolones |
|
Tx: ETEC
|
TMP-SMX or fluoroquinolones
|
|
EHEC
|
enteroHemorrhagic E. coli - hamburgers. O157:H7
HUS - hemolytic anemia, uremia, thrombocytopenia |
|
MCC septic arthritis in young sexually active pts
Opthalmia in neonates (vertical transmission via delivery) - sticky eye discharge - can cause blindness |
N. gonorrhoeae
|
|
EPEC
|
enteroPathogenic E. coli - similar to shigella - bloody diarrhea
|
|
EIEC
|
enteroInvasive E. coli - intestinal wall invasion, fever, bloody diarrhea
|
|
Bacteroides fragilis
|
most abundant organism in LI. Peritoneal abscess in trauma, surgery, appendix perforation
|
|
UTI causers/Tx
|
E. coli
Klebsiella pneumoniae Proteus mirabilis Staph saprophyticus S. aureus/Pseudomonas if nosocomial Tx - TMP-SMX, 1st gen Ceph, aminopenicillins (these two good in pregnancy, NOT TMP-SMX because of DNA synthesis), nitrofurantoin |
|
Tx: UTI
|
TMP-SMX, 1st gen Ceph, aminopenicillins (these two good in pregnancy, NOT TMP-SMX because of DNA synthesis), nitrofurantoin
|
|
Proteus mirabilis
|
enterobacter
very motile, can't grow in agar, UTI, urease+, staghorn renal calculi |
|
Leptospira interrogans
|
interrogans = question mark shape
Water contaminated with animal urine Flu-like Sx, fever, headache, abdominal pain, JAUNDICE, prevalent in tropics |
|
Weil's dz.
|
icterohemorrhagic leptospirosis - severe form with jaundice and azotemia from liver and kidney dysfunction. fever, hemorrhage, anemia
|
|
Lyme dz. - Reservoirs, carriers
|
transmitted by Ixodes tick, mice reservoirs, deer required for tick life cycle
|
|
Lyme dz. classic Sx
|
erythema chronicum migrans, also affects joints, CNS, heart
Also: Bell's palsy (bilateral), Arthritis, cardiac block |
|
Lyme dz stages
|
1 - erythema chronicum migrans, flu-like Sx
2 - neurologic and cardiac manifestations 3 - chronic monoarthritis, migratory polyarthritis |
|
Tx: Lyme
|
doxycycline
|
|
Tx: Lyme
|
doxycycline
|
|
Treponemes
Disease, manifestations, transmission, epidemiology, serology of less common one |
T. pallidum - syphilis
T. pertenue - yaws - infection of skin, bone, joints --> healing with keloids --> severe limb deformities. Dz. of tropics. Not STD (but VDRL positive) Destruction of nasal bone + cartilage if untreated for 5+ years |
|
Primary syphilis
|
painless chancre (with many treponemes inside) - localized dz.
|
|
Secondary syphilis
|
Systemic dz. with constitutional Sx, maculopapular rash (palms and soles), condyloma lata. Treponemes present in condyloma. Alopecia ariata (bald patches on scalp)
|
|
Tertiary Syphilis
|
Gummas (chronic granulomas), aortitis (vasa vasorum destruction), neurosyphilis (tabes dorsalis - dorsal columns lost --> sensory deficit (proprioception) --> locomotor ataxia), Argyll Robertson pupil
|
|
Sx: broad-based ataxia, positive Romberg, Charcot joints, stroke without HTN
|
Tertiary Syphilis
|
|
Argyll Robertson Pupil
|
Accommodates but doesn't react - tertiary syphilis
|
|
FTA/VDRL
|
FTA more specific, earliest positive, remains positive longer (even after treatment)
|
|
VDRL false positives
|
Dx syphilis
False positives - SLE, viral infection (mono, hepatitis), some drugs, rheumatic fever, leprosy VDRL: Viruses, Drugs, Rheumatic fever, Lupus/Leprosy |
|
Bacteria - dairy products, contact with animals
|
Brucella spp. - brucellosis - undulant fever (Unpasteurized dairy gives Undulating fever)
|
|
Tick bite, RABBITS, deer
|
Francisella tularensis
|
|
Flea bite, rodents, especially prairie dogs
|
Yersinia pestis - plague
|
|
Gardnerella vaginalis
|
pleomorphic, gram-variable rod
Vaginosis - off-white/gray vaginal discharge, fishy smell on KOH prep, nonpainful (Mobiluncus, an anaerobe, also involved) Sexual activity not necessary for transmission Clue cells |
|
Tx: Gardnerella vaginalis
|
metronidazole (GET GAP on the metro)
|
|
Rickettsiae general characteristics, classic symptoms
|
obligate intracellular that need CoA and NAD. All but Coxiella transmitted by arthropod vector and cause Headache, Fever, Rash (classic triad)
|
|
Why is Q fever strange?
|
no rash, no vector, negative Weil-Felix (for Rickettsiae), spore former that can survive for long time outside host, doesn't have Rickettsia as genus name (Coxiella burnetii), causes pneumonia
Inhaled aerosol, interstitial pneumonia seen in farmers |
|
Tx: Rickettsial organisms
|
Tetracycline
|
|
Rash: Rickettsia vs. Typhus
|
Rickettsia starts on wRists then to trunk
Typhus on Trunk, then spreads out |
|
Rocky Mountain Spotted Fever
|
Rickettsia rickettsii
Classic triad: Headache, fever, rash on palms/soles --> wrists, ankles --> trunk Endemic to EAST coast |
|
DDx: Rash on palms and soles
|
Coxsackie A
Rocky mountain spotted fever Syphilis (secondary) You use your palms and soles when you drive CARS |
|
Desquamation of palms/soles
|
Kawasaki Dz., Hg poisoning, Rocky Mt. Spotted Fever
|
|
Weil-Felix reaction
|
antirickettsial Ab, which cross-react with Proteus Ag. Positive for typhus, Rocky Mt. Spotted Fever, negative for Q fever
|
|
Chlamydiae forms
|
Elementary bodies Enter via Endocytosis
Reticulate body Replicates in cell by fission, reorganize into (smaller) elementary bodies |
|
Chlamydiae characteristics
|
cell wall lacks muranic acid, can't make ATP (obligate intracellular), causes mucosal infections
|
|
Chlamydia trachomatis
|
reactive arthritis, conjunctivitis, nongonococcal urethritis, PID
|
|
C. psittaci/pneumoniae
|
cause atypical pneumonia, transmitted via aerosol
Psittaci has avian reservoir |
|
Dx: Chlamidiae
|
cytoplasmic inclusions seen on Giemsa or fluorescent Ab-stained smear
|
|
Tx: Chlamidiae
|
erythromycin or tetracycline
|
|
Chlamydia trachomatis serotypes
ABC D-K L1/2/3 |
ABC - chronic eye infection (trachoma), cause blindness in Africa
D-K - Urethritis/PID, ectopic pregnancy, neonatal pneumonia, neonatal conjunctivitis L1/2/3 - lymphogranuloma venereum (acute lymphadenitis). Primary ulcers, then 6-8 weeks later, get lymphadenopathy, later get bad rectal dz that can be mistaken for UC ABC - Africa/Blindness/Chronic infection L - lymphogranuloma venereum D-K - everything else |
|
Mycoplasma pneumoniae
|
classic cause of 'walking' pneumonia (insidious onset, headache, nonproductive cough, diffuse interstitial infiltrate
High titer of cold agglutinins (IgM) Grown on Eaton's agar No cell wall, not gram stained Only bacterial membrane with cholesterol More common in pts <30 Outbreaks in military recruits, prisons |
|
Block cell wall synthesis by inhibition of peptidoglycan cross-linking
|
Penicillin, ampicillin, ticarcillin, piperacillin, imipenem, aztreonam, cephalosporins
|
|
Dz: HSV-1
|
gingivostomatitis, keratoconjunctivitis, temporal lobe encephalitis (MCC sporadic encephalitis in US), herpes labialis
|
|
Transmission: HSV-1
|
respiratory secretions, saliva
|
|
HSV-1 hides in?
|
Trigeminal ganglion
|
|
Dz: HSV-2
Outbreak occurrence/frequency? |
multiple ulcers in genital region. Most outbreaks in first year, usually decreased outbreaks over time. Also neonatal herpes
|
|
Transmission: HSV-2
|
Sexual contact, perinatal
|
|
HSV-2 hides in?
|
S2-S3 ganglia
|
|
Dz: VZV
|
aka HHV 3
Shingles, Chicken pox (different aged lesions at same time), encephalitis + pneumonia (especially when adults get for first time) |
|
Transmission: VZV
|
respiratory secretions
|
|
VZV remains dormant in?
|
DRG and trigeminal
|
|
Dz: EBV
|
aka HHV 4
Infectious mononucleosis, Burkitt's lymphoma, Hodgkin's lymphoma, nasopharyngeal carcinoma, CNS lymphoma in IC pts |
|
Virus causing fever, fatigue, hepatosplenomegaly, pharyngitis, lymphadenopathy (especially posterior cervical nodes)
|
EBV - peak incidence 15-20 years.
|
|
Virus causing abnormal CD8 cells with foamy/downy appearance in circulation, hairy oral leukoplakia
|
EBV
|
|
Very high fevers (102-104) in infant with no other signs, when fever breaks, rash breaks out, lasting a few hours
|
HHV 6 - Roseola infantum. Rash over whole body
|
|
HHV 7 associated with?
|
Monkey bites
|
|
Dx: EBV
|
Positive monospot test - heterophil antibodies detected by agglutination of sheep RBCs
|
|
E.g.s of heterophile- mononucleosis
|
CMV, Listeria, toxoplasma
|
|
Dx: HSV-1/2, VZV
|
Tzanck test - smear of opened skin vesicle to detect multinucleated giant cells. Also intranuclear Cowdry A inclusions
|
|
Dz: CMV
|
congenital infection (TORCH), mononucleosis (negative monospot), pneumonia.
|
|
Dx: virus causing Owl's eye appearance
|
CMV due to intranuclear Cowdry A inclusions
|
|
Transmission: CMV
|
Congenital, transfusion, sexual contact, saliva, urine, transplant
|
|
Dz: HAV
Incubation period? Who's susceptible? Carrier state? |
acute: short incubation (3 weeks), jaundice, liver dz.
Alcoholics, IVDA, HepB/C pts all susceptible and should be vaccinated. No carriers Usually asymptomatic |
|
Transmission: HAV
|
fecal-oral route
|
|
Infective agent: HAV
|
RNA Picornavirus - pico = small
|
|
Dz: HBV
|
long incubation (3 months).
Carrier state Vaccine Chronic, cirrhosis Hepatocellular carcinoma association. Incorporates its DNA into hepatocytes. Have to monitor alpha-fetoprotein levels. |
|
Transmission: HBV
|
parenteral, sexual, maternal-fetal
|
|
Infective agent: HBV
|
DNA hepadnavirus - hepa + dna + virus
cellular RNA polymerase transcribes RNA from DNA template. Reverse transcriptase transcribes DNA from RNA intermediate. However, virion enzyme is a DNA-dependent DNA polymerase |
|
Dz: HCV
|
Mostly same clinical presentation as HBV, but no vaccine
Chronic, cirrhosis, carcinoma, carriers Hepatocellular carcinoma association. Have to monitor alpha-fetoprotein levels. |
|
Transmission: HCV
|
primarily blood (not sexual). Common cause of post-transfusion hepatitis and hepatitis of IVDA in US
|
|
Infective agent: HCV
|
RNA flavivirus
|
|
Dz: HDV
|
Defective virus Dependent on HBVsAg as envelope. Can coinfect or superinfect (worse Px)
|
|
Infective agent: HDV
|
RNA deltavirus
|
|
Dz: HEV
|
Resembles HAV in course, severity, incubation. High mortality rate in pregnant women
|
|
Transmission: HEV
|
transmitted enterically and causes water-borne epidemics
|
|
Infective agent: HEV
|
RNA hepevirus = hepatitis + E + virus
|
|
Significance of serological marker:
IgG HAVAb |
Indicates prior infection; protective against reinfection
|
|
Significance of serological marker:
IgM HAVAb |
IgM Ab to HAV - best test to detect ACTIVE HepA
|
|
Significance of serological marker:
HBsAg |
Active disease
|
|
Significance of serological marker:
HBsAb |
recovery from exposure, including vaccination. Provides immunity
|
|
HBcAg
|
New disease
|
|
HBcAb
significance of positive titer |
Hx of dz - have recovered or still have it. Not seen in vaccinated patients. Positive during window period. IgM = recent disease. IgG = chronic disease
|
|
Significance of serological marker:
HBeAg |
Pt. is contagious
Indicator of active viral replication |
|
Significance of serological marker:
HBeAb |
Pt. not very contagious
|
|
Serological test results in HBV
Acute disease HBsAg: HBsAb: HBcAb: |
Serological test results in HBV
Acute disease HBsAg: + HBsAb: - HBcAb: - HBsAb: IgM in acute stage, IgG in chronic or recovered stage |
|
Serological test results in HBV
Window Phase HBsAg: HBsAb: HBcAb: |
Serological test results in HBV
Window Phase HBsAg: - HBsAb: - HBcAb: + Pt. has HBsAb, but it is bound to HBsAg and not detected |
|
Serological test results in HBV
Complete recovery HBsAg: HBsAb: HBcAb: |
Serological test results in HBV
Complete recovery HBsAg: - HBsAb: + HBcAb: + |
|
Serological test results in HBV
Chronic Carrier HBsAg: HBsAb: HBcAb: |
Serological test results in HBV
Chronic Carrier HBsAg: + HBsAb: - HBcAb: + |
|
Serological test results in HBV
Immunized HBsAg: HBsAb: HBcAb: |
Serological test results in HBV
Immunized HBsAg: - HBsAb: + HBcAb: - |
|
DNA virus characteristics and exceptions
|
HHAPPPP (Hepadna, Adeno, Pox, Parvo, Papilloma, Polyoma
DS (except parvo - SS) Linear (except papilloma/Polyoma (circular, supercoiled) and hepadna (circular, incomplete)) Icosahedral (except pox - complex) Replicate in nucleus (except popx - carries own DNA-dependent RNA polymerase) |
|
Adenovirus
|
DNA, constellation - combination of some of following:
Febrile pharyngitis - sore throat Pneumonia Conjunctivitis (pink eye) Gastroenteritis |
|
Parvovirus
|
ONLY SS DNA virus
B19 virus - aplastic crises in SCD pts. Prodromal febrile URI in child, followed by sudden onset 7-10 days later of 'slapped cheek' rash (ERYTHema infectiosum - 5th Dz [think slapped cheek - CN V]) - targets ERYTHROID precursors, replicates in BM, hydrops fetalis - O (other) in TORCH |
|
Papillomavirus
DNA/RNA? Causes what diseases? What strains cause cancer? |
DNA
HPV - warts (different strains cause warts + cancer), CIN (which can lead to cervical cancer), VIN (which can lead to vulvar cancer), cancer of penis. Cancer associated - HPV 16, 18 |
|
Polyomavirus
|
DNA
JC virus - progressive multifocal leukoencephalopathy (PML) in HIV |
|
Poxvirus
|
DNA
Smallpox - germ warfare Vaccinia - cowpox - infected cow udders Molluscum contagiosum - raised lesions with central pit. Very common vaginally. Can be transmitted vertically to infant. No clinical problems, can freeze off, but resolves spontaneously in few years. |
|
Reoviruses
|
ONLY DS RNA viruses
Reovirus - Colorado Tick Virus Rotavirus |
|
Dz: Rotavirus
Infects whom/when/what settings/course/mechanism? Histological presentation? |
MCC fatal diarrhea in children
acute diarrhea in children in winter months, especially in day care centers, KG Villous destruction with atrophy leads to decreased absorption of Na and water 1-2 week, green foul-smelling diarrhea |
|
Picornaviruses
|
RNA
PERCH on a 'peak' (pico) Polio Echo Rhino Coxsackie HAV |
|
Poliovirus
|
Picornavirus RNA
Salk/Sabin vaccines Affects anterior horns |
|
Dz: Echovirus
|
RNA picornavirus
MCC aseptic meningitis, which is not bad, presents like cold/flu (except MC in summer months), no hospitalization necessary. Also - myocarditis |
|
Rhinovirus
|
RNA Picornavirus
MCC common cold |
|
Coxsackievirus
|
RNA Picornavirus
#2 MCC aseptic meningitis (after echo) Herpangina - febrile pharyngitis hand, foot, mouth dz. myocarditis |
|
Calicivirus
|
RNA
Norwalk virus - viral gastroenteritis Cruise ships |
|
Viruses that cause aseptic meningitis and myocarditis
|
Echovirus
Coxsackievirus both RNA picornaviruses |
|
Flaviviruses
|
RNA
Flavi=yellow HCV, Yellow fever, Dengue fever, St. Louis Encephalitis, West Nile Virus |
|
Yellow Fever Virus
|
RNA flavivirus (arbovirus)
Monkey/human reservoir, mosquito (Aedes) vector Sx: high fever, black vomitus, jaundice Councilman bodies (acidophilic inclusions seen in toxic or viral hepatitis) may be seen in liver |
|
Dengue
|
RNA Flavivirus
Life-threatening break-bone fever, hemorrhagic shock syndrome |
|
St. Louis Encephalitis
|
RNA Flavivirus
|
|
West Nile virus
Reservoir, vector, host? |
RNA Flavivirus
Reservoir = birds Vector = mosquitoes Incidental hosts = humans, dogs, horses |
|
Sx: West Nile virus
|
RNA Flavivirus
flu-like 1/150 get meningitis or even encephalitis Flaccid paralysis can develop - anterior horns Altered consciousness, possibly death |
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Dx: West Nile Virus
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IgM anti-WNV
IgG would indicate previous infection |
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Tx: West Nile Virus
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supportive care
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HTLV
What kind of virus? What does it cause? |
RNA Retrovirus
T-cell leukemia |
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Coronavirus
What kind of virus? What two things does it cause? |
RNA virus
2nd MCC common cold SARS, which can lead to ARDS |
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Orthomyxovirus
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RNA
Influenza |
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Influenza shift vs. drift
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Oh Shift!
Shift - pandemic - reassortment of viral genome, usually from mixing with animal virus Drift - minor (Ag drift) changes based on random mutation. Vaccines try to predict this. |
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Orthomyxovirus characteristics
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RNA
Hemagglutinin (promotes viral entry) and Neuraminidase (promotes progeny virion release) Patients at risk for fatal bacterial superinfection |
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Paramyxoviruses
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RNA
Infect children Parainfluenza - croup RSV - bronchiolitis in babies Rubeola (Measles) Mumps |
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Parainfluenza
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RNA Paramyxovirus
Croup - laryngotrachobronchitis Barking seal cough Respiratory distress, inspiratory stridor Leading cause of hospitalization in <4y/o pts. |
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Dx: Parainfluenza
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Steeple sign - trachea narrows near top
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Tx: Parainfluenza
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cool moist humidifier at night (when Sx worst)
racemic epinephrine 1 dose dexamethasone Mostly supportive |
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Sx: RSV
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bronchiolitis - can cause pneumonia esp. in infants. brassy cough. wheezing, respiratory distress.
Suspect if asthma-like Sx in pt <2 y/o with acute onset in winter months. |
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Prophylaxis: RSV - what and to whom/when?
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Passive immunization with palavizumab - monoclonal RSV Ig - monthly in winter months in premies (<34 weeks gestation) or chronic lung dz infants
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Tx: RSV
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albuterol or racemic epinephrine
DON'T use steroids - not beneficial and potential for harm |
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Rhabdovirus
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RNA
Rabies |
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Rabies
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Negri bodies - cytoplasmic inclusions in infected neurons
Bullet shaped capsid Long-incubation period (weeks to months) - can vaccinate after bite Fatal encephalitis with seizures, hydrophobia, hypersalivation, pharyngeal spasm Travels to CNS via retrograde fashion up nerve axons |
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Togaviruses
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RNA
Rubella (German measles) Eastern equine encephalitis Western equine encephalitis |
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Rubella (German Measles)
What kind of virus/family? Dz characteristics in adult/child/neonate |
RNA Togavirus
German (3-day) measles Fever, lymphadenopathy, arthralgias, fine truncal rash Mild disease in children Serious congenital disease (PDA association) - TORCH dz |
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Winter viruses
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Flu, RSV, rota
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Rubeola
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RNA paramyxovirus
Measles Koplik spots (red spots with blue-white center on buccal mucosa) diagnostic SSPE (subacute sclerosing pan-encephalitis) years later encephalitis and giant cell pneumonia rare Rash spreads from head to toe - bucket of paint poured on head 3 Cs - Cough, Conjunctivitis, Coryza (runny nose) |
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Mumps
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RNA Paramyxovirus
Parotitis (increased amylase), orchitis (rare), aseptic meningitis |
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Filoviruses
Type? Name two diseases |
RNA
Ebola (--> DIC), Marburg hemorrhagic fever Often fatal |
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Arenaviruses
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RNA
LCMV - lymphocytic choriomeningitis virus Lassa fever encephalitis - mice |
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Bunyaviruses
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RNA
California encephalitis Sandfly/Rift Vally fevers Crimean-Congo hemorrhagic fever Hantavirus - hemorrhagic fever, pneumonia, associated with mice |
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Avian flu
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RNA, Orthomyxovirus, H5N1
only spread birds --> human for now (human --> human shift would cause pandemic) Pancytopenia, URI, GI (diarrhea/fever), increased LFTs |
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Dx: Avian flu
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reverse transcriptase PCR or viral culture
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Tx: Avian flu
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oseltamivir
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HIV proteins
Envelope: Capsid: |
HIV proteins
Envelope: gp41, gp120 Capsid: p24 |
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HIV binding
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CXCR4 and CD4 on T cells, CCR5 and CD4 on Macrophages
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HIV immunity
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homozygous CCR5 mutation = immunity
Heterozygous CCR5 mutation = slower course |
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Dx: HIV
What tests to RULE OUT and RULE IN? |
Presumptive: ELISA - high false+ and low threshold - RULE OUT test
Confirmed with Western blot assay - RULE IN |
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HIV monitoring/Dx: what test?
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HIV PCR/viral load tests
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HIV false tests
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falsely negative in first 1-2 months of HIV infection
Falsely positive initially in babies born to infected mothers (anti-gp 120 crosses placenta) - use viral load instead. |
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HIV-associated infections, CD4 count and prophylaxis < 400
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oral thrush, tinea pedis, reactivation VZV, reactivation Tb, other bacterial infections (e.g. H. flu, S. pneumoniae, Salmonella)
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HIV-associated infections, CD4 count and prophylaxis <200
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Reactivation HSV, crypto, Isospora, disseminated coccidio, PJP - TMP-SMX (or dapsone if sulfa allergy)
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HIV-associated infections, CD4 count and prophylaxis < 100
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Candidal esophagitis, toxo, histo
Azithro for MAI |
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HIV-associated prophylaxis CD4 < 75
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Clarithro
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Neoplasms associated with HIV
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Kaposi's Sarcoma(HHV-8), HPV CIN, primary CNS lymphoma, non-Hodgkin's lymphoma
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HIV encephalitis
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late in HIV course. Gains CNS access via infected macrophages. See microglial nodules with multinucleated giant cells.
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Prions
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Infectious proteins
Creutzfeldt-Jakob Disease - rapid progressive dementia - kuru, scrapie (sheep), mad cow disease. Spongiform encephalopathy association |
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HIV vertical transmission risk in pregnancy
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risk of vertical transmission is in blood-mixing due to trauma or during labor, so C-section often preferred. ZDV proph in pregnancy
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Normal flora: Dominant
Skin - Nose - Oropharynx - Dental plaque - Colon - Vagina - |
Skin - S. epidermidis
Nose - S. epidermidis, colonized by S. aureus (give AB in nose as well if MRSA) Oropharynx - Viridans Dental plaque - S. mutans Colon - Bacteroides > E. coli Vagina - Lactobacillus, colonized by E. coli and GBS |
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Bugs causing food poisoning
Seafood - Meats, mayonnaise, custard - Reheated meat dishes - Improperly canned foods - Undercooked meat - Poultry, meat, eggs, reptiles - Reheated rice - |
Seafood - Vibrio
Meats, mayonnaise, custard - S. aureus (preformed toxin) Reheated meat dishes -C. perfringens Improperly canned foods - C. botulinum (bulging cans) Undercooked meat - E. coli O157:H7 Poultry, meat, eggs, reptiles - Salmonella Reheated rice - B. cereus |
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Bugs causing bloody diarrhea
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Campylobacter - comma/s-shaped
Salmonella - Lac- Shigella - Lac-, very low ID50, Shiga toxin EHEC - O157:H7 - HUS, shiga-like toxin EIEC - invades colonic mucosa Yersinia - day care outbreaks, pseudoappendicitis C. dif - either bloody or watery E. histolytica - protozan - amebic dysentery |
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Bugs causing watery diarrhea
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ETEC - ST and LT toxins
Vibrio cholerae - Comma-shaped C. perfringens - also causes gas gangrene Protozoa - Giardia, Crypto (in IC pts) Viruses - Rota (winter), adenovirus (pink eye + diarrhea), Norwalk (cruise ships) |
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Pneumonia in neonates (< 4 weeks)
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GBS
E. Coli (Remember, Listeria causes meningitis in this group) Broad spectrum - Ampicillin + Gentamycin |
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Pneumonia in Children (4 weeks - 18 years)
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Viruses (RSV) (MCC)
Mycoplasma Chlamydia pneumoniae Streptococcus pneumoniae Broad spectrum: Cephalosporin for S. pneumo, Macrolide for atypical pneumonias |
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Pneumonia in Adults (18-40)
Top 3 causes and Tx |
Mycoplasma
C. pneumoniae S. pneumoniae Broad-spectrum - Macrolides and Cephalosporin (same infective agents as in children, minus the viruses) |
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Pneumonia in Adults (40-65)
Tx? |
S. pneumonia
H. influenzae Anaerobes Viruses Mycoplasma Broad-spectrum - Cephalosporin + Macrolide + Clindamycin (for anaerobes) |
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Pneumonia in Elderly (65+)
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S. pneumonia, Viruses, Anaerobes, H. influenzae, Gram-ve rods
Broad-spectrum - Imipenem + Cilastatin or Meropenem |
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Pneumonia in special groups:
Nosocomial - IC - Aspiration - Alcoholic/IVDA - CF - Postviral - Atypical - |
Nosocomial - Staph, enteric gram-ve rods
IC - Staph, enteric gram-ve rods, fungi, viruses, PJP (with HIV) Aspiration - anaerobes Alcoholic/IVDA - S. pneumoniae, Klebsiella, Staph, aspiration with anaerobes (alcoholic) CF - Pseudomonas (quinolones) Postviral - Staph, H. influenzae Atypical - Mycoplasma, Legionella, Chlamydia |
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Meningitis in newborns (0-6 mos)
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GBS
E. coli Listeria Ampicillin + Gentamycin |
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Meningitis in children (6 mos - 6 years)
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S. pneumoniae
N. meningitidis (assoc. w/ severe rash) HiB Enteroviruses (echo-, coxsackie) - MCC. (remember: aseptic meningitis > septic) Ceftriaxone - go to for meningitis |
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Meningitis in 6-60 years
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N. meningitidis
Enteroviruses S. pneumoniae HSV |
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Meningitis in 60+
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S. pneumoniae
Gram-ve rods (decreased hygiene) Listeria |
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Viral causes of meningitis
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enteroviruses (esp. echo/coxsackie), HSV, HIV, West Nile, VZV
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Meningitis in HIV
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Crypto, CMV, Toxo (brain abscess), JC virus (PML)
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CSF findings in Meningitis
Pressure/Cell Type/Protein/Sugar in Bacterial, Fungal/TB, Viral H=High N=Normal L=Low |
Bacterial - H/H PMNs/H/L
Fungal/TB - H Lymphos/H/L Viral - NH/H Lymphos/NH/N |
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Osteomyelitis causes
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Most people - S. aureus
Sexually active - GC (rare) - septic arthritis more common DM/Drug addicts - Pseudomonas SCD - Salmonella Prosthetic replacement - S. aureus, S. epidermidis Vertebal - M. Tb (Pott's dz) Cat/dog bites/scratches - Pasteurella multocida |
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Osteomyelitis tests
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Elevated CRP/ESR classic but non-specific - RULE OUT
Definitive test - bone scan/MRI |
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UTI causes
Ambulatory - Hospital - |
Ambulatory - E. coli Klebsiella, S. saprophyticus (2nd MCC in young, sexually active ambulatory women), Proteus
Hospital - E. coli, Proteus, Klebsiella, Serratia, Pseudomonas, MRSA |
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UTI epidemiology, predisposing factors
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women: men = 10:1 (shorter urethra with fecal flora)
Predisposing factors - flow obstruction, kidney surgery, catheterization, gynecologic abnormalities, diabetes, pregnancy, labial adhesions in infants/toddlers |
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Male congenital defects --> UTIs
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posterior urethral valves --> difficulty emptying bladder, reflux
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UTI Sx in elderly
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delirium in addition to usuals
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UTI bugs
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Serratia - some produce red pigment; often nosocomial, drug resistant
E. coli - leading cause, colonies show metallic sheen on EMB agar Enterobacter cloacae - often nosocomial/drug resistant Klebsiella - large mucoid capsule, viscous colonies Proteus - motility causes swarming on agar, produces urease, struvite stones Pseudomonas - blue-green pigment, fruity odor, usually nosocomial and drug resistant |
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Congenital Toxoplasma
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classic triad:
Chorioretinitis Intracranial calcifications Hydrocephalus May be asymptomatic at birth |
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Congenital Rubella
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sensorineural deafness, cataracts and/or glaucoma, heart defects (PDA, pulmonary stenosis), microcephaly, MR, blueberry muffin baby due to rash, meningoencephalitis, behavioral changes
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Congenital CMV
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petechial rash, intracranial calcifications, MR, HSmegaly, microcephaly, jaundice, opthrochorioretinitis, optic atrophy, central vision loss, hemolytic anemia. 90% asymptomatic at birth, 15% of whom develop [usually unilateral] hearing loss
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Congenital HIV
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HSmegaly, neurologic abnormalities, frequent infections
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Congenital HSV II
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temporal encephalitis, conjunctivitis, vesicular skin lesions, often asymptomatic at birth, most infections transmitted during birth. If active skin lesions, must do C-section
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Congenital syphilis - early manifestations
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HSmegaly with elevated LFTs, hemolytic anemia, jaundice, rash --> dequamation of palms/soles, sniffles, blood-tinged nasal secretions, radiologic changes at birth including metaphysial dystrophy + periosteitis
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Congenital syphilis - late manifestations
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the more standard Sx - saddle nose, saber shins, Hutchinson teeth, CN VIII deafness, frontal bossing, etc.
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Vaginal discharge + vaginitis DDX (aside from GC/Chlam)
Low pH |
physiologic discharge, candidiasis
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Vaginal discharge + vaginitis DDX (aside from GC/Chlam)
High pH |
Trichomonas, bacterial vaginosis
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Vaginal discharge + vaginitis
Physiologic discharge vs. candidiasis |
Physiologic discharge presents at puberty, see WBCs on wet prep
Candidiasis - cottage cheese, wet prep: budding yeast + pseudohyphae |
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Vaginal discharge + vaginitis
Trichomonas vs. bacterial vaginosis |
Trichomonas - cervical irritation, strawberry red, fryable cervix. wet prep: triangular, flagellated protozoa
Bacterial vaginosis - wet prep: Clue cells Either way: Tx - Metronidazole |
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DDx: Fever in post-op patient
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Wind - atelectasis day 1-2
Water - UTI day 3-5 Wound day 5-7 Walking - DVT 'Wein' - thrombophlebitis Wonder drugs - usually ABs Sinusitis - from NG tube |
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Nosocomial infections:
Newborn nursery - Urinary catheter Respiratory therapy equip - Work in renal dialysis unit Hyperalimentation - Water aerosols - |
Newborn nursery - CMV, RSV
Urinary catheter - E. coli, Proteus Respiratory therapy equip - Pseudomonas Work in renal dialysis unit - HBV Hyperalimentation - Candida Water aerosols - Legionella |
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Granulomatous diseases
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Tb (only one that's caseating)
Fungal infections (e.g. histoplasmosis) Syphilis Leprosy Cat Scratch Fever Sarcoidosis Crohn's disease Berylliosis |
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Mechanism: Chronic granulomatous disease
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Lack of NADPH oxidase activity or similar enzymes - defect of neutrophil microbicidal activity. Can't make H2O2, but can still make HOCl radical from H2O2 provided by bacteria, so especially susceptible to catalase+ bacteria (e.g. staph). Susceptible to Aspergillus, Nocardia, Serratia, Pseudomonas
Negative NBT dye test |
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Encapsulated bacteria
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Strep pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Klebsiella pneumoniae. Capsule serves as vaccine Ag. Asplenic individuals need to be vaccinated. C3 deficient pts also susceptible
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MOPS vs MOPE
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MOPS - Meningitis, Otitis media (in children), Pneumonia, Sinusitis - S. pneumoniae
MOPE - Meningitis, Otitis media, Pneumonia, Epiglottitis - H. influenzae |
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Rickettsial vectors
Rocky Mt. Spotted Fever Endemic Typhus Epidemic Typhus Ehrlichiosis Q Fever |
Rocky Mt. Spotted Fever - tick
Endemic Typhus - fleas Epidemic Typhus - human body louse Ehrlichiosis - tick Q Fever - none |
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Dimorphic fungi with culture/tissue forms
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Sporothrix (cigar shaped or round budding yeast), Coccidioides (Spherules), Histoplasma (oval yeast in macrophages), Blastomyces (large round yeast with single broad based bud)
All but Coccidioides (hyphae with doubly reflective wall) have branching hyphae in tissue |
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Post-Group A Strep:
Rheumatic fever vs. glomerulonephritis |
Glomerulonephritis takes 1-5 weeks and can follow S. pyogenes skin infection OR pharyngitis. Rheumatic fever (with heart murmur, etc.) takes 4-6 weeks and follows ONLY pharyngitis.
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Right sided endocarditis
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typically occurs in IVDA and typically caused by S. aureus (pseudomonas 2nd MCC). Can develop multiple septic emboli in lungs - infarcts almost always hemorrhagic because of dual blood supply.
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V. cholerae sensitivity
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prefers alkaline environments, is acid-sensitive. Achlorhydria, food ingestion and antacid ingestion can increase pH of the stomach and decrease the minimum infective dose of V. cholerae by many orders of magnitude
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Cold agglutinin causers
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S. pneumoniae, EBV, hematologic malignancy
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Post-flu bacterial pneumonia-causing pathogens
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Top 3: S. pneumoniae, S. aureus, H. influenzae.
Elderly especially susceptible |
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Route of infection: N. meningitidis meningitis
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Pharynx --> blood --> choroid plexus --> meninges
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Route of infection: H. influenzae meningitis
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Pharynx --> lymphatics --> meninges
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Route of infection: S. pneumoniae meningitis
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Middle ear --> contiguous tissues --> meninges
(possible route, though unusual) |
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Route of infection: S. aureus meningitis or CNS abscess
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traumatic wound --> leaking CSF --> meninges. Following penetrating skull trauma or neurosurgery, S. aureus introduced from skin
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Route of infection: Tb meningitis
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Primary lung focus --> blood --> meninges. Chronic meningitis, monocytes and lymphocytes in CSF, primarily affecting basal meninges
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HIV resistance
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Pol gene mutations responsible for protease variants that are resistant to standard protease inhibitors and structural changes in reverse transcriptase that make it resistant to standard NRTI and NNRTIs.
Env gene mutations enable HIV to escape from host neutralizing Abs. |
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Oral Thrush causes
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Candida albicans - associated with wearing dentures, DM and immunosuppression. Unexplained oral thrush in otherwise healthy person suggests HIV infection possibility.
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Mucormycosis
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facial pain, headache, black necrotic eschar in nasal cavity - can proliferate in walls of BVs and cause infarction/necrosis of distal tissue. Rhinocerebral, frontal lobe abscesses. Rapid brain infection --> death can follow in 2-4 hours. mold with irregular, nonseptate hyphae branching at right angles.
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Tx: Mucormycosis
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debridement and amphotericin B
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Cryptococcus
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Yeast form only, round/oval encapsulated cells with NARROW based buds. Primary infection - lung. MC infection form - meningoencephalitis. Present in soil/pigeon droppings. Dx: india ink, latex agglutination of CSF, Culture (Sabouraud's), Methenamine (GMS)/mucicarmine stains of tissue.
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Tx: Cryptococcus
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Amphotericin B and flucytosine (acute meningitis), fluconazole for lifelong proph
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HIV associated infections and prophylaxis, CD4 < 50
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CMV retinitis/esophagitis, disseminated MAI, crypto meningoencephalitis.
Fluconazole |
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Cat Scratch Dz
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Bartonella henselae - low fever, lymphadenopathy, self-limited course
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Bartonella henselae
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Cat scratch dz
bacillary angiomatosis - red-purple papular skin lesions - may also be found within viscera - fatal if untreated. Also can cause culture negative endocarditis |
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Polysaccharide vaccines
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S. pneumoniae - can be given in unconjugated form (elderly pts - 23 of 80+ serotypes) or conjugated (infants - 7 of 80+, stimulates T-cell dependent immune (memory) response
N. meningitidis and H. influenzae vaccines also polysaccharide vaccines. |
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Live attenuated vaccines
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bacterial: BCG, typhoid
viral: measles, mumps, rotavirus, VZV, Sabin polio |
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Killed vaccines
Bacterial and viral e.g.s What's required for it to induce immunity? |
Bacterial: anthrax, cholera, pertussis, plague
viral: HAV, flu, rabies, Salk polio Require multiple inoculations to induce immunity |
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MCC Otitis Media
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S. pneumoniae, H. influenzae, Moraxella. Chronic infections of this kind suggest humoral immunodeficiency.
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Host response: Giardia
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Secretory IgA impairs adherence. Persistent giardiasis is a sign of IgA deficiency
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Characteristics: E. coli
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motile, lac+ gram-ve rods, encapsulated (virulence factor in meningitis)
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