5: bacterial Flashcards
increased risk of impetigo in adults with
HIV, diabetes, dialysis
most common impetigo; cause and appearance
nonbullous most common
strep pyogenes + staph aureus
cornflakes glued to skin
bullous impetigo cause and age
more in newborns; caused by staph aureus
erysipela eponym
saint anthony’s fire
erysipela most common location
leg associated with athlete’s foot (tinea pedis)
facial erisypelas ddx
lupus, melasma, angioedema
erisypela skin texture
peau d’orange
scarlet fever tongue
white strawberry first 2 days
red strawberry days 4-5
scarlet fever skin rash description
subnurn with goose pimples (erection of hairs_’ also sandpaper rash
sanpaper rash
scarlet fever
orange peel skin infection
erysipelas
pastia’s lines
red streaks in skin folds 2/2 vessel fragility in scarlet fever
red streaks in scarlet fever
pastia’s lines
tonsillar concretions why
keratin, bacteria, foreign material
dystrophic calcification in tonsil
tonsillolith, calcified concretions
diphtheria caused by
C diphtheriae (Klebs-Loffer)
primary syphilis lesion
chancre
secondary syphilis lesions
skin rash, mucous patches, condyloma lata
condyloma lata syphilis stage
2
mucous patches syphilis stage
2
chancre syphilis stage
1
skin rash syphilis stage
2
mucous patch over oral commissure
syphilis stage 2, split papules
split papules syphilis stage
2; mucous patches on commissures
widespread secondary syphilis when and name
lues maligna, especially in HIV+
pupil does not react to light infection
Argyll-Robertson, tertiary syphilis
glossitis in tertiary syphilis
interstitial glossitis/lobulated tongue
glossitis syphilis stage
3
luetic glossitis
atrophy and loss tongue papillae
congenital syphilis triad
hutchinson’s teeth, ocular keratitis, eighth nerve deafness
initial response to tx in syphilitic pts
Jarisch Herxheiner – fever, malaise, headache, exacerbation of skin lesions
infection with gonorrhea during childbirth
gonococcal ophthalmia neonatorum
complication of gonorrhea in women
pelvic inflammatory disease
muultiple small foci of TB
miliary TB
TB vs pneumonia
TB low grade fever vs pneumonia high
skin involvement in TB
lupus vulgaris
lupus vulgaris
skin involvement in TB
wasting syndrome in TB
consumption
calcified cervical TB LN
scrofula
scrofula
calcified cervical TB LN
false negative PPD settings
HIV+, sarcoidosis, Hodgkins, measles
TB tx
isoniazid, rifampin, pyrazinamide
two forms of leprosy
tuberculoid (localized/paucibacillary) and lepromatous (diffuse/multibacillary/nerve involement, leonine fascies, collapse of nose bridge, oral lesions)
oral lesions which leprosy
diffuse/lepromatous
facies leprosa why
bone destruction
atrophy of anterior nasal spine, maxillary alveolar ridge, endonasal infalmmation
lepra cells
vauolated histiocytes, mainly multibacillary lepra
noma agents
fusobacterium necrophorum and Prevotella intermedia
noma causes/settings
measles, leukemia, AIDS
poor OH, poverty, malnitrition
actinomyces 2 species
israelii and viscosus
forms of actinomycosis
cervicofacial, abdominopelvic, pulmonary
sulfur granules agents
actinomycosis and botryomycosis (S aureus infection)
cat scracth disease agent
bartonella henselae
bartonella henselae causes
cat scratch disease and bacillary angiomatosis
cat scratch disease associated syndrome
oculoglandular syndrome of parinaud
conjunctival granuloma and periauricular lymphadenopathy
conjunctival granuloma and periauricular lymphadenopathy
oculoglandular syndrome of parinaud
cat scratch disease associated
oculoglandular syndrome of parinaud
conjunctival granuloma and periauricular lymphadenopathy
cat scratch disease associated
bacillary angiomatosis agent
bartonella henselae
scarlet fever why rash
bacterial toxins attack blood vessels
cause of scarlet fever
group A beta hemolytic streps
pastia’s lines
red streaks in skin folds in scarlet fever
tonsillitis most commonly 2/2
viral (70%)
cause of diphtheria
corynebacterium diphth
bull neck
edematous neck in diphth
mucous patches of syphilis histo
exocitosis adn spongiosis
widespread secondary syphilis
lues maligna
gumma histo
granulomatous inflammation
gumma most common sites
palate or tongue
tongue in 3ry syphilis
interstitial glossitis (lobulated, lingula muscles contract after healing of gummata) luetic glossitis -- diffuse atrophy and loss of tongue papillae
congenital syphilis triad
hutchinsons teeth,
ocular keratiis (opacified cornea)
eighth nerve deafness
mulberry molars other names
fournier’s or moon molars
congenital syphilis 4 non-triad features
frontal bossing, short mx, high arched palate, saddle nose
saber shin feature of infx
syphilis
anterior bowing of tibia 2/2 periostitis
rhagades
perioral fissuring in syphilis
unilateral enlargement of clavicle infection and name
higoumenakis sign in syphilis
higoumenaki sign
syphilis
unilateral enlargement of clavicle
perioral fissuring in suphilis
rhagades
painless synovitis and enlargement of joints in syphilis
clutton’s joint
clutton’s joint
painless synovitis and enlargement of joints in syphilis
stains for syphilis
warthin starry or steiner (silver)
serology for syphilis
VDRL, RPR, FTA-ABS (best)
antibiotic adverse reaction in syphilis
Jarisch-Herxheiner reaction:
secondary release of endotoxin when abx kill large numbers of bacteria
fever, malaise, headache, exacerbation of skin lesions
fever, malaise, headache, exacerbation of skin lesions in pt given penicillin for syphilis
Jarisch-Herxheiner reaction:
secondary release of endotoxin when abx kill large numbers of bacteria
Jarisch-Herxheiner reaction
secondary release of endotoxin when abx kill large numbers of bacteria
fever, malaise, headache, exacerbation of skin lesions
most common reportable bacterial infx in US
neisseria gonorrhear
racial gonorrhea
19x more common in AA
symptoms in M vs F gonorrhea
80% F asymptomatic
10% M asymptomatic
site of infx in M vs F gonorrhea
M urethra
F cervix
significant complication of gonorrhea in F
pelvic inflammatory disease
uterus and ovarian tubes
disseminated gonorrhea
papules and pustules with hemorrhage in skin of extremities
oral gonorrhea
NUG-like but no odor
aphthae in soft palate and oropharynx
NUG-like but no odor
oral gonorrhea
gonorrhea in infant during birth
goncoccal ophthalmia neonatorum
oral TB; locations for primary and secondary
chronic painless ulcer (rarely also nodular, granular, or leukoplakic)
primary – gingiva, mucobuccal fold, exo site
seconday - tongue, palate, lips
histo term for TB granuloma
tubercle
TB stains
acid fast and ziehl nielssen
what does PPD test indicate
exposure to TB
false negative PPD possible in who
HIV+, sarcoid, Hodfkin, measles
TB tx
isoniazid+rifampin +pyrazinamide +ethambutol
vaccine against TB
BCG (bacille calmet-guerin)
scrofula infected by what
m bovis –> enlargement of oropharyngeal and cervial LN, can become calcified
leprosy types
tuberculoid - localized - usually paucibacillary
lepromatous - diffuse - usually multibacillary
multibacillary leprosy face and mouth
leonine facies, collapse of nose bridge, yellow/red oral papules that ulcerate
facies leprosa look and reason
triad: atrophy of anterior nasal spine, atrophy of mx alveolar ridge, endonasal inflammation
2/2 bone destruction
leprosy teeth
pulp involvement –> vascular damage –> red discoloration of crown
which form of leprosy has granulomas
only tuberculoid; few bacilli
lepra cells
multibacillary lepra
vacuolated histiocytes
rich in bacilli
special stain for lepra
acid fast, Fite method
tx for lepra
rifampin
NOMA causative
fusobacterium necrophorum and prevotella intermedia
NOMA inciting factors
often preceded by measles
also herpes, varicella, scarlet fever, TB, gastroenteritis, bronchopneumonia
AIDS, cancer, poor OH, poverty, malnutrition etc
actinomycosis organisms and staining
A israelii and A viscosus
G+, silver+
colonies of actinomyces in tonsillar crypts
concretions
actinomycosis locations
55% cervicofacial
25% abdomino pelvic
15% pulmonary
then other (skin, ileocecal, GU)
sulfur granules what are and seen in
large yellow flecks = colonies of bacteria
actinomycosis and botryomycosis (S aureus)
large yellow flecks which infx
actinomycosis and botryomycosis (S aureus)
bacterial colonies
aka sulfur granules
botryomycosis histo
abundant necrosis with admixed basophilic concretions surrounded by eosinophilic band (Splendori-Hoeppli phenomenon: in vivo formation of eosinophilic material around microbes)
splendori-hoeppli phenomenon
eosinophilic band around basophilic concretions
botryomycosis
actino clinical (location and look)
wooden induration of angle of MD with abscess and sinus tract
also tongue, subMD gland, parotid
poss osteomyelitis, tonsillar hyperplasia
periapical; and in cysts
special stains for actino
Grocott methenamine silver
Brown and Brenn
cat scratch dz causative
bartonella henselae and quintana
most common cause of chronic regional LAD in children
cat scratch dz
cat scratch dz clinical - and oral
papule/pustule along scratch line
50% single LN involvement
if oral: mass in buccal mucosa
consider also:
oculoglandular syndrome of parinaud
conjunctival granuloma and preauricular LAD
oculoglandular syndrome of parinaud
conjunctival granuloma and preauricular LAD in cat scratch dz
conjunctival granuloma and preauricular LAD
oculoglandular syndrome of parinaud
cat scratch dz
cat scratch dz histo and stains
granulomatous infalmmation with central stellate abscess
warthin starry or Brown Hopps
bacillary angiomatosis cause and mech
bartonella henselae
subQT vascular proliferation
bacillary angiomatosis clinical and histo ddx
clinical ddx from Kaposi
histo similar to histiocytoid hemangioma
sinusitis most common cause and predisposing factors
blockage of ostiomeatal complex
presidposing: recent upper respiratory viral infx and allergic rhinitis
bacteria in acute sinusitis
S pneum, H influ, Moraxella catarrhalis
klebsiella infx of nasal cavity
rhinoscleroma
rhinoscleroma
klebsiella infx of nasal cavity
phases of rhinoscleroma
rhinitic, florid, fibrotic
rhinoscleroma clinical
anesthesia of soft palate, uvula hypertrophy
hebra’s nose – destruction of nasal cartilage with formation of nodules
destruction of nasal cartilage with formation of nodules
hebra’s nose in rhinoscleroma (klebsiella)
hebra’s nose
destruction of nasal cartilage with formation of nodules in rhinoscleroma (klebsiella)
special cells in rhinoscleroma; general histo and stains
Mikulicz – large m/ph with clear vacuolated/foamy c/pl
seen in association with plasma cells, lymphocytes, and fibrosis (late stage)
warthin starry (best), Giemsa, gram
rhinoscleroma ddx
leprosy (need acid fast), TB, PCM, extranodla Rosai-Dorfman
most common vector borne illness in US
Lyme dz - through deer tick – Borrelia burgdorgferi
borrelia burgdorferi
lyme dz
bartonella
cat scratch and bacillary angiomatosis
lyme dz classic clinical
erythematous papular rash of extremities (erythema migrans)
can involve joints, heart, CNS
group and infx of strep pyogenes
group A beta hemolytic strep
impetigo, erysipelas, scarlet fever
calssic group a beta hemolytic strep
pyogenes
corynebacterium morphology and toxin
gram + rod
exotoxin –> necrosis
diphtheria clinical + organ damage
pseudomembrane on tonsils
LAD
bull neck
damages heart, kidney
neisseria morphology and culture conditions
G- coffee bean diplococci
chocolate agar + CO2
aerobic
mycobacterium leprae aka, morphology, oxygen
other names for disease
Mycobacterium leprae
( Hansen’s bacillus spirilly )
Aerobic rod shaped
Leprosy ( Hansen disease)
noma agents
Fusobacterium necrophorum
Prevotella Intermedia
st anthony’s fire seen in x3
1- Erysipelas
2- Ergotism
3- Herpes zoster
diseases with saddle nose
1-Syphilis 2-Leprosy 3-Wegeners 4- Polychondritis 5-Drug abusers (cocaine) 6- α-mannosidosis
+ve lepromin test eponymous rxn
Mitsuda rxn -
= intradermal injection of armadillo-derived lepra bacilli
risks with chronic cutaneous lepra lesions
SCC
stellate abscess
cat scratch bartonella
cat scratch stains
Brown Hoppe and Warthin Starry
noninvasive mycetoma causative
aspergillus fumigatus – antroliths and chronic sinusitis