8. Opportunistic Infections Flashcards
1
Q
What is an opportunistic infection?
• Infections that occur more frequently and more severely in individuals with ____ immune systems
• Infections that develop because of a ____ event such as fracture, open wound, etc
• Bacteria – \_\_\_\_ – Actinomycosis • Mycobacteria – \_\_\_\_ Fungus – \_\_\_\_ – Histoplasmosis – \_\_\_\_ • Virus – \_\_\_\_ – Human papillomavirus – \_\_\_\_
• Increased prevlaence or multiple occurences ○ Immuno-comrpirmesed - \_\_\_\_, anemic, chemo for cancer, unctorleled diabetics whose overall helath is bad, elderly patients (weak immune system) ○ All at risk for opportunistic ifnections • Infections discussed today can occur in healthy indnividuals ○ Can get syphilis if you're not \_\_\_\_ positive • Scratch yourself > can become secondarily infected (predisposing area to infection) • \_\_\_\_ the most common opportunisitc infection we will see in clinical context ○ Complete maxilary denture > if not cleaned will predispos themselves to candidiasis • OHL > condition caused by \_\_\_\_ that was most commonly encountered in immuno-sppressed patietns; poorly controleld diabetics, \_\_\_\_ patients (not just HIV!) following chemo • \_\_\_\_> can be opportunistic, but can devleop w/o being immu-suppressed
A
weakened predisposing syphilis tuberculosis candidiasis mucormycosis OHL molluscum contagiosum
HIV HIV candidiasis EBV HPV
2
Q
Syphilis • Highly \_\_\_\_, sexually transmitted • \_\_\_\_ • With direct contact > \_\_\_\_ – \_\_\_\_ heals
• Secondary disease – Oral mucous \_\_\_\_ – Maculopapular rash – \_\_\_\_latum – Spontaneous healing
• Bacterial disease - was quite prevalent bc of sex then it died down, then with HIV epidemic > back to surface as rampant disease > then it died down, and now it's increasing again (no one knows why) • TP > \_\_\_\_, corkscrew type shape) • Direct contact with ifnected tissue (oral, skin, mucosal, etc.) > you \_\_\_\_ get infected ○ First lesion is called a chancre > first spot that's being actively ifnected ○ Will spontaneously resolve, but the patients remain \_\_\_\_ > after resolution: secondary disease • Secondary disease > \_\_\_\_ verisoin os f syphilis > most commonly get oral lesions, body wide skin rash, where each rash is contagious (maculopapular rash), get wart-like lesion in oral/genitalia (condyloma litum) ○ This stage of syphilis alos spontaneously resolve (secondary) • Initial exposure > weeks for organism to propaage to primary > lesion may last for weeks (may go away on its own even w/o treatment) > once primary lesion resolvs/ or doesn’t > if resolves you may go wihtout lesions for a while until you wake up with rash > secondary disease > lasts a few weeks > may resolve on it owns > after reoslution, may go monhs/years with no further progrression >w ake up with \_\_\_\_, hole in palate (\_\_\_\_), \_\_\_\_ diseas with unknown origin > tertiary syph (not \_\_\_\_ anymore, cant contract anymore ) > longstadning complciation of syphliss infection
A
contagious
treponema pallidum
chancre
spontaneously
patches
condyloma
spirochete will infected/contagious disseminated dementia perforation cardiovascular infective
3
Q
- Chancre > ____; secondary syphilis > whitish, ____ ulcerated
- Condolutliutm > almost like a wart > ____ of tongue
A
deeper
superficial
dorsum
4
Q
Syphilis • Tertiary syphilis – \_\_\_\_ – Cardiovascular disease – \_\_\_\_
• Congenital syphilis
– ____ molar and ____ incisors
– ____-nerve deafness
– Interstitial ____ of cornea
• Tert syph: ○ Brain > \_\_\_\_, may become blind may lose ability to walk and talk propery; not \_\_\_\_ ○ Cardiovascular disease ○ Developed a liteal hole in their palate > preceded by a stage where the mucosa becomes kind of white and \_\_\_\_ > results in a development of palate • Not \_\_\_\_ > cocaine snorting can cause palatal perforation ○ Same mechnaism > \_\_\_\_ to the palate • Pregnant > contract syph > developing fetus is at risk for severe complications > baby has congenital syphilis > as get older > structural changes tha tare \_\_\_\_ for syphlitic infection • Teeth > unique morpholy > hutchinson incisoers > \_\_\_\_ screwdriver > take on a screw driver morphology; mulburry molars > unique \_\_\_\_ surfaces (raspberruy/blackberry) • At risk for blindness > get \_\_\_\_ > areas of keratosis on their cornea • Prone to deafness > eighth nerve deafness • \_\_\_\_ betweens econdary and priamry > contagious; once secondary dies down > not contagious
A
gumma neurosyphilis mulberry hutchinson eigth keratitis
dementia infective ischemic pathoneumic ischemia
pathoneumonic flathead occlusal leukoplakias latent
5
Q
Diagnosis and treatment • \_\_\_\_ • Dark-field microscopy • \_\_\_\_ testing – \_\_\_\_ Disease Research Laboratory – \_\_\_\_ reagent – \_\_\_\_ • Treat with \_\_\_\_
• Priamryily diagnose syph with immuno-histo (lab) > makes use of antigens (glycoproteins) in organisms where you identify the antibody • Infected tissue > organisms in tissue (secondary and rpimary syp) > incubate with antbiody > idenitfy the protein directly ○ Black dots > orgnaisms (\_\_\_\_) that's within this patients tissue > either primary or secondary syph, wouldn't be tertairy tissue (\_\_\_\_ complication secondary to the organisms, like rhemuatic feveer and poststrep glomerulonephritis) • DF micro > specialized microscope > flip condesner so field becomes dark, and bugs \_\_\_\_ in the dark > not used anymore really • Serologic esting > IVF treatments > during process both partners tested for syphilis via blood test > RPR test (routine) > test for protein (ELISA test) that indicates a \_\_\_\_ of syphilis (not presence or past) but shows you being exposed to syp organisms at some point > will be treated with antibiotic treatment before IBF • There's ELISA > more \_\_\_\_, primarily use RBR because it's \_\_\_\_ • Lupus patient > early in disease state > had a psoitive RPR > used mainly for syph, but may yield a false positive for patients with \_\_\_\_ and \_\_\_\_ • ELISA > indicates an active syphilis, no \_\_\_\_ here but more expensive • VDR > serologic test to detect a \_\_\_\_of syphiliss • Irrespetive of mechanism or primary/secondary > treated with penicillin (amoxicillin) > bug is still resposnive to penicillin > once you're treated you're no longer infected > but 10-15 years down the road will still be RPR \_\_\_\_ (antibodies will recognize you as being positive)
A
immunohistochemistry serologic venereal rapid plasmin ELISA penicillin
spirochetes immunologic light history expensive cheaper lupus rheumatoid arthritis false positive history positive
6
Q
Cervicofacial actinomycosis
• \_\_\_\_ bacterial, non-\_\_\_\_ infection • \_\_\_\_ – Commensal \_\_\_\_ organism • Predisposing factors – \_\_\_\_ procedure – Severe systemic disease – \_\_\_\_ – Medication-induced osteonecrosis of jaw • Pus with \_\_\_\_ granules • Treat with long-term high-dose \_\_\_\_
• Almost exlcusively \_\_\_\_ (not occuring in healthy people, or healthy tissue) ○ Syph most comonly oppurtinistc, but sometimes healthy • Fracture site in \_\_\_\_, inflammatiory tissue in apex of tooth (non-vital), ulceration in mucosa > retricted to head/neck area • \_\_\_\_ bug > we have it, part of existing normal flora • Systemic disease > weaken imune system • Radioation/chemtherapy may induce damage; \_\_\_\_ to treat osteoporsis or to strengthen bones from metases of cancer > medication induced ONJ • Bacterial ifnection > you do see pus > composed of \_\_\_\_, dead cells, \_\_\_\_, macrophages, bacterial \_\_\_\_, toxins, fluids ○ And sulfur granules > look \_\_\_\_ and are really hard, circular structures composed of millions of \_\_\_\_ > surrounded by \_\_\_\_ then \_\_\_\_
A
chronic contagious actinomyces irsraelii gram positive dental osteoradionecrosis sulfure penicillin
opportunistic maxilla/mandible commensal bisphosphonates neutrophils bacteria byproducts yellow bugs neutrophils lymphocytes/plasma
7
Q
Cervicofacial actinomycosis
• Purple > millions of bugs, surrounded by inflam cells > very firm to touch, feels like a small calcification
○ ____ coming out of neck > some calcified feeling structures also
• Do a ____ > actinomyces look like a baseball bat > narrow base and a ____ head
• Treat with penicilli (clinda, doxi, etc.), and make sure you clean out the area of infection and repair the tissue
A
pus
gram-stain
bulbous
8
Q
NOMA (cancrum oris)
Rapidly progressive polymicrobial infection – \_\_\_\_ – Prevotella intermedium – \_\_\_\_ – Staphylococcus aureus
Predisposing factors – \_\_\_\_ – Pool oral hygiene – \_\_\_\_ – Immunodeficiency – Poor \_\_\_\_, poverty, unsafe water
Mainly in children in ____ countries
• NOMA jis not an ancronym • \_\_\_\_ disease, but a rapidly progressive \_\_\_\_ infection, four organisms ○ Ones listed are most common, but not the only ones we see • Mostly seen in third world countries and sub sharan africa; see here, the aptient is in a severly immuno comporimsed state > malnutrition, poor oral hygiene, predipspoing systemic odnition, immunodeficiency, and social factors/envrionemtnal factors • Disease typically occurs in children in third world countries ○ In US, typically in an \_\_\_\_ patient that's an adult ○ In the pic, half of face eaten away from infection > like a flesh easting disease > OMC, soft tissue and bone are at risk of necorsis of rapidly progressing infection ○ Right: person is not \_\_\_\_ anymore, after treated and removed tissue
A
fusobacterium nacrophorum
borrelia vincentil
malnutrition
severe systemic disease
sanitation
underdeveloped
non-contagious
polymicrobial
immuno-compromised
infected
9
Q
NOMA (cancrum oris) • May begin as \_\_\_\_ or \_\_\_\_ • \_\_\_\_ and metronidazole or \_\_\_\_ • Surgical debridement • Reconstructive surgery
• Where does it start > priairly in the HN area > presents initially as an \_\_\_\_ infection as an necrotizing gingivtis or necrotizing peridontisis > progressed to nasty disease that's gone beyond gingival tissues • HIV disease, papilla blunted, at the \_\_\_\_ have pus ○ Necrotoiznig gingivitia ○ Bottom > \_\_\_\_ > treated disease if caught early with antbiotic therapy • Treat > not just treating but also removing damged tissue in order to remove as much bacteri as possibletissue
A
necrotizing gingivitis
necrotizing ulcerative stomatitis
penicillin
clindamycin
oral
tips
necrotizing ulcerative stomatitis
10
Q
- Gingiva is inflaedm > if progressises > ____ (still just gums)
- Ulcerative periodntis > start to see ____ from crevices, significant bone loss and massive ____ of periodnotium and soft tissues > if occurs on maxillary tissues > rspread to ____ and regional tisses
A
necrotizing ulcerative gingivitis
pus
ulceration
vestibule
11
Q
NOMA in an AIDS patient
* Within 7 days > treatment debride the infected tissue and give high dose anibiotic therapy > and then reconstruction * Just \_\_\_\_! Won't resolve \_\_\_\_ but will resolve the \_\_\_\_
A
bacterial
damaged tissue
infection
12
Q
Tuberculosis • \_\_\_\_ • Common cause of \_\_\_\_-related death • \_\_\_\_ transmission • Macrophages phagocytose but do not \_\_\_\_ bugs
• Mycobacterium > \_\_\_\_ staining ○ Leprae, manaerum (infection that can contract by sticking fingers in dirty dfish tank water) ○ Tuberculosiss is most common cause of infectionr elated death § Thought was under contorl, but with HIV Tb went right back to top of common cause of infection related detah > once HIV was under control it went down > but now it's back once again • Even just by breathing can still trasnmit the bug > risky for \_\_\_\_ travel! • \_\_\_\_ disease - once treated you still harabor the live organisms in the body (following months of medicinal treatment) > sequestered within \_\_\_\_ Important - medications that are on market - \_\_\_\_, etc. > biologic therapies > inhibit \_\_\_\_ > prevent macrophaegs form retaining control of organisms; befroe treating patients with these (khrons, RA etc) > get tested to make sure they're not tested with Tb or deep fungal infeciton > bc upon therapy > can \_\_\_\_ of bugs > restablishment of \_\_\_\_ dieseae
A
mycobacterium tuberculosis infection airborne kill acid-fast airplane granulomatous macrophages ifliximab TNF-alpha dissemination systemic
13
Q
Tuberculosis • \_\_\_\_ • Mimic \_\_\_\_ disease • Scrofula • Diagnosis via – \_\_\_\_ with AFB stain – \_\_\_\_ test – \_\_\_\_ release assays – \_\_\_\_radiograph
• Orally > non-helaing ulceration > what's most common diff diagnosis of non-helaing ucleration > \_\_\_\_ (tb), \_\_\_\_ and \_\_\_\_ ○ Deep \_\_\_\_ (histo, syphilis) can also cause non-healing ulceration • scrofula > drink infected \_\_\_\_ > Tb of the \_\_\_\_ > sores/ulcers/swellings of ht eneck> can also get Tb of spine, brain, and can get in distinct anatomic compartments > all treated the saem way • AFB > organisms will be \_\_\_\_ • If you ge tbump after PPD > \_\_\_\_ > exposed to mycobacterium ○ ,vaccinated with \_\_\_\_ not with Tb bugs, but with a protein that's found in cows and ambobous (which is a mimic of Tb antigen) > will always have a \_\_\_\_ on your PPD > just to confirm they'll do a \_\_\_\_ x-ray (most comonly affects the lungs) ○ PD test is very cheap (esp in third worlds) • IFN-gamma > much mro \_\_\_\_ ebut more expensive
A
ulceration periodontal histopathology tuberculin interferon gamma chest
infection
cancer
trauma
fungal
milk
neck
purple wheal BCG false-postive chest sensitiv
14
Q
AFB stains organisms magenta
* Lomas; \_\_\_\_ giant cells; I the cneter you see \_\_\_\_ necrosis (not \_\_\_\_) * Pruple dots represent organisms
A
langhans
caseous
pathoneumonic
15
Q
Treatment and prognosis
- ____, rifampin, ____, and ethambutol
- ____ consecutive negative sputum cultures in order to be considered cured of disease
- Treated with potent cocktail of drugs > several months duration (or year+)
- To be free (not cured bc you’re nevere really cured bc once you’re free of disease/active disease) > no longer ifnected/contagious
- You can reactivated Tb > severely ____ suprpressed (or take a drug that inhibts ____) > macropahegs no longer confine organisms within cells and can reactivate the disease in a later stage
A
isoniazid pyrazinamide 3 immuno TNFalpha
