Anderson Immuno/Micro Flashcards
Acid tolerant organisms…
Lactobacillus, Strep, H. Pylori
Endo or exo toxin: LPS Denatured by boiling Antigenic Form Toxoid Pyrogenicity High specificity Protein Extracellular Part of outer membrane
Endo Exo Both Exo Endo, sometimes Exo Exo Exo Exo Endo
What are the three responses of the body to cold temperature?
Thyroid hormone - increased metabolism
Sympathetic nervous system - activates beta-receptors in brown fat to increase metabolism
Shivering - activated by posterior hypothalamus
What part of the hypothalamus is responsible for the body temperature set point?
Anterior hypothalamus
How do pyrogens affect the set-point temperature? How do they do that?
They increase it.
IL-1 triggers fever, via prostaglandins
How do aspirin and steroids reduce fever?
Aspirin - cox inhibitor - reduce prostaglandins
Steroids - block release of arachidonic acid from phospholipids
Heat exhaustion vs. stroke
Exhaustion - dehydrated from sweating, syncope, wet
Stroke - body temp approaches tissue damage, dry
All the immune cells mature in the bone marrow except ______ cells.
T-cells
Mature in the thymus
Name the immune cell:
Cell-mediated immunity
Ab (Humoral) immunity
Immunological surveillance
T-cells
B-cells
NK Cells, Macrophages
What is the classical vs. alternate activation of complement?
Classical - Ag/Ab rxn, strong
Alternate - activated w/o Ag/Ab rxn, weaker, starts at C3 locus
Name the interferon:
Made by leukocytes, inhibits tumor cell growth, stimulates NK cells
Made by fibroblasts
Made by T-cells, activates NK, killer-T cells, activates phagocytic cells
IF- alpha
IF - beta
IF -gamma
What does TNF-alpha do? TNF-beta?
Alpha - stimulates apoptosis
Beta - induces IL-10
Name the interleukin:
Fever, t-cell proliferation
Promote cellular immunity, secreted by CD4
Promote humoral immunity, secreted by CD4
Promote humoral immunity, secreted by T-cells
Fibroblast secretion, megakaryocyte potentiator
IL-1 IL-2 IL-4 and 5 IL-10 IL-11
Which MHC:
Present viral antigen to CD8, activate CD8
Docking protein on MO which hooks to a CD4
MHC1
MHC2
Definition: Incomplete antigen, unable to stimulate immune response on its own. Reacts with other proteins making them antigenic.
Haptens
Name the antibody and their response: "Allergy" "Secretory" "First Responder" "Long Term"
IgE - Type 1 Hypersensitivity, parasitic infection
IgA - Mucosal, dimer
IgM - basis for ABO-blood type antigen rxn, short-lived, pentamer
IgG - MC, focuses NK cells, immunization
Name the hypersensitivity rxn: Immune complex mediated Antibody mediated IgE mediated, anaphylaxis Delayed, cytotoxic type
Type III, humoral
Type II, humoral
Type I, humoral
Type IV, cell-mediated (e.g. PPD TB test)
Name the AI dz:
Thymic hypoplasia, absences of T-cell immunity
Excessive systemic collagen/fibrosis of microvasculature
AI destruction of salivary/lacrimal glands
Type III and II auto-Ab, remitt/relapse, ANA
Inflammatory myopathy w/ skin involvement
Inflammatory myopathy w/o skin involvement
DiGeorge's Syndrome Scleroderma/Systemic Sclerosis Sjogren's Syndrome SLE Dermatomyositis Polymyositis
What are the primary and secondary responses of T-cells?
Primary: T-cells are activated by APC, signaled directly to site of antigen
Secondary: T-cells cloned and stored in lymph nodes
What are the primary and secondary responses of B-cells?
Primary: Interleukin, prostaglandin, TNF, IF production
Activate complement, and draw MO to area
Secondary: memory B-cells respond, IgG produced, complement activated
Beta-hemolytic vs. alpha-hemolytic
Beta - complete hemolysis
Alpha - incomplete hemolysis
T/F: Gram + cocci tend to have NO flagella and are NON-motile, and NON-spore-forming.
T
Staph or Strep: Beta-hemolytic Toxic Shock Syndrome, Food Poisoning Impetigo Coagulase positive ASO titer +
Staph and Strep Staph Staph or Strep Staph Strep
Type of staph that is coagulase negative and usually due to surgical or wound infections and can cause subacute endocarditis.
S. epidermidis
Type of staph that is the least common and associated with UTIs. Also coagulase negative.
S. saprophyticus
What type of strep is grp A? grp B? What is each more closely associated with?
S. pyogenes - pharyngitis, impetigo, scarlet fever, rheumatic fever
S. agalactiae - post-partum infection, neonatal sepsis/meningitis
Name the strep:
Pneumonia, sinusitis, meningitis, otitis media
Endocarditis, bacteremia, dental caries
S. pneumoniae
S. viridans
What family are the Gm - diplococci?
Neiserria
MC STD in US? Second MC?
Chlamydia
N. gonorrhea
T/F: N. gonorrhea produces an IgG that neutralizes the IgA of humans.
N. gonorrhea produces a neutralizing IgA
What is the histological finding of N. gonorrhea?
Intracellular gm- diplococci inclusions in neutrophils
What is the difference between n. meningitidis and gonorrhea?
gonorrhea - can ferment in glucose
meningitidis - can ferment in glucose and maltose
M/C organisms causing meningitis in each age grp: 0-4wks 4-12wks 3mo-18yr 18yr-50yr >50yr
Grp B strep, E. coli, Listeria monocytogenes
S. pneumoniae, grp B strep, E. coli, L. monocytogenes
S. pneumoniae, N. meningitidis
S. pneumoniae, N. meningitidis
S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic gm - bacilli
What are the families of gm- spore-forming rods?
Clostridia and Bacillus
Name the clostridium:
Anti-cholinergic neurotoxin, descending paralysis
Gas gangrene
Inhibit glycine and GABA, tetanus
Pseudomembranous colitis, post-antibiotic therapy
Botulinum
Perfringens
Tetani
Difficile - MC, often normal flora
Name the Bacillus: Found in soil (around animals), highly fatal GI and eye infections Chinese food poisoning Highly fatal - cutaneous, inhalation, GI
anthracis
cereus
cereus
anthracis
What are the families of gm+ non-spore forming rod?
Corynebacterium and Listeria
Name the corynebacterium:
Pseudomembrane, gray coating which can cause severe hemorrhage.
Acne, cutaneous infections
C. diptheriae
Other
Name the infection:
Targets pregnant women, neonates, elderly, immunocompromised. Granulomotosis infatiseptica. Replicates in MO, with help from listeriolysin O and thus avoids Ab and other bactericidal agents. Likes to go to heart and brain.
Listeria monocytogenes
All members are facultative anaerobes, ferment glucose, oxidase negative, reduce nitrates to generate energy.
Gm - rods (salmonella, eschericia, shigella, klebsiella pneumoniae, enterobacter, citrobacter, yersinia, proteus, pseudomonas, legionella)
What sugar does E. coli ferment?
Lactose
What are the four groups of E. Coli and where do they live?
Enterotoxigenic and Enteroaggregative - small intestine
Enteropathogenic - large intestine, infantile non-bloody diarrhea
Enteroinvasive - large intestine/colon, watery diarrhea w/ small bloody stools
Enterohemorrhagic - colon, verotoxin (shiga-like toxin), blood stool
What is the worse variety of E. coli and why?
E. Coli 0157:H7
Name the salmonella:
Typhoid fever, rigid belly, rose spots on stomach
More acute onset, egg shells, resolves 2-7d
S. typhi
S. enteritidis - MC
What are the two types of shigella? How do they create sx?
S. dysenteriae
S. sonnei (MC in US)
Shiga-toxin - more aggressive than salmonella
Transmitted via four F’s
Name the organism:
Alcoholics, “currant jelly” sputum
Nosocomial usually
Transmitted via flea bite, 75-90% fatal, pneumonia or bubonic
Looks like appendicitis, w/ polyarthritis, close proximity to large animals
Klebsiella pneumoniae
Enterobacter aerogenes
Y. pestis
Y. enterocolitica
Name the organism for diarrhea according to incubation time, type of diarrhea, and presence of emesis:
4-12hr, watery/profuse, ++emesis, no fever
2-7d, watery/profuse, +emesis
1-4d, variable/bloody, mild emesis, severe abd pain, + fever
1-3d, bloody, mild emesis, severe abd pain, mild fever
8-72hr, variable/watery, mild emesis/abd pain, no fever
S. aureus, C. perfringens E. coli, giardia Salmonella, Campylobacter, Shigella, Enteroinvasive E. coli, Entamoeba histolytica Hemorrhagic E. coli, C. difficile V. cholerae, Enterotoxigenic E. coli
Name the organism:
UTI, elevated pH, increased stone formation, “urea-splitting”
Burn infections, resistant to antibiotics, fruity odor, CF
Transmitted via standing water, pneumonia or flu-like
Proteus mirabilis and vulgaris Pseudomonas aeruginosa Legionella pneumophilia (Pontiac fever, Legionnaires dz)
Gm - curved rods
H. pylori, Campylobacter jejuni, V. cholerae
Name the organism:
Gastric ulcers, risk for adenocarcinoma of the stomach
Shellfish vector, MC cause of bacterial enteritis in US, fecal-oral transmission, self-limiting
“Rice-water” stools, 20L/day fluid loss
24hr incub, explosive diarrhea for 72hr
H. pylori
C. jejuni
V. cholerae (O1 more deadly than non-O1 antigen)
V. parahemolyticus
Gm - coccobacilli
Hemophilus, bordetella
Name the organism:
Childhood sinusitis, meningitis, epiglottitis, otitis, COPD pneumonia
Painful genital ulcer “Chancroid”
Assoc w/ BV, “strawberry cervix”, + whiff test
“Whooping cough”, death can occur due to hypoxia/pneumonia
H. influenzae
H. ducreyi
H. vaginalis
Acid-fast rods
Mycobacterium
Name the mycobacterium:
Gohn complex, granulomatous, can go to any organ
Leprosy/Hansen’s dz
Lung dz in immunocompromised patients, bird vector
M. tuberculosis
M. leprae
M. avium
Spirochetes
Treponema, borrelia, leptospira
Name the treponema:
Syphilis
Trench mouth
Yaws
T. pallidum
T. pertenue
T. vincentii
Describe the stages of syphilis.
Primary: painless chancre, regional LA
Secondary: general rash, fever, disseminated, highly infectious
Late (tertiary): Gumma, tabias dorsalis, encephalitis
Congenital: no sx. at birth, onset of rash/systemic dz later
Erythema migrans, tick-borne dz, two stages of infections.
Borrelia burgdorferi (Lyme)
Biphasic illness beginning w/ fever, chills, and intense HA. Can resemble aseptic meningitis, uncommon
Leptospira interrogans (Weil’s dz)
Wall-less bacteria - smallest free living bacteria
Mycoplasma pneumonia, ureaplasma urealyticum
What does the cellular membrane of M. pneumonia contain that no other bacterial membrane does?
Cholesterol
M. pneumonia or U. urealyticum: Gm -, strictly aerobic Non-specific urethritis in men "walking pneumonia" "Fried egg" appearance on agar Resp/sexual transmission (w/ Chlamydia)
M. pneumonia U. urealyticum M. pneumonia M. pneumonia U. urealyticum
Name the Rickettsia:
Louse borne, Typhus, severe fever/HA, macular rash
Tick borne, Rocky Mountain Spotted Fever, MC in US
Flea borne, Murine (endemic) typhus, chest maculopapular rash, flu sxx
R. prowazeki
R. rickettsii
R. typhi
Obligate intracellular bacteria
Chlamydia, Rickettsia
Name the chlamydia:
Preventable blindness, MC STD in US
Pharyngitis, bronchitis, sinusitis
Parrot fever, myocarditis, encephalitis, hepatitis
C. trachomatis
C. pneumoniae
C. psittaci
What two organisms would you be concerned about with someone handling birds?
C. psittaci
H. avium
Cryptococcus neoformans
Name the fungal infection:
Ohio/Mississippi valley, flu-like resp illness, similar to TB
California desert/SW, cough, fever, chest pain, “Valley fever”
Chicago, ulcerative granulomata of the skin/bone
Histoplasma capsulatum
Coccidiodes immitis
Blastomyces dermatiditis
Name the opportunistic fungal infection:
Normal in small quantity, problem in immunocompromised (IC)
Allergic trigger, “fungus balls” that is movable, lung function
Fungal CNS infections in IC, pigeon carrier
“Cosmopolitan organism”, AIDS, pneumonia
Candida albicans
Aspergillus
Cryptococcus neoformans
Pneumocystis carinii
Name the herpes virus and pathogenesis: HSV I HSV II HSV III HSV IV HSV V HSV VI
Oral herpes - vesicles, live in trigeminal nerve
Genital herpes - vesicles, live in lumbar/sacral ganglia, can also cause aseptic meningitis
Varicella zoster - chicken pox/shingles - LPS
Epstein Barr virus - Mono, Burkitt’s Lymphoma, B-cell lymphocytes in salivea, histo: downey cell
Cytomegalovirus - likes neuro/eye tissue, infantile meningitis, “Mono-like”, saliva/sexual secretions/vertical transmission
Roseola infantum
Most common cause of diarrhea in children
Adenovirus - DNA virus
Which HPV: Warts Condylomata Cervical HPV Vulvar HPV
HPV 1-4
HPV 6, 11
HPV 16, 18, 31, 33
HPV 16, 18
Measles or Mumps Rubeola- RNA virus Viral parotitis Koplik's spots, maculopapular rash Resp droplet transmission Cough, coryza, conjunctivitis (3 C's) Sequelae: sterility, DM Sequelae: subacute sclerosing pan-encephalitis (SSPE)
Measles Mumps Measles Both Measles Mumps Measles
Paramysoviruses
RSV, measles, mumps, parainfluenza
Most common cause of FATAL acute resp infxn of infants.
Resp syncytial virus - bronchiolar necrosis and mucus plugging, small airway susceptible to distress
Organism that causes croup, SUB-epiglottic swelling. What is your DDX?
Parainfluenza virus
DDX: H. influenza epiglottitis
Name the hepatitis: Fecal-Oral transmission, abrupt onset DNA virus Endemic to Mexico, Africa, Indochinese Fatality in women 15-25% RNA virus Can become chronic Requires Hep B infxn High risk of cirrhosis, hepatocellular carcinoma
Here you go! Hep A and E Hep B Hep E Hep E Hep A, C, D, E Hep B, C, D Hep D Hep C and B
When is foreign travel more likely to be relevant in a case?
If travel occurs 30-60d ago.
Common cold virus.
Rhinovirus
T/F: Influenza virus has no GI symptoms.
T
Adult vs. child influenza
Adult: rapid onset high fever, malaise, myalgia, pharyngitis, non-productive cough
Child: same sx, higher fever, otitis, GI pain/vomiting, croup (non-productive cough)
Which type of influenza (A, B, or C)
Pandemic
Local epidemic
Mild URT infxn
A
B
C
What are the polio vaccines? Which is live/dead?
Salk (dead) and Sabin (live)
What virus causes Hand-Foot-Mouth Dz?
Cocksackie
What is the most common viral cause of myocarditis?
Cocksackie B
What aspect of the spinal cord can be infected by polio virus?
Anterior horn producing paralysis
What is the pathognomonic histo finding of rabies?
Negri bodies
What virus causes German Measles?
Rubivirus (Rubella)
Togaviruses
Rubella, alpha/flavi viruses ( West Nile, Eastern Equine, Dengue, Yellow fever)
Which alpha/flavi viruses are transmitted via mosquito?
Dengue, Yellow Fever (black vomit), West Niles, Eastern Equine, Japanese/St. Louis/Russion Encephalitis
Describe the timeline of HIV in terms of sx and CD4 counts.
Infection: 1-8mo, mono-like illness, resp signs
Stage 1: 8-36mo, CD4 drop from 700 to 2500, latent sx, chronic LA, some opportunistic infxn
Stage 2: 36-60mo, CD4 150-250, sub-clinical immune dysfunction
Stage 3: 60-72mo, CD4 50-150, AIDS
Stage 4: 72+mo, CD4 0-50, AIDS
What is the clinical diagnosis of AIDS?
HIV + and CD4 count less than 200
What is the only DNA virus that replicates in the cytoplasm?
Poxvirus
Name the condition: Variola major (15-40% mortality) and minor (1% mort) Resp droplet spread Lesions extend to deep dermis (scarring) All lesion at same stage of development Centrifugal that moves peripherally
Smallpox
Name the condition: Molluscipoxvirus Small raised papule w/ crater or pus center Self-limited, in kids Assoc w/ HIV patients
Molluscum contageosum
T/F: Parvovirus is the ONLY dsDNA virus.
F. ssDNA
What is the smallest DNA virus and what condition does it cause?
Parvovirus B19, Fifth Dz- slapped cheek rash, arthritis in adults
What is the ONLY dsRNA virus?
Reovirus (Rotavirus)
What are some prion dz?
Kuru, Creutzfeld-Jacob, Scrapie, Wasting syndrome, BSE
What are the TORCH conditions?
Toxoplasmosis Other - Syphilis, Varicella-Zoster, Parvo B19 Rubella Cytomegalovirus (CMV) Herpes
Name the flagellated protozoa: Giardia or Trichomonas Non-bloody foul diarrhea/flatulence Sexual transmission Foul-smelling green vaginal d/c Water-borne
Giardia lamblia
Trichomonas vaginalis
Trich
Giardia
What disease is caused by trypanosomes?
African Sleeping Sickness or Chagas Dz - unilateral eye swelling, cardiomegaly, megaesphogus, megacolon
What are sz of leishmania? What is the vector?
Cutaneous (Oriental sore) or visceral manifestation,
Sandfly
Sporozoa
Plasmodium, Toxoplasma gondii, cryptosporidium, babesia
Name the parasite: Malaria Kitty litter infxn Water borne diarrhea Tick-borne, arthralgia/fatigue, attacks RBCs
Plasmodium spp.
Toxoplasmosis gondii
Cryptosporidium parvum
Babesia bigemina - can look like Lyme
Name the worm:
Roundworm, likes liver/lung, LONG (20-35cm)
Pinworm
Hookworm, microcytic anemia
Trichinosis, via pigs, cardiac/nervous tissue infxn
Ascaris lumbricoides
Enterobius vermicularis
Necator americanus
Trichinella spirilis
Name the worm:
Elephantiasis, clog lymphatics
Snail host, bladder/bowel/liver dz
Tapeworms, long, cause nutrient def (esp B12)
Filariasis
Schistosoma spp. (blood fluke)
Taenia spp (T. solium (pork), T. saginata (beef))
