Ch5 Bacteria (Gonorrhoeae thru Leprosy) Flashcards
What is the most common reportable bacterial infection in the United States?
Neisseria Gonorrhoeae
Gonorrhea: sexual contact (genital areas) Indirect infection is rare (because of _____ and cannot
penetrate intact stratified squamous epithelium). incubation = ________. Affected areas often demonstrate significant ______ discharge, but 10% men and 80% women are ASYMPTOMATIC
drying…2 to 5 days…purulent
75% of patients with disseminated gonorrhea = characteristic skin rash develops…what do they look like? Here are they found?
Papules and pustules that often exhibit a hemorrhagic component and occur primarily on the extremities
Oral cavity gonorrhea can mimic ______, but what is ONE KEY difference?
NUG…LACK OF FETOR ORIS (bad smell)
What is the term for when gonorrhea is spread to the eye during birth of a child?
Gonococcal opthalmia neonatorum
What is the gram for neisseria gonorrhoeae? Whats the morphology?
gram negative diplococcus
What is the most common coinfection with gonorrhea?
chlamydia trachomatis
What is the first line treatment for gonorrhea?
IM CEF-TRI-AXONE + azithromycin or doxycycline
What is the estimate for amount of the world population infected with TB?
ONE FUCKING THIRD :-O (2 buh-buh-billion)
What are two other mycobacterium besides TB that cause infection?
mycobacterium bovis and mycobacterium avium-intracellulare
Besides HIV-infected individuals, how do MOST other cases of NON-TB mycobacterial infections present?
localized chronic cervical LAD in otherwise healthy children
What flavor of mycobacterium is most common as an opportunisitic infection in HIV+ pts?
Mycobacterium avium-intracellulare
Primary TB is in previously UNEXPOSED pts and ALMOST ALWAYS involves what organ?
lungs
What % of patients with TB progress from infection to ACTIVE DISEASE?
ONLY 5-10% (usually in immunocompromised)
What is another name for SECONDARY TB? (reactivation of the bug)
Miliary TB (resembles millet seeds)
Primary TB is usually ASYMPTOMATIC, but what two symptoms are most likely to occur if symptomatic?
fever and pleural effusions
Classically the lesions of secondary TB are located in WHAT REGION of the lungs?
APEX
What is the term for TB involvement of the skin?
Lupus Vulgaris
What are the three most common head & neck sites for extrapulmonary TB?
Cervical lymph nodes, larynx, and middle ear
What are the most common presentations of oral TB? (rare)
chronic ulcers or swellings
Because TB can have ulcerations in the mouth and palpable lymph nodes, what is also on the differential?
SCC
What is the reported prevalence of oral TB lesions? What are the 2 proposed methods of how pulmonary TB would move to the oral cavity?
0.5 - 5% of TB cases have oral manifestations….1) hematogenous spread vs 2) exposure to infected sputum
Primary oral TB WITHOUT pulmonary involvement is RARE…what AGE group is more likely to have this?
children / adolescents
What is the name for a (nonTB) mycobacterial infection obtained from drinking contaminated milk? What are the clinical features? What is a radiographic feature?
SCROFULA…enlargment of OROPHARYNGEAL lymphoid tissues and CERVICAL lymph nodes…radio: calcification of the lymph nodes
What type of giant cell is seen in a TB granuloma?
Langhans (nuclei around the rim)
What is the term for a TB granuloma (besides caseating/necrotizing)?
tubercle
What % of special stains for TB will actually be positive? What is the newer fluorescence microscopy technique called?
27-60%….Auramine-rhodamine stains
What does PPD stand for in the PPD TB skin test?
purified protein derivative
Culturing of TB from a patient is recommended for diagnosis. How long does this take?
4 to 6 weeks may be required to identify the organism in culture
What are the 6 TB meds?
PRIEST: pyrazinamide, rifampin, isonazid, ethambutol (not listed in Neville: Streptomycin, T?)
What is the name of the vaccine used for positive PPD tests? (given in 85% of the world, but not in US due to controversy of its effectivness)
BCG vaccine (Bacilus Clamette-Guerin)
What is the bug responsible for LEPROSY?
Mycobacterium LEPRAE
Where is leprosy thought to first enter the body?
nasal or oropharyngeal mucosa
Why does leprosy choose to live in the skin, nasal cavity, and the palate?
they need a COOL environment
In patients with a high immune reaction to leprosy, what is the term?
tuberculoid leprosy
Which form of leprosy?? Typically, the organisms are not found in skin biopsy specimens, skin test results to heat-killed organisms (LEPROMIN) are positive, and the disease usually is localized.
Tuberculoid leprosy
In patients with a LOW immune response to leprosy, what is the term?
Lepromatous leprosy
Which form of leprosy?? These patients exhibit numerous organisms in the tissue, do not respond to lepromin, and have diffuse disease..
Lepromatous leprosy
What are the 5 categories of leprosy infection?
Tuberculoid leprosy Lepromatous leprosy borderline-tuberculoid borderline-borderline borderline-lepromatous
Woah, what are the incubation periods for tuberculoid and lepromatous leprosy?
2-5 years for tuberculoid, 8-12 years for lepromatous
_______ leprosy exhibits a small number of well-circumscribed, hypopigmented skin lesions. Nerve involvement usually results in anesthesia of the affected skin, often accompanied by a loss of sweating.
tuberculoid (paucibacillary)
_______ leprosy begins slowly with numerous, illdefined, hypopigmented macules or papules on the skin that, with time, become thickened
Lepromatous (multibacillary)
Lepromatous leprosy commonly involves the face and produce enlargements and distort the face, called _______
leonine facies
COLLAPSE OF THE BRIDGE OF THE NOSE IS PATHOGNOMONIC for ?
lepromatous leprosy
Leprosy can cause MACROCHEILIA which can be confused clinically and microscopically with ?
cheilitis granulomatosa
What are the TRIAD of lesions in FACIES LEPROSA?
1.atrophy of the anterior nasal spine 2. atrophy of the anterior maxillary alveolar ridge 3. endonasal inflammatory changes
What color can the crowns of infected leprosy teeth be in children?
red
What is one of the most treatable causes of neuropathy in the world?
neuropathy caused by leprosy
Lepromatous leprosy demonstrates no well-formed granulomas; the typical finding is sheets of lymphocytes intermixed with vacuolated histiocytes known as ______ cells
LEPRA
Which form of leprosy will show an abundance of organisms on histology? Which will show little or none?
Lepromotous = LOTS, tuberculoid = little
Can you culture M. Leprae in culture?
Nope. ID’d by molecular techniques tho
What three abx are given for multibacilliary (lepromatous) leprosy?
(RCD) Rifampicin, Clofazimine, Dapsone
What two abx are given for paucibacilliary (tuberculoid) leprosy?
Rifampicin, dapsone
What are the three animals associated with being hosts for mycobacterium leprae?
armadillos, chimpanzee, mangabey monkey
