Comprehensive: RNA Viruses-Fungi Flashcards
Pneumocystis jiroveci Pneumonia
- Inhaled, common in AIDS patients (probably latent endogenous infection), often fatal.
- Trophozoites (yeast-like) reproduce in alveolar type 1 cells and form cysts and rupture - alveoli fill with frothy eosinophillic material; diffuse lung inflitrate.
- Best seen with methenamine silver stains
Candida (albicans)
- Usually superficial (deep infections uncommon and life threatening)
- Endogenous flora, most common precipitating factor = antibiotic use. Yeast converts to invasive hyphae or pseudohyphae form.
- Limited to mucocutaneous sites:
- Thrush = oral cavity, fuzzy white coat on tongue (maceration predisposes)
- Vulvovaginitis = thick white discharge, itchy (antibiotics, preg., diabetes, steroids)
- Sepsis and disseminated candidiasis = usually deadly (catheter, IV, dialysis)
- Endocarditis = large vegetations (IV drug use)
- Other surfaces include esophagitis, paronychia (nailbeds), diaper rash and intertrigo (opposed skin surfaces)
Aspergillosis
-spores (conidia) inhaled
-Allergic bronchopulmonary aspergillosis: restricted to
asthmatics, spores can germinate in airways and cause long-term antigen exposure → exacerbation and infiltrates
-Aspergilloma (fungus ball): Occur in old TB cavities. Cavity wall is collagenous connective tissue with lymphs and plasma cells. Usually left untreated if asymptomatic.
-Inasive Aspergillosis: Occurs when neutrophil count is low (steroids, leukemia). Produces lung and pleural infarcts, but often spreads to blood and causes disseminated infec tion and thrombosis. Usually fatal, antifungals may help.
Mucormycosis (Zygomycosis)
- Environmental fungi, cause severe necrotizing, invasive infections that begin in sinuses and lungs (spores are inhaled)
- Rhinocerebral: creates a black crust with friable/hemorrhagic underlying tissue - spreads to vessels and brain. Tx = surgery, amphotericin B, may be fatal
- Pulmonary: Usually fatal, looks like aspergillosis (sepsis and infarction)
- Subcutaneous zygomycosis: In the tropics, hard inflamm. mass (infects subcutaneous fat) on shoulder, trunk, buttock, thigh
Cryptococcosis (C. neoformans) - encapsulated
- Inhaled- natural reservoir is pigeon droppings
- Impaired cell-mediated immunity common (AIDS, hodkins disease, leukemia)
- CNS = site of primary infection–meningitis. Also causes progressive pulmonary disease
- Fatal without treatment
- Proteoglycan capsule is critical for virulence, - stains poorly with H&E - stains with mucicarmine
- India Ink stain of CNS infection
Histoplasmosis
- Histoplasma capsulatum.
- Primarily effects lung, typically SELF_LIMITED in HEALTHY.
- Intracellular, macrophages = > granulomatous, may resemble TB. => caseous necrosis + calcifications.
- Can dissemminate bone, spleen, liver, adrenal glands, mucocutaneous membranes–AIDS, hepatosplenomegaly (granulomatous deposits) immunocompromised–fatal,
Coccidioidomycosis “Valley fever” “Desert Fever”
- “Valley fever” “Desert Fever”
- Coccidioides immitis or Coccidioides posadasii
- Endemic in certain parts of Arizona, California, Nevada, New Mexico, Texas, Utah.
- Flu-like, maculopapular rash,
- Begins with pulmonary infection (granuloma-caseous)–nodules form in lung with hemoptysis, then disseminates, can cause meningitis in immunocompromised.
- usually after pulomary infection, appearance of eryhthema nodosum (IgG deposits-allergic reaction in fat underneath skin)
Blastomycosis (Blastomyces dermatitidis)
- Very similar to coccidiomycosis, granulomatous, but also suppurative pulmonary dissease–cavitary pneumonia and meningitis with cerebral abscesses.
- Endemic to Midwest, Mississippi river and Ohio river basins, and around the Great Lakes.
- Skin (>50%) and bones (>10%) are most common sites of extrapulmonary involvement.
- skin lesions from disseminated infection resembling squamous cell carcinoma.
- Usually self-limited (1/3 of patients)
Paracoccidioidomycosis (South American/Brazilian Blastomycosis)
- similar to coccidiodomycosis + blastomycosis
- chronic granulomatous infection (with purulent exudates) starting with lung involvement–dissemination in immunocompromised to skin, oropharynx, adrenals, and macrophages of lymphatic system.
- central + south america
- usually acute, self-limited and mild disease
Sporotrichosis
- Rose Gardner’s disease
- accidental inoculation through breaks in skin from thorns piercing skin.
- chronic granulomatous skin infection with suppurative center-necrosis and ulceration–lead to secondary cellulitis
- can disseminate through lymphatic vessels-spread to joints and bone.
Chromomycosis
- tropics and subtropics
- barefooted agricultural workers
- inoculation through skin–lesion(papule) and become verrucous (wart like with ulceration)
Dermatophyte Infections (Microsporum, Epidermophyton and Trichophyton)
- obtain nutrients from keratin–common and benign
- Athlete’s foot or tinea pedis
- Ringworm of the body or tinea corpora
- Facial ringworm or tinea faciei
- Blackdot ringworm or tinea capitis
- Scalp ringworm or tinea capitis
- Ringworm of the hands or tinea manuum
- Ringworm of the nail, Onychomycosis, or tinea unguium
Mycetoma
- chronic granulomatic + suppurative cutaneous disease-through breaks in the skin
- tropical workers–affect feet: MADURA FOOT
- disfiguring skin infection–abscesses that combine–large abscesses with ulceration–purulent discharge-white or black.
Tuberculosis (Mycobacterium tuberculosis hominis, M. bovis)
- Spreads by aerosols from person to person, enters into the lungs
- Forms GHON COMPLEX lesions in lungs (area of infection + lymph nodes) - contains caseous granuloma (necrotizing center) / hilar lymphadenopathy,
- Most cases of primary TB are asymptomatic. In progressive cases (kids, immunocompromised, homeless) non specific symptoms (fever, night sweats, weight loss, fatigue).
- Secondary TB (reactivation or reinfection) - T-cells are already familiar with antigen and cause necrosis and cavities in lungs. Same as primary symptoms + hemoptysis. Disease may disseminate (miliary) and become fatal.
- Todays treatment - long term antibiotics.
Leprosy (Mycobacterium leprae)
-Spreads person to person through intimate contact - respiratory tract or open wounds
-Proliferates in areas of lower body temperature (hands and face)
-Infection occurs in 5% of exposed people and is either tuberculoid or lepromatous
Tuberculoid = Moderate: few lesions, dermal granulomas with sensory loss (not caseous). Reflects appropriate TH1 activation
Lepromatous = Severe: foamy macrophages act as incubators and form globi. Form diffuse, tumor like lesions of skin, eyes, testes, nerves, lymph nodes and spleen–claw shaped hands, saddle nose. Results from deficient TH1 activation.
Mycobacterium avium-intracellulare Complex (MAI)
- Spreads by aerosols from infected water (or infected food, soil)
- Immunocompromised older people (⅓ of AIDS patients!). COPD predisposes.
- Begins in lungs - causes TB like pulmonary cavities and caseating granulomas (but slow progressing)-years to decades. Macrophages engulf (but dont kill) bugs, then spread throughout body
- Antibiotics may control but not cure.
Atypical Mycobacteria
- Not common, may be inhaled, ingested, or inoculated
- M. kansasii - granulomatous disease similar to MAI in older people
- M. scrofulaceum - granulomatous, cervical lymphadenitis in young children
- M. marinum - granulomatous or pyogenic, localized skin lesions - from water (pools)
- M. chelonae or fortuitum - painless abscesses from trauma that ulcerate and then heal
Atypical pneumonia (Mycoplasmal pneumoniae) = Walking pneumonia
- Light or non-productive cough.
- Non-lobar, very small localizations. “Patchy consolidation” often in lower lung.
- Caused by unexpected organisms (Not: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis)
- Caused by atypical bacteria, viruses, fungi,
- smallest free-living prokaryotes
Rocky Mountain Spotted Fever
- Tick-borne, caused by Rickettsia rickettsii , Gram (-) coccobaccilus.
- obligate intracellular pathogen
- Serious, life-threatening illness.
- Early presentation is non-specific, febrile.
- 2-5 days after fever
- Maculopapular or petechial rash spreading from limbs toward trunk.: from infection of vascular smooth muscle and endothelium of large and small vessels
- microthrombi–infarction + dic from hemorrhaging of blood vessels–fatalities
- other symptoms: pulmonary edema,
Epidemic (Louse-Borne) Typhus
- Caused by Rickettsia prowazekii,
- Transmitted by lice, often during disasters, war, or in prisons; human pool.
- Obligate intracellular pathogen–endothelial cells
- Early stage = Febrile
- Later = A rash begins on the chest (infects capillary endothelial cells) about five days after the fever appears, and spreads to extremities (from trunk).
- vasculitis from invasion of enothelial cells–severe
- typhus nodules on liver and spleen.
Endemic (Murine) Typhus
- Caused by Rickettsia Typhi
- Transmitted by flea; rodent pool.
- Similar phenotype to epidemic louse-bourne typhus, but less dangerous.
-Flea feces can be inhaled–pulmonary infection
Scrub Typhus
- Orientia tsutsugamushi, a Gram-negative α-proteobacterium of Rickettsia family.
- Transmitted by Chigger (mites) bite, leaving a black eschar that helps with diagnosis.
- Endemic to parts of Russia, Korea and Japan.
- Generalized lymphadenopathy
- Can be fatal without treatment.
- Similar effects to those above.–obligate intracellular pathogen–infects endothelial cells–hemorrhaging and intravascular coagulation
- myocarditis, meningioencephalitis other complications
Q Fever
- Coxiella burnetii
- From animals–inhalation of aerosolized dropletts
- phagocytosed and proliferation inside macrophages.
- focal bronchopneumonia–atypical pneumonia (from immune response to granulomas
- Typically a self-limited systemic infection, particularly lungs and liver.
- Granulomatous hepatomegaly.
Chlamydiae trachomatis Infections
- most common STD
- Intracellular, cant make ATP -Elementary body attached to cell and becomes endocytosed
- Reticulate body becomes active inside cell, pirates the cell machinery.
- Genital and Neonatal Infections
- Serovars D through K -Asymptomatic in approx 60% women.
- Inflammation of GU tracts, exudate, PID
- Generally non lethal, can cause permanent damage to reproductive system.
- Lymphogranuloma Venereum
- Serovars 1 through 3
- Buboes or abscesses in the groin (inguinal) region where draining lymph nodes are located, progress to necrotizing lymphadenitis.
- Often seen with HIV.
- Trachoma
- Serovars A,B,C
- Leading cause of blindness in underdeveloped.
- Neonatal exposure from mom.
- Effects eyes: characteristic roughening of the inner surface of the eyelids. -Painful, Can lead to visual impairmnent.
Psittacosis (Ornithosis) (Chlamydiae psittaci)
- Spread from Birds in tropics–zoonotic.
- inhalation–atypical pneumonia: no lobar infiltrates
- obligate intracellular pathogen–alveolar cells + macrophages
- Self-limited interstitial pneumonia–alveolar cell lining necrosis and invasion of macrophages
- disseminates–necrosis in liver and spleen and mononuclear infiltrates (macrophages) in heart, kidney and brain. Rose colored spots appear: Horder’s spots
- splenomegaly
- death from complications from hepatitis, endocarditis, myocarditis, encephalitis (
Chlamydia pneumoniae
- obligate intracellular pathogen
- invade epithelial and alveolar cells of lung–necrosis
- atypical pneumonia–bronchopneumonia–no lobar consolidation
- Acute, self-limiting.
- P2P droplet spread.
- fever, sore throat, cough
Syphilis (Treponema pallidum)
- Gram(-), highly motile. -granulomatous–taken up by macrophages
- Pyogenic STD with 3 characteristic stages
- Primary: Chancre (firm, painless) with luetic vasculitis, occasionally multiple lesions in immunecompromised.
- Secondary: (involves systemic spread) Maculopapular rash on palms and soles of the feet, follicular and numular syphilids-cutaneous + mucous membran lesions, condylomata lata (white plaques on perineum region), obliterative endarteritis.
- Latent stage: Asymptomatic
- Tertiary (3-15 yrs after infection): Gumma: soft, tumor-like balls of inflammation which may vary considerably in size–necrotic center with inflammed reddened surrounding–leads to cardiac and cerebral complications if present in heart, or brain. NeuroSyphilis - meningitis, seizure, dementia + tabes doralis (peripheral nerve demyelination) Cardiovascular syphilis- aortitis => aneurism.
- Congenital syphilis can cause snuffles, saddle nose, saber shins, and Hutchinson teeth in newborn
Yaws (Treponema pallidum pertenue)
- Found in tropics, skin-to-skin transmission
- Pyogenic: neutrophilic Raspberrry-like papilloma lesion.
- Diffuse skin lesions, ones on the sole of feet can cause “Crab Yaw” walking
- hyperkeratosis-darkening of skin with infection
- After a latent period, re-emerges as face and upper airway lesions
Bejel (endemic syphilis) (Treponema pallidum endemicum).
- gummas in skin, airways, bone
- transmission is mouth-to-mouth, breast-to-mouth, or utensil-to-mouth
- usually begins in childhood as a small mucous patch, often on the interior of the mouth, followed by the appearance of raised, eroding, Pyogenic lesions on the limbs and trunk. Periostitis (inflammation) of the leg bones is commonly seen, and gummas of the nose and soft palate develop in later stages.
- Mediterrenian/West Africa
Pinta (Treponema carateum)
- spirochete, invade macrophages
- Skin-to-skin transmission
- Mexico, Central America
- Colored spots, scaly/flakey, disease limited to the skin; may leave behind areas of hyperpigmentation
Lyme disease (Borrelia burgdorferi)
- Zoonotic spirochete, Transmitted by ticks, reservoir = mice, deer.
- Stage 1: erythema chronicum migrans (characteristic annular red lesions), fever, malaise
- Stage 2: muscle, heart, and nerve problems, including meningitis and facial nerve palsy
- Stage 3: more joint, skin, and nerve problems - mimics rheumatoid arthritis
- Late manifestations (years later): acrodermatits chronica atrophicans, patchy atrophy and sclerosis of skin
- Diagnosis usually established using antibody titers
Leptospirosis
- Transmission: Water w/ animal urine contacts breaks in the skin.
- Usually mild and self-limited, sever forms cause hepatic and renal failure
- Leptospiremic phase: bacteremic: 1-2 weeks of nonspecific fever, shaking chills, headache, myalgia that resolve on their own (Gets in CSF, but not very virulent–does not cause severe disease by itself)
- Immune phase / Weil disease: 3 days after the leptospiremic phase, symptoms return with vasculitis, hemorrhage, meningitis (CNS pleocytosis), liver and kidney failure, shock and death.
- Mortality of Weil disease is 5-30%
Relapsing Fever (Borrelia recurrentis)
- Epidemic fever disease from lice, caused by Borrelia recurrentis: high untreated mortality
- Endemic version is from ticks, many species
- General symptoms: fever, lethargy, arthralgia, headache, myalgia, petechiae -More specific symptoms: splenomegaly with miliary microabscesses, hemorhages, hepatomegaly because the spirochetes live in liver sinusoids → inflammation
- Sickness comes and goes abruptly in 1-2 week long waves, each time the duration is shorter and symptoms are milder.
- Spirochetes also change their antigenic coats in between each febrile period
- can be fatal
Tropical Phagedenic Ulcer (Bacillus fusiformis and Treponema vincentii)
- a.k.a Tropical Foot, fusospirochetal infection
- Follows trauma (lesions) in the tropics, malnutrition is a factor.
- Painful leg legion with necrosis, sloughing of skin, and gray putrid exudate -May be complicated by tibial osteomyelitis and squamous cell carcinoma
- Deep wounds that persist for years, often need reconstructive surgery to fix
Noma / gangrenous stomatits / cancrum oris
- A disfiguring, smelly facial necrosis that destroys both soft tissue and bones of mouth and face
- Often targets malnourished kids in and immune compromised in the tropics
- Common bacteria: T. vincentii, B. fusiformis (fusospirochetal), Bacteroides, Corynebacterium
- Underlying bone may be revealed.
- Usually need antibiotics and reconstructive surgery
Actinomyces (Actinomycosis)
- filamentous, anaerobic, Gram(+) commensual saprophytes present in oropharynx, GI tract, vagina–requires trauma to cause disease (anaerobic environment)
- Cervicofacial: jaw injury or after dental surgery–leads to purulent abscesses in jaw. “lumpy jaw” -form sulfur granules made of Splendore-Hoeppli material (tangled masses of branching filaments in polysaccharide protein matrix)
- Sinus tracts that penetrate lobe to lobe in pulmonary infections
- progressive, slow growing (anaerobic), disease that is well controlled by antibiotics
- Fatal if untreated
Nocardia (Nocardiosis)
- respiration or cutaneous inoculation
- gram(+) aerobic filamentous
- May affect lungs, brain, skin or systemic dissemination in immunocompromised
- Disease of immunocompromised.
- Pyogenic: Pulmonary abcesses-pyogenic pneumonia w/ central necrosis.
- Fatal if untreated, long term antibiotics.
Brucellosis (Brucella)
- Facultative intracellular parasites causing chronic disease, which usually persists for life.
- four types: goats/sheep, cattle, swine, dogs
- enter through lungs, through skin, oropharynx
- produces UNDULANT FEVER (waxes and wanes)
- multiply in macrophages (lymph nodes, spleen, liver): multi-organ non-necrotizing granulomas
- common complications: spondylitis, arthralgia, meningitis, endocarditis–treat with tetracycline -usually self-limited. mortality