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Infectious Disease > ID Exam 1 > Flashcards

ID Exam 1 Flashcards

1
Q

How can we vaccinate children under two months of age?

A

Give vaccine to mother -> maternal antibodies

Ex: whooping cough vaccine in 3rd trimester

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2
Q

Whooping cough vaccine age groups

A

Tdap: 11 years and older, including pregnant women
DTaP: children 2 months to 6 years

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3
Q

Vaccines contraindicated in pregnancy and immunocompromised

A

Varicella
Zoster
MMR

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4
Q

Special use vaccines

A 
Anthrax
Rabies
Small pox
TB
Typhoid
Yellow fever
Japanese encephalitis
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5
Q

Types of bacteria that don’t gram stain

A

No cell wall (mycoplasma, chlamydia)
Intracellular
Other: M. TB, spirochetes, legionella

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6
Q

3 common lactose fermentors

2 rare

A

E coli, klebs, enterobacter

citrobacter, arizona

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7
Q

3 common non-lactose fermentors

A

pseudomonas, salmonella, shigella

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8
Q

2 gram positive rods and size

A

Small: listeria
Lage: clostridium

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9
Q

3 factors that affect infection/dz

A
  1. Host: behavior, susceptibility, response
  2. Agent: prevalence, virulence
  3. Environment
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10
Q

G+ staining factors

A 
Teichoic acid (binds epithelial cells)
Thick PG wall (one wall)
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11
Q

G- staining factors

A 
Endotoxin/LPS
Periplasmic space (ß-lac location)
Thin PG layer (two membranes)
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12
Q

Enterococcus

A

S. Facealis

S. Faecium (VRE)

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13
Q

Staph Aureus virulence

A

Protein A
Capsule
Teichoic acid

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14
Q

Two conditions you can see chronic staph infections

A 
Chronic granulomatous disease
Hyper IgE (Job's)
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15
Q

Staph vs. strep scarlet fever

A

Strawberry tongue in strep only

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16
Q

Staph aureus toxins

A

Exfolatin: Scalded skin and scarlet fever
TSST-1: TSS
Enterotoxin: preformed - food poisioning

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17
Q

Lancefield groups of strep

A

A: beta hemolytic, throat
B: beta hemolytic, vagina
D: none, E faecalis/E faecium, intestinal tract

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18
Q

G A Strep virulence factors

A

M proteins
Attachment: pili and fibronectin binding
Spreading: streptokinase, hyaluronidase, DNA-ase
Toxins: ExoA (TSSL), ExoB (nec fac), A and C (scarlet)
Streptolysin O: RBC lysing

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19
Q

Eagle effect

A

In SEVERE strep treatment
Clinda is better as beta lactams may cause mass release of toxins
Clinda is static, less toxin, better clinical use

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20
Q

Clinical predictors of bacterial vs viral sore throat

A 
Bacterial = tender LN, close contact spread
Viral = runny nose, cough, <3yr old
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21
Q

Strep leading to rheumatic fever risk factors

A

M3 or M18 strain
Family history
Higher ASO titer
PREVENTABLE with abx tx (as opposed to PSGN)

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22
Q

PSGN

A

Not preventable with abx
Only certain M types (M4, M12, M49)
IC deposition in glomerulus BM

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23
Q

ASO titers in strep infection

A

Only for RF and PSGN

Not for acute infection

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24
Q

Infective dose and acid stability

A

Acid stable organisms have lower infective dose
Shigella (10-100) and EHEC (10^3)
Infective dose decreased with food (protection)

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25
Q

G- antigens

A

LPS: (lipid, A, core sacc, O antigen)

Flagellum -> H antigen (motile) T3SS

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26
Q

Genetics of virulence (plasmids, bacteriophage conversion, and chromosomal)

A

Plasmids: resistance, pili, entertox, secretion systems
Bacteriophage conversion: toxins (shiga, cholera)
Chromosomal: PI’s (regions in DNA)

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27
Q

Non-invasive enterics

A

Cholera
ETEC
EPEC
EHEC

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28
Q

Invasive enterics (tend to be inflammatory, therefore WBC in stool sample)

A 
Shigella
EIEC
Salmonella
Yersinia
Campy
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29
Q

Cholera: serogroup, enterotoxin/mech, path, stool, tx

A 
Serogroup A1
Cholera toxin (bacteriophage conversion
Perm binding of AC (increase cAMP, and Cl out)
B binds cell, A trans toxin
Rice water stool
ORT, tetracycline if SEVERE
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30
Q

ETEC: toxins and mech, tx

A

Heat Labile: increase cAMP
Heat Stable: increase gGMP
Non-hemorrhagic stool
Tx: FQ’s

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31
Q

EPEC: setting, virulence/target, path

A

Watery diarrhea in developing country kids
LEE T3SS, Intimin R and inhibit pedestal formation
Loss of microvili leads to malabsorption (increased O2 = more E. Coli)

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32
Q

EHEC: plate fermenting, resivoir, virulence, complications

A

Sorbitol non-fermenting
Cow resivoir (undercooked beef)
LEE T3SS and Shiga toxin
HUS

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33
Q

Shigella: virulence, targets, serotype difference, tx

A

T3SS, uptake, apoptosis of macs, inflammation
A: shiga toxin, dysentery, HUS (O antigen variation)
Tx: Cipro

34
Q

Salmonella non-typhi: transmission, incubation, tox, tx

A 
Food transmit
6-24 hr incubation
PMNs
SPI1 T3SS: invasion, into enterocyte
SPI2 T3SS: survival in macs (replicate in vacuoles)
Self limiting, Cipro in compromised
35
Q

Salmonella typhi: transmission, incubation, tox, tx

A 
Person to person
1-3 weeks
Mononuc phags
SPI1 T3SS: invasion, into enterocyte
SPI2 T3SS: survival in macs (replicate in vacuoles)
Capsule
Typhoid toxin (A2B)
Vaccine (live attenuated)
Cipro and ceftri
36
Q

Campy tox, tx

A

Flagella
Cytolethal
Distending toxin
Erythromycin

37
Q

H. Pylori tx

A

PPI, bismuth, clarithromycin, amox, metro

38
Q

Watery diarrhea: characteristics, bugs

A

Copious, no blood or pus

ETEC, EPEC (esp >14d), (campy)

39
Q

Dystentery: characteristics, bugs

A

Scant volume, pus/mucus present
Tissue invasion, large intestine
Shigella, EIEC, (campy)

40
Q

Bloody, watery: bugs

A

Salmonella, campy, yersina

41
Q

Hemorrhagic colitis

A

Liquid blood, no leuks

EHEC

42
Q

Signs of invasive diarrhea

A 
Penetration of intestines
Decreased volume of stools/blood/mucus (due to inflammation)
Increased pain and cramps
Presence of fecal leuks
Fever
43
Q

General signs of viral GI infection

A

Short on/short off
Prolonged shedding, stable viruses
Seasonal
>75% gastroenteritis is viral

44
Q

Pathophys of viral GI

A 
Local infection of enterocytes
Malabsorption (enterocyte loss)
Local vilus ischemia (blunting)
Viral enterotoxin
Dx often not needed but helpful with outbreak, immunocompromised, and severe cases
45
Q

Reinfection with viral GI bugs

A

Common due to:
Different virus
Multiple serotypes
Short lived immunity

46
Q

Calcivirus (norovirus): characteristics, epi, settings, immunity, dx, tx

A

ssRNA + sense, naked, GII.4 Sydney = US outbreaks
Fecal-oral, surface
8 weeks Asx. shedding, 10-100 infective dose
Cruise ships, nursing homes, hospitals
~6mo immunity (homo FUT2 = heavy resistance)
Dx = PCR, Tx = Rehydration

47
Q

Rotavirus: viral structure and toxin

A

Outer capsid: VP7 w/ VP4 spikes
Inner capsid: VP6
Toxin = NSP4 (increase Cl, maybe destab membrane and increase Ca2+)
Group A is responsible for human infections

48
Q

Rotavirus: epi and shedding

A

50% Asx.
Winter (seasonal)
4-8 days (1-3 incubation, 3 weeks shedding)

49
Q

Rotavirus and calcivirus vaccines

A 
Rotavirus: live vaccine, taken orally
Increased risk of intisusseption
Rota Teq (RV5) pentavalent like bovine (98% against severe dz) - 3 doses (2,4,6 months)
Rotarix (RV1) monovalent live human (85% against severe dz) - 2 doses (2,4 months)
50
Q

Astroviruses

A

Naked star shaped
Needs to be activated by trypsin
7 serotypes identified

51
Q

Adenovirus: GI infection

A

Serotypes 40 and 41
Naked, dsDNA virus
Fecal-oral, no seasonality
Diarrhea THEN vomit 5-12 days

52
Q

Methods of entry and bugs for intracellular pathogens

A

Zipper: Listeria, mycobacterium TB, legionella (tight interaction with engulf)
Trigger: Salmonella, Shigella (T3SS)

53
Q

OBLIGATE intracellular

A

Chlamydia, coxiella, ehrlichia, mycobacterium leprae (deficient in genes), rickettsia

54
Q

FACULTATIVE intracellular

A

All ella’s except coxiella, listeria, mycobacterium TB, nocardia, salmonella, shigella

55
Q

Host defenses for intracellular bugs to avoid and examples

A
  1. NADPH Oxidase (Listeria, shigella = leave vacuole, salmonella = produces SOD takes ROS to H20)
  2. Avoid fusion with lysosomes (legionella, chalymydia)
  3. Fusiogenic (coxiella)
  4. Survives in RBC’s (bartonella)
56
Q

Top infections causing cancer (20% of cancer)

A
  1. H pylori
  2. HBV, HCV
  3. HPV
57
Q

HPV etiology, cancer caused

A

Naked, dsDNA

Cervical (100%) and HandN (25%) CA

58
Q

Late vs early genes in HPV
L1, L2
E1-E7

A

L1: Major capsid
L2: Minor capsid
E6: p53 disruption
E7: RB disruption (E2F)
E5: also virulence, proliferation, transformation, escape
E2: genome maintenance, deletion leads to increased E6 and E7 expression

59
Q

HPV life cycle

A

Epithelial/skin cell infection
Only infects basal layers
Only released from fully differentiated upper layer

60
Q

HPV risk factors

A 
Early onset sex (<20yr so basically everyone)
Multiple partners
Warts
Immunocompromised
Oral sex -> oral infection
Smoke, OCP
61
Q 
Common types of HPV
Common wart
Plantar wart
Anogenital wart
Respiratory papillomatosis (larynx warts)
Epidermaldysplasia verruciformis
Cervical CA
HN CA
A

Common wart: 2,7
Plantar wart: 1,2,4
Anogenital wart: 6, 11
Respiratory papillomatosis (larynx warts): 6, 11
Epidermaldysplasia verruciformis: AR susep. to HPV
Cervical CA: 16 (50%), 18, 31, 33
HN CA: OPSCC (25%)

62
Q

HPV Screening
Ages
Flowchart

A 
<21, >65 yrs: none
21-29: every 3
30-65: every 5
If positive -> cytology -> colposcopy
If cytology neg -> repeat 6-12 months
63
Q

HPV vaccine

A 
L1 only, no L2
No therapeutic effect
Gardisil: 6,11,16,18
Cervarix: 16,18
Gardisil-9: 6,11,16,18,31,33 and more
64
Q

Basic features of herpes viruses

A

Liner, dsDNA, envelope
Latent in cells
Intranuclear inclusions
Multinuclear cells

65
Q

Alpha HHV: virus, latency, replication speed

A

HSV1/2, VZV
Latent in neurons (trigeminal and sacral ganglion ex)
Fast replication

66
Q

Beta HHV: virus, latency, replication speed

A

CMV, HHV6/7
Latent in myeloid cells (CD-34 positive, lymphs and macs)
Slow replication

67
Q

Gamma HHV: virus, latency, replication speed

A

EBV, HHV8
Latent in B cells (CD-21 positive)
Very slow replication

68
Q

Replication cycle basics

A
  1. Infection/enter (glycoproteins)
  2. Unloads dsDNA -> circle = episome
  3. Gene expression: Immediate early, early, late
  4. Protein/capsid enters nucleus to package (inclusions)
  5. Egress via Golgi
69
Q

HHV gene expression: early/late

A

Immediate early: conducive environment
Early: replication
Late: structural proteins (for exit)

70
Q

Viral inclusions

A

Nuclear acidic: Cowdry bodies (HSV, VZV) alpha
Nuclear basic: Owl eyes (CMV)
Nuc/cyto: HH6/CMV, beta

71
Q

HSV-1: location, transmission, clinical manifestations, latency

A 
Above the belt (<50% in common with HSV-2)
Respiratory secretions/saliva
Gingivostomatitis, erythemia multiformis
Encephalitis, herpetic keratitis
Latent in trigeminal ganglion
72
Q

HSV-2: location, transmission, clinical manifestations, latency

A 
Below the belt (<50% in common with HSV-1)
Sexual contact, genitals
Can lead to pharyngitis (oral sex)
Meningitis
Latent in sacral ganglion
73
Q

HSV Reactivation

A

Shortened course of illness compared to original
Rarely systemic
No antiviral tx
Possible but rare: encephalitis/meningitis via reactivation

74
Q 
Herpes encephalitis (HSV-1):
Clinical
CSF
Imagining
Tx
A

Clinical: Fever, HA, AMS
CSF: mononuclear cells, HSV DNA (PCR)
Imaging: MRI>CT
Tx: IV Acyclovir

75
Q

HHV-3: presentation, complications, treatment, vaccine

A 
VZV (varicella and zoster)
Lesions in various stages of healing
Encephalitis, pneumonia
Post herpetic neuralgia (decreases with tx)
Tx: acyclovir within 3 days of start
Vaccine for both. Zoster >60yrs
76
Q

HHV-5 populations and consquences, treatment

A

CMV
Teens: mono, spot - (esp if immunocompetent)
Transplant patients: pneumonia
HIV patients: retinitis
Most common HHV infection in newborns (often mild)
TORCHES (severe, reflects material immune status)
Tx: Gangcyclovir, Forcarnet if resistant

77
Q

HHV6/7: pathophys, presentation, treatment

A

Roseola
Ab reaches 100% by 2 years old (infection occurs early)
Infects B and T cells (latent in same, myeloid)
HIGH fever >104 for 3-7 days, adenopathy, red TMs
Seizure risk with fever
Fever ends and diffuse macular rash starts on trunk and moves out
Tx: Gangcyclovir, Forcarnet if resistant

78
Q

HHV-4: diagnosis early and late

A

EBV
Acute: viral capsid antigen (VCA) and early antigen (EA)
Latent: Epstein-Barr Nuclear Antigen (EBNA)
EBNA-1: links viral to cell genome (closed episome)
EBNA-2: turns on latent genes including cmyc (chr8: Burkitt lymphoma)
Latent in B cells (CD-21)

79
Q

Mono pathophys

A 
HHV-4/EBV
Infects B cells, T cells attack and lyse = symptoms
T on B attack = atypical lymphocytes
Adenopathy, pharyngitis, splenomegaly
Heterophile antibody positive (monospot)
80
Q

HHV-4 associated malignancy

A 
EBV
Post transplant lymphoproliferative disorder
Burkitt lymphoma
B- cell lymphoma
Hodgkin lymphoma (owl's eyes inclusions)
Nasopharyngeal carcinoma
Gastric adencarcinoma
81
Q

HHV-8

A

Kaposi’s Sarcoma and B cell lymphoma
HIV/AIDS patients (and transplant)
Dark/violaceous plaques
Latent in B cells (CD-21)

Infectious Disease (13 decks)

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