Infection and Inflammation II Flashcards
TB detection
Acid fast bacilli in sputum or pus smears by Ziehl-Neelson staining
Very slow growing
3 consecutive samples required
BCG and Mantoux tests
BCG-Live attenuated vaccine
Mantoux test: Intracutaneous or topical application.
Type IV hypersensitivity reaction if previous exposure
Immunosuppressed patients with TB may not be able to mount a response
Systemic characteristics
Cachexia
Caseating granulomas
Ileocaecal, IBD like presentation, RLQ mass
Adrenal: Bilateral, Addisons disease
Peritonitis
Urinary: sterile pyuria, predisposes to bladder Ca.
Treatment
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Pyridixone to reduce isoniazide induced neuropathy
Syphilis
Vertical and horizontal sexual transmission
Increases HIV risk 3-5 fold
Teratogenic
Stages I: Primary
Chancre ulceration 2-6 weeks at mucosal sites
disappears regardless of treatment
30% risk of chronicity
Stages I: Secondary
Skin rash on palms and soles of feet (brown sores)
Fever, head ache, sore throat, lymphadenopathy
Stages I: Tertiary
Gummas (Granulomas with coagulative necrosis
Systemic damage
Diagnosis and treatment
VDRL test
Penicillin V (!)
Leprosy
Acid Fast Bacillin on skin scrapings
Disfiguring skin lesions, nerve damage
Predisposes to amyloidosis A
Treatment of leprosy
Rifampicin, dapsone and ethionamide
Schistosomiasis causes and sequelae
Schistosomiasis ova infiltrate GI and urinary systems causing reactionary granuloma formation resulting in bleeding, fibrosis and strictures
Often causes portal hypertension
Granulomas: immune reaction type and disease states
Type 4 hypersensitivity reaction
Disease states: PBC, Sarcoidosis, Wegener’s granulomatosis, Crohn’s
Tumours such as lymphoma and seminoma
Wegener’s granulomatosis
Granulomatous vasculitis-can occur anywhere
Affects respiratory system commonly and also glomerulonephritis
Sarcoidosis (General)
Non-caseating granulomatous disease predominantly affecting:
- Young
- Female
- Black patients
Often seen in chest with bilateral hilar lymphadenopathy
Sarcoidosis (Respiratory)
Bilateral hilar lymphadenopathy Fever, cough, arthralgia, erythema nodosum Pulmonary fibrosis (controlled by steroids)
Sarcoidosis (CNS)
Uveitis
Cranial nerve palsy
meningitis
Sarcoidosis (Renal)
Nephropathy
Renal calculi due to hypercalcaemia
Sarcoidosis (Cardiac)
Arrhythmias
Cardiomyopathy
pericardial effusion
ESR
Sign of chronic inflammation
Occurs due to increased plasma viscosity
Increased in malignancy Increased in: -Females -Elderly -Obese -Pregnancy -Anaemia
CRP (actions)
- Opsonin
- Activates classical complement pathway
- Upregulates adhesion molecules
- Increases pro-inflammatory markers
CRP (levels)
Acutely raised often in surgical trauma
Mildly raised predisposes to colon cancer and atherosclerosis
>300 independently poor prognostic sign
Steroid side effects
Mineralocorticoid:
Hypertension
Fluid retention
Glucocorticoid: Steroid diabetes Iatrogenic Cushings Poor wound healing Osteoporosis Adiposity
NSAIDS general pharmacology
Absorbed in stomach and small intestine
Detectable after 30-45 mins
Mostly peripheral nerve system effect
Ceiling analgesia
NSAIDs mode of action
Lipophilic at lower pH-as seen around inflamed tissue
Incorporate into cell bilayer and disrupt signals
COX-1 and COX-2 inhibited-therefore PG12 and PGE2 inhibited-antipyretic, anti-inflammatory and analgesic
COX-1
COX-1 constitutive production of prostaglandin-mucin production in stomach and renal perfusion
COX-2
COX-2 inducible from cytokines
NSAID side effects
GI disruption e.g. dyspepsia, gastric and duodenal ulceration Renal toxicity Fluid retention and hypertension Bronchospasm Tinnitus
