Infectious Flashcards
HPV
Type of Virus
dsDNA
HPV-virulence and growth factors
E1-7
E5,6,7 -> amplification
E6: destroys p53 (tumor suppressor)-> proliferation
E7: Binds to RB (stops inhibition of E2F)-> proliferation
L1-L2
Palmo/plantar warts
HPV 1, 2, 4, 27, 57
Flat warts
HPV- 3, 10, 28, 41
Butcher’s warts
HPV- 2, 7
Epidermodysplasia Verruciformis
HPV 5, 8 (associated with AK, SCC)
3, 9, 12, 14, 15, 17, 19, 25, 36, 38
Genetic Mutations EVER1 (TMC6) and EVER2 (TMC8)
Syndromes with HPV
Warts, Hypogammaglobulinemia, Infections, Myelokathexis (CXCR-4)
Warts, Immunodeficiency, Lymphedema, Dysplasia (anogenital)
Most Common STD
genital HPV
High Risk HPV
16, 18, 31, 33, 45
HPV Vaccines and Strains
Quadrivalent (6,11,16,18)
Nine Valent (6, 11, 16, 18, 31, 33, 45, 52, 58)
Epithelioma cuniculatum
HPV 2, 11, 16
Oral warts
HPV 6, 11
Heck’s disease
HPV-13, 32
Human Herpes Virus
linear dsDNA
herpetic sycosis
hsv folliculitis
HSV Laboratory Detection
PCR (most sensitive/specific)
Chowdry A inclusions on histology
HSV treatment
Suppressive thearpy if > 6 outbreaks per year
HHV-3
Varicella zoster virus
Transmission aerosolized droplets
chickenpox: crops in various stages
Congenital Varicella
First 20 weeks of gestation
CNS, ocular and limb abnormalities
VZIG for mom!
disseminated VZV
> 20 lesions outside a dermatome
Ramsay Hunt
Geniculate ganglion (facial nerve-VII)
tympanic membrane
facial paralysis
loss of taste anterior 2/3 of tongue
Hutchinson’s sign
V1 (nasociliary branch of CN-V)
Uveitis, keratitis (2)
Primary Varicella-Rx
Within 3 days of lesion onset
iv acyclovir for immunocompromised
oral in healthy children and adults
Varicella Post-Exposure Prophylaxis
Vaccination: 72-120 hours after exposure in non-immune immunocompetent
VZIg: within 96 hourse in immunosuppressed, pregnant and neonates
Varicella Zoster- Rx
Within 72 hours
decreased PHN in >50 years old w/ Rx
Vaccines also decrease PHN
steroids do not decrease PHN
HHV-4
Ebstein-Barr virus
EBV associated diseases
Infectious Mononucelosis
Oral Hairy Leukoplakia
Burkitt’s lymphoma?
Post-Transplant Lymphoproliferative Disorder
Extranodal NK cell lymphoma
Hydroavacciniforme
HV associated lymphoma
Gianotti Crosti
HHV-5
CMV
CMV-Diagnosis
Fibroblast Culture
EBV-Rx
None
CMV-Gancyclovir
HHV-6
Affects T-Cells
Roseola Infantum
Exanthum Subitum
Sixth Disease
HHV-7
a/w pityriasis rosea and some exanthem subitum
HHV-8
Kaposi’s sarcoma
Multi-centric Castleman
Primary effusion lymphoma
Poxviruses
dsDNA
Smallpox (variola) (Orthopox)
Vaccinia (Orthopox)
Monkeypox (Orthopox)
Cowpox (Orthopox)
Orf (Parapox)
Paravaccinia (Parapox)= milker’s nodules
Molluscum (Molluscipox)
Chikungunya
ssRNA
Togaviridae
Aedes (vector)
Zika
ssRNA
Flaviviridae
Aedes
Timeline to conception for Traveling
Female (2 months)
Male (3 months)
Dengue
ssDNA
Flavivirdae
Aedes
Diagnosis?
Trichodysplasia spinulosa
CMV and HSV
Colonizer of HSV lesions if CD4 < 50
Differential for Molluscum like lesion
Cryptococcus
Coccidioides
Histoplasmosis
Penicillium marneffei
HIV
CD4 < 200
KS
Eosinophillic folliculitis
Apthae
bacillary angiomatosis
disseminated coccidiomycosis
histoplasmosis
crusted scabies
CD 4< 100
cryptococcus
HIV CD4 < 500
psoriasis
herpes zoster
HPV
HSV
staph
candida
HIV CD4 > 500
Seborrheic dermatitis
Oral Hairy Leukoplakia
Vaginal candidiasis
Anti-retroviral lipodystrophy
protease inhibitors (-navir)
Bullous Impetigo
S. Aureus
phage group II (types 55 and 71)
Impetigo
S. aureus > Strep pyogenes
Gram negative folliculitis Rx
isotretinoin
Abscesses, furuncles, carbuncles
culprit?
S. aureus
commonly MRSA
MRSA factoids
Resistance mechanism:
mecA gene (encodes PBP2a)
Virulence factor (Panton-Valentine leukocidin)
SSSS
phage group II (types 55 and 71)
encodes exfoliatoxin A and B -> cleavage of DSG1
S-TSS
Pathogenesis
Syndrome: High fever, rash, hypotension
Blood Cultures often negative
Mortality (3-20%) vs Strep TSS (30-60%)
TSST-1: superantigen (VB region on TCR) which leands to nonspecific T-Cell activation and cytokine storm
Pyomyositis
S. Aureus skeletal muscle infection
Ecthyma
Strep pyogenes
Punched out ulcers
Group A Strep
Strep pyogenes
Strep dysgalactiae
Perianal Strep treatment of choice
cefuroxime
Blistering distal dactylitis
S. pyogenes > S. aureus
Scarlet fever: TOC
penicillin, erythromycin (if pcn allergic)
Strep TSS
Primary source=skin infection (eg necrotizing fasciitis)
Strep A, B, C pyrogenic toxins
Superantigens
Meleney’s gangrene
postoperative nec fasc: polymicrobial
Erythrasma
C. minnitissum
coproporphyrin III (coral)
Trichomycosis axillaris
C. tenuis
Rx: shaving or topical erythromyin
C. perfringens
toxins
Gram + rod (anaerobic)
a-toxin (lipid cleavage)
perfringolysin (vascular clots)
Actinomycosis
treatment of choice
Non-acid fast
penicillin G or ampicillin
Nocardia
Treatment of Choice
weakly acid fast
sulfonamides
Mneumonic: SNAP: sulfonamides=nocardia, actinomyces=penicillin
Actinomycotic mycetoma
causes
Nocardia most common cause > actinomyces
N brasilienis in mexico and S. America
Anthrax
Gram + spore forming rod
Rx for cutaneous anthrax (fluoroquinolones, doxycycline)
Virulence factors:
- capsule (poly-d-glutamic acid)
- Lethal toxin (TNF-a, IL-1B)
- Edema toxin (cAMP-> edema)
Erysipeloid
erysipelothrix (gram positive rod)
Fisherman, poultry/fish handlers
Rx: penicillin, cipro (if pcn allergic)
Listeria
motile gram + rod
neonatal sepsis
Rx: ampicillin, tmp-sulfa
Green Nails
pyocyanin (pseudomonas)
Pseudomonal folliculitis
Treatment
spontaneously resolves within weeks
immunocompromosed or generalized (fluoroquinolone)
diagnosis?
Pseudomonas Hot Foot Syndrome
Red nodules on weight-bearing areas after wading in pools of water
Rx: spontaneous resolution
B. bacilliformis
Cause of Carrions/Oroya fever/verruga peruana
transmission: sandfly (lutzomayia)
Death 2/2 salmonella bacteremia
Rx:
Oroyo fever: chloramphenicol
Verruga Peruana: rifampin/streptomycin
Bartonella culture
chocolate agar
Diagnosis?
Rx
Bacillary Angiomatosis
B. henslea and B. quintana
HIV, CD4 <200
Rx: Erythromycin
Intracellular gram negative rods
Bartonella
Rickettsia
Cat Scratch Disease
young people
immunocompetent> immunocompromised
Rx: Spontaneously resolves (aka no rx)
For severe/complicated: doxy + rifampin
Vector: C. felis (cat flea)
B. quintana
Rx
Trench fever
Rx: doxycycline + aminoglycoside
Ricketsia rickettsii
RMSF
Vector: Dermacentor
Rx: Doxy, even for children
Rickettsia conorii
Mediterranean spotted fever
Conor sounds like a european name!!
doxy
if mild, children: azithro, clarithromycin
Vector: Rhipicephalus (brown dog tick)
Rickettsia akari
Rickettsiapox
Liponyssoides (house mouse mite)
papulovesicle-> eschar -> papulovesicles with hemorrhagic crusts
Rx: None
Ricketsia prowazeki
Epidemic Typhus
Vector: human body louse
Rx: doxy
Ricketsia typhi
Endemic typhus (murine)
Rat flea (Xenopsylla cheopis)
Cat flea typhus (C. felis-> same as bartonella henslea)
Orientia tsutsugamushi
Scrub typhus
Cigers (thrombiculid mites)
Rx: Doxy
Preg: Azithromycin
Ricketsial Diseases without Eschar
Endemic typhus
RMSF
Name?
Disease?
Amblyomma (lone star)
Ehrlichia (infects monocytes and macrophages)
Tick?
Disease?
Ixodes
Lyme, Anaplasma, Bebesia
Coxiella Burnetii
Q fever
Atypical pneumonia or granulomatous hepatitis occurring occasionally.
Chronic Q fever most often manifests as “culture-negative” endocarditis affecting a previously damaged heart valve
aerosols from sheep and cattle
Gram negative diplococcus and coccobacillus
Dipococcus
N. meningitidis
Coccobacillus
Brucella
Francisella tularemia
H. influenzae
Meningococcemia
Treatment of Choice
1) Penicillin
Prophylaxis for contacts with: azithromycin, cipro, rifampin
Virulence factor: polysaccharide capsule
Endotoxin-> shock and purpura fulminans
In US types B, C, and Y are most common
Malta Fever
Brucellosis
Unpasturized milk, inhalation
Rx: Doxy + (streptomycin, rifampin, TMP/SMX, etc)
Glanders
Burkholderia mallei
infected horses
1) Localized-> papulopustule
2) Chronic -> soft tissue nodules
Rx: 60-150 day amox/clav, doxy, TMP/SMX
3) Septicemic
4) Pulmonary
Rx: Carbapenem+ cipro or doxy
Meliodosis
B. pseudomallei
Contaminated water and soil
Risk factors: DM, alcohol, IVDU
Malakoplakia
E. Coli
Histology:
Von Hansemann cells (macrophages)
Michaelis-Gutmann bodies (basophilic inclusions)
Rx: Surgery
Michaelis-Gutmann bodies
Malakoplakia
Stain with von Kossa, PAS, Perls, Giemsa
Tularemia
treatment of choice
most common is ulceroglandular (transmitted via tick bite)
streptomycin
H influenza in children
cellulitis
Rx: ceftriaxone