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Infectious disease Flashcards

1
Q

What are the classes of human pathogens? Give an example of each and a disease it causes

A

Prions: prion protein, Creutzfeld-Jacob
Virus: poliovirus, poliomyelitis
bacteria: Streptococcus pneumoniae, pneumonia
fungi: Candida, thrush
protozoa: Trypanosoma cruzi, Chagas disease
helminths: trichinella spiralis, trichinosis

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2
Q

What histochemical stain highlights Histoplasma capsulatum?

A

Romanowsky/Giemsa

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3
Q

Which coccobacillus is negative for Gram staining but stains with silver (causes necrotizing bronchopneumonia)

A

Legionella pneumophila serogroup 1

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4
Q

What is the typical pattern of injury in a kidney bx from post-streptococcal kidney failure?

A

Diffuse proliferative glomerulonephritis

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5
Q

Name 4 viruses that can cause interstitial nephritis

A

CMV, EBV, BK, Hantavirus

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6
Q

Name 4 organisms other than TB that stain with acid fast stain

A

Nocardia sp.
Mycobacterium marinum
Legionella micdadei
Rhodococcus equi

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7
Q

What is the causative organism in cat scratch associated lymphadenitis?

A

Bartonella henselae

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8
Q

What intracerebral infection (ring enhancing lesion) in an HIV patient with a CD4 count of 50?

A

Toxoplasma gondii

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9
Q

What morphology do dimorphic fungi show in histology samples?

A

yeast structures

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10
Q

Negri bodies are seen in which condition?

A

Rabies encephalitis

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11
Q

What are 3 conditions associated with HHV8?

A

Kaposi sarcoma
Multicentric Castleman disease
Primary effusion lymphoma

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12
Q

Name 4 viruses causing hemorrhagic fevers

A

Lassa virus
Ebola virus
Marburg virus
Machupo virus

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13
Q

What are the histologic findings in a colon bx from a patient infected with Shigella?

A

Cryptitis, crypt abcess, pseudomembranes

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14
Q

Name 4 category A disease/bioterrorism agent as classified by the CDC?

A

Bacillus anthracis
Yersinia pestis
Clostridium botulinum toxin
Variola major virus (smallpox)

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15
Q

What is a finding in pseudomonas infections?

A

Necrotizing pneumonia

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16
Q

Name features of primary, secondary, tertiary syphilis

A

1: chancre on the penis/scrotum/vulva/cervix
2: diffuse rash (palmar)
3: endarteritis of proximal aorta, gummas of skin, bone, liver
Argyll0Robertson pupils

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17
Q

What is a cause of elephantitis?

A

Worms in the lymphatic system causing damage to lymphatics; aka filariasis. Includes Wuchereria bancrofti and Brugia sp.

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18
Q

What species of fungi are the most frequent cause of human infections?

A

Candida species

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19
Q

What does symbiosis imply?

A

Organisms that live on or in other organisms (hosts), with a mutually advantageous arrangement

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20
Q

Give 4 features of Whipple disease

A
  • caused by gram-positive actinomycete Tropheryma whippelii
  • histology shows dense accumulation of distended, foamy macrophages in the small intestinal lamina propria
  • Ddx includles intestinal tuberculosis
  • foamy macrophages are positive for PASD, but do not stain with acid fast stain
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21
Q

Name at least 4 human prion diseases

A 
Creutzfeld-Jacob 
Variant Creutzfeld-Jacob
Kuru
Fatal familial insomnia
Gerstmann-Straussler-Scheinker syndrome
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22
Q

What is the condition caused by prions?

A

Transmissible spongiform encephalopathies

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23
Q

What are prions, and how do they differ from other infectious organisms?

A

Infectious agents composed of misfolded proteins, that cause transmissible neurodegenerative disorders
They differ from others in that they do not contain nucleic acids

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24
Q

Describe the pathogenesis of prion disease

A

Normal prion protein (PrP), normally present in neurons undergoes a conformational change to abnormal form making it indigestible to proteases
Infectious (PrPsc) binds to normal (PrP) protein, catalyzing it into the abnormal form
- The new PrPsc continues to catalyze the transformation of more prion protein
- Abnormal prion protein accumulates in neural tissues, causing pathology

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25
What are the 3 methods by which prion disease arises in humans?
- Acquired - Familial - Sporadic
26
What are the clinical presentations of prion diseases?
- Personality changes - Psychiatric disorders (depression) - Lack of coordination - Ataxia - Myoclonus - Sensory changes - Insomnia - Confusion - Memory deficits - Dementia - Paralysis
27
List 5 types of CJD
- Classic CJD - Iatrogenic CJD - Variant CJD - Familial CJD - Sporadic CJD
28
Compare and contrast classical and variant CJD
Classic: age at death: 68 duration of illness: 4 months s/s: dementia, neurologic EEG with periodic short waves: present in 75% florid plaques on histology: absent IHC: variable accumulation immunoblot for protease-resistant protein: not reported detection of infective prion in lymphoid tissue: not detected ``` Variant: age at death: 28 yrs duration of illness: 13 months s/s: psychiatric, behavioural, sensory symptoms EEG periodic short waves: absent pulvinar sign on MRI: present florid plaques on histology PrP accumulation significant on IHC Significant PrP accumulation on immunoblot prion detected in lymphoid tissue ```
29
What are the microscopic features of CJD?
- Spongiform transformation of cerebral cortex, caudate, putamen - Uneven distribution of variably sized small microscopic vacuoles within neuropil and perikaryon of neurons, expanding into cyst-like spaces - Severe neuronal loss and reactive gliosis in advanced cases - Kuru plaques (aggregates of PrPsc) frequently in cerebellum - Kuru plaques also found in cerebral cortex in variant CJD - Plaques are Congo red and PAS positive
30
Which prion disease does not show spongiform change? What are the characteristic histologic findings?
- Fatal familial insomnia - Shows neuronal loss in anterior ventral and dorsomedial nuclei of thalamus, inferior olivary nuclei - Reactive gliosis in anterior ventral and dorsomedial nuclei of thalamus
31
What four factors affect viral tropism?
- Host cell receptors - Cellular transcription factors that respond to viral enhancers and promoter sequences - Anatomic barriers - Local environment including temperature, pH, host defenses
32
Through what 3 mechanisms do viruses cause damage to human hosts?
- Direct cytopathic effects - Eliciting immune response that damages tissues - Transforming infected cells into neoplastic cells
33
What are the three components of the viral particle?
- Envelope - Capsid - Core
34
List the Baltimore classification of viruses and give an example of each.
- dsDNA: herpesvirus - ssDNA: parvovirus - dsRNA: reovirus - +ssRNA: West Nile virus - -ssRNA: rabies virus - ssRNA-RT: HIV - dsDNA-RT: hepatitis B
35
What is the classification of viral hepatitis?
- can be classified by virus or by clinical syndrome - clinical: acute symptomatic infection with recovery, acute symptomatic hepatitis with recovery, chronic hepatitis (+/- progression), fulminant hepatitis (massive/submassive hepatic necrosis) - by virus type: hepatotrophic: hepatitis A,B,C,D, E non-hepatotrophic: CMV, EBV, herpes, adenovirus, HIV
36
What is the definition of chronic hepatitis?
Symptomatic, biochemical or serologic evidence of continuing/relapsing hepatic disease for greater than 6 months
37
What is the frequency of chronic liver disease for each hepatotrophic virus?
- Hep A: 0% - Hep B: 10% - Hep C: 80% - Hep D (coinfection): 80% with HepB - Hep E: 0%
38
What genotypes of HCV have the best response to treatment
- Genotypes 2 and 3
39
What defines the carrier state of HBV?
- Infected individual who can transmit the virus, but is asymptomatic (no liver disease or non-progressive damage) - serologically have anti-HBe, normal AST/ALT, low serum HBV DNA - do not have HBe-Ag
40
What are the laboratory and histologic findings in a healthy carrier of HBV?
- HBsAG+, HBeAG- - AntiHBe+ - HBV-DNA low or negative - ALT/AST normal - bx: lack of inflammation or necrosis
41
What are the histologic findings in acute hepatitis
Hepatocyte ballooning degeneration Cholestasis Lymphocytic infiltrate, zone 3 Apoptotic hepatocytes with fragmented nuclei and eosinophilic cytoplasm focal hepatocyte dropout w/ macrophages Kupffer cell hypertrophy and hyperplasia with lipofuscin pigment portal tract infiltrate with mixed inflammatory cells
42
What are some specific histologic features of acute HAV and HBV?
HAV: plasma-cell predominant inflammatory infiltrate of portal, periportal, lobular areas with perivenular cholestasis, extensive microvesicular steatosis HBV: ground glass hepatocytes caused by cytoplasm packed with spheres of HBsAg
43
What are the histologic findings of chronic hepatitis?
- Lymphocytic portal infiltrate, +/- interface hepatitis - varying degrees of necrosis/bridging necrosis - varying degrees of fibrosis periportal--bridging
44
What are some specific histologic features of chronic HBV and HCV?
HBV: ground glass hepatocytes HCV: lymphoid aggregates +/- germinal centres and reactive bile duct changes, focal macrovesicular steatosis esp. with genotype 3
45
What are the histologic findings in cirrhosis?
Hepatocytes divided into irregularly sized nodules separated by thick bands of fibrosis
46
What are several common grading/staging systems for viral hepatitis?
``` Hepatic activity index Ishak modification Scheuer classification Metavir classification Batts-Ludwig ```
47
What is reported in a grading/staging system for viral hepatitis
- Grade: degree of inflammation/necrosis | - Stage: degree of fibrosis
48
What is fulminant hepatic failure
Hepatic insufficiency that progresses from the onset of symptoms to hepatic encephalopathy in 2-3 weeks in an individual who does not have chronic liver disease
49
What are the morphologic features of fulminant hepatitis?
- Loss of liver mass - Limp, red tissue - Wrinkled capsule - Necrotic red interior with hemorrhage - Complete destruction of hepatocytes, with collapsed reticulin and preserved portal tracts
50
Describe transmission incubation period diagnostic investigations for the hepatotrophic viruses
A: F/O, 2-6 weeks anti-HAV (IgM) B: parenteral, vertical, 6wks-6mo, HbSAg, HBVAg antibody C: parenteral, 5-10wks, HCV RNA or anti-HCV (IgG/IgM) D: parenteral, close contact; 6wks-6mo, Anti-HDV (IgG/IgM), HDV RNA, HDVAg in liver E: F/O, 2-6wks, Anti HEV (IgG/IGM) or HEV RNA
51
What IHC stains are useful in HBV, and how are they used?
- HBV core antigen and HBV surface antigen - can be negative in acute HBV - positive in chronic, with decreased staining when +++Inflammation - HBsAg stains cytoplasm - HBcAg stains nucleus, represents active viral replication - if HBsAG is membranous and HBcAg cytoplasmic=unopposed replication
52
Describe the serological/PCR findings of HBV in the following: - Acute - Chronic (high-infectivity) - Chronic (low-infectivity) - Recovered - Immunized
Acute: HBsAG+, HBeAg+, Anti-HBC IgM, HBV DNA+ Chronic/infective: HBsAG+, HBeAg+, Anti-HBc IgG, HBV DNA+ Chronic/non-inf.: HBsAg+, HBeAg-, Anti-HBe+, Anti-HBC IgG, HBV DNA- recovered: HBsAg-, AntiHBs+, HBeAg-, AntiHBe+, AntiHBc-IgG, HBV DNA- immunized: Anti-HBs + (all the rest negative)
53
What are risk factors for HCV?
- IV drug use - multiple sex partners - recent surgery (6 mo) - Needle stick injury - Multiple contacts with HCV infected popuation - employment in medical/dental fields
54
What is the natural history of HCV infection?
- Persistent infection/chronic hepatitis in 80% | - cirrhosis in 5-20 yrs in 1/3 of pts with persistent infection
55
Describe the morphology and IHC of HDV
- Same features as HBV | - HDAg
56
Describe HDV co-infection, superinfection and helper independant latent infection
- Acute co-infection: occurs on exposure to both HBV/HDV; HBV establised first, providing HBSAg necessary for HDV virions; hepatitis ranges from mild to fulminant (rarely chronic) - Superinfection; occurs when chronic HBV exposed to new HDV; acute hepatitis 30-50d later, fequently develops into chronic disease/cirrhosis - Helper independant: in liver transplants, HDV detected in nuclei of liver w/o HBV (prevented with HBV immunoglobulins)
57
What is hepatitis F
Various undesignated viruses causing hepatitis | some cause hemorrhagic hepatitis with toga-virus like particle on EM
58
Define Hepatitis G
Flavavirus related to HCV, transmitted by blood/sexual contact - no known human disease, not hepatotrophic and no elevations in ALT/AST
59
What is relationship between HGV/HIV
- commonly co-infect | - dual infection protective against HIV
60
What should you do if you cut your finger during an autopsy?
- Follow facility's procedures - Wash wound with warm water/soap - Hold affected limb down to get it to bleed - Do not squeeze wound or soak in bleach - apply antiseptic if necessary (poviodine-iodine 10%) - contact occ heath or ED ASAP
61
What is the usual clinical presentation of infectious mononucleosis?
- Fever, generalized lymphadenopathy, splenomegally, sore throat, fatigue, atypical activated T lymphocytes (mononucleosis cells) in the blood
62
What are the uncommon complications of acute EBV infection?
splenic rupture, upper airway obstruction, hepatitis, encephalitis, pneumonitis, hemophagocytic lymphohistiocytosis

General Pathology Theory (6 decks)

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