Infectious Disease -- Bacterial V - Anthrax, Syphilis, and Mycobacterial Infections

Question 1

Anthrax causative organism?

Answer 1

Bacillus anthracis

Question 2

Bacterial features of Anthrax?

Answer 2

Highly Pathogenic
Encapsulated
G+ Rod
Spore Producing

Question 3

Method of Anthrax transmission?

Answer 3

Contact with animals, animal hides, or animal products

Inhalation of powder if weaponized

Question 4

Which animals are most prone to be all full of Anthrax

Answer 4

Sheep and Goats

Question 5

Progresion of Anthrax

Answer 5

Cutaneous – Small hemmorrhagic pustule into black eschar
Painful Lymphadenitis
Pulmonary – Woolsorter’s Disease
Extensive pneumo. w/ serofibrinous exudation
Septicemia, DIC, Death

Question 6

Anthrax bacteremia may give rise to…

Answer 6

meningitis

Question 7

Virulence factors associated with Anthrax

Answer 7

Antiphagocytic Activity/Leukopenia inducing
Edema Factor
Cytotoxic Factor

Question 8

Why is Anthrax considered a good potential weapon of biological terrorism

Answer 8

Stability in Environemnt
High Virulence
Ease of Respiratory Transmission

Question 9

How is Anthrax controlled

Answer 9

There is a vaccine (limited use in US)
Penicillin
Doxy

Question 10

Mycobacterium tuberculosis is what type of staining

Answer 10

Acid Fast Staining

Question 11

Speed of Mycobacterium tuberculosis growth

Answer 11

pretty slow

Mostly facultative intracellular invaders

Question 12

Virulence factors associated with Mycobacterium tuberculosis?

Answer 12

Glycolipids promote intracellular resistance to intra killing
Inhibit interferon-activation of macrophages
Prevent phago-lysosomal membrane fusion
Stimulate destructive cell-mediated inflammatory injury

Question 13

Mycobacterium tuberculosis histologic hallmarks

Answer 13

Caseating Granulomas

Question 14

Transmission for Mycobacterium tuberculosis

Answer 14

Requires Sustained Contact

Associated with Poverty, Malnourishment, Immunosuppression (AIDS), Elderly, Alcoholism

Question 15

Pathogenesis of Mycobacterium tuberculosis?

Answer 15

Destructive lesions caused by Type 4 rxn

Granuloma

Question 16

Components of a Granuloma

Answer 16

Plump, Round Histiocytes (epithelioid cells)
Langerhan’s multinucleate giant cell
Peripheral collar of fibroblasts
Lymphocytes

Question 17

What causes granuloma formation.

Answer 17

Inability of macrophage to kill bacteria –> Persistent Infections
Development of TH1 cells –> IFN-g
TNF induces chemotaxis of more monocytes + epitheloid

Question 18

Key features of a granuloma formation

Answer 18

Persistent infection by mycobacterium
Type 4 HS
Synthesis of IFN-g
Granuloma, eventual fibrosis + caseous necrosis

Question 19

Features of Primary or Latent Tuberculosis

Answer 19

Individual lacking previous contact with TB
Formation of Ghon focus in middle of lobes
Typically Causes fibrosis, Calcification (rarely progression)

Question 20

Who usually has progression of Primary tuberculosis to miliary/meningtis

Answer 20

Children

Question 21

What is a Ghon complex?

Answer 21

Primary lung lesion with a caseating granuloma in a draining lymph node

Question 22

Causes of Secondary Tuberculosis

Answer 22

Reactivation

Reinfection

Question 23

Symptoms seen in secondary tuberculosis

Answer 23

Cavitary lesions in apical lobes – Higher oxygen tension
Satellite lesions in nodes are distinctly rare
Fever, Night Sweats, Weakness, Loss of Appetite, Weight Loss, Productive Cough, Blood-streaked symptoms

Question 24

What is seen when secondary tuberculosis spreads to tertiary?

Answer 24

Extension to other parts of the lung, empyema
Miliary tuberculosis (bacteremia)
Isolated-organ TB

Question 25

How does the TB spread out of the lungs

Answer 25

Drainage of organisms into lymphatic leads to organism dumping into the blodo via thoracic duct

Question 26

How to diagnose Mycobacterium tuberculosis?

Answer 26

Gold Standard -- Positive Culture Organism (not AFB) AFB in sputum Characteristic X ray findings Quantiferon Test

Question 27

Characteristic findings of Mycobacterium tuberculosis infection

Answer 27

Cavitary Lesion | Calcification of lymph nodes

Question 28

What is a Mycobacterium tuberculosis Quantiferon Test?

Answer 28

An in vitro measure of interferon production in response to exposure to Mycobacterium tuberculosis

Question 29

What happens to most folks exposed to Mycobacterium tuberculosis

Answer 29

Pretty much Nothing. No infection or latent infection. Change in PPD status

Question 30

Progression to Secondary Mycobacterium tuberculosis adds in what symptoms

Answer 30

Pulmonary symtpoms AFB in sputum X ray changes

Question 31

Most common presentation of Tertiary TB

Answer 31

Miliary TB in lung

Question 32

Pathogenesis of Leprosy

Answer 32

Involvement of skin -- Macular, Papular, or Nodular Lesions Infection of Nerves -- Ulnar, Peroneal Greatest effects in coolest parts of the body

Question 33

Organism responsible for leprosy

Answer 33

Mycobacterium leprae

Question 34

Two types of leprosy

Answer 34

Tuberculoid | Lepromatous

Question 35

What happens in lepromatous leprosy

Answer 35

Lack of TH1 mediated immunity Proliferation of Organism in macrophages (foam cells) Contagious

Question 36

What is some generic crap you should know about Syphilis

Answer 36

Microaerophilic spirochete Outer sheath that masks bacterial antigens Sexual and transplacental transmission

Question 37

Organism responsible for Syphilis

Answer 37

Treponema pallidum

Question 38

How do diagnose Syphilis

Answer 38

RPR/VRDL - Nonspecific Cardiolipin antibody test Dark field microscopy + silver stain Specific fluorescent trep. antibody (FTA-Abs)

Question 39

Dark field microscopy can diagnose which stages of Syphilis

Answer 39

Primary and Secondary

Question 40

RPR/VRDL have false positives in what illnesses

Answer 40

Mono, Lupus

Question 41

Antibodies vs. Presence of Organism. | Primary Syphilis

Answer 41

No Antibodies + Organism Present

Question 42

Antibodies vs. Presence of Organism. | Secondary Syphilis

Answer 42

Antibodies + Organism Present

Question 43

Antibodies vs. Presence of Organism. | Tertiary Syphilis

Answer 43

Antibodies + No organisms

Question 44

Syphilis pathogenesis

Answer 44

- Scarcity of treponemes and inflammatory infiltrate suggest central role for immune response in lesions. - Chancres infiltrated with TH1 - Antibody response doesn't eliminate the infection - Endarteritis central to pathology of all lesions (Vasculitis)

Question 45

Type of infiltrate associated with Syphilis

Answer 45

Lymphoplasmacytic | like Lyme Disease

Question 46

Primary Syphilis is characterized by...

Answer 46

Development of Hard Chancre + Spirochete invasion Intense mononuclear infiltrate w/ plasma Obliterative endarteritis Vessel wall Infiltrates

Question 47

Secondary syphilis occurs ____ weeks after primary chancre

Answer 47

2-10

Question 48

Describe Secondary Syphilis

Answer 48

Painless Macular Plaques of Skin ad Mucous Membranes Condylomata Lata Widespread muco-cutaneous regious/Red-brown lesions

Question 49

What are condylomata lata

Answer 49

Wart-like lesions on the genitals in secondary syph

Question 50

Tertiary syphilis requires a latent period of at least...

Answer 50

5 years

Question 51

System most commonly affected by Tertiary Syphilis | How?

Answer 51

Cardiovascular Damage to Proximal Aorta/Aortic Root Obliterative Endarteritis Aneurysms and Dissections/Coronary Insufficiency

Question 52

Non-CV symptoms of Tertiary Syph

Answer 52

- Neurosyphilis (Chronic Meningoencephalitis, Tabes Dorsalis, Charcot's Joint) Syphilitic Gumma

Question 53

What is tabes dorsalis

Answer 53

Foot Drop

Question 54

What is Charcot's Joint

Answer 54

Sensry loss causes person to lose the ability yo feel their feet People knock them into the ground, eventually hurt the ankle/knee

Question 55

CSF Findings in Neurosyphilis

Answer 55

Pleiocytosis Increased Protein Decreased Glucose

Question 56

Pathology of Tertiary Syphilis

Answer 56

Lymphoplasmacytic Infiltrates Obliterative endarteritis Focal epithelioid Granulomas Type 4 rxn

Question 57

What happens in obliterative endarteritis

Answer 57

Endothelial proliferation and intimal fibrosis

Question 58

The important details about Congenital syphilis

Answer 58

Fetus born within 5 years of infection Can cause late abortion Saddle Nose Deformity, Saber Shin, Hutchison teeth Liver and Lungs fucked up

Question 59

Symptoms specific to late occuring form of congenital syphilis

Answer 59

Interstitial Keratitis and CN8 deafness

Question 60

Mycoplasma cause two types of disease. Name them and a causative organism for each.

Answer 60

Pneumonia - Mycoplasma pneumoniae | Urethritis - Ureaplasma urealyticum, Mycoplasma hominis

Question 61

What is BCG vaccine

Answer 61

A vaccination for TB | Extremely variable, not universally protective

Question 62

How is leprosy transmitted

Answer 62

respiratory aerosols

Question 63

Leprosy is propagated in what animal? | Why?

Answer 63

Armadillo | Low Core Temperature

Question 64

Key feature of nerve invovlement in lepros?

Answer 64

anesthesia of the skin

Question 65

Tuberculoid Leprosy has a strong TH_ response

Answer 65

1 | TH1 sucks in lepramatous

Question 66

What do tuberculoid leprosy granulomas look like?

Answer 66

Indurated, flat, hyperpigmented margins with depressed pale centers

Question 67

Is it easy to find bacteria in a tuberculoid lep. granuloma?

Answer 67

Paucibacillary (few bacteria seen in lesions)

Question 68

Describe lepramatous leprosy lesions

Answer 68

Diffuse with lipid laden macrophages containing many bacteria (multibacillary)

Question 69

Which form of leprosy is contagious?

Answer 69

leptramatous