Infectious disease Chapter 5 Flashcards
1
Q
Phenolic glycolipid-1 is important in identification of?
A
Mycobacterium Leprae
2
Q
In patients with hepatitis C viral infections treated with interferon, appearance of what skin disease has been most commonly reported?
A
Sarcoidosis
3
Q
Components in HPV important for binding/
entering epithelial cells?
A
L1 (major structural protein) and L2 (minor structural protein)
4
Q
What proteins are responsible for HPV DNA replication and keratinocyte immortalization?
A
Early proteins E1–E7
5
Q
What HPV proteins are expressed in superficial epidermis and encode structural proteins required for virion formation?
A
Late proteins (L1–L2)
6
Q
What strains are in Butchers warts?
A
HPV-7 and HPV-2
7
Q
HPV high-risk mucosal subtypes?
A
E6 and E7 in high-risk mucosal subtypes are oncoproteins.
- E6 -> ubiquitin-mediated p53 destruction -> decrease apoptosis, increase replication, increase mutations
- E7 -> binds RB -> loss of inhibition of E2F transcription factor -> increase expression of genes important for DNA replication
8
Q
Which genus of HPV is mucosal , cutaneous and which is epidermal
A
Genus alpha (most of the mucosal and cutaneous HPV types) and beta (epidermodysplasia verruciformis [EV]- associated HPV types)
9
Q
A
10
Q
Palmar/plantar warts, HPV?
A
HPV-1, HPV-2, -4*, -27, and -57. Vs flat/plane (3,10,28)
Histology: “church spire” papillomatosis + hyperkeratosis, acanthosis (with elongated rete ridges), hypergranulosis, koilocytosis (granular layer); h dermal vessels
11
Q
Flat/plane warts, HPV?
A
HPV-3, -10, -28, and -29.
12
Q
Ridged warts retain normal dermatoglyphics strain?
A
HPV-60
13
Q
Autosomal recessive disorder where host has susceptibility to genus b HPV types (HPV-3, -5, -8, -9, -12, -14, -15, -17, -19–25, -36–38, -47, -49)?
A
Epidermodysplasia verruciformis; mutations in TMC6 (EVER1) and TMC8 (EVER2) (encode transmembrane proteins in endoplasmic reticulum, which interact with Zn transporter 1 -> decreases Zn intracellularly -> decreases Zn-associated transcription factors); Acquired form may be seen in HIV
14
Q
What is WHIM syndrome?
A
Immunodeficiency caused by a CXCR4 mutation— Autosomal dominant
Warts
Hypogammaglobulinemia
Infections (bacterial)
Myelokathexis (= a defective release of BM cells into the peripheral blood; causing neutropenia)
15
Q
What is WILD syndrome?
A
Warts
Immunodeficiency
Lymphedema
Dysplasia
16
Q
Dew drop on a rose petal is seen in:
A
Chicken pox
17
Q
What is Buschke-Lowenstein tumor?
A
HPV-6 and HPV-11, cauliflower-like tumors that infiltrate deeply on external genitals and perianally
18
Q
Red smooth plaque on glabrous penis/vulva that is HSIL or SCCIS; increased risk of progression to invasive SCC; has high-risk HPV types, called?
A
Erythroplasia of Queyrat
19
Q
Epithelioma cuniculatum?
A
Is a keratinizing carcinoma the sole, HPV-2, -11, and -16
20
Q
Heck’s disease?
A
HPV-13 and 32
21
Q
How does HSV evade the immune system?
A
HSV decreases expression of CD1a by antigen-presenting cells [APCs], increases Langerhans cells apoptosis, decreases TLR signaling, interferes w/ MHC class I/II); CD8+ T cells and TLRs control infection
22
Q
Herpes gladiatorum?
A
HSV-1 infection 2° to athletic contact, classically on lateral neck, side of face and forearm.
23
Q
Branching dendritic corneal ulcer?
A
Ocular HSV
23
Q
Biologic associated with increased risk of HSV encephalitis?
A
Natalizumab - indicated for Crohn’s + MS
24
Bodies seen in HSV?
Cowdry A inclusions = eosinophilic inclusion
bodies
25
Tx of acyclovir-resistant HSV?
Foscarnet or cidofovir
26
HHV-3 causes?
Varicella (chickenpox) and Herpes zoster (shingles)
27
Death in disseminated herpes zoster immunocompromised patients?
SIADH development
28
Which CN is affected by herpes zoster that results in hearing impairment or deafness?
CN-VIII - Vestibulocochlear nerve
29
Ramsay Hunt syndrome affects which nerve?
Disease of the geniculate ganglion of facial nerve (CN-VII). Causing ipsilateral facial nerve paralysis, dry mouth/ eyes, anterior two thirds of the tongue taste loss, and auditory (e.g., deafness and tinnitus).
30
Hutchinson’s sign in herpes zoster ophthalmicus is?
Involvement of the side and tip of nose indicates disease of the external division of the V1 nasociliary branch
31
Reye’s syndrome?
Encephalitis + fatty liver, with
concomitant aspirin use
32
What type of HHV is EBV?
HHV-4; Causes infectious mononucleosis, oral hairy leukoplakia, hydroa vacciniforme, Gianotti-Crosti syndrome, genital ulcers, Burkitt’s lymphoma, NK/T-cell lymphoma, post- transplant lymphoproliferative disorder, and nasopharyngeal carcinoma.
33
How is EBV transmitted?
Saliva and blood. EBV infects B cells via CR2/CD21 receptors.
34
Gianotti-Crosti syndrome and papular-purpuric glove and socks syndrome due to what virus?
More common w/ parvovirus B19, may occur in setting of Epstein-Barr virus (EBV) infection
35
What does Monospot test detect?
IgM heterophilic antibodies which are often present in EBV infection and may persist for months after infection; Positive heterophilic antibody (>1:40) and >10% atypical lymphocytes suggests acute infection
36
What is HHV-5?
Cytomegalovirus
37
First -line for CMV?
Ganciclovir (IV) and valganciclovir (oral)
38
HHV-6?
Roseola infantum
assoc. w/ Pityriasis Rosea, Rosai-Dorfman and DRESS syndrome
39
DRESS syndrome associated with?
HHV-6, EBV, CMV and HHV-7
40
HHV-8 etiologic factor for?
Kaposi sarcoma, multicentric Castleman disease, primary effusion lymphoma, and paraneoplastic pemphigus
41
S/E of smallpox vaccine?
LAD, ocular vaccinia, generalized vaccinia, single crusted papule at vaccination site, vesiculopustular, urticarial/morbilliform eruption, eczema vaccinatum (patients with atopic dermatitis, Darier, or Hailey- Hailey disease), EM/SJS, postvaccinial CNS disease, and progressive vaccinia (immunosuppressed patients; can cause death)
42
Cowpox vs. Orf?
Cowpox - Orthopox
Orf - Parapox
43
Orf paradox 6 lesions stages?
1- Maculopapular (umbilicated)
2- Targetoid
3- Acute (weeping nodule)
4- Regenerative (nodule w/ thin crust and black dots)
5- Papillomatous
6- Regressive (crust overlying resolving lesion) then self-resolves
44
Histology of Orf?
Intracytoplasic eosinophilic inclusion bodies, keratinocyte vacuolization, epidermal necrosis, finger-like acanthosis
45
What are Milker’s nodules?
“Pseudocowpox” papules at the site of contact (usually muzzles of calves and teats of cows
46
Chikungunya virus?
Single-stranded +sense RNA virus belonging to Togaviridae family
47
Chikungunya virus transmitted by?
Aedes aegypti
48
Chikungunya virus px?
High fever, marked joint symptoms, “Chikungunya” is an African word for “crooked/bent joints”, and neuropathic acral findings.
Skin: morbilliform eruption, mucosal aphthous-like ulcers, postinflammatory pigmentation of face/extremities
49
Zika virus?
ssRNA virus within the Flaviviridae family
50
Zika virus transmitted by?
A. aegypti and A. albopictus mosquitos
51
Classic cutaneous manifestation of Hepatitis B?
Polyarteritis nodosa. Also, Urticarial vasculitis, Urticaria, Erythema multiforme, Porphyria cutanea tarda, Pruritus
52
HIV is?
ssRNA in retroviridae family (HIV-1 > HIV-2 in causing AIDS)
53
Tx of choice for Erythema elevatum diutinum?
Dapsone
54
HIV most at risk of developing which carcinoma?
BCC > SCC > melanoma
55
HIV-associated disorders CD4+ <50?
Giant Mollusca, MAC, CMV-perianal ulcers, Large non-healing mucocutaneous HSV, papular pruritic eruption
56
HIV-associated disorders CD4+ <250?
Bacillary angiomatosis, Eosinophilic folliculitis, Seborrheic dermatitis, Cryptococcosis, Histolasmosis, Coccidioidomycosis, Botrymycosis, extensive Mollusca, Disseminated HSV
57
HIV-associated disorders CD4+ <500?
Kaposi sarcoma, Oropharyngeal candidiasis, herpes zoster, psoriasis, eruptive atypical melanocytes nevi
58
filler types for HIV-associated facial lipoatrophy?
Poly-L-lactic acid and calcium hydroxylapatite are approved for tx
59
Most common antiretroviral to cause DRESS?
Abacavir, others include: efavirenz, nevirapine, TMP-SMX, and dapsone
60
HLA associated with Abacavir HSRxn?
HLA-B*5701, screen patients before initiating therapy
61
Bullous impetigo is due to?
Phage group II (types 55* and 71*) S. aureus produces exfoliatoxins A and B (ETA and ETB) cleaveing desmoglein 1 causing subcorneal/ intragranular acantholysis
62
Acquired hypertrichosis lanuginosa is associated with?
Lung cancer, Colon cancer, Breast cancer and Plamoplanter keratoderma
63
The Brunsting- perry variant of cicatricial pemphigoid:
Is localized to the head and neck
64
Langerin stain AKA?
CD207 NOT CD117 (mast cells)
65
Tx of widespread Bullous impetigo?
Oral b-lactamase–resistant PCN or first- generation cephalosporin (CSN; clindamycin or clarithromycin if PCN-allergic)
66
Non-bullous impetigo caused by?
S. pyogenes serotypes 1, 4, 12, 25, and 49. Poststreptococcal glomerulonephritis in 5%.
67
Name given to superficial form of S. aureus folliculitis?
Bockhart’s impetigo: small papulopustules on erythematous background
68
Name given to deep form of S. aureus folliculitis?
“sycosis barbae”: large red papulopustules +/– plaques with small pustules
69
Tx for pseudomonal folliculitis, from poorly chlorinated hot
tubs?
self-resolves; ciprofloxacin if severe
70
Gram -ve folliculitis tx?
Isotretinoin
71
Primary site for furuncles?
Head and neck
72
Definition of carbuncle?
Collection of furuncles, often deeper w/ multiple draining sinuses; most often affects thick skin of posterior neck, back, and thighs. Tx: doxycycline, TMP-SMX, and clindamycin.
73
MRSA pathogenesis?
Resistance: specific mecA genes* (from SCCmec types I–VI, mobile genetic elements) encodes mutated penicillin- binding protein, PBP2a* decreasing affinity for b-lactams
74
Virulence factor in community-associated MRSA?
Panton-Valentine leukocidin (PVL) virulence factor
75
Pathogenesis of Staphylococcal toxic shock syndrome (TSS)?
Production of toxic shock syndrome toxin-1 (TSST-1) by certain strains of S. aureus. TSST-1 acts as superantigen, binding to Vb region of TCR and class II MHC on APCs. Nonspecific activation of T cells 1 cytokine storm (increased TNF-a, IL-1, IL-6, TLR2, and TLR4)
76
Toxic shock syndrome (TSS)? tx?
b-lactamase–resistant antibiotics, clindamycin (suppresses toxin production)
77
What's Pyomyositis?
S. aureus infection of skeletal muscle; usually have predisposing factors (immunosuppression, diabetes, trauma, and intravenous drug abuse [IVDA])
78
How to dx Pyomyositis?
MRI
79
What's Botryomycosis?
Deep granulomatous and suppurative infection most frequently caused by S. aureus
80
Splendore-Hoeppli phenomenon?
Seen in histology of botromycosis. Histology: large granules w/ basophilic center (non-filamentous bacteria) and eosinophilic/hyaline periphery (Splendore-Hoeppli phenomenon; composed of IgG and C3 deposits), granules are surrounded by abscess and granulomatous inflammation, granules are PAS+, Giemsa+, and Gram+
81
Ecthyma is?
Deep variant of impetigo; most common in children; caused by S. pyogenes
p/w few vesicopustules, most commonly on legs n develop into “punched-out” ulcers with purulent base and hemorrhagic crust n slowly self-resolves w/ scarring
82
Tx for Perianal streptococcal skin infection?
Oral cefuroxime (1st-line) or PCN (slightly less effective)
83
Erythrasma is caused by?
Corynebacterium minutissimum (Gram- positive filamentous rod) vs. Corynebacterium tenuis seen in Trichomycosis axillaris
84
Erythrasma fluoresces “coral red” w/ Wood lamp due to?
Coproporphyrin III production
85
Pitted keratolysis is caused by?
Kytococcus sedentarius
86
Microbiology of Actinomyces israelii?
Gram-positive, non-acid fast, and anaerobic filamentous bacteria
87
Microbiology of Nocardiosis?
Gram-positive, weakly acid-fast, filamentous bacteria, AFB+, Fite > Ziehl-Neelsen and GMS+
88
Microbiology of Bacillus anthracis?
Gram-positive, spore-forming rod
89
Px of Bacillus anthracis?
“malignant pustule” that drains serosanguinous fluid, vesicle ulcerates to form painless/black/necrotic eschar w/ satellite vesicles and edema
90
The green in green nail syndrome?
Pyocyanin pigment production
91
Blue-green purulent exudate, “moth-eaten” appearance to skin surface, with “mousy” or “grape-like” odor?
Pseudomonal pyoderma
92
Cutaneous lesion indicative of P. aeruginosa septicemia?
Ecthyma gangrenosum
93
Dense neutrophilic infiltrate, and extra- and intracellular organisms (within endothelial cells—Rocha-Lima inclusions) seen w/ Warthin-Starry stain is?
Bacillary angiomatosis and verruga peruana
94
Culturing Bartonella?
B. bacilliformis—PCR, culture, immunologic testing
B. henselae and B quintana—PCR assay (rapid, sensitive), serologies (sensitive, specific; not for B. quintana), chocolate agar culture (slow!)
95
Typhus group?
R. typhi and R. prowazekii
96
Scrub typhus?
R. tsutsugamushi
97
Spotted fever group?
R. rickettsii, R. conorii, R. akari, R. africae, R. japonica, and R. australis
98
Tx for Carrion’s disease?
= Bartonellosis, 1st-line Chloramphenicol plus b-lactam antibiotic
99
Mediterranean spotted fever vector?
Rhipicephalus sanguineus (brown dog tick)
100
Tx for pregnant woman with RMSF?
Chloramphenicol is treatment of choice for pregnant patients but risk of “gray baby syndrome”
101
Rickettsialpox vector?
Liponyssoides sanguineus (house mouse mite). Px w/ papulovesicle at bite site then progresses to eschar then widespread cutaneous eruption
102
Epidemic typhus vs. Endemic typhus vector?
Epidemic - Pediculus humanus var. corporis (human body louse)
Endemic - Xenopsylla cheopis (Oriental rat flea)
103
p/w Fever + similar systemic symptoms as spotted fever group + erythematous macules and papules initially on axillae?
Typhus group always starts in axilla. This px is specifically Endemic typhus
104
Tx for typhus?
Doxycycline in all types of typhus
105
Scrub typhus AKA?
Orientia tsutsugamushi transmitted by the Larval trombiculid mites* “chiggers”
106
Most common in Southern United States; p/w fever, myalgias, thrombocytopenia, leukopenia, and maculopapular or petechial rash (30%–40%) most commonly on trunk, extremities?
Human monocytic ehrlichiosis (HME)
(Ehrlichia chaffeensis) <-- this is a rickettsia-like bacteria
107
Reservoir for Human monocytic ehrlichiosis (HME) (Ehrlichia chaffeensis)?
white-tailed deer (no eschar seen)
108
Ixodes scapularis and Ixodes pacificus (same as Lyme and Babesiosis) also transmit?
Human granulocytic anaplasmosis (Anaplasma phagocytophilum)
109
Q fever AKA?
Coxiella burnetii - transmitted by sheep and cattle
110
Main virulence factor in mennigiococcemia?
polysaccharide capsule* and the endotoxin* causes septic shock and purpura fulminans
111
Neisseria meningitides (gram-negative diplococcus) Quadrivalent vaccine protects against?
Types A/C/Y/W-135
112
Microbiology of Brucellosis (Malta fever)?
Gram-negative coccobacillus
113
What can you get from infected horses, mules, or donkeys?
Glanders caused by gram-negative bacillus, Burkholderia mallei.
114
What are the 4 forms of Glanders?
1- "Localized" - hemorrhagic, ulcerative papulopustule at inoculation site
2- "Chronic" - multiple soft tissue nodules “farcy buds”* on skin overlying lymphatics
3- "Septicemic form" - mortality rate 95% without treatment and 50% w/ treatment
4- "Pulmonary form—mortality similar to septicemic form
115
Gram-negative bacillus Burkholderia pseudomallei causes?
Melioidosis caused by direct contact w/ contaminated water or soil
116
Risk factors of Melioidosis?
Diabetes, CKD, immunosuppression, and IV drug abuse
117
Chronic granulomatous infection as a result of the inability of macrophages to kill phagocytosed E. coli, usually in immunocompromised, causes?
Malakoplakia
118
Malakoplakia usually affects what areas?
Most commonly affects GU tract; may affect skin of perianal/genital region (ulcerated abscesses and soft polypoid lesions)
119
Michaelis-Gutmann bodies seen with granulomatous malakoplakia around the "von Hanzemann cells" stain with?
Von Kossa, PAS, Perls, Giemsa
Von Hanzemann cells stain CD68, lysozyme, alpha-1-antitrypsin
120
What are von Hansemann cells vs. Michaelis-Gutmann bodies?
von Hansemann cells are large macrophages w/ eosinophilic cytoplasm and Michaelis-Gutmann bodies: round, laminated, calcified basophilic intracytoplasmic inclusions; comprised of incompletely killed bacteria within calcified phagolysosomes
121
Tularemia microbiology?
Gram-negative coccobacillus
122
Tx for Tularemia (Francisella tularensis)?
Streptomycin
123
H. influenza microbiology?
Gram-negative coccobacillus
124
What is Rhinoscleroma?
Chronic granulomatous infection of nose and upper respiratory tract
125
Microbiology of Rhinoscleroma?
Gram-negative rod, non-motile
126
Mikulicz cells?
Seen in Rhinoscleroma that is caused by klebsiella = macrophages with phagocytose bacteria
127
Phases of Rhinoscleroma?
Three clinical phases:
○Catarrhal phase - rhinitis, obstruction from soft tissue edema
○Granulomatous/infiltrative phase - granulomatous nodules in upper respiratory tract, epistaxis, dysphonia, anesthesia of soft palate, and Hebra nose
○Sclerotic phase - extensive scarring requires tracheotomy and nasal reconstruction
128
Hx of Rhinoscleroma?
Dense pan-dermal infiltrate of Mikulicz cells containing bacteria (seen w/ Warthin-Starry, Giemsa) and Russell bodies
129
Rat-bite fever (“Haverhill fever”) is caused by?
Streptobacillus moniliformis
130
Classic triad of rat bite fever?
Paroxysmal fever, migratory polyarthritis,
and acral rash
131
Gram-negative bipolar bacillus?
Yersinia pestis --> Plague shows characteristic "safety pin" appearance of bacteria on gram or giemsa stain
132
Most commonly affects men >40 years old who have predisposing factors: liver disease (hemochromatosis, cirrhosis, or alcoholism), diabetes?
Vibrio vulnificus from shellfish
133
Vibrio vulnificus px with?
Hemorrhagic bullae; Tx: doxycycline
134
Organisms from dog bites?
Pasteurella multocida, Pasteurella canis, or Capnocytophaga canimorsus
135
Organism from cat bites?
P. multocida
136
Organisms from human bites?
Eikenella corrodens (a/w chronic
infections), S. aureus (a/w severe infections), Peptostreptococcus, Enterococcus, and Bacteroides
137
Features of second stage of Lyme disease "Early disseminated"?
Early disseminated stage is a result of hematogenous spread of spirochetes if initial phase untreated
♦Borrelial lymphocytoma strongly a/w B. afzelii* and B. garinii* p/w firm, plum-colored tender nodule on earlobes (children), or nipple/areola (adults)
♦Arthritis (60%): monoarticular (knee)
♦Neurologic abnormalities (10%): Bell’s palsy
♦Cardiac complications (5%): AV block, myopericarditis
138
Features of third stage of Lyme disease "Chronic"?
♦Acrodermatitis chronica atrophicans strongly a/w B. afzelii* and B. garinii* occurs months to years after initial infection in middle-aged women; two clinical phases: erythematous plaques with “doughy”/ swollen skin on distal extremities (early phase; easily treated/reversible) n progresses to atrophic “cigarette-paper” skin w/ telangiectasias and subcutaneous fibrous nodules overlying joints
♦Other: encephalopathy, neuropathy, and chronic arthritis
139
What are the non-venereal treponematoses?
Yaws, pinta, and endemic syphilis (bejel)
All caused by Treponema pallidum subspecies
140
Yaws is caused by?
T. pallidum pertenue
141
Yaws is characterized by how many stages?
1° stage: indurated, red, painless papules that enlarges to 1–5 cm, then ulcerates (“Mother Yaw”); occurs at site of inoculation; lower extremities most common
2° stage: multiple, smaller, symmetrical, widespread eruption w/ “daughter yaws” face and intertriginous most common; hyperkeratotic plaques on soles (“crab yaws”); osteoperiostitis, polydactylitis, periosteal thickening
3° stage: necrotic and ulcerative abscesses that heal with severe/deforming scars; palmoplantar keratoderma; bony damage
"Skin + bone disease" "Yaws = Jaws"
142
Pinta is caused by?
T. pallidum carateum
143
Pinta stages?
1° stage: legs w/ papules surrounded
by red halo; enlarges to 10 cm plaques
2° stage: smaller scaly papules and psoriasiform plaques erupt (“pintids”) and change in color from red to blue to brown
to gray/black
3° stage: symmetric vitiligo-like lesions over bony prominences w/ atrophic epidermis; palmoplantar hyperkeratosis;
144
Endemic syphilis/“bejel” is caused by?
T. pallidum endemicum (mucosal disease “ENDemic syphilis attacks ENside surfaces”)
145
Early congenital syphillis features <2 years old?
Snuffles, perioral fissures, dactylitis, Parrot’s pseudoparalysis, syphilitic pneumonitis, epiphysitis, marasmic syphilis, pemphigus syphiliticus, and hepatitis
146
Late congenital syphillis features >2 years old?
Keratitis, mulberry molars, Hutchinson’s teeth (notched/peg-shaped incisors), rhagades (linear scars at angles of mouth), saddle nose, Higoumenakis syndrome, Clutton’s joints, optic atrophy, corneal opacities, and eighth nerve deafness
147
Treponemal and non-treponemal serologic studies?
Treponemal - FTA-ABS, MHA-TP, FTA-ABS-19S-IgM, SPHA
Non-treponemal - RPR, VDRL; IgG/IgM to cardiolipin
148
First serologic test to become positive in syphilis?
RPR and VDRL
149
What stains spirochetes?
Warthin-Starry stain
150
What "bodies" are seen in chlamydia?
“Gamma-Favre bodies” in macrophages on Giemsa stain
151
What "bodies" are seen in Granuloma inguinale?
“Safety pin” Donovan bodies on Wright or Giemsa stain of smears.
Granuloma inguinale is caused by intracellular Gram-negative bacillus
152
What is TB verruca cutis?
Reinfection via inoculation, in patients w/ previous infection w/ moderate to high immunity; #1 form of cutaneous TB; warty/verrucous, growing papule may heal over years
153
Hematogenous dissemination from lung, most often in immunosuppressed patients; pinpoint blue-red crusty papules n small scars
Acute miliary TB
154
Hansen's disease = ?
Leprosy
155
Microbiology of leprosy?
Obligate intracellular, weakly acid-fast bacillus that parasitizes macrophages and Schwann cells
156
Leprosy cultures on?
Cannot be cultured in vitro n must be cultivated in mouse footpads or in armadillos
157
What is the Ridley-Jopling scale?
Divides leprosy into two polar forms (Lepromatous/LL [Th2 response] and Tuberculoid/ TT [Th1 response]), and three borderline forms (BL, BB, and BT)
158
Severe necrotizing vasculitis w/ thrombosis in patients from Mexico and South America with diffuse lepromatous leprosy is called?
Lucio phenomenon
159
Names of the 2 reactions states in leprosy?
Type 1 (reversal reaction; Th1) and Type 2 (erythema nodosum leprosum; Th2)
160
Ulceration of existing leprosy lesions and preferential targeting of nerves is called?
A type 1 reversal reaction, Th1, cell-mediated reaction (in BL).
Tx: Prednisone
161
Multisystem vasculitis and EN-like lesions scattered at previously unaffected leprosy skin sites is called?
Type 2, erythema nodosum leprosum reaction, highest risk with BL and LL patients receiving antimicrobial therapy; treatment = thalidomide
162
Leprosy type that has a grenz zone?
Lepromatous leprosy LL
163
Culturing M. marinum?
M. marinum grows best at 31°C (3 weeks required for growth), as opposed to the usual 37°C for most other mycobacteria
164
Rapid growing mycobacteria?
Mycobacterium fortuitum, chelonae, and abscessus
165
Nonfluorescent dermatophytes?
T. mentagrophytes, T. rubrum, M. nanum, T. megninii, T. gypseum, and T. verrucosum
166
Favus?
T. schoenleinii
167
Kerion caused by?
M. canis, T. verrucosum, T. mentagrophytes, and T. tonsurans
168
Majocchi granuloma and Tinea corporis caused by?
T. rubrum
169
What causes Tinea barbae?
T. verrucosum, T. mentagrophytes,
T. tonsurans, and T. rubrum
170
Tinea cruris caused by?
T. rubrum, E. floccosum, and
T. interdigitale
171
What causes vesiculobullous tines pedis?
T. mentagrophytes
172
What causes black piedra?
Piedra hortae
173
What causes white piedra?
Trichosporon asahii (most strongly linked to white piedra; may cause disseminated disease in immunocompromised patients), T. ovoides, T. inkin, and T. cutaneum
174
Tinea nigra is caused by?
Hortaea werneckii
175
Sporotrichoid spread mnemonic?
"No SALT"
Nocardia, Sporotrichosis, Atypical mycobacteria, Leishmaniasis, Tularemia
176
Cigar-shaped budding yeast?
Sporotrichosis from soil; Tx of choice: Itraconazole
177
“pop bead” or “chain of coins” appearance seen in?
Lobomycosis with species: Lacazia (Loboa loboi)
178
Px of Lobomycosis?
Keloid-like verrucous fibrotic nodules that can ulcerate; ear helix #1 site; men>women
179
Actinomycetoma different grain colors?
white grains > N. asteroides
red grains > A. pelletieri
yellow grains > Streptomycin somaliensis
180
Actinomycetoma tx?
Streptomycin/amikacin 1 TMP-SMX
181
Eumycetoma tx?
Surgical debridement
182
Fonsecaea pedrosoi causes?
Chromoblastomycosis
183
Pseudoepitheliomatous hyperplasia (PEH), granulomatous dermal inammation with medlar bodies (pigmented muriform cells, “copper pennies”) is seen in?
Fonsecaea pedrosoi
184
Diseases with parasitized macrophages?
185
tuberculoid granuloma with
intracellular 2 to 4 mm yeast in histiocytes (looks like leishmaniasis, but see yeast have surrounding halo and are more evenly distributed throughout histiocyte cytoplasm; lacks “marquee sign” and kinetoplast seen in?
Histoplasmosis; geographically: Ohio and Mississippi River valley from inhaled bird and bat droppings
186
Granulomatous dermal inflammation
with unipolar budding yeast (8–18 mm) (broad-based
buds
Blastomycosis; Geography: Eastern USA, Great Lakes, Ohio, and Mississippi River valleys
187
Coccidioidomycosis geography?
Desert Southwest United States (esp. Central Valley/San Joaquin Valley, California), Mexico, and Central America
VS. Paracoccidioidomycosis which is SOUTH America and Mexico
188
Microscopy of coccidioidomycosis?
Large (up to 100 mm) spherules
containing endospores; also has PEH and granulomatous inflammation
189
Px of Coccidioidomycosis?
Face #1 site; verrucous nodules or papules (can be molluscum-like), pustules, abscesses, or ulcerative lesions but Pulmonary manifestations are most common presentation
190
Microscopy: PEH, granulomatous dermal inflammation w/ multipolar budding yeast, mariner’s wheel or Mickey Mouse?
Paracoccidioidomycosis
191
Paracoccidioidomycosis px?
Granulomatous ulcerative oropharyngeal and perioral involvement in 70% of adults; cutaneous lesions can be contiguous, hematogenous, or via inoculation; clinical appearance of ulcers with infiltrated borders (verrucous) and hemorrhagic dots, and associated LAD (can be massive)
192
Candida species in chronic paronychia?
C. parapsilosis
193
Candida species with fluconazole resistance?
C. glabrata and C. krusei
194
Candida species with oropharyngeal candidiasis in HIV patients?
C. dubliniensis
195
Candida microscopy?
KOH = yeast and pseudohyphae
196
What allows candida to adhere to mucosal surfaces?
Chitin, mannoprotein, and glucan
197
"Median rhomboid glossitis" caused by mucocutaneous candida
198
"erosio interdigitalis blastomycetica" caused by candida usually affects third web space of fingers; also fourth web space of toes
199
Microscopy: single-celled sphere with a double cell wall and thick capsule (“halo” appearance), may have one or more buds (blastoconidia); collections of organisms look like soap bubbles is?
Cryptococcosis; C. neoformans and C. gattii
200
Stains for cryptococcosis?
India ink, PAS, mucicarmine, GMS, and Fontana-Masson
201
Virulence factor for cryptococcosis?
Glucuronoxylomannan polysaccharide capsule
202
Septate hyphae with 45° angle
branching?
Aspergillosis and Fusarium
203
Most common species of Aspergillosis?
Aspergillus fumigatus most common
A. flavus second most common
A. niger causes otomycosis
204
Most common fungus cultured in burn patients?
Fusarium solani
205
What can be acquired by inhalation or possibly abrasions with bamboo rat exposure as a risk factor?
Penicilliosis
* Species: P. marneffei is only pathogenic species
* Geography: Southeast Asia
206
Penicilliosis lesions?
Papules with central necrosis and molluscum-like lesions; face, arms, and
trunk
207
Broad ribbon-like nonseptate hyphae with 90° angle branching?
Zygomycosis i.e. mucormycosis
208
Phaeohyphomycosis is due to?
Dematiaceous (pigmented) fungi: Exophiala jeanselmei
209
Hyphae are pigmented/brown, and stain positive with Fontana-Masson?
Phaeohyphomycosis
210
Introduced into skin via trauma in contaminated water. Microscopy shows organisms with a morula-like appearance on H&E is?
Protothecosis
* Species: Prototheca wickerhamii, not a fungus but an algae. Px: olecranon bursitis
211
Very large, up to 300 mm sporangia
containing trophozoites in dermis, is most likely?
Rhinosporidiosis
212
Rhinosporidiosis px with slow-growing friable, red-purple, soft, lobulated, mucosal polyps, particularly on nose (associated with epistaxis), and conjunctivae in young men
213
Dermatobia hominis, human botfly causes?
Myiasis
214
Vector for leishmaniasis?
Sandflies, Phlebotomus (old world) or Lutzomyia (new world)
215
New World leishmaniasis?
L. mexicana, L. amazonensis, L. braziliensis (mucocutaneous)
216
Most common agent in diffuse cutaneous leishmaniasis, usually in immunocompromised?
L. amazonensis (Americas), L. aethiopica (Africa)
217
What is kala-azar?
Visceral leishmaniasis, old > new world most commonly L. donovani (India, Sudan, Bangladesh; most common cause in adults), L. infantum (Europe; often a/w HIV), L. chagasi
218
Kala-azar or black fever will present with?
Specific: papules, ulcers at bite site
Non-specific: purpura, hyperpigmentation (“black fever”), kwashiorkor changes (brittle hair
w/ discoloration), purpura
219
Leishmaniasis culture?
Novy-McNeal-Nicolle medium
PCR is most sensitive and specific test
220
Lesions arising up to 20 years after presumed recovery from untreated visceral leishmaniasis as nodules, verrucous papules, or hypopigmented macules, is?
Post-kala-azar dermal leishmaniasis
221
“Marquee sign” = amastigotes with kinetoplasts are arrayed around periphery of parasitized histiocyte cytoplasm
222
Leishmaniasis tx?
■ Cutaneous and mucocutaneous leishmaniasis: pentavalent antimony (e.g., sodium stibogluconate), miltefosine, pentamidine, intralesional 0.2% ciprofloxacin 1 long-pulsed Nd:YAG
■ Visceral leishmaniasis: amphotericin B (ToC)
223
Trypanosomiasis is caused by?
T. brucei gambiense - West Africa
T. brucei rhodesiense - East Africa
Vector: tsetse fly (Glossina)
224
What is trypanids?
Erythematous, urticarial or macular diffuse eruptions [6–8 weeks] seen in Trypanosomiasis
225
Trypanosomiasis tx?
Suramin or pentamidine if early Melarsoprol (E. African) or eflornithine (W. African) if CNS involvement
226
Ancylostoma braziliense cause?
Cutaneous larva migrans
227
Strongyloides stercoralis causes?
Larva current, moves 5–10 cm/hr, (cutaneous larva migraines moves slower 1-3cm/hr
228
Loeffler’s syndrome is?
= chronic strongyloidiasis which affects
lungs and GI tract and eosinophilia
229
Simulium fly, leopard skin, onchocercomas, causes?
Onchocerciasis (“River blindness”)
230
In Onchocerciasis, “River blindness”, if given diethylcarbamazine and an itchy eruption develops shortly after giving med in infected patient, is called?
Mazzotti reaction
231
Visible worms in adult eyes is called?
Loiasis
232
Chronic—granulomatous reaction in lymphatics causing lymphedema, elephantiasis, hydrocele causes?
Filariasis
233
Edwardsiella lineata (sea anemone) and Linuche unguiculata (thimble jellyfish cause?
Seabather’s eruption
234
Schistosoma, during the cercarial stage (snails are a vector) cause?
Swimmer’s itch, “cercarial dermatitis”
235
Primary dermatologic manifestation is periorbital edema (as a result of type I allergic reaction) and petechiae during parasite migration (esp. splinter hemorrhages) with peripheral eosinophilia and IgE are clues; muscle biopsy is diagnostic are indicative of?
Trichinosis
236
What can you get by eating raw sushi?
Gnathosomiasis
237
Gnathosomiasis px as?
GI symptoms + fever early on;
nodular migratory panniculitis
238
Free-living amoeba that can cause chronic ulcers?
Acanthomoeba
239
Free-living amoeba that can cause painless, red, and granulomatous plaque on central face?
Balamuthia
240
Free-living amoeba that can cause fulminate, fatal acute necrotizing meningoencephalitis?
Naegleria
241
GI-associated amoeba causing amebic colitis, +/- liver, lung involvement?
Entamoeba histolytica
242
Toxin in Fire ants?
Solenopsin D (piperidine alkaloid)
243
Bed bugs?
Cimex lectularius
244
Exaggerated bite reactions occur with?
CLL, chronic EBV
245
Immune reaction substance in bed bugs?
Nitrophorin
246
B. henselae causes?
B. quintana causes?
B. henselae -> cat scratch disease, bacillary angiomatosis
B. quintana -> bacillary angiomatosis
247
Train-track appearance of urticaria or hemorrhage and ophthalmia nodosa are seen in?
Lepidopterism (caterpillar dermatitis) due to direct contact with hairs and toxin-mediated reactions
