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MHD 1 > L85-L88 > Flashcards

L85-L88 Flashcards

1
Q

Fungi are ___ cells; bacteria are ___ cells.

A

Eukaryotic; prokaryotic

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2
Q

What are two unique features of fungi that distinguish them from human eukaryotic cells?

A
  1. Chitin (rigid cell wall)

2. Ergosterol (predominant sterol)

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3
Q

What is budding?

A

Asexual fungal reproduction of single-celled yeasts

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4
Q

How do fungi with hyphae reproduce?

A

Asexually - bits of the hyphae break off and continue to grow as separate entities, or form stalks containing spores

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5
Q

How do fungi produce spores?

A

Sexually - two mating cells from hyphae of different strains fungi can mate by fusing together and forming a spore stalk

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6
Q

A solitary yeast cell can morph into either a ___ or ___.

A

Germ tube; blastoconidia

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7
Q

What do germ tubes become?

A

True hyphae with septa

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8
Q

What do blastoconidia become?

A

Pseudohyphae

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9
Q

What is the collective term for a mass of hyphae?

A

Mycelium = mold

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10
Q

What is the difference between sporangium and conidiophore?

A

Sporangium: enclosed sac containing spores
Condidiophore: specialized hyphal structure that bear conidia (spores)

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11
Q

What are arthroconidia?

A

Small barrel shaped structures that become spores by breaking off from hypha at septation points

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12
Q

What are chlamydoconidia?

A

Spores at the end of hyphae; contains stored food

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13
Q

What are macro and microconidia?

A

Small and large types of conidia in a fungus

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14
Q

What are dimorphic fungi?

A

Fungi that are yeast-like at 35 C and mold-like at 25 C

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15
Q

What are 4 important examples of dimorphic fungi?

A
  1. Histoplasma capsulatum
  2. Blastomyces dermatitidis
  3. Coccidioides immitis
  4. Sporothrix schenckii
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16
Q

How are fungi transmitted?

A
  1. Person-to-person (Athletes’ s foot)
  2. Contact with environment (inhalation of spores, traumatic inoculation)
  3. Contact with animals (poop, skin/hair)
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17
Q

Fungal ___ mediate colonization of epithelial surfaces.

A

Adhesins

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18
Q

What are some examples of fungi invading natural barriers?

A
  1. Trauma (rose thorns)
  2. Inhalation of spores (Coccioides in dust)
  3. Breakdown of mucosal barriers (catheters)
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19
Q

What are some examples of fungi avoiding phagocytosis?

A
  1. Histoplasma multiply in macrophages

2. Cryptococcus has a capsule

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20
Q

What type of host immunity is required to eradicate infection with fungi?

A

Cellular immunity (humoral is not protective)

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21
Q

What is the most common opportunistic fungal pathogen?

A

Candida

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22
Q

Where is Candida normal flora?

A

GI and GU tracts

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23
Q

How does Candida appear in body fluids?

A

Oval budding yeasts

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24
Q

How does Candida appear in tissues?

A

Yeasts with pseudohyphae

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25
What two species of Candida have germ tubes?
C. albicans | C. dubliniensis
26
C. dubliniensis typically infects what patient population?
Patients who are HIV-positive
27
Which two species of Candida are resistant to fluconazole?
C. glabrata | C. krusei (intrinsic resistance)
28
What type of Candida is associated with UTIs?
C. glabrata
29
In addition to adherence to mucosal cells, how does Candida invade the host?
Production of lytic enzymes to facilitate invasion of epithelial surfaces
30
What are important host defense mechanisms against Candida?
1. Intact skin 2. Normal bacterial flora 3. Recognition of cell wall mannan, which activates the alternate complement pathway and leads to Ab formation 4. Neutrophils and macrophages
31
Mucocutaneous forms of candidiasis are associated with defects in ___, while system spread is generally associated with ___.
Cell-mediated immunity; neutropenia
32
What are risk factors for infection with Candida?
1. Antibiotic therapy 2. Steroids 3. Decreased T cell function 4. Diabetes
33
What are the major clinical manifestations of Candida?
1. Skin and nail infections 2. Mucocutaneous infection (thrush) 3. Vulvovaginal 4. Chronic mucocutaneous candidiasis (disfiguring rash) 5. Candida endopthalmitis (blindness) 6. Candida Esophagitis 7. Systemic infections
34
What is chronic mucocutaneous candidiasis?
Hereditary immunodeficiency disorder due to malfunction of T cells
35
What are the two forms of Candida endopthalmitis?
1. Exogenous - trauma/surgery leads to direct inoculation of anterior chamber 2. Endogenous - candidemia with seeding of retina and choroid
36
How is Candida albicans diagnosed in the lab?
1. Gram stain - produces clusters of round blastoconidia along the hyphae; can also see pseudo and true hyphae 2. Calcofluor - white fluorescent brightener that binds chitin 3. Sabouraud dextrose agar - white to cream-colored, pasty, smooth colonies 4. Production of germ tube
37
Aspergillus is a rapidly growing mold found in ___, ___, and ___.
Soil; air; construction dust
38
Describe the shape and appearance of Aspergillus.
Dichotomous branching (Y-shape, acute angle) and septate hyphae
39
Discuss the pathogenesis of Aspergillus.
1. Inhale spores. 2. Spores bind to fibronectin 3. Inhibition of alternate complement
40
What are the clinical manifestations of Aspergillus?
1. Allergic aspergillosis 2. Fungal ball 3. Invasive aspergillosis 4. Dissemination infection 5. Angioinvasion
41
Describe the color and structure of Aspergillus fumigatus.
Blue-green and fluffy
42
___ refers to angiotropic infection produced by various fungi.
Mucormycosis
43
Where are agents of mucormycosis found?
Fruit, bread, soil, decaying organic debris
44
The species most commonly associated with mucormycosis is ___.
Rhizopus arrhizus
45
Discuss the pathogenesis and prognosis of infections with R. arrhizus.
Invade major blood vessels, cause ischemia/necrosis/infarction, produce black pus Acute, rapidly fatal
46
What are some host risk factors for mucormycosis?
1. Acidotic diabetes 2. Malnourished children 3. Severe burns 4. Severe leukopenia 5. Immunosuppressive disorders 6. Steroids
47
Discuss the pathogenesis of mucormycosis.
Inhalation and deposition of spores in the nasal turbinates or direct inoculation of abraded skin
48
What are the clinical manifestations of mucormycosis?
1. Rhinocerebral mucormycosis 2. Pulmonary 3. GI tract 4. Cutaneous 5. Dissemination 6. Periorbital mucormycosis (may invade brain cavity)
49
What populations most frequently experience rhinocerebral mucormycosis?
People with diabetes/ketoacidosis
50
How does rhinocerebral mucormycosis present?
Face/eye pain, proptosis, progressive signs of involvement of orbital structures; results in death
51
What populations most frequently experience pulmonary syndromes related to mucormycosis?
People with neutropenia
52
What populations most frequently experience GI syndromes related to mucormycosis?
Patients with severe malnutrition
53
What are the treatment strategies for mucormycosis?
1. Early diagnosis 2. Reverse underlying risk factors (immunosuppression, hyperglycemia) 3. Debridement
54
How is mucormycosis diagnosed in the lab?
1. Broad, ribbon-like hyphae with 90 degree irregular branching 2. Wooly white/grey growth 3. Characteristic sporangia
55
Fungal infections of keratinized tissues are typically caused by ___.
Dermatophytes
56
What is onychomycosis?
Nail infections caused by any fungus
57
Transmission of dermatophytosis requires what?
Close personal contact
58
What are the 3 genera of dermatophytes?
1. Epidermophyton 2. Microsporum 3. Trichophyton
59
Describe tinea pedis.
Athlete's foot, most common dermatophyte infection Weeping, peeling lesion between 4th and 5th toes; scaling, fissuring, maceration, erythema, itching, burning
60
Describe tinea capitis.
Dermatophytosis of scalp due to invasion of hair Hair becomes dull, lusterless, breaks near the follicle
61
Describe tinea corporis.
Dermatophytosis of glabrous skin (face, shoulder, arms) Classic ringworm
62
Describe tinea cruris.
Infection of groin, perineum, scrotum, perianal area More common in men Erythema, pustule formation, hyperpigmentation, itching, burning
63
Discuss the pathogenesis of dermatophytes.
Inoculation via minor trauma, penetration of stratum corneum, proliferation, lateral spread
64
How is dermatophytosis diagnosed in the lab?
1. KOH preparation | 2. Examine hair under Wood's light
65
Describe the shape of Cryptococcus neoformans.
Round (not oval) with polysaccharide capsule
66
Where is C. neoformans found?
Worldwide, pigeon poop, soil
67
C. gattii is endemic to what locations?
SoCal, Mexico, Pacific Northwest
68
What does a positive skin test for Cryptococcosis indicate?
Exposure (not illness)
69
Discuss the pathogenesis of Cryptococcosis.
Inhalation from environment to lungs, from there to CNS Capsule blocks complement
70
What are the clinical manifestations of Cryptococcosis?
Meningoencephalitis
71
What are the symptoms of meningoencephalitis?
Headache, nausea, gait abnormalities, dementia, irritability, CN abnormalities, hydrocephalus, fever, nuchal rigidity, coma, death
72
What types of skin lesions may be seen in Cryptococcosis?
Raised skin lesions with dissemination
73
How is Cryptococcosis diagnosed in the lab?
1. Fast growing, soft, mucoid, cream/pink/yellow-brown 2. Encapsulated yeast in India ink preparation 3. Standard: flow assay/latex agglutination for Ag detection 4. Gram stain 5. GMS 6. Mucicarmine stain
74
How is C. neoformans differentiated from other forms of Cryptococcus?
Ability to grow at 37 degrees C
75
Where is Histoplasma capsulatum found?
Soil, bird/bat droppings
76
Where is H. capsulatum found in the world?
OH/Mississippi River Valleys
77
Describe the yeast and mold phases of H. capsulatum.
Yeast: found in macrophages Mold: tuberculate macroconidia No capsule
78
What are the clinical manifestations of H. capsulatum?
1. Asymptomatic 2. Pulmonary (infiltrates, lymphadenopathy, cavitating lesion, fever/night sweat/weight loss) 3. Disseminated
79
Discuss the pathogenesis of H. capsulatum.
Conidia inhaled, convert to yeast, which are phagocytosed by macrophages Infection of RES by yeasts growing in macrophages
80
What is the primary lesions seen in H. capsulatum?
Granuloma in the lung
81
How is Histoplasmosis diagnosed?
1. Standard: urine antigen test Can do skin test and bone marrow culture
82
__ budding yeast cells are typical in H. capsulatum.
Intracellular
83
H. capsulatum predominates at the ___ portion of lesions.
Central
84
Describe H. caspulatum at 25 C.
1. Slow growing 2. Granular to cottony 3. White, then buff brown 4. Hyphae are septate and hyaline 5. Macro and microconidia
85
Describe the yeast and mold forms of Blastomyces dermatitids.
Yeast: large thick walled with broad based buds Mold: not unique
86
Where in the US is Blastomyces dermatitidis found?
Central US
87
Blastomyces dermatitidis is associated with ___ and ___.
Soil; wood
88
What are the clinical manifestations of Blastomyces dermatitidis?
1. Pulmonary - acute or chronic pneumonia 2. Skin lesions 3. Lytic bone lesions 4. Disseminated disease
89
Describe the appearance of Blastomycoces dermatiditis at 25 C.
Membranous texture White to beige Septate hyaline hyphae and unbranched short conidiophores Look like lollipops
90
Describe the appearance of Blastomycoces dermatiditis at 37 C.
Appears as budding yeast cells with a double-contoured refractile wall and broad base budding
91
Where in the US is Coccidiodomycosis found?
SW US
92
Describe the yeast and mold forms of Coccidiodes.
Tissue: spherule filled with endospores Culture: mold with barrel shaped arthroconidia
93
Which type of Coccidiodes is found in CA and which is found outside CA?
In CA: C. immitis | Outside CA: C. posadasii
94
Discuss the pathogenesis of Coccidioides.
Inhalation of arthroconidia bypasses upper airway into alveoli Monocytes ingest; arthroconidia convert to spherules
95
What are the clinical manifestations of Coccidiomycosis?
Fever, cough, chest pain, malaise Dissemination Erythema nodosum
96
How is Coccidiomycosis diagnosed in the lab?
1. Microscopic exam to detect spherules 2. Culture - demonstrate alternating arthroconidia 3. Skin test 4. Serology
97
What are two causes of subcutaneous mycoses?
1. Sporotrichosis | 2. Chromoblastomycosis
98
Describe the yeast and mold forms of Sporothrix schencki.
Yeast: cigar-shape Mold: daisy-like conidiophore
99
Where is Sporothrix schenckii found?
Soil, rose thorns, moss
100
What are the clinical manifestations of Sporotrichosis?
Papular skin lesions that enlarge and ulcerates, appearance of subcutaneous firm nodules
101
Discuss the pathogenesis of Sporothrix.
Inhalation or traumatic inoculation, multiplication, pyogenic/granulomatous response, spread via lymphatics
102
What is a post-traumatic chronic infection of subcutaneous tissue and how does it appear?
Chromoblastomycosis; verrucous cauliflower-like papules on lower extremities
103
How does Chromoblastomycosis appear on histology?
Copper pennies
104
Only ___% of people infected with TB develop disease in their lifetimes. The remainder have ___ infections.
7-10; latent
105
Of those who are infected with TB, ___% of patients with AIDS will develop active disease per ___.
10; year
106
Who is at risk for being infected with TB?
1. Close contacts 2. Foreign-born persons from areas where TB is common 3. Medically underserved, low income populations 4. Residents of long-term care facilities 5. Persons who inject drugs 6. Migrant farm workers and homeless persons 7. Occupationally exposed persons
107
Who is at risk for progressing to disease with TB?
1. People with HIV 2. People who were recently infected with TB 3. Certain medical conditions 4. Injection drug use 5. History of inadequately treated TB
108
How is TB transmitted?
Airborn
109
True or false - extrapulmonary TB is rarely contagious.
True
110
Discuss the pathogenesis of TB.
Pathogen gains access to alveolar macrophages, proliferates, and spreads via lymph nodes and blood.
111
What is the primary site of lung infection in TB?
Ghon focus
112
What is the Ghon focus + mediastinal lymph nodes?
Ghon complex
113
What is a calcified Ghon complex?
Ranke complex
114
The vast minority of secondary (reactivation) TB disease is ___.
Extrapulmonary (most are pulmonary)
115
What is seen on CXR in TB?
Upper lung field infiltrates, cavities
116
What are common sites of extrapulmonary TB?
Brain, epiphyses of long bones, kidneys, vertebral bodies, lymph nodes
117
In immunocompetent patients, ___% have pulmonary TB. ___% have XPTB. What about patients with AIDS?
85; 15 1/3 - pulmonary 1/3 - XPTB 1/3 - both
118
Which type of XPTB is most common in children? Which type is most common in older patients?
Children - CNS TB | Older patients - TB pericarditis
119
What is osteomyelitis of the spine (TB)?
Pott's disease
120
What are the groups of non-TB mycobacteria?
Group 1: photochromogens Group 2: scotochromogens Group 3: nonphotochromogens Group 4: rapid growers
121
Where is NTM found?
Bioaerosols, water, soil
122
What are predisposing conditions for NTM lung disease?
Structural lung abnormalities (COPD, bronchiectasis, IPF, chest radiotherapy, congenital cystic abnormalities, previous pulmonary emboli/infarct, recurrent aspiration pneumonia)
123
How does NTM infection contrast with TB?
1. NTM is environmental in origin (not human-to-human) 2. NTM requires an underlying predisposition 3. NTM does not have a prolonged latent phase 4. NTM infections do not disseminate outside the lungs 5. No skin/Quantiferon testing for NTM 6. CXR presentations of NTM may differ from TB
124
What are the most common infections in the US?
URIs
125
What are the syndromes included under the designation of URI?
1. Rhinitis 2. Sinusitis 3. Otitis 4. Pharyngitis 5. Laryngotracheitis 6. Epiglotitis 7. Bronchitis
126
The vast majority of URIs are ___ and ___.
Viral; self-limited
127
Rhinitis refers to a "___."
Runny nose
128
What are some causes of rhinitis?
Infections, allergies, over-use of nasal decongestants, systemic disease
129
Infectious rhinitis = "___."
The common cold
130
What are the etiologic agents in the vast majority of infectious rhinitis cases?
Viruses
131
Acute sinusitis is commonly preceded by ___.
Acute or chronic rhinitis
132
What is an important contributor to the pathogenesis of acute sinusitis?
Impaired drainage of the sinuses by inflammatory edema of the mucosa
133
What are the clinical symptoms of acute sinusitis?
Congestion, sinus tenderness, fevers, purulent nasal drainage
134
90% of acute sinusitis cases are caused by viruses. What are the bacterial causes?
Bacteria in the oronasal cavity - S. pneumoniae, H. influenzae, Moraxella, oral anaerobes
135
If there is strong suspicion of bacterial sinusitis, what antibiotics should be given?
Ampicillin Amoxicillin Bactrim Augmentin (amoxicillin-clavulanate)
136
How do patients with pharyngitis present?
Sore throat and fever
137
70% of pharyngitis cases are caused by viruses. What bacteria can cause this?
Group A or B Strep - Strep throat - high fevers and patchy tonsillar exudates
138
Epiglottitis occurs most often in ___. How do they present?
Children age 2-7 High fever, sore throat, drooling, sitting upright, signs of systemic toxicity
139
Why might epiglottitis become a medical emergency?
Swelling can lead to airway obstruction
140
What can be seen on CXR in epiglottitis?
Thumb sign (enlarged epiglottis protruding from the anterior wall of the hypopharynx)
141
What are the most common etiologic organisms of epiglottitis?
H. influenzae GAS H. parainfluenzae
142
How is epiglottitis treated?
Assess/secure airway Augmentin (amoxicillin-clavulanate) Unasyn (ampicillin-sulbactam) 3rd gen cephalosporin
143
What is the typical presentation of acute bronchitis?
Cough with purulent sputum production for 5+ days
144
Acute bronchitis is most commonly caused by viruses. What are common bacterial agents?
Mycoplasma S. pneumoniae H. influenzae B. pertussis
145
What is the treatment for acute bronchitis?
Supportive care | Not cough syrups, anti-tussives, or mucolytics (don't work)
146
What is a lower airway infection/inflammation?
Pneumonia
147
What are the 5 possible routes for pathogens to reach the lower airways?
1. Direct inhalation 2. Aspiration of upper airway contents 3. Spread along the mucous membrane surface 4. Hematogenous spread 5. Direct penetration (rare)
148
What are risk factors for developing pneumonia?
1. Old age 2. Underlying pulmonary disease 3. Smoking 4. Recent viral illness 5. DM 6. CKD 7. Immunodeficiency
149
What are the symptoms of pneumonia?
Cough, sputum production, shortness of breath, fever Elderly patients may not have this typical constellation and may present with mental status changes/not acting quite themselves
150
What are signs of pneumonia on exam?
Crackles, rhonchi, increased bronchial breath sounds, vocal fremitus, dullness to percussion over the areas of consolidation, leukocytosis
151
What will CXR show in pneumonia?
Focal infiltrate, maybe air bronchograms
152
What is the difference between bronchopneumonia and lobar pneumonia?
Bronchpneumonia: patchy, >1 lobe, infection starts in bronchioles and spreads to parenchyma Lobar: contiguous, 1 lobe, S. pneumo
153
What are the 7 syndromes of pneumonia?
1. Community-acquired bacterial 2. Community-acquired viral 3. Nosocomial 4. Aspiration 5. Chronic 6. Necrotizing/abscess 7. Immunocompromised host
154
What are the common etiologic agents of community acquired bacterial pneumonia?
Common: S. pneumo, H. flu, M. catarrhalis, S. aureus Less common: Mycoplasma pneumoniae, Chlamydia pneumonia, Legionella pneumophilia - cause "walking pneumonia"
155
How is Legionella diagnosed?
Urinary antigen
156
How do patients who have community acquired bacterial pneumonia with S. pneumoniae present?
Fever, shaking chills (single chill), rusty colored sputum, dyspnea, pleuritic chest pain
157
How is community acquired bacterial pneumonia treated?
Outpatient: macrolides or doxycycline Outpatient with comorbid illness/recent antibiotic therapy - respiratory FQ Inpatient: macrolid + beta lactam At least 5 days
158
What are the most common viral causes of pneumonia?
Influenza RSV Adenovirus Parainfluenza
159
What are the symptoms of influenza?
Fever, cough, headache, sore throat, feel MISERABLE
160
What are the antiviral therapies to treat influenza?
Oseltamivir | Zanamivir
161
How do children with community acquired pneumonia present?
Tachypnea, fever, mild cough, dyspnea
162
What tends to cause community acquired pneumonia in children under 2?
Viral
163
What tends to cause community acquired pneumonia in children 5-10?
Mycoplasma
164
What tends to cause community acquired pneumonia in children 10-16?
S. pneumoniae, Chlamydia
165
What are the common etiologic agents of nosocomial pneumonia?
``` K. pneumoniae E. coli Enterobacter Proteus Serratia Pseudomonoas Acinetobacter MRSA ```
166
What is the treatment for nosocomial pneumonia?
Anti-pseudomonal cephalosporin Anti-pseudomonal carbapenem Beta lactam + beta lactamase Add Vancomycin if MRSA is concerning
167
Who typically gets aspiration pneumonia?
Debilitated patients Loss of gag/swallow reflex Repeated emesis
168
What organisms are involved in aspiration pneumonia?
Polymicrobial - mix of GN aerobes and anaerobes
169
How is aspiration pneumonia treated?
Beta lactam + beta lactamase | 3rd generation cephalosporin + metronidazole
170
What characterizes chronic pneumonia?
Subacute onset of symptoms of 6+ weeks
171
What causes chronic pneumonia?
Slow growing organisms (mycobacterium, nocardia, actinomyces) Endemic fungi (Histoplasmosis, Blastomycosis, Coccidiomycosis) Coxiella Tularemia Obstructed airway
172
What can cause abscess pneumonia?
Necrotizing pneumonia (S. aureus, S. pneumo, Klebsiella, Pseudomonas) Aspiration Tooth abscess Septic emboli
173
What bugs can cause abscess pneumonia?
Fusobacterium Bacteroides Peptostreptococcus Aerobic/anaerobic strep and GN rods
174
How is abscess pneumonia treated?
Piperacillin-tazobactam (Zosyn) Clindamycin 4-6 weeks
175
What are causes of neutrophil dysfunction?
Chemo, leukemia, CGD
176
What organisms lead to pneumonia in people with neutrophil dysfunction?
GN rods Staph Aspergillus Candida
177
What are causes of T cell dysfunction?
AIDS T-cell lymphoma Solid organ transplant DiGeorge syndrome
178
What organisms lead to pneumonia in people with T cell dysfunction?
``` CMV Herpes Simplex Virus Pneumocystis Listeria Candida Aspergillus Cryptococcus Mycobacteria ```
179
What are causes of B cell dysfunction?
Splenectomy Lymphoma Myeloma Gamma globulin deficiency
180
What organisms lead to pneumonia in people with B cell dysfunction?
``` S. pneumo H. flu Neisseria Klebsiella E. coli Giardia ```
181
Exposure to bat or bird droppings may lead to pneumonia with ___.
Histoplasma capsulatum
182
Exposure to birds may lead to pneumonia with ___.
Chlamydophila psittaci
183
Exposure to rabbits may lead to pneumonia with ___.
Rabbits
184
Exposure to farm animals may lead to pneumonia with ___.
Coxiella burnetti
185
Hotel or cruise ships may lead to pneumonia with ___.
Legionella
186
Travel to SW USA may lead to pneumonia with ___.
Coccidiosis
187
Structural lung disease may lead to pneumonia with ___.
Pseudomonas
188
Alcoholism may lead to pneumonia with ___ or ___.
Anaerobes; Klebsiella

MHD 1 (58 decks)

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