Micro (and some renal) Flashcards
Bacteria that secrete enterotoxins
c. perfringens, c. difficile
s. aureus
shigella
yersinia
enterotoxigenic e. coli
vibrio cholera
subacute endocarditis
viridans strep
enterococci
coagulase- negative staphylococci such as staph epidermidis
penicillinase- sensitive extended spectrum PCNs
h. influenzae
e.coli, enteroccoci
listeria
proteus
salmonella
shigella
causes a rash on the hands and feet
Drive Kawasaki CaRS with hands and feet
Kawasaki
Coxsackie A
RMSF
Secondary syphilis
Signs of congenital syphilis
saber shins saddle nose CN 8 deafness Hutchinson teeth mulberry molars snuffles (blood snot)
WAGR complex
Wilms tumor
Aniridia
Genitourinary malformation
mental Retardation (intellectual disability)
Risk factors in transitional cell carcinoma development
PeeSAC Phenacetin Smoking Aniline dyes Cyclophosphamide
Acute interstitial nephritis
fever rash eosinophilia azotemia 1-2 wks following drug administration
most common tumor of the urinary tract
Transitional cell carcinoma
BMP changes in a patient with renal failure
BUN, Cr, potassium increase. hypocalcemia
most common renal tumor of early childhood
Wilm’s tumor, associated with WT1, WT2 loss of function (these are tumor suppressor genes).
contains embryonic glomerular structures and presents with huge palpable flank mass and/or hematuria
May present with WAGR (beckwith- weidemann)
bacterial casts
pyelonephritis
WBC casts
pyelonephritis, transplant rejection, tubulostitial inflammation
WBCs in the urine (pyuria) may occur with acute cystitis. Casts only come from the distal convoluted tubule or collecting duct and are indicative of kidney infection.
Epithelial cell cast
ATN, toxic ingestion
Muddy brown cast
ATN
hyaline cast
nonspecific, may be normal with dehydration, formed of epithelial secretions
granular (muddy brown) casts
acute tubular necrosis
waxy casts
advanced renal disease/ chronic renal failure, 2/2 breakdown of cellular casts/ aggregates/ albumin/ light chains
fatty casts
nephrotic syndrome
RBC casts
glomerulonephritis, ischemia, malignant hypertension, appears yellow- brown with ragged edges
bladder cancer, kidney stones might produce hematuria without casts. indeed, hematuria can come from anywhere and RBC casts come only from the kidney, specifically the distal convoluted tubule or collecting duct
Drugs associated with drug- induced interstitial nephritis
NSAIDs (this can take months to show up) PCN/cephalosporins, especially methicillin sulfonamides: TMP/SMX, furosemide, etc. ciprofloxacin cimetadine allopurinol PPIs indinavir mesalamine
presentation: fever, eosinophilia, azotemia, rash
Tx: corticosteroids
eosinophilia
DNAAACP
Drugs (NSAIDs, PCN/ cephalosporins)
Neoplasm
Allergis, asthma (Churg- Strauss), allergic bronchopulmonary aspergillosis
Adrenal insufficiency (Addison disease)
Acute interstitial nephritis
Collagen vascular disease (PAN, dermatomyositis)
Parasites (Strongyloides, Ascaris –> Loeffler eosinophilic pneumonitis)
Other: HIV, hyper IgE, hypereosinophilic syndrome, coccidioidomycosis, numerous other potential causes)
helminth that causes the most infections in the US
enterobius vermicularis
one quarter of the world is infected with this helminth
ascaris lumbricoides
helminth with a snail host that causes swimmer’s itch
schistosoma species
helminth that is the most common predisposing factor for bladder cancer in developing countries
schistosoma hematobium
helminth that is contracted by eating undercooked fish and causes an inflammation of the biliary tract
clonorchis sinensis (liver fluke)
soil to skin to venous blood to lungs coughed to pharynx then swallowed to the intestines where they reside
strongyloides (skin)
ingested to venous blood to lungs, coughed to pharynx then swallowed into the intestine where it resides
ascaris lumbricoides
helminth that is contracted by eating undercooked crabmeat and causes inflammation of the lung
paragonimus westermani
pork tapeworm
taenia solium
responsible for lymphatic filariasis
wuchereria bancrofti
adult patient from mexico with new onset seizures and brain calcifications (helminth)
neurocystercercoma (Schistosoma)
hookworm
ancylostoma duodenale, necator americanus
giant roundworm
ascaris lumbricoides
helminth hematuria in a patient from a developing country
schistosoma hematobium
What medications for giardia, entamoeba, trichomonas
gardnerella, anaerobic bacteria, h. pylori
metronidazole
how to treat most malarias
chloroquine
how to treat plasmodium vivax or ovale
chloroquine plus primaquine (check G6PD status)
how to treat almost all flukes and tapeworms
praziquantel
how to treat hookworm, pinworm, roundworm
benzimadazole or pyrantel pamoate
how to treat chagas
benzimidazole or nfurtimox
how to treat roundworms
mostly benzymidazoles or pyrantel pamoate
how to treat leishmaniasis
cutaneous- sodium stibogluconate
visceral- liposomal amphotericin B
how to treat pediculosis capitis and pubis
permethrin, pyrethrin
nematodes- roundworms that cause intestinal infections
enterobius vermicularis (pinworm) ascaris lumbricoides (giant roundworm) strongyloides stercoralis ancylostoma duodenale, necator americanus (hookworm) trichinella spiralis
nemotodes- roundworms that infect tissue
onchocerca colculus, loa loa, wuchereria bancrofti (lymphatic filariasis), toxocara canis
transmission- pinworm enterobius vermicularis
fecal- oral
dx scotch tape test
sx anal pruritis
tx bendazoles, pyrantel
ascaris lumbricoides (giant roundworm) transmission
200,000 eggs or more released daily, human ingests the eggs (even just a little bit), and the worm goes to the lungs, trachea, oropharynx, is then swallowed into the intestine where it matures.
hypersensitivity to ascaris at the lungs can lead to loffler eosinophilic pneumonitis (dyspnea, eosinophilic PNA)
eggs in feces visible under microscope
Tx bendazole or pyrantel pamoate
strongyloides stercoralis transmission
larvae in soil penetrate the skin, travel to lungs, trachea, swallow, GI tract, intestinal infection. Tx ivermectin, albendazole
ancylostoma duoenale, necatur americanus (hookworm) transmission
larvae penetrate skin, travel to lungs, trachea, swallow, mature at GI tract where they hook into the intestinal wall and suck blood out. abdominal discomfort, anemia. Tx. bendazoles, pyrantal pamoate
trichonella spiralis transmission
undercooked meat, meat of wild game, larvae migrate from GI tract to muscles causing myositis, fever, eosinophilia, perorbital edema. Tx: Benzimidazole
Feco- orally transmitted nematodes
EAT (enterobius, ascaris in fecal contamination and trichonella spiralis in meat)
skin- transmitted nematodes
strongyloides, ancylostoma, and necator, which all penetrate bare feet. Strongyloides is in the soil.
SANd
Bites
LOW
loa loa
oncherocerca volvulus
wuchereria bancrofti
Cestodes (tapeworms)
taenia solium
diphyllobrothrium latum
echinococcus granulosus
Trematodes (flukes)
schistosoma (blood fluke) clonorchis sinensis (liver fluke) paraconimus westermani (lung fluke)
Schistosoma
eggs into snails, then they penetrate skin to enter into humans (swimmer’s itch), in which the schistosomes migrate to lungs or liver and mature.
s. mansoni matures at mesenteric vessels, portal htn
carribean, s. america
s. hematobium goes to the lower urinary tract, leading to scc of bladder (painless hematuria)
western hemisphere, including egypt
embolized eggs may get stuck in the portal system leading to splenomegaly
tx: praziquantel
chlonorchis sinensis (liver fluke)
comes from eating undercooked fish. biliary inflammation results in pigmented gallstones, cholangiocarcinoma
tx. praziquantel
paragonimus westermani (lung fluke)
sx- chronic bronchitis, hemoptysis, undercooked crab meat
tx: praziquantel
taenia solium (pork tapeworm)
ingested larvae that are encysted in undercooked pork lead to intestinal infection, leading to cystercercosis and neurocysticercosis
cysticercosis= larval infection resulting from cyst ingestion leads to myositis at muscles, neurocystercercosis in the brain
tx: praziquantel, albendazole for neurocysticercosis
echinococcus granulosus (dog tapeworm)
ingestion of eggs from dog feces.
mature larval cysts occur in the host parenchyma
hydatid cysts in the liver cause anaphylaxis if antigens released (surgeons preinject with ethanol to kill cysts before removal)
tx: albendazole
biliary tract disease, cholangiocarcinoma
clonorchis sinensis
brain cysts, seizures
taenia colium (cysticercosis)
hematuria, bladder cancer
schistosoma haematobium
liver (hydatid cysts)
echinococcus granulosus
microcytic anemia
anculostoma, necator
perianal pruritis
enterobius
portal hypertension
schistosoma mansoni, schistosoma japonicum
B12 deficiency
diphyllobothrium latum
found in SW US including w Texas and CA
coccidiomycosis immitus
Mississippi and OH river basin
histoplasma capsulatum
San Joaquin valley fever
coccidiomycosis immitus
rural Latin America
paracoccidiuides brasiliensis
associated with plant thorns and cutaneous injury
sporothrix schenki
found in states east of the mississippi river
blastomycosis dermatotiditis
found in bird and bat droppings
histoplasmosis capsulatum
mold form contains barrel= shaped arthroconidia
cocidioides immitus
associated with dust storms
coccidiomycosis immitus
broad- based budding of yeast
blastomycosis dermatididis
multiple budding of yeast form
paracoccidiomycosis brasiliensis
infections associated with birds
H5N1 (avian influenza) cryptococcus neoformans- pigeon poop chlamydia psittaci- parrots WNV- crows histoplasma capsulatum
treatment for sporothrix
potassium iodid, itroconazole is newer (plant a rose in a pot)
treatment fo oral candidiasis
fluconazole, nystatin swish and swallow
mc opportunistic infection in HIV patients
PCP
ppx for cryptococcus in AIDS
fluconazole
ppx for PCP in AIDS
TMP-SMX when CD4<200
treatment for systemic candidiasis
fluconazole, amphotericin B, echinocandin
4 molds that are considered dermatophytes (fungal species invading only superficial layers of skin
trichophyton
microsporum
epidermophyton
malassezia furfur
ringworm
tinea corporis, tinea capitis (looks round with a central clearing but there is no actual worm)
DNA virus and erythema infectiosum
parvovirus B19
heterophile- positive mono
EBV
can cause conjunctivitis or diarrhea
adenovirus
enlarged cell with owl’s eye inclusions
CMV
identified with PAP
papillomavirus 16, 18 are high risk
milkmaid blsters
vaccinia poxvirus
Burkitt lymphoma
EBV
gingivostomatitis
HSV1
hides in sensory ganglia of S2 and S3
HSV2
hides in trigeminal ganglia
HSV1
hides in dorsal root ganglia
VZV
viral family of JC virus
polyomavirus
Downey cells
EBV T cells that target B cells
human progressive multifocal leukoencephalopathy
JC Virus polyomavirus
oral hairy leukoplakia
EBV
multinucleate giant cells on Tzanck test
HSV1,2, VZV
only DNA virus that is not double stranded
HBV
roseola
HHV6
heterophile negative mononucleosis
CMV
SCC penis
HPV 16, 28
aplastic anemia in SCD
parvovirus B19
child with a fever and slapped cheek rash on the face that spreads to the body
parvovirus B19 5th disease
where does herpes virus acquire its envelope?
most enveloped viruses get their envelope from plasma membrane when they exit the cell but herpes gets its envelope from the nuclear membrane
viral families that are naked
DNA:
parvovirus, adenovirus, papillomavirus, polyoma virus
RNA: calicivirus, picornivirus, reovirus, hepevirus
Loffler syndrome
Ascaris lumbricoides
eosinophilic pulmonary infiltrates
most common worldwide cause
Symptoms develop when larvae are within the lungs, approximately 9-12 days after ingesting the ascaris eggs but then subside after about 5-10 days depending on the severity.
symptoms and signs:
- irritating, nonproductive cough, burning substernal discomfort
-dyspnea, blood- tinged sputum
-urticaria for the first few days
-fever over 38.3 (101)
-crackles, wheezing, no consolidation
-hepatomegaly
-CXR: round or oval infiltrates that range in size from millimeters to centimeters in both lung fields
-migratory infiltrates, confluent on perihilar areas, usually clear completely after several weeks
