Micro Exam 10 Flashcards
1
Q
what is the major pathogen of osteomyelitis that is facultatively intracellular in osteoblasts
A
staph aureus
2
Q
which pathogen must be considered for osteomyelitis in sickle cell patients
A
salmonella
3
Q
which pathogen must be considered for osteomyelitis in children
A
kingella kingae
4
Q
which pathogen must be considered for osteomyelitis in puncture wounds
A
pseudomonas
5
Q
which pathogen must be considered for osteomyelitis in immunocompromised
A
aspergillus, mac, candida (Chronic agents)
6
Q
what are the 3 ways osteomyelitis occurs from greatest to least
A
surgery/trauma
spread
hematogenous
7
Q
what is the pathogenesis for osteomyelitis
A
inflammation at bone site, osteoclast activation, pus formation leading to vascular blockade
8
Q
what are the 4 ways patients present with osteomyelitis
A
after surgery/trauma (systemic)
joint replacement
diabetes checkup
bacteremia (systemic)
9
Q
what signs indicate osteomyelitis on physical exam in a pt with diabetic foot ulcer
A
ulcer area > 2cm squared
positive probe to bone test
10
Q
what signs indicate chronic osteomyelitis
A
sequestra (dead/necrotic bone)
11
Q
what is the tx for osteomyelitis
A
acute - abx parenterally for weeks
chronic - abx orally for months to years
12
Q
how do you prevent osteomyelitis
A
give abx 30 mins before surgery
13
Q
mycoplasma and ureaplasma may cause
A
septic arthritis
14
Q
how long does it take for septic arthritis to occur
A
during prosthetic surgery up to 1 year after
after prosthetic surgery by hematogenous dissemination more than 1 year after
15
Q
What causes dmg in septic arthritis
A
PMNs releasing degradative enzymes which damage cartilage
16
Q
how is the damage in septic arthritis similar to osteomyelitis
A
effusion in septic arthritis can interfere with blood supply like the pus in osteomyelitis
both are from increased pressure
17
Q
what are the 3 manifestations of septic arthritis
A
acute, disseminated gonoccocal, granulomatous
18
Q
what is disseminated gonococcal infection and what does it cause
A
when gonococcal genital infxn spreads days after the infxn causing a rash, fever, and joint symptoms
septic arthritis
19
Q
what is granulomatous arthritis
A
septic arthritis
20
Q
what causes granulomatous arthritis
A
TB, coccidioides, blastomyces
21
Q
which disorder has granuloma formation
A
granulomatous arthritis (a form of septic arthritis)
22
Q
HLA B27 is not required but associated with
A
reactive arthritis
23
Q
what precedes reactive arthritis
A
RT infxn, urogenital infn, Gi infxn
24
Q
which gender is ReA more common in
A
males
25
what type of infxns cause reactive arthritis
G- mucosal infxn
26
which has autoantibodies form
ReA
27
Does septic arthritis have systemic signs
yes
28
does reactive arthritis have systemic signs
only if mucosal infection causes fever
29
how many joints are typically affected in septic arthritis
1
30
how many joints are typically affected in ReA
3-4
31
how many days does it take for reactive arthritis to occur
1 to 2 weeks
32
what diagnostic method is used to differentiate septic from reactive arthritis
arthrocentesis of SF
33
how does the arthrocentesis sample differ in SA vs ReA
Septic - Positive for agents. Reduced glucose level
ReA - Negative for agents. Normal glucose level
34
how does the tx for SA differ from ReA
Abx for sure in SA
Not for sure in ReA
35
whats the agent of syphils and describe it
treponema pallidum. G- spirochete. motile
36
why do you have to becareful when diagnosing syphilis
treponema may just be normal flora
37
which is hard chancre
syphilis
38
which are the GUDs
syphilis, chancroid, LGV, granuloma inguinale, and HSV
39
what is the virulence factor in treponema
lipoprotein that is similar to lps
40
how do you visualize treponema
darkfield microscopy. NOT gram stain
41
which pathogen is very sensitive to various environmental factors
treponema palllidum
42
which disorder has vascular pathologies including enarteritis obliterans and periarteritis
syphilis
43
which disorder has primary, secondary, latent, and tertiary stages
syphilis (LGV has primary secondary tertiary)
44
hard chancre
primary stage of syphilis
45
button like induration
primary stage of syphilis
46
how long before primary stage of syphilis starts
3-90 days
47
which can have regional lymphadenopathy
all GUDs
48
which dz has secondary disseminated form
syphilis
49
bilateral symmetrical rash of soles and palms
syphilis
50
condyloma lata mucous patches
syphilis
51
alopecia
syphilis
52
does syphilis have systemic signs
yes in secondary form
53
how long does it take for secondary syphilis to occur
2-6 weeks
54
what is the latent syphilis
post primary with positive serology bu asymptomatic
55
what is the diff between early and late latent syphilis
before 1 year and infectious bc relapse to secondary
| after 1 year and rarely infectious bc rarely relapse to secondary
56
which are passed placentally
syphilis, herpes, toxoplasma, malaria
57
which is dz of thirds and what are they
syphilis
1/3 from secondary to 3
1/3 cured spontaneously from secondary
1/3 persistently infected but asymptomatic
58
how long does does it take for tertiary syphilis to occur
2-30 years later
59
what are the 3 forms of tertiary syphilis
cardiovascular, nerurosyphilis, and gumma syphilis
60
what is cardiovascular syphilis
destruxn of vasa vasorum in aortic arch
61
what is early vs late neruosyphilis
early may have meningitis
late has paresis (mnemonic) and tabes dorsalis
62
what is tabe dorsalis
destruxn of posterior columns with altered pain and temperature and argyll robertson pupil
63
what is robertson pupil
small, not responding to light, dilates imperfectly to mydriatics, not dilating to painful stimuli
64
what is gumma syphilis
benign granuomatous like lesions in many tissues (great immitator)
65
when does congenital syphilis occur
passed any time during pregnancy, but symptoms only 18-20th week b/c immune sys fomrs then
66
how does congenital syphilis present
stillborn, symptomatic newborn, infantile (secondary in adults), latent if they survive the first year, late congenital (tertiary in adults) which has Hutchinsons triad or stigmata
67
what does the late congenital syphilis form present with
hutchinsons triad (8th nerve deafness, corneal ulcers, hutchinsons teeth)
Also frontal bossing, bulldog jaw, higoumenakis sign, and saber shins
68
how is syphilis first seen and which is the first serology
darkfield microscopy and treponema SPECIFIC (FTA) is first one positive
69
where is treponema seen
not in blood. in lesion
70
what do non treponemal specific ab tests identify
Reagin
71
what are the screening tests for syphilis
the non treponemal specific ab tests
venereal VRDL
reagin RDR
and EIA
72
what is bad about the screening test for syph
low specificity
73
what are teh screening tests used for in syph
primary to early latent syphilis and monitor efficacy of tx
74
what are the confirmatory syphilis tests used for
late latent to tertiary but NOT to monitor therapy
75
which are the confirming tests for syph
fluorescent FTA
hemagglutination MHA-TP
EIA
76
tx for syphilis
benzathine penicillin G
77
backup syphilis tx
azithromycin but they may be resistant so tetracyclines also
78
when should you give mom tx for syphilis
more than 1 month before birth
79
what is jarisch herxheimer reaction
endotoxin like shock in response to syphilis tx that occurs within 12 hours due to dying treponema
80
in what disorder should you follow up for many months post tx
syphilis
81
which is a reportable dz
syphilis
82
cytolethal distending toxin
haemophilus ducreyi
83
most strongly associated with HIV transmission
chancroid (also chlamydia and gonorrhea)
84
bubos
chancroid, LGV
85
non indurated, purulent papule which ulcerate with ragged edges
chancroid
86
school of fish appearance on gram stain
chancroid
87
haemophilus ducreyi
chancroid
88
chlamydia trachonatis causes
lymphogranuloma venereum
89
L1, L2, and L3 serovars
LGV serovars of chlamydia trachomatis
90
homosexual males
LGV and herpes
91
bacteria infect macrophages and enter lymphatics
LGV
92
which disorder has primary, secondary, and tertiary stage
LGV (syphillis has latent stage also)
93
how long before the primary lesion of LGV occurs
3-30 days
94
how long for secondary lgv to occur
2-6 weeks
95
groove sign
lgv
96
tx for lgv
macrolide
97
donavanosis
granuloma inguinale
98
agent of granuloma inguinale
klebsiella granulomatis
99
how long does it take for signs of granuloma inguinale to occur
week to a year
100
how long does it take for signs of granuloma inguinale to occur
week to a year
101
what are the lesions of granuloma inguinale
nodular, ulcerovegetative, cicatrical, and hypertrophic/verrucous
102
pseudobubo
granuloma inguinale
103
elephantiasis
lgv and granuloma inguinale
104
safety pin bacteria
klebsiella granulomatis
105
dx of granuloma inguinale
wright or giemsa stain shows donovan bodies: clusters of organism in macrophages or monocytes
106
Agent of genital herpes
hsv 1 and hsv 2
107
highly infectious lesions
herpes
108
asymptomatic shed virus also
herpes, chlamydia trachomatis, and neisseria gonorrhea
109
life long latency in sacral root ganglion
herpes
110
incubation period for herpes
less than a week
111
follows nerve to skin to cause recurrent infxn
herpes
112
dewdrop on a rose petal lesion
herpes
113
often forgotten agent of urethritis
herpes
114
disseminated and constitutional symptoms on primary infxn
herpes
115
disseminated primary infxn more common in women
herpes
116
Multiple recurrences within a year that decrese over lifetime
herpes
117
what are the 3 herpes presentations in neonates that occur in the second week of life
SEM, disseminated, encephatlitis
118
what factors put you at greatest risk for congenital herpes
primary infxn, symptomatic, vaginal delivery
119
tzanck smear
herpes
120
syncitia formation can be seen in
herpes
121
viral culture is used for
herpes
122
only GUD caused by a virus
herpes
123
acyclovir doesn't cure, but helps
herpes
124
medical personnel should wash hands and use protective barriers
herpes
125
genital warts
HPV
126
HPV morphology
nonenveloped icosahedral dsDNA virus
127
which HPV types cause genital warts
6 and 11
128
which HPV types cause cancer
16, 18, 31, 33, 45, 52, 58
129
condyloma acuminatum
HPV
130
cervical papillomas that may progress to neoplasms
HPV
131
head and neck SCC risk
HPV
132
Infect skin cells
HPV
133
affects p53 growth suppressors
HPV
134
infected cells have cytoplasmic vacuoles surrounded by dense cytoplasm
HPV
135
koilocytosis
HPV
136
how long for hpv
3-4 months
137
hard for CMI to access it due to location
HPV
138
cauliflower like raised lesion
HPV
139
pap smear shows koilocytic cells
HPV
140
acetowhite shows white patches
HPV
141
Tx of warts
excision, laser, chemical therapy, antivirals
142
imiquimod facilitates CMI
HPV
143
what is the vaccine available which covers 9 types and contains capsid but no DNA. Administer BEFORE
9vHPV
144
Serotypes D-K
Chlamydia trachomatis in urethritis/cervicitis
145
etiology of neisseria gonorrhea
gram - diplococcus, facultative intracellular
146
etiology of chlamydia
doesn't gram stain, lacks cell wall, obligate intracellular
147
more common in women
GC and CT STD
148
agents of urethritis/cervicitis
neisseria, chlamydia, HSV sometimes
149
age groups 15-19 mainly and 20-24
chlamydia and GC STD
150
affects columnar cells
chlamydia trachomatis
151
what may asymptomatic cervicitis lead to
PID
152
Skenes and bartholins glands are involved with pus
gonococcal cervicitis
153
tender friable cervix with exudate, and dyspareunia
cervicitis
154
what agents cause PID
Chlamydia 1st
Gonorrhea 2nd
Normal flora
Can be polymicrobial
155
why does PID cause infertility
destruxn of fallopian tubes
156
chandelier sign +
symptomatic PID
157
lower abdominal pain and dysmenorrhea
symptomatic PID
158
complications of PID
abscess, fitz hugh curtis syndrome and peritonitis, tubal scarring leding to ectopic pregnancy
159
violin string fibrotic adhesions between liver and abdominal wall
fitz hugh curtis syndrome (complication of PID)
160
How do you diagnose PID
Ultrasound/CT of fallopian tubes shows abscess or fluid filled tubes. Also violin string adhesions seen on laparascopy (gold standard)
161
which gender has more asymptomatic cases of urethritis
females
162
which has shorter incubation period, neisseria or chlamydia
neisseria
163
what is the difference between gonococcal urethritis vs chlamydial
purulent discharge in gonorrhea
| more serous discharge in chlamydia
164
what is uncomplicated gonorrhea
has not disseminated
165
which are the signs of disseminated gonococcal infxn
fever, joint pain, rash days after a genital infxn
166
what are the complications of urethritis/cervicitis that are common to men and women
DGI, reactive arthritis, proctitis, anorectal gonococcal dz, pharyngitis (gonococcal mainly), conjunctivitis, ophthalmia neanotorum (gonorrhea mainly)
167
what leads to epididymitis
urethritis
168
how do you diagnose gonococcal urethritis/cervicitis
gram stain and see G- diplococci in PMNs (careful in women b/c they have G- diplococci as NF)
Thayer martin low O2 media
169
how do you diagnose chlamydial urethritis/cervicitis
won't see on gram stain, but if you see more than 5 leukocytes on high power field, suspect it
170
oxidase positive
Neisseria gonorrhea
171
when treating urethritis/cervicitis, what organism must you cover
BOTH neisseria and chlamydia
172
what is the tx for urethritis/cervicitis caused by neisseria
cefrtriaxone and azithromycin
173
what is the tx for urethritis/cervicitis caused by chlamydia
tetracyclines and azithromycin
174
what bacterial type predominates in the vagina as normal flora
anaerobes
175
how is overgrowth of abcteria in the vagina prevented
lactobacillus produces H2O2 that maintains acidic environment
176
what is the normal ratio of PMNs to vaginal epithelial cells
1:1
177
what are clue cells
VECs covered with bacteria
178
what is the order of most frequent cases to least of vaginal infxn
vaginosis, candidiasis, trichomoniasis
179
what can alter vaginal flora
mensturation, oral contraceptives, douches, prolonged steroid/abx therapy, immunocompromised/diabetic
180
what is trichomonas vaginalis
protozoan with 4 flagella and anaerobic (lacks mitochondria) that engulfs bacteria, RBCs, and PMNs
181
herky jerky nondirectional motility
trichomonas vaginalis
182
only protozoan that is transmitted sexually
trichomonas vaginalis
183
what type of vaginal environment does trichomonas prefer
pH of 5-6 that occurs during menses
184
what does trichomonas vaginalis infxn result in
asymptomatic in males usually. maybe urethritis
| desquamation of vagina in females with itchy foamy discharge
185
how long before vaginitis occurs from trichomonas
5-30 days
186
what is a correlation with t vaginalis infections
preterm birth weights
187
how do you diagnose t vaginalis
elevated pH, increased PMNs, negative sniff test
188
what is the treatment for T vaginalis vaginitis
Metronidazole orally or douching to return normal flora
189
what is the agent of vulvovaginitis
candida
190
which pathogen is NF of the vaginal tract
Candida
191
which pathogen forms pseudomembranous patches that are yellowish white cottage cheese appearing on the external genitalia
candida
192
how do you diagnose candidal vulvovaginitis
normal pH, increased PMNs, negative sniff test
193
how do you prevent candidal vulvovaginitis
probiotics of lactobacillus
194
what is the tx for candidal vulvovaginitis
ketoconazole, nystatin, and miconazole
195
whats unique about bacterial vaginitis as opposed to the previous 2
no inflammation
196
what are the agents of bacterial vaginosis
mobiluncus, gardnerella vaginalis, and atopobium vaginae
197
increased risk in homosexual females
bacterial vaginosis
198
which forms biofilms
bacterial vaginosis, catheter associated bacteremias, infective endocarditis
199
where are clue cells seen
bacterial vaginosis
200
in vaginosis, what causes the destruxn
anaerobe production of carboxylase enzymes
201
what has a malodorous gray discharge
bacterial vaginosis
202
positive sniff
bacterial vaginosis
203
how do you diagnose bacterial vaginosis
elevated PH, positive sniff, 20% clue cells
204
which have elevated vaginal pH
trich and bacterial vulvovaginitis
205
which have increased PMNs
trich and candidal vulvovaginitis
206
which have negative sniff
trich and candidal vulvovaginitis
207
what is the tx for vaginosis
clindamycin and metronidazole
208
why is menstrual toxic shock not that common
gotta have the strain that produces toxin as NF in vagina, has to make enough toxin, host has to be non immunized
209
what favors release of TSST1
menses where pH rises, decreased levels of Mg, increasd surfactant, higher O2 tension
Most of these are caused by menses and tampon use
210
what is the toxin in menstrual toxic shock
toxic shock syndrome toxin 1
211
what is the main agent of menstrual toxic shock
staph aureus
212
what makes TSST1 toxin so devastating
it is a super antigen that links HLA 2 and TCR together without antigen specificity
213
what are the signs of menstrual toxic shock
fever, hypotension, erythema on mucosal surfaces, diarrhea/vomiting, rash with desquamation, diarrhea, myalgia
214
tampons
menstrual toxic shock syndrome
215
what is a significant bacteriuria
more than 10^5 bacteria/mL of urine
216
pyuria
leukocyte in urine
217
what is lower uTI
bladder or urethral infection (cystitis/urethritis)
218
what is an upper UTI
kidney infection (pyelonephritis
219
what is a complicated UTI
UTI with a underlying condition that increases risk of failing therapy like diabetes or pregnancy
220
what is the diff between recurrent, relapse, and refinection uti
recurrent - within 2 weeks
relapse - same organism within weeks or months
reinfection - different organism within weeks or months
221
what is interstitial cystiti
bladder pain in the absence of other etiologies
222
what are the types of utis
uncomplicated cystitis, uncomplicated pyeonephritis, complicated UTI, catheter associated UTI
223
what is the most common agent of UTI
E coli. Candida yeasts in catheter associated
Also proteius, klebsiella, and staph saphrophyticus
224
what are most UTis caused by
monomicrobial by gram negative rods
225
which gender is more susceptible to UTI
females, shorter urethra
226
why do neonates and infants get UTIs
structural defects
227
why do school age women get UTIs
anatomy
228
why are UTIs bad during pregnancy
mental retardation, premature labor, neonatal death, growth retardation
229
when is screening for UTI done in pregnant women (baacturia check)
12-16th week
230
what things predispose to a uti
catheters, diabetes, obstruction, abx
231
how do the uti agents get to the urinary tract
from the colon travel on skin by sweat, or more commonly hematongeously
232
what is the protein that prevents pathogen attachment to the pithelium and prevents kidney stone formation
tamm horsfall or uromodulin
233
what are the signs of UTI in children
fever, not feeding, suprabuci tenderness, vomiting
234
what are the signs of UTI in adults
fever and vertigo
235
what are the signso f uncomplicated cystitis
painful urination, blood in the urine, suprapubic pain
236
what are the signs of uncopmlicated pyelonephritis
spiking high fevers, chills, headache, nausea and vomiting, flank pain, dysuria
237
how is a complicated UTI associated with kidney stones
infectious agent produces urease that cleaves urea increasing the pH of urine where it precipitates magnesium ammonium phosphate and calcium carbonate
238
what are the signs of complicate UTI with stone formation
flank pain, ammonia smelling urine, alkaline pH
239
how do you diagnose a complicated UTI
microscopy will show magnesium ammonium phosphate crystals in urine. also can just do Xray/CT
240
when might the urine appear cloudy
cystitis
241
how can you get a urine sample
mid stream clean catch, catheter, suprapubic bladder aspiration
242
what is found in almost al lcases of UTI and in about half of all cases
pyuria
hematuria
243
What should you treat UTI with
Sulfonamide (TMP SMX) if bacterial
Fluconazole if fungal
244
what is the diff between bloodstream infxn and bacteremia
bacteremia is specifically bacteria in the blood
245
what is the diff between spontaneous bacteremia and transient bacteremia
spontaneous is normal event like brushing your teet
transient is caused by trauma to mucosal surface
246
what is intermittent/recurrent bacteremia
when a pt tests positive then negative
247
what type of bacteremia occurs over a long period and is associated with infective endocarditis
continuous bacteremia
248
what is an occult bacteremia
febrile kid without other symptoms but tests + for bactereia in the blood
249
what is the diff between a primary and secondary blood stream infxn
primary has bacteria in the blood from IV or arterial line but NO DISTAL FOCI
secondary has bacteria in the blood subsequent to an infxn at another site
250
what in our body fights off bactermeia
liver and spleen
251
what are the main agents of bacteremia
staph aureus (not polyclonal), coag negative staph (polyclonal), enterococci, GNR, strep
252
what are some causes of bacteremia
catheters, UTIs, dz
253
what are the leading causes of bacteremia in neonates and elerly
Neonates is Strep agalactiae followed by E coli
Elderly is GNR
254
how do you diagnose bacteremia
take large blood samples at least twice separated by time and from 2 different sites
255
why do you have to take multiple samples of blood in cases of bacteremia
they could have an intermittent form where it goes and comes
also they probably don't have that much in their blood or they would be in shock so just to make sure you don't miss any
256
what are the definition of sepsis
life threatening organ dysfunction due to a dysregulated host response to infxn
patients having 2 of the 3: tachypnea, AMS, low BP
257
what is septic shock and how is it defined
septic shock is a subset of sepsis in which vasopressors must be administered to maintain BP and lactate levels are elevated after fluid resuscitation
258
what is infective endocarditisi
microbial invasion of the heart endothelium or valve with continual shedding of organism into the bloodstream
259
what are the three forms of infective endocarditis
native valve endocarditis, prosthetic valve endocarditis, intravenous drug abuse
260
which is the most common form of infective endocarditis
native valve endocarditis
261
what are the agents of native valve endocarditis
staphs, strep, bacteroides, enterococci, GNR, etc.
262
what are predisposing factors for native valve endocarditis
prior heart conditions
263
what causes a native valve endocarditis
bacteremia
264
which valves are most commonly affected in native valve endocarditis
mitral and aortic
265
what causes a prosthetic valve endocarditis
early form is caused by a recent valve surgery
late form is caused by bacteremia
266
what area is at greatest risk for iv drug abuse related infective endocarditis
inner city peeps
267
which valve is typically involved with iv drug abuse infective endocarditis
tricuspid
268
what causes a iv drug abuse infective enedocarditis
bacteremia from drug use
269
what are the main agents of prosthetic valve endocarditis
staph, strep, GNR etc.
270
what are the main agents of IV drug abuse infective endocarditis
staph and coag negative staph
271
which is the most common to least common form of infective endocardiits
native, prosthetic, IV drug abuse
272
which valves are most commonly involved in endocarditis from greatest to least
mitral, aortic, tricuspid
273
what do bacteria colonize on in infective endocarditis
nonbacterial thrombus that forms from fibrin deposition on an arterial defect
274
what are the comlications of infective endocarditis
embolus flicking off, impaired valvular function, continuous bacteremia, type 3 vasculitis
275
what are the two major forms of infective endocarditis
subacute and acute
276
what are the signs and symptoms of subacute
weeks to months long infection before death with fever, murmurs, janeways lesions, oslers nodes etc. due to type 3 hypersensitivityu in vessels
277
what is the main agent of subacute IE
strep
278
what is a janeway lesion
painless petechial lesons on palms and soles
279
what are oslers nodes
painful petechial lesions on fingers and toes
280
what are the signs and symptoms of acute IE
may be asymptomatic or symptomatic but it progresses over days until death
signs are frequently embolic stuff causing ischemia like stroke, heart attack, liver failure etc. with fever of course and heart murmur
281
how do the signs and symptoms of subacute differ from acute
acute doesn't have weight loss, anemia, splenomegaly, etc. b/c it happens so fast
282
what agents cause acute IE
high virulence bacteria (not strep) but staph aureus, coag negative strep, and GNR
283
what requires 10x the MBC parenterally for 4-6 weeks to get rid of
infective endocarditis, meningitis, osteomyelitis
284
how do you diagnose infective endocarditis
transthoracic or transesophageal echo
285
what are the unique oropharyngeal flora that may cause infective endocarditis
HACEK
```
haemophilus
aggregatibacter
cardiobacterium
eikenella
kingella
```
286
what agent causes leishmaniasis
Leishmania donovani
287
what is leishmania donovani
obligate intracellular protazoan
288
what can make leishmania donovani more virulent and less susceptible to treatment
the leishmania virus
289
who is susceptible to leishmaniasis
travelers to middle east or immigrants from there
290
which is divided into old world and new world
leishmaniasis
291
which is passed by sandflies
leishmaniasis
292
which has dogs as a reservoir
leishmaniasis and chagas
293
what cells are infected by leishmania donovani
reticuloendothelial (macrophages, monocytes, Langerhans)
294
what is the pathogenesis of leishmaniasis
sandfly bites. promastigote goes into macrophage cytoplasm and turns into amastigote. macrophage lyses and amastigote released. disseminates via lymphatics to spleen, liver, and bone. new sandfly bites and gets the amastigote
295
how can leishmaniasis be passed
congenitally, transfusions, sexual intercourse
296
what immunity is necessary for leishmaniasis
CMI
297
what are the 3 forms of leishmaniasis in regards to immunity
cutaneous (Th1)
diffuse (Th2)
mucocutaneous (mononuclear)
298
what can be grouped by dz it causes or geographic location
leishmaniasis
299
what are the 3 clinical forms of leishmaniasis
visceral dz, mucocutaneous dz, and cutaneous dz
300
how long does it take for visceral leishmaniasis to occur
months to years
301
how does visceral leishmaniasis present
fever, weakness, hemorrhaging, anemia, diarrhea
302
what is post kala azar dermal leishmaniasis
skin lesions present months to years after a patients recovery from visceral leismaniasis
303
who is susceptible to viscerotropic leishmaniasis
GIs from desert storm
304
how do cutaneous and mucocutaneous leishmaniasis differ from visceral
they lack systemic signs
305
what is the incubation period for cutaneous leishmaniasis
1-3 months
306
what does the lesion of cutaneous leishmaniasis look like
a painless non pruritic papule that increases in size
307
what are the two types of cutaneous leismaniasis
localized, diffuse (has multiple widespread), recidivans
308
what is leishmaniasis recidivans
recurrence of infxn years later at the site of original infxn. Usually on the face
309
how does mucocutaneous leishmaniasis differ from cutaneous
cutaneous lesion that spreads to oral and nasal mucosa causing a disfigurement
310
what is present in the lesions of mucocutaneous leishmaniasis
mononuclear cells but few parasites
311
how do you diagnose leishmaniasis
travel history and biopsy of bone marrow, spleen, lymph node, liver, or other tissue with giemsa stain showing amastigotes in macrophages. Also leishman intradermal skin test
312
which has a monocytopenia occur followed by a pancytopenia
leishmaniasis
313
what is the tx for leishmaniasis
combination therapy of amphotericin B, pentavalent antimony, miltefosine, paromomycin etc.
314
what is the agent of Chagas
Trypanosoma cruzi
315
what is another name for Chagas
american trypanosomiasis
316
who is susceptible to trypanosomiasis
central and south americans
317
what is the etiology of trypanosome cruzi
C or U shaped protozoan hemoflagellate that is obligate intracellular
318
what has a vector that is the reduvid bug
trypanosome cruzi
319
what ist he pathogenesis of chagas
reduvid bug bites you and poops at the same time. invade cytoplasm of local host cells. replicate and turn into trypomastigotees. lyse the cells they are in and disseminate to the myocardium and CNS. new bug bites and gets the trypomastigotes
320
what are the complications of chagas
megadisease (megacolon/megaesophagus)
321
which organ is most commonly affected in chagas
heeart
322
what are the 3 forms of chagas disease
acute, intermittent, and chronic
323
how does acute chagas present
asymptomatic or
with local nodule called a chagoma, romanias sign (conjunctivitis with edema), and fever, myocarditis, etc if parisitemia
324
when does chronic chagas disease occur
years after the acute dz
325
how does chronic chagas present
biventricular enlargement and megadisease
326
how is chagas diagnosed
motile parasites seen in blood exam
327
what is thet x for chagas
nifurtimox and benzidiazole
328
what is the agent of African trypanosomiasis and its etiology
trypanasoma brucei is a S shaped protozoan hemoflagellate that is obligately EXTRACELLULAR
329
what is another name for African trypanosomiasis
African sleeping sickness
330
which pathogen is obligately extracellular
trypanosome brucei
331
what is the vector for African sleeping sickness
```
tsetse fly
subspecies gambiense (west)
subspecies rhodesiense (east)
```
332
what is the pathogenesis of African sleeping sickness
tetse fly bites you and injects into blood. parisetemia occurs after local multiplication. long slender form changes to short stumpy form and new insect bites
333
which form of trypanosome btrucei does not divide and is adapted to the insect
short stumpy form
334
what is the immunity against trypanosome brucei
antibodies against the variant surface glycoprotein
335
which pathogen creates antigenic variants of its surface proteins
trypanosome brucei
336
what are the different stages of African sleeping sickness caused by the gambiense fly
primary lesion, hemolymphatic stage, and meningoencephalitic stage
337
what are tye symptoms of gambiense fly associated African sleeping sickness
primary lesion - painful chancre at bite site
hemolymphatic stage - posterior cervical lymph nodes involved (winterbottoms sign)
Meningoencephalitic stage - meningoencephalitis with kerandels sign and difficulty arousing
338
what is kerandels sign
prolonged sensation to pain present in African sleeping sickness caused by gambiense fly
339
what is winterbottoms sign
posterior cervical lymphadenopathy seein in African sleeping sickness caused by gambiense fly
340
when can trypanosomes be found in the blood in African sleeping sickness
during the fever
341
how does rhodesiens version of African sleeping sickness differ from gambiense
more rapid progression with myocarditis and severe febrile CNS illnesses occurring in weeks with early deathj
342
How do you diagnose African sleeping sickness
collect blood during fever and examine under microscope
343
what I tx for African sleeping sickness
prior to CNS involvement: suramin or pentamidine
| after CNS involvement: malasoprol or eflornithine
344
which has a toxic tx
African sleeping sickness
345
What is the etiology of the agent of Toxoplasmosis
toxoplasa gondii an obligate intracellular protazoan
346
what cells does toxoplasma gondii invade
nucleated cells
347
what are the three forms of toxoplasma gondii
trophozoite - actively proliferates in all tissues
tachyzoite - actively proliferates in macrophages
bradyzoite - found in pseudocysts in muscle and brain
348
what is the 2nd most common cause of CNS infxn in AIDS pts
Toxoplasma gondii
349
what is the leading cause of death attributed to foodborne illness in the US
Toxoplasma gondii
350
Toxoplasma is found in what animals
rodents and birds
Felines - definite host
humans - intermediate host
351
what are some of the main ways toxoplasma gondii is passed
```
undercooked meat
inhalation (children)
blood transfusion
direct spread
transplacentally
```
352
where is toxoplasma commonly found
US and europe
353
how does toxoplasma usualy present in an immune competent host
asymptomatic
354
what is the life cycle of toxoplasma
cat eats trophozoite/tachyzoite which replicates in the intestinal epithelium and is pooped out. Human eats cat fece or cysts in meat which go to epithelium and replicate and convert to trophozoites. These multiply and infect adjacent cells and macrophages. They may spread by lymph or blood to other organs. They are encysted for years and come out when CMI wanes.
355
What organs are affected by toxoplasma
CNS mainly
eyes
lungs
skeletal muscle
356
what does the CMI response do to toxoplasma gondii
encysts it in the visceral organs where it may stay for years. Also mainly CD8 and CD4 handle it by producing IFN gamma that prevent replication
357
how does symptomatic toxoplasmosis present like
mononucleosis like syndrome of fever, myalgia, splenomegaly, and lymphadenoathy
358
how does severe toxoplamosis present
posterior uveitis and myocarditis,
359
how logn does it take for severe toxoplasmosis to occur
5-20 days
360
what has to occur in order for toxoplasmosis to occur congenitally
the mom has to be affected DURING the pregnancy. NOT before
361
when is the risk of toxoplasma infection to the child in utero greatest
during the 2nd and 3rd trimester
362
when is the risk of toxoplasmma disease to the child in utero greatest
1st trimester
363
what is the result of congenital toxoplasmosis
90% asymptomatic most of the time or vision/hearing problems later
```
10% death or severe disease of the newborn with the tetrad of:
retinochoroiditis (most common)
hydrocephalus
convulsions
intracerebal calcifications
```
364
how is toxoplasmosis diagnosed
IgM and IgG presence
Sabin-Feldman dye test
TORCH
365
tx for toxoplasmosis
pyrimethamine and sulfonamides target tachyzoites
spiramycin also for pregnant peeps
366
how do you prevent toxoplasmosis
throw cat feces away promptly and cook meat
367
what is the agent of schistosomiasis
schistosoma
368
what is schistosoma
fluke
369
what are the 3 schistosoma agents and their differences
schistosoma mansoni - release eggs in feces
schistosoma japonicum - release eggs in feces
schistosoma haematobium - release eggs in URINE
370
What is the life cycle of schistosoma mansoni
snail releases cercariae which penetrate human through hair follicle. Schisosomula migrate through the lungs to the the inferior mesenteric veins where male and female worms reside. Ova are produced and leave in feces. Ova go to fresh water and release miracidum where it penetrates a snail
371
what is the immune response to schistosomiasis
IgE ADCC
372
What is the main problem with schistosomiasis
eggs deposit and host has a granulomatous response that causes fibrosis and tissue destruction
373
What are the clinical manifestations of schistosomiasis
schistosomal dermatitis - itchy rash at penetration site
katayama fever
Trapped in liver veins with granulomatous response
374
how long does it take for katayama fever to occur and what is it
4-8 weeks
an infxn usually by s japonicum that results in fever, myalgia, headache, N/V/D, a cough from lung invasion, toxic hepatitis, and intestinal hemorrhaging with pseudodysentery
375
what is the tx for schistosomiasis
praziquantel
376
what is another name for schistosome dermatitis
swimmers itch or claim diggers itch
377
what animal is associated with schistosome dermatitis
waterfowl
378
what occurs in schistosome dermatitis
larvae penetrate human tissue and die there causing a severe allergic dermatitis
379
what are the agents of malaria
```
plasmodium vivax
plasmodium falciparum
plasmodium malaeriae
plasmodium ovale
plasmodium knowlesi
```
380
what cells do plasmodium infect
RBCs
381
what is the vector for plasmodium
anophele mosquito
382
what confers resistance to p falciparum
Fetal Hb, Hb S, Hb C, Sickle cell, G6PD Deficiency
383
what confers resistance to p vivax
duffy blood group negative
384
what is the lifecycle of plasmodium
mosquito bites and it invades the liver. they invade hepatic cells and transofrm into trophozoites and then schizonts. incubation period occurs and then liver cells rupture releasing merozoites. merozoites infecct RBCs and become trophozoites.RBC becomes a schizont containing many merozoites. RBC ruptures and releases merozoites causing malaria symptoms. new mosquito bites and ingests male and female gametocytes
385
when does immunity develop to malaria
after multiple exposures to the same strain
386
what are the clinical manifestations of malaria
high fever with chills and rigors when RBCs rupture
387
what are the complications of malaria
p malariae - nephrotic syndrome
p falciparum - sticky rbcs causing ischemia. Blackwater fever. Stillbirths. Cerebral malaria. Algid malaria
p vivax and p ovale - relapse
388
what is blackwater fever
Sudden massive hemolysis which results in hemoglobinuria and ischemia in several organs
389
what is algid malaria
characterized by low temperatures, feeling cold, severe diarrhea, and weakness
390
what is the diagnosis for malaria
blood smears to ID species and see the percent of RBCs infected
Antigen dipstick to check LDH levels
391
what is the tx for malaria
antimalarials like Chloroquine (falciparum is resistant) which destroys parasites in blood and Primaquine which destroys parasites in liver
P falciparum is what you want to make sure you treat for if you are not sure what it is
