Micro Exam 11 Flashcards
toxemia
Bacillus anthracis
non arthropod vector transmission
s typhi leptospira bacillus anthracis brucella p multocida
louse transmission
r prowazekii
bartonella quintana
borellia recurrentis
tick transmission
francisella
r rickettsii
borellia burgdorferi
flea transmission
yersinia pestis
bartonella quintana
bartonella henselae
fly transmission
francisella tularensis
ticks and mites are vector and reservoir in all except
ehrlichia
lyme dz
extracellular
borellia
leptospira
facultative intracelllular
which target endothelial as opposed to macrophages/epithelial
bacillus anthracis brucella francisella salmonella yersinia bartonella quintana (endothelial) bartonella henselae (endothelial)
encapsulated
bacillus anthracis
yersinia pestis
salmonella typhi
high infectious dose
salmonella typhi
babesia
francisella (ingestion route)
obligate intracellular?….
rickettsia
ehrlichia
anaplasma
babesia
human spread only important in
yersinia pneumonic plague
humans are sole reservoir
salmonella
ricketsii prowazekii
b recurrentis
vaccine preventable
antrhax typhoid fever yersinia HAV HBV
salmonella morphology
encapsulated non coliform gram - rod
motile and invaive
salmonella
vi antigen
salmonella
fxns of vi antigen
antiphagocytic for pmns
prevents intracellular killing by type 3 secretion
reportable dz
salmonella, francisella, rickettsia, HAV, HBV
asia, africa, latin america
salmonella
main transmission of salmonella
ingestion of food and water with fecal contmaination
year round seasonality
salmonella
age group for salmonella
under 30
oral anal sex puts you at risk of
salmonella
carriers are females over 50
salmonella
salmonella incubation
1-2 weeks
salmonella pathogenesis
multiplies in peyers patches in SI then spreads to liver, spleen, bone marrow where it is phagocytized by macrophages (NOT PMNS). Multiplies intracellularly. Spreads again to gallbladder where it stays
Gallbladder carriage
salmonella
signs and symptoms of salmonella
4 weeks of dz 1 - bacteremia with fever and flu signs 2 - bacteremia with fever and maculopapular rash 3 - ulceration of peyers patches 4 - cholecystitis
children under 5 have weird s and S
salmonella
intestinal perforation
salmonella
diagnose salmonella
1-3 weeks - blood
4+ weeks - feces > urine
2 weeks - serology for vi antigen
tx for salmonella
ampicillin, tmp smx, ciprofloxacin
vaccine for salmonella
vivotif Ty21a - oral live with boosters every 5 years
Typhim vi - parenteral recombinant with boosters every 2 years
Seen in macrophages
salmonella
fruits/vegetables
salmonella
Rat pee in water
Leptospirosis
Weil’s dz is a form of
Leptospirosis
dark field microscopy
leptospirosis, borrelia miyamotoi, lyme
chronic in kidney
leptospirosis
CNS type 3 vasculitis
leptospirosis
biphasic
leptospirosis
sispecial media
leptospirosis
s and s of leptospirosis
rash, aseptic meningitis, tibial tenderness, hemoptysis
spirochete with hooked ends
leptospira
multiple serovars for different animals
leptospira
tropical climates
leptospira
transmission of leptospira
water contact through skin abrasion
vertical transmission by placenta and breast milk
Pathogenesis of leptospira
endothelial damage resulting in vasculitis and persisting in kidney without renal impairment
Anicteric and icteric forms
leptospirosis
which form of lepto is most common
anicteric
acute leptospiremic phase
fever, headache, conjuncitval suffusion
immune leptospiruric phase
aseptic meningitis from immunopathology vasculitis
Abx are not effective when
immune phase of lepto
Weil’s dz is known as what and is characterized as what
icteric leptospirosis (anicteric signs of conjunctival suffusion and aseptic meningitis + JAUNDICE)
what causes weils
vascular dyfunction
Humoral immunity
leptospirosis, anthrax, borrelias
Binds DC SIGN to induce dendritic cell maturation
Humoral immunity in lepto
rats peei n water
lepto
diagnosis for lepto
Week 1 - blood and csf culture
Week 2 - urine culture
serology for ab’s
tx for lepto
penicillin
doxy
tetracycline
jarisch herxheimer
lepto
doxy chemoprophylaxis
lepto
yersinia
Spring seasonality
brucella
brucella morphology
gram - rod
abortus
suis
melitensis
canis
brucella
most common zoonotic dz
brucella
bangs dz
brucella
unpasteurized milk
brucella
transmission of brucella
ingestion
contact with skin abrasions or conjunctiva
inhalation
pathogenesis of brucella
enters skin or mucous membranes and spreads by lymphatics. Multiplies in macrophages preventing their apoptosis
brucella virulence factors
5’ GMP and AMP - suppress myeloperoxidase
Atypical LPS - doesn’t activate complement
signs and symptoms for 2-8 weeks
brucella
signs and symptoms of brucella
night sweats, fever, weight loss, malodorous perspiration
acute, undulant, and chronic form
brucella
tx for brucella
tetracycline with streptomycin for 6 weeks
spore forming
bacillus anthracis
GI, pulmonary, cutaneous
bacillus anthracis
boxcar shaped
bacillus anthracis
bacillus anthrasis morphology
encapsulated gram positive rod
virulence factors for bacillus anthracis
Poly D glutamic acid capsule (PXO2)
Protective antigen toxin
Lethal factor toxin
Edema factor toxin
LF fxn
Cleaves mitogen activated protein kinase kinases causing macrophage lysis
Targets cardiomyocytes and vascular smooth muscle cells
EF fxn
calcium calmodulin dependent adenylate cyclase
Acts on hepatocytes
herbivores
bacillus anthracis
WMD
bacillus anthracis, tularemia
WMD anthrax form
pulmonary
transmission of bacillus anthracis
excreted in feces, urine, and saliva with spores in soil
toxemia
bacillus anthracis
forms of anthrax
cutaneous - most common. eschar with edematous ridge (malignant pustule)
pulmonary (wool sorters dz) - inhale spores. multipy in lungs causing hemorrhage and necrosis.
GI - eat infected meatt which invades GI causing N/V/ bloody diarrhea and ascites
whcih form of anthrax is immune to abx pretty much
pulmonary
mediastinal widening
pulmonary anthrax
increase in vascular permeability causing respiratory deistress, hemorrhage, shock, and death
pulmonary anthrax
Target of immunity in anthrax
PA antigen
Tx for bacillus anthracis
penicillin, doxy, cipro
vaccine for anthrax
PA purified vaccine with small amounts of LF and EF
tularemia agent
francisella tularensis
morphology of francisella
Encapsulated G- coccobacillus
intracellular in macrophages, endothelial cells, and hepatocytes
francisella
virulence factor for francisella
lipoprotein encoded by FTT1103
ocurs in all states except hawaii
francisella
rabbis
francisella
no P2P ever documented
Francisella, trench fever
transmission of francisella
contact with animal carcasses
cat or tick bite
aerosol
ingestion (high ID)
warmer months
francisella, RMSF, Spotted fever group
multiplies in macrophages and amoebae
francisella
signs and symptoms of francisella
uleceroglandular form - papule at entry site, enlarged lymph nodes, granulomatous nodules
Inhalation form
GI form
detected by visualizing antibodies with a 4 fold increaase
francisella
tx for francisella
streptomycin, tetracycline, chloramphenicol
yersinia morphology
gram - coccobacillus
wide temperature range for growth
yersinia
virulence factors of yersinia
YOPS OMP VW F1 Coagulase (28 degrees C)
Top 3 control survival in macrophages. 3 and 4 form capsule
location of yersinia
asia, brazil, west coast
domestic and sylvatic cycles
yersinia
1 microorganism is enough
yersinia
may spread by droplet nuclei
yersinia
form of yersinia that results in epidemic
droplet nuclei spread resulting in pneumonic plague
transmission of yersinia
droplet nuclei
flea bite
type 3 secretion
salmonella and francisella
bubonic plague
yersinia
3 forms of yersinia
bubonic plague - pustule at bite site, femoral and inguinal lymphadenopathy, gangrene of extremities
pneumonic - cervical buboes, lung pathology
septicemia - internal buboes w/ bacteremia before buboes
diagnosis for yersinia
serology for F1 antigen
Tx for yersinia
doxycycline
strict quarantine
yersinia
vaccine for yersinia
F1 and VW ag
obligate intracellular and target endothelial
rickettsia
do not produce their own ATP
rickettsia
arthropod borne ONLY
ricketsia
mites and ticks are reservoir
rickettsia
transovarial transmission
rickettsia, endemic relapsing fever
pathogenesis for rickettsia
arthropod bites. infects endothelial cells causing vasculitis
rickettsia signs and syptoms
triad of fever, headache, and rash
both humoral and CMI and gamma interferon
Rickettsia
rickettsia tx
doxy
diagnosis for rickettsia
FA of lesion
Weil felix agglutination reaction
Southeastern US
RMSF, SPotted fever group
people under 10
RMSF
agent of RMSF
R. rickettsia
Enters endothelial cells of larger vessels and smooth muscle
RMSF
Binds to Ku70 via OMP to enter cells
RMSF
Fever with conjunctivitis and photophobia
RMSF
RMSF signs and symptoms
Prodrome of fever, conjunctivitis, photophobia followed by rash on palms and soles that spreads
highly cytotoxic
RMSF
RMSF diagnosis
Thrombocytopenia, hyponatremia, LFTs elevated
PCR of rash site
Spotted fever group agent
Rickettsia parkeri
eschar
bacillus anthracis, SFGR, rickettsial pox, scrub typhus
difference between RMSF and SFGR
eschar
urban setting
rickettsial pox
rickettsial pox agent
r akari
spread by mouse mite
rickettsial pox
rickettsial pox signs and symptoms
eschar, prodorome, lymphadenopathy, rash that spreads centrifugally
epidemic typhus agent
r prowazekii
crowded conditions
epidemic typhus
Epidemic typhus signs and symptoms
centrifugally spreading rash
brill zinsser
recrudescent epidemic typhus with IgG
agent of murine endemic tyhus
r typhi
rat fleas and cat fleas in LA spread
murine endemic typhus
Raash that remains centraly located
murine endemic typhus
agent of scrub typhus
orientia tsutsugamushi
lacks peptidoglycan and LPS
Rickettsia and orienta
Chiggers
scrub typhus
endemic in asia india and pakistan
scrub typhus
rainy season with river banks and grassy areas
scrub typhus
what are you at risk of when lying in the grass
scrub typhus
scrub typhus signs and symptoms
Week 1 - fever, eschar, rash
Week 2 - hearing loss
coinfxn with lepto
scrub typhus
lymphopenia followed by lymphocytosis and a decreased CD4:CD8 ration
scrub typhus
Weil felix
Ricketsia and scrub typhus
White foot mouse and deer
Anaplasmosis, babesia, lyme
Ixodes
Anaplasmosis, Ehrlichiosis, babesia, lyme
Leukopenia/Neutropenia
Anaplamsmosis
Inclusions in neutrophils
Anaplasmosis
Doxy treats
rickettsia, anaplasma, ehrlichiosis, bartonellas
Infects monocytes
Ehrlichiosis
Rash from coinfxn
Anaplasma and ehrlichiosis
Mostly asymptomatic unless transfused
ehrlichiosis
Agent of babesiosis
babesia microti
can’t donate blood
babesia
In Rbc’s
babesia
anemia risk
babesia
nymph most important stage
babesia, lyme
persistent fever
babesia
dark urine
babesia
protozoan
babesia
lymphadenopathy absent
babesia
misdiagnosed as malaria
babesia
Most common complication of babesia
ards
hemolytic anemia
babesia, bartonellosis
maltese crosses in RBCs
babesia
tx for babesia
quinine and clindamycin
atovaquone and azithromycin
trench fever agent
bartonella quintana
cat scratch dz agent
bartonella henselae
bacillary angiomatosis agent
bartonella henselae and bartonella quintana
bartonellosis agent
bartonella bacilliformis
occurs in immunocompetent
trench fever
homeless
trench fever
cat flea, cat urine spread it
trench fever
shin bone fever
trench fever
humans and cats are reservoirs
trench fever
bone pain
trench fever, lepto
cat scratch dz age
children mainly
elderly and immunocompromised
wartin starry silver stain
cat scratch
doesn’t respond to abx
cat scratch dz
higher in kittens
cat scartch dz
fever, scratch, lymphadenopathy
cat sratch dz
resolves spontaneously in 3 months
cat scratchz
blood filled lsions
bacilary angiomatosis
looks like kaposis
bacilary angiomatosis
peliosis if involves organs
bacilary angiomatosis
jarich herxheimer oddly even though not spirochete
bacilary angiomatosis
cat contact can spread
bacillary angiomatosis
Vasoproliferative dz of the skin
bacillary angiomatosis
titer greater than 1:64 indicates infxn
bacillary angiomatosis
tx for bacillary angiomatosis
doxy with rifampin
Immunocompromised should avoid cats
bacillary angiomatosis
Western slopes of andes
bartonellosis
affects RBCs and endothelium
Bartonellosis
sandfly
bartonellosis
Verruga peruana
bartonellosis
lesions for months to years that are indictative of endothelial hyperplasia and up to 4cm on the head and limbs
bartonellosis
Relapsing fever agents
borrelia recurrentis
borellia hermsii
borella myamotoi
colder months
epidemic relapsing fever
Spirochete thick enough to be seen on blood smear
borellia recurrentis, borellia hermsii
agent of epidemic relapsing fever
borellia recurrentis
human body louse is crushed during scratching causing infxn
epipdemic relapsing fever
wearing the same clothes and crowding puts you at risk for
epidemic relapsing fever
agent of endemic relapsing fever
borellia hermsii
difference between epidemic and endemic relapsing fever
louse vs tick
west coast
endemic relapsing fever
soft bodied tick transmits
endemic relapsing fever
tick only active at night
endemic relapsing fever
May- september seasonality
Endemic relapsing fever
replicates in blood
borellia relapsing fevers
antigenic variation
borellia relapsing fevers
high fevers with 5 day break between
borellia relapsing fevers
antibodies immobilize organism and enhance PMN phagocytosis against
borellia relapsing fevers
lyme dz without rash
Borellia miyamotoi
East coast
borrelia miyamotoi, lyme (pretty much everywhere now)
Dementia
borellia miyamotoi
hard bodied ticks
borrelia miyamotoi and lyme dz
diagnosed via PCR
borrelia miyamotoi
coinfxn with lyme
borrelia miyamotoi
how does lyme differe from borrelia miyaotoi
Gi symptoms, no rash
tx for borrelia
tetracycline
juvenile arthritis
lyme
affects 1 joint
lyme
most common vector born dz
lyme
S and S of lyme
erythema migrans, bells palsy, encephaopathy
tick transmission is vital to maintain cycle
lyme
lyme dz ticks
ixodes and dermacentor
adults feed on larger things like deer
lyme
multiplies in skin before spreading everywhere
lyme
3 stages of lyme
acute - rash
disseminated - arthritis, multiple rashes, bells palsy, cardiac, conjunctivitis, hepatitis
chronic - arthritis (HLA DR4 possibly) Alzheimers
Alzheimers
Chronic Lyme
complication includes coinfxn with other ixodes agents
lyme
2 tiered testing with ELISA and IgG
Lyme
Tx for lyme
doxy, amoxicillin, cefuroxime
Cefrtriaxone/penicillin if neurologic or cardiac
post treatment syndrome that is unaffected by abx
lyme
which heaptitises cause jaundice
all
which heps are chronic
B, C, D
which heps can be fulminant
all
which hep ha the longest incubation
hep B (2-6 months)
what are the s and s of acute viral hepatitis
Prodrome (preicteric phase) with dull right UQ pain
Icteric phase about a week later with jaundice, vasculitis (Hep B), and glomerulonephritis (Hep B and C)
Convalescent phase - jaundice clears but prodrome stuff may stay
PicoRNA
Hep A
Noneveloped SSRNA
Hep A, HEV
Only replicates in hepatocytes
Hep A
inactivated by chlorination (not heating)
Hep A
Virus enters via GI and leaves via feces
Hep A
when does peak HAV infxn occur
2 week period before juaundice or elevation of liver enzymes
what causes damage in Hep A
Immune response CD8 killing liver
Neutralizing IgG provide long term protection from infxn
Hep A
Jaundice indicates halting of prodoromal symptoms
hep A
Complications of HAV
vasculitis of butt, prolonged PR and QT
how do you diagnose HAV
IgM and symptoms
IgM presetnts 5 days beofee symptoms
HAV
Post exposure prophylaxis for HAV
HAV vaccine if 12 months to 40 y/o otherwise Ig
Prevention of HAV
post exposure prophylaxis with HAV vaccine or immune globulin
Passive immunization with generic HSIG before or within 2 weeks
Active - Killed accine havrix and vaqta within 2 weeks IM
How long does active HAV vaccine last
20 years
TwinRix
Mix of havrix and energix used as active immunization for both hep a and b
Fecal oral in pregnant peeps
HEV
Enveloped DNA virus
HBV
Hepadnaviridae
HBV
Reverse transciptase
HBV
Partially double stranded
HBV
More infectious than HIV by a lot
HBV
No integrase activity
HBV
C gene
Encodes HBcAg and HBeAG
P gene
reverse transciptase in HBV
S gene
HBsAg
Dane particle
Complete HBV virus with postive sense DNA
first serologic marker for HBV
HBsAg
How do you diagnose chronic HBV infxn
HBsAg and total anti HBc present in two specimens 6 months apart
HBsAg and total anti HbC but no IgM anti HbC
Complication of Hep B
hepatocellular carcinoma and cirrhosis
what are the preventions for Hep B
HBIG passively
Recombinant Surface antigen made in yeast (energix and Recombivax)
Give babies Ig within 12 hours of birth
HBV
which hep virus is enveloped
B and D and E
what are the serology markers for HDV
total anti HDV
IgM anti HDV
HDVag
which form of HDV is preventable
coinfxn
leading cause of cirrhosis and liver failure and hepatocelluar carcinoma in the west
chronic HCV
most people with which hep progress to chronic infxn
HCV
