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MQW U4 > Micro/Immuno > Flashcards

Micro/Immuno Flashcards

1
Q

Contained infection by this is called “valley fever” or “desert rheumatism”
What is it?

A

Coccidioides immitis

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2
Q

Pathogenesis of Histoplasma capsulatum involves what immune cell? How?

A

Macrophages – engulfs spores, which survive by producing bicarb and ammonia to raise pH and inactivate hydrolytic enzymes.

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3
Q

Immunocompromised geriatric patient has cough, chest pain, hemoptysis, weight loss, other flu-like symptoms, and ulcerated lesions on tongue. Exam/Lab/Imaging/Biopsy: cavitary lung lesions, granulomas in liver and spleen, pancytopenia.
What is it?

A

Histopalsmosis (H. capsulatum)

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4
Q

A patient has a fungal infection that requires treatment w/ amphotericin B, but he has kidney problems.
What do you do?

A

Give liposomal form of Amphotericin B

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5
Q

Histoplasma capsulatum has 2 types of asexual spores:
Tuberculate macroconidia and Microconidia.
–Which type is infectious?
–Which type has thicker walls?
–Which type has Fingerlike projections?
–Which type can be grown in 25C Sabouraud’s agar?

A
  • -Infectious = microconidia
  • -Thicker = tuberculate macroconidia
  • -Projections = tuberculate macroconidia
  • -Agar = tuberculate macroconidia
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6
Q

(unexposed/contained/disseminated/cleared) Coccidoides:
PPD w/ coccidioidin or spherulin:
–When is it (+)?
–When is it (-)?

A

(+) = exposed w/ cleared or contained infection

-) = unexposed, disseminated infection (in immunosuppressed

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7
Q

What are red, tender nodules on exterior surfaces like lower legs that develop due to cell-mediated hypersensitivity to fungal antigens?

A

Erythema nodosum

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8
Q

What are the 4 Systemic Mycosis organisms?

A
  1. Coccidioides immitis
  2. Histoplasma capsulatum
  3. Blastomyces dermatitidis
  4. Paracoccidioides brasiliensis
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9
Q

Which systemic mycosis has the following endemic areas:

  • -Eastern North America and Great Lakes region?
  • -Rural Latin America?
  • -Ohio and Mississippi River valley?
  • -Southwest US, Latin America?
A

Blastomyces dermatitidis
Paracoccidioides brasiliensis
Histoplasma capsulatum
Coccidioides immitis

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10
Q

What dimorphic fungus has a mold for that is hyphae w/ small pear-shaped conidia and a yeast form w/ doubly refractive wall and a single broad-based bud?

Which form is found in tissue vs. culture?

A

Blastomyces dermatitidis

  • -Tissue biopsy –> yeast cells
  • -Culture –> hyphae
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11
Q

What dimorphic fungus has a mold for w/ thin, septate hyphae and a yeast form that is thick-walled w/ multiple buds?

A

Paracoccidioides brasiliensis

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12
Q

What are the 5 Opportunistic Mycosis organisms/groups?

A
  1. Candida
  2. Cryptococcus neoformans
  3. Aspergillus fumigatus + others
  4. Mucor/Rhizopus
  5. Fusarium spp
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13
Q

An AIDS patient accidentally ingests bird poop (specifically pigeon).
What mycosis is he at risk for?

A

Cryptococcus neoformans

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14
Q

Patient w/ Hx of steroid use, malignant disease, previous transplant, and HIV+ has a slight fever and slight stiff neck w/ subcutaneous nodules. Lab: CSF stain w/ India ink shows yeast w/ wide capsule. Serology: CrAg.
What is it?

A

Cryptococcus neoformans

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15
Q

Culture shows: mold only – septate hyphae w/ V-shaped branches, conidia forming radiating chains.
What is it?

A

Aspergillus fumigatus

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16
Q
  • -Virulence factors: gliotoxin (immunosuppressive), toxic metabolites, proteases
  • -Impairs macrophage and neutrophil responses
  • -Airborne infectious conidia
  • -Colonizes abraded skin, burns, cornea ,ear, sinuses

What is it?

A

Aspergillus fumigatus

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17
Q

Patient w/ asthma and CF has coughs of brownish substance w/ blood in sputum, fever, wheezing. Doesn’t respond to Abx. CXR: “grape cluster”/”hand in mitten” clusters in bronchi. Labs: Eosinophilia, high IgE. Treated w/ omalizumab and sinus surgery.
What is it?
Pathogenesis?

A

–Allergic bronchopulmonary aspergillosis (ABPA)

  • -Hypersensitivity to bronchi infection by aspergillus.
  • -Exacerbates asthma, CF
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18
Q

Patient w/ Hx of alcoholism, collagen-vascular disease, chronic granulomatous disease, COPD, and long-term corticosteroid use has subacute pneumonia (ineffective Abx), fever, cough, night sweats, weight loss, and ineffective TB treatment.
What is it?
Pathogenesis?

A

–Chronic necrotizing pulmonary aspergillosis (CNPA)

  • -Hyphae invade lung tissue –> pneumonia w/ hemoptysis and granulomas
  • -Rare, hard to diagnose
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19
Q

Patient w/ Hx of TB and CF has cough, fever, severe hemoptysis. CXR: fungus ball that changes position when sitting up vs. lying down.
What is it?
Pathogenesis?

A

–Aspergilloma

  • -Fungus balls form at site of cavitary lesion left by past TB, pulmonary mycosis, or CF.
  • -Can cause lethal pulmonary hemorrhage
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20
Q

Patient w/ Hx of COPD on corticosteroids and A LOT of immunosuppressives has fever, cough, pleuritic chest pain, worsening hypoxemia. Chest CT: “halo sign”. Labs: high serum glactomannan antigen.
What is it?
Pathogenesis?

A

–Invasive aspergillosis

  • -Rapid, progressive invasion of blood vessels –> infarction, hemorrhage, necrosis
  • -“Halo sign” = pulmonary infarction surrounded by alveolar hemorrhage
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21
Q

Patient w/ Hx of DM, burns, leukemia, IV steroids, TNFa blocker, or iron overload has and infection that causes brain, eyes, lungs, skin, GI or CNS failure due to impaired blood flow. Biopsy: nonseptate hyphae w/ broad irregular walls, branches at right angles
What is it?

A

–Mucor/Rhizopus/Absidia

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22
Q

Where might an infection by Fusarium spp develop in an immunocompetent patient?
Treatment?

A

–Under fingernails or in the cornea

–Amphotericin B, voriconazole, posaconazole

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23
Q

What is the most common Fusarium organism for both corneal and disseminated infections?

A

Fusarium solani

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24
Q

Fusarium microscopic morphology:

A

Banana-shaped macroconidia w/ “foot cell” at base

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25
Q

What organism is uniquely acid-fast staining and an obligate aerobe?

A

Mycobacterium tuberculosis

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26
Q

5 Important structural components of M. tuberculosis:

A
  1. Mycolic acids – acid fastness
  2. Wax D – adjuvant
  3. Phosphatides – caseation necrosis
  4. Cord factor (trehalose dimycolate) – virulence, microscopic serpentine appearance
  5. Phtiocerol dimycocerosate – lung pathogenesis
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27
Q

Exudative TB lung lesion, usually lower lobe, w/ acute inflammatory response and draining lymph node.
What is it called?

A

Ghon Complex

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28
Q

TB lesion w/ central area of infected Langerhans’ giant cells surrounded by epithelioid cells
What is it called?

A

Granulomatous Lesions

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29
Q

Old TB granuloma surrounded by fibrous tissue, central caseation necrosis. Healed by fibrosis and calcification.
What is it called?

A

Tubercule

30
Q

TB is controlled by what type of immunity?

A

Cell-Mediate Immunity (CMI) – CD4+ Th1 cells, macrophages, gamma-interferon

31
Q

Patients receiving what drug for Rheumatoid Arthritis or Crohn’s disease may reactivate latent TB infection?

A

Remicade

32
Q

What is it called when TB disseminates to cause osteomyelitis?

A

Pott’s Disease

–Osteomyelitis = infection of bone or bone marrow

33
Q

What is cervical adenitis associated w/ TB called?

What other organism can cause it?

A
  • -Scrofula

- -M. scrofulaceum in pediatric patients

34
Q

PPD skin test measures what type of hypersensitivity?

A

Type IV – Delayed Hypersensitivity

35
Q

What are the 4 groups of Atypical Mycobacteria?

A
  • -Group 1: Photochromogens – produce pigment in light
  • -Group 2: Scotochromogens – produces pigment in dark
  • -Group 3: Nonchromogens – no pigment
  • -Group 4: Rapidly growing mycobacteria – no pigment
36
Q

What mycobacteria has armadillos as a reservoir?

A

M. leprae

37
Q

CMI response difference in Tuberculoid vs. Lepromatous leprosy?

A

–Tuberculoid = strong CMI response –> CD4+, Th1, IFN-gamma, IL2, IL12, (+) skin test

–Lepromatous = poor CMI response –> useless Th2, nonprotective antibodies, (-) skin test

38
Q

Where do M. leprae replicate?

A

Intracellular = skin histiocytes, endothelial cells, Schwann nerve cells

39
Q

Tuberculoid or Lepromatous leprosy has:

  • -Granulomas containing giant cells?
  • -Many bacilli in skin, mucous membrane
  • -Immunogenic nerve damage
  • -(+) Lepromatin Skin test
  • -Foamy Histiocytes
A

Tuberculoid–Granulomas containing giant cells?
Lepromatous–Many bacilli in skin, mucous membrane
Tuberculoid–Immunogenic nerve damage
Tuberculoid–(+) Lepromatin Skin test
Lepromatous–Foamy Histiocytes

40
Q

What type of leprosy?

  • -Hypopigmented macular or plaque-like skin lesions, thickened superficial nerves, anesthesia of skin lesions
  • -Multiple nodular skin lesions, “leonine facies”
A

Tuberculoid–Hypopigmented macular or plaque-like skin lesions, thickened superficial nerves, anesthesia of skin lesions
Lepromatous–Multiple nodular skin lesions, “leonine facies”

41
Q

Pseudomonas aeruginosa:

  • Gram ___
  • Shape?
  • Aerobic/Anaerobic status?
  • Fermenter/nonfermenter?
  • Oxidase ___
  • 2 exotoxins are?
A
  • -Gram (-)
  • -Rod
  • -Strict aerobe
  • -Nonfermenter
  • -Oxidase +
  • -Pyocyanin and pyoverdin
42
Q

This pneumonia causing bacteria is also associated with foot rot in swamp-developed military.

A

B. cepacia

43
Q

Cepacia syndrome is accelerated pulmonary couse w/ rapidly fatal bacteremia in what patient population?

A

Cystic Fibrosis pneumonia patients

44
Q

In cultures of what pneumonia causing bacteria do you look for pigments, metallic sheen, and fruity aroma?

A

Pseudomonas aeruginosa

45
Q

Foot rot in swamp-deployed military is caused by what organism?

A

Burkholderia cepacia

46
Q

What are the 2 weaponizable pneumonia causing organisms?

A

B. pseudomallei

B. mallei

47
Q

Blood culture and gram stain of a pneumonia patient shows “wrinkled” colony morphology
What organism?

A

B pseudomallei

48
Q

Developing-nation vetrinarians and farmers develop a flu-like pneumonia. They recall having encountered horses with a disease called “Glanders”
What organism?

A

B mallei

49
Q

Patient who works at pet shop had a sick bird last week and comes in with a severe pneumonia.
What organism?

A

Chlamydia psittaci

50
Q

Legionella:

  • Stain? Gram ___
  • Shape?
  • [Intra/Extra]cellular?
  • Motility?
  • human-to-human transmission?
A
  • POOR STAINING, Gram (-)
  • Rod
  • Facultative intracellular
  • Infectious = motile w/ flagella
  • BUT replicative = nonmotile, intracellular
  • NO transmission
51
Q

What are the 3 ways a Legionella infection clinically presents?

A

1–Asymptomatic seroconveresion
2–Pontiac Fever = flulike, immunogenic symptoms in previously healthy patient
3–Legionnaires Disease = pneumonia w/ kidney involvment and diarrhea in previously ill

52
Q

What human cells do Legionella infect?

A

Human alveolar macrophage (in lung)

53
Q

Old, smoking, grandpa (male) w/ HIV (immunosuppression), COPD and CHF (chronic heart or lung disease), and some kind of chronic swallowing disorder has pneumonia symptoms.
What kind of presentation of what pathogen?

A

Legionella – Legionnnaires Disease

54
Q

Q fever is caused by what organism?

A

Coxiella burnetii

55
Q

What places are associated with Coxiella infection (Q fever)?

A
  • -Europe: Netherlands, France, Spain

- -Iraq

56
Q

When you see pneumonia w/ hepatitis, think what organism?

A

Coxiella

57
Q

What bacterial organism uniquely has:

  • -no cell wall
  • -cholesterol in membrane
  • -“fried-egg” colonies
  • -incomplete immunity
A

Mycoplasma pneumoniae

58
Q

“Walking pneumonia” in which CXR looks worse than the patient looks. Has “cold-agglutinins” and becomes anemic.
What organism?

A

Mycoplasma pneumoniae

59
Q

Influenza A vs Influenza B

  • -Which usually causes pneumonia?
  • -Which usually causes rhinitis/pharyngitis
A
  • -Pneumonia = A

- -Rhinitis/pharyngitis = B

60
Q

What virus causes croup and lower respiratory tract disease in children?

A

Parainfluenza virus

61
Q

What virus causes pneumonia and bronchiolititis in young children?

A

Respiratory Syncytial virus (RSV)

62
Q

SARS and MERS are caused by what virus?

A

Coronavirus – (+) ssRNA virus

63
Q

Orthomyxoviridae vs. Paramyxoviridae:

  • -Which is segmented?
  • -Which replicates in cytoplasm?
  • -Which is enveloped?
A
  • -Segmented = Ortho
  • -Cytoplasmic replication = Para
  • -Evenloped = BOTH
64
Q

Close contact in day cares, military camps, swimming clubs increases risk for this icosahedral, naked, linear DNA virus

A

Adenovirus

65
Q

Haemophilus influenzae requires what unique additives to chocolate agar to grow in culture?

A

Factor X = heme

Factor V = NAD

66
Q

Which serotype of H. influenzae causes most severe disease?

A

Type B –> meningitis, epiglottitis, pneumonia, sepsis

67
Q

What age is most likely to get H. influenzae B infections?

A

6mo-6yr, peak = 6mo-1yr

68
Q

Whooping cough is caused by what organism?

A

Bordetella pertussis

69
Q

What Bordetella pertussis virulence factor attaches the bacteria to cilia of epithelial cells lining respirtory tract?

A

“Filamentous hemagglutinin” pilus

70
Q

What are the 2 exotoxins of Bordetella pertussis

A
  • -Pertussis toxin = kill ciliated cells, inhibit chemokines –> lymphocytosis
  • -Tracheal cytotoxin = kills ciliated cells
71
Q

What are the 2 types of Bordetella pertussis vaccine?

A
  • -Acellular = pertussis toxiod

- -Heat-killed bacterium

MQW U4 (9 decks)

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