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Hematology-Oncology Exam 2 > Micro: opportunistic infections (didnt know it was done already) > Flashcards

Micro: opportunistic infections (didnt know it was done already) Flashcards

1
Q

What is a compromised host?

A

greater than 1 defect in the bodies natural defense
can be defect with innate or adaptive

they have an increased likelihood of suffereing from severe, life threatening infections

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2
Q

In general, what are primary deficiencies?

A

inherited, congenital

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3
Q

In general, how do secondary deficiencies arise?

A

d/t underlying diseases or from a treatment from disease

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4
Q

Give examples of primary innate immunodeficiencies?

A

complement and phagocytic deficiency

something that’s wrong with the body’s immune system

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5
Q

Give examples of secondary innate immunodeficiencies?

A

Burns- Damage to skin –> 1st barrier to infection and vascular tissue

Trauma/Surgery- organism goes into blood via wound, GI –> sepsis and shock

Obstruction- urine flow via catheter –> UTI , ciliary action, peristalsis

from another source

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6
Q

Give examples of primary adaptive immunodeficiencies?

A

T-cell, B-cell, and combined immunodeficiencies

These usually manifest as peds diseases

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7
Q

Give examples of secondary adaptive immunodeficiencies?

A

Malnutriition, AIDS, cancer, transplantation, stress, pregnancy

All these are immunosuppression

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8
Q

What deficiency is C3 and what is it?

A

A complement deficiency
Affects all immune pathways

C3 is missing –> C3b missing –> no opsonization –> can’t remove bacteria

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9
Q

What are some bacteria that are involved in C3 complement deficiency?

A

Enterobacteriaceae
Gram positive cocci
Haemophilus influenzae
Pseudomonas aeruginosa

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10
Q

MAC (membrane attack complex), which complements are involved?

A

C5-9

which cause defects in cell surfaces –> cell death

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11
Q

What is the most common recurrent infection with MAC deficiency?

A

recurrent bacterial meningitis from N. meningitidis

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12
Q

Chronic granulomatous disease (CGD) occurs with which deficiency and what is it?

A

Phagocytic deficiency

NADPH oxidase is deficient which leads to a recurrent infection with catalase positive bacteria

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13
Q

What are some bacteria assocaited with CGD?

A 
Enterobacteriaceae
Staphyococcus
Pseudomonas aeruginosa
Aspergillus
Mucor (Rhizopus)
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14
Q

Leukocyte adhesion deficiency (LAD) occurs with which deficiency and what is it?

A

Phagocytic deficiency

A defect in LFA-1 integrin protein which allows neutrophils to make their way out of the blood stream by adhering to receptors on the apical surface of endothelial cells in the infected areas –> recurrent infections

No pus, no abscess develops

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15
Q

What are some bacteria assocaited with LAD?

A

Gram pos. cocci, Gram neg. rods

Strep pneumoniae
S. aureus
S. epidermidis
Klebsiella pneumoniae
Enterobacter cloacae
Pseudomonas aeruginosa
Acinetobacter baumanii
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16
Q

Most common organism associated with burn wound infections?

A

P. aeruginosa (50%) and S. aureus (50%)

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17
Q

What are other types of infections associated with burn wound infections?

A

Bacterial infection : coag neg. staph, enterobacteriaceae

Fungal infection: candida (localized), Mucor (disseminated), Aspergillus

Viral infections: herpes, uncommon

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17
Q

What are other types of infections associated with burn wound infections?

A

Bacterial infection : coag neg. staph, enterobacteriaceae

Fungal infection: candida (localized), Mucor (disseminated), Aspergillus

Viral infections: herpes, uncommon

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18
Q

In obstruction, what constitutes 40% of nosocomial infections?

A

catheters –> always check for UTI

common source of bacteremia

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18
Q

In obstruction, what constitutes 40% of nosocomial infections?

A

catheters –> always check for UTI

common source of bacteremia

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19
Q

Most common organism associated with obstruction infections?

A

E.coli

its teh most common community and HAI

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19
Q

Most common organism associated with obstruction infections?

A

E.coli

its teh most common community and HAI

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20
Q

T-cell Primary adaptive immunodeficiencies?

A

DiGeorges*

Viruses, fungal pathogens

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20
Q

What are other organisms associated with Obstruction infection?

A 
mostly nosocomial: 
-K.pneumoniae (drug resistant)
Proteus
-Pseudomonas (drug resistant 
yeast
Enterococci
S.epidermidis
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21
Q

B-cell Primary adaptive immunodeficiencies?

A

X-linked agammaglobulinemia - most common
-No B cells in the periphery
-S.pneumoniae, H.influenzae
Hyper-IgM syndrome, selective IgA deficiency
-Bacterial infections at mucosal surfaces
Non-enveloped viruses (B19, norovirus)

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22
Q

Malnutrition affects T-cell or B-cell immunity?

A

BOTH, t-cell and b-cell immunity

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23
Q

T-cell Primary adaptive immunodeficiencies?

A

DiGeorges

Viruses, fungal pathogens

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24
Q

Combined immunodeficiency Primary adaptive immunodeficiencies?

A

SCID – susceptible to just about anything

Bacteria, viruses, fungi, parasites

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25
Q

Malnutrition is..?

A

secondary adaptive immunodeficiency

an imbalance supply of nutrients and energy and the body’s demand to ensure growth, maintenance, and specific function

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26
Q

Malnutrition affects which immunity?

A

BOTH, t-cell and b-cell immunity

27
Q

Which patients are HIV mostly seen in?

A

AIDS, cancer, transplant pt

28
Q

Persistent, generalized is what stage of HIV?

A

asymptomatic infection

29
Q

what is the algorithm for HIV symptomatic?

A

lymphadenopathy→symptomatic→AIDS defining conditions

AIDS: T-cell count is <200

30
Q

what are the clinical stages of HIV?

A

acute, asymptomatic, symptomatic, AIDS

31
Q

What happens in acute stage?

A

the p24 levels peak early BUT also drops quickly

that’s why the immune system is able to keep the virus “in check” at first, then it goes all ape shit

32
Q

What happens in asymptomatic stage?

A

CD4 levels decrease
No trace of p24 protein
Ab to env Ag begin to rise slowly
Ab to p24 rise and plateaus

33
Q

What happens in symptomatic stage?

A

CD4 levels decrease even more
Increase of p24 protein
Ab to env Ag plateaus
Ab to p24 decrease with CD4 levels

34
Q

What happens in AIDS?

A

T-cell count <200

35
Q

what are the most common pulmonary infections for HIV pt with >= 200 cell count?
(There are more on the chart she gave us but I wrote the ones she read off )

A

S.pneumoniae,
H.influenzae,
Mycobacterium tuberculosis

36
Q

what are the most common pulmonary infections for HIV pt with 50-200 cell count?

A 
Pneumocystis jiroveci
Cryptococcus, 
Aspergillus, 
Mycobacterium kansasii
\+
S.pneumoniae,
H.influenzae, 
Mycobacterium tuberculosis
37
Q

what are the most common pulmonary infections for HIV pt with <50 cell count?

A 
CMV
\+
Pneumocystis jiroveci
Cryptococcus, 
Aspergillus, 
Mycobacterium kansasii
\+
S.pneumoniae,
H.influenzae, 
Mycobacterium tuberculosis
38
Q

What is special about Ab to env Ag?

A

susceptible to ANTIGENIC DRIFT

so immune system needs to always keep up

39
Q

what are the most common pulmonary infections for HIV pt with >= 200 cell count?
(There are more on the chart she gave us but I wrote the ones she read off )

A

S.pneumoniae,
H.influenzae,
Mycobacterium tuberculosis

40
Q

what are the most common GI infections for HIV pt with <50 cell count?

A 
HSV
CMV
M. avium intracellulare
\+
Cyrptosporiudium
Isospora
Cyclospora
\+
Candida
oral hairy leukoplakia - EBV
HHV-8
C.difficile
41
Q

what are the most common pulmonary infections for HIV pt with >= 200 cell count?

A 
CMV
\+
Pneumocystis jiroveci
Cryptococcus, 
Aspergillus, 
Mycobacterium kansasii
\+
S.pneumoniae,
H.influenzae, 
Mycobacterium tuberculosis
42
Q

what are the most common GI infections for HIV pt with >= 200 cell count?
(There are more on the chart she gave us but I wrote the ones she read off )

A

Candida
oral hairy leukoplakia - EBV
HHV-8
C.difficile

43
Q

what are the most common GI infections for HIV pt with 50-200 cell count?

A 
Classic parasites:
-Cyrptosporiudium
-Isospora
-Cyclospora
\+
Candida
oral hairy leukoplakia - EBV
HHV-8
C.difficile
44
Q

what are the most common GI infections for HIV pt with <50 cell count?

A 
HSV
CMV
M. avium intracellulare
\+
Cyrptosporiudium
Isospora
Cyclospora
\+
Candida
oral hairy leukoplakia - EBV
HHV-8
C.difficile
45
Q

what are the most common cutaneous infections for HIV pt with > 500 cell count?

A

S. aureus
S.pyogenes
Tineas

46
Q

what are the most common cutaneous infections for HIV pt with 250-500 cell count?

A

VZV (zoster)

HSV

47
Q

what are the most common cutaneous infections for HIV pt with < 250 cell count?

A 
Bartonella
HHV-8
CMV
Leishmania
Molluscum contagiosum
Candida
Scabies
disseminated fungal infections
48
Q

What are the two most common pathogens associated with CNS issues? (for HIV pt)

A

Cryptococcus neoformans (<200 cells/mm3)

49
Q

The other CNS infections?

A 
TB
Syphillis
Listeria
HIV
systemic fungi
50
Q

Which BACTERIAL infection is generally seen in the first month after transplant?

A

P. aeruginosa, S. marcescens and E.cloacae
MRSA, VRE
Leginella, Nocardiosis

Basically gram - rods and gram + cocci

51
Q

What is generally seen in the first month of post transplantation?

A 
nosocomial infections
most common viral is HSV seen within first weeks 
surgery related
UTI 
immunosuppression exacerbates
52
Q

What is seen 2-6 months post transplantation?

A

immunosuppression

53
Q

What is seen after 6 months post transplantation?

A

Community acquired infections
UTI
VZV reactivation
things seen after discharged from hospital

54
Q

Which bacterial infection is generally seen in the first month after transplant?

A

P. aeruginosa, S. marcescens and E.cloacae
MRSA, VRE
Leginella, Nocardiosis

Basically gram - rods and gram + cocci

55
Q

What are the other FUNGAL infections? post transplant

A

Cryptococcus
-For HIV mostly
Coccidiodes
Histoplasmosis

56
Q

What s/s do post transplant CMV pt get?

A

interstitial pneumonitis

AIDS pt also get retinitis

57
Q

What are the other viral infections post transplant?

A

VZV, HSV, EBV - mono
BK virus - renal disease
Influ A and B, adenovirus - respiratory infections

58
Q

What are the 2 most common FUNGAL infections post transplant?

A

Candida

Aspergillus –>very bad news for IC pt.

59
Q

Acid fast oocysts, parasites

A

small circular acid fasts –> cryptosporia parvum

huge, elliptical acid fasts –> isosporia

isospora clincally looks like giardia b/c it causes malabsorption

60
Q

Owl’s Eye?

61
Q

Dented helmets, condoms?

A

PCP (pneumocystis pneumonia)

aka PJP

62
Q

HIV pt with PERSISTENT diarrhea

A

ALWAYS cryptosporia!!

Persistent diarrhea –> Parasite

63
Q

Acid fast oocysts, parasites

A

small circular acid fasts –> cryptosporia parvum
huge, elliptical acid fasts –> isosporia

isospora clincally looks like giardia b/c it causes malabsorption

64
Q

HIV pt, excessive weight loss, CD4 count is 75, Acid fast bacilli

A

M. avium intracellulae

65
Q

HIV, severe headache

A

CNS issues:
Toxoplasma –> “ring enhancing” lesions

Crytococcus neoformans –> encapsulating yeast –> leading form of meningitis in AIDS pt

66
Q

What do you see in pt with Mucor

A

IC pt with respiratory infection
Labs: ketoacidosis diabetic and sinusitis
90 degrees, nonseptae hyphae

67
Q

sickle cell anemia, tachy, hypotension, fever
Labs: leukocytosis with left shift
encapsulated gram + cocci
blood agar - alpha hemolysis

A

some kind of sepsis is going on
- encapsulated bacteria

S. pneumo

68
Q

HIV, multi-colored lesions

A

Kaposi = HHV-8 (which is most common)

Bacillary angiomatosis = Bartonella (B. henselae)

69
Q

IC pt with respiratory infection
Labs: neutropenia
sputum negative for bacterial growth
septae at 45 degrees

A

Aspergillosis

70
Q

IC pt with respiratory infection
Labs: ketoacidosis diabetic and sinusitis
90 degrees, nonseptae hyphae

Hematology-Oncology Exam 2 (15 decks)

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