Micro Review Flashcards
Branching rods on oral infection
Actinomyces israelii
HHV-8
Kaposi sarcoma
EBV associated iwth
Hodgkin lymphoma
(Reed-sternberg cells)
Burkitt lymphoma
(starry sky, 8;14)
Nasopharyngeal carcinoma
Streptococcus bovis assoc with
Colon cancer
Schistosoma haematobium assoc with
Squamous cell cancer of bladder
Clonorchis sinensis assoc with
Biliary cancer
Enveloped viruses spread
Droplets perientrally or sexually
Non-enveloped viruses spread
Fecal oral spread
Non-enveloped RNA viruses
“my Real Heavy Picture of California was Ruined without an Envelope”
Reovirus
Hepevirus
Picornavirus
Calicivirus
New ERs Helps People Receive Care
Non-enveloped DNA viruses
“PaPa and Aunt Poly Didnt have an Envelop”
Parvovirus
Papillomavirus
Adenovirus
Polyomavirus
DNA viruses typically replicate
In the nucleus
RNA viruses typically replicate
in the cytoplasm
DNA viruses that replicate in the cytoplasm
Smallpox virus
Molluscum contagiosum
RNA viruses that replicate in the nucleus
Orthomyxovirus (Influenza virus)
Retroviruses
Viral recombination where two viruses exchange entire segment
- example
- only what
Viral reassortment
RNA viruses only
Influenza virus
When two different viruses infect same host a genes are exchanged from two different chromosomes
Viral recombination
When two viruses infect a cell and one is non-functional so other virus makes a functional protein that serves both viruses
Viral Complementation
When two viruses infect the same host and the progeny receive surface proteins from either parent
Phenotypic mixing
Ploidy of viruses
All RNA and DNA viruses are haploid
Except: retroviruses (2) of ssRNA
DNA viruses
- examples
- typical features
- exceptions
HAPPy HiPPo Dung
HHAPPPPy
Herpesvirus Adenovirus Parvovirus Papillomavirus Hepadnavirus Polyomavirus Poxvirus DNA
Linear dsDNA
Icosahedral shape
Replicate in nucleus
Only parvoviridae (ssDNA)
Papillomarvirus (circular)
Polyomavirus (circular)
Hepadnavirus (circular)
RNA viral genomes
(+) stranded RNA viruses
I went to a RETRO TOGA party, where I drank FLAvored CORONA and ate HIPPIE CALIfornia PICkles
Retrovirus Togavirus Flavivirus Coronavirus Hepevirus Calicivirus Picornavirus
All ssRNA except reoviridae (dsRNA)
Negative-sense ssRNA
Not immediately translated
Can only be transcribed and not directly translated
Bring along viral transcriptase
Always Bring Polymerase Or Fail Replication
Arenaviruses Bunyaviruses Paramyxoviruses Orthomyxoviruses Filoviruses Rhabdoviruses
dsRNA brings along what
Polymerase
Live attenuated vaccine
“Attention Teachers” Please Vaccinate Small Beautiful Young Infants with MMR Regularly
Adenovirus Typhoid Polio (Oral) Varicella Small pox BCG Yellow fever Influena (intranasal) MMR Rotavirus
Killed vaccine
RIP Always
Rabies
Influenza (injection)
Polio (injectable)
Hepatitis A
Subunit vaccines
Use specific viral antigens to stimulate immune response
hepatitis B
HPV
Egg allergy
Yellow fever
Influenza
(MMR)
When should live virus vaccines be considered for HIV positive patients
All infants with HIV
- Rotavirus vaccine
CD4 count > 200
- MMR
- Varicella vaccine
Not recommended
- Live virus influenza vaccine
- Herpes zoster vaccine
What condition is suggested by each of the following
- Signet ring cells
- Nutmeg liver
- RBC casts in urine
- Gastric adenocarcinoma, lobular carcinoma in situ of breast
- Right sided heart failure and budd-chiari
- Acute glomerulonephritis
Infects spindle cells
HHV-8 Kaposi sarcoma associated herpesvirus (KSHV)
Temporal lobe encephalitis
Herpes simplex virus 1 (HSV-1)
Tzanck smear
Multinucleated giant cells positive
HSV-1, HSV-2, VZV
Low specificity
Low sensitivity
Intranuclear eosinophilic inclusions
Type A Cowdry bodies
HSV, VZV, CMV
EBV infects what cells
causes what
cell type seen
Infects B cells
Causes T cell response
Downey cells
- Foamy appearing basophilic cytoplasm
Foamy appearing cells with basophilic cytoplasm
Downey cells
T cells
EBV
Fever
Sorethroat
LAD of posterior cervical nodes
Splenomegaly
(+) monospot test
Infectious mononucleosis
EBV
Ab against antigens found on horse, sheep and beef RBCs
Monospot test
Detects heterophiles
EBV
Heterophile (-) mononucleosis
CMV infection
Acute HIV
Owl eye nuclear inclusions
CMV
Retinitis blind within days
CMV w/ AIDS
HIgh fever (102) 3-5 days
Fever breaks
Maculopapular rash all over body
Seizures
Roseola
Sixth disease
Human Herpes virus -6
What group of patients is prone to esopahgitis caused by CMV
HIV patients (CD4 < 50)
Child with bright red rash on cheeks
Slap cheek rash Erythema infectiosum (fifth disease)
Parvovirus B19
Upper respiratory infection
Then conjunctivitis
Diarrhea
Adenovirus
dsDNA virus
Variola poxvirus vs vaccinia pox virus
Variola poxvirus
- smallpox
Vaccinia poxvirus
- cowpox
Flesh colored dome shaped lesions with central dimple (umbilication)
Molluscum contagiosum
In immunocompetent will resolve in less than a year
Demyelination of DNA due to destruction of oligodendrocytes
AIDS
Progressive
Visial symptoms
Progressive Multifocal leukoencephalopathy
JC virus
Polyomavirus
Only Hepatitis virus dsDNA
Hepatitis B virus
Hepatitis B virus is what type of virus
Hepadnavirus
Hepatitis B virus replication
dsDNA virus
Partially double-stranded circular DNA enter nucleus
Host polymerase makes RNA intermediate from dNA
Viral reverse transcriptase makes DNA from RNA intermediate
Hides in sensory ganglia of S2 S3
Hides in trigeminal ganglia
Hides in dorsal root ganglia
HSV-2
HSV-1
VZV
Opacities seen on X ray on both sides of carina
Bilateral hilar lymphadenopathy
Sarcoidosis
Common cold
Rhinovirus
Coronavirus
Severe diarrhea and vomiting Winter months Daycare center Non-enveloped dsRNA virus
Rotavirus
type of reovirus
Western US/ canada
Hiker, Fisherman, camping
Flu- like
Coltivirus
(type of reovirus)
Self limiting
Types of picornaviruses
PERCH
Enterovirus
- Poliovirus
- Coxsackievirus
- Echovirus
- Hepatitis A virus
Rhinovirus
Types of enteroviruses
- labeled as
Enterovirus falls under Picornaviruses
Spread through enteric system
4 types
- Poliovirus
- Coxsackievirus
- Echovirus
- Hepatitis A virus
Poliovirus
Infects grey matter of the anterior horn of the spinal cord and motor neurons of the pons of the medulla
Causes paralysis
Aseptic meningitis
Myocarditis
URIs
Summer
-Diagnosis?
Echovirus
PCR of CSF
Hand foot and mouth disease
Coxsackievirus
Most common cause of viral myocarditis in US
features of disease (5)
Coxsackievirus
Dilation of all chambers Dyspnea Chest pain Fever Arrhythmias
Mouth blisters, fever
herpangina
Coxsackievirus
Coxsackievirus can cause
Myocarditis Aseptic meningitis Pericarditis herpangina (blisters mouth and fever) Hand, foot and mouth disease Febrile pharngitis
Picornavirus that is not an enterovirus
Rhinovirus
Common cold
Vomiting and diarrhea
Cruise ship
Norovirus (caliciviruses)
Fecal oral route
Types of flaviviruses
Yellow fever Dengue fever West nile virus St. Louis Encephalitis virus HCV
Most are arboviruses
(spread by arthropod)
High fever, HA Epistaxis Gum bleeding petechial and purpura Black vomit Jaundice Africa
Spread by?
Yellow Fever
Aedes mosquitoes
Liver damage
Fever
Severe musculoskeletal pain
Retro-orbital headache
Spread by?
Can get?
Test?
Dengue fever
Mosquito
Hemorrhagic fever
Tourniquet test
- field test for hemorrhagic fever
- BP inflated leave 5 min
- Excess petechiae
Headache Malaise Backpain Myalgia Anorexia Alteration in consciousness Neck stiffness
West Nile virus (WNV)
Mosquito
Serology for IgM anti-WNV antibodies
Tx supportive
A 26-year-old woman has headaches for 4 weeks
along with increasing malaise. Physical examination yields
no remarkable findings. CT scan of the head shows no
abnormalities. A lumbar puncture yields clear, colorless CSF
with a normal opening pressure. Laboratory analysis of the
CSF shows a normal glucose concentration and a minimally
increased protein level. A few lymphocytes are present,
but there are no neutrophils. A Gram stain and India ink
preparation of the CSF are negative. Her condition gradually
improves over the next 6 months. Serum serologic tests are
most likely to show an elevated titer of antibodies to which
of the following infectious agents?
A Cryptococcus neoformans
B Echovirus
C Listeria monocytogenes
D Neisseria meningitidis
E Toxoplasma gondii
B. Echovirus
Acute lymphocytic meningitis
West nile
Echovirus
Togaviruses
Rubella virus
Fever Lymphadenopathy
Arthralgia
Macuopapular rash
Rubella or german measles
Congenital rubella
Cardiac defects
- PDA
- Pulmonic stenosis
Cataracts
Deafness
11 A 6-year-old girl has a blotchy, reddish-brown rash
on her face, trunk, and proximal extremities that developed
over the course of 3 days. On physical examination, she has
0.2-cm to 0.5-cm ulcerated lesions on the oral cavity mucosa
and generalized tender lymphadenopathy. A cough with
minimal sputum production becomes progressively worse
over the next 3 days. Which of the following viruses is most
likely to produce these findings?
A Epstein-Barr
B Mumps
C Rubella
D Rubeola
E Varicella zoster
D Rubeola
Measles (rubeola)
Rash
Koplik spots
Rubella: german measles, is a much milder infection than rubeola
7 term infant has initial Apgar scores of 8 and 10 at 1
and 5 minutes. On auscultation of the chest, a heart murmur
is audible. There is hepatosplenomegaly. Cataracts of the crystalline
lens are noted. The infant is at the 30th percentile for
height and weight. Echocardiography shows a patent ductus
arteriosus. Which of the following events is the most likely
risk factor for the findings in this infant?
A Congenital rubella infection
B Dietary folate deficiency
C Dispermy at conception
D Erythroblastosis fetalis
E Maternal thalidomide use
F Paternal meiotic nondisjunction
A
Rubella in first trimester
38 A family who recently emigrated from Romania
brings their 7-year-old child to the pediatrician
with complaints of conjunctivitis and periorbital
swelling. The child has had coughing
with a runny nose and high fever for 3 days.
Small lesions with blue-white centers are seen
in his oral cavity. Which of the following is the
most likely cause of this child’s symptoms?
(A) Diphtheria
(B) Pertussis
(C) Roseola
(D) Rubella
(E) Rubeola
E
Rubeola
Retroviruses
Use reverse transcriptase
HIV
Human T cell Luekemia virus (HTLV)
What is the number one cause of fatal infantile gastroenteritis
Rotavirus
Posterior cervical adenopathy
EBV mononucleosis
Cat scratch disease (bartonella)
Acute otitis media
Avian influenza
H5N1
Spread only from bird to human
60% mortality
Severe rapidly progressive couse
Fever cough myalgias
diarrhea, pancytopenia
Tx: Oseltamivir
Swine flu
- type
- composed of
- symptoms
- tx
H1N1
Two swine strain
One human strain
One avian strain
Flu and GI symptoms
Tx: Oseltamivir or zanamivir
Influenza virus
- type of virus
- description of virus
- two key features
Orthomyxoviruses
Enveloped ssRNA
Hemagglutinin
- viral attachment to host cell
Neuraminidase
- release progeny virions
Barking seal cough child
Croup
Parainfluenza virus
- enveloped
Steeple sign
Croup
Parainfluenza virus
- enveloped
Winter months viruses
Influenza
Rotavirus
RSV
Summer months enterovirus
Poliovirus
Echovirus
Coxsackievirus
Summer months arbovirus
West Nile virus
Bronchiolitis
Child
Pneumonia in child
Infection of bronchioles
RSV
Primary cause of penumonia in children
RSV
RSV virus has what
Transmembrane protein called Fusion protein (F protein)
This allows infected cells to bond to near by uninfected cells
Multinucleated giant cells
55 A 3-year-old boy has had a cough, headache, and slight
fever for 5 days. He is now having increasing respiratory difficulty.
On physical examination, his temperature is 37.8° C,
pulse is 81/min, respirations are 25/min, and blood pressure
is 90/55 mm Hg. On auscultation, there are inspiratory crackles,
but no dullness to percussion or tympany. Respiratory
syncytial virus is isolated from a sputum sample. Which of
the following chest radiographic patterns is most likely to be
present?
A Hilar lymphadenopathy
B Hyperinflation
C Interstitial infiltrates
D Lobar consolidation
E Pleural effusions
F Upper lobe cavitation
C Interstitial infiltrates
RSV
Paramyxoviruses
RSV
Parainfluenza virus
Rubeola virus (measles)
Mumps
Runny nose
cough
Conjunctivitis
Blue grey specks on buccal mucosa surround by base of red
Wide spread maculopapular rash that started on head and spread
Measles
Enveloped
Koplik spots
Parotits
Orchitis
Meningitis
Mumps enveloped
Inflammation of parotid gland
Viral meningitis
Coxsackievirus
Echovirus
Enterovirus
Mumps virus
Negri bodies Fever Nausea vomiting Strange behavior Hallucinations Hydrophobia Coma Death
Rabies virus
(Rhabdovirus)
Enveloped RNA
Eosinophilic cytoplasmic inclusions that contain viral nucleocapsids
Negri bodies
Rabies
Bullet shaped capsid
Rabies
Fever
Progressive pulmonary edema
Respiratory failure
Exposure to mouse urine
Hantavirus
A 27-year-old man dies of acute respiratory distress syndrome 1 day after presenting to the hospital with shortness of breath and a fever of 38° C (100.4° F). On the second hospital day, he developed extreme pulmonary edema and
hypotension before he died. His family says
that he had recently gone hiking and caving in an area known to be heavily populated with rodents.
Which of the following is the most likely
cause of death?
(A) Dengue virus
(B) Ebola virus
(C) Hantavirus
(D) Marburg virus
(E) Rhabdovirus
C. Hantavirus
Illnesses spread through animal urine
Hantavirus
Lassa virus
LCM virus
Leptospirosis
Fever HA myalgias Followed by vomiting and diarrhea Multiorgan failure Shock Death
Ebola virus
A patient present with fever, vomiting and diarrhea. She was in west africa two weeks visiting family. What viral infection? Type of isolation
Ebola
Contact and droplet precautions
Viral proteins of HIV
Gp120
Gp41
Gp120
Grabs onto CD4 surface receptor on T cells and macrophages
Once connected, changes shape and allows it to bind to coreceptor (CCR5 or CXCR4)
Tropsim
Which coreceptor HIV uses to enter cell
only CXCR4: X4 viruses
Only CCR5: R5 viruses
Both : dual tropism
GP41
Fusion and entry into host cells
Three main structural genes in HIV genoma
Gag: encodes p24 capsid protein
Env: gp120 and gp41
Pol: codes for reverse transcriptase
Diagnosis of HIV check
P24 antigen adn HIV antibodies
Viral load (PCR test)
AIDS diagnosis
CD4 < 200
< 14% lymphocytes are Cd4
AIDs defining condition
- Pneumocystis jirovecii pneumonia
Ring enhancing lesions
HIV associated Primary CNS lymphoma
(solitary lesion)
Toxoplasmosis
(multiple lesions)
HIV < 200 opportunistic infections
Pneumocystis jirovecii pneumonia
HIV < 100 opportunistic infections
Histoplasmosis capsulatum
Candida albicans
HIV < 50 opportunistic infections
Mycobacterium tuberculosis
Mycobacterium avium complex
CMV retinitis
Hepatosplenomegaly
Fever
Cough
CD4 < 150
Histoplasmosis capsulatum
Chronic watery diarrhea
HIV patient
diagnosis
Cryptosporidium spp. (c.parvum)
Oocytes on modified acid-fast stain of stool turns bright pink or red
HIV patient covered in what look likes cherry angiomas
Bacillary angiomatosis
Bartonella henselae
What four molds are considered dermatophytes (fungal species that invade superficial skin)
Trichophyton
Microsporum
Epidermophyton
Malassezia furfur
Diaper rash
Satellite lesions
Candida albicans
Shiny skin or eroded
Blood culture
Germ tubes have small projections on side of cell
Candida albicans
Narrow based budding yeast
Cryptococcal neoformans
India ink
Clear circle
Cryptococcal neoformatns
Soap bubble lesion on imaging
Cryptococcal meningoencephalitis
Silver stain
Ground glass appearance of interstital infiltrates
Pneumocystis jirovecii (PCP)
Narrow septate hyphae that branch at acute angles (45 degrees)
Aspergillus fumigatus
Broad irregularly shaped, nonseptate hyphae branching at right angles (90 degrees)
Mucor and Rhizopus
Facial pain HA Large necrotic lesion, black escar Blindness CN deficits
Rhinocerebral mucomycosis
Most common type of dermatophytes with animal reservoir
Microsporium (dog or cat)
Hypopigmented or hyperpigmented lesion on body
Scaling plaque
Yeast
Tinea versicolor
Malassezia furfur
KOH prep spaghetti and meatball appearance
Tinea versicolor
Malassezia furfur
What is associated iwth each clue
- Cat scratch
- Cat bite
- Cat feces
- Puppy feces
- Animal urine
- Bartonella henselae
- Pasteurella multocida
- Toxoplasma
- Yersinia enterocolitica, campylobacter jejuni
- Leptospira, hantavirus
Organisms associated with birds
Histoplasma capsulatum (bird/bat droppings)
Cryptococcus neoformans (pigeon droppings)
Chlamydophilia psittaci (parrots)
H5N1 influenza
West Nile virus
Mississippi ohio river valley
Bird and bat droppings
Spelunkers
- Imaging
- what happens to it
Histoplasma capsulatum
Enters through lung
Engulfed by macrophages
Hyphae and spores on imaging
Macrophage filled w/ 100 spores
Mississippi and ohio river basins
Thick refractile wall around yeast
broad based budding
Blastomyces dermatitidis
Granulomatous nodules
Southwestern U.S
Mexico
Pneumonia
Spherule
-filled with endospores
Coccidioides immitis
A 46-year-old man from northern Mexico has had fever,
nonproductive cough, and weight loss for 2 months. On examination
his temperature is 37.5 ° C. A chest radiograph shows
a miliary pattern of small nodules in all lung fields. Bronchoalveolar
lavage is performed and microscopic examination of
the fluid shows organisms averaging 50 microns in diameter
with thick walls and filled with endospores. Which of the following
infections is he most likely to have?
A Blastomycosis
B Coccidioidomycosis
C Histoplasmosis
D Mycobacteriosis
E Nocardiosis
F Paracoccidioidomycosis
B. Coccidioidomycosis
Pneumonia
Granulomatos changes in mucous membranes
Captain wheel
Latin america
Paracoccidioides brasiliensis
Paracocci parasails with a captains wheel all the way to Latin america
Gardner
Dimorphic fungus
Pustule on puncture site
Nodules follow draining lymphatics
Tx
Sporothrix schenckii
Tx: Itraconazole (first line)
potassium iodine
Mold form contains barrel shaped arthroconidia
Coccidioides immitis
Associated iwth dust storms
Coccidioides immitis
Multiple budding of yeast form
Paracoccidioides brasillensis
Councilman bodies
Apoptotic liver cells
Viral hepatits
yellow fever
Acute fatty foul smelling diarrhea
Abdominal bloating
- Diagnosis
Tx
Giardia lamblia
Pear-shaped trophozoites or cysts in stool
Metronidazole
Tinidazole
Pear-shaped trophozoites
Giardia lamblia
Trichomonas (protozoal)
Bloody diarrhea
Flask shaped ulcers
RUQ pain
- type organism
- transmittered
- diagnosis
- tx
Entamoeba histolytica
Liver abscesses
Fecal-oral route
- eating food or water contaminated with feces that contain cysts
Trophozoites or cysts in stool
Treatment
- trophozoites= metronidazole or tinidazole
- cysts= iodoquinol or paromomycin
Foul smelling vaginal discharge
Motile
-transmission
- wet mount
- vaginal pH
- tx
-
Trichomonas vaginalis
Sexual transmission
Pear shaped appearance
Increase vaginal pH
Metronidazole
Ring enhancing lesions in brain
Tx
Toxoplasma gondii
Pyrimethamine
Chorioretinitis
Hydrocephalus
Intracranial calcifications
Tx
Toxoplasma gondii
Pyrimethamine
Toxoplasma gondii acquired how
Cat feces or litter
Eating cyst in infected meat
Rapidly fatal meningoencephaltiis
Swimming
Naegleria fowleri
Swimming in freshwater lakes
Enters nose passes through cribriform plate
A 40-year-old man goes on a camping vacation
with his family. One day after swimming in a
freshwater lake near the camp site, he develops
nausea and vomiting and starts to behave irrationally.
His family takes him to the emergency
department, where blood samples are taken
and a spinal tap is performed. He is diagnosed
with a rapidly progressing meningoencephalitis
and dies shortly thereafter. Which of the following
protozoa was most likely the cause of
the man’s illness?
(A) Cryptosporidium species
(B) Entamoeba histolytica
(C) Leishmania donovani
(D) Naegleria fowleri
(E) Plasmodium falciparum
(D) Naegleria fowleri
55 A 9-year-old child who is living in a mud hut in Paraguay
has a sore persisting on her face for 4 days. Physical examination
shows an indurated area of erythema and swelling just
lateral to the left eye, accompanied by posterior cervical lymphadenopathy.
She has unilateral painless edema of the palpebrae
and periocular tissues. Two days later, she has malaise, fever,
anorexia, and edema of the face and lower extremities. On
physical examination 1 week later, there is hepatosplenomegaly
and generalized lymphadenopathy. Which of the following
pathologic findings is most likely to develop in this patient?
A Cerebral abscesses
B Chronic arthritis
C Dilated cardiomyopathy
D Meningitis
E Mucocutaneous ulcers
F Paranasal bony destruction
C Dilated cardiomyopathy
Trypanosoma cruzi
Tx Nifurtimox
Trypanosoma brucei spp
- sickness
- vector
- symptoms
- later symptoms
- blood smear
- tx
African sleeping sickness
tsetse fly
Fever
Enlarged LN
Sleepiness
Encephaltiis
Coma and death
Blood smear: long whispy organisms in blood
Early: Suramin
CNS involved: Melarsoprol
Dilated cardiomyopathy
Megesophagus
Megacolon
Trypanosoma cruzi
Chagas disease
Reduviid bug
- painless bit
- Feces scrated into skin
Benznidazole
Nifurtimox
Spiking fevers
Hepatosplenomegaly
Pancytopenia
- transmission
- diagnosis
- tx
Leishmania donovani
Visceral leishmaniasis
Sandfly
Amastigotes inside macrophages
Liposomal amphotericin B
Ulcerating papules that are slow to heal
Leishmania donovani
- Cutaneous leishmaniasis
Sandyfly
Sodium stibogluconate
Cyclic fever
Headache
Anemia
Splenomegaly
Malaria
Plasmodium species
Mosquito
Malaria fever due to
RBCs rupture and release merozoites
Malaria that fever spikes every 48 hrs
Every 72 hrs
48 hr
- P. ovale
- P. vivax
72 hr
- P. malariae
Malaria
- subtype
- tx
- Diagnosis
Plasmodium species
P. vivax and P. ovale
- dormant infection in liver
Tx primaquine
P. falciparum - most severe - no dormant form - sequestration of RBCs --> occlusion of small vessels Tx: Chloroquine (SE: Retinopathy and pruritis )
Blood smear
- Merozoites
- Trophozoite= diamond ring
- Gametocytes: banana shaped
Two ring forms inside one erythrocyte
Trophozoite form
Babesia Microti
Maltese cross
inside RBC
merozoites
Babesia Microti
Babesia Microti
- symptoms
- blood smear
- transmission
- tx
Fever
Hemolytic anemia
Progressive fatigue
Two rings inside RBC
Maltese cross
Ixodes tick
coinfection w/ lyme disease
Tx
Quinine + Clindamycin
(atovaquone + azithromycin)
Names of following stages of malaria life cycle
- Looks like diamond ring
- Ruptures the cell host
- Replicating intracellularly
- Form injected from the anopheles mosquito
- banana shaped
- Early trophozoite
- Merozoite
- Schizont
- Sporozoite
- Gametocyte
Ingest helminths
“EAT”
Enterobius vermicularis
Ascaris lumbricoides
Trichinella spiralis
Penetrating helminths
“Sand”
Stronglyoides
Ancylostoma
Necator
D
Worm lays eggs at anus
tx
Enterobius vermicularis
Nematode (round worm)
Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate
Giant round worm
Eosinophilic pneumonitis
- diagnosis
- tx
Ascaris lumbricoides
Ingest eggs Hatch in intestines Release larvae penetrate bowel --> lungs Migrate up trachea and swallowed Mature worms in intestine
Eggs released in stool
Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate
Myositis
Fever
Eosinophilia
Periorbital edema
- acquired
- diagnosis
- tx
Trichinella spiralis
Undercooked meat
GI –> muscles
Muscle biopsy: cysts with larvae in muscle tissues
Bendzimidazoles
A 28-year-old woman from rural Guyana with a history
of rheumatoid arthritis develops painful swelling of her
hands and feet. She is treated with corticosteroid therapy.
A month later, she develops profuse, watery diarrhea along
with fever and cough. On examination, she has a temperature
of 37.3° C. Laboratory studies show WBC count, 12,900/
mm3; and the WBC differential count shows 57% segmented
neutrophils, 5% bands, 16% lymphocytes, 8% monocytes,
and 14% eosinophils. Microscopic examination of a stool
specimen shows ova and small rhabditoid larvae. Similar
larvae are present in a sputum specimen. Which of the following
infectious diseases is most likely to produce these
findings?
A Cysticercosis
B Onchocerciasis
C Schistosomiasis
D Strongyloidiasis
E Trichinosis
D. Strongyloidiasis
Rhabditiform larvae in feces
tx
Strongyloides
Threadworm
Ivermectin
Albendazole
Wound on feet
Anemia
Abdominal discomfort
tx
Ancylostoma
Necator
Hook worms
Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate
Taenia solium
- transmission
- symptoms
- tx
Cestodes (tapoworms)
Ingestion of alrvae in undercooked port
- GI tract infection by adult worm
Ingestion of eggs in contaminated food or water
- brain filled w/ cysts
Tx
Albendazole
Praziquentel
Dexamethaone: keep CNS symptoms from getting worse
Cestodes
Tape worms
Taenia solium
Diphyllobothrium latum
Echinococcus granulosus
Brain filled with cysts
Seizures
Taenia solium
Ingestion of eggs in contaminated food
Giant limbs
- type
- transmitted
- tx
Wuchereria bancrofti
Helminth, neomatoid
Round worm in GI
Mosquitoes
Migrate to lymphatics
Elephantiasis of limbs
Hydrocele of scrotum
Tx
Diethylcarbamazine
Raw fish
Megaloblastic anemia
-def
tx
Diphyllobothrium latum
B12 deficiency
Praziquantel
Hydatid cyst lesion in liver
RUQ pain
Well circumscribed circular lesion
- transmitted
- can find where in body
- symptom
- tx
Echinococcus granulosus
dog feces
Egg shell calcifications
Form mature larval cysts in liver and lungs
Anaphylaxis
Surgical removal of cysts
A 23-year-old man presents to the physician
with abdominal distention and tenderness with
no vomiting or diarrhea. Physical examination
shows hepatosplenomegaly. Bowel sounds are
normal. On questioning, the patient says that
he traveled to eastern South America 1 year
ago. Several weeks after returning from his trip,
he remembers having fever, diarrhea, weight
loss, and “funny looking stools.” Ultrasonography
shows ascites and hepatic periportal fi brosis.
Which of the following is most likely
responsible for this patient’s present symptoms?
(A) Appendicitis
(B) Bowel obstruction
(C) Enterocolitis
(D) Portal hypertension
(E) Ruptured viscus
D. Portal hypertension
Schistosoma mansoni
A 29-year-old man has had hematuria for the past
month. On physical examination, he is afebrile. There is diffuse
lower abdominal tenderness, but no palpable masses. An
abdominal radiograph shows a small bladder outlined by a
rim of calcification. Cystoscopy is performed, and the entire
bladder mucosa is erythematous and granular. Biopsy samples
are taken. Which of the following histologic findings is
most likely to be seen in these samples?
A Acid-fast bacilli of Mycobacterium avium complex
B Eggs of Schistosoma haematobium
C Larvae of Trichinella spiralis
D Migrating Ascaris lumbricoides
E Taenia solium cysts
B. Eggs of schistosoma haematobium
Deals with snails
Schistosoma
Portal HTN
Splenomegaly
Egyptian immigrant
tx
Schistosoma
- blood fluke
Praziquantel
Chronic bronchitis
Hemoptysis
acquired
-t x
Paragonimus westermani
Adult fluke in lung
Undercooked crab meat
Praziquantel
Pigmented gallstones
Cholangiocarcinoma
- transmission
- lives
- Tx
Clonorchis sinensis
- liver fluke
undercooked fish
Lives in biliary tract
Praziquantel
Albendazole
Swimmers itch
Schistosoma
Fluke associated iwth hematuria and bladder cancer
Schistosoma haematobium
Burns all over the body what will occur over the 7 day?
Increased metabolic rate
Not
- Increased extracellular volume
- Not increase in serum cholesterol concentration
- Not loss of B vitamins in skin
Testicular tumor with friend egg appearance
Seminoma
Germ cell tumor
Umbilical cord compression of infant, monitoring shows a normal fetal heart rate of 150/ min with variable spontaneous decelerations to 110/min. Why the decrease in fetal heart rate
Increased fetal systemic vascular resistance
Compressing vessel, decreases radius increase in resistance
Cause reflex bradycardia
20 yr history of T1D uses insulin
why hypoglycemia
Impaired release of glucagon
Erythematous scaly rings with central clearing
From pet
Tinea corporis
White plaque on side of tongue
what happens if dont tx
Hairy leukoplakia
EBV
Progress into submucosa
Black escar nose
Mucor
Ixodes deer tick
Borrelia burgdorferi
Anaplasma
Babesia
Fever Diarrhea Splenomegaly Muscle wasting Pancytopenia
Bitten sand fly
Leishmania spp
Disease form bed bugs
Staph aureus
E coli makes many proteins how
mRNA contains sequence for many proteins
Scratches
Vetarianian
Parrot
Tender regional lymphadenopathy
Bartonella henselae
Bartonella henselae can cause what in immunocompromised
Bacillary angiomatosis
Red-purple papular skin lesions
Fever myalgias, malaise, and progressive fatigue over 2 week period
No sore throat
Splenomegaly
No Lad or jaundice
Fails to agglutinate horse erythrocytes
Mono
(normally EBV0
but since no agglutination
CMV
Dont gram stain
The Little Microbes May Unfortunately Lack Real Color But Are Everywhere
Treponema, Leptospira
- too thin
Mycobacteria
- high lipid
Mycoplasma, Ureaplasma
- no cell wall
Legionella, Rickettsia, Chlamydia, Bartonella, Anaplasma, Ehrlichia
- primarily intracellular
Giemsa Stain
Rickettsia Chlamydia Trypanosomes Plasmodium Borrelia Helicobacter pylori (Histoplasma)
Ricky got Chlamydia as he Tried to Please the Bored Hot Geisha
Chinese Painted wHores Bow To Rich
PAS
Stains for glycogen
Whipple disease
Tropheryma whipplei
Ziehl Neelsen stain
Acid fast
Mycobacteria
Nocardia
Mycolic acid in cell wall
- Cryptosporidum oocytes
India ink
Cryptococcus neoformans
Silver stain
Fungi
- Coccidioides
- Pneumocytstis jirovecii
- Legionella
- H. pylori
Mycobacterium spp virulence factors
Cord factor
- creates serpentine cord appearance in virulent M tuberculosis strains
- activates macrophages -> release of TNF-alpha
Sulfatides (surface glycolipids) inhibit phagolysosomal fusion
-bendazole
benzimidazole
Mebendazole
Albendazole
Antiparasitic
-cillin
Penicillin
Amoxicillin
Methicillin
-conazole
Imidazole (antifungal)
Fluconazole
Ketoconzole
Penicillins MOA
Interact w/ transpeptidase and inhibit peptidoglycan cell wall synthesis
Inhibit DNA gyrase and topoisomerase (which participate in supercoiling)
Fluoroquinolones
Inhibit bacterial ribosome translational proofreeding
Aminoglycosides
Inhibits viral assembly
Amantadine
Also inhibits viral release through interactions iwth the viral M2 protein
No longer used due to resistance
Inhibits viral protein synthesis
Ribavirin inhibits viral RNA polymerase activity and rRNA fragment initiation and elongation leading to viral protein synthesis inhibition
Used in Chronic Hep C infections and respiratory syncytial virus infection
Viral reverse transcriptase inhibitors
Lamivudine
emtricitabine
Tx HIV
Etoposide
Cancer drug
Inhibits topoisomerse II
Myelosuppression
Alopecia
Bacterial resistance to fluoroquinoles (Ciprofloxacin)
Efflux pumps
Antibitoics that target protein synthesis 30s subunit
Tetracyclines (Doxycycline)
Aminoglycosides (Streptomycin)
Antibiotics that target 50s subunit
Chloramphenicol Clindamycin Macrolides (erythromycin) LInezolid Linocmycin Streptogramins
Anti-TNF alpha
Infliximab
Etanercept
TNF-alpha inhibitors
Etanercept Inflixumab Adalimumab Golimumab Certolizumab
Clostiridium difficle tx
Tx
- Metronidazole
- Oral vancomycin
- Fidxomicin (recurrent)
Corynebacterium diphtheriae tx
Erythromycin or penicillin
Antitoxin
Vaccinate
Tx N. GOnorrhoeae
Ceftriaxone
Azithromycin
Tx N. Meningitides
Prophylaxis
- Rifampin
- Ciprofloxacin
- Ceftriaxone
Tx
- Cefotaxime
- Ceftriaxone
Legionella pneumophila tx
Macrolides
Fluoroquinole
Psudomonas aeruginosa tx
Oral: fluoroquinolones
- Ciprofloxacin
Levofloxacin
Ticardillin Pipercillin Cefepime ceftazidime Carbapenems - impenem - meropenem
H. pylori tx
Tx: Triple therapy - PPI - Clarithromycin - Amoxicillin or metronidazole
Quadruple therapy
- PPI
- Bismuth
- Metronidazole
- Tetracycline
Tx Shigella
Tx Salmonella
Tx Campylobacter
Tx Yersinia enterocolitica
Tx Vibero cholerae
Shigella (bloody)
- Fluroquinolones
- TMP-SMX
- Azithromycin (macrolide)
Salmonella (bloody)
- Fluroquinoles
- ceftriaxone
Camppylobacter jejuni (bloody)
- Supportive
- Fluroquinoles
- Azithromycin
Yersinia enterocolitica (bloody)
- Supportive
- Fluroquinoles
- TMP-SMX
Vibero cholerae
- rehydration
Tx Leptospira interrogens
Question mark shaped
Rodent urine
Pencillin
Ceftriaxone
Doxycycline
Tx Borrelia burgdorferi
lyme disease
Tx Doxycycline (early stage)
Amoxicilin (children <8)
Doxycycline or Ceftriaxone (late)
Syphilis tx
Penicillin G
allergy: doxycycline
Tx Tb
RIPE
2 months Rifampin Isoniazid Pyrazinamide Ethambutol
4 months
Rifampin
Isoniazid
what antibiotic is used for prevention of mycobacteriuma vium intracellulare (MAI) in AIDs patients? When is it began
Azithromycin
Given once weekly
Beginning when CD4 < 50
Rifampin
Tb tx
RNA polymerase inhibitor
Revs up cytochrome P450
Red orange body fluids
Rapid Resistance used alone
Hepatotoxicity
Isoniazid (INH)
Inhibits synthesis of mycolic acids
Hepatotoxicity
Peripheral neuropathy
Give w/ B6
Ethambutol
Inhibits arabinosyl transferase
Imparied cellw all synthesis
Optic neuropathy
Color blindness
Decreased visual acuity
Mycobacterium leprae tx
Tuberculoid disease
- Dapsone + rifampin (12 months)
Lepromatous disease
- Dapsone + rifampin + cloflazimine (24 months)
Dapsone uses
Leprosy
Penumocystis jirovecii pneumonia
Hemolysis in G6PD deficiency
Tx Gardnerella vaginalis
Oral metronidazole
Metronidazole cream
Rickettsial disease tx
Doxycycline
Tx Chlamydia
Azithromycin
Tx Atypical pneumonia
Azithromycin
Tx Chlamydophila pneumoniae
Doxycyline
or azithromycin for atypical pneumoniae
Immunosuppressant mneumonic
I’m Supposed to cycle past tacos sir but my appetitie
Immuno Suppressant Cyclosporine Pimecrolimus Tacrolimus Sirlimus Basiliximab Mycophenolate mofetil Azathioprine
Cyclosporine
- binds
- inhibits
- prevents
SE (2)
Binds cyclophilins
Inhibits calcineurin
Prevents IL-2 production
Nephrotoxicity
HTN
Tacrolimus and Pimecrolimus
- bind
- inhibit
- prevent
SE (3)
FK506
Binds FK binding protein
Inhibits calcineurin
Prevents IL-2 production
Nephrotoxicity HTN Neurotoxicity - HA - Paresthesias
Sirolimus
- aka
- bind
- inhibit
- type inhibitor
SE (1)
aka rapamycin
Binds FK protein 12
Inhibits mTOR
Inhibits T cell proliferation and response to IL-2
Not nephrotoxic
Azathioprine
- is what
- interferes
- Se
- Metabolized
Precursor of 6-mercaptopruine (cancer drug)
Interferes w/ nucleic acid synthesis
Bone marrow suppression
Metabolized by xanthine oxidase (toxic effects increased by allopurinol)
Mycophenolate (mycophenolate mofetil)
- inhibits
- inhibits
- prevents
Inhibits inosine monophosphate (IMP) dehydrogenase
Inhibits guanine synthesis
Prevents lymphocyte proliferation
Bacteria that increase efflux pump is resistant to
Tetracycline
Enterococci that substitute D-lactate for D-alanine in synthesis of pentapeptide proteoglycan precursors.
Decreases binding of what antibiotic
Vancomycin
Drugs acting on microtubules (6)
Vincristine: block polymerization, prevent growing
Vinblastine: block polymerization, prevent growing
Taxanes: hypersensitize the microtuble, can grow but breask down
Benzimidazoles
Griseofulvin: antifungal
Colchicine: anti-inflammatory gout
Tx acute otitis media
S. pneumoniae
Nontypable H. influenzae
Ml. catarrhalis
Antibiotics
- Amoxicillin
- Amoxicillin + clavulanic acid
- Cephalosporins
Tx for H. pylori
Triple therapy
- PPI + clarithromycin + amoxicillin
“-prazole”
- PPI + clarithromycin + metronidazole
Quadruple therapy
- PPI + bismuth + metronidazole + tetracycline
Clarithromycin: macrolide
-50 S subunit
Metronidazole
- forms free toxic radical damages DNA
Amoxicillin
- AMPed up penicillin
- D-Ala-D-Ala structural analog
- Binds penicillin binding proteins (transpeptidases), blocks crosslinking of peptidoglycan in cell wall
Antibiotic
Red urine
Rifampin
red urine
Tx Chlamydia and chlamydophila species
Macrolides
Tetracyclines
Tx Hepatitis B
Tenofovir
Entecavir, telbivudine, lamivudine, adefovir
Resistance of Rifampin
MOA
Altered structure of enzyme involved in bacterial RNA synthesis
Inhibition of bacterial DNA-dependent RNA polymerase
Isoniazid MOA
Ethamutol MOA
Isoniazid:
inhibition of mycolic acid synthesis
Ethambutol: inhibition of arabinosyl transferase
Prophylactic tx for neisseria meningitidis
Rifampin
Tx: current infection
- penicillin, ceftriaxone
Drug binds to cell wall glycoproteins
Drug interferes with DNA replication proteins
Drug binds to ribosomal proteins
Drug binds to transpeptidases
Vancomycin
Fluoroquinolones, binds DNA gyrase
Macrolides, tetracyclines
Pencillin, cephalosporins
Resistance to cephalosporins
Change in protein structure
Inhibits binding
Antiretroviral target
inhibit HIV protease
Inhibit production of functional viral encoded enzymes
Rabies vaccine
Inactivated vaccine
Tx Gonorrhea
Macrolide
Third generation cephalosporin
Tx Lung abscess
Clindamycin
- anaerobic oral organisms and aerobes
How do alcohol based disinfectants work?
Kills vegetative bacteria (not spores) fungus and enveloped viruses
Dissolves their lipid bilayer membranes
Drug that block surface glycoproteins
Neuraminidase blocking
Neuramindase inhibitors
- Oseltamivir
- Zanaamivir
Penicillin MOA
Bind to penicillin binding proteins
Inhibit formation of corss linkages between peptidoglycan chains
Cell lysis
Upregulate autolysins
Penicillin coverage
Gram positive Spirochetes- syphilis Gram positive rods Gram negative cocci - neisseria
Penicillinase resistant penicillins
Bulky R group
Methicillin
Nafcillin
Oxacillin
Dixcloxacillin
Aminopenicillins
- examples
- inhibition
- Use
Ampicillin (IV)
Amoxicillin (greater oral bioavailability)
Pencillinase sensitive
HHEELPSS H. influenzae H. pylori E. coli Enterococci Listeria Proteus mirabilis Salmonella Shigella
Beta lactamase inhibitors
CAST
Clavulanic acid
Avibactam
Sulbactam
Tazobactam
Add to pencillinase sensitive drugs
Resistant otitis media
Amoxicillin + clavulanic acid
Cefdinir (3rd generation)
Surgical infections
Sulbactam + ampicillin
Carboxypenicillins
- examples
- MOA
- use
Ticarcillin
Carbenicillin
Piperacillin
Attacking cell wall
Pseudomonas
Gram neg rods
Suscpetible to penicillinase
Pseudomonas infxn treatment
CAMPFIRE Carbapenems Aminoglycosides Monobactams Polymyxins Fluroquinolones (ciprofloxacin, levofloxacin) thIRd and fourth generation cephalosporins - ceftazidime - cefepime Extended spectrum penicillins -Ticarcillin -Carbenicillin -Piperacillin
Cephalosporins
- MOA
- Coverage
- Inhibition
Active against cell wall
Bind to penicillin binding proteins
Gram (+)
Gram (-)
Less susceptible to penicillases
1st generation cephalosporins
Cefazolin
Cephalexin
Gram + cocci
PEcK
Proteus mirabilis
E. coli
Klebsiella
UTIs
URIs
Prophylaxis viridans strep endocarditis
1st line prophylaxis against viridans strep endocarditis
Amoxicillin
2nd generation cephalosporins
Cefoxitin
Cefaclor
Cefuroxime
Cefprozil
HENS PEcK H. influenza Enterobacter Neisseria Serratia marcescens Proteus mirabilis Ecoli Klebsiella
Not used for gonorrhea
3rd generation cephalosporins
Ceftriaxone
Cefotaxime
Ceftazidime
Cefdinir
Serious gram - infections
HENS PEcK E.coli Proteus mirabilis Klebsiella Enterobacter Serratia Citrobacter Neisseria H. influenza Strep pneumoniae **
Tx neisseria gonorrhoeae
- details (3)
Ceftriaxone
Longest 1/2 life
GIve IV
Excreted in bile (good for renal failure)
4th generation cephalosporin
- use
- coverage
cefepime
broad spectrum
Pseudomonas
Gram + coverage
5th generation cephalosporin
Ceftaroline
Broad spectrum
MRSA
Cephalosporin for MRSA
Ceftaroline
Cephalosporins not effective against
LAME Listeria Atypicals (mycoplasma, chlamydia) MRSA Enterococci
Aztreonam
- MOA
- key feature
- covers
Monocyclic beta lactam
Inhibits cell wall synthesis
Binds to penicillin binding protein 3
No sensitivity allergy
E. Coli Lebsiella Pseudomonas Serratia (Gram neg only)
Carbapenems
- Examples
- Coverage
- MOA
Imipenem- cilastatin
Meropenem
Ertapenem
Doripenem
Gram + cocci
Gram - rods
Anaerobes
Pseudomonas
Binding penicillin binding proteins
Imipenem and cilastatin
Cilastatin inhibitor of renal dehydropeptidase 1
Decreased activation of imipenem in renal tubules
Vancomycin
- MOA
- Coverage
- Toxic
Inhibit cell wall synthesis
Inhibits cell wall mucopeptide formation by binding to the D-ala D-ala moieties of the cell wall precursors
Inhibts cell wall glycopeptide polymerization
Gram positive only MRSA Enterococci Clostridium difficile (oral) Coagulase negative staph endocarditis
NOT
Nephrotoxicity
Ototoxicity
Thrombophelbitis
Redman syndrome
- diffuse flushing
- nonspecific mast cell degranulation
pretreat w/ antihistamines
Protein synthesis inhibitors
mneumonic
Buy AT 30, CCELL at 50
30S inhibitors
- Aminoglycosides
- Tetracyclines
50S
- Chloramphenicol
- Clindamycin
- Erythromycin, macrolides
- Lincomycin
- Linezolid
MRSA tx on outpatient basis
MOA
Can cause
Linezolid
BInds 23S RNA and interacts with the bacterial initiation complex
Serotonin syndrome
TCA
- MOA
- coverage
- avoid with
- toxicity
Binds 30S
Prevents attachment of aminoacyl tRNA
VACUUM THe BedRoom Vibrio cholerae Acne Chlamydia Ureapolasma urelyticum Mycoplasma pneumoniae Tularemia Helicobacter pylori Borrelia burgdorferi Rickettsia
Avoid with
- milk antiacids
Iron, calcium, magnesium
(inhibit absorption in gut)
Discoloration teeth
Inhibit bone growth kids
Photosensitivity
Blue skin (minocycline)
Patient presents with blue skin
antibiotic?
Minocycline (TCA)
Aminoglycosides
- MOA
- Ineffective against
- Use
- TOxicity
Mean GNATs can NOT kill anaerobes
Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin
Inhibits the formation of the initation complex and causes misreading of mRNA
Ineffective against anaerobes
Use
- severe gram negative rod infections
- bowel surgery (neomycin)
“NOT”
Nephrotoxicity
Ototoxicity
Tetatogenic
Macrolides
- Examples
- MOA
- Coverage
- Adverse effects
- key feature
- resistance
Azithromycin
Clarithromycin
Erythromycin
-romycin
Inhibits protein synthesis by blocking translocation
Binds to the 23S rRNA of the 50S ribosomal subunit
“PUS”
Pneumonia
-Mycoplasma Chlamydophilia, legionella
URI
- strep pyogenes
- h. influenza
STD
- chlamydia
- gonorrhea
Prolonged QT
Drug interaction w/ warfarin
MACRO
- Motility issues
- Arrthymia (by prolong QT)
- Cholestatic hepatitis (acute)
- Rash
- eOsinophilia
Safe in pregnancy
Methylation of the 23S rRNA binding site
Chloramphenicol
- MOA
- Coverage
- Toxicity
Inhibits 50S peptidyltransferase activity
Meningitis
- H. influenza
- N. meningitides
- strep. pneumoniae
Toxicity
- Anemia
- Aplastic anemia
- Gray baby syndrome
Vomiting Grey color of skin Poor muscle tone Cyanosis CV collapse
Tx
Gray baby syndrome
Chloramphenicol
Phenobarbital
Streptogramins
- MOA
- Use
- SE
- Inhibit
Quinupristin
Dalfopristin
Bind 23S portion of 50S
MRSA
VRE
Staph and Strep skin infxn
Hepatotoxicity
Pseudomembranous colitis
Inhibit CYP450
Clindamycin
- MOA
- Use
- Toxicity
Blocks peptide bond formation with the 50S subunit
Anaerobic infections ** MRSA Protozoal infections Topically acne Bacteroides fragilis Clostridium perfringens MRSA skin abscess
Toxicity: pseudomembranous colitis
Glycylcyclines
- Example
- MOA
Tigecycline
Binds to 30S
atypical pneumonia coverage
Macrolides
- romycin
Drugs with photosensitivity
SAT
Sulfonamides
Amiodarone
Tetracycline
Side effects of aminoglycosdies
NOT
Nephrotoxicity
Ototoxicity
Teratogenic
Redman syndrome
Vancomycin
too quick infusion
Sulfonamides
- examples
- MOA
- side effect
Sulfamethoxazole
Sulfadiazine
Folic acid inhibitors
Competitive inhibitors of enzyme dihydropteroate synthetase
Hemolysis in G6PD def Nephrotoxicity Kernicterus (infants brain damage due to bilirubin build up) Photosensitivity Steven Johnson syndrome
Sulfa drug allergies
“Sulfa Pills Frequently Cause Terrible Allergy Symptoms”
Sulfasalazine Probenecid Furosemide Celecoxib Thaizide (TMP-SMX) Acetazolamide Sulfonyureas
TMP-SMX uses
UTIs Shigella Salmonella MRSA skin infections Pneumocystis jirovecii pneuonia
Inhibits dihydrofolate reductase
Trimethoprim
Methotrexate
Fluoroquinolones
- Examples
- MOA
- Dont take with
- Use
- Side effect
- Resistance
Levofloxacin
Nalidixic acid
Inhibits DNA gyrase (topisomerase II)
Dont take w/ antiacids or supplements contains calcium, iron or magnesium
Gram negative infections Gram negative rods UTIs GI tract infections Pseudomonas Varying Gram positive coverage
Cartilage damage
Tendonitis and tendon rupture
QT interval prolongation
Chromosome endoced mutation at the DNA gyrase
Drug to use in children iwth cystic fibrosis with pseudomonas
Fluorquinolones
Antibiotic that treats protozoal infections
Metronidazole
Metronidazole
- MOA
- Uses
- Adverse reaction
Forms toxic radicals that damage DNA
"GET GAP on the Metro" Giardia lamblia Entamoeba histolytica Trichomonas GArdnerella vaginalis Anaerobic bacteria (clostridium spp, bacteriodes fragillis) Pylori
Disulfiram like reaction
Prophylaxis
1) meningococcal meningitis
2) H. influenza meningitis
Tx
3) Gonorrhea
4) Syphilis
5) Recurrent UTIs
6) Pneumocystisi jirovecii (CD4<200)
7) Endocarditis (dental procedure)
8) Group B strep (pregnant)
9) Gonococcal/ chlamydial conjunctivitis
10) Legionella tx
11) Pseudomonas tx
12) Chlamydia trachomatis
13) Candida albicans
14) Cyroptococus neoformans
15) Toxoplasma gondii
1) Ciprofloxacin
2) Rifampin (prophylaxis)
Tx: Ceftriaxone/ penicillin
3) Ceftriaxone (add doxycycline for c. trachomatis)
4) Penicillin G
5) TMP-SMX
Amoxicillin
6) TMP-SMX
7) Penicillin, Amoxicillin, Cephalexin
8) Ampicillin
9) Erythromycin
10) Macrolides (azithromycin)
11) Piperacillin/ tazobactam, aminoglycosides, carbapenems
12) Doxycycline
13) Fluconazole, Caspofungin
Amphotericin B
14) Amphotericin B and flucytosine
Maintenance: fluconazole
15) Sulfadiazine + pyrimethamine
Identify antibiotic
1) Inhibit dihydropteroate syntherase
2) Inhibit dihydrofolate reductase
3) Inhibits DNA gyrase (topoisomerase III)
4) Inhibit bacterial ribosomes
5) Forms toxic free radicals that damages DNA
6) Acts like cationic detergent
1) Sulfonamides
2) Trimethoprim
Methotrexate
3) Fluoroquinoles
4) Nitrofurantoin
5) Metronidazole
6) Polymyxin B
Empiric Tx Meningitis
Broad spectrum
Ceftriaxone
Vancomycin
Ampicillin
Tx if exposed to bacillus anthracis
Ciprofloxacin
Doxycycline
HIV prophylaxis to newborn
Zidovudine
HSV prophylaxis for newborn
Mother: acyclovir starting at 36 weeks
Which antibiotic?
1) Inhibits prokaryotic RNA polymerase
2) Inhibits prokaryotic topoisomerase
3) Inhibits prokaryotic dihydrofolate reductase
1) Rifampin
2) Fluroquinoles
3) Trimethoprim
Macrolides effective against
“PUS”
Pneumonia (atypical) - mycoplasma pneu - Legionella - Chlamydophilia pneu
URI
- Strep pyogenes
- H. influenza
STDS
- Gonorrhea
- Chlamydia
Topoisomerase inhibited by
Fluoroquinoles
Etoposide
Tetracyclines effective against
VACUuM THe BedRoom
Vibrio cholerae Ache Chlamydia Ureaplasma urelyticum Mycoplasma pneumoniae Tularemia H. pylori Borrelia burgdorferi RIckettsia rickettci
Rifampin
4 Rs
Inhibits RNA polymerase
Red secretions
RREvs up cytochrome p450
Vaccines
1) 1st Given
2) Who gets flu shot
3) 2 months
4) 4 months
5) 6 months
1) Hep B- 1st given
2) Yearly from 6 months
2,4,6 (8) who do we appreciate STRIPPERS
“Damn BaBy, ROTate that ass on the POLe”
3) Dtap, HepB, Hib, Rotavirus, Polio (IPV), PCV (pneumococcal)
4) DTaP, Hib, Polio, PCV, Rotavirus
5) DTAP, Hib, PCV, RV
Tx for neonatal infections
Ampicillin + gentimycin
Which class of antibiotics inhibits prokaryotic DNA topisomerase
Fluoroquinoles
Acyclovir
- key feature
- MOA
- uses
- resistance
- adverse effect
Guanosine analog
First phosphorylated by viral thymidine kinase
Inhibits DNA polymerase
HSV-1
HSV-2
VZV
EBV
Valacyclovir hydrolyzed to acyclovir
Mutated viral thymidine kinase
Obstructive crystalline nephropathy and acute renal failure if not adequately hydrated
Famciclovir
- type
- key feature
- uses
- preferred for
- resistance
- adverse effect
Prodrug of penciclovir
- Acyclic guanosine nucleoside analog
Relies on viral thymidine kinase
HSV-1
HSV-2
VZV
Preferred over acyclovir for VZV
Mutated viral thymidine kinase
Obstructive crystalline nephropathy and acute renal failure if not adequately hydrated
Tx VZV
Famiclovir
Tx HSV-1, HSV-2
Acyclovir
Famciclovir
Ganciclovir
- activated by
- MOA
- side effects
- resistance
Activated by CMV viral kinase
Inhibits viral DNA polymerase
Bone marrow suppression
Renal toxicity
mutated viral kinase
Tx CMV
Ganciclovir
Foscarnet (retinitis)
Herpes drug that doesnt require viral kinase activation
MOA
Uses
SIde effects
Foscarnet
Inhibits DNA polymerase
Resistant HSV
CMV retinitis
Renal toxicity
Anemia
Electrolyte abnormalities –> seizures
Anti-influenza antivirals
Neuroaminidase inhibitors
Zanamivir
Oseltamivir
Block release of virions from host cell
Treatment of Chronic Hepatits C
Ribavirin
- inhibits syn of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase
- SE: hemolytic anemia
Sofosbuvir
- Inhibits HCV RNA dep RNA polymerase acting as chain terminator
Simeprevir
- HCV protease inhibitor, prevents viral replication
- SE: Photosensitivity, rash
IFN-alpha
Ribavirin
uses
side effects
Guanosine analog
RSV
Hep C
Teratogenicity
Hemolytic anemai
Tx croup
One dose of dexamethasone
supportive
RSV immunization
Passive w/ palivizumab
HIV prophylaxis CD4 < 200
PCP prophylaxis
TMP-SMX
Dapsone (in sulfa allergy)
HIV prophylaxis CD4 < 100
Toxoplasmosis prophylaxis (if positive IgG before)
TMP-SMX
Dapsone + pentamidine + leucovorin
HIV prophylaxis CD4 < 50
MAC prophylaxis
Azithromycin
saquinavir
- example
- MOA
- adverse effects
-navir
Protease inhibitors
GI intolerance
Inhibit cytochrome p450
Hyperlipidemia hyperglycemia
Lipodystrophy
Protease inhibitor that can cause pancreatitis
Ritonavir
Protease inhibitor that can cause Nephrolithiasis
Kidney stone
indinavir
Atazanavir
Protease inhibitor that can increase bilirubin
Atazanavir
HAART
Combination of at least 3 different HIV medications
2 nucleoside reverse transcriptase inhibitors and a different class medication
Lamivudine
-vudine
Nucleoside Reverse Transcriptase inhibitors (NRTIs)
Didanosine
Abacavir
Emtricitabine
Tenofovir (NtRTI)
Nucleotide reverse transcrptase inhibitor
Tenofovir
Nucleoside Reverse Transcriptase inhibitors (NRTIs)
- examples
- MOA
- key feature
- adverse effects
Lamivudine Zidovudine Didanosine Abacavir Emtricitabine Tenofovir (NtRTI)
Competitive inhibitors
Have to be phosphorylated by thymidine kinase to work
Bone marrow suppression
Lactic acidosis
anemia (zdv)
pancreatitis (didanosine)
Tx Newborns born to HIV mothers
Zidovudine (AZT)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- examples
- MOA
- key feature
- adverse effects
-vir, -virine
Nevirapine Delavirdine Efavirenz Etravirine Rilpivirine
non-competitively inhibit reverse transcriptase
Do NOT require phosphorylation
Rash
Hepatotoxicity
Vivid dreams (efavirenz)
CNS symptoms (Efavirenz)
Which NNRTI must be taken with food and not w/ meds that decrease gastric acid
Rilpivirine
Fusion inhibitor
Enfuvirtide
En envelop
Fu fusion
Binds Gp41 and blocks HIV fusion
Given by injection
Raltegravir
- example
- MOA
- adverse effect
-tegravir
Integrase inhibitors
Blocks integration into host DNA
Increase creatine kinase
CCR-5 antagonist
Maraviroc
CCR-5 on macrophages and CD4 T cells
Inhibits gp120 conformational change
Only in patients with all R5 virus
HIV drug causes
- Bone marrow suppression
- Pancreatitis
- Hepatic steatosis
- Hypersensitivity rxn
- Rash
- Nightmares, vivid dreams, depression
- False-positive to drug test for cannabinoids
- Teratogenic
- Nephrolithiasis
- Increases bilirubin
- peripheral neuropathy
- Zidovudine (NRTI)
- Didanosine (NRTI)
Ritonavir (PI) - Didanosine (NRTI)
- Abacovir (NRTI)
- NNRTIs
- Efavirenz (NNRTI)
- Efavirenz (NNRTI)
- Efavirenz (NNRTI)
- Indinavir, Atazanavir (protease inhibitor)
- Atazanavir (protease inhibitor)
- Didanosine
What are the two HIV envelope proteins and what drugs interfere with them
gp 41: Enfuvirtide
Gp120: maraviroc (not directly CCR-5
Tx Candida albicans
Superficial
- Nystatin
- Clotrimazole (topical)
- Fluconazole (oral) oral thrush
Systemic
- Fluconazole
- Amphotericin B
- Echinocandin
Tx Cryptococcal neoformans
Amphotericin B + flucytosine
Followed by fluconazole
Tx Pneumocystis jirovecii (PCP)
TMP-SMX
Sulfa allergy
- Pentamidine
Clindamycin + primaquine
Tx Aspergillus fumigatus
Voriconazole
Lipid formation of amphotericin B
Tx Mucor
Surgical debridement
Amphotericin B
Tx Dermatophytes
Topical terbinafine or azole
Extensive skin infection or scalp/hair
- Oral terbinafine or azole
Tx Tinea versicolor
Malassezia furfur
Topical azole
Topical selenium sulfide
Oral azole
Antifungal that
- Disrupts membrane
- Disrupts microtubules
- Blocks precursors to pyrimidines
- Blocks Squalene to lanosterol
- Blocks lanosterol to ergosterol
- Nystatin, Amphotericin B
- Griseofulvin
- Flucytosine
- Terbinafine
- -azoles
Amphotericin B
- MOA
- uses
- Side effects
Binds ergosterol (unique to fungi) forms membrane pores that allow leakage of electrolytes
AmphoTEARicin “ tears holes in membrane
Cryptococcosis Blastomycosis Coccidioidomycosis Aspergillosis Histoplasmosis Mucormycosis
Feverand chills
Anemia
Arrhythmias
Nephrotoxicity
Tx cutaneous candidiasis
Diaper rash
Vulvogainitis
MOA
Nystatin
Pores in membrane
Binds to ergosterol
Converted into 5-fluorouracil
Flucytosine
by cytosine deaminase
Inhibits DNA and RNA biosynthesis by conversion to 5-FU
Inhibits cell wall synthesis by inhibiting synthesis of beta-(1,3)-D-glucan
- uses
- toxicites
Caspofungin
Invasive aspergillosis
GI upset
Flushing (histamine release)
First line tx for dimorphic fungi
Itraconazole
Blastomyces Coccidioides Paracoccidioides Histoplasma Sporothirx
Azole for aspergillus
Voriconazole
Azole for refractory fungi
Posaconazole
Azole for topical fungal infections
Clotrimazole
Micronazole
-azole side effects
Decreased production of cortisol and testosterone
Gynecomastia
Impotence
Drug-drug interactions
Increase hepatic enzymes
Terbinafine
- use
- side effects
Inhibits enzyme squalene epoxidase
uses superficial fungal infections
Hepatotoxicity
GI symptoms
Headache
TASTE disturbance
Griseofulvin
- mOA
- deposits in
- uses
- side effects
Targets microtubule function –> inhibits mitosis
Deposits in keratin containng tissues
Tinea corporis
Tinea capitis
Onychomycosis
Tertatogenicity HA GI symptoms Confusion Cytochrome p450
What antifungal would you use
- Cell wall synthesis inhibitor used in invasive aspergillosis
- “Swish and swallow” for oral candidiasis or thrush
- Most common treatments for onychomycosis
- Deposits in keratin-containing tissues to to treat tinea capitis adn onychomycosis
- Used for cryptococcal meningitis in AIDs
- Drug of choice for sporotrichosis
- Caspofungin
- Nystatin
- Terbinafine, itraconazole, fluconazole
- Griseofulvin
- IV amphotericin B + flucytosine
- Itraconazole
Which antifungal can be used intrathecally for fungal meningitis
Amphotericin B
Tx Giardia lamblia
Metronidazole
Tinidazole
Tx Entamoeba histolytica
Treatment
- trophozoites= metronidazole or tinidazole
- cysts= iodoquinol or paromomycin
Tx Trichomonas vaginalis
Metronidazole
Gardnerella vaginalis tx
Metronidazole
Tx Toxoplasma gondii
Sulfadiazine + pyrimethamine + folinic acid
Tx Naegleria fowleri
Amphotericin B
Tx Trypanosoma brucei
African sleeping sickness
Early: Suramin
CNS involved: Melarsoprol
Tx Trypanosoma cruzi
Benznidazole
Nifurtimox
Tx Leishmania donovani
- Visceral leishmaniasis
Liposomal amphotericin B
Tx Leishmania donovani
- cutaneous leishmaniasis
Sodium stibogluconate
Tx Malaria
P. vivax, P. ovale
- primaquine
P. falciparum
- chloroquine
(SE: retinopathy, pruritis)
Tx Babesia microti
Quinine + clindamycin
Atovaquone + azithromycin
-romycin
macrolide
Tx Enterobius vermicularis
Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate
Tx Ascaris lumbricoides
Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate
Tx trichinella spiralis
symptoms
Muscle inflammation
Benzimidazoles
- Albendazole
- mebendazole
Tx strongyloides stercoralis
symptoms
Vomiting
Diarrhea
Epigastric pain
Ivermectin
Albendazole
Tx Ancylostoma and Necator
symptoms
Anemia
Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate
Tx Diphyllobothrium latum
Praziquantel
Tx Echinococcus granulosus
Surgical removal of cysts
Tx Taenia solium
Albendazole
Praziquentel
Dexamethaone: keep CNS symptoms from getting worse
Tx schistosoma
Praziquantel
Tx Paragonimus westermani
Praizquantel
Tx Clonorchis sinensis
Praziquantel
Albendazole
Tx Wuchereria bancrofti
Diethylcarbamazine
Tx Lice
Permethrin Pyrethrin
Malathion
Tx Scabies
Permethrin
Ivermectin
-Azole MOA
Inhibition of the cytochrome P450-dependent demethylation reaction
HIV tx and MOA
NRTIs main line
- competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain
Abacavir
Didanosine
Lamivudine
Tenofovir
Tx Scabes
Topical permethrin
Inhibits Na channel deactivation –> neuronal membrane depolarization
DNA viruses
HHAPPPPy
Hepadna Herpes Adeno Pox Parvo Papilloma Polyoma
Positive sense ssRNA virus (7)
Picornavirus (PERCH)
- Poliovirus
- Echovirus (meningitis)
- Rhinovirus (cold)
- coxsackie virus (meningitis, handfootmouth, myocarditis)
- HAV (acute)
Hepevirus
- HEV
Caliciviruses
- Norovirus (gastroenteritis)
Flaviviruses
- HCV
- Yellow fever
- Dengue
- West Nile (meningoencephalitis)
- Zika
Togaviruses
- Rubella
Retroviruses
- HTLV ( T cell leukemia)
- HIV
Coronaviruses
-common cold
Negative sense ssRNA virus (6)
Orthomyxoviruses
- Influenza virus
Paramyxoviruses
- Parainfluenza (croup)
- RSV (bronchiolits in babies)
- Measles
- Mumps
Rhabdoviruses
- Rabies
Filoviruses
-Ebola
Bunyaviruses
- Hantavirus (hemorrhagic fever, pneumonia)
Delta virus
-HDV
Spiking fever
Hepatosplenomegaly
Southeast Asia
Pancytopenia
Tx
Leishmania
Sandfly
Aphotericin B
Sodium stibogluconate
Farmer Headache Cough Malaise Pneumonia Fever, aching muscles Dry cough Sore throat
No rash
Coxiella burnetii
Q fever
Spore forming
Chronic assoc w/ endocarditis
Capsule of B anthracis
Poly-D-glutamate
Spiral Gram neg bacteria
Borrelia (Giemsa)
Leptospira
Treponema
Anaerobes
Anaerobes Cant Breath Fresh Air
Clostridium
Bacteroides
Fusobacterium
Actinomyces
Facultative intracellular
Some Nasty Bugs May Live FacultativeLY
Salmonella Neisseria Brucella Mycobacterium Listeria Francisella Legionella Yersinia pestis
Urease positive
Pee CHUNKSS
Proteus Cryptococcus H pylori Ureaplasma Nocardia Klebsiella S epidermidis S saprophyticus
Catalase positive organisms
Cats Need PLACESS to Belch their Hairballs
Catalase
Nocrrdia Pseudomonas Listeria Aspergillus Candida E coli Staphylococci Serratia B cepacia H pylori
Streptococcus pneumoniae most common cause of (4)
MEningitis
Otitis media
Bacterial pneumonia
SInusitis
Rusty sputum in patients with sickle cell or asplenic
Pneumococcus
Streptococcus pneumoniae
Cereulide
Performed toxin of bacillus cereus
Listeria monocytogenes forms waht ____ which allows
Tx
“Rocket Tails”
via actin polymerization
allow intracellular movement and cell to cell spread avoiding antibodies
Ampicillin
Actinomyces tx
Penicillin
Nocardia
- found in
- symptoms
- tx
Found in soil
Pulmonary infections in IC
(mimic Tb w/ negative PDD)
Can spread to CNS
TMP-SMX
Tx Tuberculoid form of Leprosy
Dapsone
Rifampin
Tx Lepromatous form leprosy
Clofazimine
Prophylaxis Neisseria meningococci
Tx N. Meningococci
Rifampin
Ciprofloxacin
or Ceftriaxone
Tx
- Ceftriaxone
Pencillin G
Haemophilus influenzae can be grown
tx
Chocoalte agar w/ factor V and X
or w/ S. aureus which provides factor V (NAD) through hemolysis of RBCs
Tx: Amoxicillin +/- clavulanate (mucosal infxn)
Ceftriaxone (meningitis)
Rifampin prophylaxis
Pyocyanin
Blue green pigment of pseudomonas
generates reactive oxygen species
S or comma shaped
Campylobacter jejuni
- bloody diarrhea
Vibrio cholerae
- water diarrhea
Constipation Red spots of abdomen Abdominal pain Fever Followed by diarrhea
Tx
Salmonella typhi
Ceftriaxone
Fluroquinolone
H. pylori positive for
Tx
Catalase
Oxidase
Urease
Antibiotics Cure Pylori
- Amoxicillin
- Clarithromycin
- PPI
Myalgia of calves
Jaundice
Photophobia
Flu like
Tx
Leptospira interrogans
Water contaminated with animal urine
Pencillin
Ceftriaxone
Doxycycline
First line tx Lyme disease
Borrelia burgdorferi
Doxycycline
Tongue ulcers
Splenomegaly
Histoplasmosis
Severe diarrhea in AIDS
Cryptosporidium
Oocytes in water
Oocytes on acid fast
Nitazoxaninde in IC hosts
Rapidly fatal meningoencephalitis
Swimming
- diagnosis
- tx
Naegleria fowleri
Enters via cribriform plate
Amoebas in spinal fluid
Amphotericin B
Tx Babesia
Atovaquone + azithromycin
Quinine + clindamycin
Cowdry A inclusions
HSV-1, HSV-2, VZV
What viruses uses this receptor
1) Integrins
2) CD21
3) CD4, CXCR4, CCR5
4) P antigen on RBCs
5) Nicotinic AChR
6) ICAM-1
1) Integrins= CMV
2) CD21= EBV
3) CD4, CXCR4, CCR5= HIV
4) P antigen on RBCs= ParvoB19
5) Nicotinic AChR= Rabies
6) ICAM-1= Rhinovirus
Muscle pain
Joint pain
Retro orbital pain
Rash all over body
Dengue fever
ssRNA flavivirus
Thrombocytopenia
Spontaneous bleeding
Rotavirus
- causes
- type of virus
- MOA
infantile gastroenteritis
Segmented ds RNA virus (reovirus)
Diarrhea
- day care center
Villous destruction with atrophy leads to decreased absorption of Na and loss K
Paramyxovirus Prophylaxis
Palivizumab
paramyxovirus causes RSV, croup, mumps, measles
HCV lacks
3’-5’ exonuclease activity
no proofreading
variation in antigenic structure of HCV envelope proteins
HBV
- renal manifestation
- vascular
HCV
- renal manifestation
- risk of
HBV
- membranous GN –> membranoproliferative GN
- polyarteritis nodosa
HCV
- membranoproliferative GN –> membranous GN
- risk of DM and autoimmune hypothyroidism
Strawberry cervix
Trichomoniasis
Trichomonas vaginalis
Asplenic patient organisms
SHiN
S pneumoniae»_space; H. influenza type B»_space; N meingitidis
Health care provider needle stick
HBV
Trimethoprim adverse effects
TMP
Treat
Marrow
Poorly
Megaloblastic anemia
Leukopenia
Granuloctyopenia
TMP-SMX drug of choice for
Pneumocystis jiroveci
Toxoplasma gondii
Nocardia
Stenotrophomonas maltophilla
Daptomycin
- MOA
- uses
- adverse effects
Lipopeptide that disrupts the cell membrane of gram + cocci by creating transmembrane channels
S aureus skin infections
(MRSA), bacteremia, endocarditis, VRE
Adverse
- myopathy
- rhabdomyolysis
Pyrazinamide
Tx mycobacterium tuberculosis
Hyperuricemia
hepatotoxicity
What do iodine and idophors do
Halogenation of DNA, RNA and proteins.
Sporicidal
Bacteria that can do transformation
DNA is released from lysed cell adn taken up by living bacterium
DNA fragment incorportated into chromosomal DNA
- recombinant bacterium
Streptococcus pneumonia
Haemophilus influenza
Neisseria meningitidies
S. aureus tissue destruction with MRSA uses what toxin ____ affects what two cell types
Panton-Valentine Leukocidin
Neutrophils
Macrophages
Gram positive rods
Clostridum (anaerobes)
Corynebacterium
Listeria
Bacillus
Prophylaxis for dental procedures if prosthetic heart, history of endocarditis, or congenital heart disease
Amoxicillin
Elek test
Corynebacterium diphtheriae
Gram negative oxidase positive diplococci
1) sputum from COPD
2) Urethral discharge
3) CSF
1) sputum from COPD= Moraxella catarrhalis
2) Urethral discharge= N. gonorrhoeae
3) CSF= N. meningitis
Meningitis + purpura
N. meningitis
Sepsis
DIC adrenal hemorrhage
Gram negative organism
N. meningitis
Gram negative cocci
Gram negative coccobacill
Cocci
- N. meningitidis
- N. gonorrhea
- Moraxella catarrhalis
Coccobacilli
- H. influenza
- Bordatella pertussis
- Pasteurella
- Brucella
Gram negative Lactose fermenting rods
Gram negative non lactose fermenting rods
Lactose (Fast)
- Klebsiella
- E.coli
- Enterobacter
Lactose (slow)
- Citrobacter
- Settaria
Non lactose fermenter
- Shigella
- Salmonella
- Proteus
- Yersinia
- Pseudomonas (oxidase +)
Stages of Lyme disease
Stage 1: Early localized
- Erythema migrans
- Fever, HA, body ache, fatigue
Stage 2: Early disseminated - weeks to months - Multiple Erythema migrans lesions - Cardiac (AV block, myopericarditis) - Neurological (Bilateral facial nerve palsy) (Peripheral neuropathy) (Lymphocytic meningitis)
Stage 3: Late
- arthritis (large joints chronic)
- neurological findings
Inflammed and painful lymph nodes
Prarie dog
Yersinia pestis
New mexico
Safety pin on staining
Bubonic plague
Rodent or prarie dog
Groin swelling
Primary vs reactive TB lung locations
Primary
- perihilar or right sided infiltrates
Reactive
- apical posterior segments of upper lobes
Tx Rocky mountain spotted fever
Rickettsia ricksttsii
Doxycycline
[Linezolid, Tetracycline, Aminoglycoside, Macrolides, Chloramphenicol, clindamycin]
1) Ototoxicity
2) Pseudomembranous colitis
3) Prolonged QT
4) Gray baby syndrome
5) PHotosensitivity
6) MRSA/ VRE coverage
7) Anaerobic coverage
8) Discolored teeth
9) Atypical pneumonia coverage
1) Aminoglycosides
2) Clindamycin
3) Macrolide
4) Chloramphenicol
5) Tetracycline
6) Linezolid
7) Clindamycin
8) Tetracycline
9) Macrolide
MOA of each drug
1) Sulfamethoxazole
2) Trimethoprim
3) Levofloxacin
4) Nitrofurantoin
5) Metronidazole
6) Polymyxin B
1) Sulfamethoxazole
- Inhibit dihydropteroate synthetase
2) Trimethoprim
- inhibit dihydrofolate reductase
3) Levofloxacin
- Inhibit DNA gyrase (topoisomerase II)
4) Nitrofurantoin
- Inhibit bacterial ribosomes
5) Metronidazole
- Forms toxic free radicals that damages DNA
6) Polymyxin B
- Acts like cationic detergent
1) Vomiting and watery diarrhea on cruise
2) Watery diarrhea 12 hrs after eating meat or poultry from cafeteria
1) Norovirus
2) Clostridium perfringens
Osteomylitiis involving vertbrae organism
Mycobacterium tuberculosis
Which RNA virus
1) Hand, foot, and mouth
2) Break bone fever
3) Common COld
4) Fever, jaundice, black vomit
5) Meningitis ins ummer months
6) Tourniquet test helps diagnose hemorrhagic disease
7) Infects motor neurons of anterior horn
1) Hand, foot, and mouth= coxsackievirus
2) Break bone fever= dengue
3) Common COld= rhinovirus, coronavirus
4) Fever, jaundice, black vomit= yellow fever
5) Meningitis in summer months= Echovirus, coxsackievirus, other enteroviruses
6) Tourniquet test helps diagnose hemorrhagic disease= dengue
7) Infects motor neurons of anterior horn= poliovirus, west nile virus
Which antiviral
1) Prophylaxis for influenza A
2) used to tx for chronic hep C
3) First line for herpes simplex virus or VZV
4) inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase
1) Prophylaxis for influenza A= zonamivir, oseltamivir
2) used to tx for chronic hep C= ribavirin + IFN-alpha
3) First line for herpes simplex virus or VZV = acyclovir, valacyclovir, famiciclovir
4) inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase= -cyclovirs (not ganciclovir)
Which antifungal to use
1) Cell wall synthesis inhibitor used in invasive aspergillosis
2) Swish and swallow for oral candidiasis or thrush
3) Most common tx for onychomycosis
4) Deposits in keratin-containing tissues to tx tinea capitis and onychomycosis
5) used for cryptococcal meningitis in AIDS
6) Drug of choice for sporotrichosis
1) Cell wall synthesis inhibitor used in invasive aspergillosis
- Caspofungin
2) Swish and swallow for oral candidiasis or thrush
- Nystatin
3) Most common tx for onychomycosis
- Terbinafine, itraconazole, fluconazole
4) Deposits in keratin-containing tissues to tx tinea capitis and onychomycosis
- griseofulvin
5) used for cryptococcal meningitis in AIDS
- IV amphotericin B + flucytosine
6) Drug of choice for sporotrichosis
- Itraconazole
Lymphatic filariasis
Elephantism of limbs
Wuchereria bancrofti
Helminth, neomatoid
Round worm
Tx: Diethylcarbamazine
Exacerbates COPD
Haemophilus influenza
Strep. pneumonia
Moraxella catarrhalis
63 y.o in ER with recent onset of high fever, confusion, headache, watery diarrhea and mildly productive cough. Smoked for 30 years and has bronchitis. Fever 104, Gram stain shows numerous neutrophils but no bacteria.
Legionella pneumoniae
High fever w/ bradycardia
Headache confusion
Watery diarrhea
Fluroquinoles
Macrolide
Bilateral interstitial infiltrates
Silver stain
Tx
Pneumocystis jirovecii
circular ring with clear center
TMP-SMX
Budding yeast with thick capsule
Cryptococcus neoformans
HIV
Linear ulcerations
CMV
Flu vaccine against what part
Humoral response to hemaglutinin
Organisms that cause granulomatous disease
- Bacteria
- Fungal
- Parasitic
Bacteria
- Mycobacteria (tuberculosis, leprosy)
- Bartonella henselae (cat scratch)
- Listeria monocytogenes
- Treponema pallidum (tertiary syphilis)
Fungal
- Histoplasmosis
Parasitic
- Schistosomiasis
Zoonotic bacteria
1) Cat scratch
2) Rodents to Tick
3) Cattle fluids
4) Birds and pigs
5) Birds
6) Infected placenta or contaminated fluid of newborn farm animals
7) Lone star tick
8) Rabbit or squirrel
9) Infected animal urine
10) Nine-banded armadillo
11) dog bit
12) Lice
13) Fleas
14) Tick, rash on palms
15) Fleas, prairie dogs
1) Cat scratch= Bartonella henselae
2) Rodent to tick= Borrelia burgdorferi
3) Cattle fluids= Brucellosis
4) Birds and pigs= Campylobacter
5) Birds= Chlamydophila psittaci
6) Infected placenta or contaminated fluid of newborn farm animal= Coxiella burneii
7) Lone star tick= Ehrlichia chaffeensis
8) Rabbit or squirrel= Francisella tularensis
9) Infected animal urine= Leptospira
10) Nine-banded armadillo= Mycobacterium leprae
11) Dog bite= Pasteurella multocida
12) Lice= Rickettsia prowazekii
13) Fleas= Rickettsia typhi
14) Tick, rash on palm= Rickettsia rickettsii (rocky mountain spotted fever)
15) Fleas, prairie dogs= Yersinia pestis
Obligate anaerobes (3)
Tx
Clostridium species
Actinomyces (Gram +)
Bacteroides (Gram -)
Tx metronidazole
Clindamycin
Acute otitis media organisms
S. pneumonia
Nontypable Haemophilius influenzae
M. Catrrhalis
Headache
Fever
Rash on wrist and ankles moves to palms soles and trunk
Ricketta ricksttsii
Rocky mountain spotted fever
What upper GI problem associated with findings
1) Biopsy of pt with esophagitis reveals large pink intranuclear inclusions and host cells chromatin that is pushed to the nucleus
HSV esophagitis
Fried rice Reheated rice
Bacillus cereus
Gram neg rod
Green metallic sheen on eosin methylene blue agar
Hemolysis on blood agar
Ecoli
What upper GI problem associated with findings
Biopsy of a patient with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo
CMV esophagitis
Which organisms cannot be stained w/ gram stain
Treponema Rickettsia Chlamydia Legionella Mycoplasma Mycobacteria
Pseudoappendicitis
Yersinia enterocolitica
Heat stable toxin
Increase cGMP
Common infectious organism of tonsils and adenoids
Common infectious organism of salivary gland
S. pyogenes
S. aureus, viridans group streptococci
Small intestinal mucosa laden with distended macrophages in the lamina propria
Whipple disease
Bacteria vaccine
- toxin
- capsular polysaccharides
- killed bacteria
- live attenuated bacteria
Toxin
- Tetanus toxoid
Capsular polysaccharides
- S. pneumoniae
- H. influenzae
Killed bacteria
- Vibrio cholerae
Live attenuated bacteria
- Typhoid vaccine
- BCG vaccine
Lactose non-fermenters
Urease producing
-Creates what
Proteus spp
Alkaline urine Struvite stones (Staghorn calculi)
What is the unique features of gram negative bacteria cell wall
Outer membrane
- endotoxin (LPS)
- induce IL-1, TNF alpha
Periplasmic space (between membranes) - beta lactamase
A PAS stain on a biopsy obtained from a patient with esophagitis reveals hyphate orgnaisms
Candida esophagitis
Spore forming bacteria
Bacillus anthracis
Bacillus cereus
Clostridum spp
(perfringens, tetani, botulinum, difficle)
Coxiella burnetti
Superantigens
Exotoxins that simulatenously bind MHC II receptor and T cell receptor
Polyclonal expansion of T cells
Large amounts of cytokines
Staph Aureus
Strep Pyogenes
Neurotoxins
Interfere with neural transmission
Botulinum toxin
Tetanus toxin
Positive sense ssRNA virus
1) Meningitis
2) common cold
Picornavirus
Coronoavirus- cold
Hepatitis A
- type
- genus
- family
- transmission
- infection type
- signs
ssRNA virus
non-enveloped
Hepatovirus
Picronavirus
Fecal/oral, poor sanitation
Acute
Hepatitis B
- type
- genus
- family
- transmission
- infection type
- Tx
ds DNA
Orthohepadnavirus
Hepadnaviridae
Perinatally, sexual contact, blood
Chronic
Tenofovir
Hepatitis C
- type
- genus
- family
- transmission
- infection type
- Tx
ssRNA
hepacivirus
Flavivirdae
Blood, sexual contact
Chronic
Ledipasvir-sofosbuvir
Ombitasvir-paritaprevir-ritonavir + dasabuvir
Hepatitis E
- type
- genus
- family
- transmission
- infection type
- More likely to cause fulminant hepatic failure in
ssRNA
Hepevirdae
Orthohepevirus
Fecal/oral route, contaminated water
Acute
Pregnant women
Weight loss Lymphadenopathy Hyperpigmentation Cardiac symptoms Arthralgias Neurlogic symptoms PAS+ Foamy macrophages in lamina propria
Whippe disease Tropheryma whipplei (Gram +)
Penicillin
Ampicillin
Tetracycline
HA
Fever, Rash centrally spreads to extremities
Rickettsia prowazekii
-Lice
Rickettsia typhi
- Fleas
Whitish patch on posterior oropharynx, makes greyish membrane, will bleed if scrap off
Tx
Corynebacterium diphtheriae
Erythromycin or penicillin
Antitoxin
Vaccinate
WHich mycobacterium species fits each
1) Causes leprosy
2) Causes pulmonary TB-like symptoms in COPD patients
3) Causes cervical lymphadenitis in children
4) Cuases a disseminated disease in AIDS patients
5) Associated iwth hand infection in aquarium handlers
1) Myco. leprae
2) Myco. kansasii
3) Myco. scrofulaceum
4) Myco. avium intracellulure (MAI)
Myco. avium complex (MAC)
5) Myco. Marinum
Septic aborption organisms
Staph aureus
Ecoli
Group B strep
Ecoli toxin
Verocytotoxin (Shiga toxin)
- Bloody diarrhea
- HUS
Heat labile toxin - stimulates adenylyl cyclase - Increase cAMP Heat stabile toxin -stimulate guanylyl cyclase - increase cGMP ETEC
Bordetella pertussis
Pertussis toxin binds and inactivates inhibitory G proteins –> increase cAMP
Nef
tat
HIV regulatory genes
Nef: downregulates teh expression of class I major histocompatibility complex proteins on teh surface of infected cells, limits immune recognition by cytotoxic T cells
tat: is a transcriptional activator that promotes viral gene expression
What is a feature of gram positive bacteria cell wall
Lipoteichoic acids
Induce cytokine production
IL-1, TNF-alpha
Rapid onset sepsis
Altered consciousness
Organ failure
Petechial/ ecchymotic rash
virulence factor
N. meningitidis
Lipo-oligosaccharide (LOS)
Headache fever inattentiveness Chemotherapy Increased opening pressure Increased protein, low glucose Image: Cds
Tx.
Cryptococal meningoencephalitis
Initial:
Amphotericin B
Flucytosine
Long term maintenance therapy:
Fluconazole
Acute otitis externa organisms
S. aureus
Pseudomonas aeruginosa
Chlamydophila psittaci
Chlamydophila pneumoniae
Chlamydia trachomatis
- A, B, C
- D-K
- L1 L2 L3
Chlamydophila psittaci
- bird exposure
- pneumonia
Chlamydophila pneumoniae
- interstitial pneumoniae
- walking pneumonia
Chlamydia trachomatis
- A, B, C (trachoma eye infxn)
- D-K (PID, urethritis, conjunctivitis)
- L1 L2 L3 (lymphogranuloma venerum, primary ulcer and LAD)
How HIV attaches
Attaches to host cells using the viral surface glycoprotein gp120
This glycoprotein bins to teh CD4 as the primary receptor and teh chemokine receptor CC45 as the coreceptor
Conformation change in gp120 exposes teh underlying transmembrane glycoprotien gp41 which mediates viral fusion
Corynebacterium diphtheriae is virulent how
phage conversion permitting exotoxin production
Fever chills, fatigue, dyspnea Temp Ring shaped and Maltese cross Splenectomy Intraerythrocytic inclusions
Babesiosis
Tick borne infection
Babesia microti
5 y.o difficulty breathing
dysphagia
drooling fever
Swollen and cherry red epiglottis
sign
H. influenzae type B
thumb sign
Headache Fever Malaise Cough Nodular infiltrates Clumping once room temp
Mycoplasma pneumoniae
Walking pneumoniae
Cross reactive IgM
Activate complement –> erythrocyte lysis
Cold agglutinins
COPD exacerbation due to
virus: rhinovirus, influenza virus, parainfluenza (most common)
bacterial: h. influenza, moraxella catarrhalis, strep. pneumoniae
Which infectious agent fits
1) Common cause of pneumonia in immunocompromised patients
2) Most common cause atypical pneumonia
3) Agent for penumonia in alcoholics
4) Can cause an interstitial pneumonia in bird handlers
5) Pneumonia in pts w/ hx of exposure to bats and bat droppings
6) Pneumonia in pt who visited south california, new mexico, or west texas
7) Pneumonia associated iwth currant jelly sputum
8) Q fever
9) Assocaited with pneumonia acquired from air conditioners
10) Most common cause of pneumonia in children 1 year old or younger
11) Pneumonia in neonate
12) Pneumonia in children and young adults (college, militrary, prison inmates)
13) Viral pneumonia
14) Causes wool-sorter’s disease (life-threatening pneumonia)
15) Common pneumonia in ventilator patients and those with CF
16) Pontiac fever
1) Common cause of pneumonia in immunocompromised patients = Pneumocystis jirovecii
2) Most common cause atypical pneumonia = Mycoplasma pneumoniae
3) Agent for penumonia in alcoholics = Klebsiella pneumoniae
4) Can cause an interstitial pneumonia in bird handlers = Chlamydophila psittaci
5) Pneumonia in pts w/ hx of exposure to bats and bat droppings = Histoplasma
6) Pneumonia in pt who visited south california, new mexico, or west texas = Coccidioides immitis
7) Pneumonia associated iwth currant jelly sputum = Klebsiella pneumoniae
8) Q fever = Coxiella burnetii
9) Assocaited with pneumonia acquired from air conditioners = Legionella pneumophilia
10) Most common cause of pneumonia in children 1 year old or younger = RSV
11) Pneumonia in neonate = Group B strep, E coli
12) Pneumonia in children and young adults (college, militrary, prison inmates) = Mycoplasma pneumoniae
13) Viral pneumonia = RSV
14) Causes wool-sorter’s disease (life-threatening pneumonia) = Bacillus anthracis
15) Common pneumonia in ventilator patients and those with CF = Pseudomonas, MRSA
16) Pontiac fever= Legionella pneumophila
Green metallic sheen on eosin methylene blue agar
Ferments lactose
1) Parasite eggs in stool
2) Perianal egg deposition
3) Proglottids in the stool
4) Rhabdoitiform larvae in the stool
5) Trophozoites and cysts in the stool
1) Schistosoma mansoni or S. japonicum
2) Enterobius vermicularis (pinworms)
3) Intestinal tape worms (Taenia solium, T saginata, Diphyllobothrium latum)
4) Strongyloides stercoralis
5) Protozoal infections (Giardia lamblia, entamoeba histolyticsa)
Silver stain
Fungi
- coccidoides
- pneumocystis jirovecci
Legionella
Helicobacter pylori
Name the exotoxin
1) Causes scarlet fever
2) Inactivates EF-2
3) Blocks release of the inhibitory neurotransmitter glycine
1) Erythogenic toxin Pyogenic toxins (s. pyogenes)
2) Diphtheria toxin Exotonin A (pseudomonas)
3) Tetanospasmin (c. tetani)
scabes tx
topical permethrin
Most common cause of viral conjunctivitis
Adenovirus
Ds non enveloped linear DNA virus
Four obligate aerobic bacteria
Nagging Pest Must Breathe
Nocardia
Pseudomonas aeruginosa
Mycobacterium tuberculosis
Bacillus
Fever Headache Nuchal rigidity Normal glucose elevated protein
Aseptic meningitis
Enteroviruses
- coxsackievirus
- echovirus
- poliovirus
Anorexia Nausea Dark-colored urine Trip to mexico Fever Right upper quadrant pain
liver biopsy?
Acute viral hepatitis
HAV
Hepatic swelling
N gonorrhoeae infection and repeat infections
High variability of gonococcal surface antigens (porins, opa proteins and lipooligosaccharide) limits effectiveness of antibody response
Previous infections results in almost no protective immunity against future infections
H. influenzae type b virulence factor
Polysaccaride capsule
composed of polyribosylribitol phosphate (PRP)
Man to ER Found unconscious Temp White patches on mucosa Bilateral crackles in lungs Bilateral interstitial infiltrates
Silver stain
Pneumocystisi pneumonia
atypical fungal infection
Opportunistic infection
Fever Malaise sore throat VERY tired Palatal petechiae cervical LAD Splenomegaly
-Assoc with
Mono
- EBV
Vaccine with virus-like particles
Subunit type
Induces only the Ag that stimulate the immune system
Hep B
HPV
Toxic associated with Staph aureus
- hemolysis
- tissue destruction w/ mRSA affects both neutrophils and macrophages
- food poisoning
- release of cytokines, high fever, hypotension, diffuse rash
- Scalded skin syndrome in newborns
Hemolysis
- alpha-toxin (alpha hemolysin)
- sphingomyelinase C (beta)
- leukocidin (gamma)
- delta-toxin
Panton-Valentine leukocidin
Enterotoxin (superantigen)
Toxic shock syndrome toxin 1 (superantigen)
Exfoliative toxin
Lung abscess bacteria
Tx
Complication of
Anaerobes
Peptostreptococcus Prevotella Bacteroids Fusobacterium S. aureus Klebsiella pneumoniae Gram negative bacteria
First line for anaerobe
- Clindamycin
Aspiration pneumonia
- alcoholics
- drug abusers
- general anesthesia
Missouri caves
histology
Histoplasma capsulatum
Macropahges iwth intracellular small yeasts
Pig farmer
Loeffler syndrome
Ascaris infection
Eosinophilic invasion due to parasitic infection
Vesicular rash
Chicken pox
HIV process involving glycosylation
Only glycosylated HIV polyprotein is gp160
- product of the env gene
gp160 is extensively glycosylated in the rough ER and golgi
cleaved into envelope proteins gp120 and gp41
gp120: mediates viral attachment
gp41: mediates viral fusion
Myalgia Fatigue HA Chills Fever
Sick and recovered
Mild jaundice
Hepatosplenomegaly
Elevated indirect bilirubin
Ringed inclusions
Malaria
Trophozoites (ringed inclusions) on Giemsa
Dormant hepatic phase
High fever
Nasal discharge
Bilateral conjunctival injection
Several small white spots with an erythematous base on buccal mucosa
No vaccines
What else is seen
Measles
Maculopapular rash
Goes with?
Lecithinase
M protein
Protein A
Trehalose dimycolate
Polyribosylribitol phosphate (PRP)
Lecithinase: toxin A, clostridium perfringens
- results in cell lysis and gas gangrene
M protein: strep. pyogenes
-Binds factor H to prevent opsonization and destruction by alternative complement pathway
Protein A: staph aureus
- prevent opsonization by binding Fc region of immunoglobulins
Trehalose dimycolate: cellw all component , mycobacterium tuberculosis
- protects from being killed by macrophages and stimulates granuloma formation
Polyribosylribitol phosphate: Haemophilus influenzae type b
- capsule protects against phagocytosis and complement mediated lysis by binding factor H (prevents complement C3b deposition on host cells
Endocarditis with negative blood cultures
HACEK
- Haemophilus
- Actinobacillus
- Cardiobacterium
- Eikenella
- Kingella
Coxiella burnetii (Q fever)
Bartonella
Brucella
Meningitis gram negative coccobacilli
H. influenzae
1) Budding yeast with thick capsule
2) Macropahges with intracellular small yeast
3) Round spherules iwth multiple endospores
4) Septate hyphae with dichotomous branching
5) Yeasts with pseudohyphae and blastoconidia
1) Cryptococcus neoformans
- bird droppings
- immunocompromised
- meningoencephalitis
2) Histoplasma capsulatum
- Missouri caves
- fever nonproductive cough
3) Coccidioides immitis
- pulmonary disease
4) Aspergilus fumigatus
- V shaped branching
- AIDS
5) Candida species
- immunocompromised
Ziehl neelsen stain
Acid fast organism
IPV vaccine
Poliomyelitis
HIV pol gene encodes for
reverse transcriptase
integrase
protease
RT: ssRNA –> ds DNA
Integrase: integrate into host genome
Protease: cleave HIV polyproteins into individual proteins after trasncription in rough ER
Virus that infects by CD21
Virus that infects by glycoprotein gp120
Virus that infects via the blood group P antigen (globoside)
1) EBV
2) HIV
3) Parvovrus B19
What type of meningitis?
1) Unvaccinated child
2) Outbreak in dorm
3) Meningitis with petechial rash
4) Patient with HIV
5) RBCs in CSF + temporal lobe involvement on MRI
1) H. influenza type B
2) N. meningitis
3) N. meningitides
4) Cryptococcus neoformans
5) HSV encephalitis
Frothy yellow green
Fishy odor
pH > 4.5
Pear shaped
Tx
Trichomonas vaginalis
Metronidazole
negative sense ssRNA virus
Arenavirus- hemorrhagic fever
Perinuclear cytoplasmic clearing
Koilocytes
HPV
Thick white cottage cheese like
4-4.5 pH
Tx
Candida spp
Azoles
Nystatin
Congenital Rubella possible heart defect
PDA
Pulmonary artery stenosis
Multiple ulcers
Mucosal erosions
Large cells iwth basophili cintranuclear and intracytoplasmic inclusions`
CMV
herpesvirus
Pathologic finding of varicella zoster
Multinucleated cells with intranuclear inclusions
Rash followed by desquamation of hands and feet (sloughing of skin)
Snuffles (blood tinged nasal secretions)
Skeletal abnromalities
Hepatomegaly
Early manifestations Congenital syphilis (during first 2 years)
Identify
1) Epithelial cells covered with gram-variable rods
2) Epithelial cells with rare leukocytes
3) Gram-negative intracellular diplococci
4) leukocytes and pear-shaped organisms
5) Pseudohyphae with leukocytes
1) Gardnerella
2) normal vaginal discharge
3) Gonorrhea
4) trichomonas vaginitis
5) Candida vaginitis
Identify
1) Multiple painful ulcers
2) Painful single ulcer
3) Painless ulcer, raised indurated edges
4) School of fish
5) Granulomatous lesions on skin ( large areas of dying flesh)
1) Herpes simplex
2) Haemophilus ducreyi
3) Syphilis
4) Haemophilus ducreyi
5) Tertiary syphilis
- Gummatous syphilis
Variola virus
Pox virus
Small pox
Respiratory droplets
Contaminated objects
Rash around mouth –> spread to face –> trunk extremities
Painful red nodules on finger and toe pads
Erythematous maculoes on palms and soles
Splinter hemorrhages in fingernails
Fever
Organisms?
Acute vs subacute
Endocarditis
- inflammation of valves
S. Aureus
Viridans streptococci
Enterococcus
Coagulase neg staph
Acute
- s. aureus
- days
- normal valves
Subacute
- Viridans streptococci
- wks –> months
- previously damaged valves
Still get Haemophilus influenzae even though had vaccine how?
The strain responsible for the patients disease does not produce a capsule
H. influenzae nontypeable
Vaccine only against more invasive type b strain
Histopathologic evaluation of syphilis lesion
Intense plasma cell rich infiltrate with proliferative endarteritis
Anthrax toxin
Edema factor (adenylyl yclase)
Lethal factor
Protective antigen
Bacillus anthracis
Red prominent bumps smooth dots
Baronella henselae
Bacillary angiomatosis
Pear shaped organism
Watery diarrhea
Small bowel shows?
Immune mechanism?
Giardia lamblia
(parasite)
Villus atrophy and crypt hyperplasia
CD4 T cells and secretory IgA production
Thin gray-white fishy odor
>4.5 pH
Clue cells
Tx
Gardnerella vaginalis
Part of normal flora
Metronidazole
Clindamycin
Viridans streptococci
Colonizer of the oral cavity
Cause infective endocarditis
No capsule
Partial hemolysis
Which causes of vaginal discharge/ vaginitis are associated iwth a high vaginal pH?
Wjocj are associated iwth a low vaginal pH?
Low vaginal pH
- physiologic dischrage
Candida
High vaginal pH
- gardnerella
Trichomonas
Vibrio cholerae
Cholera toxin
stimulates adenylyl cyclase
increase cAMP
chloride and water cross lumen
rice water stools
Bloody dirarrhea
Eosinophils
E. histolytica
Meningitis gram positive rod
LIsteria monocytogenes
Splenomegaly
South asia
Anemia
thrombocytopenia
Malaria
Severe fetal anemia
Ascites
Pleural effusions
Hydrops fetalis
Parvovirus B19
Positive VDRL w/ vulvar lesion
Tertiarty syphilis
Gumma
Gram negative rod
Swarming motility
Urease positive
Forms what
Proteus mirabilis
Hydrolyzes urea to ammonia
Urine more alkaline
Struvite stones
Magnesium ammonium phosphate stones
Staghorn calculus
S. bovis risk of
Streptococcus gallolyticus
Causes subacute bacterial endocarditis
Part of normal flora of colon
Associated with colon cancer
Ballooning multinucleated giant cells
Herpes simplex
Enlarged cells w/ intranuclear inclusions, cell fusion produc giant cells
Inactivates EF-2
Exotoxin A - pseudomonas
Diphtheria toxin
Clostridium perfringens toxins
Alpha toxin (phospholipase)
- Gas gangrene
- Myonecrosis
Enterotoxin
- Food poisoning
- Food left out too long once cooked
Acute flu like illness w/ pneumoniae
Works on farm
- chronic assoc w/
Coxiella burnetii
- Q fever
- Spore forming
- chronic assoc w/ endocarditis
Newborn
Jaundice
Hepatosplenomegaly
Sensorineural hearing loss
CMV
Decaying vegetation
Infection in immunocompromised
Nocardia
Nosocomial infection
1) Catheter assoc UTI
2) Ventilator assoc pneumonia
3) Central lines infxn
4) Surgical wounds/ decubitus ulcers
5) Parenteral nutrition
1) E. coli
Gram neg rods
Pseudomonas
Candida
2) Pseudomonas
Staph aureus
3) Staph epidermdiis
4) Staph aureus
5) Candida
A patient with IL-12 receptor deficiency is at particualr risk for what type of infection?
Mycobacterial
Malaise, HA Low grade fever Nonproductive cough Diffuse interstitial infiltrates Coughing for weeks
CXR: patchy reticulonodular infiltrate
Tx
Mycoplasma pneumonia
College kids- dorms
Military recruits
Macrolide (azithromycin)
Doxycycline (empiric)
Fluroquinoles (empiric)
Cold agglutinins
- Nonspecific IgM Ab to erythrocytes
Question marked shaped
Rodent urine
Phase 1
Phase 2
Leptospira interrogans
Phase 1
Fever chills
Body ache
HA
Phase 2
Hyponatremia
Renal failure
Liver damage w/ jaundice
Pregnant lady and cat feces or undercooked meat
- What happens
Toxoplasmosis
Chorioretinitis
Hydrocephalus
Intarcranial calcifications
Liver abscess
E histolytic
Protozoan
Amebic dysentery
Bacteria w/ capsule pneumonic
Even Some Pretty Nasty Killers have Shiny Bodies
E coli Strep pneumonia Pseudomonas Neisseria meningitidis Klebsiella Haemophilius influenza type B Salmonella Group B strep
Cryptococcus neoformans
- encapsulated yeast
Infects transfered through placenta or during birth
TORCHeS
Toxopolasmosis Other (parvovirus B19) Rubella CMV HIV/HSV Syphilis
Chlamydia Types
1) A-C
2) D-K
3) L1-L3
Tx
A-C
- Acute eye infection
- Can lead to scarring and blindness
D-K
- Urethritis, cervicitis, PID
- Neonatal pneumonia and conjunctivitis
L1-L3
- Lymphogranuloma venereum
- Genital ulcer
- Unilateral lymphadenopathy
- Groove sign
- Proctitis
Tx: Azithromycin
Spiral shaped rod
urease positive
causes
tx
Helicobacter pylori
Gastric adenocarcioma
Tx: Triple therapy - PPI - Clarithromycin - Amoxicillin or metronidazole
Quadruple therapy
- PPI
- Bismuth
- Metronidazole
- Tetracycline
Herpes virus
dsDNA
Rapid onset Headache Fever Altered mental status Nuchal rigidity Pruritic rash
Type of vaccine?
Meningococcal meningitis
Capsular polysaccharide Ag
Small ovoid yeast in lungs
Histoplasma capsulatum
- dimorphic
- inhaled as microconidia
- pneumonia
Hepatitis B C D vs A E
BCD transmitter parenterally (IV, blood)
AE: fecal oral
What can have painful inguinal lymphadenopathy
Bubo
Lymphogranuloma venereum
Chlamydia trachomatis
Bulls eye Fever HA Body ache Fatigue
Tx
Borrelia burgdorferi
Ixodes tick
Tx Doxycycline (early stage)
Amoxicilin (children <8)
Doxycycline or Ceftriaxone (late)
Bilateral facial nerve palsy
Tx
Borrelia burgdorferi
Ixodes tick
Tx Doxycycline (early stage)
Amoxicilin (children <8)
Doxycycline or Ceftriaxone (late)
Diphtheria toxin
Inactivates EF-2
Inhibits protein synthesis
Corynebacterium diphtheriae
Increases bidning to host tissues, induce coagulation or blood clotting
Coagulase
Common disease caused by Group A strep (pyogenes)
Acute pharyngitis
Cellulitis
Invasive infection
Acute post-streptococcal glomerulonephritis
Rheumatic fever
Toxic shock syndrome
India ink
Fungus
Crytococcus neoformans
S. epidermidis vs s. saprophyticus
S. epidermidis
- Novobiocin sensitive
- heart valves
S. saprophyticus
- Novobiocin resistant
- UTI
Group A Strep immunologic complications
Body immune response to bacteria
Jones Joints Pancarditis (endo/myo/pericarditis) Nodules (SQ) Erthema marginatum Sydenham chorea
Splenomegaly
South asia
Progressive splenic enlargement
WL over months
Leishmaniasis
Rash involving palms and soles
Maculopapular
Kawasaki disease
Coxsackie A virus
Rocky mountain spotted fever
Syphillis
Meningococcemia
You drive Kawaski CARS with your hands and feet
Contaminated deli meat
Listeria
Neonatal sepsis
Group B strep
Listeria
Ecoli
Pigment producing bacteria (4)
Staph aureus
- Large golden colonies
Actinomyces israelii
- yellow (sulfur) granules
- yellow sand
Pseudomonas aeruginosa
- blue green pigment
Serratia marcescens (MARsecens) - red pigment
Egg based vaccines
Influenza
Yellow fever
(MMR) tiny amount
Mega-esophagus
Cardiomegaly
Chagas disease
- Trypanosoma cruzi
Bacteria cause subscute endocarditis
Coagulase neg Staph Viridans group streptococci Strep bovis Enterococci HACEK organisms
HACEK - not gram (+) Haemophilus aphrophilus Aggregatibacter spp Cardiobacterium hominis Eilcenella corrodens Kingella kingae
Toxins secreted by Strep pyogenes
Streptolysin O
- hemolysis (oxygen labile)
Streptolysin S
- hemolysis (oxygen stable)
Streptococcal pyrogenic exotoxins Type A, B, C/ erythrogenic toxins
- red rash (erythro-) and fever (pyro-) of scarlet fever
(superantigen)
Potato salad
Staphyloccus aureus
Rapid vomiting
Gram (+) cocci
Catalase negative
Dental plaque
S. mutans (most)
S. sanguinis
- preexisting heart flow problems
What three bacteria are obligate intracellular bacteria
Rickettsia
Coxiella
Chlamydia
Degrades H202 into H20 and O2
Catalase
Replicative process
1) DS dna –> DS dna template –> ds DNA progeny
2) DS dna -> +RNA template -> partially ds-DNA
3) ssDNA –> ds DNA template –> ss DNA progeny
4) ss +RNA –> ds DNA template –> ss +RNA progeny
5) ss +RNA –> - RNA template –> ss + RNA progeny
6) ss -RNA –> +RNA template –> ss -RNA progeny
1) Adenovius, herpesvirus, poxvirus
2) Hepatitis virus
3) Parvovirus B19
4) Retroviruses (HIV)
5) poliovirus
6) Influenza virua, measles virus, rabies virus
Cyst in brain
Not IC
Seizures
Taenia solium
Pork tapeworm
Feces contaminated food
Live Virus vaccinations pneumonic
Attention! Please Vaccinate Young Infants with MMR Regularly
Attenuated virus vaccines
Polio (sabin, oral) Varicella Yellow fever Intranasal influenza MMR Rotavirus
Infection from puppy
Campylobacteri jejuni
meningitis in very young and old
Listeria
9 month old
2 minute general seizures
Fever
3 days later
afebrile
Maculopapular rash on trunk
Human herpesvirus 6
Child sticking nose in air
Esophagitis
H. infuenzae type B
Vaginal discharge
Grayish white
Fishy smelling
What is seen on microscopy?
Epithelial cells covered with gram-variable rods
What enzymes do obligate anaerobes lack
Catalse
Superoxide dismutase
Argyll robertson pupil
Pupil constricts with accomodation but doesnt react w/ direct light
Neurosyphilis
Flaccid paralysis Hyporeflexia weakness Faciculations Fever, HA, malaise Lymphocytic pleocystois (increase lymphocytes in CSF) Slightly elevated protein Normal glucose
Polio
Gram positive diplococci
Strep. pneumoniae
Pneumonia in neonates (Birth to 28 days
Pneumonia in children
Pneumonia in adults
Neonates
- Group B streptococcus
- E coli
- Chlamydia trachomatis
- HSV
Children
- Viruses (RSV)
- Streptococcus pneumoniae
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
Adults
- Streptococcus pneumoniae
- H. influenza
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Influenza virus
Elderly
- Streptococcus pneumoniae
- H. influenza
- Influenza virus
- S. aureus
- Gram negative rods (klebsiella )
Listeria is acquired how
Contaminated food
Unpasteurized milk
Uncooked meats
Spiral shaped bacteria
H. pylori
For viral particle to be coupled to MHC class I it first has to be involved with what
Ubiquitin ligase
6 month old gets flaccid paralysis after eating honey. Organism? MOA?
Clostridum botulinum
Inhibits release of acetylcholine
Organism taht causes pneumonia in each of these patients
1) Alcoholic patient
2) Patient with decrased level of consciousness
3) Pt w/ cystic fibrosis
4) Pt w/ HIV and CD4<200
5) Post-influenza
6) Acquired from patio-cooling water mister
7) Travel to southwestern U.S.
8) Exposure to bird/ bat droppings in ohio missiissippi river
9) Patient with pet parrot
1) Klebsiella
2) Anaerobes
3) Pseudomonas
4) Pneumocystis jirovecii
5) Staphylococcus aureus
6) Legionella pneumophilia
7) Coccidioides immitis
8) Histoplasma capsulatum
9) chlamydophila psittaci
Meningococcal vaccine recommendation
11 or 12 yo
Boooster at 16
Diarrhea
HIV patient
Hemorrhagic nodules or polypoid masses
Spindle cells
Kapsoi sarcoma
-HHV8
Vaccine with live attenuated organisms
“Attention Teachers! Please vaccinate SMALL, Beautiful Young INFants with MMR Regularly!”
Adenovirus Typhoid Polio Varicella Small pox BCG Yellow fever Influenza (intranasal) MMR Rotavirus
Strawberry cervix
Trichomoniasis
CSF findings in viral meningitis
Opening pressure WBC count Cell type Protein Glucose Gram stain
Normal or increased opening pressure
WBC increased
Lymphocytes
Normal or increased protein
Normal glucose
No stain
Mutations in pol gene in HIV patient
Inconsistent use of antiretroviral–> antiretroviral resistance
What diarrheal illnesses should be reported
Salmonella
Shigella
Encapsulated bacteria?
Test for encapsulated bacteria
Even Some Pretty Nasty Killers Have Shiny Bodies
E.coli Strep pneu. Pseudomonas Neisseria meningitis Klebsiella H. influenza Salmonella B Group B strep
Quellung rxn
CSF findings bacterial meningitis
Opening pressure WBC count Cell type Protein Glucose Gram stain
Increased pressure
Increased WBC
Neutrophils
HIGH protein
Decreased glucose
Gram stain positive
Vaccine with inactivated (killed organisms)
RIP Always
Rabies
Influenza (injection)
Polio (oral)
Hep A
Cataracts and deafness
Rubella
Facial infection of jaw/mandible
Sinus tracts draining yellow pus
Actinomyces israelii
What bacteria secrete enterotoxins?
Vibrio cholerae Enterotoxigenic E.coli Staph aureua Shigella Yersinia Clostridium spp.
Frontal bossing Interstitial keratitis Hutchinson teeth Saddle nose Perforation of hard palate Sabershins
Late mnaifestation of congenital syphilis
CSF findins TB/ fungal meningitis
Opening pressure WBC count Cell type Protein Glucose Gram stain
Increased pressure
INcreased WBC
Lymphocytes
Increased protein
Decreased glucose
No stain
Epiglottitis
Haemophilus influenza
Osteomelitis
Gangrene organism
Clostridium perfringens
Alpha toxin
Meningitis by age
Neonates
Infants/children
Adults
Elderly adults
Neonates
- Group B strep
- E.coli
- Listeria monocytogenes
Infants/ children
- Streptococcus pneumoniae
- Neisseria meningitides
- H. influenza type B
- viruses (enteroviruses)
Adults
- strep pneumoniae
- Neisseria meningitidis
- enteroviruses
Elderly
- Streptococcus pneumoniae
- Listeria
- Gram negative rods (ecoli)
Clue cell
- organism
- characteristic (2)
- change
- tx (2)
Vaginale pithelial cell covered in coccobacilli
Gardnerella vaginalia
- gray vaginal discharge
- fishy smell
- elevated pH >4.5
Oral metronidazole
Metronidazole cream
Meningitis gram positive diplococci
Streptococcus pneumoniae
Budding yeast and peudohyphae
Candidiasis
Shiga toxin
Cleaves host rRNA at adenine base in 60S ribosomal subunit
Inhibition of protein synthesis
Shigella
Diphtheria toxin and Exotoxin A (pseudomonas)
Inactivates EF-2 vis ribosylation, thus inhibiting host cell rpotein synthesis
Oval budding yeast forms germ tubes at 37 C
Candida albicans (true hyphae at 37)
Normal commensal of skin and GI
Chocolate agar
- requires
Haemophilus influenza
Factor V and X
Broad, nonseptate hyphae that branch at wide 90 angles
Mucor
Rhizopus
Absidia
Measles vaccine is
Live attenuated
Clostiridum difficile
- toxins
- diagnosis
- tx
Toxin A (enterotoxin)
- binds brush border
- secretion and inflammation
Toxin B (cytotoxin) - disruption actin cytoskeleton
Pseudomembrnaous colitis
Stool toxin assay (PCR or ELISA)
Tx
- Metronidazole
- Oral vancomycin
- Fidxomicin (recurrent)
Firm flesh color papules on face with umbilicated center is
Molluscum contagiosum from Pox virus
See Molluscum bodies: eosinophilic cytoplasmic inclusions
Meningitis
Slightly increased protein
Normal glucose
Incrased opening pressure
Viral meningitis
Newborn Cataracts Harsh machine like murmur Deafness Blueberry muffin rash
Rubella
What zoonotic bacterium causes each
1) Cat scratch fever
2) Lyme disease
3) Recurrent fever from variable surface antigens
4) Bloody diarrhea
5) Q fever
6) Tularemia
7) Leptospirosis
8) Cellulitis and osteomyelitis from cat or dog bites
1) Cat scratch fever
- Bartonella
2) Lyme disease
- Borrelia burgdorferi
3) Recurrent fever from variable surface antigens
- Borrelia recurrentis
4) Bloody diarrhea
- Campylobacter (puppies, livestock, fecal oral, sexual)
5) Q fever
- Coxiella burnetti (spores from tic feces, cattle placenta)
6) Tularemia
- Francisella tularesis
7) Leptospirosis
- Leptospira spp (animal urine)
8) Cellulitis and osteomyelitis from cat or dog bites
- Pasteurella multocida
PAS stain for
Tropheryma whipplei
Whipple disease
Child
Red rash on cheek spread to chest and shoulder
Parvovirus B19
Histoplasma capsulatum
Mississippi and ohio river valley
Macrophages filled with histoplasma (smaller than RBC)
(Oval yeast cells within macropahges)
Bird/bat droppings
Palatal/ tongue ulcers Splenomegaly Pancytopenia Fever, WL, Fatigue Cough dyspnea, N/V, diarrhea
CD4 < 200
Caseous Necrosis
Granuloma
Erythema nodosum
Chronic Mediastinitis
- Fibrosing mediastinitis
- due to increased formation of CT in mediastinum
