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LAST EXAMMMMMM Year I > micro- spirochetes, mycobacterium, mycoplasma > Flashcards

micro- spirochetes, mycobacterium, mycoplasma Flashcards

1
Q

what are the unique additions to spirochetes besides that LPS outer layer

A

additional phospholipid rich outer membrane with few exposed proteins
axial flagella that come out of the ends of spirochete cell wall rather thatn from outer membrane and the flagella runs under the outer membrane sheath
“periplasmic flagella”

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2
Q

how do we visualize apirochetes

A

dark field microscopy, immunofluorescence and silver stains

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3
Q

What are the 3 genera of spirochetes

A

Treponema
Borrelia
Leptospira

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4
Q

Describe primary syphilis

A

painless chancre erupts 3-6 weeks after contact
chancre is firm, ulcerated painless lesion with punched out base and rolled edges
resolves 4-6 weeks without scar
regional nontender lymph node swelling

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5
Q

Describe secondary syphilis

A

6 weeks after original chancre healed
systemic widespread rash with lymphadenopathy
fever, weight loss

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6
Q

paatiend presens with small red macular (flat) lesions symmetrically over body, palms and soles and mucous membranes of oral cavity
become bumpy and pustular

A

syphilis

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7
Q

What is condyloma latum and what infection is it manifested in

A

painless wartlike lesion in warm moist areas like vulva or scrotum
ulcerates
syphilis
resolves over 6 weeks and enters latent phase

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8
Q

Describe latent syphilis

A

asymptomatic usually
sometimes more lesions
most will remain asymptomatic but some may progress to tertiary syphilis (1/3 unTx)

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9
Q

When does tertiary syphilis develop and what are the 3 categories

A

6-40 years
gummatous
cardiovascular
neurosyphilis

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10
Q

What is Gummatous syphilis

A

3-10 yrs after infection
granulomatous lesions Gummas necrose and become fibrotic in skin and bones
skin-painless with sharp borders
bone- deep pain

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11
Q

What is CV syphilis

A

10 yrs after infection
aneurysm in ascending aorta or aortic arch
from chronic inflammation

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12
Q

What are the 5 common presentations or neurosyphilis

A 
asymptomatic- CSF is +
subacute meningitis
meningovascular syphilis
tabes dorsalis
general paresis
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13
Q

presentation subacute meningitis from syphilis

A

fever, stiff neck, HA

high lymphocyte, high protein, low glucose + syphilis

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14
Q

describe process behind meningovascular syphilis

A

spirochetes attack blood vessels in brain and meninges causing infarction and neurologica impairments

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15
Q

describe tabes doralis from syphilsi

A

affects post column spinal cord
loss os vibration and proprioception
ataxia
loss of reflexes and pain and temp from DRG

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16
Q

What form of syphilis leads to progeressive nerve cell death in brain and mental deterioration

A

general paresis

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17
Q

What is the argyll-robertson pupil

A

no reactive pupil to light from midbrain lesion

seen in syphilis

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18
Q

what is early congenital syphilis

A

within 2 yrs
widespread rash and condyloma latum
runny nose
lymph node, HSM and bone infection are common

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19
Q

patient has saddle nose(sunken in nose) and saver shins(bowing of tibias)
widely spaced incisors with central notch and the molars have too many cusps(mulberry)
what is this assoc with

A

congenital syphilis

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20
Q

when is the window to treat pregnant mother with antibiotic therapy for syphilis

A

before the 4th month of gestation

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21
Q

What is the best way to Dx syphilis active and latent

A

active is through visualization of spirochetes

serologic for latent

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22
Q

what titers do we pull for syphilis

A

anti-lecithin and cardiolipin which are Ag from cell damage

also used on CSF detection for neurosyphilis

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23
Q

What are the two most common nonspecific treponemal tests

A

VDRL and RPR

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24
Q

what are the specific treponemal tests and what are they detecting

A

Ab againts spirochetes

Indirect Imunofleurescent Trepnemal Ab-Absorptions FTA-ABS

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25
Q

If a patient after contracting syphilis has a drop in VDRL or RPR while FTA-ABS is still +, was tx successful?

A

yes

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26
Q

Immediately after Tx with syphilis patient has mild fever, chills, malaise and HA with muscle aches
what is going on

A

Jarisch-Herxheimer phenomenon

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27
Q

What treponema does not cause gummas

A

treponema carateum

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28
Q

patient from desert zone in Africa or Middle east
has skin lesions in oral mucosa ang gummas in skin and bone
Dx?

A

treponema endemicum

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29
Q

patient is from tropical area with disfigured face and open ulcers
Dx?

A

yaws

treponema pertenue

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30
Q

if a hispanic patient comes in and has red skin lesions that become blue in the sun
Dx?

A

treponema carateum

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31
Q

What diseases are caused by the Borrelia spp

A

lymes and relapsing fever

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32
Q

What are the 3 stages of lymes

A

early localized stage, early disseminated stage and late stage

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33
Q

what is the time period for early localized stage lymes and what occurs

A

10 days after tick bite lasts 4 weeks

skin lesion at site- erythema chronicum migrans with flulike symptoms

34
Q

What does the skin lesion erythema chronicum migrans look like

A

starts red round rash then spreads and the outer border stays red and the center is clear, blue or necrose

35
Q

What occurs in the early disseminated stage of lymes

A

skin, nervous system, heart and joints
many lesions
cranial nerve and motor sensory nn involved0 cranial nn palsies especially Bells and peripheral neuropathies
AV nodal block and sometimes myocarditis and L ventricular dysfunction
arthritis that is hot swollen and painful

36
Q

describe late stage lymes

A

10% untreated have chronic arthritis assoc with HLA DRB10401, HLA-DRB10101
chronic neurologic damage, encephalopathy

37
Q

What part of the lymes rash is biopsied

A

the leading edge

38
Q

What techniques are used to Dx lymes

A

ELISA and western immunoblotting of CSF

39
Q

Describe symptoms of Borrelia recurrentis

A

high fever, chills, HA muscle aches
rash with drenching sweats that last 3-6 days then relapse 8 days later
progressive shorter and milder each relapse

40
Q

What causes the relapsing symptoms of Borrelia

A

antigenic variation

41
Q

When ust you pull blood cultures in someone with Borrelia recurrentis

A

during active febrile period. negative when afebrile

42
Q

what are the phases from leptospirosis

A

leptospiremic phase- high temp, HA, malaise and muscle aches

immune phase- IgM Ab, meningismus and elevated WBC count in CSF

43
Q

What is Weils disease and what causes it

A

renal failure, hepatitis with jaundice, mental status changes and hemorrhages
Leptospirs interrogans

44
Q

What lab results lead towards leptospirosis

A

elevated liver function tests, protein in urine and clinical history of animal contact or swimming in areas shared by animals

45
Q

What are the 2 species of Mycobacterium

A

TB

leprae

46
Q

What are mycosides

A

mycolic acid- large fatty acid
mycoside- mycolic acid bound to a carb
cord factor- mycoside formed by union of 2 mycolic acids and disaccharide
sulfatides- sulfate attached to disaccharide inhibiting phagolysosomal fusion
wax D- activates protective cellular immune system

47
Q

What component of mycosides is only found in virulent Mycobacterium TB

A

cord factor

48
Q

What is the pneumonic for remembering mycosides for mycobacterium TB

A

Mike(mycosides) waxes (Wax D) his SUrfboard (sulfatides) and has a surfboard cord (cord factor)

49
Q

What type of organism is mycobacterium TB

A

acid fast

facultative intracellular growth

50
Q

What cells does M TB infect first

A

macrophages

51
Q

What causes the caseous necrosis seen in M TB

A

the cell mediated immunity of the macrophages eating everything

52
Q

what type of DTH is ppd test for M TB

A

IV

53
Q

what diseases could lead to a false negative ppd

A

steroid use, malnutrition, AIDS

because do not have normal immune response

54
Q

What is the best Dx screening for M TB

A

new IGRAS from whole blood

55
Q

presentation of primary TB

A

asymptomatic lung infection

middle and lower lobes- neutrophils and edema

56
Q

presentation of symptomatic TB

A

children usually

enlargement of mediastinal lymph nodes and lower/middle lung infiltrates

57
Q

What is ghon focus and complex

A

focus is calcified tubercle in middleor lower lung zone

complex is ghon focus plus perihilar lymph node calcified granulomas

58
Q

what is presentation of reactive pulmonary TB

A

infection in apices around clavicles

fever, night sweats, weight loss and productive cough sometimes with blood

59
Q

What other organ sysmtems can be affected by secondary TB

A 
pleural and pericardial spaces
lymph node infections
kidney- sterile pyuria
skeletal- invertebral discs
joints- chronic arthritis of 1 joint
CNS-subacute meningitis and granulomas in brain
Miliary TB- tubercles all over body
60
Q

What is sterile pyuria and what infection does it occur in

A

RBC and WBC in urine but no bacteria

M TB

61
Q

What is the best Dx tool for M TB active infection

A

sputum culture

62
Q

M leprae is common where

A

India, Brazil, Burma, Indonesia, MAdagascar and Nepal

63
Q

Why does M leprae like the skin

A

likes cooler areas of the body

also attacks superficial nn, eyes nose and testes

64
Q

What is Lepromatous Leprosy

A

severest leprosy form
no cell mediated immune response
defective T CD8 cells

65
Q

What is presentation of lepromatous leprosy

A 
thickened face- leonine facies
saddle nose deformity
internal testicular damage- infertility
blindness
loss of sensation
66
Q

What is presenation of Tuberculois leprosy

A

localized superficial unilateral skin and nerve involvement
1-2 hypopigmented skin lesions
enlarged nerves

67
Q

what is a common cause of Fever of unknown origin in AIDS patients

A

M avium complex

MAC

68
Q

What form of leprosy will have a negative lepromin skin test

A

the lepromatous leprosy because cannot mount DTH

69
Q

What is the presentation of AIDS patient with MAC

A

unexplained fevers, weight loss, diarrhea and general malaise
elevated alkaline phosphatase

70
Q

What is confirmatory Dx for MAC

A

growth in mycobacterial blood cultures

71
Q

Describe structure of mycoplasma organisms

A

no peptidoglycan cell wall

just cell membrane with sterols to help shield organelles

72
Q

What are the pathogenic spp of mycoplasma

A

pneumoniae and Ureaplasma urealyticum

73
Q

What is the number one cause of bacterial bronchitis and pneumonia in teenagers

A

mycoplasma pneumoniae

74
Q

What are the virulence factors of mycoplasma pneumoniae

A

Protein P1 an adhesin

75
Q

What is walking pneumonia

A

gradual onset, fever sore throat, malaise and peristent dry hacking cough

76
Q

what is presentation of CXR walking pneumonia

A

streaky infiltrate

77
Q

What is erythema multiforme or Stevens-johnson syndrome

A

severe skin run with erythematous vesicles and bullae over mouth eyes and skin
caused with mycoplasma pneumonia sometimes

78
Q

What is a rapid way to test someone for Mycoplasma pneumoniae

A

put their blood in test tube then on ice and if the blood clumps then has cold agglutinins which are in mycoplasma pneumoniae

79
Q

what does a mycoplasma culture look like

A

tiny dome fried egg appearance

like a mulberry

80
Q

what bacteria cause atypical pneumoniae

A

Mycoplasma, legionella and chlamydia

81
Q

What is T strain mycoplasma

A

Ureaplasma urealyticum

82
Q

What could cause a young sexually active woman to have burning while peeing and yellow mucoid discharge

A

N gonorrhea, Chlaymydia

Ureaplasma urealyticum!

LAST EXAMMMMMM Year I (24 decks)

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