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Respiratory II Exam 1 > Microbio review (Kinder) > Flashcards

Microbio review (Kinder) Flashcards

1
Q

Bordetella pertussis

A 
Whooping cough
Highly contagious
Spread by large droplets
Gram negative aerobic coccobacillus capsulate
Humans are only known reservoir
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2
Q

Clinical Manifestations

of whooping cough

A

Onset of symptoms 1-3 weeks after exposure

Catarrhal Phase
Rhinorrhea, lacrimation, conjunctival injection, low grade fever – lasts days to a week

Paroxysmal phase
Uncontrollable expirations, followed by gasping inhalation – whooping cough
Cough Associated with post cough cyanosis, gagging, and vomiting
Lasts up to 4 weeks

Convalescent Phase
Reduction in frequency and severity of cough can last from weeks to months

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3
Q

Bordetella pertussis complications, dx, tretment and prevention

A

Complications- pneumonia

Diagnosis
- Nasal swabs for culture or PCR

Treatment:
Supportive
Azithromycin
Chemoprophylaxis to control outbreaks

Prevention – accellular pertussis vaccine

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4
Q

Klebsiella pneumonia

A

Gram negative, non-motile, capsulate rods
Facultative anaerobes
UTI, soft tissue infections, endocarditis, central nervous system infections, and severe bronchopneumonia.
Community and hospital acquired pneumonias
Cavitary lung lesions
Currant Jelly sputum

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5
Q

Moraxella catarrhalis

A 
Gram negative bacteria that grows well on blood or chocolate agar
diplococci
Catalase positive
Oxidase positive
Pneumonia, especially in the elderly
Otitis media in young children
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6
Q

Neisseria meningitidis

A

Aerobic gram negative kidney shaped diplococci, capsule
Oxidase positive, ferments maltose and glucose Grows on Thayer-Martin media, chocolate agar
Commensal of the human upper respiratory tract
Transmitted through close contact via larger respiratory droplets.
Clinical manifestation
- Meningitis
- Septicemia
- Pneumonia
- Septic arthritis, pericarditis, chronic bactermia, or conjunctivitis

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7
Q

Neisseria meningitidis, dx, treatment and prevention

A

Diagnosis
Gram stain from CSF
CSF PCR
CSF culture, blood culture, or skin culture

Treatment
Penicillin
3rd generation cephalosporin

Prevention
Chemoprophylaxis with rifampin in close contacts
Meningococcal polysaccharide-protein conjugate vaccines

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8
Q

Neisseria meningitidis prognosis

A

Untreated systemic disease with 70-90% mortality
10% mortality with treatment
Morbidity
Limb loss, hearing loss, long-term neurologic disability

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9
Q

Pseudomonas aeruginosa

A

Aerobic gram-negative rod
Produces pyocyanin on laboratory medium – blue/green pigment
Primarily nosocomial pathogen
In hospital can colonize moist surfaces of the axilla, ear, and perineum
Isolated from water in sinks, drains, toilets, and showers
Even isolated from flowers in patients rooms

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10
Q

Pseudomonas aeruginosa infections

A

Hospital acquired pneumonia, Ventilator Associated Pneumonia
Community acquired infections related to hot tubs, whirlpools, swimming pools, and extended contact lenses
Otitis externa
Puncture wounds through tennis shoes
Endopthalmitis – complication of eye surgery
Endocarditis, from sharing contaminated needles
UTI
Skin Infections, burns, ecthyma gangrenosum

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11
Q

Pseudomonas aeruginosa host factors, bacterial factors, treatment

A

Host Factors – Neutropenia increases risk

Bacterial Factors
exotoxins, endotoxins, type III secreted toxins, pili, flagella, proteases, phospholipases, iron-binding proteins, exopolysaccharides, the ability to form biofilms, and elaboration of toxic small molecules such as pyocyanin

Treatment
Extended spectrum penicillin and aminoglycoside combination
Always treat with 2 antibiotics: Pseudo? Duo!

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12
Q

Chlamydophila psittaci

A

Gram negative obligate intracellular bacteria

Macrophages are the principal host cell

Diseases
- Psittacosis (birds)
- Atypical pneumonia
- Febrile illness
Transmission
Aerosolized bird secretions, dust
Diagnosis - Serology
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13
Q

Chlamydophila psitacci treatment, prevention

A

Treatment : tetracyclines, macrolides, fluoroquinolones
Prevention
30 day quarantine for all imported psittacine birds and their treatment with feed containing chlortetracycline

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14
Q

Chlamydophila pneumoniae

A

80% of adults are seropositive

Common infection in children under 5 years old

Atypical pneumonia

  • Incubation several weeks
  • Non productive cough
  • Preceded by nasal congestion, sore throat, and hoarseness
  • Headaches in ½ of patients
Examination
Crackles, rhonchi
Chest x-ray
Pneumonitis
Labs 
Normal white count
Prolonged course over several weeks

Diagnosis

  • Serology
  • Direct detection of organism in respiratory specimens

Treatment:
Tetracyclines
Macrolides
Fluoroquinolones

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15
Q

Coxiella burnetii

A

Gram negative that infects hosts monocytes
Incompletely eliminated after acute infection
Will continue to multiply in immunocompromised patients and endocarditis patients despite high antibody levels
Infects mammals, birds, and ticks
Mammals infected by aerosols and may shed Coxiella in feces, urine, milk, and birth products
Survives in environment and can be spread by the wind

Major outbreaks have been related to sheep and goats and associated during lambing season

Clinical Manifestations	of  Q-fever:
Prolonged fever
Pneumonia
Hepatitis
Rash
Meningitis, encephalitis, meningoencephalitis, peripheral neuropathy
Pericarditis, myocarditis

Chronic uterine infection may develop in half of patients infected during pregnancy, and may later experience multiple spontaneous abortions

Q-fever endocarditis

  • Intermittent fever
  • Vegetations frequently absent
  • Cerebral emboli, renal insufficiency, splenomegaly, hepatomegaly

Diagnosis
Based on serology

Treatment
Doxycycline x 2 weeks in acute cases
Doxycycline + hydroxychloroquine(increases phagosomal pH) for 18-36 months for endocarditis

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16
Q

Francisella tularensis

A

Tularemia is an infectious zoonosis
Small aerobic pleomorphic gram-negative bacillus
Many animals harbor infection including rabbits, squirrels, and muskrats
Humans acquire the infection through direct contact with infected animal tissues, ingestion of contaminated water or meat, the bite of an infected tick or deer fly, or breathing an aerosol of bacteria – not communicated person to person
Extreme risk to lab personnel

Clinical Manifestations:
Ulceroglandular
Glandular
Oculoglandular
Typhoidal
Oropharyngeal
Pneumonic
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17
Q

Ulceroglandular Francisella tularensis

A 
Fever and constitutional symptoms
Swollen lymph nodes that drain an inoculation site
Ulcer formation
Sore throat
Patchy infiltrates on chest x-ray
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18
Q

Glandular Francisella tularensis

A

Fever
Constitutional symptoms
Lymphadenopathy

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19
Q

Typhoidal Francisella tularensis

A

Fever of unknown cause

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20
Q

Oropharyngeal Disease Francisella tularensis

A

Uncommon in the United States
Mucous membranes of the mouth and pharynx are the portal of entry
Contaminated water or food such as inadequately cooked game meat is the source
Painful exudative pharyngitis and tonsillitis
Pharyngeal ulcers
Swollen retropharyngeal and cervical lymph nodes

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21
Q

Pneumonic disease Francisella tularensis

A

Inhalation exposure
Fever, malaise, dry cough, substernal discomfort, pleural effusion, dyspnea, and sore throat
Chest x-ray with peribronchial infiltrates to bronchopneumonia with effusion
Hilar adenopathy

Diagnosis
Serologic testing

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22
Q

Francisella tularensis treatment and prognosis

A

Treatment
Gentamcin or streptomycin
Doxycycline
Ciprofloxacin

Prognosis
When appropriately treated mortality is 1% or less

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23
Q

Bacillus anthracis

A

Spore forming gram-positive non motile rod that is aerobic or facultatively anaerobic, catalase positive, hemolysis negative
Grows on sheep agar
Zoonotic infection from goats, sheep, cattle, antelope, kudu, pigs, horses, zebu, and other animals.
Animal related products include meat, wool, hides, bones, and hair
Soil contaminated with spores

Clinical Manifestations
Inhalation:
Mediastinal adenopathy
Mediastinal widening
Pleural effusion
Rapidly fatal if not treated with multiple antibiotics and pleural drainage

Cutaneous:
Most common

Gastrointestina:l
Oropharyngeal
Intestinal

Meningeal:
Nearly always fatal, can occur as complication of inhalation, cutaneous , or gastrointestinal disease

Diagnosis
Blood culture

24
Q

Bacillus anthracis treatment, prevention, prognosis

A

Treatment
Multi-drug regimen
Pleural drainage

Prevention
Vaccination for possible exposure
Post-exposure antibiotics

Prognosis
45% mortality of inhalation in 2001 attacks
20% mortality in untreated cutaneous disease

25
Q

Yersinia pestis

A

Gram negative coccobacillus, microaerophilic, nonmotile, and non spore forming

Transmission cycles involve rodents and fleas, which act as vectors.
Prairie dogs are a common host

Clinical Manifestations of Plague

  • Bubonic
  • Septicemic
  • Pneumonic
26
Q

Bubonic Plague

Yersinia pestis

A

Swollen, tender lymph nodes (buboes) closest to site of initial infection
Fevers, chills, myalgia, arthralgia, headache, malaise, and prostration
Untreated patients have continued fever, tachycardia, agitation, confusion, delirium, and convulsions

27
Q

Septicemic plague (yersinia pestis)

A

Nausea, vomiting, diarrhea, and abdominal pain
Disseminated intravascular coagulation
Hypotension, renal failure, and obtundation
ARDS

28
Q

Pneumonic Plague

Yersinia pestis

A

Fever, cough, chest discomfort, tachycardia, dyspnea, bacteria laden sputum, chills, headache, myalgias, weakness, and dizziness
Respiratory distress, hemoptysis, cardiopulmonary insufficiency, and circulatory collapse
Death within 24 hours of symptoms

29
Q

yersinia pestis treatments

A

Streptomycin for pneumonic plague
Tetracyclines for bubonic plague
Chloramphenicol for meningitis

30
Q

Leptospirosis

A

Spirochete with terminal hook
Identified on dark field microscopy or silver staining
Obligate aerobe

Clinical Manifestations
Weil’s Disease:
Pulmonary Hemorrhage Syndrome

Reservoir:
Persistent renal carriage from rodents, dogs, pigs, cattle, and sheep
Colonizes renal tubules, excreted in urine, and survives for weeks to months in the environment

Transmission:
Penetrates the skin or mucous membranes during contact with contaminated water, soil, or vegetation

31
Q

Leptospirosis clinical manifestations

A 
Early phase:
First 3-7 days
Fever, myalgia, and headache
Nausea, vomiting,  abdominal pain, diarrhea, cough, and photophobia
Muscle tenderness
Rash
Conjunctival suffusion
Late Phase: Weil’s Disease
Jaundice
Acute hemorrhage
Renal Failure
Severe thrombocytopenia
GI bleeding
Pulmonary Hemorrhage
Myocarditis
Aseptic meningitis
32
Q

Leptospirosis dx, treatment and prevention

A

Diagnosis
Agglutination test

Treatment
Doxycycline
Penicillin

Prevention
Doxycycline post-exposure

33
Q

Haemophilus influenzae

A 
Encapsulated gram negative coccobacilli
Aerobic or facultative anaerobic
Grows on chocolate agar 
 X(hemin) Factor  and  V(NAD) Factor
Nasopharynx of adults and children
Transmission: respiratory droplets
H influenza type b was most common cause of meningitis in young children prior to effective vaccines
34
Q

Haemophilus influenzae clinical manifestations

A

Meningitis
Children under 5 years old and in adults with skull trauma or CSF leaks
Type B strains
Diagnosis made by detecting PRP capsular antigens in CSF

Epiglottitis
Life threatening infection in children that usually occurs in children younger than 5.
Symptoms include fever, drooling, dysphagia, and respiratory distress with stridor
Course is rapid over a couple of hours
Lateral neck film used for diagnosis

Pneumonia:
Fever, cough, and lobar consolidation
Parapneumonic effusion and empyema
Diagnosed by blood culture or culture from pleural fluid
Smoking – risk factor

Bronchitis
Risk factor is chronic lung disease ( COPD)

Acute Sinusitis

Otitis Media

35
Q

H. influenzae treatment and prevention

A

Treatment:
3rd generation cephalosporin for meningitis

Prevention
Conjugate capsular polysaccharide-protein vaccine effective for type b disease
Antibiotic prophylaxis in nonimmunized household or daycare contacts of patients with H influenza type b
Rifampin

36
Q

Corynebacterium diphtheriae

A 
Gram-positive bacillus – club shaped
Non-spore forming
Aerobic
Reservoir:
Throat and pharynx
Transmission:
Bacterium or phage via respiratory droplets

Respiratory Diphtheria
Incubation of 1-7 days
Sore throat, malaise, and fever
Pharyngeal erythema followed by tonsillar exudate
Exudate changes into a grayish membrane that is tightly adherent and bleeds on attempted removal

Cervical adenopathy – Bull Neck
Stridor
Extension of membrane can lead to airway obstruction
Myocariditis, recurrent laryngeal nerve palsy, and peripheral neuritis

Treatment:	
Erythromycin
Antitoxin
Prevention:
Vaccination with toxoid vaccine
37
Q

Legionella pneumophila

A

Weakly gram-negative pleomorphic rod
Facultative intracellular
Requires cysteine and iron ( Charcoal yeast extract)
Water organism, amebae, air-conditioning water cooler tanks
Transmission: aerosols from contaminated air-conditioning, no human to human transfer
Risk Factors: smokers over age 55 with high alcohol intake and immunosuppression

Legionaire’s disease
Fevers, malaise, cough, chills , dyspnea, myalgias, * headache, chest pain, and diarrhea.**
Myalgias, severe headaches, and diarrhea distinguish it from other pneumonias
Mental Confusion

Pontiac Fever
Fever, sore throat myalgia, headache, and extreme fatigue
Short duration, lasting on average 3 days

Diagnosis
Antigen urine test
DFA ( direct fluorescent antibody)

Treatment
Fluoroquinolones, azithromycin, or erythromycin + rifampin for immunocompromised patients
Drug must penetrate human cells

38
Q

Mycoplasma pneumonia

A

Smallest free-living bacteria
No cell wall – unaffected by cell-wall inhibiting antimicrobials such as B-lactams
Sterol containing membrane
Requires cholesterol for culture
Transmission: respiratory droplets, close contact, families, military recruits, dorms
Highest incidence age 5-20 years old

Respiratory Infection
2-3 weeks incubation
Fevers, malaise, headache, and cough
5-10% progress to tracheobronchitis or pneumonia
Cough usually non-productive
Walking pneumonia

Diagnosis
Primarily clinical diagnosis
Positive cold agglutinins - positive in 65% of cases

Treatment
Macrolides: erythromycin, azithromycin, and clarithromycin
Tetracyclines

39
Q

Streptococcus pneumonia

A

typical pneumonia

Gram positive diplococcus, lancet shaped
Facultative anaerobe, grows on blood agar plates
alpha hemolytic
Optochin sensitive
Lysed by bile

Reservoir – human upper respiratory tract
Transmission – respiratory droplets

Pathogenesis:
Polysaccharide capsule

Risk Factors
Influenza infection, COPD, CHF, Alcoholism, and asplenia

Pathobiology
Initially colonizes the nasopharynx then aspirated

Clinical manifestations:
Typical Pneumonia
Most common cause
Shaking chills, high fever, chills, rigors, lobar consolidation, blood tinged (rusty) sputum
Adult meningitis
Most common cause in adults
Otitis media and sinusitis
Most common cause in children

Treatment of pneumonia
Beta lactams
Macrolides
Fluoroquinolones

Treatment of meningitis
3rd generation cephalosporins
Vancomycin added if penicillin resistant

40
Q

Staphylococcus aureus

A 
Gram positive cocci in clusters
Catalase positive
Coagulase positive
Beta hemolytic
Small yellow colonies on blood agar
Ferments mannitol

Reservoir – nasal flora in 25% of population

Transmission
Hands
Sneezing
Surgical wounds
Contaminated food
= Custards
= Potato salad
= Canned meats

Over 50 virulence factors including adhesins, toxins, enzymes, surface-binding proteins, and capsule polysaccharides
Pathogenesis from tissue invasion and toxin mediated
3 toxin mediated diseases
- Staphylococcal food poisoning
- Staphylococcal toxic shock syndrome
- Staphylococcal scalded skin syndrome

Clinical manifestations
Skin manifestations include impetigo, folliculitis, furuncle, abscess, erysipelas, cellulitis, mastitis, necrotizing fasciitis, and wound infections
Bacteremia
Endocarditis
- Roth’s spots, Osler’s nodes, Janeway lesions, and petichiae
Pericarditis
Osteomyelitis – hematogenous seeding
Septic Arthritis, Infected prosthetic joints
Pneumonia – nosocomial pneumonia, **salmon colored sputum

Toxin Mediated Diseases
Staphylococcal food poisoning – Enterotoxins A-E
- 2-6 hours after eating nausea, vomiting, diarrhea, and abdominal pain
- Self limited

Toxic Shock Syndrome TSST-1 a super antigen
- Fever, erythroderma, hypotension, involvement of 3 or more organ systems, and desquamation of the palms and soles

Scalded Skin Syndrome – exfoliative toxin A or B

Treatment
Gastroenteritis is self limiting
Nafcillin/Oxacillin
MRSA – Vancomycin

41
Q

Pnemocystis jiroveci

A

Fungus
Obligate extracellular parasite
Silver stain
Opportunistic infection in HIV patients with CD4 count less than 200

Pneumonia:
Fever, nonproductive cough, and shortness of breath
X-ray with patchy infiltrate, ground glass appearance, lower lobe and periphery may be spared
Diagnosis : silver staining cysts in bronchial alveolar lavage fluids or biopsy
Treatment sulfamethoxazole/trimethoprim or dapsone
Prevention SMX/TMP prophylaxis for CD4 counts less than 200 in HIV patients

42
Q

Histoplasma capsulatum

A

Dimorphic fungus
Facultative intracellular parasite – found in RES cells
Found in soil, caves, and abandoned buildings with bird and bat guano
Transmission
- Disruption of soil; cleaning attics, bridges, and barns; tearing down old structures, and spelunking
Endemic to Mississippi and Ohio River Valleys

Clinical Manifestations:
Acute pulmonary
- Most asymptomatic
- Several weeks after exposure fevers, chills, fatigue, non-productive cough, anterior chest discomfort, and myalgias

Chronic pulmonary

  • Progressive, often fatal
  • Elderly, immunocompromised, and COPD patients at risk

X-ray

  • Acute Pneumonia with patchy lobar or multilobar infiltrate
  • Chronic Pneumonia with upper lobe infiltrates, multiple cavities, fibrosis of lower lobes – mimics TB

Treatment

  • Itraconazole
  • Amphotericin B
43
Q

Blastomyces dermatitidis

A

Thermally dimorphic fungus
Broad based budding yeast
Appears to be associated with soil and decaying vegetation, especially in areas associated with rivers and lakes.
Endemic in north central, south central, great lakes, and southeastern seaboard
Transmission – inhaled conidia

Clinical Manifestations:

  • Acute Pulmonary
    Most asymptomatic or thought to have community acquired pneumonia
    Fever, malaise, nonproductive cough
    Chest x-ray with lobar, multilobar, or nodular infiltrates
    Skin lesions
  • Chronic Pulmonary
    Fever, night sweats, fatigue, weight loss, cough, hemoptysis, and dyspnea
    Chest x-ray with cavitary, nodular, fibrosis, mass like

Treatment
All patients should be treated
Itraconazole in mild disease
Amphotericin B in severe disease

44
Q

Coccidioides immitis

A

Dimorphic fungi
Inhaled arthroconidia enlarge and form spherules
Spherules undergo internal septation producing endospores
Endemic in southwest deserts

Clinical Manifestations
- Most asymptomatic
- Pulmonary Infection:
Symptoms develop 5-21 days after exposure
Fever, weight loss, fatigue, dry cough, and pleuritic chest pain
Arthralgias
Erythema nodosum
Chest x-ray with pulmonary infiltrates, hilar adenopathy, and peripneumonic effusion
Pulmonary Nodule, cavitary

Disseminated infection
Immunocompromised , e.g. AIDS
3rd trimester pregnancy
Skin, joints, and bones

Treatment
Itraconazole
Amphotericin B

45
Q

Paracoccidioidomycosis brasiliensis

A

Thermally dimorphic fungus
Endemic to humid areas of Central and South America
Lives in soil
Most prevalent in middle-aged to elderly men
Paracoccidioidomycosis develops after inhalation of aerosolized conidia encountered in the environment
- Acute-Subacute Paracoccidioidomycosis – less than 10%
—-RES (reticulo-endothelial system) with dissemination to the liver, spleen, lymph nodes, and bone marrow

Chronic Paracoccidioidomycosis
Progressive over many years
Most patients older men
Pulmonary involvement mimics tuberculosis
Chest x-ray with nodular, interstitial, and cavitary lesions in the middle or lower lung fields
Ulcerative lesions in the anterior nares, oral cavity, and larynx that are slowly destructive

Chronic Paracoccidioidomycosis
Diagnosis
Growth in culture

Morphology
Thick-walled yeast cells that have multiple small circumferentially attached, narrow-based budding daughter yeast cells
Ship’s steering wheel

46
Q

Strongyloides stercoralis

A

Endemic in warm climates worldwide

Transmission
Exposed skin comes in contact with free-living filiariform larvae living in contaminated soil. After skin penetration, larvae enter the afferent circulation and travel to the pulmonary vasculature, where they rupture into the alveolar spaces, ascend the respiratory tree, and are swallowed into the GI tract. Development into adult worms occurs in the upper part of the small intestine. Female worms begin laying eggs. Eggs hatch in the lumen of the small intestine. Rhabditiform larvae migrate to the colon and are passed in the feces.

Pulmonary Manifestations
Can be severe in immunocompromised
Resembles ARDS with acute onset of dyspnea, productive cough, and hemoptysis accompanied by fever, tachypnea, and hypoxemia

Treatment
ivermectin

47
Q

Aspergillosis

A

Aspergillus are ubiquitous organisms found in soil, decaying matter, and air.
Spore like conidia are aerosolized from the mold form of the organism. They reach tissue and form invasive hyphae.
Can be isolated from basements, crawl spaces, bedding, humidifiers, ventilation ducts, potted plants, dust, condiments, and marijuana

48
Q

Invasive Aspergillosis

A 
Immunocompromised host
Fever
Pulmonary infiltrates
Nodules
Wedge-shaped densities resembling infarcts
Sinusitis
Extrapulmonary sites
CNS abscesses, endophthalmitis, MI, GI, renal, osteomyelitis, endocarditis

Diagnosis
Diagnosis: BAL, needle aspiration, thoracoscopic biopsy, or open lung biopsy

Treatment
Antifungal- Voriconazole or liposomal amphotericin B
Reversal of immunosuppression
Surgical resection of infected lesions

49
Q

Chronic Pulmonary Aspergillosis

A

Aspergilloma
Ball in cavity
Debris in preformed cavity from TB, Histoplamosis, or fibrocystic sarcoidosis
Treatment
Limited benefit with aspergilloma
Antifungal – itraconazole or voriconazole in chronic cavitary pulmonary aspergillosis

50
Q

Allergic Bronchopulmonary Aspergillosis (ABPA)

A

History of chronic asthma or cystic fibrosis
Airway obstruction, fever, eosinophilia, positive sputum cultures, mucous plugs containing hyphae, brown flecks in sputum, transient infiltrates, proximal bronchiectasis, upper lobe contraction, elevated IgE.
Eosinophilia in blood, sputum, and lung tissue

51
Q

Allergic Pulmonary Aspergillosis Diagnosis

A 
Asthma
Immediate cutaneous reaction to A. fumigatus antigen
Serum IgE greater than 1000 ng/ml
A. fumigatus specific serum IgE levels
Precipitating serum antibodies to A. fumigatus
Central bronchiectasis
Peripheral eosinophilia
Pulmonary infiltrates

Treatment
Corticosteroids and itraconazole

52
Q

Cryptococcosis

A

Occurs most often in the immunosuppressed – HIV
Meningitis is most common clinical manifestation
Pulmonary and other organ involvement can occur

Cryptococcus neoformans
Yeast
Environment and tissues
Polysaccharide capsule is the major virulence factor

Patients at highest risk are those with AIDS and CD4 counts less than 50.
Inhaled from the environment and causes pulmonary infection initially. Most patient asymptomatic.
If the host becomes immunosuppressed the organism can reactivate and disseminate to other sites.
C. neoformans is neurotropic

Central Nervous System Infection:
Meningoencephalitis
Headaches over several weeks
Nuchal rigidity
Lethargy
Personality changes
Confusion
Visual abnormalities
Nausea and vomiting

Pulmonary Infection
Risk factors include COPD, Corticosteroid use, and solid organ transplant
Fever, cough, and dyspnea
Treated with antifungals

Other organs affected
Skin, prostate, osteoarticular surfaces, breast, eye, and larynx.

Diagnosis
Yeast is grown in culture from CSF, Blood, sputum, skin lesions, or other body fluids
India Ink stain – visualization of budding yeast with large capsule
Latex agglutination for Cryptococcal polysaccharide antigen

Treatment of CNS infection
Non-AIDS Patients
Amphotericin B and flucytosine for 6 weeks
AIDS Patients
Amphotericin B and flucytosine for 2 weeks, followed by fluconazole 400 mg daily for 8 weeks, then suppressive therapy with fluconazole 200 mg daily

53
Q

HACEK Organisms

A 
Haemophilus spp
Actinobacillus actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella spp
5% of endocarditis cases
Normal flora
Common Cause of endocarditis in non-IV drug users
Difficult to diagnose- often takes 3 months
54
Q

Culture Requirements

A

H. influenzae Chocolate Agar with Factors V(NAD+) and X(Hematin)
N. meningitidis Thayer-Martin
B. pertussis Bordet-Gengou
C. diphtheriae Loffler medium
M. pneumoniae Eaton Agar – requires cholesterol
Legionella Charcoal Yeast Extract cysteine and iron

55
Q

Special Stain Requirements

A

Chlamydia Giemsa
Cryptococcus India Ink
Pneumocystis Silver Stain
Mycobacteria Ziehl-Neelsen

Respiratory II Exam 1 (12 decks)

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