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Pathology Year 5 > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What happens following TB exposure?

A

Either infection or not

If infected then primary TB with symptoms or latent TB (gohn focus)

Then latent TH can be reactivated with symptoms or not reactivated

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2
Q

Classic signs of TB

A

Fever, night sweats, weight loss, upper lobe cavitation, haemoptysis, caseating granuloma

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3
Q

Types of TB seen in the body

A

Subacute meningitis - headaches etc, can have confusion, diagnose LP

Spinal (Potts disease) - back pain, discitis, vertebral destruction, iliopsoas abscess

Miliary TB - disseminated causing pericarditis, renal issues, liver, testicular, lymphadenitis

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4
Q

Gold standard for TB, and results

A

Ziehl-Neelson stain on Lowenstein Jensen medium for 6 weeks

Acid fast bacilli seen

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5
Q

Other TB investigations

A

Sputum samples x3

Tuberculin skin test - detects active, latent or BCG

IGRA - only active or latent

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6
Q

Treatment for TB and how long are they given for

A

RIPE - rifampicin, isoniazid, pyrazinamide, ethambutol

All for 2 months then R&I for 4 more

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7
Q

Side effects of TB treatment

A

R - orange secretions
I - peripheral neuropathy
P - hepatotoxic
E - optic neuritis

Orange people have oranges

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8
Q

Second line TB treatment

A

Injectables, quinolones, linezolid

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9
Q

TB prophylaxis

A

Isoniazid

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10
Q

What does the BCG vaccine contain

A

Attenuated M.Bovis

Contraindicated in immunosuppression

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11
Q

Mycobacterium Leprae

A

Causes leprosy, skin pigmentation, nodules, nerve thickening and disability

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12
Q

CURB -65

A
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13
Q

Treatment according to CURB scores

A
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14
Q

Atypical vs typical pneumonia

A

Typical=classic signs and symptoms , classic X-ray changes (i.e.
consolidation), respond to penicillin Abx

Atypical=no/atypical signs and symptoms, not keeping with X-ray, don’t respond to penicillin Abx (because no cell wall). May have extra-pulmonary
features, e.g. hepatitis, hyponatraemia

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15
Q

What is HAP? Common causative agents

A

After 48 hours of hospital admission

E.coli, Klebseilla, Staph, Pseudomomas, Haemophilus

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16
Q

Typical pneumonia causes

A 
Strep p
Haemophilus I
Moraxella catarrhalis
Staph a
Klebseilla
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17
Q

Key features of strep pneumonia

Microscopic feature

A

Most common
Rusty coloured sputum, lobar

+ve diplococci

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18
Q

What is Haemophilus pneumonia associated with?

Microscopic feature

A

Associated with smoking, COPD

-ve cocco bacilli

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19
Q

What is Moraxella pneumonia associated with?

Microscopic feature

A

Smoking

-ve cocci

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20
Q

Key features of staph pneumonia

Microscopic feature

A

Associated with recent viral infection

Cavitation of CXR

+ve cocci, bunch brunch cluster

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21
Q

Key feature of klebseilla pneumonia

Microscopic feature

A

Alcoholics, elderly, haemoptysis

-ve rod

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22
Q

Causes of atypical pneumonia

A

Legionella pneumophilia
Mcyoplasma pneumoniae
Chlamydia pneumomiae
Chylamydia psittaci

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23
Q

Key points about legionalla pneumophilia

A

Travel, air conditioning, water towers, hepatitis, hyponatraemia

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24
Q

Key points about mycoplasma pneumoniae

A 
Uni students
Boarding schools
Dry cough
Arthralygia
Cold agglutinin test/AIHA
Erythema multiforme
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25
Q

Where does Chlamydia psittaci come from?

A

Birds

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26
Q

What are some infections you can get in AIDS?

A 
TB
CMV, EBV, HSV, JCV
PCP (pneumocystis pneumonia), Candida 
Cryptococcus neoformans
Toxoplasma
Salmonella septicaemia 
Cryptosporidium
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27
Q

What does a splenectomy put pts at risk of?

A

Encapsulated bacteria

E.g. H influenzae, S.pneumomiae, N.meningitidis

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28
Q

Key infections in CF

A

Pseudomonas aeruginosa

Burkholderia cepacia

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29
Q

What does neutropenia put pts at risk of?

A

Aspergillus

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30
Q

Treatment for HAP?

A

ciprofloxacin and vancomycin (tazocin and vancomycin if severe)

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31
Q

What is infective endocarditis?

A

Infection of innermost layer, mainly valves, vegetation off valves that fly around body forming emboli

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32
Q

Which valves are involved mainly in infective endocarditis and which side is associated with IVDU?

A

Mitral and aortic

Right sided

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33
Q

Risk factors for IE

A

Long term lines, IVDU, poor dentition, prosthetic valve, rheumatic heart disease, immunosuppression

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34
Q

Acute causes of IE

A

Strep pyogenes (GAS), staph aureus (IVDU), CoNS (prosthetic)

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35
Q

Causes of subacute IE (low virulence)

A

HACEK - Haemophilus, acinetobacter, cardiobacterium, eikinella, kingella

Strep viridans
Staph epidermidis

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36
Q

Signs of IE

A

Fever, anorexia, malaise, fatigue, night sweats, SOB, new mumur, janeway lesions, splinter haemorrhages, splenomegaly, Osler nodes, haematuria, septic abscesses, microemboli

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37
Q

Investigations for IE

A

Blood cultures at 3 sites, echo

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38
Q

Dukes criteria - major and minor

A

Major -

  • Positive blood cultures growing typical organisms (12 hours apart >2)
  • New regurgitant murmur/vegetation on echo

Minor -

  • Risk factors
  • > 38
  • Emboli phenomena (janeway lesions, splinter haemorrhage, splenomegaly, abscess)
  • Immune phenomena (Roth spots(in eyes), oslers nodes, haematuria)
  • Positive culture not meeting major

2 major, OR 1 major + 3 minor, OR 5 minor criteria

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39
Q

Treatment for IE

A

IV Abx
Start as soon as culture taken

Acute - flucloxacillin
Subacute - benzlypenicillin + gentamycin
Prosthetic valve - vancomycin+ gentamicin+ rifampicin

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40
Q

Three forms of GI infections , examples and symptoms of each

A

Secretory diarrhoea - toxins, chloride ions, water and electrolyte loss, watery, no fever (CHOLERA)

Inflammatory diarrhoea - inflammation and bacteraemia, fever, bloody (SHIGELLA, CAMPYLOBACTER, NON TYPHOIDAL SALMONELLA)

Enteric- fever, unwell, fewer GI symptoms ( TYPHOIDAL SALMONELLA, YERSINIA, BRUCELLA)

Enteric fever aka typhoid fever is caused by salmonella

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41
Q

Gives some GI viruses

A

Norovirus, rotavirus (<6yo), adenovirus (< 2 yo), hep A, enterovirus

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42
Q

Give examples of GI organisms

A

C.diff (after 3C - ciprofloxacin, clindomycin, cephalosporins)

Vibrio cholera (rice water stool, shellfish)

S.Aureus (vomiting and watery)

Clostridium perfringens (after reheated meat, 24hrs lasting, gas gangrene)

Clostridium botulism - canned foods and honey causing paralysis

Bacillus cereus (Chinese takeout - reheated rice)

E. coli - travellers diarrhoea, some types cause bloody diarrhoea

Shigella - inflammatory, bloody

Campylobacter jejuni- poultry, bloody foul smelling, GBS and reactive arthritis associated

Salmonella enteritides - poultry and eggs

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43
Q

Typhoid - causes and symptoms

A

Salmonella typhi and paratyphi

Transmitted by food and water

Symptoms:

  • Constipation (not diarrhoea!)
  • Fever, headache, myalgia
  • Rose spots on trunk
  • Relative bradycardia
  • Hepatosplenomegaly
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44
Q

Typhoid treatment

A

IV ceftriaxone then PO azithromycin

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45
Q

Dengue - causes and symptoms

A

Flavivirus - dengue virus

Symptoms:
•Fever, myalgia, rash (50%)
•Mild and self-limiting

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46
Q

What happens if reinfected with different sero type of dengue?

A
  • Dengue haemorrhagic fever / Dengue shock syndrome
  • Rare in travellers
  • Supportive management
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47
Q

Cause of malaria and symptoms

A

Plasmodium spp.

Life cycle: mosquitoes and humans (RBCs and liver)

Symptoms:

  • Tertian fever (48hrly)
  • Hepatosplenomegaly
  • Anaemia
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48
Q

Symptoms of severe falciparum malaria

A
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49
Q

What is zoonoses?

A

Infections which are transmitted naturally between vertebrate animals and humans

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50
Q

Give examples of zoonoses

A

Rabies (rhabdovirus) - hypersalivation, hydrophobia, negri bodies, encephalitis

Lyme disease (borellia burgoferi) - walking, camping, deer ticks, flue like, later neuro signs, bulls eye rash

Leptospirosis - swimming, dog/cat urine, conjuctival haemorrhage, jaundice, spiking fever

Q Fever (coxiella burnetti from sheep/cattle) - atypical pneumonia symptoms

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51
Q

Management for non falciparum malaria

A

Chloroquine then primaquine

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52
Q

Management for falciparum malaria

A

Mild: artemesin combination therapy (Riamet – artemether + lumefantrine)

Severe: IV artesunate

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53
Q

Distinguish between falciparum and non-falciparum

A

Thick and thin blood films

Thick demonstrates malaria; thin demonstrates species

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54
Q

Leishmania

A

Cutaneous

Diffuse cutaneous

Muco-cutaneous

Visceral - young malnourished child, abdo discomfort, distension, anorexia, weight loss

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55
Q

Organisms causing UTIs

A

E.coli
Staph saprophyticus - young females
S.aureus
Abnormal tracts - proteus, Klebseilla

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56
Q

Symptoms of pyelonephritis

A

systemically unwell, fever + rigors, loin pain

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57
Q

Treatment for UTIs

A

Lower: nitrofurantoin / trimethoprim / cephalexin / amoxicillin
•3d if uncomplicated; 7d if complicated

Upper: admit, IV co-amox + gent

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58
Q

How much upgrowth is needed in urine MC&S to diagnose UTI?

A

Culture of >10^4 colony forming units / ml is diagnostic (10^3 for E.
coli / S. saprophyticus)

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59
Q

Organisms causing infection in surgical sites

A

S. Aureus - flucoxacillin
E. Coli
Strep
Pseudomonas

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60
Q

Cause of osteomyelitis, symptoms, investigations m management

A

S. Aureus

Pain, swelling, febrile

MRI, culture, bone biopsy

IV Abx, debridement

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61
Q

Septic arthritis causes, signs, management, investigations

A

S. Aureus, Strep, E. Coli

Red, hot, swollen, febrile

Joint aspirate MCS, blood culture

I’ve Abx, drain

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62
Q

Prosthetic joint infection causes, symptoms, investigations, management

A

CoNS, S. Aureus, E.coli

Red, hot, swollen, joint failure

X-RAY/MRI, joint aspirate

IV Abx, remove prosthetic

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63
Q

C. Diff - transmission, causes, management

A

Transmission: Spore ingestion.
3Cs: clindamycin, cephalosporins,
ciprofloxacin
Toxin -> Pseudomembranous colitis.

Vancomycin.

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64
Q

MRSA

A

coag –ve staph

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65
Q

Symptoms of brain abscess

A

Swinging fever

Extension causing otitis media, endocarditis

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66
Q

Treatment of encephalitis and common causes

A

HSV1

IV acyclovir

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67
Q

Most common causes of bacterial meningitis

A

N. Meningitidis, Strep Pneumoniae, Group B Strep, Listeria, E.coli

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68
Q

Common causes of viral meningitis

A

Enterovirus (coxsackie, echovirus), mumps, HSV2

Viral presents the same as bacterial (but often less severe)

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69
Q

Common causes of fungal meningitis

A

Cryptococcusneoformans

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70
Q

Common causes of chronic/subacute meningitis

A

presents with headaches for months

caused by TB or cryptococcus

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71
Q

Risk factors for N.Meningitidis and Strep

A

N.meningitidis: complement deficiency, hyposplenism, hypogammaglobulinaemia

S.pneumoniae: Complement deficiency, hyposplenism, immunosuppressed, infection, previous head trauma

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72
Q

Treatment for meningitis

A

ceftriaxone and corticosteroids

Listeria cover with ampicillin

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73
Q

CSF analysis for meningitis

A
74
Q

Symptoms of STDs in men and women

A

Men - urethral discharge, dysuria, scotsil pain or swelling, rash, sores, systemic symptoms

Women- discharge, ulceration, itchy, abdo pain, dysuria, dyspareunia, abnormal bleeding, systemic symptoms

75
Q

Which STDs cause ulceration?

A

Syphilis, HSV

76
Q

Which STDs cause rashes/lumps/growths?

A

HPV, scabies, molluscum contagiosum

77
Q

Gonorrhoea - treatment and symptoms

A

Gram -ve diplococcus

Can transfer to neonate and cause conjunctivitis, can be disseminated and cause sepsis, rash and arthritis

Diagnosed with swabs and producing a culture

IM ceftriaxone

78
Q

Chlyamydia treatment and diagnosis

A

Genital swabs / urine sample
NAAT (nucleic acid amplification tests)

Azithromycin, or Doxycycline

79
Q

Is chlamydia gram negative or positive

A

Negative

80
Q

Syphilis stages

A

Primary - macule to papule (painless genital ulcer)

Secondary - systemic bacteraemia after 1-6 m of infections, rash on palms/soles/back/trunk/limbs, mucosal lesions, uveitis, CNS involved

Tertiary - 20-30years, can have neurospyphilis, gummatous, cardiovascular syphilis

Latent

81
Q

Gummatous, cardiovascular and neurosyphilis symptoms

A

Gummatous – skin / bone / mucosa granulomas Spirochaetes scanty

Cardiovascular – mimics any cardiac disease, especially causes aortic root dilatation /
aortitis. +++ spirochaetes, +++ inflammation

Neurosyphilis – dementia, tabes dorsalis, Argyll-Robertson pupil. Spirochaetes in CSF

82
Q

Diagnosis of syphilis

A
  • Dark-ground microscopy from primary lesions -> visualise Treponemes
  • Antibody tests (treponemal or non)

Non-Treponemal tests:
•Detect antibodies against non-specific antigens
•False positives are common (need to confirm with treponemal test)
•Titre falls in response to treatment

Treponemal tests:
•Detect antibodies against specific antigens from T. pallidum
•Remains positive for years (even after treatment)

83
Q

Treatment for syphilis

A

Single dose IM benzylpenicillin

84
Q

Trichomoniasis

A

Strawberry cervix, wet prep microscopy, metronidazole

85
Q

Management for candidiasis

A

Treatment: PO / topical antifungals, e.g. clotrimazole or fluconazole

86
Q

Molluscum contagiosum

A

Pox virus

  • Small papules with central punctum
  • Children: hands and faces, spread by skin-to-skin contact.
  • Adults: genital lesions, spread via sexual contact.
  • Widespread lesions in immunosuppressed / HIV
  • Usually no treatment necessary; cryotherapy if persistent / extensive
87
Q

A urine MC&S shows a mixed growth of Staph and Strep organisms, with squamous epithelium. What is the most likely explanation?

A

Contaminants

88
Q

Gram negative cocci

A

Neiserria

89
Q

Gram positive bacilli

A

MACDONALD

Mycobacterium
Actinomycetes
Clostridium
Diphtheria corneyebacterium
O
Nocardia
Anthracis bacillus
Listeria
Diptheroids
90
Q

Gram positive cocci

A

Streptococcus - diplococci/chains
Enterococcus
Staphylococcus - grape like clusters, coagulate positive is aureus

91
Q

Gram negative coccobacilli

A

Can’t Polar Bears Hop

Chlamydia
Pseudomonas
Bordatella
Haemophilus

92
Q

Gram negative bacilli

A

Enterobacterias

Salmonella, shigella, yersinia, e.coli, Klebseilla

93
Q

Gram negative sphirocytes

A

Leptospira
Borrelia
Treponema pallidum (syphilis)

94
Q

Four mechanisms of antibiotic resistance

A

BEAT

Bypass antibiotic sensitive pathway (MRSA)

Enzyme mediates drug inactivation (beta lactamases)

Impairment of accumulation of drug ( tetracycline resistance)

Modification of drugs target (quinolone resistance)

95
Q

Give examples of broad spectrum and narrow spectrum ABx

A

Broad spectrum: Co-amoxiclav (amoxicillin + clavulanic acid), tazocin (piperacillin + tazobactam), ciprofloxacin, meropenem

Narrow spectrum: flucloxacillin, metronidazole, gentamicin

96
Q

Antibiotic for S.aureus

A

Flucloxacillin

97
Q

Antibiotic for CAP

A

Amoxicillin

Severe then co-amoxiclav and clarithryomycin

98
Q

Antibiotic for HAP

A

Co-amox + gent or tazocin

99
Q

Antibiotic for c.diff

A

Vancomycin

100
Q

ABx for UTI

A

Trimethoprim/nitrofurantoin

101
Q

Viruses causing disease in immunocompromised

A

Herpesviridae: CMV, EBV, HSV, HHV8, VZV
- Polyomaviridae: JC virus + BK virus
- Respiratory viruses: Influenza A and B, Parainfluenza 1, 2, 3 and 4, Respiratory
Syncytial Virus (RSV), Adenovirus, MERS coronavirus.

102
Q

What are some DNA and RNA virus examples?

A

DNA- herpes,VSV,HSV,EBV,HPV

RNA - (negative sense) measles, mumps, flu, RSV

(Positive sense) polio, hep A, hep c, rubella, dengue, coronavirus

Reversivirus- HIV, Hep B

Negative sense have RNA which must become mRNA in the host (with viruses own polymerase) whilst positive sense already has mRNA

103
Q

How does a virus enter a cell and replicate?

A

Entry-> uncoating -> immune evasion and DNA synthesis, protein synthesis -> assembly of virus and release -> transmissions

104
Q

What is antigenic shift and antigenic drift?

A

Shift - when different strains infect at the same time, during virus assembly recombination of the two can occur with different genomic segments leading to a rapid and large shift can even change organisms it can infect

Drift - point mutations which change the virus over time

105
Q

Why can some viruses evade host immune response?

A

They take the membrane from the host cell so there are some self antigens present which provide evasion ability

106
Q

What is the normal WCC range?

A

4.5-11

107
Q

What does a respiratory PCT panel include?

A

RSV A+B
Parainfluenza
Influenza
Human metapneumovirus (most have had this already)

108
Q

What are some of the key parts of the influenza virus?

A

Nuclear export protein
Ion channel
RNA/DNA segment
Haemogluttinin - binds to sialic acid receptors on the host cell to allow entry
Neuroaminidase - it cleaves sialic acid residues allowing the virus to leave the cell

these are used when naming viruses

109
Q

Bird flu

A

Human to human transmission of bird flu (H5N1) difficult as virus does not replicate very well at cold temperatures of upper airways (32OC).

Better in deeper lung tissue (still not ideal – 41.5OC) and from here it is difficult to escape.

110
Q

What are some antivirals for the flu?

A

Amantadine - experimental and targets the m2 ion channel

Neuroaminidase inhibitors - oseltamivir (tamiflu), zanamavir (relenza)

111
Q

How does influenza enter the cell?

A

Binds and fuses ->endocytosis -> early endosome -> late endosome -> nuclear fusion

112
Q

Influenza vaccine

A

Custom made every year depending on the dominant strain the previous year or in Australia

113
Q

What is a marker of bacterial infection over viral?

A

Pro calcitonin

114
Q

SARS - COVID

A

Positive sense RNA with spike glycoprotein
Causes multi system disease attacking lung, kidneys, CNS, GI

Prothrombotic infection
Mainly supportive treatment

Sotrovimab - Ab

115
Q

HCMV

A

In immunocompromised (major issue for transplant patients):

  1. Encephalitis
  2. Retinitis
  3. Pneumonitis
  4. Colitis
  5. Marrow suppression
Congenital infection:
1. Ears: sensorineural deafness
2. Eyes: chorioretinitis
3. Heart: myocarditis
4. Neurology: microcephaly, encephalitis
5. Lung: pneumonitis
• Liver: hepatitis, jaundice, hepatosplenomegaly
116
Q

EBV - glandular fever symptoms and diagnosis

A

Glandular fever triad-
Fever, pharyngitis, lymphadenopathy and maculopapular rash

Blood film, monospot agglutination, EBV antibodies Nb: Paul-Bunnell test

Burkitts lymphoma

117
Q

HHV8

A

Kapoks sarcoma herpes virus

HIV

118
Q

JC virus

A

Causes progressive multi focal leucoencephalopathy in HIV patients

119
Q

Hep A

A

Faeco- oral transmission, 2-6 w incubation, months to recover, self limiting

120
Q

Hep C

A

Body fluids mainly blood
Acute and chronic disease
Can cause cirrhosis and increase risk of HCC
Mainly in IVDU

It mutates a lot so usually infected with many strains at once so if you clear one another becomes dominant hence chronic

Antiviral is available but most successful with type 2/3

121
Q

Hep B

A

Big virus with lots of DNA/RNA so can make lots of complex machinery to be latent and does this by inserting self into the host DNA

Most people clear it

Bodily fluids transmission

Acute and chronic disease

In immunocompromised (especially B-cell depleting therapies i.e. rituximab):
Risk of reactivation
122
Q

Hepatitis D

A

Always coinfection with HBV

Transmission: Sexual, parental, perinatal (only possible in combination with HBV)

123
Q

Hepatitis E

A

Acute hepatitis – India

Faeco-oral transmission

Rare complications: CNS disease – Bell’s palsy, Guillain Barre, other neuropathy;

124
Q

When is IgM made and when is IgG made?

A

IgM is accuse and IgG is chronic

125
Q

Rubella congenital syndrome

A
  1. Ears: sensorineural deafness
  2. Eyes: Cataracts, glaucoma, retinopathy, microphthalmia
  3. Heart: PDA, VSD
  4. Neurology: microcepahly, psychomotor retardation
  5. Pancreas: insulin dependent DM (late)
126
Q

Symptoms of rubella

A

a. Maculopapular rash
b. Lymphadenopathy
c. Fever
d. Lesions on soft palate (Forchheimer sign)

127
Q

Human parvovirus

A

Slapped cheek (fifth disease)

a. Erythema infectiosum
b. Transient aplastic crisis
c. Arthralgia
d. Fever and malaise
2. Viral myocarditis

Congenital infection:
1. Foetal anaemia -> cardiac failure -> hydrops foetalis

128
Q

Hepatitis B serology

A

During infection - surface and envelope antigen is exposed

With replication etc, the core antigen is exposed

Anti-HbS made when leaving the cell and you are immune to it

Anti HbC is made if you are exposed and then immune to it but won’t be present if u had just a vaccine

In chronic infection no anti HbS as you aren’t immune yet

129
Q

Complication of glandular fever

A

EBV can cause EBV hepatitis

130
Q

When is ALP and ALT raised?

A

ALP - gallbladder, cholestasis

ALT - hepatocellular injury

131
Q

Hep B vaccine

A

Synthetic HbsAg

132
Q

Serology in hepatitis

A
133
Q

What are the types of vaccines?

A

Live - attenuated, related

Dead - inactivated, subunit, RNA

Passive - antibodies

134
Q

What type of vaccine is HPV?

A

Dead

135
Q

What type of vaccine is MMR?

A

Live

136
Q

What type of vaccine is varicella zoster?

A

Live hence can get chicken pox

137
Q

What type of vaccine is polio?

A

Live (Sabin)

Dead (Salk)

138
Q

What are some CNS AIDS diseases?

A

PML
CNS lymphoma
Cerebral toxoplasmosis
Neurocystorcosis

139
Q

What are some AIDS lung infections?

A

Aspergillus fumigatus - Ball of fungus

Mucosa - like necrotising fungus

140
Q

Fungi in AIDS patients

A

Candida albicans

Cryptococcus neoformans

141
Q

Air bronchogram

A

Normally can’t see but when there is consolidation around it you can see

142
Q

What is pneumocystitis pneumonia?

A

Seen in immunocompromised such as HIV patients

Most people have had it but in immunocompromised it’s bad

143
Q

What is Cryptococcus associated with?

A

Bird and pigeons

144
Q

Tinea

A

Ringworm, athletes foot

145
Q

Pityriasis

A

Sebhorric dermatitis, depigmentation in those with darker skin

146
Q

Treatment for Candida and Aspergillus

A

Candida is fluconazole

Voriconazole for Aspergillus

147
Q

How can Cryptococcus present in HIV patients?

A

Presents as meningitis with insidious onset in HIV

148
Q

What can antifungals target?

A

Cell membrane integrity, cell membrane synthesis, DNA synthesis, cell membrane, cell wall

149
Q

What do Azoles do?

Give examples

A

Ergosterol synthesis in cell wall

Clotrimazole
Fluconazole
Voriconazole

150
Q

What do polyenes do

Give examples

A

Cell membrane integrity

Amphotericin B used for invasive fungal infections and Cryptococcal meningitis

151
Q

What does Caspofungin do?

A

Beta 1,3 glucagon synthesis affected

Is an echinocandin

152
Q

HIV treatment types

A

Egra - integrate inhibitor e.g. raltegravir

Pine - transciptase inhibitor e.g zidovudine

Maraviroc - CCR5 stops viral entry

Protease inhibitor- saquinavir

153
Q

HAART regimen drug types

A

Nucleoside reverse transcriptase inhibitors (NRTI); zidovudine

Non-nucleoside reverse transcriptase inhibitors (NNRTI): afavirenz

Protease inhibitors; ritonavir

Entry inhibitor: enfurvitide

154
Q

How does HIV enter cells?

A

Bind by gp120/gp41 to cd4 on white cells and fuses -> reverse transcriptase in cytoplasm -> when binds to nuclear pore already has mRNA -> integration

HIV has pairs of genomes to make it less error prone

155
Q

What is prion disease?

A

Rare transmissable spongiform encephalopathies in humans and animals resulting in rapid neuro-degeneration and death in months.

Currently untreatable. If suspected be very careful handling lab samples!

156
Q

Types of CJD

A

Sporadic

Variant

Iatrogenic

Inherited prion disease

157
Q

Sporadic CJD

A

Rapid, progressive dementia with myoclonus, cortical blindness, akinetic mutism and lower motor neuron signs Mean onset is 45-75yrs and mean survival time = within 6/12 of symptoms starting

158
Q

Iatrogenic CJD

A

Progressive ataxia initially. Dementia and myoclonus later stages. Speed of progression depends on route of inoculation (CNS inoculation fastest)

159
Q

Variant CJD

A

Exposure to bovine spongiform encephalopathy

Younger age of onset – typically 30yrs. Mean survival 14/12. Psychiatric symptoms to start (anxiety, paranoia, hallucinations) followed by the neuro symptoms

160
Q

Inherited prion disease

A

Fatal familial insomnia is an example it’s autosomal dominant

161
Q

Neurocysticercossis treatment

A

Steroids
Anticonvulsant
Anti parasitic
Surgery

162
Q

Protozoa vs helminths

A

Protozoa - 1 cell, e.g. toxoplasma gondii, plasmodia, leishmania, trypanosma bruceii (sleeping sickness)

Helminth - worms e.g, ascaris, schistosoma, necatar americanus

163
Q

Toxoplasma

A

Definitive host is one in which sexual reproduction occurs

Disease of immunocompromised and pregnancy
Cats litter and mainly affects muscle by causing cysts and affecting function

164
Q

What are hookworms?

A

They bite the wall of the intestine and drink the blood- necator americanus and ancylostoma duoedenale

Can cause anaemia esp in developing world

165
Q

How do some helminths move from the skin to the gut?

A

Burrow and travel to lungs via lymphatics, cough then swallow into the gut

166
Q

Schistosoma Mansoni

A

Swimming in infected water

From freshwater snail, burrows through skin

167
Q

If you suspect tonsillitis, which antibiotic shouldn’t you prescribe and why?

A

Amoxicillin. If the infection is glandular fever, then the amoxicillin can cause a widespread skin reaction

168
Q

Commonest causes of CAP

A

Streptococcus, Haemophilus, Moraxella, Staphylococcus, Klebseilla

169
Q

MRSA

A

Catheters, surgical sites, catheter associated UTI

170
Q

E.coli

A

Catheter associated UTI, ventilator associated pneumonia

171
Q

Most common HAI

A

Pneumonia

172
Q

Pneumonia in immunocompromised

A

PCP, TB, Aspergillus

173
Q

Morbillivirus

A

Measles

a. Fever, malaise
b. Cough, coryzal symptoms, conjunctivitis
c. Koplik’s spots (buccal mucosa)
d. Maculopapular rash

Congenital infection:

  1. No foetal abnormalities
  2. Foetal loss, preterm delivery
174
Q

UTI in kids

A

Culture >105cfu/ml. Microscopy: pyuria (pus cells)

175
Q

Brucellosis

A

Brucellosis – Gram-ve bacilli
• Transmission: contaminated food (untreated milk / dairy products), direct animal contact (cows, goats, sheep, pigs)
• Presentation: undulant fever (peaks in evening), myalgia, arthritis, spinal tenderness, hepatosplenomegaly, epididymo-orchitis
• Ix: Serology - anti-O-polysaccharide antibody

176
Q

Plague

A

Plague – Yersinia pestis, gram-ve lactose fermenter
• Transmission: reservoir in rats, transmitted by flea
• Presentation:
o Bubonic plague–flea bites human, Swollen nodes, dry gangrene
o Pneumonic-plague– epidemics ,person-person spread

177
Q

Anthrax

A

Anthrax - Bacillus anthracis
• Cutaneous: Painless round black lesions + rim of oedema
• Pulmonary: Massive lymphadenopathy + mediastinal haemorrhage

178
Q

Meningitis causes in kids

A

<3 m - GBS, E.coli, Listeria
3m - 6 years - N.Meningitides, S. Pneumomiae, H. Influenzae
>6yo - N.Meningitides, S. Pneumomiae

179
Q

What does terbinafine do?

A

Cell membrane

180
Q

Flucystosine

A

DNA synthesis

181
Q

Caspofungin

A

Echinocandin

Affects beta 1,3 glucagon synthesis

Pathology Year 5 (2 decks)

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