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Boards Review by Topic > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Stain and shape of Chlamydiae

A

G(-) pleomorphic

Giemsa stain

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2
Q

Stain and shape of Mycobacterium

A

G(+) rod

Acid fast

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3
Q

Stain and shape of Proteus

A

G(-) rod

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4
Q

Stain and shape of Klebsiella

A

G(-) rod

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5
Q

Stain and shape of Vibrio

A

G(-) rod

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6
Q

Stain and shape of Haemophilus

A

G(-) rod (pleomorphic)

Respiratory

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7
Q

Stain and shape of Shigella

A

G(-) rod

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8
Q

Stain and shape of Bartonella

A

G(-) rod

Zoonotic

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9
Q

Stain and shape of Clostridium

A

G(+) rod

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10
Q

Stain and shape of Staphylococcus

A

G(+) coccus

Clusters

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11
Q

Stain and shape of Propionibacterium

A

G(+) rod

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12
Q

Stain and shape of E. coli

A

G(-) rod

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13
Q

Stain and shape of Corynebacterium

A

G(+) rod

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14
Q

Stain and shape of Bacillus

A

G(+) rod

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15
Q

What are hyphae?

A

Hyphae are the long, filamentous outgrowths from fungus that are the primary way that they invade. This makes the fungus a multicellular organism in that each hyphae is a new cell.
Remember that yeasts are unicellular and do not grow as hyphae. They may not bud off perfectly and therefore would form pseudohyphae.

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16
Q

Stain and shape of Treponema

A

G(-) Spirochete

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17
Q

Stain and shape of Campylobacter

A

G(-) rod

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18
Q

Stain and shape of Neisseria

A

G(-) coccus

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19
Q

Stain and shape of Borrelia

A

G(-) Spirochete

Giemsa stain

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20
Q

Stain and shape of Burkholderia cepacia

A

G(-) rod

Respiratory

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21
Q

Stain and shape of Moraxella catarrhalis

A

G(-) coccus

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22
Q

Stain and shape of Rickettsiae

A

G(-) pleomorphic

Giemsa stain

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23
Q

Stain and shape of Enterobacter

A

G(-) rod

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24
Q

Stain and shape of Pseudomonas

A

G(-) rod

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25
Q

Stain and shape of Listeria

A

G(+) rod

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26
Q

Stain and shape of Ureaplasma

A

No cell wall, doesn’t gram stain

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27
Q

Stain and shape of Legionella

A

G(-) rod

Respiratory

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28
Q

Stain and shape of Bordetella

A

G(-) rod

Respiratory

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29
Q

Stain and shape of Brucella

A

G(-) rod

Zoonotic

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30
Q

Stain and shape of Helicobacter

A

G(-) rod

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31
Q

Stain and shape of Actinomyces

A

G(+)

Branching filamentous

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32
Q

Stain and shape of Leptospira

A

G(-) Spirochete

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33
Q

Stain and shape of Nocardia

A

G(+) (weakly acid fast)

Branching filamentous

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34
Q

Stain and shape of Gardnerella

A

G(+) rod

Gram variable

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35
Q

Stain and shape of Pasteurella

A

G(-) rod

Zoonotic

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36
Q

Stain and shape of Bacteroides

A

G(-) rod

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37
Q

Stain and shape of Lactobacillus

A

G(+) rod

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38
Q

Stain and shape of Salmonalla

A

G(-) rod

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39
Q

Stain and shape of Yersinia

A

G(-) rod

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40
Q

Stain and shape of Francisella

A

G(-) rod

Zoonotic

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41
Q

Stain and shape of Streptococcus

A

G(+) coccus

chains or pairs

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42
Q

Stain and shape of Mycoplasma

A

No cell wall, doesn’t gram stain

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43
Q

Stain and shape of Serratia

A

G(-) rod

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44
Q

Name classic G(-) cocci

A

Moraxella catarrhalis

Neisseria

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45
Q

Name G(+) rods

A 
Bacillus
Clostridium
Corynebacterium
Gardnerella (Gram Variable)
Lactobacillus
Listeria
Mycobacterium (acid fast)
Propionibacterium
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46
Q

Name gram negative enteric bacteria

A 
B. C. PPEESSSKY H. V.
Bacteroides
Camylobacter
Proteus
Pseudomonas
E. coli
Enterobacter
Salmonella
Shigella
Serratia
Klebsiella
Yersinia
Helicobacter
Vibrio
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47
Q

Name the G(-) Respiratory bacteria

A

Bordetella
Burkholderia cepacia
Haemophilus (Pleomorphic)
Legionella (silver stain)

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48
Q

Name the G(-) Zoonotic bacteria

A

Bartonella
Brucella
Francisella
Pasteurella

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49
Q

Name the branching filamentous G(+) bacteria

A

Actinomyces

Nocardia (weakly acid fast)

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50
Q

Name the pleomorphic G(-) bacteria

A

Chlamydia (Giemsa)

Rickettsiae (Giemsa)

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51
Q

Name the G(-) spirochetes

A

Borrelia (Giemsa)
Leptospira
Treponema

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52
Q

What bacteria have no cell wall and therefore gram stain not at all?

A

Mycoplasma

Ureaplasma

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53
Q

What bac do not gram stain well?

A 
(These Microbes May Lack Real Color)
Treponema, Leptospira
Mycobacteria
Mycoplasma, Ureaplasma
Legionella
Rickettsia
Chlamydia
Bartonella
Ehrlichia
Anaplasma
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54
Q

What bugs stain with Giemsa stain?

A 
(Certain Bugs Really Try my Patience)
Chlamydia
Borrelia
Rickettsia
Trypanosomes
Plasmodium
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55
Q

What does Periodic Acid Schiff stain?

A

Glycogen, mucopolysaccharides;
Used to diagnose Whipple disease
Think PaSs the SUGAR

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56
Q

Ziehl-Neelsen Stain

A

Acid fast bacteria: Mycobacteria, Nocardia

Protozoa like Cryptosporidium oocysts

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57
Q

India ink stain

A

Stains Cryptococcus neoformans

Also stains polysaccharide capsules red

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58
Q

Silver stain

A

Used for fungi like Coccidioides and Pneumocystis

Also Legionella, Helicobacter pylori

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59
Q

Media used for H. flu isolation

A

Chocolate agar

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60
Q

Media used for Neisseria isolation

A

Thayer-Martin agar

Selectively favors growth of Neisseria by containing vancomycin, Trimethoprim, Colistin, Nystatin

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61
Q

Use of MacConkey agar

A

Contains an indicator that turns pink with certain pH

Identifies lactose fermenting enteric bacteria

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62
Q

Agar for E. coli

A

Eosin–methylene blue agar

Colonies with green metallic sheen

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63
Q

Agar used for fungus

A

Sabouraud agar

Sab’s a fun guy

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64
Q

What group of bacteria are not susceptible to aminoglycosides?

A

Anaerobic because these drugs require O2 to enter the bac cell
Think: aminO2glycosides

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65
Q

Aerobic or Anaerobic?

Nocardia

A

Aerobic

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66
Q

Aerobic or Anaerobic?

Fusobacterium

A

Anaerobic

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67
Q

Aerobic or Anaerobic?

Mycobacterium tuberculosis

A

Aerobic

Apices of lungs

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68
Q

Aerobic or Anaerobic?

Pseudomonas

A

Aerobic

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69
Q

Aerobic or Anaerobic?

Actinomyces

A

Anaerobic

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70
Q

Aerobic or Anaerobic?

Bacteroides

A

Anaerobic

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71
Q

Aerobic or Anaerobic?

Clostridium

A

Anaerobic

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72
Q

General features of anaerobic bacteria besides not liking O2

A

Lack catalase and/or superoxide dismutase–why they can’t handle O2
Generally foul smelling
Difficult to culture
Produce gas in tissues (CO2, H2)
They are normal flora in the gut, but pathologic elsewhere
Not susceptible to aminoglycosides

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73
Q

What is catalase?

A

Converts H2O2 to H2O and O2

Found in most organisms exposed to O2

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74
Q

Predominant agents in neonatal bacterial meningitis

A

Streptococcus agalactiae
E. coli
Listeria monocytogens

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75
Q

Most common bacterial meningitis agents in descending order and age groups

A

Strep. pneumo: every age
Strep. agalactiae (group B strep): neonates
Neisseria meningitidis: kids to middle-age adults
Listeria monocytogens: Infants, elderly
H. influenzae: 1 mo to 18 yr

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76
Q

Catalase and coagulase in regard to Staph.

A 
All staph species are catalase positive
Coagulase Negative Staph (CoNS) are common skin flora and used to be thought as non-pathogenic. Now, they are known as common cause of bacteremia, and nosocomial infections of prosthetic devices such as heart valves and hip replacements by forming a slime/biofilm
S. aureus is coagulase positive
S. epidermidis is coagulase negative
S. saprophyticus also CoNS
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77
Q

What bacterial species is associated with rusty sputum?

A

Pneumococcus (Strep. pneumoniae)

Common cause of meningitis, otitis media, pneumonia, sinusitis

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78
Q

What is the primary test for differentiating between Staph and Strep?

A

Catalase test
Staph–positive
Strep–negative

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79
Q

What is the primary bacteria considered when faced with and infection associated with an indwelling catheter, prosthetic heart valve, or other implanted device like a hip replacement?

A

Coagulase negative staph

Staph. epidermidis

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80
Q

Treatment choice for natural valve endocarditis vs prosthetic valve

A

Prosthetic valve often by coagulase neg staph of which most are resistant to methicillin and penicillin and are best treated with vancomycin first, and possibly Gentamicin or Rifampin later
Native valve treated with Nafcillin or Oxacillin

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81
Q

What bug can cause congenital cataracts?

A

Rubella infection in utero

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82
Q

What are the common effects in a neonate of in utero infection with CMV?

A 
Chorioretinitis
Sensorineural deafness
Seizures
Jaundice
HSM
Microcephaly
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83
Q

What is inclusion conjunctivitis and what causes it?

A

Conjunctivitis presenting often with a follicular response mostly on the tarsal conjunctiva caused by Chlamydia trachomatis
Most often caused by new sex partner within last 2 months, also from poorly treated swimming pools
Also affects newborns

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84
Q

Listeria monocytogenes

A

G(+) rod, facultative intracellular
Acquired most commonly from unpasteurized dairy or cold deli meats, transplacental, or vaginal during birth
Tumbling motility in broth
Can kill fetus, cause amnionitis, septicemia, neonatal and immune compromised meningitis
Treated with ampicillin

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85
Q

What bugs are associated with unpasteurized dairy?

A

Listeria

Brucella (undulating fever)

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86
Q

What bug characteristically has tumbling motility in broth?

A

Listeria monocytogenes

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87
Q

Patient with Sx of meningitis has purulent CSF and found to have intracellular G(+) bacilli. Likely Dx?

A

Listeria monocytogenes

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88
Q

Toxoplasma and meningitis

A

Usually immune compromised patients
Comes from cat feces most often, but can also come from undercooked lamb or pork
Estimated that 50% of world pop is infected with no Sx or problems

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89
Q

VDRL and RPR tests

A

Both are tests for syphilis
Venereal Disease Research Lab test
Rapid Plasma Reagin test
Considered nontreponemal tests because they look for Ab’s against nontreponemal antigens that indirectly indicate infection
Mix serum with cardiolipin, lecithin, cholesterol and look for flucculation
This is a sensitive screening test that is followed up with a confirmatory test called FTA-ABS for diagnosis

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90
Q

Significance of cold agglutinins

A

Indication of Mycoplasma infection
Blood placed in tube with anticoagulant then placed in cup of ice and seen to agglutinate at the lower temp and return to suspension when re-warmed

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91
Q

How to diagnose and test for syphilis

A

VDRL or RPR screening test then a definitive diagnostic test called FTA-ABS

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92
Q

Treatment strategy for N. gonorrhea and Chlamydia trachomatis

A

N. gonorrhea is showing lots of drug resistance and is therefore recommended to treat with a combination therapy including 3rd gen cephalosporin–Ceftriaxone with Azithromycin
Azithromycin is also beneficial because it covers Chlamydia which is frequently a co-infection with gonorrhea

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93
Q

What disease classically has intracellular gram(-) diplococci?

A

Neisseria gonorrhea

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94
Q

PID causes, treatments, complications

A

PID most commonly caused by N. gonorrhea and C. trachomatis
Treated with Ceftriaxone and Azithromycin
Inflammation can involve the endometrium and fallopian tubes and healing can lead to scarring of these locations which can lead to infertility (tubal-factor) and ectopic pregnancy

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95
Q

Enterococcus strains, identification, and features

A

Enterococcus is a reclassified strain of Strep making it G(+) cocci that grow in chains
Normal gut flora, includes E. faecalis and faecium
Commonly cause UTI, bacteremia, endocarditis, wound infection and others in a nosocomial setting
Very resistant to many drugs making them difficult to treat
Identified by G(+) cocci, catalase (-), gamma hemolytic, grows in bile and NaCl, PYR positive

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96
Q

What bacteria are G(+) cocci, catalase (-), and alpha hemolytic? How can they be differentiated?

A

Catalase (-) = Strep
Alpha hemolytic = Strep viridan or pneumoniae

Viridans: optochin resistant, bile insoluble, associated with dental caries and endocarditis after dental work

Pneumoniae: optochin sensitive, bile soluble, associated with pneumonia, meningitis, sinusitis, otitis media

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97
Q

What bacteria are G(+) cocci, catalase (-), and beta hemolytic, and how are they differentiated?

A

Catalase (-) = Strep
Beta hemolytic = pyogenes (GAS), agalactiae (GBS)

Pyogenes: PYR positive, bacitracin sensitive, associated with cellulitis, pharyngitis, erysipelas

Agalactiae: PYR negative, CAMP positive, associated with neonatal sepsis, pneumonia, meningitis, UTI

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98
Q

What bacteria produce pigments and what colors?

A

Staph aureus–yellow
Pseudomonas aeruginosa–blue-green
Serratia marcescens–red

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99
Q

Tzanck Smear

A

Test where lesions are scraped and examined under microscope looking for Tzanck cells or multinucleated giant cells
Used for: herpes, varicella and herpes zoster, pemphigus vulgaris, CMV

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100
Q

What are the toxins and effects of Bacillus anthracis?

A

Anthrax exotoxin
Edema factor: acts as adenylate cyclase increasing cAMP causing edema and phagocyte dysfunction
Lethal factor: zinc-dependent protease that causes apoptosis and physiological disruption

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101
Q

Toxins and effects of Bordetella pertussis

A

Pertusis toxin: disinhibits adenylate cyclase through Gi ADP-ribosylation increasing cAMP and causing edema and phagocyte dysfunction
Adenylate cyclase toxin: acts like adenylate cyclase increasing cAMP

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102
Q

Clostridium difficile toxins and effects

A

Toxin A: recruits and activates neutrophils that release cytokines causing inflammation, fluid loss and diarrhea

Toxin B: induces actin depolymerization causing mucosal cell death, bowel wall necrosis and pseudomembrane formation

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103
Q

Shigella dysenteriae toxin formation and effects

A

Shiga toxin: disable 60s ribosomal subunit stopping protein synthesis causing epithelial cell death and diarrhea

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104
Q

Strep. pyogenes toxins and effects

A

Pyrogenic exotoxin: superantigen, fever, shock, assoc. c scarlet fever and TSS

Streptolysin O and S: damages erythrocyte membranes causing beta hemolysis

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105
Q

Where is EHEC O157:H7 usually picked up? How is it different from other E coli?

A

Undercooked hamburger
Does not ferment sorbitol
Does not produce glucuronidase

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106
Q

What is hemolytic uremic syndrome?

A

Thrombocytopenia, microangiopathic hemolytic anemia, renal insufficiency
Can be caused by EHEC

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107
Q

How are EHEC and ETEC different?

A

ETEC produces heat-labile toxin (LT) and heat stable toxin (ST)
EHEC produce shiga-like toxin

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108
Q

Diptheria toxin

A

Catalyzes ADP-ribosylation of elongation factor 2 inactivating it

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109
Q

What are the most common causes of impetigo?

A

Staph aureus is #1

Strep pyogenes is #2

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110
Q

Describe the effects of GAS (S. pyogenes) in terms of Pyogenic, Toxigenic, Immunologic

A

Pyogenic: pharyngitis, cellulitis, impetigo, erysipelas
Toxigenic: TSS, scarlet fever, necrotizing fasciitis
Immunologic: rheumatic fever, glomerulonephritis

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111
Q

Clinical presentation and characteristics of rheumatic fever

A 
This is an immunologic response to S. pyogenes. Ab's to M protein cross-react with heart causing damage. Has Aschoff bodies, elevate ASO titers. Follow Strep pharyngitis.
Remeber JONES criteria:
J: joints–polyarthritis
O: (heart)–carditis
N: Nodules (subcutaneous)
E: Erythema marginatum
S: Sydenham chorea
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112
Q

Describe features of Scarlet fever

A

This is a toxigenic response to S pyogenes

Blanching, sandpaper-like rash on body, strawberry tongue, circumoral pallor all in the context of GAS pharyngitis

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113
Q

What kind of infection generally precedes glomerulonephritis caused by GAS?

A

Impetigo

Though, can come after pharyngitis, cellulitis, erysipelas

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114
Q

Patient in Mississippi or Ohio river valley with history of cleaning bird cages or exploring caves has high risk of what infection?

A

Histoplasma capsulatum, a fungus commonly found in guano and soil where bird or bat droppings are
Macrophage filled with Histoplasma is common
Remember: Histo Hides in macrophages

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115
Q

Waterhouse-Friederichsen syndrome

A

Complication of meningococcemia (N. meningitidis) that may involve adrenal gland destruction, DIC (purpuric skin lesions), shock, death.

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116
Q

Most common cause of CAP and meningitis?

A

Strep pneumoniae

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117
Q

What are the most common causes of infective diarrhea in adults and kids?

A

Kids: viral
Adults: bacterial–Campylobacter, Salmonella, Shigella, E. coli

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118
Q

Most common causes of acute and subacute bacterial endocarditis

A

Acute: Staph aureus
Subacute: Strep viridans

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119
Q

Patient gardening and gets a thorn prick. Lesions develop that when cultured at 24 degrees C produce branching hyphae. Biopsy specimen showed round or cigar-shaped budding yeast. Dx? Clinical presentation?

A

Sporothrix schenckii: lives on vegetation,

Clinical: Pustules, ulcers, subcutaneous nodules along lymphatics (ascending lymphangitis)

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120
Q

Name the thermally dimorphic fungi and what dimorphic means

A

Dimorphic: mold at ambient temperature, yeast at body temp (cold=mold, heat=yeast)
Sporothrix schenkii–gardner’s disease, ascending lymphangitis
Coccidioides immitis–SW states, pneumonia and meningitis, biopsy shows thick-walled spherules (not yeast)
Histoplasma capsulatum–hides in macrophages, river valleys, guano
Blastomyces dermatitidis–river valleys and great lakes, broad based bud
Paracoccidioides brasiliensis–budding yeast with captain’s wheel formation, central and south america

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121
Q

Features of Coccidioides immitis

A

SW USA, mold in the soil
Infects the lungs: flu-like, cough, erythema nodosum
Disseminated: skin, bones, lungs
Hyphae at 25C, thick-walled spherules with endospores on biopsy

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122
Q

What are the two fungal infections in Ohio and Mississippi river valleys? How are they different?

A

Histoplasma capsulatum: bird droppings and soil, in macrophages
Blastomyces dermatitidis: great lakes region, soil, doubly refractile wall and broad based buds

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123
Q

What fungus is not dimorphic, has septate hyphae, and has V branching?

A

Aspergillus

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124
Q

What microbe causes meningoencephalitis, is heavily encapsulated, found in soil and pigeon droppings, is highlighted by India Ink or Mucicarmine, agglutinates in latex agglutination test? What is the characteristic lesion in the brain?

A

Cryptococcus neoformans
Soap-bubble lesions in the brain
Commonly causes meningitis in AIDS

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125
Q

What fungus presents with 90 degree branching and nonseptate hyphae and what is the classic presentation?

A

Mucor, Rhizopus

Paranasal infection in diabetic ketoacidosis patient

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126
Q

Metronidazole MOA and use

A

Inhibits nucleic acid synthesis by disrupting the DNA of microbial cells. Only functional when reduced by anaerobic cells and therefore has little effect on human or aerobic bacteria
Use: Bacterial vaginosis, Trichomoniasis, Giardiasis, C. difficile, E histolytica

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127
Q

Female patient has thin, off-white vaginal discharge with fishy odor but no signs of inflammation. What are the lab findings, Dx, and Tx?

A

Clue cells, + whiff test (amine odor with KOH)
Bacterial Vaginosis–Gardnerella vaginalis
Metronidazole or Clindamycin

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128
Q

Female patient has thin, yellow-green malodorous frothy discharge with inflammation. What are the lab findings, Dx, and Tx?

A

Motile trichomonads best seen under wet mount (saline microscopy)
Trichomonas vaginalis
May also show strawberry cervix
Metronidazole

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129
Q

Female patient has thick, cottage cheese vaginal discharge and inflammation. What are lab findings, Dx, Tx?

A

Pseudohyphae
Candida albicans
Fluconazole

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130
Q

Compare presentation of UTI, PID, and Vaginitis and some causes.

A

UTI: burning, frequency, urgency on urination, suprapubic tenderness, but no vaginal discharge, E. coli, S saprophyticus
Vaginitis: discharge, may have some urinary Sx, itching, but no adnexal or cervical motion tenderness, caused by Gardnerella, Trichomonas, Candida
PID: discharge from the cervical os, N. gonorrhea and C. trachomatis, cervical motion tenderness

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131
Q

What type of virus is the most common cause of viral meningitis?

A

Enteroviruses:

Coxsackievirus, Echovirus, Poliovirus

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132
Q

How does the presentation of viral meningitis differ from bacterial or fungal?

A

Viral tends to be less severe and lack focal neurological deficits, seizures, and altered mental status
But will include fever, headache, vomiting, neck stiffness

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133
Q

What is Coronavirus a common cause of?

A

Cold Sx

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134
Q

What type of virus is West Nile Virus and how might it present?

A

Flavivirus transmitted by Culex mosquito in the summer

Causes: neuroinvasive disease causing encephalitis, meningitis, flaccid paralysis

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135
Q

What complication can occur to an elderly patient with dehydration and recent intubation?

A

This combination can lead to infection of the parotid gland by Staph aureus. Sx include firm tenderness pre or post auricular and down into the jaw. Confirmed by elevated amylase without elevated lipase, and ultrasound showing inflamed ducts.

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136
Q

What is lysogenization?

A

Process by which a bacteriophage introduces DNA that changes the phenotype of the bacteria.
Example is with Corynebacterium diptheriae that gets its ability to produce toxin from a bacteriophage.

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137
Q

What is the major virulence factor for S. pneumoniae?

A

Capsule

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138
Q

What is an important virulence factor for H flu?

A

PRP Capsule

Allows it to escape destruction by humoral immunity

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139
Q

What virulence factor of TB allows it to cause disease and what are its specific functions?

A

Cord Factor
Allows the organism to grow in long serpentine cords
It inactivates neutrophils, damages mitochondria, and induces release of TNF

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140
Q

Pyrimethamine

A

Antiparasitic drug used to treat malaria and toxoplasmosis

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141
Q

HIV patient not taking meds presents with 2 weeks of lethargy, seizures, and found to have multiple ring-enhancing lesions in brain. Dx? Tx?

A

Toxoplasmosis
Pyrimethamine and Sulfadiazine or Clindamycin
Second most common cause of ring-enhancing brain lesions in HIV is Primary CNS Lymphoma

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142
Q

Which bacteria are obligate intracellular?

A

Rickettsia, Chlamydia, Coxiella

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143
Q

Which bacteria are encapsulated?

A 
(Please SHINE my SKiS)
Pseudomonas aeruginosa
Strep pneumoniae
Haemophilus influenza type B
Neisseria meningitidis
E. coli
Salmonella
Klebsiella pneumoniae
GBS
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144
Q

Which bacteria are facultative intracellular?

A 
(Some Nasty Bugs May Live FacultativeLY)
Salmonella
Neisseria
Brucella
Mycobacterium
Listeria
Francisella
Legionella
Yersinia pestis
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145
Q

Urease positive bacteria

A 
(Pee CHUNKSS)
Proteus
Cryptococcus
H pylori
Ureaplasma
Nocardia
Klebsiella
S epidermidis
S saprophyticus
Urease hydrolizes urea releasing ammonia and CO2 which raise the pH and can lead to struvite crystals (ammonium magnesium phosphate)
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146
Q

What bug causes contact lens-associated keratitis?

A

P aeruginosa

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147
Q

What is protein A?

A

Expressed by S aureus

Binds Fc region of IgG. Prevents opsonization and phagocytosis

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148
Q

What is IgA protease?

A

Virulence factor
Enzyme that cleaves IgA in order to allow colonization of mucosa
S pneumo, H flu, Neisseria

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149
Q

What is M protein?

A

Virulence factor of GAS

Prevents phagocytosis, possible reason for rheumatic fever

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150
Q

What toxins are transferred to bacteria by transduction?

A 
(ABCD'S)
GAS erythrogenic toxin
Botulinum toxin
Cholera toxin
Diphtheria toxin
Shiga toxin
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151
Q

What spore forming bacteria causes food poisoning besides C. botulinum?

A

Bacillus cereus

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152
Q

What spore forming bacteria causes Gas gangrene?

A

Clostridium perfringens

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153
Q

What are the two groups of bacteria that form spores?

A

Bacillus

Clostridium

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154
Q

What are some of the virulence factors of Neisseria meningitidis?

A

Capsule–prevents phagocytosis
LOS–responsible for most of the systemic Sx including sepsis and the bilateral cortical adrenal hemorrhages seen in Waterhouse-Friedrichsen syndrome

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155
Q

What bacteria produces TSST-1 and what does the toxin do?

A

Staph aureus causes toxic shock syndrome by binding to MHC II and TCR causing overwhelming release of IL-1,2, IFN-gamma, TNF-alpha leading to shock
TSS: fever, rash, shock, vomiting, desquamation, end-organ failure, increased liver enzymes and bili.

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156
Q

What bacteria releases exotoxin A and what does it do? What other toxin does it release?

A

Strep pyogenes
Similar effect as Staph aureus toxic shock protein leading to toxic shock syndrome by causing a cytokine storm
Also releases streptolysin O which is a protein that degrades cell membranes and lyses RBC’s making it beta hemolytic

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157
Q

What is the toxin released by C perfringens and what does it do?

A

Alpha toxin: a phospholipase that degrades tissue and cell membranes allowing for myonecrosis and hemolysis leading to gas gangrene
Also called Lecithinase or phospholipase C

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158
Q

What is endotoxin and what does it do?

A

Outer membrane of G(-) bacteria, heat stable
O antigen + core polysaccharide + Lipid A (toxic part)
Released upon cell lysis or when blebs come off membrane
3 main effects: it activates:
Macrophages: IL1,6, TNF-alpha, NO release causing fever and hypotension
Complement: C3a, C5a release causing histamine release, hypotension, edema, neutrophil chemotaxis
Tissue Factor: DIC

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159
Q

What bacteria?

G(+) cocci in clusters, catalase (+), Coagulase (+)

A

Staph aureus

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160
Q

What bacteria?

G(+) cocci in clusters, catalase (+), Coagulase (-)

A

Two options:
S epidermidis: Novobiocin sensitive
S saprophyticus: Novobiocin resistant

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161
Q

What bacteria?

G(+) cocci, catalase (+), beta hemolytic

A

Besides the Strep bac that are beta hemolytic, Staph aureus is also

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162
Q

Which Staph makes a fibrin clot around itself and how?

A

Staph aureus

Uses coagulase

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163
Q

Describe Staph aureus food poisoning

A

Ingestion of pre-formed toxin that is heat stable and therefore not inactivated by cooking
Causes rapid onset nonbloody diarrhea and emesis

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164
Q

Mechanism of resistance in MRSA

A

Altered PBP

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165
Q

Patient gets pneumonia after an infection with the flu. What is likely bacterial cause?

A

Staph aureus

166
Q

Which bacteria forms a protein that binds to the Fc region of IgG effectively camouflaging itself?

A

Staph aureus

Protein A

167
Q

What is the second most common cause of uncomplicated UTI in young women?

A

Staph saprophyticus

168
Q

Features of Strep pneumoniae

A 
G(+), lancet shaped diplococci
Encapsulated (no virulence without)
IgA protease
Alpha hemolytic
Optochin sensitive
Most common cause of Meningitis, Otitis media, Pneumonia, Sinusitis
Rusty sputum
Sepsis in sickle cell and those with splenectomy
169
Q

Which Strep viridans bacteria most commonly causes subacute endocarditis and why?

A

Strep sanguinis

Produces dextran which binds to fibrin-platelet aggregates on damaged heart valves

170
Q

What group of bacteria is S. gallolyticus and what should be assumed if it is found in the blood?

A

Strep bovis
Colonizes the gut
Bovis in the Blood = Cancer in the Colon

171
Q

What is unique about the outside of B anthracis?

A

The only bacterium with a polypeptide capsule containing D-glutamate

172
Q

What bacteria causes a painless papule that becomes an ulcer with a black eschar?

A

Bacillus anthracis

Lesion is painless but necrotic

173
Q

Describe disease presentation of inhaled anthrax

A

flu-like Sx that rapidly progress to fever, pulmonary hemorrhage, mediastinitis, and shock
known as woolsorter’s disease

174
Q

What bacteria is to blame for nausea and vomiting 1-5 hr after ingesting rice or pasta?

A

Bacillus cereus
Reheated rice syndrome
Spores survive cooking rice and keeping it warm causes germination of spores forming the enterotoxin
Also has a diarrheal type causing watery, nonbloody diarrhea

175
Q

Why can’t babies have honey?

A

Babies get floppy baby syndrome from honey that contains C botulinum spores
Leads to descending floppy paralysis
Treated with antitoxin

176
Q

How are Nocardia and Actinomyces treated?

A

Treatment is a SNAP
Sulfonamides for Nocardia
Actinomyces is Penicillin

177
Q

Disease manifestations of Nocardia and Actinomyces

A

Nocardia: immune compromised patients, cutaneous infections after trauma, pulmonary infection mimicing TB but neg PPD

Actinomyces: normal oral flora, oral/facial abscesses with yellow sulfur granules, can cause PID with IUD’s

178
Q

What are the Sx of TB?

A

Fever, night sweats, weight loss, cough, hemoptysis

179
Q

What are the virulence factors of TB?

A

Cord factor: creates serpentine cords in virulent M tuberculosis, inhibits macrophage maturation, induces TNF-alpha release
Sulfatides inhibit phagolysosomal fusion

180
Q

Describe two forms of Hansen disease and treatment

A

Caused by Mycobacterium leprae, glove and stocking loss of sensation
Lepromatous: diffusely over skin, leonine faciea, communicable, low cell-mediated immunity so mount primarily a Th2 humoral response, can be lethal

Tuberculoid: limited to few plaques, high cell-mediated immunity with largely Th1-type response

Treatment: dapsone and rifampin for tuberculoid, add clofazimine for lepromatous

181
Q

How might the presentation of a primary vs reactivation of HSV-1 be different?

A

Primary infection: ages 6mo-5yr most often, causes gingivostomatitis including painful ulcers on the gums, tongue, palate, lips, and oropharynx; also has systemic Sx of fever and malaise; resolves in 1-2 weeks, pain of the ulcers often leads to dehydration leading to hospitalization

Reactivation is generally much more mild and only involves the lips and is often unilateral

182
Q

G(-) bacillis grows white on MacConkey agar, oxidase (+), Dx?

A

Pseudomonas

183
Q

Lab diagnostic features for Pseudomonas

A

G(-), Bacillus, Non lactose fermentation, Oxidase (+)

184
Q

What are the G(-) bacilli bacteria that are lactose fermentors?

A

Fast: Klebsiella, E. coli, Enterobacter
Slow: Citrobacter, Serratia

185
Q

What are the G(-) bacilli bacteria that do not ferment lactose and are oxidase (-)?

A

H2S producing on TSI agar: Salmonella, Proteus

Non H2S: Shigella, Yersinia

186
Q

What are the tests to differentiate the G(-) diplococci?

A

All are aerobic and oxidase (+), check Maltose utilization:
(+): N meningitidis
(-): N gonorrhoeae, Moraxella

187
Q

How are the G(-) comma shaped rods that are motile differentiated?

A

All are oxidase (+)
Campylobacter: grows in 42C
Vibrio cholerae: Grows in alkaline media
H. pylori: urease producing

188
Q

How are E. coli and Enterococcus differentiated?

A

E. coli is indole (+) meaning it can convert tryptophan to indole

189
Q

What are two common causes of UTIs in patients with Foley catheters?

A

Proteus and Pseudomonas

190
Q

What is an IGRA?

A

IFN-gamma Release Assay
Tests for latent TB infection by exposing patient’s T-cells to TB antigens and looking for a response which would include release of IFN-gamma which activates macrophages and promotes development of Th1 cells

191
Q

Which ulcerating STD has multiple deep painful ulcers with a base that may be gray to yellow? What would be seen on microscopy?

A

Haemophilus ducreyi causing Chancroid disease

Microscopy would show clumping in long parallel strands like a school of fish

192
Q

What ulcerating STD has multiple, painful, grouped ulcers that are shallow and erythematous? What would be seen on microscopy?

A

Herpes Simplex type 1 or 2 causing genital herpes

Microscopy would show Multinucleated giant cells and intranuclear inclusions (Cowdry type A)

193
Q

What diseases cause painless ulcers on the genitals?

A

Klebsiella granulomatis
Treponema pallidum
Chlamydia trachomatis

194
Q

What ulcerating STD has extensive and progressive painless ulcerative lesions without LAD and shows G(-) intracytoplasmic cysts called Donovan bodies?

A

Klebsiella granulomatis causing Granuloma inguinale (donovanosis)

195
Q

What ulcerating STD has painless, single, well-circumscribed ulcers with a clean base that clear within a week or two and if not treated will lead to a rash? What is seen on microscopy?

A

Syphilis caused by Treponema pallidum

See thin, delicate, corkscrew organisms on darkfield microscopy

196
Q

What ulcerating STD has painless small and shallow ulcers with large, painful inguinal lymph nodes (buboes), and what would be seen on microscopy?

A

Lymphogranuloma venereum caused by Chlamydia trachomatis

Microscopy would show intracytoplasmic chlamydial inclusion bodies in epithelial cells and leukocytes

197
Q

What is lymphogranuloma venereum?

A

Caused by certain strains of Chlamydia
Starts with painless ulcerations of the genitals that progress to painful and swollen lymph nodes (buboes), chlamydial inclusion bodies seen in the cytoplasm of cells

198
Q

What is allergic bronchopulmonary aspergillosis?

A

Patients with asthma or COPD who are chronically on steroids to control Sx can have an aspergillus infection in the bronchi that they have an allergic reaction to. They will have elevated IgE and Eosinophils, transient and recurrent pulmonary infiltrates, and proximal bronchiectasis

199
Q

What are cold agglutinins and what diseases can they accompany?

A

Cold agglutinins are antibodies that cross react with RBC’s surface antigens but only cause agglutination at cold temperatures, can lead to transient anemia in patients.
Associated with Mycoplasma pneumoniae, EBV, hematologic malignancies

200
Q

Difference between polysaccharide vaccine and conjugated vaccine for pneumococcus

A

The conjugated vaccine combines a polysaccharide capsular antigen with a protein so it can be presented to T cells and induce a stronger and longer lasting immune response that is more protective for the elderly, infants, and immune compromised

201
Q

What is haptoglobin and how is it used as a blood value?

A

Haptoglobin binds free Hb and to prevent its oxidative action from causing damage. The complex is then removed by the reticuloendothelial system/spleen
Intravascular hemolytic anemia releases Hb into the blood and haptoglobin binds it and its levels are then reduced. If the hemolysis is extravascular, theoretically the haptoglobin levels will not be reduced though other signs like elevated bilirubin will be present

202
Q

What disease is caused by Borrelia burgdorferi?

A

Lyme disease

A spirochete bacteria

203
Q

What is Babesiosis?

A

Caused by Babesia microti a parasite that infects RBC’s that is spread by the ixodes tick
Causes acute febrile illness, thrombocytopenia, hemolytic anemia, abnormal liver tests, and cross-shaped intraerythrocytic inclusions
Patients without a spleen are at high risk of pulmonary complications such as ARDS

204
Q

What disease is known for ring-shaped erythrocyte inclusions?

A

Malaria

205
Q

Patients without a spleen are at increased risk for what kind of bacterial infections and what vaccines are they given?

A

Encapsulated bacteria
S pneumoniae
N meningitidia
H flu

206
Q

What is beta galactosidase?

A

Enzyme used by E. coli to digest lactose into glucose and galactose

207
Q

Differentiate the Neisseria species based on fermentation of sugar

A

MeninGococci (has an M and G) ferment Maltose and Glucose

Gonococci (only a G) only Glucose

208
Q

What is Fitz-Hugh–Curtis Syndrome?

A

Associated with N. gonorrhea or C. trachomatis infections in women where the microbes have spread from the reproductive tract to Glisson’s capsule around the liver and causing adhesions around the liver that cause RUQ pain that is worse with breathing, coughing, and laughing.

209
Q

How are N. gonorrhoeae and N meningitidis different?

A

N. gonorrhoeae: no capsule, no maltose, no vaccine, sexually transmitted, PID, septic arthritis, Fitz-Hugh–Curtis syndrome

N meningitidis: capsule, maltose fermentation, vaccine, respiratory or oral secretion transmission, causes meningococcemia with petechial rash and gangrene of toes and Waterhouse-Friderichsen syndrome

210
Q

Haemophilus influenzae characteristics

A

G(-) coccobacilliary rod
Aerosol transmission
Nontypeable strains (unencapsulated) most common cause of mucosal infections (otitis media, conjunctivitis, bronchitis)
Produces IgA protease
Chocolate agar growth–factor V and X needed
Causes epiglottitis, Meningitis, Otitis media, Pneumonia
Vaccine exists
Does not cause the flu
Treated with amoxicillin for mucosal, ceftriaxone for meningitis, rifampin for prophylaxis

211
Q

What is the best stain for Legionella?

A

Silver stain

212
Q

What media does Legionella grow on?

A

Charcoal yeast extract with iron and cysteine

213
Q

What is Pontiac fever?

A

mild flu-like syndrome caused by Legionella

214
Q

Legionnaire’s disease

A

Caused by Legionella
Severe pneumonia often unilateral and lobar, fever, GI and CNS Sx
Common in smokers and those with chronic lung disease

215
Q

How is Legionella spread?

A

Through aerosol transmission from AC units or hot water tanks
No person to person transmission

216
Q

What is the cause of hot tub folliculitis?

A

Pseudomonas aeruginosa

217
Q

Ecthyma gangrenosum

A

Rapidly progressive necrotic cutaneous lesion caused by Pseudomonas in immunocompromised patients

218
Q

Characteristics of Pseudomonas aeruginosa

A 
Aerobic, motile, G(-) rod, non lactose fermenting, oxidase (+)
Produces pyocyanin (blue-green pigment)
Grape-like odor
Produces endotoxin, exotoxin A (EF-2 inactivation), phospholipase C, pyocyanin (produces ROS)
219
Q

What is Pseudomonas associated with?

A 
(PSEUDOMONAS)
Pneumonia
Sepsis
Ecthyma gangrenosum
UTI's
Diabetes, drug use
Osteomyelitis (puncture wounds)
Mucoid polysaccharide capsule
Otitis externa
Nosocomial infections (catheters)
Exotoxin A
Skin infections (hot tub folliculitis)
220
Q

What are the common virulence factors of E. coli?

A

Fimbriae (P): cystitis and pyelonephritis
K capsule: pneumonia, neonatal meningitis
LPS endotoxin: septic shock

221
Q

What are the most common types of E. coli?

A

EIEC: invasive, dysentery, Sx like Shigella
ETEC: heat labile and stable enterotoxins cause traveler’s diarrhea (watery)
EPEC: No toxin, adheres and flattens villi decreasing absorption, diarrhea in pediatric patients
EHEC: undercooked meat and raw leafy vegetables, Shiga-like toxin causing dysentery, UHS–microthrombi form on damaged endothelium causing mechanical hemolysis with schistocytes, platelet consumption, and decreased renal blood flow, does not ferment sorbitol like other strains

222
Q

Characteristics of Klebsiella

A

G(-) rod, normal flora, causes lobar pneumonia with abscesses in alcoholics and diabetics who aspirate
Very mucoid colonies because of abundant capsule
Dark red “currant jelly” sputum
Causes nosocomial UTI’s

223
Q

What pneumonia causing organism produces currant jelly sputum?

A

Klebsiella

224
Q

What bacterial infection is a common antecedent to Guillain-Barre syndrome and reactive arthritis?

A

Campylobacter jejuni

225
Q

Characteristics of Campylobacter jejuni

A

G(-), comma or S shaped with polar flagella, oxidase (+), grows at 42C
Causes bloody diarrhea in kids
Fecal-oral transmission, undercooked poultry or meat, unpasteurized milk
Common antecedent to Guillain-Barre syndrome and reactive arthritis

226
Q

What bug causes Typhoid fever? Sx of Typhoid?

A

Salmonella typhi
Rose spots on abdomen, constipation, abd pain, fever, headache
An enteric fever spread through fecal oral
Remember Typhoid Mary

227
Q

What two bacteria invade the GI tract via M cells of Peyer patches?

A

Salmonella

Shigella

228
Q

How are Salmonella and Shigella same/different?

A

Salmonella is unique in that it: spreads hematogenously, produces H2S, has flagella, antibiotics prolong duration of fecal excretion and are not indicated in strains other than typhi

Shigella: cell to cell spread, no H2S, no flagella, low inoculum, antibiotics shorten fecal excretion, bloody diarrhea, invasion is key to pathogenicity

229
Q

When does Shigella typhi develop a carrier state?

A

When it colonizes the gall bladder

230
Q

How is Salmonella (except for typhi) spread? Tx? Major Sx?

A

Poultry, eggs, pets, turtles
Antibiotics not indicated
Gastroenteritis generally from these strains and not typhi

231
Q

Characteristics of Vibrio cholerae

A

G(-), flagellated, comma shape, oxidase (+)
Rice-water stools from increased cAMP
Large inoculum
Prompt oral rehydration necessary

232
Q

What bacteria can cause pseudoappendicitis?

A

Yersinia enterocolitica

233
Q

Characteristics of Yersinia enterocolitica

A

G(-) rod, usually from pet feces, contaminated milk, pork

Causes acute diarrhea or pseudoappendicitis

234
Q

What bacteria is triple positive and requires triple treatment?

A

H. pylori
catalase (+), oxidase (+), urease (+)
Therapy: Amoxicillin (or metronidazole) + Clarithromycin + PPI

235
Q

How is an H. pylori infection diagnosed?

A

Urea breath test or

Fecal antigen test

236
Q

Describe features of an H pylori infection including where it colonizes, what it causes, and what it is a risk factor for.

A

Urease produces ammonia and an alkaline environment which helps it survive in the antrum of the stomach
Causes gastritis and peptic ulcers especially in the duodenum
Risk factor for: PUD, gastric adenocarcinoma, MALT lymphoma

237
Q

Leptospirosis

A

Caused by Leptospira interrogans
Spirochete found in water contaminated by animal urine
Flu-like Sx, myalgia (classically in calves), jaundice, photophobia, red conjunctiva without exudate
Prevalent among surfers in tropics (Hawaii)

238
Q

Describe Lyme disease

A

Borrelia burgdorferi from Ixodes tick, natural reservoir is the mouse
Stage 1: early localized, erythema migrans, flu-like
Stage 2: early disseminated, carditis, AV block, bell’s palsy, migratory myalgias, transient arthritis
Stage 3: late disseminated, encephalopathies, chronic arthritis

Remember: Key Lyme pie to the FACE
Facial nerve palsy
Arthritis
Cardiac block
Erythema migrans
239
Q

What is erythema migrans?

A

Pathognomonic rash of Berrelia infection associated with Lyme disease
Bull’s eye rash/target lesion that is good enough to have a diagnosis without labs

240
Q

Describe primary syphilis

A

Localized
Painless chancre
Dx with darkfield microscopy
VDRL (+) in about 80%

241
Q

Describe secondary syphilis

A

Disseminated disease with constitutional Sx
Maculopapular rash including palms and soles, condyloma lata, LAD, hair loss
Dx darkfield microscopy
VDRL/RPR nonspecific, follow with FTA-ABS
Can become latent after this

242
Q

Tertiary syphilis

A

Gummas, aortitis, neurosyphilis, Argyll Robertson pupil (accommodates, but doesn’t react to light), braod based ataxia, (+) Romberg, charcot joint, stroke without HTN
For neurosyphilis: test CSF with VRDL, FTA-ABS and PCR

243
Q

Congenital syphilis

A

Usually transferred after first trimester through placenta
Kids have rhagades (linear scars at angle of mouth), snuffles (nasal discharge), saddle nose, Hutchinson teeth, mulberry molars, short maxilla, saber shins, CN VIII deafness

244
Q

Jarisch-Herxheimer reaction

A

Flu-like syndrome after antibiotic administration caused by killed bacteria, usually spirochetes, releasing toxins

245
Q

How is Anaplasma transmitted?

A

Ixodes tick

246
Q

What bacteria causes cat scratch disease?

A

Bartonella

247
Q

Cause and source of relapsing fever

A

Borrelia recurrentis

Louse bourne

248
Q

Patient has undulating fever. Likely Dx? Source?

A

Brucellosis, unpasteurized dairy

249
Q

What bug causes bloody diarrhea after exposure to the feces of infected pets or animals?

A

Campylobacter

250
Q

What is Psittacosis?

A

Zoonotic disease caused by parrots and other birds

Caused by Chlamydophila psittaci

251
Q

What is Q fever?

A

Caused by Coxiella burnetii
Infection from aerosols of cattle/sheep amniotic fluid
Presents as pneumonia, has no rash and no vector
Is most common cause of culture negative endocarditis

252
Q

What disease is transferred by the tick Amblyomma (Lone Star Tick)

A

Ehrlichiosis from

Ehrlichia chaffeensis

253
Q

What disease comes from water contaminated with animal urine?

A

Leptospirosis

254
Q

What bug causes cellulitis, osteomyelitis after an animal bite?

A

Pasteurella multocida

255
Q

How is epidemic typhus spread?

A

Human to Human via body louse

Rickettsia prowazekii

256
Q

What disease is caused by Rickettsia rickettsii?

A

Rocky Mountain Spotted Fever

Dermacentor (dog tick)

257
Q

How is endemic typhus spread?

A

Fleas

Rickettsia typhi

258
Q

Female patient with vaginal discharge found to have Clue cells on microscopy, Dx? Tx?

A

Clue cells appear with gardnerella vaginosis
They have a stippled appearance along outer margine
metronidazole, or clindamycin

259
Q

What is the treatment for all Rickettsial diseases?

A

Doxycycline

260
Q

Which diseases cause a rash on the palms and soles?

A

Coxsackievirus A
Rocky Mountain Spotted Fever
Secondary Syphilis

261
Q

Features of Rocky Mountain Spotted Fever

A

Rickettsia rickettsii
Dermacentor tick vector
Primarily in the south atlantic states like NC
Rash starts on wrists and ankles and spreads to trunk, palms, and soles
Triad: headache, fever, rash

262
Q

Characteristics of Typhus

A

Endemic (fleas): R. typhi
Epidemic (human body louse): R. prowazekii
Rash starts centrally and spreads out, sparing palms and soles (opposite of RMSF)

263
Q

What diseases have morulae (mulberry-like inclusions) in cytoplasm?

A

Ehrlichia: inclusions in monocytes
Anaplasmosis: inclusions in granulocytes

Morulae are like smell berries inside these cells
Both diseases are spread by ticks

264
Q

General characteristics of Chlamydia infection

A

Obligate intracellular, mucosal infections
Elementary body: small and dense, enters cell by endocytosis and transforms into reticulate body
Reticulate body: replicates in cell by fission, reorganizes into elementary body

C trachomatis: reactive arthritis, follicular conjunctivitis, urethritis, PID

C pneumoniae and psittaci: cause atypical pneumonia by aerosol transmission

Treatment: azithromycin or doxycycline, beta-lactams not very effective

Giemsa or fluorescent antibody detection

265
Q

Serotypes of C trachomatis

A

A, B, C: cause chronic infection and blindness from follicular conjunctivitis
D-K: PID, ectopic pregnancy, neonatal pneumonia
L1, L2, L3: Lymphogranuloma venereum–small painless ulcers on genitals becoming painful swollen inguinal lymph nodes called buboes, treat with doxycycline

266
Q

What causes walking pneumonia?

A

Mycoplasma pneumoniae
Has no cell wall so doesn’t gram stain
Has sterols in membrane for stability
X-ray looks worse than patient
High cold agglutinin titers
Common outbreaks in prisons and military recruits
Treatment: macrolides, doxy, fluoroquinolone

267
Q

Presentation of an infant who ingested C botulinum

A

Infant botulism: spores are ingested and toxins are produced later in the gut, constipation precedes NM Sx by days to weeks, mild weakness, lethargy, poor feeding, loss of muscle tone possible, weakened suck, swallowing, crying
Adults: ingest pre-formed toxin causing sever Sx

268
Q

How do liver enzymes compare between an acute viral hepatitis vs a more chronic condition?

A

Levels tend to me in the thousands for an acute viral infection and in the hundreds for a chronic condition

269
Q

What is Fanconi’s syndrome?

A

Condition affecting the proximal tubules of the kidney where amino acids, proteins, glucose, uric acid, phosphate, bicarb are not absorbed and lost in the urine.
Causes renal tubule acidosis, polyuria, polydipsia, dehydration, loss of phosphate leading to rickets and osteomalacia

270
Q

What is Hartnup disease?

A

Similar to Fanconi’s except more specific to inhibited transport of neutral amino acids in the intestines and proximal tubules of the kidneys, specifically tryptophan leading to low levels of Niacin among other things causing low nicotinamide needed for NAD+
Elevated amino acids in the urine

271
Q

What diseases/conditions are caused my malassezia furfur?

A 
Tinea versicolor (pityriasis) , dandruff, Seborrhoeic dermatitis
Many skin diseases are caused by M. globosa
272
Q

What are the most common Sx of a candida infection in immune compromised patients?

A

Right sided endocarditis
Renal abscesses
Pneumonia
Esophagitis

273
Q

What signs might indicate that a UTI has become pyelonephritis?

A

Fever, Chills, Flank pain

Many UTI’s can be asymptomatic

274
Q

What is the preferred method of preventing GBS leading to neonatal sepsis, meningitis, pneumonia?

A

Universal testing of mothers at 35-37 weeks gestation for presence of GBS in perianal/genital region. If positive, administer intrapartum penicillin or ampicillin

275
Q

What are the classic foods associated with S. aureus food poisoning leading to short onset of Sx from pre-formed enterotoxin?

A

Classically mayonnaise containing foods like potato or macaroni salad
Also: poultry, eggs, meat, tuna/egg/chicken/potato/macaroni salad, cream pastries, milk and dairy
Often at picnics and BBQ’s because the food is left sitting out for a while allowing the formation of the toxins

276
Q

What types of food poisoning produce their exotoxins after being ingested instead of before like S aureus?

A

ETEC, EHEC, Vibrio cholerae, Shigella

277
Q

Name some bacteria that invade the gut mucosa

A

EIEC, Salmonella, Shigella, Yersinia, Campylobacter

All can cause bloody or inflammatory diarrhea

278
Q

What enteritis causing parasite causes bloody diarrhea and liver abscesses?

A

Entamoeba histolytica

279
Q

Sx of giardia

A

Non-bloody, putrid smelling, frothy diarrhea and bloating after drinking bad water

280
Q

What are the diseases caused by exotoxin from S aureus?

A

Toxic shock syndrome
Staph scalded skin syndrome
Gastroenteritis

281
Q

What is a germ tube test?

A

Inoculate serum at 37C with fungus for 3 hours and look for budding yeast with growing pseudohyphae or germ tubes
Test for Candida albicans, other Candida species will not form germ tubes

282
Q

Immune compromised patient has crackles in lungs and CXR shows hilar LAD. Bronchoscopy specimen shows mucicarmine staining budding yeast with large capsule. Dx?

A

Cryptococcus neoformans
Very common cause of pneumonia and meningitis in immune compromised patients
Known for staining with India Ink (CSF) or Mucicarmine (pulmonary lavage) and having a thick capsule
Found in soil and pigeon droppings

283
Q

Word for painful swallowing

A

Odynophagia

284
Q

How does the diptheria toxin work?

A

It is an AB toxin that inhibits protein synthesis by ADP ribosylation of protein Elongation Factor-2
If it goes systemic, it likes heart and brain tissue causing myocarditis and neurological toxicity

285
Q

How does Corynebacterium diptheriae appear under microscope?

A

Non-motile, unencapsulated, G(+) rods
In clumps resembling chinese characters like V’s or Y’s
Cytoplasm contains granules that stain with aniline dyes (like methylene blue)

286
Q

Consumption of raw oysters leads to infection of what bacteria?

A

Vibrio species of several kinds

287
Q

HUS from EHEC most commonly affects what age group?

A

Rare syndrome usually affecting kids under 10

Can come on after treatment with antibiotics

288
Q

Are Mucor and Rhizopus septate or not?

A

Usually non septate hyphae with 90 degree branching

289
Q

Diabetic patient has black eschar on turbinates in nose, what is likely treatment?

A

This is a common sign of Mucormycosis and is treated with amphotericin B

290
Q

How are aspergillus and Mucor different in the patients they infect in the sinus?

A

Mucor is generally diabetics, thought to be because of ability to use ketones to survive in acidotic and hyperglycemic environment
Aspergillus more common in neutropenic patients

291
Q

How are local and systemic mycoses treated?

A

Local: fluconazole or itraconazole
Systemic: amphotericin B

292
Q

Erythema Nodosum

A

Think: Red Nodules on shins
Inflammatory condition with inflammation of the fat cells under the skin resulting in tender red nodules
Caused by lots of things including:
Strep in kids, Primary TB infection, Coccidioides, M. pneumo, Histoplasma, Yersinia, EBV, cat scratch

293
Q

Which systemic mycoses can increase in prevalence after an earthquake or other natural event that puts dust in the air?

A

Coccidioides

294
Q

What are desert bumps and desert rheumatism?

A

Sx of Cocci including erythema nodosum and arthralgias

295
Q

Tinea is the clinical name for what? What are the different genera or species of this group? Microscopy?

A

Tinea is word for dermatophytes
Microsporum, Trichophyton, Epidermophyton
Branching septate hyphae visible on KOH with blue fungal stain

296
Q

Name the different cutaneous mycoses and characteristics

A

Tinea Capitis: head, scalp, LAD, alopecia, scaling
Tinea corporis: torso, scaling rings with central clearing, acquired from cat or dog
Tinea cruris: Inguinal, often no central clearing
Tinea pedis: interdigital type most common, moccasin type, vesicular type
Tiniea unguium: onychomycosis on nails

297
Q

Describe Pityriasis

A

Tinea versicolor
Malassezia spp., yeast-like fungus and not a dermatophyte despite Tinea name
Feeds on lipids producing acid that damages melanocytes and causes hypopigmentation or pink patches
Any time of year, but especially summer
Spaghetti and meatballs on microscopy
Treat with selenium sulfide or other oral antifungal

298
Q

Morphology of Candida albicans

A

Dimorphic:

pseudohyphae and budding yeast at 20C, germ tubes at 37C

299
Q

Candida treatment

A

Vaginal: topical azole
Oral/esophageal: fluconazole, caspofungin, nystatin
Systemic: fluconazole, caspofungin, amphotericin B

300
Q

Aspergillus fumigatus characteristics

A

Septate hyphae, 45 degree branching, Conidia at the end of conidiophores
Invasive aspergillosis in immune compromised
Aspergillomas in pre-existing lung cavities like after TB infection
Allergic Bronchopulmonary Aspergillosis: hypersensitivity to fungus in asthma and COPD causing bronchiectasis and eosinophilia

301
Q

What fungal disease is associated with latex agglutination?

A

Cryptococcus neoformans

Test detects polysaccharide capsular antigen

302
Q

What bug causes a ground glass appearance on CXR and a diffuse interstitial pneumonia? Other features?

A

Pneumocystis jirovecii
Yeast-like fungus
Immune compromised most often
Disc-shaped yeast on methenamine silver stain of lung tissue

303
Q

How is Pneumocystis jirovecii treated?

A

TMP-SMX, pentamidine, atovaquone

Dapsone for prophylaxis only

304
Q

Lung biopsy or lavage shows disc shaped yeast on methenamine silver stain. Dx?

A

Pneumocystis jirovecii

305
Q

Morphology and treatment of Sporothrix schenkii

A

Dimorphic: cigar shaped budding yeast that grows in branching hyphae with rosettes of conidia
Treatment: itraconazole or potassium iodide

306
Q

Name and describe the three main protozoal GI infections

A

Giardia: bloating, flatulence, fatty diarrhea, Dx with multinucleated trophozoites or cysts in stool, treated with metronidazole

E. histolytica: bloody diarrhea and liver abscesses, RUQ pain, serology shows trophozoites with engulfed RBC’s or cysts with up to 4 nuclei, treat with metronidazole or iodoquinol

Cryptosporidium: severe diarrhea in AIDS, mild diarrhea in competent hosts, acid fast oocysts in stool

307
Q

What disease can you get from swimming in fresh water lakes that is rapidly fatal from meningoencephalitis?

A 
Naegleria fowleri (protozoa)
Amoebas get into spinal cord
Treat with amphotericin B, but low chance of survival
308
Q

What disease causes a triad of Sx in neonates of chorioretinitis, hydrocephalus, intracranial calcifications?

A

Toxoplasma gondii

309
Q

What disease causes ring-enhancing lesions when reactivated in AIDS? How is it treated? How is it transmitted?

A

Toxoplasma gondii
From cysts in meat or oocysts in cat feces
Crosses the placenta to fetus
Treat with sulfadiazine + pyrimethamine

310
Q

What causes African sleeping sickness?

A

Trypanosoma brucei (a protozoa that has a single flagella that runs the length of the body)

311
Q

Features of African Sleeping Sickness

A

Enlarged lymph nodes, recurring fever, somnolence, coma
Tsetse fly painful bite
Trypomastigote in the blood smear

312
Q

Name the 4 types of malaria and general features of each

A

Plasmodium vivax/ovale: tertian–48 hours between fevers, have dormant form in liver, most common types, benign
Plasmodium falciparum: tertian, most severe and cause of death, irregular fever patterns, parasites in RBC’s occlude capillaries in brain, kidneys, lungs
Plasmodium malariae: quartan, no liver

313
Q

Which malaria drug is a tissue schizonticide?

A

Primaquine

314
Q

Which malaria forms infect the liver?

A

vivax and ovale

315
Q

Drugs used for malaria

A

Chloroquine: blocks plasmodium heme synth
If resistant to above: mefloquine or atovaquone/proguanil
If life threatening: IV quinidine (test for G6PD deficiency)
For vivax/ovale: add primaquine for hypnozoites in liver

316
Q

Describe Chagas disease

A

Trypanosoma cruzi, mostly South America, from kissing bug
Dilated cardiomyopathy with apical atrophy, megacolon, megaesophagus, Romana sign
Treated with Benznidazole or Nifurtimox
Remember trypanosomes have single long flagella running length of the body, same as in african sleeping disease

317
Q

What is Romana sign?

A

Unilateral periorbital swelling characteristic of advanced Chagas disease

318
Q

What disease comes from the bite of a sand fly? Features of disease?

A

Leishmaniasis: from gulf war, infects macrophages, treated with amphotericin B or Stibogluconate sodium
Visceral form: spiking fevers, HSM, pancytopenia
Cutaneous form: skin ulcers
Mucocutaneous form: involves skin and cartilage, severe deformation

319
Q 
Differentiate these rashes:
Erythema Nodosum
Erythema Multiforme
Erythema Migrans
Erythema Marginatum
A

Nodosum: subQ nodules, inflammation of fat cells under skin, LE; causes: cocci, cat scratch, yersinia, EBV, histoplasma, M. pneumo, TB, Strep

Multiforme: many presentations (including target form) and many causes including bacterial, cocci, herpes, others

Migrans: target lesion pathognomonic for Lyme disease

Marginatum: torso, inner part of limbs and extensor surfaces, rare presentation but associated with rheumatic fever (10%)

320
Q

Young patient found to have anal puritis, Sx of an intestinal infection, and the tape test shows eggs. Dx? Transmission? Treatment?

A

Nematode infection
Dx: Enterobius vermicularis (pinworm)
Transmission: Fecal-oral
Tx: Bendazoles

321
Q

What group of worms are round worms?

A

Nematodes

322
Q

Patient has intestinal infection with a worm that obstructs the ileo-cecal valve. Dx? Transmission? Tx?

A

Nematode infection
Ascaris lumbricoides (giant roundworm)
Fecal-oral, eggs visible in feces with microscope
Bendazoles

323
Q

What worm causes intestinal infection with vomiting, diarrhea, epigastric pain that can mimic PUD? Transmission? Tx?

A

Nematode infection
Strongyloides stercoralis (threadworm)
Larvae in soil penetrate skin
Ivermectin or Bendazoles

324
Q

What worms are the hookworms? What are they known for?

A

Nematodes
Ancylostoma duodenale
Necator americanus

Known for causing anemia by sucking blood through the intestinal wall, cutaneous larva migrans

Transmission: larvae penetrate skin
Tx: Bendazoles, Pyrantel pamoate

325
Q

Disease caused by Trichinella spiralis

Transmission, Sx, Tx

A

Nematode infection
Transmission: fecal-oral; undercooked pork
Intestinal infection, larvae enter blood stream and encyst in striated muscle cells causing inflammation. Trichinosis=fever, vomiting, nausea, periorbital edema, myalgia
Tx: bendazoles

326
Q

Toxocara canis

A

Nematode infection
Visceral Larva migrans: fecal-oral, nematodes migrate through intestines to the heart, liver, CNS (seizures, coma)
Treated with Bendazoles

327
Q

Onchocerca volvulus

A

Nematode infection
Female black fly transmission, river blindness, skin changes (black nodules), loss of elastic fibers
Tx: Ivermectin

328
Q

Loa Loa

A

Nematode infection
Swelling in skin, worm in conjunctiva
Spread by Deer fly, Horse fly, Mango fly
Tx: Diethylcarbamazine

329
Q

Wuchereria bancrofti

A

Nematode infection
Causes elephantiasis: worms invade lymph nodes and cause inflammation, takes 9 mo-1yr for Sx
Spread by female mosquito
Tx: Diethylcarbamazine

330
Q

What are cestodes?

A

Tapeworms

331
Q

Taenia solium

A

Cestode infection
Intestinal tape worm from encysted larvae in undercooked pork, treat: praziquantel

Cysticercosis/Neurocysticercosis: Ingestion eggs and human feces, lodge in the brain, can cause epileptic seizures, common in poorer countries and tropicals; Praziquantel for cysticercosis, Albendazole for neurocysticercosis

332
Q

Diphyllobothrium latum

A

Cestode infection
Larvae from raw freshwater fish
Causes B12 deficiency and megaloblastic anemia
Praziquantel

333
Q

What cestode causes Hydatid cysts in the liver?

A

Echinococcus granulosus
Ingestion of eggs from dog feces
Sheep are intermediate host
Treat with Albendazole

334
Q

What are Trematodes?

A

Flukes

335
Q

What worm has eggs with a lateral spine?

A

Trematode infection
Schistosoma mansoni
Liver and spleen enlargement, fibrosis, inflammation
Snails are host

336
Q

What worm has eggs with a terminal spine?

A 
Trematode infection
Schistosoma haematobium
Can cause squamous cell carcinoma of the bladder and pulmonary HTN
Snails are host
Treat with Praziquantel
337
Q

What worm causes biliary tract inflammation leading to pigmented gallstones?

A

Clonochis sinensis
From undercooked fish
Also associated with cholangiocarcinoma
Treat with Praziquantel

338
Q

General guide to treatments for worm infections

A

Roundworms: Bendazoles

Tapeworms and Flukes: Praziquantel

339
Q

Parasite causing brain cysts and seizures

A

Taenia solium from undercooked pork

340
Q

Parasite causing hematuria, squamous cell bladder cancer

A

Schistosoma haematobium

Terminal spine on egg

341
Q

Parasite causingLiver hydatid cysts

A

Echinococcus granulosus

342
Q

Parasite causing Microcytic anemia

A

Ancylostoma, Necator

343
Q

Parasite causing Myalgias, periorbital edema

A

Trichinella spiralis

344
Q

Parasite causing perianal puritis

A

Enterobius

345
Q

Parasite causing portal hypertension

A 
Schistosoma mansoni (lateral spine on egg)
Schistosoma japonicum
346
Q

Parasite causing Vit B12 deficiency

A

Diphyllobothrium latum

347
Q

Scabies

A

Sarcoptes scabiei
Mites, burrow into stratum corneum causing puritis and burrows in web space of hands and feet
Common in kids and crowded places like jails, nursing homes
Treat with permethrin cream

348
Q

Lice

A

Pediculus humanus/Phthirus pubis
Blood-sucking insects that prefer to live in clothing
Pink macules and papules in intertriginous areas
Can transmit: Rickettsia proazekii (typhus), Borrelia recurrentis (relapsing fever), Bartonella quintana (trench fever)

349
Q

What does it mean when a virus in enveloped?

A

It has DNA inside a capsid that is covered with a lipid bilayer with proteins on it

350
Q

Name the live attenuated viral vaccines

A

Small pox, Yellow fever, Rotavirus, chicken pox (VZV), Sabin Polio, MMR, Influenza intranasal

351
Q

What live attenuated viral vaccine can be given to HIV patients who do not have Sx of immunodeficiency?

A

MMR

352
Q

What are the killed viral vaccines?

A

Rabies, Influenza (injected), Salk polio, HAV

353
Q

Difference between live and killed viral vaccines and immunity

A

Live: humoral and cell-mediated immunity
Killed: only humoral immunity

354
Q

Of the DNA viruses, which are double stranded?

A

All are dsDNA (like our DNA) except for Parvovirus (think “part of a virus”)

355
Q

Of the DNA viruses, which are linear?

A

All are linear except for papilloma, polyoma, and hepadnaviruses

356
Q

Of the RNA viruses, which are single stranded?

A

All are ssRNA (like our RNA) except for Reovirus (think repeato-virus)

357
Q

What are the + sensed RNA viruses?

A

Retrovirus, Togavirus, Flavivirus, Coronavirus, Hepevirus, Calicivirus, Picornavirus

358
Q

Infectivity of naked viral genome

A

dsDNA and + strand ssRNA are infectious on their own

- strand ssRNA and dsRNA are not infectious

359
Q

Where in the cell do viruses replicate?

A

DNA viruses: all in the nucleus except poxvirus

RNA viruses: all in the cytoplasm except influenza and retroviruses

360
Q

What are the Naked viruses without envelopes?

A

DNA: (Think PAPP) Papilloma, Adeno, Parvo, Polyoma
RNA: (Think CPR) Calici, Picorna, Reo, Hepe

361
Q

Where do viruses get their envelopes?

A

Generally from the plasma membrane when exiting the cell, except for herpesvirus that gets it from the nuclear envelope

362
Q

What are the DNA viruses?

A

HHAPPPy viruses

Hepadna, Herpes, Adeno, Pox, Parvo, Papilloma, Polyoma

363
Q

Herpesvirus

A

Linear Enveloped dsDNA

Includes: HSV-1&2, HHV-3 (VZV),4(EBV),5(CMV),6,7,8

364
Q

Poxvirus

A

Linear Enveloped dsDNA
Largest DNA virus
Causes Smallpox, Cowpox, Molluscum Contagiosum–flesh colored papule with central umbilication

365
Q

Hepadnavirus

A

Enveloped Partially dsDNA and circular

Hep B virus causing acute or chronic hepatitis

366
Q

Adenovirus

A 
Naked dsDNA linear
Causes: 
febrile pharyngitis–sore throat
acute hemorrhagic cystitis
pneumonia
conjunctivits
367
Q

Papillomavirus

A

Naked dsDNA circular

Causes: HPV–warts (serotypes 1,2,6,11), CIN, cervical cancer (16,18)

368
Q

Polyomavirus

A

Naked dsDNA circular
JC virus–progressive multifocal leukoencephalopathy (PML) in HIV
BK virus–transplant patients, commonly targets kidney
(JC=Junky Cerebrum, BK=Bad Kidney)

369
Q

Parvovirus

A

Naked ssDNA linear (smallest DNA virus)
B19 virus: aplastic crisis in sickle cell; slapped cheek rash in kids (erythema infectiosum, or fifth disease)
Causes RBC destruction in fetus leading to hydrops fetalis and death
In adults causes pure RBC aplasia and RA-like Sx

370
Q

HSV-1

Transmission, Clinical, Other

A

Transmission: respiratory, saliva
Clinical: gingivostomatitis, keratoconjunctivitis, herpes labialis, herpetic whitlow on finger, temporal lobe encephalitis
Other: most common cause of sporadic encephalitis

371
Q

HSV-2

Transmission, Clinical, Other

A

Transmission: sexual contact, perinatal
Clinical: genital herpes, neonatal herpes
Other: latent in sacral ganglia, viral meningitis more common with HSV-2 than 1

372
Q

VZV (HHV-3)

Transmission, Clinical, Other

A

Transmission: Respiratory
Clinical: chicken pox and shingles, encephalitis, pneumonia; most common complication of shingles is post-herpetic neuralgia
Other: latent in dorsal root or trigeminal ganglia

373
Q

EBV (HHV-4)

Transmission, Clinical, Other

A

Transmission: respiratory, saliva–kissing disease
Clinical: Mononucleosis–fever, HSM, pharyngitis, LAD (especially post cervical); assoc. c lymphomas–Burkitt, nasopharyngeal carcinoma
Other: infects B cells through CD21, atypical lymph on blood smear, + monospot test–heterophile Abs detected by agglutination of sheep or horse RBCs

374
Q

CMV (HHV-5)

Transmission, Clinical, Other

A

Transmission: congenital transfusion, sex, saliva, urine, transplant
Clinical: Mononucleosis (– monospot test), infection in immune compromised especially pneumonia in transplants; AIDS retinitis–hemorrhage, cotton-wool exudates, vision loss
Other: Owl Eye inclusions, Latent in mononuclear cells

375
Q

HHV-6,7

Transmission, Clinical, Other

A

Transmission: Saliva
Clinical: Roseola infantum (exanthum subitum)–high fevers that can cause seizures followed by macular rash; HHV-7 less common cause
Other:

376
Q

HHV-8

Transmission, Clinical, Other

A

Transmission: Sex
Clinical: Kaposi sarcoma (neoplasm of endothelial cells) seen in HIV and transplant patients, presents as dark plaques or nodules representing vascular proliferations
Other: can also affect GI and lungs

377
Q

Tzanck test

A

Smeat of an open skin vesicle looking for multinucleated giant cells commonly seen in HSV-1,2 and VZV
Intranuclear inclusion also seen in these viruses

378
Q

Reoviruses

A

Naked, dsRNA, linear, icosahedral
Coltivirus: colorado tick fever
Rotavirus: #1 cause of fatal diarrhea in kids

379
Q

Picornaviruses

A 
Naked, ssRNA, (+) linear, icosahedral
All are enteroviruses (fecal-oral) except Rhino
(Think PERCH)
Poliovirus: polio, Salk/Sabin vaccines
Echovirus: aseptic meningitis
Rhinovirus: common cold
Caxsackievirus: aseptic meningitis, herpangina, hand foot mouth disease, myocarditis, pericarditis
Hepatitis A Virus: acute viral hepatitis
380
Q

Hepevirus

A

Naked, ssRNA, (+) linear, icosahedral

Hepatitis E virus

381
Q

Caliciviruses

A

Naked, ssRNA, (+) linear, icosahedral

Norovirus: gastroenteritis

382
Q

Flaviviruses

A 
Enveloped, ssRNA, (+) linear icosahedral
HCV
Yellow Fever
Dengue
St. Louis Encephalitis
West Nile
383
Q

Togaviruses

A

Enveloped, ssRNA, (+) linear, icosahedral
Rubella
Western & Eastern Equine Encephalitis

384
Q

Retroviruses

A

Enveloped, ssRNA, (+) linear
Have reverse transcriptase
HTLV: T-cell leukemia
HIV: AIDS

385
Q

Coronaviruses

A

Enveloped, ssRNA, (+) linear, helical

Common cold, SARS, MERS

386
Q

Orthomyxoviruses

A

Enveloped, ssRNA, (-) linear, Helical

Influenza viruses

387
Q

Paramyxoviruses

A

Enveloped, ssRNA, (-) linear, Helical
Parainfluenza: croup
RSV: bronchiolitis in babies
Measles, Mumps

388
Q

Rhabdoviruses

A

Enveloped, ssRNA, (-) linear, Helical

Rabies

389
Q

Filoviruses

A

Enveloped, ssRNA, (-) linear, Helical

Ebola/Marburg hemorrhagic fever–often fatal

390
Q

Arenaviruses

A

Enveloped, ssRNA, (+) or (-) circular, helical
LCMV: lymphocytic choriomeningitis virus
Lassa fever encephalitis: spread by rodents

391
Q

Bunyaviruses

A 
nveloped, ssRNA (-) circular, helical
California encephalitis
Sandfly/Rift valley fevers
Crimean-Congo hemorrhagic fever
Hantavirus–hemorrhagic fever, pneumonia
392
Q

Delta Virus

A

Enveloped, ssRNA (-) circular, uncertain capsid symmetry

Hepatitis D virus

393
Q

Yellow Fever Virus

Virus type, Sx

A

Flavivirus, Aedes Mosquito

Sx: high fever, black vomitus, jaundice, Councilman bodies (eosinophilic apoptotic globules) on liver biopsy

394
Q

What is the most important global cause of infantile gastroenteritis?

A

Rotavirus

395
Q

Rotavirus

A

Most important global cause of infantile gastroenteritis

Villous destruction and atrophy leads to decreased absorption

396
Q

What togavirus causes fever, postauricular and other LAD, arthralgias, rash that starts on face and spreads to trunk and extremitites? Causes mild disease in kids but serious congenital disease.

A

Rubella virus
German Measles or Rubella
Congenital Rubella causes blueberry muffin rash from dermal extramedullary hematopoiesis

397
Q

Palivizumab

A

Monoclonal Ab against F protein that is on the surface of Paramyxoviruses and causes epithelial cells to fuse and form multinucleated cells
Viruses include: parainfluenza, mumps, measles, RSV

398
Q

Describe Croup

A 
Parainfluenza virus (paramyxovirus)
Barking cough, inspiratory stridor
Narrowing of upper trachea and subglottis leads to steeple sign on x-ray
Severe croup can lead to pulsus paradoxus from upper airway obstruction
399
Q

Describe Rubeola

A

Measles Virus (paramyxovirus)
3 C’s of measles: Cough, Coryza, Conjunctivitis
Prodromal fever with 3 c’s, then Koplick spots (bright red spots with a blue-white center on buccal mucosa) followed 1-2 days later by maculopapular rash that starts on head/neck and moves down.
Vit A can reduce mobidity and mortality especially in malnourished kids

400
Q

Describe Mumps

A

Mumps virus (Paramyxovirus)
Sx: Parotitis, Orchitis, aseptic Meningitis, Pancreatitis
Can cause sterility, especially after puberty

401
Q

Rabies virus and disease

A

Bullet shaped virus
Negri bodies: cytoplasmic inclusions commonly in Purkinje cells of cerebellum and in hippocampal neurons
Has long incubation period of weeks to months before Sx onset
Treat with wound cleaning, immunization with killed virus, rabies immunoglobulin
Travels up CNS along neurons by binding Ach receptors
Disease Progression: fever, malaise then agitation, photophobia, hydrophobia, hypersalivation then paralysis, coma then death
Most commonly bat, raccoon, skunk bites in US, can be spread by aerosol in bat caves

402
Q

Ebola virus and disease

A

Filovirus
Targets endothelial cells, phagocytes, and hepatocytes
Incubation of 21 days then abrupt onset of flu-like Sx with diarrhea, vomiting, high fever, myalgia
Can progress to DIC, diffuse hemorrhage, and shock
Dx with RT-PCR
Transmission requires contact with bodily fluids or fomites, infected bats or monkeys
No real treatment, must isolate patients

403
Q

Which hepatitis virus lack an envelope and what does this permit them to do?

A

HAV and HEV lack envelopes
Not destroyed by gut
Vowels hit your Bowels

404
Q

How does the DNA polymerase of HBV work?

A

HBV is the only hepatitis virus that is DNA
The DNA polymerase has DNA and RNA dependent functions
In the nucleus, it first finishes the partial dsDNA of the virus
The host RNA polymerase then makes mRNA from the viral DNA to make viral proteins
Viral DNA polymerase then revers transcribes the viral RNA into DNA for the progeny

405
Q

Are the hepatitis viruses RNA or DNA?

A

All RNA except for HBV is DNA

406
Q

What viral family is each hepatitis virus?

A 
A: picornavirus
B: hepadnavirus
C: flavivirus
D: deltavirus
E: hepevirus
407
Q

How are the hepatitis viruses transmitted?

A

A: fecal-oral (shellfish, travellers, day care)
B: Blood, Baby making, Birthing (B’s)
C: Blood (IVDU, transfusion)
D: Same as B
E: Fecal-oral, especially waterborne (like A)

408
Q

Hep viruses incubation times

A 
A: Short
B: long
C: long
D: short (alone), long overall with B
E: short
409
Q

Patient recently returned from Brazil and has sudden onset of fever, retro-orbital pain, headache, joint and muscle pain. Likely Dx?

A

Dengue Fever

Spread by the Aedes Aegypti mosquito

410
Q

Sx of Chikungunya

A

Fever, flu-like, prominent polyarthralgias, diffuse macular rash
Spread by Aedes Aegypti mosquito

411
Q

What bacteria releases an exfoliative exotoxin leading to scalded skin syndrome? What are the Sx of SSS?

A

Staph species release this toxin causing Staph Scalded Skin Syndrome (SSSS)
Often happens in infants and young kids
Nikolsky’s sign = sloughing of the skin with gentle pressure, epidermal necrolysis, fever, and pain associated with the rash are common Sx

412
Q

What is atopy?

A

A genetic predisposition to develop allergic diseases like allergic rhinitis, asthma, and eczema (atopic dermatitis)
It is a heightened immune response such as a type I hypersensitivity

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