Microbiology Flashcards
1
Q
What infectious disease is characterized by trismus, risus sardonicus, and opisthotonos? Also, define these terms.
A
Clostridium tetani
Trismus - Lockjaw
Risus Sardonicus - Raised eyebrows and open grin (think of creepy rhesus monkeys in sketchy)
Opisthotonos - Spasms of extensor muscles leading to back arching
2
Q
What cells in the spinal cord does tetanus effect?
A
Renshaw cells
Think wrench-saw
3
Q
What are the three main symptoms of scarlet fever?
A
- Strawberry tongue
- Pharyngitis
- Blanching, full-body rash which spares the face. (cheeks will still be flushed, with a circumoral pallor around the mouth (looks relatively pale))
4
Q
What is the life cycle of malaria species? Which can be dormant?
A
Female Anopheles mosquito injects sporozoites, they spread to blood stream and enter hepatocytes as trophozoites (cannot infect RBCs). These trophozoites mature into schizonts and rupture, releasing merozoite form. Merozoites invade RBCs -> turn into trophozoites -> schizonts -> rupture to release merozoites in cycles. Sometimes gametocytes are released by schizonts which are taken up by mosquitos.
Food = protein from heme breakdown. Need to form hemozoin to deal with heme rings.
P. vivax (Ax) and P. ovale (shield) can become dormant
5
Q
What drugs are used to treat regular P. malariae? P. vivax / P. ovale? P. falciparum? Prophyaxis?
A
P. malariae - chloroquine if susceptible (blocks heme polymerase for hemozoin formation), otherwise mefloquine (me-fly queen)
P. ovale / vivax - same treatment, except add primaquine (primal queen, treats hypnozoite dormant stage)
P. falciparum - use artemisins like artesunate, causes more serious infection
6
Q
What blood smear can be seen in malaria inside the RBC?
A
Ring form -> from trophozoite form
7
Q
What organs does P. falciparum tend to affect and why?
A
Binds to ICAM-1 receptor on endothelium in brain, kidney, and liver to avoid splenic clearance
- > can cause complications in all these organs, such as cerebral malaria
- > think of gold kidney / lung plates in sketchy
8
Q
How is Babesia microti transmitted and how can it be differentiated from malaria symptomatically? What is the biggest risk factor for severe disease?
A
via the Ixodes tic (think of Robin of Ixodes amongst the vampires)
-> fever does not follow regular cycles
Risk factor = sickle cell disease (Severe hemolytic anemia). This is in contrast to malaria, where sickle cell disease is protective.
9
Q
What is seen in peripheral blood smear of Babesia? How is it treated?
A
Maltese cross and ring form
Treatment: Atovaquone (vampire queen) + azithromycin (crow on her shoulder)
10
Q
If an AIDS patient presents with multiple ring-enhancing lesions on CT, what is the most likely diagnosis and why?
A
Toxoplasma gondii -> most likely to cause mass effect and multiple lesions, much more common than cryptococcoma
C. neoformans is unlikely to be the diagnosis as it causes soap bubble lesions, although it is the most common fungal cause of this.
Aspergillus -> more likely to cause a single abscess.
A primary central nervous system B-lymphoma (due to EBV, associated in AIDS patients) is actually more likely than these fungal causes as a second item on a DDx to Toxoplasmosis
11
Q
Where in the cell do RNA / DNA viruses replicate and what is the exception to the rule in each of these?
A
RNA - replicate in the cytoplasm
-> exception: Orthomyxoviruses
DNA - replicate in the nucleus (need an RNA polymerase)
-> exception: Poxviruses -> brings its own RNA polymerase AND makes its own envelope
12
Q
What are the clinical features of molluscum contagiosum infection?
A
Dome-shaped, flesh-colored papules all over the body except in palms / soles
- > central umbilication (ulceration in the center)
- > it is a poxvirus, common in children, but can be an STD for adults and will present as one lesion
13
Q
What pathogens can cause rashes on palms and soles?
A
Syphilis - Secondary
Rickettsia Rickettsii - RMSF
Coxsackie A virus - Hand, foot, and mouth disease
14
Q
What childhood exanthem is caused by HHV6, and what cell type does it primarily affect?
A
Exanthem subitum -> roseola (child holding rosary) -> 4 feathers on his hat for CD4 cell
15
Q
What are the clinical features of roseola?
A
Think of the four suns -> 4 day fever, extremely high fever (>104 F) that can cause seizures. Think of the boy seizing.
Think of mother mary with lacy clothes with blue flames -> once the fever has subsided, a diffuse, “lacy”, macular rash will appear all over the body except face
16
Q
What other virus can cause Roseola? How do you distinguish roseola from measles?
A
HHV7.
Measles (Rubeola) will have fever and rash at the same time.
17
Q
What is HHV8 associated with and what does that look like? Who is most susceptible?
A
Kaposi sarcoma - endothelial neoplasm due to dysregulation of VEGF
- > look like dark violet plaques / nodules, especially on hard palate and extremities
- > seen in AIDS patients / immunocompromised
18
Q
What other organs are commonly involved in Kaposi sarcoma?
A
GI tract, lungs
-> think of the colon covering to her flowers at Kate’s Posies
19
Q
How do you tell Taenia saginata vs Taenia solium apart on stool O and P?
A
Taenia solium will have hooks around its proglottid head -> remember the hooks around the pig at the carnival
20
Q
How are Taenia infections normally treated? What if they are in the brain? How do you get a Taenia brain infection?
A
11670
Normally -> i.e. intestinal or elsewhere in the body = Praziquantel (pretzel)
Neurocysticercosis -> add albenzazole (bendy bar guy)
-> the EGGS of the cestode (rather than the larvae) must be ingested
21
Q
What is Diphyllobothrium latum also known as? What is its most memorable side effect?
A
Bothrium = bathroom in sketchy Fish tapeworm (throwing plate of fish while running towards bathroom) -> largest tapeworm -> competes for B12 (must be 12 to use fireworks) in the intestine, can cause B12 deficiency and megaloblastic anemia (fireworks in background)
22
Q
What parasite is known to cause liver cysts? What are its definitive and intermediate host?
A
Echinococcus granulosus, another cestode. Think EchinoCOCKER SPANIEL -> winning the dog show
Definitive: Dogs
Intermediate: Sheep (Sheep dog is #2 in the dog show)
Humans are incidental host
23
Q
How do the hydatid cysts of Echinoccus appear on CT? Why are they concerning?
A
Appear as “eggshell calcification” as a liver cyst
- > concerning because if they rupture they can cause anaphylaxis (think of the guy holding a cyst walking next to the dog show with a red face)
- > need to be careful when removing this (vs Entamoeba which you wouldn’t remove)
24
Q
What is the #1 cause of osteomyelitis in patients with sickle cell disease? What is its primary virulence factor?
A
Salmonella typhi
Think of the seagull (gall bladder) holding the sickle with the Typhoid Mary apron.
Vi capsule = Virulence capsule, resistance to phagocytosis and opsonization
25
Why can HSV not undergo reassortment?
Only segmented viruses (i.e. influenza virus) can undergo reassortment
-> HSV viruses can coinfect cells and undergo recombination by crossing over of homologous regions, however
26
What are the segmented viruses?
```
All are RNA viruses
Include BOAR:
Bunyaviruses
Orthomyxoviruses
Arenaviruses
Reoviruses
```
27
What are the exotoxins produced via ETEC?
Labile in the Air, Stable on the Ground
1. Heat-labile toxin - overactivates adenylyl cyclase -> cAMP increase, Cl- secretion and H20 efflux in gut.
Also called Cholera-like toxin
2. Heat-stable toxin - overactivates guanylate cyclase -> cGMP increase, decreasing resorption of NaCl and H20
- > causes watery diarrhea overall
28
What is the function of cord factor in Mycobacterium TB?
It is a mycolic acid derivative required for virulence of TB.
Helps TB form "serpentine cords" with respect to the other TB bacteria. This formation activates macrophages, induces the release of TNF, and inactivates neutrophils. This allows them to be walled off in a granuloma where they can't be accessed by the rest of the immune system.
Think of the Lasso from the TB cowboy holding onto the macrophage cart driver
29
What virulence factor inhibits phagolysosome fusion in TB? How does it work?
Sulfatides -> surface glycolipids of TB. These glycolipids are released and cause secondary lysosomes to become incompetent, inhibiting fusion with the phagosome containing TB.
30
What microbe is typically the cause of bilateral adrenal gland hemorrhaging?
Waterhouse-Friderichesen syndrome, a complication of Neiserria meningitidis bacteremia which can occur without meningitis.
Also causes fever, disseminated intravascular coagulation, and shock
This is due to extensive vasoconstriction of the adrenals during shock
31
What causes undulant fever? What is the source and treatment?
Brucella - a zoonosis normally from unpasteurized dairy
Treatment - Doxycycline (remember the bicycle windmill) and rifampin (rifle actually carried by the sick person)
32
Where does Brucella live? How does this relate to disease course?
Facultative intracellularly in macrophages
Cause cause hepatosplenomegaly and LN enlargement due to its growth in macrophages
33
What microbe is characterized by a "spaghetti and meatballs" appearance under the microscope?
```
Malassezia furfur (Tinea versicolor)
-> Italian restaurant in sketchy
```
34
What are the symptoms of tinea versicolor and what is the treatment? Why does this happen?
Hypo and hyperpigmented spots on skin due to interference with melanocytes via degradation of lipids by acids.
Lives in stratum corneum (think of corn in sketchy)
Treatment = Selsun Blue (blue doorway in sketchy) = Selenium sulfide
35
What is onychomycosis and what is the treatment?
Another name for tinea unguium or tinea of the nails
Treat with terbinafine (inhibits squalene epoxidase and can cause GI upset) or griseofulvin (inhibits microtubule formation)
36
What are the treatments for Trypanosoma brucei infection?
Melarsoprol - mela "soap" - in sketchy, for CNS infections
Suramin - sounds like bottle of serum, for blood infection
37
What are the two forms of Leishmaniasis and where does the protozoa live inside the body?
Visceral (Donovan, black fever "kala-azar") and Cutaneous (Braziliensis, brazil flag, zombie is flesh-eating)
Protozoa lives as amastigotes inside macrophages (goats in macrophage cages) -> characteristically multiple in macrophages
38
What are the symptoms of cutaneous and visceral leishmaniasis?
Cutaneous - skin ulcers
Visceral / Kala-Azar - Spiking fevers, pancytopenia (think of pan with RBCs in it), and hepatosplenomegaly (from macrophage involvement). Basically think of infected macrophages crowding out the bone marrow.
39
What is the treatment for Leishmaniasis? Where is this bug spread?
Cutaneous - T-bone steak = stibogluconate
Visceral - Amphotericin B - think of frogs everywhere in da desert
Spread in Africa / Middle east -> desert area, since it is spread by the sandfly
40
What infection is especially associated with pigmented gallstones and how do you get it?
Clonorchis sinesis (think orca whale in trematode sketchy)
Get from eating undercooked fish i.e. sushi
Think of the seagull on stack of rocks to remember pigmented gallstones
41
What cancer is associated with Clonorchis sinensis?
Cholangiocarcinoma -> due to it causing biliary tract inflammation
Think of the seagull having fibrotic rope (biliary tract) grabbed on by crab
42
What are scabies and how are they spread?
Mites which burrow into skin and cause a pruritic, erythematous rash
Common in children and teachers, spread via skin to skin contact. Rash can even start on palms
#10168
43
What can be expected to happen if you eat death cap mushrooms (Amanita phalloides)? What is the mechanism of action?
Amatoxin will accumulate in liver cells and cause severe hepatotoxicity -> elevated liver enzymes
-> amatoxin binds RNA polymerase II, stopping mRNA synthesis and leading to apoptosis of the cell
44
What are the symptoms of deathcap mushroom poisoning?
Delayed onset vomiting and cholera-like diarrhea which will ultimately result in hepatotoxicity and acute renal failure
-> toxin accumulates in cells with rapid cellular turnover
45
What protein is responsible for the beta-hemolytic properties of Group A Strept?
Streptolysin O (SLO)
46
What is the capsule of Bacillus anthracis made of?
Poly-D glutamate
| -> one of the only bacteria to be made of dis capsule type (protein rather than polysaccharide)
47
What is the defining characteristic difference between the growth of Clostridia and Bacillus species?
Clostridia -> anaerobes
| Bacillus -> aerobes
48
What is the active ingredient and reversal agent for most rat poisons?
Active ingredient is a 4-hydroxycoumarin derivative called brodifacoum
Give FFP for reversal (Same as warfarin)
49
What media other than tellurite agar is used for growth of Corynebacterium diphtheriae?
Loeffler's media
| -> think of the boy laughing
50
What test is used to determine if diphtheria possesses toxins?
Elek's test
- > think "E-lick" -> Bull's tongue hanging out
- > basically have a filter paper with antitoxin on it which reacts with the exotoxin of diphtheria
51
What type of vaccine is diphtheria?
Toxoid -> inactivated toxin. Remember this because the syringe sticking out of the bull is green, same as the green bow-tie, indicating it is a vaccine of the toxin
part of the TDaP vaccine
52
Can Listeria cause a transplacental infection? Is it susceptible to cefotaxime?
Yes - causes a transplacental infection
No - not susceptible to cefotAXime or other 3rd generation cephalosporins. This is the reason why ampicillin is added to the treatment regimen of potentially susceptible populations.
53
Who tends to get Nocardia infection, what are the clinical manifestations, and how is it treated?
Immunocompromised, especially those exposed to glucocorticoids longterm
respiratory - cavitary lesions in lungs mimicking TB (think of bullet cavitating ID badge)
CNS - brain abscesses
skin - cutaneous indurated abscesses
Treatment - sulfonamide eggs
54
What is Thayer-Martin agar also called and what is it used to isolate?
VPN agar
Vancomycin - inhibit gram +
Polymyxin E (colistin) - inhibit most gram negative
Nystatin - inhibit yeast
Used to isolate Neisseria
55
What is responsible for the massive inflammatory response to Neisseria?
Think of the burning envelopes in sketchy
| -> Lipooligosaccharide (LOS) is like LPS, grows so quickly that it blebs off and activates the immune system
56
Does Neisseria gonorrhea have a capsule? Why does this matter?
No! Think of the broken glass on the floor in sketchy
| -> important because N. meningitidis DOES have a capsule -> makes it more likely in those with sickle cell
57
What's the mechanism of action of Shigatoxin?
Inactivates 60S ribosome by removing adenine from rRNA
-> think of 60s hourglass
- > there is NO ribbon in the sketch, so it's not ADP-RIBOsylating like the E2F (accordian) interaction of diphtheria or pseudomonas.
- >It's an AB toxin, but does NOT work via ribosylation
58
What gram negative bug is pretty similar to Listeria and how is it spread? Is it encapsulated / what shape is it?
Yersinia enterocolitica (Think English terrier) -> is resistant to cold temperatures, and is thus able to multiply in stored blood transfusions
Like Listeria, spread via contaminated milk (think of the Toddler holding the bottle of milk), or via pet feces (especially puppies)
It is an encapsulated gram negative organism that exhibits bipolar (safety pin) staining
59
What problems does Yersinia enterocolitica cause?
RLQ pain due to mesenteric adenitis or terminal ileitis
- > "pseudoappendicitis"
- > think of the puppy licking the child's RLQ
-> also causes acute bloody diarrhea (think of his red stool)
60
What is a Yop?
Yersinia outer proteins
-> secreted by Yersinia pestis in a Type 3 secretion system, cause macrophage and neutrophil dysfunction by inhibiting phagocytosis / cytokine production
Worker using Type 3 secretion system to give the rodent water
61
What is the treatment for Yersinia infections?
Think of the guy holding the psi as well as the rodent bicycle wheel:
aminoglycosides (particularly streptomycin) + tetracycline
62
What is the treatment for H. pylori?
1. PPI - H+ bomb
2. Clarithromycin - "Keep clear" crow
3. Amoxicillin - ammo box. Metronidazole if allergic
63
Who is at risk for Pseudomonas osteomyelitis?
IV drug users -> direct hematogenous seeding. Think of the mortar and pestle next to the fishbones in sketchy.
Diabetics -> Think of the candy jar next to the fishbones in sketchy.
64
What type of vaccine is the Hib vaccine?
Type b capsular polysaccharide polyribosylribitol phosphate, conjugated with diphtheria toxin to increase immunogenicity
65
What are the clinical features of Legionnaire's disease?
Smoker presents with high fever, lobar pneumonia, CNS symptoms (sailor getting hit by bucket) including headache / confusion, hyponatremia, and diarrhea
66
What is the gram morphology of Francisella tularensis? How is it spread?
Gram negative and radish-shaped
Spread via rabbit reservoir or indirect contact via dermacentor tick vector
67
Describe the disease that Francisella tularensis causes.
Tularemia - Bacteria lives facultative intracellularly inside macrophages (cage). Causes formation of cutaneous ulcer at site of bite, and regional lymphadenopathy with caseating granulomas (think of underground radishes pushing up dirt piles).
68
What type of immune response is adaptive for leprosy and what will the disease do in this case? Which form is transmissible between humans and how is it spread?
Th1 response - "Tuberculoid" - best response. Well controlled, with some hypoesthetic and hairless skin (think of bald guy) plaques due to peripheral involvement on cold parts of extremities. Can be confirmed via Lepromin skin test.
Th2 response - "Lepromatous" - mostly humoral - worst outcome -> respiratory communicable due to poor control. Typically stocking and glove / extensor surface involvement.
69
What's the treatment for leprosy?
Tuberculoid form - Dapsone (Deputy) + rifampin (rifle)
| Lepromatous form - Add Clofazimine (cloth)
70
How do you differentiate Chlamydia neonatal conjunctivitis from Gonorrhea?
Chlamydia - presents later, and often accompanied by pneumonia ("Staccato cough")
Gonorrhea - presents early
71
What type of arthritis do chlamydia and gonorrhea cause?
Chlamydia - reactive (B27-associated)
Gonorrhea - septic
72
What are the symptoms of Q fever and what causes it?
Coxiella burnetti - gram negative closely related to Rickettsia
Fever, retroorbital headache, lobar pneumonia, and granulomatous hepatitis
-> differentiate from Brucella by lack of undulating fever
#11859
73
How does Coxiella grow and how is it transmitted? What heart problem can it cause?
Grows as obligate intracellularly (sheep is locked in)
Transmitted via aerosolized farm animal secretions (feces or amniotic fluid) in its endospore form
Very important cause of culture negative endocarditis.
74
What agar is used to grow Mycoplasma?
Eaton agar -> don't "eat on" ice!
75
What disease does Rickettsia prowazekii cause and how does the rash spread?
Causes epidemic typhus
Just remember Typhus on the Trunk, or how the football coach directs his players from the center outward.
Another major difference from Rickettsia ricketsii is that it spares the palms and soles (football players with white hands)
76
How is R. prowazekii spread and what are the symptoms?
Spread via lice -> reason is can cause epidemics
Think of being tackled:
Arthralgias and myalgias
Pneumonia - wind knocked out of you
Encephalitis - like being concussed
77
How large is paracoccidioidomycosis and where do you get it? Symptoms?
South America
It is much larger than RBC (think of the center of the captain's wheel being red)
Symptoms: pneumonia, cervical lymphadenopathy (white beads), and mucocutaneous lesions (missing teeth)
78
What fungus causes problems in neonates receiving TPN?
Malassezia -> it loves lipids
| Think of the baby holding the piece of spaghetti (represents the catheter)
79
What are the treatments for Sporothrix?
1. Itraconazole - pine cones
| 2. Potassium iodide - think of the potassium iodide pesticide
80
What form of Candida exists at 20 and 37 degrees?
Cold - think of the branching plants on the ground (the snow it cold) -> pseudohyphae
Heat - think of the ice cream cone stand - germ tubes -
true hyphae. "37 flavors"
81
What specialize enzyme does Candida possess that most other fungi do not?
Catalase -> increased risk with chronic granulomatous disease
-> Note that Aspergillus is also catalase positive (think of Cat on top of scarecrow)
82
At what CD4 count do you start getting a candida infection of the GI tract and what is it?
Esophagitis -> think of the slide
"Max 100 pounds" -> starts at CD4 <100
Normal weight cutoff between children and adults
83
Who gets candidal endocarditis and why?
IV drug users -> Candida is a common contaminant of heroin.
Think of the three pyramids -> Candida is commonly implicated in tricuspid valve endocarditis.
84
Who is susceptible to candidal vulvovaginitis and what will the pH be?
1. Diabetics
2. OCP users
3. Antibiotic users
pH will be <4 (unlike Trichomonas or Gardnerella), candida does not change pH. Park is only open til 4pm.
85
What is the most specific test for Cryptococcus?
Latex agglutination for the polysaccharide capsule (only fungus with this unique polysaccharide capsule)
-> think of the guy with the latex gloves holding the urease bottle over the polysaccharide sarcophagus capsule
86
What is the treatment for cryptococcus meningitis?
Flucytosine + amphotericin (think of flute player with frogs around)
followed by: Fluconazole (think pine cones which follow the first drawing)
87
Other that diabetics, who gets mucor? How does it invade?
Leukemic / neutropenic patients -> immunocompromised
Invades the blood vessels then ultimately the frontal lobe thru the cribriform plate (think of the bottom of the car in sketchy) -> rhinocerebral infection
88
How is Giardia diagnosed?
ELISA - Check for antigen. Think of the name in the boat.
Stool O&P - Think of the OP on the guy's shirt
89
How is Entamoeba diagnosed?
Parasites seen with RBCs engulfed on O and P, or cysts -> often multinucleated #6779.
Serology for anti-entamoeba antibodies can be done, or ELISA
90
What is the treatment for Entamoeba liver abscess?
Treat it medically -> would not excise to treat it (vs echinococcus)
Options:
1. Metronidazole
2. Paramycin - pair of mice in the lumen
3. Iodoquinol - Queen Iodo's tomb
91
What are the treatments for PCP pneumonia vs Toxoplasmosis?
P. jirovecii - pentamidine - think of the ping pong paddle shape
Toxoplasmosis - Pyrimethamine + Sulfadiazine (analogous to TMP/SMX)
92
How do you differentiate Toxoplasma from CNS lymphoma?
Toxoplasma - usually MULTIPLE brain-enhancing lesions (think of Ghandi cat's bubbling glasses). If singular, you will need to do a brain biopsy to confirm (think of encephalitis hat with pin sticking out of it)
93
What are the ways in which Toxo is transmitted?
1. Cysts thru ingestion of meat - think of Ghandi cat tipping over the bowl of meat on hunger strike
2. Oocysts from cat feces - think of mom changing the cat litter.
3. Transplancental - TORCH infection
94
What are the symptoms of T. gondii torch infection?
Triad of:
1. Chorioretinitis - camera
2. Hydrocephalus -> seizures - cat with bowl on head
3. Intracranial calcifications - cat drinking milk
Deafness (Beethoven cat) and blueberry muffin rash may also occur
95
What is the vector for Trypanosoma brucei and what are the two subspecies? What disease does it cause? Which is worse?
Causes African sleeping sickness - Tsetse fly vector (think of the tea next to the sleeping girl)
1. West African - gambiense - Gambia. Way more indolent, human reservoir only.
2. East African - rhodesiense - Rhodesia is an old name for Zimbabwe. Way more fulminant, and reservoir is animals.
96
What are the symptoms of T. brucei?
Alot like brucellosis, oddly enough!
Undulating / recurrent fever -> due to constant antigen variation
Coma
Enlarged cervical (Winterbottom's sign) / axillary lymph nodes (necklace and sleeves of girl)
97
How does the sleeping sickness parasite move and how is it diagnosed?
Looks like an organism with a single motile flagella - single lock of pink hair
Diagnosed via trypomastigote in blood -> think goat she's holding next to her bloody finger
98
What is the treatment for sleeping sickness?
Suramin - for serum (blood-borne infection)
| MelarSOProl - "soap" - for CNS infection. Think Mel = melatonin, for sleep.
99
What disease does Naegleria fowleri cause and how? How is it diagnosed and what is the treatment?
Causes a rapidly fatal meningoencephalitis, entering thru cribriform plate. Contracted from freshwater sources like lakes and water bottles.
Diagnosed via spinal tap showing Amoebas. Treatment -> think the frogs around the sick guy. Amphotericin B has been successful in some.
100
What are the symptoms of chronic T. cruzi infection?
Chagas disease -> everything becomes big and dilated
Heart: Dilated cardiomyopathy
Esophagus: Megaesophagus (think of snake)
Colon: Megacolon -> either large or acute abdomen from perforation
101
How is Chagas disease treated?
Nifurtimox - Knee high fur moccasins
or
Benznidazole
102
Who gets Babesiosis / how is it transmitted?
Transmitted by Ixodes (deer tick), in the same area as Borrelia -> Northeastern US. So coinfection with Lyme disease is very common
103
What are the symptoms of babesiosis and who is it worse in?
Hemolytic anemia -> think of shattering stained glass RBCs
Irregularly cycling fever -> think of irregular tunic Robin of ixodes is wearing LMAO
Worse in those with asplenia, i.e. sickle cell disease
104
What do RBCs show in babesiosis and what is the treatment?
Maltese cross -> tetrad of trophozoites, on thick blood smear.
Treatment is Atovaquone (atova + queen) + Azithromycin (crows around her)
105
What are the side effects of primaquine?
Hemolysis in G6PD
There is no sketchy symbol for this, it's just fact in First Aid and was mentioned in sketchy
Remember primaquine (primal queen) is the drug added to treat the hypnozoites of VivAX and OVALe
106
What are the malaria medications which can be used in chloroquine resistant countries?
Mefloquine (Me Fly Queen) - think of her in her resistant bed thingy with the luggage on type
Atovaquone / Proguanil - In the same bed-like thing, just Vampire queen + iguana on her shoulder
-> can also be used in combination with artemisinins for treatment of P. falciparum
107
What is quinidine used for? Side effects?
Queen dining -> in the far right back. Used for severe life-threatening infections.
Remember that this is a 1A antiarrhythmic. Side effects include cinchonism (headaches, dizziness, tinnitus), thrombocytopenia, prolonged QT
108
What is the form of malaria which is best visualized in Giemsa stain?
Ring form = immature schizont (Trophozoite ring).
Remember. Merozoite infects RBC -> trophozoite -> immature schizont -> Schizont -> merozoite release
109
What is the fever cycle for all the malaria types?
P. malariae - Think of the 1-2-1 pattern of beads on the front -> quartan (72 hour) fever pattern
P. vivax / ovale - think of the hanging thing -> tertian (48 hour) fever pattern
P. falciparum - think of the irregular torn robe pattern -> irregular fever pattern
110
How is Trichomonas visualized?
Wet mount -> motile trophozoites
111
How is Enterobius vermicularis spread? Treatment / diagnosis?
Spread via fecal-oral route, especially kids
-> This is the pinworm. Diagnose with Scotch tape test
Treatment: Pyrantel PAMoate + bendazoles
112
What are Ancylostoma duodenale / Necator americanus also called together and what is their main complication?
Hookworms -> think of the guy tied off by neck and ankle swinging his grappling hook
Main complication -> other end of rope is an iron -> iron deficiency anemia.
They penetrate his red boots, make their way to the lungs ascend the bronchial tree as larvae, get swallowed, then attach to intestinal wall to suck blood.
113
How is Ascaris lumbricoides transmitted / how does the infection get worse?
Fecal-oral transmission. Think of Lumbricoides LUMBER -> big tree man in the back. This is a difference from hookworm which invades thru skin. NO RED BOOTS on lumber man.
Infection gets worse via larvae migrating thru gut wall, to bloodstream, up into lungs, and being re-swallowed to again make adults in the intestine which release more eggs.
114
What are the complications of Ascaris lumbricoides?
This is also called giant roundworm. Can easily block the ileocecal valve with so many worms -> intestinal obstruction.
Also, since there are so many larvae developing, respiratory symptoms can be seen (think of the green bronchial-tree looking patch on the tree's chest).
115
How is Strongyloides stercoralis transmitted and diagnosed?
Transmitted via soil penetrating feet (think of red boots that Strong guy is wearing)
Diagnosed via LARVAE in stool, not eggs. This is because the eggs are actually laid IN the intestinal wall and cause tons of inflammation, and larvae are shed into GI tract. Some of these larvae can mature into infective larvae form which autoinfects host in the same cycle.
116
What is the treatment for Strongyloides?
Strongman -> treat with (R)ivermectin + bendazoles
117
What condition does Dracunculus medinensis cause? How is it spread / treated?
Guinea fire worm -> think of Dracula
Spread via drinking water filled with copepods (think cups) which are infected with larvae.
These penetrate the GI tract and migrate to the skin, where they stick out of ulcers.
Treat by slow removal around a matchstick
118
What infection does Onchocerca volvulus cause and what spreads it?
Onchocerciasis - River blindness
Spread by blackfly -> think of the guy that has a black fly head in sketchy
119
What are the symptoms of River blindness and how is it treated?
Symptoms are spread due to microfilaria thru body.
Skin changes -> hypo / hyperpigmented nodules
River blindness -> blindness from them in eye
Treatment -> think of River sign behind him. Ivermectin.
120
How is Wuchereria bancrofti spread and what is the treatment?
Spread via mosquitos
Treatment is diethylcarbamazine (Diet & Carb magazine)
121
How do you get Toxocara canis? What disease does it cause?
From fecal-oral ingestion of dog / cat feces (think of the wolf in the chair)
Causes visceral larva migrans.
122
What are the symptoms of visceral larva migrans and what is the treatment?
In humans which are an accidental host, the larvae never leave the larval form and migrate around the body.
Cause inflammation / damage in affected tissues. May cause blindness -> Ocular larvae migrans.
Treatment: Bendazoles - think of the Wolf's bendy chair
123
What disease does Loa Loa cause? What other symptoms does it cause?
Think of the swamp creature from the Loa Loa lagoon
Causes African eye worm -> worm can be seen in conjunctiva. Causes swelling of the skin (angioedema), think of the spots on the dude).
124
What transmits Loa Loa and what is the treatment?
Transmitted by deer fly (think of the flies surrounding the swamp creature), and he is reading diet / carb magazine (diethylcarbamazine).
125
How do you get intestinal tapeworm vs cysticercosis?
Tapeworm - ingestion of larvae which are encysted in undercooked meet
Cysticercosis / neurocysticercosis - requires ingestion of EGGS from human feces contamination
-> suspect in an immigrant with seizures
126
What's the treatment for Diphyllobothrium latum?
Think of the nickel sign on the bathroom - Niclosamide
Also, guy holding the pretzel next to the guy running to the bathroom - Praziquantel
127
Which species cause hepatic / intestinal schistosomiasis vs urinary schistosomiasis? How do their eggs look?
Hepatic / intestinal - S. mansoni (lateral spine next to man) and S. japonicum (circular / spineless, like japanese flag circle)
Urinary - S. haematobium (long terminal spine, like a swordfish)
128
What is the life cycle of Schistosoma, including where they diverge between the two subtypes? What is their intermediate host?
Snails are intermediate host, release cercariae into water which penetrate human skin, then disseminate to portal circulation hematogenously.
- > Hepatic / intestinal will migrate as a pair to mesenteric veins
- > Urinary will migrate to vesicular veins
- > eggs are released in stool or urine respectively, which are taken up by snails after hatching
129
What does early infection with Schistosomiasis cause?
Swimmer's itch -> pruritic or papular rash where cercariae penetrated
130
What will be the late complications of the hepatic / intestinal forms of schistosomiasis (months to years later)?
Abdominal pain / bloody diarrhea, with development of intestinal obstruction / hepatic periportal "pipestem" fibrosis due to granulomatous inflammation -> inflammation is occurring around the eggs laid by the adults, adult organisms are largely ignored.
-> portal hypertension and associated symptoms are likely
131
What will urinary schistosomiasis cause long-term? Most important association?
Dysuria, hematuria, urinary tract obstruction secondary to granuloma formation (around eggs).
Can lead to chronic UTIs, chronic kidney disease (obstructed ureter with egg granulomas / irritation)
All this inflammation leads to squamous metaplasia
-> can cause SQUAMOUS CELL carcinoma of the BLADDER
132
What's the treatment for schistosomiasis + clonorchis?
Both are praziquantel -> think of swimmer diving for pretzel and seagull eating pretzel
133
What does Paragonimus westermani cause? How is it transmitted / treated?
Think of Penguins -> Lung fluke. Cause cough with bloody sputum
Think of snails (intermediate host) around the penguin cage, and they are eating crab legs -> transmitted by undercooked crab meat.
134
What viruses are the #1 cause of aseptic meningitis?
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Picornaviruses who are enteroviruses:
Poliovirus
Coxsackievirus
Echovirus
-> think of the head-shaped cage
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135
Where does Polio replicate?
Replicates mostly in the Peyer's patches, lymphoid tissue in the walls of the small intestine, also in oropharynx
136
What is the main immunologic difference between the Sabin / Salk vaccine?
Since the Salk vaccine is killed -> injected, and no normal mucosal response (lack of IgA antibody production). IgG intact.
Sabin vaccine -> alive, and will induce IgA as well as IgG antibodies, but may revert to wild type
137
What are possible sequellae of Coxsackie B virus infection?
1. Dilated cardiomyopathy
2. Aseptic meningitis - especially in summer months, just like Coxsackie A
3. Devil's Grip - Pleurodynia -> very bad inspiratory chest pain (think of bird getting gripped)
138
How does rhinovirus enter the cell? Why can't it infect the GI tract?
Can't infect the GI tract because it is acid labile - think of the lemons held by the kid
Enters the cell via the camera of the lady and David - ICAM-1 adhesion!
139
What type of vaccine is the Hep A vaccine?
Inactivated -> remember because it is on the zookeeper. Tranquilizer -> inactivator of animals.
140
What virus is likely to cause jaundice, back pain, and bloody diarrhea?
Yellow fever, a type of Flavivirus
| -> think of the ox with the live attenuated vaccine coming out of his back
141
What antibody-associated condition is HepC associated with?
Cryoglobulinemia - think of cold crystals washing up onto Hep C shore
-> condition causes gangrene of extremities due to formation of mostly IgM immune complexes which precipitate in colder peripheral temperatures to block blood flow.
142
Is coronavirus enveloped or not? What diseases does it cause? What's its shape?
Enveloped, RNA + virus which causes common cold (guy blowing his nose) as well as SARS and MERS (middle east respiratory syndrome)
Shape is helical -> helical trees and shape around castle
143
What are the structural genes of HIV? Genome type?
1. Env
2. Gag
3. Pol
RNA+ genome with 2 strands
144
What are the components of Env? Their function?
Gp160 - cleaved by protease into gp120 and gp41
Gp41 is a transmembrane protein to help with FUSION
Gp120 is a docking protein which interacts with CD4 as well as CCR5 (macrophages, T cells) or CXCR4 (T cells) depending on early / late infection, respectively. Think of the GP120 battering ram!!
Explains why homozygous CCR5 mutations will be immune to HIV infection.
145
What are the components of Gag and their function?
Capsid (p24) -> surrounds the 2 RNA strands. Think of the wizard hat with two RNA dragons inside it, with the brim like a sundial -> 24 hours in a day.
Matrix (p17)
Also p7 - nucleocapsid protein. Think 24 hours a day, 7 days a week
146
What are the components of Pol and their function?
1. Protease - maturation
2. Integrase - integration into genome
3. Reverse transcriptase - synthesis of dsDNA for integration
147
What is the threshold at which HIV can be diagnosed?
1. AIDS defining illness
or
2. CD4+ count is less than 200
148
How should HIV be diagnosed in adults?
1. ELISA - as a high sensitivity screening test
| 2. Western blot - confirmatory test, showing serum antibodies to HIV virus components
149
How should HIV be diagnosed in neonates?
Use PCR amplification tests. ELISA / Western blot would definitely come back positive since HIV positive mothers passively transfer their IgG antibodies across the placenta and it takes a while for these numbers to decrease
150
How does influenza invade? How does it get released?
Hemagglutinin binds sialic acid on host cell and promotes viral entry
Gets released when neuraminidase (Nurse Assistant's scalpel) is used to cleave those same sialic acids so the viral particles do not remain stuck to the nearby cells.
151
What is the drug target of Amantidine?
The M2 ion channel, which is required for uncoating and thus viral infectivity in influenza A strains.
152
Where does influenza replicate?
In the nucleus (only RNA virus to do this) -> think of little octopi replicating in the diver's helmet
153
What is a Warthin-Finkeldey cell?
A fused lymphocyte giant cell, usually caused by the fusion protein of Measles (Rubeola)
154
What is the most common cause of bronchiolitis in children and how is it prevented?
RSV - respiratory syncytial virus
Prevents with Palivizumab -> a monoclonal antibody against the fusion protein (think of sticky IgG toy) which prevents pneumonia in PREMATURE infants -> high risk group.
155
What virus causes Croup and what is this also called?
Parainfluenza virus
| Also called laryngotracheobronchitis - identified by steeple sign and inspiratory stridor
156
What is the structure of Rhabdovirus?
single stranded RNA negative virus, with envelope
| -> RABIES!!!!!!!!
157
How do Bunyaviruses get their envelope? What's the structure of the genome?
Gold bathrobe -> Golgi apparatus
RNA negative virus with three CIRCULAR segments (think of the three chopped down tree stumps with rings)
158
How are the Bunyaviruses transmitted?
Hantavirus - think of haunted deer mice -> transmitted by deer mice feces / urine
California encephalitis / Rift Valley fever -> transmitted by arthropods (arboviruses) (think of the trellace in the back also seen in the togavirus sketch)
159
How does Hantavirus do damage?
Pulmonary capillary leak -> think of Paul Bunyan's sweaty shirt
Leads to pre-renal azotemia
160
What are the unique characteristics of Arenavirus and what is its most famous subtype?
Ambisense (ambidextrous) - both positive and negative RNA virus
-> circular with two segments (two gladiators fighting in circles)
Rodents are the reservoir
Causes LCV -> lymphocytic choriomeningitis virus (aseptic meningoencephalitis)
161
What type of virus is Zikavirus? What is its symptom other than congenital microcephaly?
Flavivirus transmitted by Aedes mosquito (like Dengue fever)
Symptom - conjunctivitis
162
Why is rotavirus important and how does it mediate its disease? Genome structure?
Most important global cause of diarrhea in young children
Mediates disease via NSP-4 protein which increases permeability of intestinal lumen to chloride
Note it is a dsRNA virus with 11 segments
163
What other Reovirus is important other than rotavirus and what are its symptoms?
Colorado tick fever
- > similar to Rocky Mountain Spotted Fever, except no rash
- > same area. Lack of rash is how you differentiate
164
What type of vaccine is rotavirus vaccine? Side effect?
Live attenuated oral vaccine (think of the news anchor putting the mic up to his mouth)
-> Enlargement of Peyer's patches can act as a leadpoint for intussuception
165
What eye problems does HSV-1 cause?
Keratoconjunctivitis - serpiginous ulcers seen on slit lamp exam
-> think of the snakes around Hermes' torch
166
What is the strongest association with erythema multiforme?
HSV-1, targetoid lesions which are small and advance up the arm -> the of the targets on Hermes' arm
167
What are the atypical lymphocytes in EBV called and what are they?
Downey cells - Reactive CD8 cytotoxic cells (not the infected B cells)
168
What receptor EBV use to infect cells?
Infects the CD21 receptor on B cells
| -> must B 21 years old to enter Epstein's Barr
169
What type of Hodgkin lymphoma is associated with EBV? What type of oral lesion is EBV associated with?
Mixed cellularity subtype -> the subtype seen in immuncompromised patients with eosinophilia
Can cause hairy oral leukoplakia in HIV patients
170
Where does CMV lie latent?
Mononuclear cells, i.e. T cells, B cells, and macrophages
171
How do CMV and HSV-1 esophagitis differ?
HSV-1 - shallow, punched out ulcers
| CMV - linear ulcers -> think of the conveyor belt in sketchy
172
How do you tell apart mono caused by CMV and EBV?
CMV - monospot test NEGATIVE (no heterophile antibody)
| EBV - monospot positive -> think of the target in the bar
173
What do you suspect if someone presents with new onset blindness in one eye and vesicles on their forehead?
Herpes Zoster Ophthalmicus -> from reactivation in the V1 distribution of the trigeminal ganglion
174
What type of vaccine is used for VZV?
Live attenuated vaccine in both children and adults (>60 years, for singles)
175
What are the features of VZV torch infection?
Limb hypoplasia - small limbs of doll
Blindness - bird eating doll eye
Dermatomal scarring - think of doll stuffing in a dermatomal distribution
Last two should be obvious because they are both complications of shingles in adults.
176
What exanthem does HHV-6 cause and what does the virus infect?
Exanthem subitum. Virus infects CD4 T cells (think of the helper squire)
177
What are the clinical symptoms of exanthem subitum?
4 days of high fever which can cause febrile seizures, followed by a rash that appears "subitum" or suddenly, has a lacy appearance and spares the face. Rash occurs after fever (blue flames)
(Roseola)
178
What do Kaposi sarcoma lesions appear and what is the most common spot?
Appear anyone on skin or on mucous membranes, including GI tract
Most common spot is the hard palate -> think of how Kate's Posie's roof is like a hard palate, also your exam question
179
What is the structure of polyomaviruses? Is it enveloped?
Circular dsDNA virus which has NO envelope (JC's robe is falling off)
180
What causes PML and how can it be differentiated from toxoplasmosis on CT?
Caused by JC virus when CD4 < 200. Differentiated from toxoplasmosis because lesions on non-enhancing on CT / MRI scan (vs toxo). This is because toxoplasmosis causes vasogenic edema (breakdown of BBB).
Remember cytotoxic edema would be gray matter edema due to cellular swelling (loss of Na/K ATPase activity)
181
What is interstitial edema?
Interstitial edema is non-protein increasing (vs vasogenic) breakdown of the BBB, usually near the ventricles, due to increased ICP (i.e. communicating hydrocephalus).
182
What disease does HPV commonly cause in the mouth of children?
HPV 6 & 11 are associated with vertical transmission and can cause multiple papillomas on the true vocal cords called laryngeal papillomatosis
-> think of the kid eating the pillbug
183
What childhood exanthem does Parvovirus B19 cause? What is it's pattern of spread which allows you to differentiate it from Roseola?
Erythema infectiosum - Slapped Cheek Rash - 5th disease
Much like Roseola, it starts after the fever and the child is not contagious by the time the rash has appeared. However, the rash STARTS on the face and spreads downward (vs Roseola which normally spares the face) -> think of the plane with flames coming from the head of it.
Also, the fever is much lower in Parvo infection and will not cause febrile seizures.
184
What syndrome does Parvovirus cause in adolescents sometimes? How is it unique?
Papular purpuric gloves and stocks syndrome
| -> they will have purple extremities and WILL be contagious
185
What type of vaccine is given for adenovirus and who is it given to?
Live vaccine -> it would be grim to draw dead lions in "a den of" lions sketch
Given to military recruits who are at high risk of spread
-> spread via fecal-oral route (children) and respiratory droplets in close quarters
186
What are the cellular inclusions of poxviruses and what are they called?
Intracytoplasmic bodies (Large since they replicate entirely in the cytoplasm)
They are called "Guarnieri bodies" -> the name of the shipping company
187
What is Smallpox also called and how does it differ from Varicella in terms of rash?
Variola
Smallpox -> all lesions are the same age
Varicella -> all ages are welcome to the play.
188
What main protein does Hepatitis B use in the process of replication? What does replication of Hepatitis B occur?
"P-protein" - a DNA polymerase which has both DNA-dependent and RNA-dependent (reverse transcriptase) capabilities
Occurs in both nucleus and cytoplasm -> think of the guy popping his head out in sketchy.
189
What is the process of replication for Hepatitis B virus?
Partially dsDNA genome enters the cell and promptly enters the nucleus.
Upon entering the nucleus, P protein finishes transcription to a dsDNA circular genome.
Host (human) DNA-dependent RNA polymerase makes a + sense RNA from the viral - sense DNA.
+ sense RNA is used to make viral proteins in the cytoplasm, as well as P-protein acts upon it via reverse transcriptase to synthesize - sense DNA. It also acts in a DNA-dependent method to make it partially double-stranded, and replication is complete.
190
What antibody should be tested for during the window period of Hep B?
Check for Anti-HBc -> core antigen
These antibodies will be elevated and IgM. During a window period, anti-HBs is eliminating HBsAg so both may be undetectable in the blood.
191
What drugs are used to treat chronic HBV infection?
Think NRTIs (lady wielding mace) and lamivudine (lamb), as well as IFN-alpha antenna
Most commonly used are entecavir and tenofovir, suppressing virus
192
What is used for HBV prophylaxis in possibly exposed infants?
Combination of HB Ig and HB vaccination (active and passive immunization within 12 hours)
193
What is the structure of HDV genome and what is required?
```
RNA deltavirus - negative sense necklaces
Circular RNA (headband)
```
Requires HBsAg for infectivity. Superinfection is worse than coinfection (think of how annoyed the dad is for having his kid sitting on top of him)
194
What is the significance of having anti-HBe antibodies?
Indicates the infection is less transmissible, even if you haven't yet resolved the infection (i.e. no anti-HBs yet)
- > particularly relevant for pregnant mothers
- > HBeAg indicates a >90% chance of vertical transmission, vs
195
What type of viral meningitis / encephalitis is associated with flaccid paralysis and parkinsonian features?
West Nile Virus -> this virus is neuroinvasive causing a myelitis similar to polio
-> think of the bird with the flaccid neck
-> basically the picture of polio in the United States.
-> can also cause parkinsonian tremor
#1906
196
How is Neisseria meningitidis spread? What allows this spread?
Nasopharyngeal swab of mac -> respiratory secretions.
Attachment to the nasopharyngeal epithelium is mediated via the pili which displays antigenic variation
The capsule (vaccine target) just prevents phagocytosis by the immune system
197
Why does Clostidium perfringens cause a double zone of hemolysis on blood agar?
It possess a toxin called lecithinase / phospholipase C / alpha toxin which cleaves phospholipids in cells, even RBCs, causing them to lyse.
198
Where is Staph aureus vs Entamoeba histolytica abscess likely to come from?
S. aureus -> abscess likely to spread hematogenously, and more likely in developed countries.
Entamoeba -> likely to ascend portal track into liver, especially in developing countries (transmitted fecal-orally). Not going to happen due to a stabwound lol.
199
What type of vaccine is the rabies vaccine? What are the symptoms of raging infection?
Killed vaccine - think of the vaccine with a skull and cross bones rifle in sketchy
Symptoms - encephalitis which causes foaming at the mouth, laryngeal spasm, hydrophobia (Fear of water), aerophobia (spasm provoked with air blowing), dysphagia, coma.
200
What is cord factor?
A membrane glycolipid which prevents phagolysosome acidification in TB and leads to the formation of caseating granulomas. It is required for virulence.
201
What are the symptoms of dengue fever?
Break bone - arthralgias and myalgias
Hemorrhagic fever -> bleeding, thrombocytopenia
Retro-orbital pain and flu-like symptoms
May precipitate acute renal failure #11377
202
What is Donovanosis also called and what is it caused by?
Granuloma inguinale
STI caused by Klebsiella granulomatis
203
What are the features of Donovanosis and how is it told apart from LGV?
Starts as a painless, beefy red ulcer.
Donovan bodies will be present in the cytoplasm (K. granulomatis) similar to the intracytoplasmic bodies of LGV.
However, Donovanosis is NOT associated with painful lymphadenopathy, unlike LGV
204
Why is campylobacter more likely to be transmitted to you by dogs than Shigella?
Shigella is a human-only pathogen -> cannot be carried by animals.
Note that Salmonella typhi is also humans only.
205
What does it mean to be oxidase positive? Can you respire without it?
Means you possess a specific cytochrome c oxidase (Complex IV) which makes the test positive
Yes, you can respire without it, using different cytochromes for terminal electron deposition (i.e. E. coli is a facultative anaerobe which can respire oxygen, and is oxidase negative).
206
What is the hemolysis pattern of enterococcus and S. bovis? Are they aerobic or anaerobic?
Gamma hemolytic - shows no hemolysis on blood agar
They are facultative anaerobes.
207
Give two ways S. bovis is told apart from enterococcus?
1. S. bovis cannot grow in 6.5% NaCl
| 2. S. bovis is PYR negative while enterococcus is PYR positive.
208
What are the symptoms of botulinum toxin toxicity?
Both muscarinic and nicotinic blockade -> motor and autonomic symptoms
- > Anticholinergic symptoms - dry mouth fixed pupillary dilation
- > antinicotinic symptoms - diplopia, dysphagia, respiratory depression
209
What does botox toxin do to the CMAP (compound motor action potential)?
General decrease in CMAP due to loss of amount of ACh release when stimulated (cleaved tSNARE/vSNARE proteins)
However, repetitive stimulation increases the Ca+2 in the cytosol and can somewhat improved this generalized decrease (rapid stimulation = improvement). A little bit similar to LEMS, but will not totally recover
210
How will neurocysticercosis usually present?
Seizures and non-enhancing brain lesion in an immunocompetent immigrant patient from Central / South America #11670
211
Does H. influenzae produce an IgA protease?
Yes. Fuck sketchy
212
How does the healing of a primary TB lesion differ from secondary?
Primary - forms calcified Gohn complex which heals by fibrosis + calcification (Ranke complex)
Secondary - tends to form a cavity lesion -> this is where aspergillomas can form
213
What portion of Lipopolysaccharide (LPS) is bioactive and mediates septic shock?
The Lipid A component in the membrane -> binds CD14 on macrophages (TLR4)
Think LPS = Lipid A
The O antigen is only useful for typing, and is the carbohydrate moiety expressed on the bacterial surface
214
How do you tell apart ABPA from asthma due to dust mites?
ABPA (allergic bronchopulmonary aspergillosis) typically presents with signs of bronchiectasis, mucus plugging, and patchy infiltrates
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Asthma exacerbations due to dust mites will usually show a normal chest X-ray
#1925
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