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Pathology > Microbiology part 2 (p44-58- Fungal, herpes, PUO, GI, HAI, Prion + Zoonoses) > Flashcards

Microbiology part 2 (p44-58- Fungal, herpes, PUO, GI, HAI, Prion + Zoonoses) Flashcards

1
Q

How are fungal infections classified?

A

Yeasts vs Moulds

Superficial vs systemic

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2
Q

How are superficial fungal infections diagnosed?

A

Woods Lamp

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3
Q

Key organisms for superficial fungal infections?

A

Tinea- dermatophyte e.g. tricophyton rubrum: ringworm, athletes foot
Pityriasis- malassezia globossa/furfure- seborrhoeic dermatitis, T versicolor

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4
Q

Key organisms for deep seated fungal infections?

A

Candida- in immunocompromised
Aspergillus
Cryptococcus- immunocomprosised particularly HIV

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5
Q

How are candida infections diagnosed?

A

Culture, mannan, antibodies

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6
Q

How are candida infections treated?

A

Fluconazole for c. albicans and amphotericin-B for invasive disease

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7
Q

How do aspergillus infections present?

A

Pneumonia esp in immunocompromised- high mortality

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8
Q

How are aspergillus infections diagnosed?

A

ELISA, PCR, beta-glucan test, grows on czapek dox agar

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9
Q

How are aspergillus infections treated?

A

Voriconazole

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10
Q

How do cryptococcus infections present in HIV?

A

Meningitis with insidious onset

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11
Q

What animal are cryptococcus infections associated with?

A

Birds especially pigeons

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12
Q

How are cryptococcus infections diagnosed?

A

Cryptococcal antigen in serum/CSF + india ink staining

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13
Q

Tx of cryptococcus infections?

A

3/52 amphotericin B +/- flucytosine

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14
Q

What are the five different classes of antifungals and what do they target?

A 
Polyene e.g. amphotericin- targets cell membrane integrity
Azole- cell membrane synthesis
Terbinafine- cell membrane
Flucytosine- DNA synthesis
Echinocandin- cell wall
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15
Q

How are herpes infections diagnosed?

A

Blood PCR, histopathology, tissue immunofluorescence, cell culture in human fibroblasts, serology

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16
Q

Treatment of Herpes?

A

Ganciclovir, cidofovir and foscarnet

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17
Q

How does roseola virus present?

A

3/7 fever then transient rash
Abx often prescribed for fever then rash blamed on penicillin falsely
Most common cause of febrile convulsions

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18
Q

How is roseola virus diagnosed?

A

Blood PCR

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19
Q

How does VZV present as chickenpox?

A

Fever, malaise, headache followed by characteristic rash. Lesions scab after a week

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20
Q

How is chickenpox diagnosed?

A

Exam- vesicles
Cytology
Immunofluorescence cytology
PCR

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21
Q

What can chicken pox during pregnancy led to?

A

Congenital varicella syndrome- scarring, hypoplastic limbs, cortical atrophy, psychomotor retardation, choreoretinitis, cataracts

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22
Q

Treatment for chickenpox?

A

Acyclovir 800mg PO TDS 7/7 in all adults with chickenpox, neonates, immunocompromised, eye involvement or pain

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23
Q

What causes shingles?

A

VZV reactivation -> stress/decreased immunity

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24
Q

How does shingles present?

A

Painful rash in specific dermatome

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25
Q

Treatment for shingles?

A

Acyclovir 800mg PO 5x daily or famciclovir or valaciclovir
Topic eye drops plus oral for opthalmic
PEP for immunocompromised

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26
Q

How does infectious mononucleosis present?

A

Fever, pharyngitis. lymphadenopathy + maculopapular rash

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27
Q

How is infectious mononucleosis diagnosed?

A

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

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28
Q

How does Burkitt’s lymphoma present?

A

African kids with a big jaw

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29
Q

What is the definition of pyrexia of unknown origin?

A

> 38.3’ fever on several occasions persisting for >3w without diagnosis despite >1w of intensive investigations

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30
Q

4 different types of PUO?

A

Classical
Healthcare associated- develops in patient following >24h in hospital
Neutropenic PUO (<500/uL)- EMERGENCY
HIV-associated PUO

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31
Q

Examples of classical PUO?

A

Infections
Neoplasms
CTD

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32
Q

Examples of healthcare associated PUO?

A

Surgery, drugs, medical devices, LRTI, c diff, immobilisation

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33
Q

Examples of neutropenic PUO?

A 
Chemo
Haematological malignancies
Fungal
Mycobacteria
Drug fever
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34
Q

Causes of fever in returning traveller?

A

Malaria, dengue (rash), typhoid, rickettsia, bacterial diarrhoea, UTI, pneumonia, HIV seroconversion, brucella, viral haemorrhagic fevers (ebola etc)

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35
Q

What pathogen causes typhoid and what would you see on microscopy?

A

Salmonella typhi- anaerobic gram -ve bacillus

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36
Q

Clinical presentation of typhoid?

A

Fever, headache, abdo pain, diarrhoea or constipation, rose spots, relative bradycardia, hepatosplenomegaly

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37
Q

How is typhoid diagnosed?

A

Hx, blood cultures, stool

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38
Q

Management of typhoid?

A

IV fluids, oral or IV abx

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39
Q

What carries malaria?

A

Female anopheles mosquito

Bites at night, attracted by heat and CO2. Needs blood proteins for eggs

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40
Q

Most common pathogen causing malara?

A

Plasmodium falciparum

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41
Q

Common symptoms of p.falciparum malaria?

A 
Fever + rigors
Flu-like
Headache
Back pain
Myalgia
N+V
42
Q

Investigations for p. falciparum malaria?

A

Thick film- find parasitaemia
Thin film- distinguish malaria species
Various antigen tests
Bloods- WCC rarely raised, decreased platelets, deranged LFTs, anaemia

43
Q

Treatment for P. falciparum malaria?

A

Mild- quinine + doxycycline/clindamycin or malarone or riamet
Severe- artemisin combination therapy (ACT) or Quinine + doxycycline/clindamycin

44
Q

Major features of severe malaria?

A 
Impaired consciousness
Seizures
Renal impairment
Acidosis
Hypoglycaemia
Pulmonary oedema
Anaemia
Spontaneous bleeding/DIC
Shock
Haemoglobinuria
45
Q

What is a common source of clostridia botulinum infection?

A

Canned/vacuum packed foods- honey or beans

46
Q

How is c. botulinum treated?

A

Antitoxin

47
Q

What is the pathophysiology of c. botulinum?

A

Toxin blocks Ach release from peripheral nerves -> descending paralysis

48
Q

What is a common source of c. perfringens infection?

A

Reheated meats

49
Q

What is the pathophysiology of c. perfringens?

A

Superantigen enterotoxin binds to TCR + MHC outside peptide binding site -> massive cytokine production by CD4- systemic toxicity + suppression of adaptive responses -> watery diarrhoea and cramps

50
Q

What is a common cause of c difficile?

A

Use of abx e.g. cephalosporins/floroquinones

51
Q

Treatment of c difficile?

A

Metronidazole then vancomycin

52
Q

What is a common source of bacillus cereus infection?

A

Reheated rice

53
Q

Treatment for b cereus?

A

Self limiting

54
Q

Main virulence factor in staph aureus?

A

Protein A

55
Q

Four different types of E Coli?

A

ETEC- Toxigenic/Travellers
EIEC- Invasive dysentery
EHEC- haemorrhagic
EPEC- paeds

56
Q

Treatment for E.coli?

A

Can be self limiting but can treat with ciprofloxacin

57
Q

Treatment for salmonella?

A

Ceftriaxone or ciprofloxacin

58
Q

How does shigella present?

A

Mainly affects the distal ileum + colon -> mucosal inflammation, fever, pain, bloody diarrhoea

59
Q

What is a common route of transmission for yersinia enterocolitis?

A

Food contaminated with domestic animals excreta

60
Q

Which condition causes ‘rice water stool’?

A

Cholera

61
Q

What is the pathophysiology of cholera?

A

Increased cAMP opens Cl- channel at apical membrane of enterocytes -> efflux of Cl- to lumen

62
Q

Common sources of camplyobacter jejuni?

A

Drinking unpasteurised milk or eating food like poultry

63
Q

Treatment for c jejuni?

A

Erythromycin or cipro if first 4-5d

64
Q

Common sources of listeria monocytogenes?

A

Refrigerated food- unpasteurised dairy or veg

Perinatal infection or immunocompromised

65
Q

Treatment for listeria monocytogenes?

A

Ampicillin
Ceftriaxone
Cotrimoxazole

66
Q

Which GI infection is common in MSMs?

A

Entamoeba histolytica- flask shaped ulcers on histology

Shigella etc

67
Q

What GI infection is common in travellers, hikers, MSM and mental hospitals and what is its aetiology?

A

Giardia lambia- from ingesting cysts from faecally contaminated H2O

68
Q

Treatment for Giardia lambia?

A

Metronidazole

69
Q

How is C diff transmittted?

A

Spore ingestion

70
Q

What predisposes c diff infection?

A

Existing gut flora disturbed by antibiotics- particularly 3Cs- clindamycin, cephalosporin + ciprofloxacin

71
Q

What is the bowel like in c diff?

A

Pseudomembranous colitis

72
Q

How do you treat c diff?

A

Oral metronidazole

73
Q

Common UTI HAI?

A

E. coli- RF is catheter

74
Q

What is prion disease?

A

Protein only infectious agent

75
Q

Prognosis of prion disease?

A

Leads to rapid neurodegeneration an death in months- currently untreatable

76
Q

Definition of zoonoses?

A

Diseases and infections which are transmitted naturally between vertebrate animals and man

77
Q

What infections are associated with water sports?

A

Leptospirosis, HAV, Giardia, Toxoplasmosis, Mycobacterium marinum/ulcerans,
Burkholderia pseudomallei, E. coli

78
Q

What infections are carried by food?

A

Listeria (cow cheese-human), Taenia, Cysticercosis, toxoplasmosis, trichinellosis,
yersiniosis, Giardia

79
Q

How is brucellosis transmitted?

A

Inhalation, skin or mucous membrane contact or consumption of contaminated food (dairy), animal contact

80
Q

Symptoms of brucellosis?

A

Fever- undulant (peaks in eve), malaise, rigors, sweating, myalgia, arthralgia, tiredness

81
Q

Complications of brucellosis?

A

Endocarditis, osteomyelitis

82
Q

Signs of brucellosis?

A

Arthritis, spinal tenderness, lymphadenopathy, splenomegaly, hepatomegaly, epididymo-orchitis

83
Q

Investigations in brucellosis?

A

Serology- anti-O polysaccharide antibody, WCC normal, rare leucocytosis, neutropenia

84
Q

Treatment of brucellosis?

A

Tetracycline or doxycline combined with streptomycin

85
Q

What are pathognomonic of rabies?

A

Negri bodies

86
Q

What is presentation of rabies?

A

Prodrome (fever, headache, sore throat) -> encephalitis

87
Q

Treatment of rabies?

A

Rabies IgG post exposure

88
Q

Pathogen that causes plague?

A

Yersinia pestis

89
Q

Types of plague?

A

Bubonic- flea bites human 0 swollen lymph - dry gangrene

Pneumonic- seen during epidemics, person-person

90
Q

Treatment of plague?

A

Streptomycin, doxycycline, gentamicin, chloramphenicol

91
Q

How is leptospirosis commonly transmitted?

A

Excreted in dog/rat urine. Penetrates broken skin/swimming in contaminated water

92
Q

Treatment of leptospirosis?

A

Amoxicillin, erythromycin, doxycycline or ampicillin

93
Q

What pathogen causes anthrax?

A

Bacillus anthracis

94
Q

Symptoms of anthrax?

A

Painless round black lesions with rim of oedema

Pulmonary- massive lymphadenopathy + mediastinal haemorrhage, pleural effusion and resp failure

95
Q

What pathogen causes Lyme disease?

A

Borrelia burgdoferi (spirochaete)

96
Q

Presentation of lyme disease- early localised, disseminated and late persistent?

A

Early localised- cyclical fevers, non specific flu like, erythema chronicum migrans (ECM)- Bullseye rash

Early disseminated- malaise, lymphadenopathy, hepatitis, carditits, arthritis

Late persistent- arthritis, focal neurology, neuropsychiatric disturbances

97
Q

How is Lyme disease diagnosed?

A

Biopsy edge of ECM + ELISA for Lyme Abs

98
Q

Treatment of Lyme disease?

A

Doxycycline 2-3/52

99
Q

What pathogen causes Q fever?

A

Coxiella burnetti

100
Q

How is cutaneous leishmania transmitted?

A

Sandfly bites- skin ulcer

Pathology (13 decks)

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