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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
Treatment for shingles?
Acyclovir 800mg PO 5x daily or famciclovir or valaciclovir Topic eye drops plus oral for opthalmic PEP for immunocompromised
26
How does infectious mononucleosis present?
Fever, pharyngitis. lymphadenopathy + maculopapular rash
27
How is infectious mononucleosis diagnosed?
Blood film, monospot agglutination, EBV antibodies, Paul-Bunnell test
28
How does Burkitt's lymphoma present?
African kids with a big jaw
29
What is the definition of pyrexia of unknown origin?
>38.3' fever on several occasions persisting for >3w without diagnosis despite >1w of intensive investigations
30
4 different types of PUO?
Classical Healthcare associated- develops in patient following >24h in hospital Neutropenic PUO (<500/uL)- EMERGENCY HIV-associated PUO
31
Examples of classical PUO?
Infections Neoplasms CTD
32
Examples of healthcare associated PUO?
Surgery, drugs, medical devices, LRTI, c diff, immobilisation
33
Examples of neutropenic PUO?
``` Chemo Haematological malignancies Fungal Mycobacteria Drug fever ```
34
Causes of fever in returning traveller?
Malaria, dengue (rash), typhoid, rickettsia, bacterial diarrhoea, UTI, pneumonia, HIV seroconversion, brucella, viral haemorrhagic fevers (ebola etc)
35
What pathogen causes typhoid and what would you see on microscopy?
Salmonella typhi- anaerobic gram -ve bacillus
36
Clinical presentation of typhoid?
Fever, headache, abdo pain, diarrhoea or constipation, rose spots, relative bradycardia, hepatosplenomegaly
37
How is typhoid diagnosed?
Hx, blood cultures, stool
38
Management of typhoid?
IV fluids, oral or IV abx
39
What carries malaria?
Female anopheles mosquito Bites at night, attracted by heat and CO2. Needs blood proteins for eggs
40
Most common pathogen causing malara?
Plasmodium falciparum
41
Common symptoms of p.falciparum malaria?
``` Fever + rigors Flu-like Headache Back pain Myalgia N+V ```
42
Investigations for p. falciparum malaria?
Thick film- find parasitaemia Thin film- distinguish malaria species Various antigen tests Bloods- WCC rarely raised, decreased platelets, deranged LFTs, anaemia
43
Treatment for P. falciparum malaria?
Mild- quinine + doxycycline/clindamycin or malarone or riamet Severe- artemisin combination therapy (ACT) or Quinine + doxycycline/clindamycin
44
Major features of severe malaria?
``` Impaired consciousness Seizures Renal impairment Acidosis Hypoglycaemia Pulmonary oedema Anaemia Spontaneous bleeding/DIC Shock Haemoglobinuria ```
45
What is a common source of clostridia botulinum infection?
Canned/vacuum packed foods- honey or beans
46
How is c. botulinum treated?
Antitoxin
47
What is the pathophysiology of c. botulinum?
Toxin blocks Ach release from peripheral nerves -> descending paralysis
48
What is a common source of c. perfringens infection?
Reheated meats
49
What is the pathophysiology of c. perfringens?
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
What is a common cause of c difficile?
Use of abx e.g. cephalosporins/floroquinones
51
Treatment of c difficile?
Metronidazole then vancomycin
52
What is a common source of bacillus cereus infection?
Reheated rice
53
Treatment for b cereus?
Self limiting
54
Main virulence factor in staph aureus?
Protein A
55
Four different types of E Coli?
ETEC- Toxigenic/Travellers EIEC- Invasive dysentery EHEC- haemorrhagic EPEC- paeds
56
Treatment for E.coli?
Can be self limiting but can treat with ciprofloxacin
57
Treatment for salmonella?
Ceftriaxone or ciprofloxacin
58
How does shigella present?
Mainly affects the distal ileum + colon -> mucosal inflammation, fever, pain, bloody diarrhoea
59
What is a common route of transmission for yersinia enterocolitis?
Food contaminated with domestic animals excreta
60
Which condition causes 'rice water stool'?
Cholera
61
What is the pathophysiology of cholera?
Increased cAMP opens Cl- channel at apical membrane of enterocytes -> efflux of Cl- to lumen
62
Common sources of camplyobacter jejuni?
Drinking unpasteurised milk or eating food like poultry
63
Treatment for c jejuni?
Erythromycin or cipro if first 4-5d
64
Common sources of listeria monocytogenes?
Refrigerated food- unpasteurised dairy or veg | Perinatal infection or immunocompromised
65
Treatment for listeria monocytogenes?
Ampicillin Ceftriaxone Cotrimoxazole
66
Which GI infection is common in MSMs?
Entamoeba histolytica- flask shaped ulcers on histology | Shigella etc
67
What GI infection is common in travellers, hikers, MSM and mental hospitals and what is its aetiology?
Giardia lambia- from ingesting cysts from faecally contaminated H2O
68
Treatment for Giardia lambia?
Metronidazole
69
How is C diff transmittted?
Spore ingestion
70
What predisposes c diff infection?
Existing gut flora disturbed by antibiotics- particularly 3Cs- clindamycin, cephalosporin + ciprofloxacin
71
What is the bowel like in c diff?
Pseudomembranous colitis
72
How do you treat c diff?
Oral metronidazole
73
Common UTI HAI?
E. coli- RF is catheter
74
What is prion disease?
Protein only infectious agent
75
Prognosis of prion disease?
Leads to rapid neurodegeneration an death in months- currently untreatable
76
Definition of zoonoses?
Diseases and infections which are transmitted naturally between vertebrate animals and man
77
What infections are associated with water sports?
Leptospirosis, HAV, Giardia, Toxoplasmosis, Mycobacterium marinum/ulcerans, Burkholderia pseudomallei, E. coli
78
What infections are carried by food?
Listeria (cow cheese-human), Taenia, Cysticercosis, toxoplasmosis, trichinellosis, yersiniosis, Giardia
79
How is brucellosis transmitted?
Inhalation, skin or mucous membrane contact or consumption of contaminated food (dairy), animal contact
80
Symptoms of brucellosis?
Fever- undulant (peaks in eve), malaise, rigors, sweating, myalgia, arthralgia, tiredness
81
Complications of brucellosis?
Endocarditis, osteomyelitis
82
Signs of brucellosis?
Arthritis, spinal tenderness, lymphadenopathy, splenomegaly, hepatomegaly, epididymo-orchitis
83
Investigations in brucellosis?
Serology- anti-O polysaccharide antibody, WCC normal, rare leucocytosis, neutropenia
84
Treatment of brucellosis?
Tetracycline or doxycline combined with streptomycin
85
What are pathognomonic of rabies?
Negri bodies
86
What is presentation of rabies?
Prodrome (fever, headache, sore throat) -> encephalitis
87
Treatment of rabies?
Rabies IgG post exposure
88
Pathogen that causes plague?
Yersinia pestis
89
Types of plague?
Bubonic- flea bites human 0 swollen lymph - dry gangrene | Pneumonic- seen during epidemics, person-person
90
Treatment of plague?
Streptomycin, doxycycline, gentamicin, chloramphenicol
91
How is leptospirosis commonly transmitted?
Excreted in dog/rat urine. Penetrates broken skin/swimming in contaminated water
92
Treatment of leptospirosis?
Amoxicillin, erythromycin, doxycycline or ampicillin
93
What pathogen causes anthrax?
Bacillus anthracis
94
Symptoms of anthrax?
Painless round black lesions with rim of oedema | Pulmonary- massive lymphadenopathy + mediastinal haemorrhage, pleural effusion and resp failure
95
What pathogen causes Lyme disease?
Borrelia burgdoferi (spirochaete)
96
Presentation of lyme disease- early localised, disseminated and late persistent?
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
How is Lyme disease diagnosed?
Biopsy edge of ECM + ELISA for Lyme Abs
98
Treatment of Lyme disease?
Doxycycline 2-3/52
99
What pathogen causes Q fever?
Coxiella burnetti
100
How is cutaneous leishmania transmitted?
Sandfly bites- skin ulcer

Pathology (13 decks)

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