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RESPII > Microbiology Review > Flashcards

Microbiology Review Flashcards

1
Q

Bordetella pertussis

A

Whooping cough
Gram negative aerobic coccobacillus capsulate
Humans are only known reservoir

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2
Q

Bordetella pertussis: clinical manifestations

A

Onset of symptoms 1-3 weeks after exposure
Catarrhal Phase

Paroxysmal phase - Uncontrollable expirations, followed by gasping inhalation – whooping cough, associated with post cough cyanosis, gagging, and vomiting

Convalescent Phase -Reduction in frequency and severity of cough can last from weeks to months

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3
Q

Bordetella pertussis: treatment

A

Supportive
Azithromycin
Chemoprophylaxis to control outbreaks

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4
Q

Klebsiella pneumonia

A

Gram negative, non-motile, capsulate rods
Facultative anaerobes
UTI, soft tissue infections, endocarditis, central nervous system infections, and severe bronchopneumonia.
Community and hospital acquired pneumonias
Cavitary lung lesions
Currant Jelly sputum

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5
Q

Moraxella catarrhalis

A 
Gram negative bacteria that grows well on blood or chocolate agar
diplococci
Catalase positive
Oxidase positive
Pneumonia, especially in the elderly
Otitis media in young children
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6
Q

Neisseria meningitidis

A

Aerobic gram negative kidney shaped diplococci, capsule

Oxidase positive, ferments maltose and glucose Grows on Thayer-Martin media, chocolate agar

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7
Q

Neisseria meningitidis: clinical manifestations

A

Meningitis
Septicemia
Pneumonia
Septic arthritis, pericarditis, chronic bactermia, or conjunctivitis

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8
Q

Neisseria meningitidis: treatment & prevention

A

Penicillin
3rd generation cephalosporin

Chemoprophylaxis with rifampin in close contacts
Meningococcal polysaccharide-protein conjugate vaccines

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9
Q

Neisseria meningitidis: prognosis

A

Untreated systemic disease with 70-90% mortality
10% mortality with treatment
Morbidity
Limb loss, hearing loss, long-term neurologic disability

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10
Q

Pseudomonas aeruginosa

A

Aerobic gram-negative rod
Produces pyocyanin on laboratory medium – blue/green pigment
Primarily nosocomial pathogen
In hospital can colonize moist surfaces of the axilla, ear, and perineum

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11
Q

Pseudomonas aeruginosa: infections

A

HAP, VAP
Community acquired infections related to hot tubs, whirlpools, swimming pools, and extended contact lenses
Otitis externa
Puncture wounds through tennis shoes
Endopthalmitis – complication of eye surgery
Endocarditis, from sharing contaminated needles
UTI
Skin Infections, burns, ecthyma gangrenosum

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12
Q

Pseudomonas aeruginosa: Host & Bacterial Factors

A

Host Factors – Neutropenia increases risk

Bacterial Factors
exotoxins, endotoxins, type III secreted toxins, pili, flagella, proteases, phospholipases, iron-binding proteins, exopolysaccharides, the ability to form biofilms, and elaboration of toxic small molecules such as pyocyanin

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13
Q

Pseudomonas aeruginosa: treatment

A

Extended spectrum penicillin and aminoglycoside combination

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14
Q

Chlamydophila psittaci

A 
Gram negative obligate intracellular bacteria
Macrophages are the principal host cell
Diseases
  Psittacosis
  Atypical pneumonia
  Febrile illness
Transmission - Aerosolized bird secretions, dust
Diagnosis - Serology
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15
Q

Chlamydophila psitacci: treatment & prevention

A

Treatment : tetracyclines, macrolides, fluoroquinolones

Prevention
30 day quarantine for all imported psittacine birds and their treatment with feed containing chlortetracycline

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16
Q

Chlamydophila pneumoniae

A

80% of adults are seropositive
Common infection in children under 5 years old
Atypical pneumonia
Incubation several weeks
Non productive cough
Preceded by nasal congestion, sore throat, and hoarseness
Headaches in ½ of patients

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17
Q

Chlamydophila pneumoniae: PE

A 
Examination
  Crackles, rhonchi
Chest x-ray
  Pneumonitis
Labs 
  Normal white count
Prolonged course over several weeks
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18
Q

Chlamydophila pneumoniae: treatment

A

Tetracyclines
Macrolides
Fluoroquinolones

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19
Q

Coxiella burnetii

A

Gram negative that infects hosts monocytes
Will multiply in immunocompromised patients and endocarditis patients despite high antibody levels
Infects mammals, birds, and ticks
Mammals infected by aerosols and may shed Coxiella in feces, urine, milk, and birth products
Survives in environment and can be spread by the wind

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20
Q

Coxiella burnetii: Q fever

A

Prolonged fever, pneumonia, hepatitis, rash
Meningitis, encephalitis, meningoencephalitis, peripheral neuropathy
Pericarditis, myocarditis
Chronic uterine infection during pregnancy, may later experience multiple spontaneous abortions
Q-fever endocarditis
Intermittent fever
Vegetations frequently absent
Cerebral emboli, renal insufficiency, splenomegaly, hepatomegaly

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21
Q

Coxiella burnetii: treatment

A

Doxycycline x 2 weeks in acute cases

Doxycycline + hydroxychloroquine(increases phagosomal pH) for 18-36 months for endocarditis

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22
Q

Francisella tularensis

A

Small aerobic pleomorphic gram-negative bacillus
Not communicated person to person
Extreme risk to lab personnel

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23
Q

Francisella tularensis: Ulceroglandular

A 
Fever and constitutional symptoms
Swollen lymph nodes that drain an inoculation site
Ulcer formation
Sore throat
Patchy infiltrates on chest x-ray
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24
Q

Francisella tularensis: Glandular & Typhoidal

A

Glandular
Fever
Constitutional symptoms
Lymphadenopathy

Typhoidal
Fever of unknown cause

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25
Q

Francisella tularensis: Oropharyngeal Disease

A

Uncommon in the United States
Mucous membranes of the mouth and pharynx are the portal of entry
Contaminated water or food such as inadequately cooked game meat is the source
Painful exudative pharyngitis and tonsillitis
Pharyngeal ulcers
Swollen retropharyngeal and cervical lymph nodes

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26
Q

Francisella tularensis: Pneumonic disease

A

Inhalation exposure
Fever, malaise, dry cough, substernal discomfort, pleural effusion, dyspnea, and sore throat
Chest x-ray with peribronchial infiltrates to bronchopneumonia with effusion
Hilar adenopathy

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27
Q

Fransicella tularensis: treatment

A

Gentamcin or streptomycin
Doxycycline
Ciprofloxacin

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28
Q

Bacillus anthracis

A

Spore forming gram-positive non motile rod, aerobic or facultatively anaerobic, catalase positive, hemolysis negative
Grows on sheep agar
Zoonotic infection
Animal related products include meat, wool, hides, bones, and hair
Soil contaminated with spores

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29
Q

Bacillus anthracis: clinical manifestations

A 
Inhalation
  Mediastinal adenopathy
  Mediastinal widening
  Pleural effusion
  Rapidly fatal if not treated 
Meningeal
  Nearly always fatal, can occur as complication of inhalation, cutaneous , or gastrointestinal disease
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30
Q

Bacillus anthracis: treatment, prevention, prognosis

A 
Treatment
  Multi-drug regimen
  Pleural drainage
Prevention
  Vaccination for possible exposure
  Post-exposure antibiotics
Prognosis
  45% mortality of inhalation in 2001 attacks
  20% mortality in untreated cutaneous disease
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31
Q

Yersinia pestis

A

Gram negative coccobacillus, microaerophilic, nonmotile, and non spore forming
Transmission cycles involve rodents and fleas, which act as vectors.
Prairie dogs are a common host

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32
Q

Bubonic Plague

A

Swollen, tender lymph nodes (buboes) closest to site of initial infection
Fevers, chills, myalgia, arthralgia, headache, malaise, and prostration
Untreated patients have continued fever, tachycardia, agitation, confusion, delirium, and convulsions

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33
Q

Septicemic Plague

A

Nausea, vomiting, diarrhea, and abdominal pain
Disseminated intravascular coagulation
Hypotension, renal failure, and obtundation
ARDS

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34
Q

Pneumonic Plague

A

Fever, cough, chest discomfort, tachycardia, dyspnea, bacteria laden sputum, chills, headache, myalgias, weakness, and dizziness
Respiratory distress, hemoptysis, cardiopulmonary insufficiency, and circulatory collapse
Death within2 24 hours of symptoms

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35
Q

Yersinia pestis: treatment

A

Streptomycin for pneumonic plague
Tetracyclines for bubonic plague
Chloramphenicol for meningitis

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36
Q

Leptospirosis

A 
Spirochete with terminal hook
Identified on dark field microscopy or silver staining
Obligate aerobe
Clinical Manifestations
  Weil’s Disease:
  Pulmonary Hemorrhage Syndrome
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37
Q

Leptospirosis: early clinical manifestations

A 
First 3-7 days
Fever, myalgia, and headache
Nausea, vomiting,  abdominal pain, diarrhea, cough, and photophobia
Muscle tenderness
Rash
Conjunctival suffusion
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38
Q

Leptospirosis: Late Phase-Weil’s Disease

A 
Jaundice
Acute hemorrhage
Renal Failure
Severe thrombocytopenia
GI bleeding
Pulmonary Hemorrhage
Myocarditis
Aseptic meningitis
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39
Q

Leptospirosis: diagnosis, treatment, prevention

A 
Diagnosis
  Agglutination test
Treatment
  Doxycycline
  Penicillin
Prevention
  Doxycycline post-exposure
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40
Q

Haemophilus influenzae

A

Encapsulated gram negative pleomorphic rod
Aerobic or facultative anaerobic
Grows on chocolate agar
Factor X(hemin) and Factor V(NAD)
Nasopharynx of adults and children
H influenza type b was most common cause of meningitis in young children prior to effective vaccines

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41
Q

Haemophilus influenzae: meningitis

A

Children under 5 years old and in adults with skull trauma or CSF leaks
Type B strains
Diagnosis made by detecting PRP capsular antigens in CSF

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42
Q

Haemophilus influezae: epiglottitis

A

Life threatening infection in children that usually occurs in children younger than 5.
Symptoms include fever, drooling, dysphagia, and respiratory distress with stridor
Course is rapid over a couple of hours
Lateral neck film used for diagnosis

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43
Q

Haemophilus influenzae: pneumonia & bronchitis

A 
Pneumonia:
  Fever, cough, and lobar consolidation
  Parapneumonic effusion and empyema
  Diagnosed by blood culture or culture from pleural fluid
  Smoking – risk factor
Bronchitis
  Risk factor is chronic lung disease ( COPD)
Acute Sinusitis
Otitis Media
44
Q

Haemophilus influenzae: treatment & prevention

A

Treatment:
3rd generation cephalosporin for meningitis
Prevention
Conjugate capsular polysaccharide-protein vaccine effective for type b disease
Antibiotic prophylaxis in nonimmunized household or daycare contacts of patients with H influenza type b
Rifampin

45
Q

Corynebacterium diptheriae

A 
Gram-positive bacillus – club shaped
Non-spore forming
Aerobic
Reservoir:
  Throat and pharynx
Transmission:
  Bacterium or phage via respiratory droplets
46
Q

Respiratory Diptheria

A

Incubation of 1-7 days
Sore throat, malaise, and fever
Pharyngeal erythema followed by tonsillar exudate
Exudate changes into a grayish membrane that is tightly adherent and bleeds on attempted removal

47
Q

Corynebacterium diptheriae: clinical

A

Cervical adenopathy – Bull Neck
Stridor
Extension of membrane can lead to airway obstruction
Myocariditis, recurrent laryngeal nerve palsy, and peripheral neuritis

48
Q

Corynebacterium diptheriae: treatment & prevention

A 
Treatment:	
  Erythromycin
  Antitoxin
Prevention:
  Vaccination with toxoid vaccine
49
Q

Legionella pneumophila

A

Weakly gram-negative pleomorphic rod
Facultative intracellular
Requires cysteine and iron ( Charcoal yeast extract)
Water organism, amebae, air-conditioning water cooler tanks
No human to human transfer
Risk Factors: smokers over age 55 with high alcohol intake and immunosuppression

50
Q

Legionaire’s disease

A

Fevers, malaise, cough, chills , dyspnea, myalgias, headache, chest pain, and diarrhea.
Myalgias, severe headaches, and diarrhea distinguish it from other pneumonias
Mental Confusion

51
Q

Pontiac Fever

A

Fever, sore throat myalgia, headache, and extreme fatigue

Short duration, lasting on average 3 days

52
Q

Legionella pneumophila: diagnosis & treatment

A

Diagnosis
Antigen urine test
DFA ( direct fluorescent antibody)

Treatment
Fluoroquinolones, azithromycin, or erythromycin + rifampin for immunocompromised patients
Drug must penetrate human cells

53
Q

Mycoplasma pneumonia

A

Smallest free-living bacteria
No cell wall – unaffected by cell-wall inhibiting antimicrobials such as B-lactams
Sterol containing membrane
Requires cholesterol for culture
Transmission: respiratory droplets, close contact, families, military recruits, dorms
Highest incidence age 5-20 years old

54
Q

Mycoplasma pneumonia: clinical manifestations

A 
Respiratory Infection
  2-3 weeks incubation
  Fevers, malaise, headache, and cough
  5-10% progress to tracheobronchitis or pneumonia
  Cough usually non-productive
  Walking pneumonia
Bullous myringitis
55
Q

Mycoplasma pneumoniae: diagnosis & treatment

A

Diagnosis
Positive cold agglutinins - positive in 65% of cases

Treatment
Macrolides: erythromycin, azithromycin, and clarithromycin
Tetracyclines

56
Q

Streptococcus pneumonia

A

Gram positive diplococcus, lancet shaped
Facultative anaerobe, grows on blood agar plates
alpha hemolytic
Optochin sensitive
Lysed by bile
Reservoir – human upper respiratory tract
Transmission – respiratory droplets

57
Q

Streptococcus pneumonia: patho

A

Pathogenesis:
Polysaccharide capsule
Risk Factors
Influenzae infection, COPD, CHF, Alcoholism, and asplenia
Pathobiology
Initially colonizes the nasopharynx then aspirated

58
Q

Streptococcus pneumonia: clinical manifestations

A 
Typical Pneumonia
  Most common cause
  Shaking chills, high fever, chills, rigors, lobar consolidation, blood tinged (rusty) sputum
Adult meningitis
  Most common cause in adults
Otitis media and sinusitis
  Most common cause in children
59
Q

Streptococcus pneumonia: treatment

A

Treatment of pneumonia
Beta lactams
Macrolides
Fluoroquinolones

Treatment of meningitis
3rd generation cephalosporins
Vancomicin added if penicillin resistant

60
Q

Severe Acute Respiratory Syndrome (SARS)

A

Coronavirus – second most common cause of the common cold
Reservoir: birds and small mammals
Virus is also found in urine, sweat, and feces
Original case thought to be transmitted from animal to human

61
Q

SARS: clinical manifestations

A 
Fever greater than 100.4 F
Flu-like illness
Dry cough
Dyspnea
Progressive hypoxia

Diagnosis
Clinical history and history of travel to endemic area or association with a traveler
Travel to far east or Toronto.

62
Q

SARS: treatment

A

Treatment is supportive

Mortality is 50% in the elderly

63
Q

Varicella-Zoster Virus

A

Reservoir – human mucosa and nerves
Transmission – respiratory droplets
Virus infects epithelial cells and lymphocytes in the oropharynx and upper respiratory tract, then infected lymphocytes spread the virus throughout the body.
The virus enters the skin through endothelial cells in blood vessels and spreads to epithelial cells where it causes a vesicular rash.
Virus remains dormant in the cranial nerve ganglia and dorsal root ganglia. Reactivation of virus leads to Herpes zoster .

64
Q

Varicella-Zoster Virus: treatment

A

Shingles – oral acyclovir
Immunocompromised with shingles – IV acyclovir
Aspirin contraindicated due to Reye’s syndrome

65
Q

Varicella-Zoster Virus in immunocompromised

A

Vaccine contraindicated in hematologic malignant neoplasms, AIDS, HIV infection with CD4 count of 200/mm3 or lower, and in persons receiving high dose immunosuppressive therapy, or anti-tumor necrosis factor –a therapy.
VZIG (varicella-zoster immunoglobulin) post exposure prophylaxis of immunocompromised patients

66
Q

Staphylococcus aureus

A 
Gram positive cocci in clusters
Catalase positive
Coagulase positive
Beta hemolytic
Small yellow colonies on blood agar
Ferments mannitol
67
Q

Staphylococcus aureus: virulence

A

Over 50 virulence factors including adhesins, toxins, enzymes, surface-binding proteins, and capsule polysaccharides
Pathogenesis from tissue invasion and toxin mediated
3 toxin mediated diseases
Staphylococcal food poisoning
Staphylococcal toxic shock syndrome
Staphylococcal scalded skin syndrome

68
Q

Staphylococcus aureus: clinical manifestations

A

Skin manifestations include impetigo, folliculitis, furuncle, abscess, erysipelas, cellulitis, mastitis, necrotizing fasciitis, and wound infections
Bacteremia
Endocarditis
Roth’s spots, Osler’s nodes, Janeway lesions, and petichiae
Pericarditis
Osteomyelitis – hematogenous seeding
Septic Arthritis, Infected prosthetic joints
Pneumonia – nosocomial pneumonia, salmon colored sputum

69
Q

SA Toxin Mediated Diseases

A

Food poisoning – Enterotoxins A-E
2-6 hours after eating nausea, vomiting, diarrhea, and abdominal pain; Self limited

Toxic Shock Syndrome TSST-1 a super antigen
Fever, erythroderma, hypotension, involvement of 3 or more organ systems, and desquamation of the palms and soles

Scalded Skin Syndrome – exfoliative toxin A or B

70
Q

Staphylococcus aureus: treatment

A

Gastroenteritis is self limiting
Nafcillin/Oxacillin
MRSA – Vancomicin

71
Q

Pnemocystis jirovecii

A

Fungus
Obligate extracellular parasite
Silver stain
Opportunistic infection in HIV patients with CD4 count less than 200

72
Q

Pneumocystis jerovecci: pneumonia

A

Fever, nonproductive cough, and shortness of breath
X-ray with patchy infiltrate, ground glass appearance, lower lobe and periphery may be spared
Diagnosis : silver staining cysts in bronchial alveolar lavage fluids or biopsy
Treatment sulfamethaxazole/trimethoprim or dapsone
Prevention SMX/TMP prophylaxis for CD4 counts less than 200 in HIV patients

73
Q

Histoplasma capsulatum

A

Dimorphic fungus
Facultative intracellular parasite – found in RES cells
Found in soil, caves, and abandoned buildings with bird and bat guano
Transmission - Disruption of soil; cleaning attics, bridges, and barns; tearing down old structures, and spelunking
Endemic to Mississippi and Ohio River Valleys

74
Q

Histoplama capsulatum: clinical manifestations

A

Acute pulmonary
Most asymptomatic
Several weeks after exposure fevers, chills, fatigue, non-productive cough, anterior chest discomfort, and myalgias
Chronic pulmonary
Progressive, often fatal
Elderly, immunocompromised, and COPD patients at risk

75
Q

Histoplamsa capsulatum: PE & treatment

A

X-ray
Acute Pneumonia with patchy lobar or multilobar infiltrate
Chronic Pneumonia with upper lobe infiltrates, multiple cavities, fibrosis of lower lobes – mimics TB
Treatmet
Itraconazole
Amphotericin B

76
Q

Coccidiodes immitis

A

Dimorphic fungi
Inhaled arthroconidia enlarge and form spherules
Spherules undergo internal septation producing endospores
Endemic in southwest deserts

77
Q

Coccidiodes immitis: pulmonary infection

A

Symptoms develop 5-21 days after exposure
Fever, weight loss, fatigue, dry cough, and pleuritic chest pain
Arthralgias
Erythema nodosum
Chest x-ray with pulmonary infiltrates, hilar adenopathy, and peripneumonic effusion
Pulmonary Nodule, cavitary

78
Q

Coccidiodes immitis: treatment

A

Disseminated infection
Immunocompromised , e.g. AIDS
3rd trimester pregnancy
Skin, joints, and bones

Treatment
Itraconazole
Amphotericin B

79
Q

Paramyxoviruses

A 
Enveloped, helical nucleocapsid
Negative-sense ssRNA
Parainfluenza
Measles
Mumps
RSV
80
Q

Parainfluenza

A

Transmission by large particle fomites and close person-to-person contact
Most children exposed by start of elementary school
Coryza, rhinorrhea, pharyngitis without lymphadenopathy, and low grade fever
Symptoms usually last 3-5 days
Signs of lower tract infection present as croup

81
Q

Parainfluenza: clinical

A

Croup
Raspy, barking cough with inspiratory stridor, dyspnea, and respiratory distress
Symptoms result from subglottic inflammation and edema
Bronchiolitis or Pneumonia
Cough, rales, wheezing, and hypoxia
Cold
Reinfection of adults with parainfluenza typically causes cold symptoms in normal adults and children

82
Q

Measles – Rubeola

A

Highly contagious
3 C’s cough, coryza, conjunctivitis
Generalized maculopapular rash
Fever
Transmission by direct contact with large respiratory droplets
Infectious 4 days prior to rash until 4 days after onset of rash

83
Q

Measles – Rubeola: clinical

A

Incubation 8-12 days
Prodrome of fever, cough, coryza, conjunctivitis, and Koplik spots
Malaise, myalgia, and headache
Koplik spots proceed rash by 1 day and are resolved 2 days into rash
Rash typically starts 2-6 days after the onset of catarrhal symptoms and starts on face or behind ears as individual macules. Rash coalesces, forms papules and progresses from head to trunk to extremities. Rash covers entire body by 4 days. Fades in same order.

84
Q

Measles – Rubeola: complications

A

Diarrhea, otitis media, and pneumonia
Postinfectious encephalomyelitis
2 weeks after rash with onset of headache, recurrence of fever, vomiting, stiff neck
25% mortality
33% of survivors with neurologic sequelae
Subacute sclerosing panencephalitis
Degenerative demyelinating disease due to chronic infection.
Occurs years after the acute measles infection and is universally fatal

85
Q

Measles - Rubeola: treatment

A

Treatment is supportive
Prevention
Live, attenuated vaccine - MMR

86
Q

Mumps

A

Transmission droplet spread of upper respiratory secretions
Incubation 18 days
Clinical Manifestations
Parotitis
Aseptic Meningitis – common and usually mild
Encephalitis rare and severe
Orchitis
Treatment – supportive
Prevention – live, attenuated vaccine - MMR

87
Q

Respiratory Syncytial Virus

A

Epidemics begin in late fall in southern states and peak in February and March in colder climates
60% of bronchiolitis and 25% of pneumonia in infants
Transmission
Direct contact with large-particle fomites of respiratory secretions

88
Q

RSV: Clinical Manifestations - infants

A

Conjunctival injection, mucopurulent nasal discharge, cough, low-grade fever
Otitis Media
Lower respiratory symptoms in 25-50% of infants with cough, wheezing, tachypnea, use of accessory muscles, and cyanosis.
Expiratory wheezing, rhonchi, and fine rales on lung examination
Chest x-ray
Hyperinflation and diffuse interstitial pneumonitis

89
Q

RSV: treatment

A

Treatment – Ribavarin
Prevention
Frequent handwashing
No vaccination available

90
Q

Strongyloides stercoralis

A

Exposed skin comes in contact with free-living filiariform larvae living in contaminated soil. After skin penetration, larvae enter the afferent circulation and travel to the pulmonary vasculature, where they rupture into the alveolar spaces, ascend the respiratory tree, and are swallowed into the GI tract. Development into adult worms occurs in the upper part of the small intestine. Female worms begin laying eggs. Eggs hatch in the lumen of the small intestine. Rhabditiform larvae migrate to the colon and are passed in the feces.

91
Q

Strongyloides stercoralis: clinical

A

Pulmonary Manifestations
Can be severe in immunocompromised
Resembles ARDS with acute onset of dyspnea, productive cough, and hemoptysis accompanied by fever, tachypnea, and hypoxemia

Treatment - ivermectin

92
Q

Aspergillosis

A

Ubiquitous organisms found in soil, decaying matter, and air.
Spore like conidia are aerosolized from the mold form of the organism.
They reach tissue and form invasive hyphae.
Can be isolated from basements, crawl spaces, bedding, humidifiers, ventilation ducts, potted plants, dust, condiments, and marijuana

93
Q

Invasive Aspergillosis

A 
Immunocompromised host
Fever
Pulmonary infiltrates
Nodules
Wedge-shaped densities resembling infarcts
Sinusitis
Extrapulmonary sites
  CNS abscesses, endophthalmitis, MI, GI, renal, osteomyelitis, endocarditis
94
Q

Invasive Aspergillosis: diagnosis & treatment

A

Diagnosis: BAL, needle aspiration, thoracoscopic biopsy, or open lung biopsy

Treatment
Antifungal- Voriconazole or liposomal amphotericin B
Reversal of immunosuppression
Surgical resection of infected lesions

95
Q

Chronic Pulmonary Aspergillosis

A

Aspergilloma
Ball in cavity
Debris in preformed cavity from TB, Histoplamosis, or fibrocystic sarcoidosis

Treatment
Limited benefit with aspergilloma
Antifungal – itraconazole or voriconazole in chronic cavitary pulmonary aspergillosis

96
Q

Allergic Bronchopulmonary Aspergillosis (ABPA)

A

History of chronic asthma or cystic fibrosis
Airway obstruction, fever, eosinophilia, positive sputum cultures, mucous plugs containing hyphae, brown flecks in sputum, transient infiltrates, proximal bronchiectasis, upper lobe contraction, elevated IgE.
Eosinophilia in blood, sputum, and lung tissue

97
Q

Allergic Pulmonary Aspergillosis: diagnosis & treatment

A 
Asthma
Immediate cutaneous reaction to A. fumigatus antigen
Serum IgE greater than 1000 ng/ml
A. fumigatus specific serum IgE levels
Precipitating serum antibodies to A. fumigatus
Central bronchiectasis
Peripheral eosinophilia
Pulmonary infiltrates
Treatment
  Corticosteroids and itraconazole
98
Q

Cryptococcosis

A

Occurs most often in the immunosuppressed – HIV
Meningitis is most common clinical manifestation
Pulmonary and other organ involvement can occur

Cryptococcus neoformans
Yeast
Environment and tissues
Polysaccharide capsule is the major virulence factor

99
Q

Cryptococcus in immunocompromised

A

Patients at highest risk are those with AIDS and CD4 counts less than 50.
Inhaled from the environment and causes pulmonary infection initially. Most patient asymptomatic.
If the host becomes immunosuppressed the organism can reactivate and disseminate to other sites.
C. neoformans is neurotropic

100
Q

Cryptococcus: meningoencephalitis

A 
Headaches over several weeks
Nuchal rigidity
Lethargy
Personality changes
Confusion
Visual abnormalities
Nausea and vomiting
101
Q

Cryptococcosis: Pulmonary Infection

A

Risk factors include COPD, Corticosteroid use, and solid organ transplant
Fever, cough, and dyspnea
Treated with antifungals

102
Q

Cryptococcosis: diagnosis

A

Yeast is grown in culture from CSF, Blood, sputum, skin lesions, or other body fluids
India Ink stain – visualization of budding yeast with large capsule
Latex agglutination for Cryptococcal polysaccharide antigen

103
Q

Cryptococcosis: treatment of CNS infections

A

Non-AIDS Patients
Amphotericin B and flucytosine for 6 weeks

AIDS Patients
Amphotericin B and flucytososine for 2 weeks, followed by fluconazole 400 mg daily for 8 weeks, then suppressive therapy with fluconazole 200 mg daily

104
Q

Cytomegalovirus

A

Member of herpesvirus family
Double stranded DNA genome
Latent infections
Most clinical disease caused by reactivation of latent virus in the immunocompromised host.
Hallmark pathology is large central basophilic intranuclear inclusion “Owls eye”

105
Q

Cytomegalovirus: clinical

A

Congenital and Neonatal
Microcephaly, intracerebral calcification, hepatosplenomegaly, and rash
Mental retardation and hearing loss
Mother with primary infection during pregnancy

Immunocompetent Most asymptomatic, few with mono like illness

106
Q

Cytomegalovirus in immunocompromised

A 
Transplant Recipients
  Fever, neutropenia, atypical lymphocytes, and hepatosplenomegaly
  Hepatitis – transplanted liver
  Pneumonia
  Colitis - diarrhea
AIDS
  CD4 counts less than 50
  Retinitis
  Colitis
107
Q

Cytomegalovirus: diagnosis, treatment, prevention

A 
Diagnosis
  Culture
  CMV Antigen or nucleic acid detection
  Serology
Prevention
  Reducing exposure to body fluids, “safe sex”
Treatment
  Antivirals

RESPII (5 decks)

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