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CMBM EXAM 4 LC > Opportunistic Infx > Flashcards

Opportunistic Infx Flashcards

1
Q

list the 3 types of defects in the compromised host and give an example of each ?

A

1- defects or injury to physical barrier
ex- serious burns
2- deficiency in innate immunity
ex- reduced # or function of PMN (leukemia, chemotherapy, cong. immune def.)
3- deficiency in adaptive immunity
ex- t cells (HIV/AIDS) ; B cell and Ab (congen. immune def)

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2
Q

What organisms are the MCC of burn infections (4) which of these are on skin?

A

Pseudomonas, Staph aureus (skin), Strep (skin), Candida (skin)

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3
Q

Where is psuedomonas likely to grow within a hospital?

A

In moist/ wet areas : sinks etc,

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4
Q

In the case of a servere burn patient what factors increase risk of infection?

A

1- burn itself- loss of protective skin
2- severe burns decrease in PMN function
3- hospitalization- at risk for nosocomial infection

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5
Q

Where could aspergillus be found in a hospital?

A

potted plants (soil) , air ducts etc. transmitted to skin via spores

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6
Q

A serverely burned child has multiple nosocomial infections one of which is aspergillus- what is the preferred treatment and what are possible side effects

A

amphotericin - TOXIC TO KIDNEYS

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7
Q

list several possible drug treatments for a pseudomonas infection

A

extended spectrum PCN +/- beta-lactamase inhibitors; carbapenems, aztreonam, fluoroquinolones, ceftazidime, cefepime, aminoglycoside

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8
Q

what are ways a neonate can become infected with Listeria from the mother?

A

transplacental transmission
ascending infx through ruptured amniotic membranes
during birth through infx birth canal

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9
Q

what is the DOC for infant with Listeria infx?

A

Ampicillin + Gentamycin

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10
Q

what is the DOC for mother if showing sx of Listeria

A

Ampicillin

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11
Q

severe asthmatic patient dx with pneumonia. the origin is Nocardia sp. - what made this patient suceptible to this infx?

A

long term cortico steroid therapy !!!!

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12
Q

What are common sources of nocardia bacteria?

A

soil!

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13
Q

What are some KEY buzzwords/characteristics regarding Nocardia?

A

aerobic, G+ bacilli tends to form CHAINS OR FILAMENTS, weakly acid fast

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14
Q

What is the DOC for Nocardia infx?

A

TMP/SMX - folic acid inhibitor

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15
Q

Pt w/ h/o AIDS presents w/ fever, night sweats, fatigue, diarrhea past 3 mo. Dx Mycobacterium avium. GROWING IN MACROPHAGES-
A- how would it be killed?
B- where does it come from?

A

A- normally T cells will kill infx Macrophages

B- soil

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16
Q

When T cell count gets below 50 in AIDS pt what is DOC for Mycobacterium avium tx? CAN USE EVEN AS PREVENTION!

A

Macrolide + Ethambutol

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17
Q

What are some causes of neurologic signs in AIDS patient suspect???

A

AIDS dementia; Toxoplasmosis; EBV- B cell lymphoma; CMV; Coccidiodes/ Cryptococcus; JCV (polyoma virus)

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18
Q

AIDS pt c/o slow onset of progressive confusion/forgetful past 6 weeks; develops hemiparesis on one side of body. CSF fluid PCR dx JCV. What is the dz caused by this

A

PML - progressive multifocal leukoencephalopathy

19
Q

What are sx of PML associated with JCV

A

slow onset of focal sx includes behavior/speech/cognitive behavior/motor/visual impairment; aphasia, hemiparesis, ataxia, cortical blindness,

20
Q

how can you make a definitive dx of PML due to JCV

A

PCR of CSF sample

21
Q

23 y/o AIDS pt develops fever, nuchal rigidity, severe HA - what is the MCC of meningitis in AIDS pt? What is one of the virulence factors associated with this organism

A

Crytococcus meningitis - CAPSULE

22
Q

Where is Cryptococcus meningitis commonly found?

A

soil- bird droppings

23
Q

What is missing in the immune response why AIDS pt gets cryptococcus

A

macrophage cant be activated bc T cell counts very low and if no T cells no IFN-gamma to activate Macrophage!

24
Q

How would you diagnose cryptococcus ?

A

India Ink stain CSF- yeast w/ capsule

Confirm with growth on Sabouraud’s agar, Heart Brain infusion agar

25
Q

How would you treat cryptococcus in AIDS pt ?

A

Amphotericin B and flucytosine

26
Q

AIDS pt from SE Missouri, presents w/ persistent high grade fever, weight loss, hepatosplenomegaly, mucocutaneous ulcers. You perform ELISA on serum and urine for antigen was +
A- Whats the source of infection?

A

HISTOPLASMA CAPSULATUM

A- spores inhaled

27
Q

What would histoplasma infection look like on CXR in an immunocompetent pt

A

walled off (granulomas present)

28
Q

What T cell is needed for granuloma formation/ chronic inflammation? what happens when a pt with granulomas develops AIDS

A

Th1 cells - no T cell response so dissemination

29
Q

Who is at risk for H. capsulatum ? What would be the immunocompetent pt immune response?

A

ANYONE that is in MS river valley area/ frequently goes caving etc.
Th1 involved/ Macrophage involved in forming granuloma wall the infection off

30
Q

What is the DOC/tx for H. capsulatum ?

A

Amphotericin B +/- azole

31
Q

What are 2 disseminated infections that AIDS patients may get?

A

Mycobacterium avium

Hisoplasmosis

32
Q

What is the MCC of pneumonia in immunocomp pt

A

Pneumocystis jiroviri

33
Q

When the T cell count of AIDS pt gets below 200 what should the patient be placed on for prophylaxis for pneumocystis jiroviri ???

A

TMP-SMX

34
Q

Where does pneumocystis jiroveci replicate and what does this do damage to?

A

Replicates in surfactant layer

DAMAGES basement membrane

35
Q

Pt on chemotherapy- PMN count drops below 500 and develops fever. What are the causes of fever in a neutropenic CA pt ?

A

neutropenia less than 7 days- infx with staph, strep, pseudomonas, e. coli, klebsiella
neutropenia greater than 10 days- bacterial but could also be fungal- aspergillus, candida sp.
CA itself can cause fever
chemo itself can cause fever

36
Q

What is an empiric therapy to start while waiting for labs for CA pt receiving chemotherapy that is neutropenic and develops fever?

A

carbapenems, vancomycin,

azole

37
Q

CA chemo pt w/ fever cultures came back + for candida infx- where does this infx come from ?

A

skin and MM

38
Q

what drugs are used for candidemia ?

A

caspofungin, fluconazole, voriconazole, amphotericin B

39
Q

AIDS pt with neuro signs possible causes?

A

AIDS dementia, cryptococcal meningitis, JCV, CMV, toxoplasma

40
Q

What things are associated with ring enhancing lesions in the brain on MRI of an AIDS pt (3)

A

lymphoma
cryptococcus
toxoplasmosis

41
Q

what is the 3 drug combo treatment for toxoplasmosis

A

pyrimethamine
sulfadiazine
leukovorin

42
Q

what are sx in the fetus with a mother newly infected with toxoplasmosis

A

crosses placenta

MAJOR NEURO SX & OCULAR SX IN FETUS !

43
Q

what is the classic triad in a newborn infected with toxoplasmosis?

A

hydrocephalis
intracranial calcifications
chlorioretinitis

44
Q

How is cryptosporidium diagnosed?

A

ELISA of stool

CMBM EXAM 4 LC (3 decks)

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