Resp Exam 3 Flashcards
Pneumocystis jiroveci (Pneumocystis Pneumonia)
lab tests
PCP Ping Pong
Bronchoalveolar lavage (BAL) for diagnosis.
Will often not be visible on XRAY, but if it is, it will have a cracked glass appearance in both lungs.
Methamine silver stain to identify fungus. Looks like disc shaped yeasts.
Pneumocystis jiroveci (Pneumocystis Pneumonia)
predisposing factors
PCP Ping Pong
- Associated with AIDS CD4 < 200
- Premature infants
- Immunocompromised
Pneumocystis jiroveci (Pneumocystis Pneumonia)
signs and symptoms
PCP Ping Pong
- PCP is a diffuse interstitial pneumonia
- pneumonia-like symptoms
- NON-productive cough
(symptoms evident in immunocompromised vs. asymptomatic in healthy individuals.)
Pneumocystis jiroveci (Pneumocystis Pneumonia)
Treatment
PCP Ping Pong
- Prophylaxis begins when CD4 count is < 200:
Bactrim (TMP/SMX) (Trimethoprim and sulfamethoxazole)
- If sulfa allergies:
Pentadamine
Antigenic Drift vs. Antigenic Shift
- Antigenic Drift
Point mutation in the viral genome → can lead to changes in molecules like hemagglutinin (HA) or neuraminidase (NA) → usually causes endemics (like seasonal flu)
- Antigenic Shift
Segments (like HA or NA) are shared to form a new species → can lead to epidemics and pandemics (like swine flu antigenic shifted from humans, avian, and swine influenzas)
Otrhomyxovirus (Influenza)
lab tests
Night Shift at the Orthodontist’s
NEG** sense _S_S RNA**
Enveloped virus
8 Segments (B.O.A.R. mnemonic)
Otrhomyxovirus (Influenza)
3 main influenza viruses strains
*** Most common cause of the flu!!! ***
Night Shift at the Orthodontist’s
Strains A,B, and C
- Influenza A causes epidemics and pandemics (Antigenic shift, and drift)
- Influenza B causes endemics (Antigenic drift)
Otrhomyxovirus (Influenza)
Source
Night Shift at the Orthodontist’s
Spread by respiratory droplets
Main flu season in U.S. is from DEC → FEB
Otrhomyxovirus (Influenza)
VF
Night Shift at the Orthodontist’s
- Hemagglutinin (HA) antigens (H1, H2, H3… H18) define cell tropism (cells that can be affected)
Humans can make anti-HA antibodies to protect from the same strain in the future.
- Neuraminidase (NA) cleaves the sialic acid inside the host cell allowing the virus to break free.
Otrhomyxovirus (Influenza)
signs and symptoms
Night Shift at the Orthodontist’s
- Myalgia, fever, and non-productive cough for about 7 days
- After it gets a little better can get pneumonia (common complication of influenza).
- Pneumonia usually from Staph aureus, but can be from others and includes symptoms of pneumonia, fever, and productive cough.
Otrhomyxovirus (Influenza)
Vaccines
Night Shift at the Orthodontist’s
Get vaccine in October so have time to build an immune response before flu season (DEC → FEB)
1) Killed virus (IM)
- 2 forms of killed vaccine. Trivalent (2A + 1B) and quadravalent (2A + 2B)
- Children can get this vaccine after 6 months
2) Live vaccine (nasal spray)
Otrhomyxovirus (Influenza)
MOA
Night Shift at the Orthodontist’s
- Influenza hemagglutinin (HA) is a glycoprotein found on the surface of influenza virus.
- HA binds to sialic acid on the cell membranes in the hosts URT and RBC’s.
- Virus is endocytosed into the cell after binding
- low pH activates the Matrix-2 (M2) protein channel to bring protons into the virion core
- pH change allows HA to faciliate fusion of the viral envelope with the hosts endosome membrane
- Virus uncoats, releasing the viruscontents, including its RNA genome, into the cell’s cytoplasm
Otrhomyxovirus (Influenza)
Treatment
Night Shift at the Orthodontist’s
1) M2 protein inhibitors (Amantadine, Rimantadine)
- Inhibits uncoating, but allows ↑ dopamine release in CNS
- Older drugs, high resistance, only works against Inf. A
2) NA inhibitors (TamV/Tamiflu AKA Oseltamivir/Anamivir)
* Block release of the virus
Otrhomyxovirus (Influenza)
Influenza associated syndromes
Night Shift at the Orthodontist’s
- Pneumonia: (common complication) usually from Staph aureus, but can be from others and includes symptoms of pneumonia, fever, and productive cough.
- Reyes syndrome: Aspirin tx can cause encephalitis and hepatomegaly, liver failure, fever, rash, and vomiting by uncoupling (OX PHOS) mitochondrial proton gradient on ETC in the hepatic cell mitochondria.
- Guillen Barre syndrome: ascending paralysis with high protein in CSF and low WBS (albuminocytologic dissociation, an increase in the protein concentration of cerebrospinal fluid without an accompanying increase in the number of cells )
Strep pneumonia
lab tests
The alpha knight tournament
gram (+) cocci
catalase (-)
α hemolytic (surrounding zone is a green hue)
Optochin Sensitive
Lancet** shaped _diplo_cocci**
Bile soluble (does not grow in bile)
Polysaccharide Capsule (Major VF!)
Strep pneumonia
signs and symptoms
1 cause of MOPS
The alpha knight tournament
Rust collored sputum
lobar pneumonia
(Meningitides, Otitis Media, Pneumonia, Sinusitis)
Strep pneumonia
VF
The alpha knight tournament
Polysaccharide Capsule
Strep pneumonia
MOA
The alpha knight tournament
Protease that cleaves IgA
Allows invasion of mucosa reducing host defenses
Removal of spleen leads to susceptibilty of infection by encapsulated organisms like in sickle cell anemia.
Strep pneumonia
Treatment
The alpha knight tournament
Azithromycin Macrolides
Ceftriaxone
Strep pneumonia
Vaccines
The alpha knight tournament
Adult:
23 valiant polysaccharide
(T-cell independent response creates IgM)
Children:
7 valent conjugated to a protein
(more robust, leads to production of IgG in children)
Haemophilus influenza
lab tests
Phyllis’s Chocolate Covered Cherries
gram (-) Coccobacillary shape
grown in chocolate agar due to need for factor 5 (NAD, nicotinamide) and factor 10 (hemodin) *“hemoTEN”
Haemophilus influenza
signs and symptoms
Phyllis’s Chocolate Covered Cherries
epiglottitis: symptoms drooling, inflamed epiglottis, strider (inspiratory strider, high pitched wheezing)
*“Cherry red epiglottis”
Otitis Media
Meningitides (Only caused by type B capsular form!)
Sepsis and Septic arthritis in pt without spleen, hemophilic infections, especially sickle cell disease
Haemophilus influenza
Treatment
Phyllis’s Chocolate Covered Cherries
Ceftriaxone
tx for close contacts is rifampin
Haemophilus influenza
Vaccines
Phyllis’s Chocolate Covered Cherries
Conjugated with diphtheria toxoid and haemophilus type B capsule.
(Vaccine for only the B type capsule of H. influenza, vs neisseria vaccine for all but B type!!!)
Vaccinate between 6 weeks to 18 months
Nocardia
lab tests
No card game for old men
gram (+) Filamentous bacilli
Catalase (+)
Urease (+)
Obligate Aerobe (vs. anaerobe for actinomyces)
Mycolic Acids stain light acid fast on carbofusion stain
DOES NOT form spores (but found in soil)
Nocardia
Increased risks for?
No card game for old men
Increased risks for…
- CGD patients (Chronic Granulomatous Disease) have increased risk from catalase (+) organisms.
- Immunocompromised are especially vulnerable.
- Men > Women
Nocardia
signs and symptoms
No card game for old men
3 parts
- Pulmonary: Pneumonia like symptoms, Cavitating in the lungs)
- CNS: Due to systemic spread from lungs. Brain abscess formation.
- Cutaneous: Indurated (hardened) lessions and inflammatory reaction
Nocardia
Treatment
No card game for old men
Sulfonamides
Paramyxovirus Family
lab tests
Paranormal Mixer
NEG** sense _S_S RNA**
Enveloped non-segmented virus
Anti-measles antibodies in the CSF (SSPE from Measles) or Warthin–Finkeldey cells in lymphoid tissue (for Measles/Rubeola)
Syncytia (cells merged together from RSV)
Steeple radiographic sign on xray (for Parainfluenza)
Paramyxovirus Family
Viruses in the Paramyxo family
Paranormal Mixer
*** Respiratory droplet transmission! ***
- Measles (Rubeola) AKA 1st disease
- Mumps
- Respiratory Syncytial Virus (RSV)
- Parainfluenza
Paramyxovirus Family
VF for each Paramyxovirus
(HA, NA, or Fusion proteins)
Paranormal Mixer
- Measles (Rubeola): HA & Fusion (no NA)
- Mumps: HA, NA, & Fusion
- Respiratory Syncytial Virus (RSV): Fusion (only)
- Parainfluenza: HA, NA, & Fusion
Measles (a Paramyxovirus)
signs and symptoms
Initial infection
AKA: Rubeola, 1st disease
Paranormal Mixer
- Prodromal (early) symptoms (4 C’s!!!): include Cough, Conjunctivitis, Koplic signs (blue spots on red near molars on bucal mucosa), Coryza (runny/stuffy nose)
- Fever of 104º F (40º C)
- 1-2 days later, after Koplic spots, a late maculopapular rash starts on head and works down (like rubella), but is a confluence rash (vs. rubella which does not coalesce)
- Complications including viral or bacterial pneumonia
Measles (a Paramyxovirus)
signs and symptoms
Persistent infection
AKA: Rubeola, 1st disease
Paranormal Mixer
Subacute sclerosing panencephalitis (SSPE)
AKA Dawson disease
- Rare and chronic form of progressive brain inflammation
- 1-15 years after initial Measles (Rubeola) infection
- Symptoms include personality changes, seizures, myoclonus, ataxia, coma, and possibly death.
- Buzzwords: “Measles as a child” or “Immigrants”
Measles (a Paramyxovirus)
VF
AKA: Rubeola, 1st disease
Paranormal Mixer
- Hemagglutinin (HA): causes RBC to stick together
- Fusion proteins: Causes multinucleated giant cells and red (eosinophilic) inclusion bodies → found in lymphoid tissue (AKA Warthin–Finkeldey cell)
*** NO Neuraminidase (NA)!!! ***
Measles (a Paramyxovirus)
To reduce mortality and complications you can give what vitamin?
AKA: Rubeola, 1st disease
Paranormal Mixer
Vitamin A
can reduce mortality and complications
Measles & Mumps (Paramyxovirus family)
Vaccine
Measles AKA: Rubeola, 1st disease
Paranormal Mixer
- MMR vaccine!
- Live attenuated vaccine to induce humoral and cell mediated immunity.
- Do NOT give to pregnant women.
- HIV pt should only get the vaccine if CD4 count is > 200.
Mumps (a Paramyxovirus)
signs and symptoms
Paranormal Mixer
- Fever, muscle pain, headache, and feeling tired.
- Usually followed by painful swelling of one or both parotid* salivary glands.
- Orchitis* (inflammation of testicle tissue) unilaterally (more rarely bilaterally) → can lead to impaired fertility and testicular atrophy.
- Meningitis*
* (Mumps replicates in the parotid glands, testes, and CNS)
Mumps (a Paramyxovirus)
VF
Paranormal Mixer
- Hemagglutinin (HA)
- Fusion proteins
- Neuraminidase (NA)
Respiratory Syncytial Virus (RSV) (a Paramyxovirus)
signs and symptoms
Paranormal Mixer
- Attaches to G protein to infect respiratory epithelial cells
- Bronchiolitis and Pneumonia (most common cause of these in infants!!!)
- Rhinitis and Pharyngitis
Respiratory Syncytial Virus (RSV) (a Paramyxovirus)
VF
Paranormal Mixer
- Fusion proteins (NO HA or NA for RSV)
Fusion proteins on the surface of the virus cause the cell membranes on nearby giant multinucleated cells to merge and stick together, forming syncytia.
Respiratory Syncytial Virus (RSV) (a Paramyxovirus)
Treatment
Paranormal Mixer
- Ribavirion for adults.*
* (Not children or pregnant women!!!)
- Palivisumab, a monoclonal antibody (IgG**) against the F protein of RSV, is used for high risk children and premies.
Pseudomonas
lab tests
The suiters of pseudo Mona
gram (-) bacillus
obligate Aerobe
oxidase (+)
catalase (+)
Blue green pigment when plated (from Pyocyanin and pyoverdin, may even turn wounds blue)
Encapsulated
Pseudomonas
signs and symptoms
The suiters of pseudo Mona
* Thrives in aquatic environments (HOT TUB FOLLICULITIS)
- ⬆ risk if pt has Chronic Granulomatous Disease
- Fruity grape like odor
- May turn wounds blue (from Pyocyanin and pyoverdin)
- Most common gram (-) Nosocomial Pneumonia
- Osteomyelitis in IV drug users and diabetics
- UTI’s (catheters!)
- Burn patients are especially susceptile
- Ecthyma gangrenosum
- Otitis Externa (Swimmers ear)
Pseudomonas
Respiratory failure in who?
The suiters of pseudo Mona
Respiratory failure in CF patients.
Most common gram (-) Nosocomial Pneumonia.
(CL- channels dysfunctional in CF)
Pseudomonas
MOA
The suiters of pseudo Mona
Exotoxin A
Ribosolation of EF2** → inhibition of protein synthesis and cell death
Pseudomonas
Treatment
The suiters of pseudo Mona
Piperacillin (penicillin)
amingoglycosides
and Fluoroquinolones
Chlamydia Trachomatis, Pneumonia, and Psittaci
lab tests
The pirates of Calam Island
gram indeterminate (does not gram stain)
use Giemsa stain or NAAT test (aka PCR)
obligate intracellular (cannot create its own ATP, like ricketsia)
Lacks muramic acid in the cell wall.
Elementary and Reticulate bodies.
Chlamydia Trachomatis, Pneumonia, and Psittaci
Elementary vs. Reticulate bodies.
The pirates of Calam Island
Elementary bodies:
1st stage of life cycle outside of cell. The infectious form! Elementary enters the eukaryotic cell and is taken up by phagosomes.
Reticulate bodies:
Dividing form! Reticular replicates to form inclusion bodies seen under microscope in cells when infected.
*After bacteria replicate with its host cells, they leave the cell and become elementary stage again
Chlamydia Trachomatis
3 main groups of C. Trachomatis
The pirates of Calam Island
3 main groups of C. Trachomatis
- A-C → Blindness
- D-K → STI
- L1-L3 → LGV
* “Can’t see, Can’t pee, Can’t climb a tree” (Reiter’s syndrome)
Chlamydia Trachomatis
Blindness group of C. Trachomatis
The pirates of Calam Island
C. trachomatis A-C → Blindness
Trachoma is the leading cause of blindness in the world!
Transmission is usually from hand to eye contact, but can also be from fomites (objects like clothes or phones)
* mnemonic “A-_C (see) with your eyes_”
Chlamydia Trachomatis
STI group of C. Trachomatis
The pirates of Calam Island
C. trachomatis D-K → STI
- Most common bacterial STI in the U.S.
- Watery discharge (vs. Gonorrhea with mucoprulent).
- Can lead to PID w/o symptoms or ectopic pregnancies.
- If mother has it during delivery can lead to neonatal conjunctivitis and pneumonia. Presents in 1-2 weeks (vs. Gonorrhea in 2-4 days) as possible staccato cough (short sudden bursts with breath inbetween) or conjunctivitis.
Chlamydia Trachomatis
LGV group of C. Trachomatis
The pirates of Calam Island
C. trachomatis L1-L3 → LGV (Lymphogranuloma Venerum)
(also is an STI)
- Starts with painless genetial ulcer (similar to syphilis)
- Presents as tender lymphadenopathy with draining lymph nodes.
Chlamydia Trachomatis
Reiter’s syndrome
The pirates of Calam Island
Reiter’s syndrome Triad
- Cant see (Conjunctivitis)
- Can’t pee (Urethritis)
- Can’t climb a tree (Arthritis)
* Reactive arthritis due to cross reaction of antibodies fighting chlamydia hitting the knee or sacroiliac joint.
Chlamydia Trachomatis, Pneumonia, and Psittaci
treatment
The pirates of Calam Island
Macrolides - Azithromycin
Tetracycline - Doxycycline
* also tx for Co-infection of Chlamydia and Gonorrhea with cephtriaxone
Chlamydia Pneumonia
signs and symptoms
The pirates of Calam Island
Walking (atypical) pneumonia.
More commoin in the elderly.
Chlamydia Psittaci
signs and symptoms
The pirates of Calam Island
Transmitted by birds and bird droppings.
Causes pneumonia!
Mycoplasma pneumonia
lab tests
Walking on thin ice
gram indeterminate (does not gram stain, no cell walls)
Cholesterol in the membrane (sterols help stabilize cell membrane and allow flexability)
Grown on Eatons agar (“dont eat on ice”; takes >1 week so not often used)
Patchy infiltrates on XRAY (Walking pneumonia, XRAYs appears much worse then pt does clinically)
Test for IgM cold agglutination
Mycoplasma pneumonia
signs and symptoms
Walking on thin ice
Walking pneumonia
Young adults (<30 years old)
Crowded areas (military recuits etc)
IgM molecules that agglutinate red blood cells in cold temperatures → lysis of RBC’s (1-2 weeks into infection)
Mycoplasma pneumonia
treatment
Walking on thin ice
Macrolides - Zpack (azithromycin)
Legionella
lab tests
The SS cysteine joins the legion
gram (-) bacilli visualized under silver stain
oxidase (+)
Charcoal yeast extract agar with cysteine** and **iron added.
Rapid urine antigen test to confirm
Legionella
signs and symptoms
The SS cysteine joins the legion
- Pontiac Fever: Fever and malaise, usually self limiting.
- Legionnaries Disease: common in smokers and elderly men.
- Atypical pneumonia w/ patchy unilobed infiltrate.
- Hyponatremia (excess HNO3 ammonia Na. wasteing salt)
- Neurologic symptoms: headache w/ confusion
- Diarrhea
- High fever over 104F!
* (high yield: pneumonia w/ diarrhea & hypnonatremia)
Legionella
VF
The SS cysteine joins the legion
Zinc Melloprotease is the main VF
It’s cytotoxic and inhibits PMN production, inhibits superoxide reduction, deactivates il-1 and CD4 and TNF
Legionella
Treatment
The SS cysteine joins the legion
macrolides and fluoroquinolones
Bordetella pertussis
lab tests
Board and Care (for vets!!!)
gram (-) bacilli
Aerobic
Lymphocytosis: (ADP disables chemokine receptors for lymphocytes → lymphocytes unable to enter lymphoid tissue → ⬆ WBC in bloodstream )
Bordetella pertussis
VF
Board and Care (for vets!!!)
Respiratory droplets are very infective due to their pilus (called filamentous hemagglutin)
3 toxins; Pertussis toxin, Adenylate cyclase toxin (most virulent), and Tracheal toxin
Bordetella pertussis
Toxins
Board and Care (for vets!!!)
3 toxins:
- Pertussis toxin → Ribosylates Gi (G inhibitor protein), disabling it
- Adenylate cyclase toxin (most virulent) → acts like anthracis toxin edema factor → ⬆ cAMP
- Tracheal toxin → damages ciliated cells in the epithelium
Bordetella pertussis
Three stages
Board and Care (for vets!!!)
- Catarrhal stage → Last 1-2 weeks. Nonspecific symptoms of URI such as low-grade fever, nasal congestion. MOST contagious!!!
- Paroxysmal stage → Last 2-8 weeks. Paroxysms of coughing followed by inspiratory whoop.
- Convalescent stage → Last weeks to months. Subsiding cough (100 day cough). MOST susceptible to secondary infections!!!
Bordetella pertussis
Treatment
Board and Care (for vets!!!)
Macrolides
Very useful for removing from respiratory tract, but not as useful if circulating
Bordetella pertussis
Vaccines
Board and Care (for vets!!!)
DTaP
Acellular vaccine using purified antigens
Klebsiella, Enterobacter, Serratia
lab tests
(common to all three)
Hospital room scene
gram (-) bacilli
Ferments Lactose → turns pink on MacConkeys
Klebsiella, Enterobacter, Serratia
Enterobacter ddx
Shared traits
gram (-) bacilli
Ferments Lactose → turns pink on MacConkeys
Hospital room scene
Very motile
Klebsiella, Enterobacter, Serratia
Serratia ddx
Shared traits
gram (-) bacilli
Ferments Lactose → turns pink on MacConkeys
Hospital room scene
Very motile
Red pigment when cultured
(like a pink ring around shower or bright red)
Catalase (+)
Klebsiella, Enterobacter, Serratia
Klebsiella ddx
Shared traits
gram (-) bacilli
Ferments Lactose → turns pink on MacConkeys
Hospital room scene
* 3 A’s!!! (Alcoholics, Abscesses, Aspiration)
* sputum that is red color
Klebsiella is Immotile
Urease (+)
Polysaccharide capsule
Cavatary “TB like” lesions
Klebsiella, Enterobacter, Serratia
Treatment
Hospital room scene
Multi Drug Resistant Carbopenam
or
Clindamycin
Staphylococcus aureus
lab tests
The golden staff of moses
gram (+) cocci
catalase (+)
coagulase (+)
ß hemolytic
Ferments Mannitol Salt Agar (turns yellow)
Staphylococcus aureus
VF
The golden staff of moses
Protein A
component of cell wall that binds to FC region of antibodies
Staphylococcus aureus
signs and symptoms
The golden staff of moses
Pneumonia
-patchy infiltrate on x-ray
Septic arthritis
Large erythematous abcesses
Tricuspid valve endocaritis
-IV drug users
Scalded skin syndrom
Toxic shock syndrome
Staphylococcus aureus
Toxis Shock Syndrome (TSS) MOA
The golden staff of moses
Toxic Shock Syndrome (TSS)
- commonly caused by leaving in a bandage or tampon
- causes nonspecific binding of MHC II to T cell receptors causing over reaction and cytokine storm
- TSST superantigen
Staphylococcus aureus
Food poisoning MOA
The golden staff of moses
-due to preformed toxins
(not the actual organisms)
-usually from meats and mayonnaise
(also salad and creme filled pastries)
-usually sick in 6 hours
Staphylococcus aureus
Treatment
The golden staff of moses
Vancomycin
for methicillin sensitive S. aureus use:
Nafcillin
(“Naf for staph”)
Histoplasma capsulatum
lab tests
The Historians Cave
Macrophages w/ intracellular oval bodies.
Histoplasma is MUCH SMALLER than RBC.
Diagnosis through KOH, rapid serum**, or **urine antigen test.
Dimorphic (mold in cold, yeast in beast).
Histoplasma capsulatum
source
The Historians Cave
Bird or Bat droppings
Caves or Chicken coops
Mississippi (His on the Mis!) and Ohio river valleys (Midwestern US)
Transmitted through respiratory
Histoplasma capsulatum
signs and symptoms
The Historians Cave
- Pneumonia
- Granulomas (can look like TB) w/ calcified nodes and nodules in the hilar region.
- Erythema nodosum (painful red nodules, usually found on shin)
- Hepatosplenomegaly (In the immunocomprised) because the fungus targets the reticuloendothelial system that has a lot of macrophages (which are prevalent in the liver and spleen!)
Histoplasma capsulatum
treatment
The Historians Cave
For local and mild infections: Azole drugs
For systemic infections: AMP B
Coccidioides immitis
lab tests
Presidio San Joaquin
Non-budding Spherules packed w/ endospores (not yeast!) in the lungs.
Coccidioides are LARGER than RBC.
Diagnosis through KOH.
IgM** against Cocci** indicates recent infection.
Dimorphic (mold in cold, spherule of endospore in the body! NOT yeast !)
Coccidioides immitis
source
Presidio San Joaquin
Dust
Very common after earth quakes.
CA and SW US
Transmitted through inhalation
Coccidioides immitis
signs and symptoms
Presidio San Joaquin
- Asymptomatic in most
- May see pneumonia, knee pain, and fever
- Radiology may be unremarkable, or may show cavaties and / or nodules
- Erythema nodosum (painful red nodules, usually found on shin)
- In the immunocomprised it can spread to the bone, or cause meningitis
Coccidioides immitis
treatment
Presidio San Joaquin
For local and mild infections: Azole drugs
For systemic infections: AMP B
Blastomycoses dermatidis
lab tests
The blast of the cannon
Broad Based Budding
Blastomycoses is typically the same size as RBC’s.
Diagnosis through KOH, or with a urine antigen test.
Dimorphic (mold in cold, yeast in beast).
Blastomycoses dermatidis
source
The blast of the cannon
Great lakes and Ohio river valley
Southern and Southeastern US
Transmitted through spores via inhalation
Blastomycoses dermatidis
signs and symptoms
The blast of the cannon
- Patchy alveolar infiltrate on XRAY (“haziness”)
- Granulomatous lesions in the lungs
- Systemic infections in the immunocomprised → Osteomyelitis, damages skin and bones.
Blastomycoses dermatidis
treatment
The blast of the cannon
For local and mild infections: Itraconazole
For systemic infections: AMP B
Paracoccidioides brasiliensis
lab tests
Piratas del Sur (south)
Multiple buds radiating out from a central vacuole
“Captains wheel” appearance
Paracoccidioides are a LOT LARGER than RBC’s.
Dimorphic (mold in cold, yeast in beast).
Paracoccidioides brasiliensis
source
Piratas del Sur (south)
South America
Transmitted through respiratory droplets
Paracoccidioides brasiliensis
signs and symptoms
Piratas del Sur (south)
- Lymphadenopathy in chains of lymph nodes in cervical region.
- Progressive to lungs, causing granulomas
- Mucosal ulcers and cutaneous lesions in the upper mouth and gums → small hemorrhages with ragged borders
- Starts in upper respiratory and moves down, can also be seen in axiallary or inguinal lymph nodes
Paracoccidioides brasiliensis
treatment
Piratas del Sur (south)
For local and mild infections: Itraconazole
For systemic infections: AMP B
Aspergillus fumigatus
lab tests
Asparagus Farm
Catalase (+) *
Acute branching (< 45º) with septations (Aspergillus)
(ddx Mucor which has 90º branching and is nonseptate)
* Candida also catalase (+). Catalase (+) ↑ risk of Chronic Granulomatous Disease (CGD)
Aspergillus fumigatus
source
Asparagus Farm
Aspergillus fumigatus is found nearly everywhere in soil and decaying plants (like compost heaps), and generally won’t infect healthy people.
They are condiospores with fruiting bodies that get inhaled by human.
Aspergillus fumigatus
3 types of infection
Asparagus Farm
- Allergic bronchopulmonary aspergillus (ABPA)
- Aspergillosis causing aspergillomas
- Angioinvasive aspergillosis
Aspergillus fumigatus
3 types of infection
1. Allergic bronchopulmonary aspergillus (ABPA)
Asparagus Farm
Causes asthma, wheezing, fever, and a migratory pulmonary infiltrate.
Type 1 hypersensitivity, IgE response.
Aspergillus fumigatus
3 types of infection
2. Aspergillosis causing aspergillomas
Asparagus Farm
Associated with TB (susceptibility ↑ with TB cavities)
Aspergillomas are gravity dependent so fungus balls will be at the bottom of the cavity
Aspergillus fumigatus
3 types of infection
3. Angioinvasive aspergillosis
Asparagus Farm
Seen in pt with neutropenia from leukemia or lymphoma.
Aspergillus invades blood vessels and the surrounding tissues.
Leads to kidney failure, endocarditis, ring enhancing lesions in the brain.
Invades nasal sinus (causing Angioinvasive aspergillosis) leading to hemoptysis (coughing up blood) or blood stained mucos.
Aspergillus flavus
Aspergillus flavus key facts
(NOT Aspergillus fumigatus!)
Asparagus Farm
Aflatoxin associated with peanuts or grain!
Can lead to Hepatocellular carcinoma (HCC)
Aspergillus fumigatus
treatment
Asparagus Farm
_For less serious infection_s: Voriconazole
For angioinvasive disease: AMP B
Cryptococcus neoformans
lab tests
Crypt for Cryptococcus
- Cryptococci are heavily encapsulated.
- Repeating polysaccharide antigen. Can be detected by Latex agglutination test by causing agglutination.
- Urease (+)
- Bronchopulmonary washings of lung tissue that resembles soap bubbles. (can be stained with mucicarmine red or methanamine silver stains).
- Lumbar puncture and India ink will show wide encapsulated halos (Negative stain! Dark background with transparent organisms)
Cryptococcus neoformans
source
Crypt for Cryptococcus
Transmitted by pigeon droppings!
Also found in soil.
Inhaled into lungs.
Cryptococcus neoformans
signs and symptoms
Crypt for Cryptococcus
- Opportunistic infection. HIV, High dose steroids, Malignancies.
- Pulmonary symptoms like cough, dyspnea, pneumonia and other lung infections.
- Can spread to the CSF and cause meningitis, often leading to permanent neuro deficits.
- Fever
- Distinct pathology of brain having soap bubble lesions.
Cryptococcus neoformans
Treatment
Crypt for Cryptococcus
Joint therapy with AMP B and flucytosine…
Then fluconazole after
Mycobacterium tuberculosis
lab tests
Shoot out at the TB Corral
- Acid fast (carbol fuschien stain; mycolic acids)
- Lowenstein medium
- Obligate Aerobe
- Test for TB with PPD, BCG vaccine will always show (+) skin test.
- Proliferates in macrophages
- Clumping of bacteria into serpentine formation (cord factor)
Mycobacterium tuberculosis
VF
Shoot out at the TB Corral
- Cord factor (Glycolipid responsible for clumping of bacteria into serpentine formation).
- Sulfatides (prevent phagolysosome fusion).
Mycobacterium tuberculosis
MOA
Shoot out at the TB Corral
- Human to human respiratory spread.
- Cord factor ⬆ granuloma formation by ⬆ TNF-a.
(Allows TB to attract and hide in macrophage granulomas)
- Sulfatides prevent phagolysosome fusion
(Allows TB to survive in macrophages by creating incompetent secondary lysosomes preventing fusion with phagosomes to prevent phagolysosome formation, thus avoiding exposure to the lysosomal hydrolases)
Mycobacterium tuberculosis
Paths of progression of TB after primary infection
Shoot out at the TB Corral
- Healed latent infection
- Systemic infection (Miliary TB)
- Reactivation TB
Mycobacterium tuberculosis
Healed latent infection
Shoot out at the TB Corral
- Primarily lower or middle lobes of lungs.
- Usually in children
- Long fever
- usually resolves by fibrosis and becomes latent
- GHON complex
- TB resides in broken down necrotic macrophages (Langerhans giant cells) → Caseation Granulomas
Mycobacterium tuberculosis
GHON complex
Shoot out at the TB Corral
Visual calcification of lung parenchyma and hilar lymph nodes.
(Hilar lympadenopathy + peripheral granulomatous lesion in middle or lower lung lobe).
Lesion heals → eventually becomes fibrotic and calcifies, along with nearby draining (hilar) lymph nodes.
Mycobacterium tuberculosis
(+) TB PPD skin test
Shoot out at the TB Corral
Type 4 hyper sensitivity reaction
PPD will show positive for:
- active infections
- latent infections
- prior BCG vaccine (attenuated)
Mycobacterium tuberculosis
Systemic infection (Miliary TB)
Shoot out at the TB Corral
- Multi-organ failure
- Primarily bone, liver, and lymphatics, but can spread to any organ in the body
- Can be lethal
Mycobacterium tuberculosis
Reactivation TB
(occurs in only 5-10% of TB pt)
Shoot out at the TB Corral
- Usually in upper lobes
- Associated with immunosuppression (HIV, old age, cancer) through the ⬇ regulation of TNF-a release
- Always screen for PPD before using TNF inhibitors!!!
- Cough, night sweats, hemoptysis (bloody cough)
- Cachexia (body wasting)
- Skeletal system: Pots disease
- CNS involvement: meningitis or tuberculoma (cavitary lesion) in 10-15% of reactivations
Mycobacterium tuberculosis
Pots disease
Shoot out at the TB Corral
When TB infects the spinal column.
Usually multiple vertebrae.
Demineralization of the bone, spinal weakness, soft tissue swelling (swelling leads to pain).
Can lead to abcess formations, spinal deformities, and weakness due to loss of support.
Mycobacterium tuberculosis
treatment
Shoot out at the TB Corral
mnemonic RIPE
- Rifampin
- Isoniazid
- Pyrazinamide
- Ethambutol
For prophylaxis: Rifampin and Isoniazid for 9 months
