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STDs Flashcards

1
Q

Bacterial Vaginosis

A
  • Polymicrobal infection of anaerobic bacteria
  • Gardenella vaginalis-mycoplasma hominis, mobiluncus, prevotella
    • Vaiginalis is found 100% of vaginosis
    • Gram variable-Pleomorphic rods
    • Normal vagina flora <u>(90% healthy flora Lactobacillus Gram + rods)</u>
  • Cause: balance between normal flora resulting in overgrowth of anaerobic bacteria
    • <u>Increases risk of STDs</u>-<strong>HSV, Chlamydia, gonorrhea</strong>
  • Symptoms: White/gray discharge w/milk-like appearance (unpleasant order stronger after sex)
    • <strong>MINIMAL prevaginal itching/irritation</strong>
  • Diagnosis (3 of 4 +)-<strong>Thin homogenous discharge</strong>,<strong> pH greater than 4.5</strong>, <strong>Clue cells</strong>(R<u>ough cell membrane)</u>, <strong>Whiff test </strong><u>(mix of discharge &amp; 10% KOH=order</u>)
  • Treat: Metronidazole w/probiotics-Lactobacillus
    • Acidification treatment-<strong>Boric acid</strong>
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2
Q

Vulvovaginal Vacdidiasis

A
  • Candida albicans-Yeast w/Pseudohyphae
    • <strong>Normal body flora (Skin, mouth, vagina, GI)</strong>
  • Disease due to overgrowth of increased sugar, decrease in normal flora or pH change
  • High risk-Diabetes, Antibiotic use, pregers, birth control pills
  • Disease: Thick curd/cottage cheese discharge
  • Contains epi cells & mass yeast/pseudohypha
  • INTENSE itching of vulva w/redness of vagina/labia
    • <strong>Ferments alcohol=Irratation/itching</strong>
  • Treat: Antifungal Nystatin <strong>(no need to treat partners)</strong>
  • Diagnose: Germ-test tube test @ 37 for 90min
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3
Q

Trichomoniasis

A
  • Flagellated protozoans
  • _Symptoms: _
  • Itching & burning (Strawberry cervix)
  • Watery foul-smelling, greenish foamy discharge
  • Urethritis w/dysuria <strong><u>(men/women)</u></strong>
  • Cervix demonstrates tiny micro hemorrhages
  • Diagnosis: Wet mount MOTILE trichomonads
  • Treat: Metronidazole
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4
Q

PID

A
  • _Infection & inflammation of upper part of female repro _
  • Endometritis-inflammation of inside lining of uterus
  • Salpingitis-Inflammation of fallopian tubes
    • <strong>Scarring/adhesions=Ectopic pregers/infertility</strong>
  • Tubo-ovarian adscesses
  • Pelvic peritonitis-Inflammtion inside ab cavity surrounding female repro organs
  • Symptoms:
    • Moderate fever
    • Bilateral lower ab pain-aggravated by body movement
    • Increased discharge & irregular bleeding
    • Nausea/Vomiting
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5
Q

Neisseria Gonorrheae (General)

A
  • Gram (-) diplococcis (covered w/pili)-Bean shaped
  • Facultative intracellular-Oxidase/catalase (+)
  • Ferments glucose NOT MALTOSE
  • Transmission: Sexual & neonatal
  • High Risk: Def of C6-C9 (risk of disseminated infections)
  • Disease:
  • Genirourinary tract, eye, rectum, throat (oral sex)
    • Local neutrophilic response-<strong>Purulent discharge</strong> <u>(white-yellow)</u>
  • Urethritis-Thick creamy grey/white (pain urinating)
    • Men show symptoms w/in <u>5 days</u> & 50% of women shown asyptomatic
  • Cervicitis-Discharge thick grey/white, bleeding between menstrual periods, painful intercourse (bleeding)
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6
Q

Neisseria Gonorrheae (proteins)

A
  • Surface proteins-
  • Pilin (pili): Initial binding to epi cells & antiphagocytic
  • Opa (outermembrane): Mediates firm adhesion to eukaryotic cells
  • Rmp (outermembrane): Formation of ineffective Ab block bactericidal Ab against pilin & LOS
  • Por (outermembrane porin): promotes intracellular survival preventing phagolysosome formation in neutrophils
  • LOS (outermembrane lipooligosacc): Elicits inflammatory response, triggers realase of pro-inflamm cytokines
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7
Q

Neisseria Gonorrheae (Pathogenesis)

A
  • Virulence factors:
  • IgA proteases-Evade mucosal immunity
  • Antigenic heterogeneity:
  • Exsistence of multiple varieties-Pili, por, opa, LOS
    • <strong>Ag switching (phase variation)</strong>
  • Pili & Opa switch in same isolate-Programmed gene rearrangement
  • Receptors for transferrin-Helps to absorb iron <u>(competes w/host)</u>
  • Repeared infection-Lack of protective immunity due to Ag variation
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8
Q

Gonococcal Disease (upper repro)

A
  • Men:
  • Epididmyitis-inflammation leads to swelling of scrotum-Leads to sterility
    • Coiled spermatic ducts <u>mature/store Sperm</u> between testis & Vas
  • Women (PID):
  • Endometritis & Salpingitis-Tubo-ovarian abscesses/scarring leads to sterility
  • Vulvovaginitis-Prepubertal women (due low kerantinization)
  • Fitz-Hugh Curtis syndrome (complication of PID)-
  • Acute perihepititis infection from tube to liver <strong>(thin layer connective tissue capsule)</strong>
  • Severe pain in Upper right ab (over gallbladder) w/tenderness & Peritoneal inflammation
  • Laproscopy:“violin string” adhesions (capsule & peritoneum)
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9
Q

Gonococcal Disease (Systemic)

A
  • Procititis (rectal infection) & pharyngitis=<strong>Among homosexual men</strong>
  • Opthalmia neonatorum: eye infection in newborns
    • assoc w/septicaemia @ 2-5 days after birth
  • Conjunctivits: Adults (autoinfection)
  • Disseminated infections (local infections NOT treated):
  • Bacterimia (blood infection) Leads to-
    • Meningitis (brain)
    • Endocarditis (heart)
    • Arthritis (joint infection) common in adults
  • Skin lesions seen on extremities (bacterimia)
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10
Q

Gonnococcal Diagnosis

A
  • Evaluation of presenting symptoms & sex history
  • HIsto: Gram stain of exudates (urethra, cervix, rectum, pharynx)
  • PMNs phagocytosed w/Gram- diplococci indicative of gonorrheal infection.
  • Culture:Thayer Martin/New York city medium
  • Choco agar + antibiotics organism require 5% CO2
    • Specimens collected w/Ca+2 alginate swab
    • <strong>N. meningitis also (+) NYC media</strong>
  • Biochem test-Ferments glucose NOT maltose
    • Used to differ <u><strong>N. meningitidis</strong></u>
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11
Q

Gonnococcal Treatment

A
  • Resistance to common Antiobios
    • Plasmid-mediated <u>beta-lactamase </u>production
  • 3rd gen Cephalosprins (ceftriaxone, Ceftixime, Cefotaime)
  • Doxycycline or Erythromycin=Co-infection w/chalmydia trachomatis
  • Sex partners should be treated/consulted
  • Vaccine: hard to develop due to Ag variation
  • Screening Annually: Women younger 25 sexually active
  • Chemoprophylaxis: prevent ophthalmia in neonates
    • <em><strong>Silver nitrate <u>(not used due to diff in storage)</u></strong></em>, Erythromycin, Tetracycline
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12
Q

Chalmydia Trachomatis (General)

A
  • Obligate intracellular (ADP dependent) bacteria
  • Cell wall w/no muramic acid <strong>(does NOT gram stain)</strong>
  • Energy dependent=Biphasic growth cycle
    • Elementary body & Reticulate body
      • <u><strong>EB=</strong></u>Infectous stage/metab inactive & <u><strong>RB=</strong></u>Metab active
  • ​​Inclusion body-EB & or RB inside cell vesicle
    • More than 15 serotypes (A-L)
  • Trachomatis (A, B, C)-Hand to eye fomites=Trachoma
    • Turns eyelids inward & corneal scarring-<u>Blindness</u>
    • <u><strong>Inclusion conjunctivitis-</strong></u>newborns bilateral swelling
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13
Q

Chalmydia Trachomatis (pathogenesis)

A
  1. Infects non-ciliated comlumnar/cubodial epi cell of mucosal layer (EB attaches to cell surface w/endocytosis)
  2. EB (endosome) no fusion to lysosome & reorganizes to RB
  3. RB replicates by binary fission-Eventual lysis of cells
  4. Clinical manifestations=Destruction of cells & host inflammatory response (Granuloma formation)
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14
Q

Chalmydia Trachomatis (Gential Disease)

A
  • Serotype D-K (most common <u>bacterial STD</u> in US)
  • Reiter’s syndrome-Autoimmune (Can’t pee, see, climb a tree)
  • Follicular palpebral conjunc-inclusion conj contains lymphoid follicles
  • Men: Urethritis w/watery discharge
    • Epididymitis (Back of testi storage/mature of sperm)
    • Proctitis (rectum)
  • Women: Cervicitis & Urethritis w/watery discharge
    • PID-lead to infertility or ectopic pregers
    • Fitz-Hugh-Curtis syndrome
  • Infants:
    • pneumonia-4-11 weeks after birth
    • Inclusion conjunctivitis-5-14 days after birth
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15
Q

Chalmydia Trachomatis (Diagnosis/Treat)

A
  • Histo: Giemsa Inclusion bodies (obligate intracellular)
  • Culture: NAAT (nucleic acid amplification test)
  • Treat: Doxycycline or Azithromycin
  • Prevention:
  • Erythromycin (macrolide) expecting mothers
  • Annual screening-Women 25 yrs younger sexually acitve
  • Treat sexual partners
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16
Q

Genital Mycoplasma

A
  • Genitallium, Homins, Ureaplasma Urealyticum
  • Cell wall less (sterol in membrane)-Smallest living organism
  • Ureplasma (urease +) needs urease in culture
    • Associated with kidney stones
  • Found in genitourinary tract sexual active adults
    • <em><strong>Ureaplasma & Homins</strong></em> are part of normal flora
  • Disease:
  • Non-gonococcal (watery discharge)Chlamydial urethritis-PID
  • Homins-Assoc w/Postabortal-postpartum fever
    • <strong>Resistant to erythromycin</strong>
  • Treat: Doxycline
  • Diagnosis: A8 agar <strong>(Yeast/Blood)</strong>-“Fried egg”
  • No gram stain=NO cell wall
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17
Q

Syphilis (general)

A
  • Spirochete-endoflagella (axial filament)-Cell wall like Gm- (too thin to gram stain)-DARK field
    • Does not grow on culture-<strong><u>extracellular pathogen</u></strong>
  • Transmission-Sex-Kissing/Transplacental (3 yrs from infection)
  • Through broken skin (mucus membranes)
  • Virulence factors:
  • Cell wall-Endotoxin
  • Additional outer sheath glycosaminoglycan covers surface antigens
  • Hyaluronidase-degrades hyaluronic acid allows for spread into tissues
  • Produces Abs cross react w/Cardiolipin (Mitochondria)
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18
Q

Syphilis (Primary)

A
  • 30% of cases resolve spont
  • 30% remain serological latent (+ but no symptoms)
  • 1/3 progress to tetiary (very destructive)
  • Primary: Chancres (ulceration) one or more @ site of entry
  • Painless hard ulcer w/raised borders <u><strong>(heals 2 months)</strong></u>
  • Regional lymph-firm, non suppurative, presist for months (Even w/healing of chancres)
    • HIGHLY infectious stage
19
Q

Syphilis (Secondary)

A
  • Skin/mucous membrane lesions & systemic disease
  • Pt is infectious @ this stage
  • Lesions-Macular(flat), Papular(raised), pustule, nodular
    • Painless <em><strong>(Scaling, firm, <u>RED-BROWN)</u></strong></em>
    • Palms & Soles BUT no presentation in face
    • Papulosquamos _(papules & scales) _Trunk
    • Mucous patches-mouth/tongue
    • “Snail track” buccal & genitalia
  • Condyloma lata-Wart-like appearance on moist areas of skin (angogenital, axilla & mouth)
  • Systemic disease-Flu-like, lymphadenopathy, liver, kidney, joints, brain
20
Q

Syphilis (Tertiary)

A
  • Latent-test + for syphilis w/no symptoms
    • Some pts heal spontaneously OR can relaspe to 2 or progress to 3
  • Tertiary-Chronic inflammation w/tissue destruction
    • Appears years after initial infection <strong>(10-40 yrs)</strong>
  • Non-contagious BUT highly destructive (Spirochete found in CSF)
  • Gummatous-Granulomatous lesions/Painless (NO spirochete)
  • Cardiovascular syphilis
  • Destructive joint disease
  • Neurosyphilis-Psychosis, dementia, Seizures <strong>(category 1)</strong>
  • Myelopathy <u><strong>(tabes dorsalis-</strong></u>demylenation of dorsal columns)
  • Optic nerve destruction (<u><strong>Argyll-Robertson</strong></u>-bilateral irreg shape small pupils)
21
Q

Syphilis (cong)

A
  • Early symptoms: 2-6 weeks after birth
    • Nasal discharge, skin/mucous membrane lesions & rashes w/failure to thrive
  • Generalized eruption on healthy child (macular lesions on soles)
  • Late: Appears after 2 years of age
  • Early damage to developing structures (teeth & long bones)
  • “Hutchinson’s Teeth”-effects incisors (screwdriver shape)
  • Infection to nasal bone (destruction to septa)-Saddle Nose
  • Growth retardation-seperation of epiphysis
    • <strong>Other manifestations mimic Tertiary</strong>
  • Interstitial Keratitis-inflammation of connective tissue corneas
  • Can result-Miscarriage & stillborn
22
Q

Syphilis (Diagnosis)

A
  • Specimen: Lesions, CSF, blood
  • Histo: Detection of Siprochete
  • Dark field-UNstained live spirochetes
  • Bright field-Silver staining technique
  • DFA-TP-Highly specific
  • Serology: anti-treponemal Abs (late syphilis)
  • VDRL or RPR use of cardiolipin as Ag
    • Easy, rapid, inexpensive <u><strong>(99% second stage+)</strong></u>
    • <strong>False + = Tissue diseases, Mono, Malaria, Leprosy, Infective endocard</strong>
  • Tremonemal tests-FTA-ABS, MHA-TP, TP-PA
    • Treponema as Antigen
23
Q

Syphilis (Treponemal)

A
  • Use of Antigens specificto TP
    • <strong>Used to confirm RPR or VDRL tests w/syphilis</strong>
  • Not useful in pts following treatment (+ for life)
  • FTA-ABS-Immunofluoresence & killed treponemas fixed to slide
  • Agglutination-Particles coated w/trepanemal Ags
    • Inert particle (color coated w/TP ags)
    • RBC (coated w/TP ags)
  • TP-PA-Treponema pallidium particle assay
    • Gelatin particles in microtiter agglutination
  • MHA-TP-RBC attached w/TP spec Ags-_Microhema test in presence of Ab specific to TP_
24
Q

Syphilis (Treatment)

A
  • Penicillin-Long acting benzathine (Single dose for primary)
    • <strong>Allergic pts=Erthromycin & Tetracycline</strong>
  • Can cross placenta=prevent cong infections
  • “Jarisch-Herxheimer” rxn:
  • Sudden massive destruction of spirochetes massive release of LPS
    • Fever, hypotension, rigors
  • NO vaccine
25
Q

Non-conventional treponemes

A
  • Non-sexual transmission & Regional
  • Endemic/Bejel
  • Transmission: Sharing drinks or foods (utensils)
    • Skin lesions around oral mucosa
  • Bone & skin granuloma-LATER presentation
  • Region: Desert in Africa/Middle East
  • Yaws
  • Later development of gummas (granuloma skin & bones)
  • Region: Tropical & Desert of SA, Africa, Asia
  • Pinta:
  • Primary & Secondary lesions
  • Limited to skin-Late=Blue variety
  • Healed lesions leave skin depigmented-“White patches”
  • Region: Central & South America
26
Q

Lymphogranuloma Venereum

A
  • Infectous agent-Chlamydia trachomatis (L1-3)
  • Obligate intracellular bacteria (lack muramic acid-cell wall)
    • Does NOT gram stain
    • Bi-phasic growth cycle <u><strong>(EB-RB)</strong></u>
  • Diagnosis: Cytoplasmic inclusion bodies
  • Treat: Doxycycline & Azithromycin
  • Symptoms:
  • Genital ulcer-Painless lesions <strong>(unoticed for days)</strong>
  • Extensive swelling of Inguinal lymph-Drainage issues
    • Blockage of lymph lower body=Elephantiasis
  • Common in hot climates
27
Q

Chancroid-Soft Chancre

A
  • Infectous agent-_Haemophilus ducreyi _
  • Gram(-) rod, Chain former, LOS cell wall
  • Capnophile <u><strong>(requires CO2</strong></u>) grows in choco agar
  • Symptoms: “EXTERMELY painful”
  • Genital ulcerations-Begin as papules progress to pustules (“Soft chancres”)
  • Lesion begins solitary-<u><strong>Autoinoculation multiple lesions</strong></u>
  • Men-Appears on glans/shaft or anus
  • Women-Appears on cervix, vagina or perianal
  • Tender inguinal lymphademopathy-may rupture & leave chornic fistlae-“Bubo”
28
Q

Chancroid (Clinical)

A
  • Diagnose: Gram staining MAY reveal chains or coccobacilli
  • Dark field exam rule out Syphilis (tests +)
  • PCR & Antigen detection-BEST choice
  • Treat: Penicillin resistant
  • Drug of choice-Cephalosporins
  • Drainage of fluctant lymphadenopathy may be required
29
Q

Granuloma Inguinale (general)

A
  • Infectious agent: Klebsiella granulomatis (Obligate Intracellular)
  • Gram(-) rod - Grows well in culture (egg yolk)
  • HIGH risk: Sex & possible GI
  • Africa, Papua new guina, India, Caribbean
  • Homosexual men in USA
  • Symptoms (90% symptomatic):
  • Papule on penis/labia or Anal
    • Extra genital lesions are common=<strong>Lips, face, neck</strong>
  • Lesions are PAINLESS-beefy red open sores that slowly enlarges-Foul smell
  • Regional lymphdenopathy (inguinal regions <u>NO lymph involvement</u>)
  • Pseudo-buboes-Subcutaneous granulomas
  • Results in extensive Scarring
30
Q

Granuloma Inguinale (Clinical)

A
  • Diagnose: Tissue biopsy & microscopic
  • Demonstrates mononuclear cells w/intracytoplasmic vacuoles
  • Vacuoles-Bacteria (Donovan bodies)
  • Treat-Tetracycline
31
Q

HIV (General)

A
  • Enveloped-diploid (+) sense RNA
    • (reverse transcriptase-RNAdependent-DNApolymerase)
  • Proteases/Integrase-w/host chromosome & replicate through DNA Intermediate
  • HIV-1 (worldwide) & HIV-2(West Africa)
  • HIV-1 group M has Several subtypes
  • Divisions based on <strong>envelope antigens & Gag genes</strong> <u><strong>(capsid/matrix)</strong></u>
  • Transmission-HIV infected cells=macrophages, lymphocytes, spermatozoa (no FREE virus transmission)
    • Mother-child=Delivery or breast feeding
  • HIV + inflammatory STD (syphilis, gonorrhea, Herpes)=High risk
32
Q

HIV (Long term survivor)

A
  • Still infected BUT do not progress to HIV infected cells
  • Mutated CCR5-receptor for virus
    • Heterogenous=Slow progression & Homo=Resistance
  • HLA alleles-HLA-A 6802, 0202, B18
    • <strong>Show COMPLETE resistance to HIV infection</strong>
    • <strong>HLA class 1 & 2</strong>
  • HIV viruses mutated nef gene=Long term survival
33
Q

HIV Structure

A
  • Envelope Glycoproteins (coded by evelope gene gp160):
  • gp120-Attaches to CD4
  • gp41-binds to CCR5/CXCR4 fusion w/host cell membrane
  • Enzymes (Coded by Polymerase gene p160):
  • Protease-cleaves precursor polypeptides
  • Reverse transcriptase-Viral RNA-Viral DNA (latency)
  • Capsid protein: P24 used in diagnosis (coded by p53)
  • Nucleic acid: +ssRNA-2 copes
  • Anti-HIV drugs target-gp41 (fusion) STOPS all enzymes
    • Enfuvirtide
34
Q

HIV-Pathogenesis

A
  • Any cell expressing CD+4 (CCR5/CXCR4) can be infected
  • Gp-120 recognizes CD4 and binds chemokine receptor
    • CCR-5 (macrophages, dendritic, microgila)-Carried to lymph
    • CXCR4 (Tcell)
  • Viral envelope fused to host cell through gp41
    • Reverse transcriptase moves to nucleus
    • Viral DNA + Host gentic info=<em><strong>Provirus</strong></em>
    • <em><strong>Integrase </strong></em>enzyme cleaves
  • Lytic infection of CD4 T-cells=Immunosupression
    • Killing of CD-4 cells by CD-8 <strong>(Less 200 T-cells)</strong>
  • HIV reduces MHC-1 (nef/tat gene)=Avoids attack by CD-8
  • Latent phase=in lymph multiplying in follicular dendritic cells
35
Q

HIV-Staging (one)

A
  • 1-primary infection (acute phase)=Asymptomatic
  • Incubation 1-3 weeks-Mono-like symptoms
    • Fever, headache, sore throat, malaise, meningitis
  • Rash-Small pink papules/macules over majority of body <u>(NO palms/soles)</u>
  • HIGHLY infectous stage-Virus found in large conc in genital fluids
  • Viremia=High lvls of p24 (capsid) & viral DNA in blood
  • Asyptomatic= 10 years or 2 years in children
    • Virions can start to multiply=Killing immune cells in lymph or can lay dorment
    • <em><strong>Decline in CD+4 T cells & P24/viral RNA</strong></em>
    • Normal CD4 count <em><strong>above 500</strong></em>
36
Q

HIV staging (2 & 3)

A
  • Stage 2-AIDS related complex (ARC)-Symptomatic
  • Persistent fever, weight loss, fatigue, night sweats, lymphadenopathy
  • Present w/oppurtunistic infections CD count 200-400:
    • Diarrhea longer than a month
  • Karposi sarcoma (HHV-8), cadidiasis, Hairy leukoplakia (EBV)
  • Stage 3-Full blown=HIV +
    • Fewer than <em><strong>200 CD4+</strong></em> & <em><strong>P24/viral RNA HIGH</strong></em> in serum
  • Life-threatening infections by opportunistic pathogens
    • <strong>Pneumocystis Jirovecii,</strong> Atypical mycobacterial infections<strong> (avium complex)</strong>
  • Malignancies-Karposi sarcoma (purple/red skin lesions-HSV8)
  • AIDs related dementia-Microglial cells _(confusion, forgetfulness, seizures, coordination) _
37
Q

HIV Diagnosis

A
  • Serology through antiviral Ab
  • ELISA, RAPID Ab Test (urine, saliva, blood)
  • Western blot-used as confirmation of + ELISA
  • Detects Ab against viral Ags (gp41 +120/160 or p24+120/160)
  • Serology (-) during window period (asymptomatic=1)
  • Viral load-Detect viral nucleic acid/viral proteins
    • Large # of Viral RNA & P24 = Early or Late
  • Viral RNA-RT-PCR: Reverse transcriptase polymerase chain rxn
    • Detect viral protein-P24
  • CD-4 count-Staging disease
    • Used to intiatre therapy & determine treatment success
38
Q

HIV-Treatment

A
  • Reverse-Transcriptase inhibitors-Inhibit virus multiplication
    • Nucleoside/nucleotide-NRTI
    • Non-nucleoside-NNRTI
  • Protease inhibitors-PI inhibit viral multiplication
  • Highly active anti-retroviral treatment (HAART)
    • combo treatments
  • Biding & fusion inhibitors:
  • Enfuviritide<strong> (mimics gp41)</strong>=Blocks **gp41 **
  • Maraviroc=Blocks CCR5
  • Integrase inhibitors-Isentress (stop latency)
39
Q

Cytomegalovirus (HHV-5)

A
  • Ds DNA eveloped (isosahedral)-Lytic, persistent, & latent infection
  • Forms multinucleated syncytia w/basophilic inclusion body (Owl’s eye)
  • Humans 80% sero-(+) samples isolated from saliva, tears, urine, stool, semen (highest conc)
  • Transmission: Transplacental, intrauterine, breat milk. Sexual contact
  • High risk: immunocompromised, AIDS, transplant pts, chemo pts
  • Responsible for kidney transplant failures
40
Q

Cytomegalovirus (pathogenesis)

A
  • Lytic infection of epi cells & others
  • Latent state & persistent infection w/in T-cells, endothelial cells & _monocyte-macrophages _
    • “Downey Cells”-Atypical macrophages
  • Occur more frequently in Immunocompromised
    • Inhibiting expression of MHC1/2 <strong>(ex HIV)</strong>
    • Multisymptomatic-Pneumonia, retinitis, colitis, meningitis
    • Reactivation-occurs
  • Asymptomatic mother (virus can still shed-Serogegative) infects infant interuterine-Transplacental infection:
    • <strong>Microcephaly, Periventricular calcificaion, </strong><strong>Jaundice</strong>
    • <strong>Rash=B</strong><strong>lue Berry muffin lesions</strong>
    • Perinatal infection (during birth)=NO disease
41
Q

Cytomegalovirus (Diagnosis)

A
  • Histo: demonstrates cytomegalic cell (enlarged)
  • Contains dense central basophilic inclusion body=OWL’s eye
  • Serolgy: Detect IgM
  • Treat: Gancicovir <strong>(inhibits viral DNA poly)</strong>
  • Diagnosis in infants can be found up to 2-3 weeks after birth
  • Infects 0.5-2.5% of all newborns & can cause still births
42
Q

Human Papilloma Virus (Warts)-general

A
  • Ds CIRCULAR DNA-NON-enveloped
    • <strong>Isocahedral replicates in nucleus</strong>
  • Several types (show tissue preference)
  • Humans can be infected w/more than 1 type
  • _High risk: _
  • Genital HPV-Unprotected sex
  • Skin warts common w/children & young adults
  • Infects/replicates in sqaumos epi cells (skin & mucous membranes)
  • Induces cell prolif=benign outgrowth <u><strong>"warts"</strong></u>
  • Hyperplasia of prickle cells & excess production of keratin
  • 16 & 18 are oncogenic (cervix, penis, anus)
    • Protein E-6 inactivates P53
    • Protein E-7 inactivates p105RB (retinoblastoma)
43
Q

Molluscum Contagiosum (pox virus)-General

A
  • DNA <u>Double enveloped Virus / Brick like</u>
  • DNAdep-RNA poly <em><u>(replicate in cytoplasm)</u></em>
  • Strictly HUMAN pathogen
  • Transmission: Direct contact or fomites (sharing towels, swimming pools, showers)
  • High risk: Children & Adults with active sex lives
  • Causes _Hyperplasia of epithelial cells _
  • Cells have inclusion bodies seen=Warts
  • Disease (2-8 weeks): “Cutaneous warts”
  • Appear in clusters-Small, firm, white, flesh-colored (pearl like) bumps
  • Dimple in center
  • Cheesy white material @ pit
  • Painless
  • Appear on lower ab (pubis, genitalia) in ADULTS
  • Appear on trunk or extremties in CHILDREN
44
Q

Herpes SImplex (HSV 1/2)-General

A
  • Surface glycoproteins made by viral genes
    • <strong>Lipid bilayer from the host cel</strong>l
  • Tegument=initiation of viral replication
  • Ds Linear DNA/Enveloped
  • Cytopahtic effect=Change in nuclear structure & margination of chromatin
  • Cowdry type A <u>(intranuclear inclusion bodies)</u>
  • Causes fusion of cells=Syncytia <u>(avoid immunity)</u>
  • Transmission: Contact through secretions of lesions
  • Contact w/saliva<u> (Type 1</u>), sexual/transplacental<u> (Type 2)</u>
  • Life long infection=Asymptomatic shedding
  • 3 infection phases:
  • Initial lytic-Actively multiplies & kills cells
  • Latent infection-Neurons (sensory ganglion)=Inactive
  • Reactivation-Exits neurons to infect/Kill epithelial cells

Microbio-2 (20 decks)

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