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Test 4/final Flashcards

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1
Q

Sporotrichosis

A

Sporothrix schenckii (subcutaneous)

Rose gardener’s disease
Cigar shaped yeast form

Lymphatic involvement

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2
Q

Chromoblastomycosis

A

Fonsecaea, Phialophora, Cladophialophora (subcutaneous)

Tissue morphology: Sclerotic/medlar bodies (yeast)

Verrucous califlower-like lesions on lower extremities (bare feet)

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3
Q

Phaeohypomycosis

A 
Cladophialophora bantiana (brain lesions) = fatal
(subcutaneous)

Usually forms a cyst on the hands

Tissue morphology: pigmented septate hyphal fragments

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4
Q

Eumycetoma

A

Draining sinuses containing granules
(subcutaneous)

Madura foot (bare feet)

*can also be caused by actinomycetes (bacteria)

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5
Q

Dermatophytes

A

Cutaneous

Digest keratin (nutrient source)

Tinea barbae, corporis, capitis, cruris (groin), pedis, manuum, unguinum (onchomycosis)

*favus variant tinea capitis = scutula that covers scalp (gross)

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6
Q

Pityriasis (tinea versicolor)

A

Superficial

Malasserzia furfur

Hyper/hypopigmented maculae usually on trunk/proximal limbs

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7
Q

Tinea nigra

A

superficial

Hortae Werneckii

Brownish maculae on palms and soles (looks like melanoma)

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8
Q

Black Piedra

A

Piedraia hortae (superficial)

Microscopic = discrete, hard, dark brown nodules on hair

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9
Q

White piedra

A

Trichosporan spp (superficial)

Microscopic = soft,white to yellowish nodules loosely attached to hair

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10
Q

Endemic, Dimorphic fungi

A 
coccidioidomycosis
histoplasmosis
blastomycosis
paracoccidioidomycosis
penicilliosis marneffi
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11
Q

Coccidioidomycosis

A

Mnemonic: Coccidio Crowds san joaquin valley, “valley fever”

Coccidioides immitis (califiornia)
Coccidioides posadasii (arizona)

Self-limited pulmonary febrile illness, lung lesions, valley fever (30%), highest incidence >65

*Microscopic = Spherule filled with endospores

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12
Q

Histoplasmosis

A

Mnemonic: Histo Hides within macrophages, bird and bat droppings

Histoplasma capsulatum
Found in soil, bat, and bird droppings

Asymptomatic (95%), pneumonia, chronic cavitary fibrosing mediastinitis, disseminate via RES, sepsis

  • Microscopic = macrophage filled histoplasma
  • Urine histoplasma antigen testing
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13
Q

African Histoplasmosis

A

larger, thick-walled yeast cells
pronounced giant cell formation in infected tissue
diminished pulmonary involvement
greater frequency of skin and bone lesions

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14
Q

Blastomycosis

A

Mnemonic: Blasto buds broadly

Blastomyces dermatitidis
Epidemiology: soil, near inland waterways

Asymptomatic (50%, more virulent), pulmonary infection, subcutaneous nodule, disseminate to bone or skin (immunocompromised)

*Microscopic = bud attached to parent by broad base

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15
Q

Paracoccidioidomycosis

A

Mnemonic: Paracoccidio Parasails with the captain’s wheel all the way to latin america

Paracoccideioides brasiliensis
Epidemiology: central-south america

Asymptomatic, nodular lesions in lungs, mucocutaneous orolabial and nasal lesions

*Microscopic = multiple budding yeasts the buds are attached to the parent cell by a narrow base “pilot’s wheel”

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16
Q

Penicillium Marneffei

A

Important cause of fungal infection in HIV people in southeast asia

with AIDS = dissemination to other organs, with hallmark skin lesions on face/trunk

*Microscopic = yeast form in ellipitcal with fission septae

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17
Q

Cryptococosis

A 
Opportunistic yeast (heavily encapsulated) 
Found in soil and pigeon droppings 
Cryptococcus neoformans var grubii (N. american)
C. gattii = pulmonary disease in immunocompetent

pulmonary can be asymptomatic or fulminant
CNS meningitis and cyptococcoma (leading cause of fungal meningitis)

  • Microscopic = wide variation in size, india ink stain capsules appears as a “halo”
  • capsular polysaccharide antigen detection in serum/CSF (very sensitive)
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18
Q

Candidiasis

A

Leading cause of opportunistic fungal infection
Candida albicans is the most common species

Diagnosis via microscope = budding yeast with pseudohyphae
Germ tube test

i. Localized disease of skin and nails (e.g. diaper rash)
ii. Mucosal infections (vaginitis, oral thrush, esophagitis)
iii. Invasive disease involving bloodstream, sterile sties, and/or multiple organ systems
USUALLY CATHETER RELATED, with risk of dissemination (must pull catheter)
2. 3rd most common cause of central line associated blood stream infection (CLABSI), 40% mortality rate
3. Also infect bone, joint, peritoneum, other deep organ system involvement

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19
Q

Hepatosplenic candidiasis

A

unique to cancer patients with prolong neutropenia, microabscesses in liver and spleen, blood culture usually negative

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20
Q

Diagnosis of Candida problems

A

Early diagnosis is difficult

i. Lack of inflammatory response in host
ii. Invasive diagnostic procedures risky (organisms do not hang out in blood, have to biopsy more invasive areas)
iii. Lack of sensitive, minimally invasive assays

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21
Q

Risk factors for invasive candidiasis

A

i. Antibiotic use (increase with each additional drug)
ii. Colonization with Candida
iii. Presence of central venous catheter
iv. Neutropenia (for hepatosplenic disease)
v. Staying in the hospital too long

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22
Q

Aspergillosis

A

Mnemonic: Acute Angles in Aspergillus
Most common cause of invasive mould infection
c. Aspergillus fumigatus = most common species

Unlike candida, aspergillus do not routinely colonize healthy persons

*Diagnosis via microscope = septate hyphae that branch at acute angles (<45 degrees), conidiophore with rare fruiting bodies

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23
Q

Aspergillosis Clinical syndromes

A

Clinical syndromes
Allergic bronchopulmonary aspergillosis

Aspergilloma in pre-existing cavity = secondary colonization of a lung cavity (fungus ball, hemoptysis, occasional local invasion)

Semi-invasive aspergillosis = chronic cavitary, chronic fibrosing, chronic invasive

Invasive aspergillosis

  1. Extremely serious, life threatening (60-95% mortality)
  2. Angioinvasive with tissue infarction, rapid spread, dissemination
  3. Risk factors = neutropenia, corticosteroids, transplant graft vs host disease
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24
Q

Galactomannan test

A

Test for aspergillosis

polysaccharide cell wall component, test approved for serial monitoring of hematologic malignancy patients

  1. Not useful if patient is on antifungal therapy
  2. Certain antibiotics have galactomannan (false positive) = Piperacillin-tazobactam
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25
Zygomycosis
Rhizopus, Mucor, Rhizomucor, others Usually cause rhinocerebral or pulmonary disease, can cause disseminated disease in immunocompromised Diagnosis microscopic = nonseptate hyphae with sporangia, branch at wide angles i. Difficult because any damage to nonseptate hyphae kills them (should be minced rather than crushed or ground) Risk factors Diabetes/diabetic ketoacidosis with hyperglycemia, acidosis hematologic malignancies, deferoxamine therapy, steroids, voriconazole prophylaxis in bone marrow transplant patients
26
Pneumocystis jiroveci (formerly P. carinii)
A major opportunistic myoctic infection (AIDS defining Illness), also seen in other immunocompromised patients Diagnosis = cannot be grown on culture therefore microscopy is only option i. Ground glass infiltrates Interstitial pneumonia 1. In AIDS patients, risk if CD4 <200 2. Insidious onset on dyspnea, tachypnea, non-productive cough, and fever 3. Ground glass infiltrates on CXR or cavitary lesions (looks like TB) Treatment = trimethoprim-sulfamethoxazole (Bactrim) = antibiotic (not-antifungal) i. Patients can worsen in first few days as large antigen load from lysing organisms is released from the lungs (give steroid to mitigate this effect)
27
Toxoplasmosis
Toxoplasma gondii Oocysts = infectious form in cat stool Tissue Cysts = infectious form in under cooked meat Acute = asymptomatic Acute in HIV = encephalitis, brain abscess Congenital toxo = passed to fetus 2/3 = neurologic disease (chorioretinitis, intracranial calcification, hydrocephalus) 1/3 = generalized disease Ocular taocoplasmosis = sequelae of congenital/acute infection (headlight in a fog)
28
Babesiosis
Acquire via tick bite (Ixodes sp.) Easily confused with malaria (trophozoites, merozoites) B. microti = northeast USA, recently in midwest and west coast (WA-1) ``` Disease = fever, hemolytic anemia Asplenia = increased risk of severe disease ```
29
Leishmaniasis
``` Promastigote = sand fly (Lutzomyia or Phlebotomus) Amastigote = intracellular macrophage ``` Reservoir = dogs, rats, humans (india) Diseases Visceral = RES infections = mostly fatal Cutaneous = chronic ulcer with heaped-up margins Mucocutaneous = ulcer and mutilating cartilage Viscerotropic = spiking fevers, pancytopenia
30
American Trypanosomiasis
Typanosoma cruzi vector = reduvid bug (kissing bug) Acute Chaga's disease = Chagoma, Romana's sign (unilateral periorbital edema), fever Chronic Chaga's disease = cardiomegaly, megaesophagus, megacolon
31
African trypanosomiasis
Trypanosoma brucei = sleeping sickness Vector = glossina sp (Tsetse fly) Winterbottom's sign Sleeping sickness = brain perivascular cuffing
32
Amebiasis
Entamoeba histolyica, entamoeba dispar ``` Cyst = infectious, in water Trophozoite = invasive ``` Fecal oral spread, cyst is immediately infectious, person to person spread Disease: Acute rectocolitis (DYSENTERY) Liver abscess Diagnosis: Colitis = stool exam for cysts/trophozoites Liver abscess = serology
33
Giardiasis
Giardia lamblia, Resistant to chlorine! Reservoirs = humans, beavers Fecal oral spread (campers, day care, institutions for mentally retarded) Disease = bloating gas, chronic or recurrent diarrhea Malabsorption of fat (Mnemonic: Ghirardelli chocolates for fatty stools of Giardia) Diagnosis = stool antigen test
34
Intestinal non-inflammatory protozoa
All worse in immunocompromised and cause diarrhea (non-inflammatory unlike amebiasis) Giardia = immediately infectious, person to person spread, chlorine resistant, fatty stools Cryptosporidiosis = immediately infectious, person to person spread, chlorine resistant, AFB stain Cyclospora = not immediately infectious, no person to person spread, water/food (raspberries), AFB stain, Nepal (more infections) Microsporidia = no immediately infectious, no person to person spread, extraintestinal infections (seen in AIDS pts), biopsy (stain poorly)
35
Intestinal Nematodes (roundworms)
Pinworm (intestinal) = mild infection; person-to-person spread within families, day cares Trichuris trichiura (intestinal) = mild infection, but no person to person spread Ascaris lumbricoides (intestinal with tissue migration) = largest intestinal nematode: lung phase (loeffler's syndrome) Hookworm (skin penetrating intestinal) = iron deficiency anemia Stongyloides stercoralis (skin penetrating intestinal) = autoinfection results in long-term infection, hyperinfection during immunocompromise
36
Enterobius vermicularis
Pinworm (intestinal nematode) life cycle = intestinal only fecal oral spread NOT a geohelminth = PERSON to PERSON spread! human reservoir only (eggs immediately infectious) Diagnosis = scotch tape test (eggs on perianal skin) ``` Clinical = Intestinal infection, anal pruritus complications = due to adult migration, UTIs ```
37
Trichuris trichiura
Whipworm (intestinal nematode) life cycle = intestinal only fecal oral spread Unlike Enterobius it has an obligate period of soil development = no person to person spread Diagnosis = stool sample Clinical = usually asymptomatic, rectal prolapse
38
Ascaris lumbricoides
``` Giant roundworm (intestinal nematode) = largest one life cycle = intestinal with tissue migration oral acquisition, GI and tissue (lung) phases Eggs = resistant to harsh environment ``` Intestinal phase = abdominal pain, excreted worms Pulmonary phase = Loeffler's syndrome (eosinophilia, transient pulmonary infiltrates) Diagnosis = stool, eosinophilia
39
``` Ancylostoma duodenale (old world) Necator americanus (new world) ```
Hookworm (intestinal nematode) = common cause of IRON-DEFICIENCY ANEMIA life cycle = skin penetrating intestinal, must develop in soil Acquired by walking barefoot diagnosis = eggs in stool Clinical: skin = itch at site of penetration Pulmonary (mild) Intestinal = eat blood = iron deficiency anemia, protein loss
40
Strongyloides stercoralis
Life cycle = skin penetrating intestinal Difference from hookworm = potential for autoinfection (does not need to develop in soil) Can persist for years (>45 years) associated with HTLV-1 Diagnosis = larvae in stool (not egg) Clinical: skin rash pulmonary = migratory (loeffler's syndrome) Chronic persistent infection = recurrent diarrhea *Hyperinfection syndrome = in immunocompromised, overwhelming reproduction = allow gram negatives to penetrate blood stream = 86% mortality
41
Tissue Nematodes (Filarial Infections = vector-borne nematodes)
Adult worms = reside in blood or lymphatic vessels or in subcutaneous tissue, transmitted through an insect bite Microfilariae = immature larvae in blood, skin, or eye Wuchereria bancrofti = elephantiasis Brugia malayi = elephantiasis Onchocerca volvulus = river blindness Loa loa = calabar swelling, eye worm
42
Lymphatic Dwelling Filariae
Wuchereria bancrofti | Brugia malayi
43
Wuchereria bancrofti
Lymphatic dwelling filariae Life cycle = mosquito vector, adults resides in lymphatics, microfilariae in blood (diagnostic) Nocturnal or diurnal periodicity of microfilariae in blood (correlates with mosquito feeding) Clinical: acute = adenolymphangitis (adult worms), filarial fever (microfilariae) Chronic obstructive symptoms = elephantiasis of extremities (especially genitalia)
44
Brugia malayi
Lymphatic dwelling filariae Clinical: Elephantiasis of the extremities (extremities more often, genitals less)
45
Tropical pulmonary eosinophilia
hypersensitivity reaction to microfilaria hypereosinophilia associated with hypersensitivity to W. bancrofti, B. malayi fever, weight loss, Loeffler's like syndrome
46
Tissue Dwelling Filariae
Adult worm in tissue (vs lymphatics) Loa Loa Onchocerca volvulus
47
Loa loa
Tissue dwelling filariae Adult forms in subcutaneous tissue, conjunctiva vector = horsefly Clinical residents of endemic areas = asymptomatic Calabar swellings = edema over bony prominence (lasts about a week) Eye worm = few sequelae Meningoencephalitis (microfilaria in CSF mostly due to treatment)
48
Onchocerca volvulus
Tissue dwelling filariae River blindness (2nd most infectious cause) Vector = black fly *microfilariae in the skin ``` Clinical: subcutaneous nodules (bony prominences) dermatitis = due to microfilariae Regional lymphadenitis (hanging groin) Eye manifestations = blindness ``` *Diagnosis = skin snip
49
Nematode with larval stages causing human disease
Nematodes with worst pathology due to larval forms of parasites Trichinella spiralis Larva migrans (toxocara) Anisakiasis
50
Trichinella spiralis
nematode (larval stage causes disease) Life cycle = adult/larvae in human, larvae causes the disease Acquired via eating undercooked pork/bear ``` Clinical: larvae disseminate via blood/lymphatics Encyst in muscles (nurse cell) = symptoms based on cyst load, splinter hemorrhages >1000 = life threatening *eosinophilia ```
51
Larval Migrans syndromes
nematode (larval stage causes disease) Humans as aberrant hosts for dog and cat intestinal helminths Toxocara canis = dog ascarid Toxocara cati = cat ascarid Acquire exposure to dog, cat feces in soil = larvae enter vasculature and travel to systemic circulation visceral larva migrans (VLM) = liver, lungs, CNS, muscle = high eosinophilia, fever, hepatomegaly, etc Ocular larva migrans (OLM) = eosinophilic inflammatory mass in eye Cutaneous larva migrans = serpiginous creeping eruption *eosinophilia
52
Anisakiasis
nematode (larval stage causes disease) Found in various types of fish (sushi) Humans are incidental hosts Clinical: stomach anisiakiasis = 1-7h after eating, epigastric pain, nausea, vomiting Intestinal = 1-5 days, larvae invade ileal wall Extra-intestinal = larvae may penetrate into peritoneum, pleural space
53
Trematodes (flukes) = flatworms
``` leaf shaped parasites 2 suckers (anterior, ventral) most are hermaphroditic (except schistosomes) ``` Schistosoma = blood flukes Clonorchis sinensis = liver flukes Fasciola buski = intestinal flukes Paragonimus westermani = lung flukes Life cycle: snail = first intermediate hosts (except schistosomes, 2nd intermediate host)
54
Trematode life cycle
humans pass eggs in feces --> miracidium develops in egg --> released into water --> miracidium enters SNAIL --> Cercaria leave sail (infectious!) *Schistosomes = cercaria invade human skin --> become schistosomula --> then adult worms
55
Schistosomes
``` Trematode (flukes) = flatworms Life cycle: Cercariae penetrate skin (3-5 min proteases) Schistosomula migrates through blood Adult worm paired migration: S. mansoni = inferior mesenteric venules S. japonicum = superior mesenteric venules S. haematobium = bladder ``` Schistosomula and adult worms = Avoid immune response! via: absorption of MHC Class I & II, DAF-like molecule (inhibits complement) Eggs = elicit immune response = facilitate penetration of eggs through bowel, some do not penetrate = granuloma formation Clinical: Cercarial dermatitis = swimmer's itch acute schistosomiasis = katayama fever Chronic schistosomiasis: gastrointestinal = hepatosplenic, hepatomegaly, portal HTN, intestinal polyposis, colon cancer Urinary = obstruction, squamous cell bladder cancer Rare = CNS, lungs
56
Cestodes (tapeworms)
Flattened, no body cavity, all are parasitic hermaphrodites Humans definitive hosts = harbor adult (sexual) worms, symptoms are minimal Humans intermediate hosts = harbor larval stages, causes serious complications
57
Diphyllobothrium latum
Cestode (tapeworm), largest human tapeworm Fresh water Fish tapeworm Clinical: often asymptomatic *Vitamin B12 deficiency
58
Hymenolepis nana
Cestode (tapeworm), dwarf tapeworm *eggs are immediately infections = human to human spread autoinfection & hyperinfection (immunocompromised) Clinical: diarrhea
59
Taenia spp.
Cestode (tapeworm) T. saginata (beef) = proglottids (15-20 uterine branches) are diagnostic, mild GI T. solium (pork) = human can be intermediate host, larvae can disseminate throughout body/person to person spread, can cause cysticercosis (MOST COMMON HELMINTH IN CNS), can also cause calcifications, proglottids (7-13 uterine branches)
60
Echinococcus granulosus
Cestode (tapeworm) Human = intermediate host Dog = definitive host Clinical: Cystic hydatid disease LIVER CYST, cyst rupture = sudden anaphylactic reaction

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