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CLS 790 > TORCH, Spirochetes, Mono > Flashcards

TORCH, Spirochetes, Mono Flashcards

1
Q

What does TORCH stand for?

A

T = toxoplasmosis

O = others perinatal infections (gonorrhea, syphilis, HIV)

R = Rubella

C = CMV

H = Herpes

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2
Q

What is TORCH used for?

A

Prenatal screening test

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3
Q

Toxoplasmosis - infectious agent. Modes of transmission

A

Toxoplasma gondii
-cannot be cultured

From cats or uncooked meats

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4
Q

Toxoplasmosis gold standard. Another test includes…

A

Sabin-Feldman Dye test

EIA

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5
Q

Toxoplasmosis - clinical findings

A

Mono-like symptoms

Hydrocephalus birth defects

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6
Q

Difference between EBV and CMV

A

EBV produces heterophile antibodies

CMV does not

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7
Q

CMV is a member of…

A

Herpes virus

-almost everyone has it

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8
Q

CMV - clinical findings

A

Neurological symptoms = mental-retardation, stillbirth

Mono-like symptoms

Cold sores, blisters

-mostly asymptomatic

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9
Q

Rubella - at what titer is a person considered immune? A recent infection has these findings…

A

1:8

4 fold increase in titer with symptoms

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10
Q

Rubella - clinical findings

A

Defects - CHF

Hepatitis

Diabetes

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11
Q

Rubella tests

A

EIA

Latex agglutination

Hemagglutination inhibition (HAI) - rubella can agglutinate chick RBCs. Mix patient serum with RBCs. Antibodies present = no agglutination

Passive hemagglutination (PHA) - human RBCs coated with Rubella antigen and serum diluted. Positive result is RBC agglutination (antigen-antibody complex)

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12
Q

What type of virus is the herpes virus? Which herpes virus is genital herpes?

A

DNA virus

HSV-II

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13
Q

Herpes tests

A

EIA

Viral culture - reference lab

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14
Q

Herpes - clinical findings

A

Fatal to infant if transmitted

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15
Q

Can spirochetes be gram-stained?

A

No

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16
Q

Syphilis bacterium

A

Treponema pallidum

  • fragile, need open lesion to pass
  • mother can transmit to newborn
  • quickly disseminate throughout body in 30 mins
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17
Q

Syphilis - clinical findings

A

Primary (chancre)
Secondary (lymphadenopathy, skin rash, sore throat)
Latent (asymptomatic)
Tertiary (granulomatous inflammation, cardiovascular disease, neurosyphilis)

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18
Q

Congenital syphilis - clinical findings

A

Generalized lymphadenopathy, hepatosplenomegaly, jaundice, anemia, bone abnormalities, neurosyphilis

Facial deformity: Hutchinson’s teeth

19
Q

Suspected Treponema infection should be screened for… Confirm with…

A

Non-treponemal antibodies first

  • MUST be confirmed
  • test is non-specific to treponema

Confirm with treponemal antibodies assay - cumbersome, expensive, lengthy

20
Q

What are Reagin antibodies? What do Reagin antibodies target?

A

Antibodies that develop targeting cholesterol-containing compounds in the cell membrane when they rupture from a syphilis infection

  • seen as “foreign”
  • Reagin is non-specific, seen in old people, autoimmune, cancer, TB, chickenpox, hepatitis
  • diminish over time

Cardiolipin

21
Q

Direct lab diagnosis of syphilis (2)

A

Fluorescent microscopy

Darkfield microscopy - corkscrew morphology, flexing mobility
-cannot be gram-stained

22
Q

Serological tests for syphilis are divided into two categories. Which is screening and which is confirmatory?

A

Non-treponemal = screening

Treponemal = confirmatory

23
Q

What are the 2 non-treponemal tests? Are they sensitive or specific for treponema?

A

VDRL and RPR
-look for flocculations = cardiolipin clumping

Both sensitive but not specific for treponema

24
Q

VDRL vs RPR - which one is easier to do? Benefit of VDRL?

A

RPR - sensitive, faster, no microscope needed

Can be used on CSF samples

25
Q

VDRL - weakness. What are the results?

A

Temperature sensitive - antigen MUST be prepared between 23-29C

Reactive - medium/large clumps
Weakly reactive - small clumps
Nonreactive - no clumps

-uses microscope for observation

26
Q

RPR - cardiolipin antigen is attached to… What are the results?

A

Charcoal

Reactive - medium/large clumps
Weakly reactive - small clumps
Nonreactive - no clumps. A “tail” is seen when swirled

-can be observed by eye

27
Q

Treponema confirmatory tests (4)

A

Fluorescent treponemal absorption (FTA-ABS) - antibodies to treponema. Remove cross-reacting antibodies in serum with sorbent first. Fix treponema to slide, add serum and conjugate Ig, observe fluorescence
-gold standard

T. pallidum passive/particle agglutination (TP-PA) - agglutination on plate

Microhemagglutination assay (MHA-TP) - discontinued

Immunoassays/ELISA - by request

28
Q

Treponemal vs non-treponemal - how do test results look over time

A

Treponemal titers appear during primary syphilis and remain elevated for life

Non-treponemal titers decline over time - peak at secondary-early latent stages

29
Q

Why do non-treponemal (RPR and VDRL) tests decline over time?

A

Patient recovers after treatment, antibodies decline in later stages of syphilis
-elevated for first 6 months of infection

30
Q

When testing fetuses for congenital syphilis, why should we look for IgM instead of IgG?

A

IgG comes from mother through placenta, false positive

-syphilis can cross placenta as well

31
Q

Neurosyphilis patients should be tested using these tests (2)

A

ELISA

VDRL using CSF

32
Q

3 types of diseases caused by spirochetes

A

Syphilis

Lyme disease

Relapsing fever

33
Q

Lyme disease - caused by…

A

Borrelia burgdorferi

34
Q

Lyme disease - clinical manifestations

A 
Stage 1
Localized rash
Stage 2
Early dissemination
Stage 3
Late dissemination with arthritis
35
Q

Lyme disease diagnosis

A

ELISA

Western blot - ELISA followup

IgM and IgG antibody levels

  • IgM = recent
  • IgG = awhile ago
36
Q

Lyme disease - western blot MUST show this band… It must also be positive for…

A

41 kDa + 2 other bands specific for spirochete

37
Q

This disease mimics Lyme disease… caused by…

A

Relapsing fever

Borrelia miyamotoi

38
Q

Mono - caused by this virus… Virus is part of this family…

A

EBV = oncogenic

Herpes

39
Q

How is mono detected?

A

ELISA

Heterophile antibody

40
Q

Mono causes a rise in…

A

Lymphocytes - 50% lymphocytosis = more Igs

Spike in gammaglobulins

41
Q

Mono produces heterophile antibodies that are this Ig class…

A

IgM

42
Q

How are heterophile antibodies tested for (2)

A

Paul Burnell heterophile antibody test

Davidsohn differential test

43
Q

Mono test result for differential test

A

Negative - bovine RBC + sheep RBC + serum = no agglutination

Positive - guinea pig kidney + sheep RBC + serum = agglutination

44
Q

First EBV antibody to appear during an infection

A

Anti-VCA (IgM)

-virus capsid antigen

CLS 790 (13 decks)

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