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Patho > Viruses and parasites > Flashcards

Viruses and parasites Flashcards

1
Q

Childhood viruses

A
  1. Measles
  2. Mumps
  3. Rubella
  4. Parvovirus B19
  5. HHV 6,7
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2
Q

diseases by number

A

1st disease: Measles (rubeola)
2nd: Scarlet fever
3. Rubella
4. staphylococcal scalded skin syndrome
5. 5th disease- Erythema infectiosum
6. Roseola infantum

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3
Q

Measles virus

A

trans: respiratory droplets
Contagious b4 rash appears
Stages:
1. Incubation 6-19 days
2. Prodrome- Malaise, anorexia, fever that increases over several days-> 3 C’s- conjunctivitis (can cause photophobia), coryza (running nose) and cough
3. Exanthem- Koplik spots first (enanthem 48 hrs b4)-> Morbilliform rash (red, maculopapular, blanching, on face first)
4. Recover- within 48 hrs of rash

Complications: Encephalitis, Thrombocytopenia, pneumonia, OM

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4
Q

Modified Measles

A

Attenuated infxn in individuals w/ pre existing measles immunity-> prolonged incubation period, mild prodrom, discrete rash

Result from:
post exposure vaccination with ISG
incomplete vaccination and waning immunity and exposure to wild type

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5
Q

Atypical measles

vaccine sens to virus ag without providing full protection

A

SXS: Fever, pneumonia, pleural effusions, edema
Centripetal rash- Petechial-> central focused
Abdominal pain
Myalgias

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6
Q

SSPE

Subacute sclerosing panencephalitis

A
  • Persistent wild type measles virus in CNS

Stage 1: Personality changes, lethargy
Stage 2: jerking movements, wrosening dementia
Stage 3: flaccidity, further neuro deterioration
Stage 4: vegetative state and death

Seizures at any stage
FATAL- GET VACCINATED

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7
Q

Mumps virus

A

Salivary gland swelling
* parotid predilection-> usually bilateral
* Respiratory transmission
* Prodrome: fever, malaise, anorexia, swelling of salivary glands

Complications:
Orchitis in males older than 12yrs- if bilateral lead to sterility

Meningitis

Live virus vaccine

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8
Q

Rubella virus

A

Benign illness-> immunize bc of teratogenicity-> risk if not vaccinated
* Nonimmune pregnant mothers infected in 1st trimester-> significant congenital malformations
* Transmit: respiratory transmission and transplacentally
* Prodrome: fever and malaise-> 3 day rash maculopapular, POSTAURICULAR NODES, ARTHRALGIA IN FEMALES

LIVE VIRUS VACCINE- DO NOT GIVE IF PREGNANT OR IMMUNOCOMPROMISED

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9
Q

Parvovirus B19

respiratory route and transplacentally

A

Erythema Infectiosum- Fifth disease
* primary infects: erythroblasts in marrow and endothelial cells-> vasculitis
* usually asymp
* SXS: slapped cheeks, sore throat, coryza, low grade fever, lacy rash on body

Benign except:
* Chronic anemias-> sickle cell anemia can have a crisis
* Pancytopenias secondary to impaired immune system-> AIDS, cancer tx, antirejection drugs after organ transplant

Infection during Pregnancy
1. during 1st trimester-> Fetal death
2. During 2nd trimester-> Hydrops fetalis- edema, anemia, CHF of fetus

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10
Q

Roseola

HHV- 6,7

Herpes virus

A

Exanthem subitem
high fever 3+ days, otherwise well appearing
Defervescence followed by rash
can have URI sx, nodes, fussiness

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11
Q

Hepatitises

A
  • Hepatitis A- RNA genome- food born- fecal oral- vaccine avail—-> kids= asymp or with GI, Adults are symptomatic
  • Hepatitis B- DNA- Blood, baby, babymaking- can have chronic infxn but self limiting- yes vaccine
  • Hepatitis C- RNA- Blood and Sexual- yes chronic but 15-25% clear spon
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12
Q

Acute Hepatitis

A

SXS:
Pre-Icteric phase= nonspecific
* anorexia, N/V, fatigue, abdominal pain

Icteric phase- liver stuff
* jaundice, dark urine, light stool, weight loss, hepatomegaly

Clinical manifestations of hep are usually same no matter the virus

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13
Q

Hep A stats

Infectious hepatitis

A

46% unknown
14% sexual or household contact

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14
Q

Hepatitis B

serum hepatitis

A

HBeAG and anti HBe
Incubation period:
* HBsAg- hepatitis B surface ag

Prodrome, acute disease:
* HBsAG (antiHBc)- hepatitis B core antibody

Early convalescence: Anti HBc
Late convalescence: Anti HBs

anti hbc - indicate acute infxn
HBeAG- infection
Ag must disappear then anti Hbs

Anti HBs= immunity

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15
Q

Chronic hepatitis B

A

SXS: fatigue, lethargy, anorexia, n/v, RUQ pain, pruritus, abdominal fullness, complaints of bleeding
PE: Jaundice. increased abdominal girth
fluid wave, spider angiomata, asterixis, bruises, hepatosplenomegaly
Labs: HBsAG > 6 months, elevated AST, ALT, viral load, biopsy

Often Asymp or have mild nonspecific symptoms untill progress to cirrhosis

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16
Q

Indications of vaccinations for Hep A and B

A

Hep A:
* kids 12-23 months
* travelers to HAV endemic
* MSM
* ALL ILLICIT DRUG USERS
* occupational risk
* pts at risk for severe disease with HAV
* homeless pop
* expecting close contact w. foreing adoptee

Hep B:
* at birth and under 19yrs old
* high risk sexual activity
* anyone at risk for exposure
* healthcare workers
* travel to endemic
* incarcerated persons
* pts with Hep C or HIV
* pts with Chronic liver disease

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17
Q

Hepatitis C

MC blood borne infection

A

Leading cause of chronic liver disease
Common indication= liver transplantation and IV drug use
Workup: HCV RNA-> viral load, genotype, Elisa for anti HCV-> false + vertical transmission of AB, false - immunosuppression
LFTs- see how much damage done
AFP

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18
Q

Hep C progression

A

25% HCV spontaneously
new tx expensive but effective-> eradicate

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19
Q

Hep D and E

A

Hep D:
* delta agent
* contracted direct contact with infected blood
* ALWAYS IN CONJUNCTION W/ HEPATITIS B- cannot multiply without Hep B
* not common in US

Hep E:
* waterborne disease
* FECES CONTAMINATED WATER
* poor sanitation
* uncommon in US
* Middle east, asia, central america, africa

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20
Q

Respiratory illness

A
  1. Influenza
  2. parainfluenza- Croup
  3. RSV- respiratory syncytial virus- Bronchiolitis in infants
  4. Metapneumovirus- bronchiolitis
  5. Adenovirus- Pharyngitis, atypical pneumonia, conjunctivitis
  6. Rhinovirus- common cold
  7. Corona
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21
Q

Influenza virus Overall

A

3 group specific ag:
1. Influenza A- pandemic flu
2. Influenza B- endemic/epidemic flu
3. Influenza C- mild respiratoryu infxns

2 type specific AG:
1. Hemagglutinin (H)-binds to cell surface receptors (sialic acid), Initiates entry into cell
2. Neuraminidase (N)- Cleaves sialic acid to facilitate release of progeny virus from cell

2 types of antigenic changes:
* Antigenic shift- major change gene segment reassortment
* Antigenic drift- minor change based on mutations

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22
Q

Influenza virus

A

Reservoir: birds and pigs
Transmission: respiratory droplet
Incubation:
Influenza A-> 2 days
Influenza B-> 1 day
SXS: fever, headache, sore throat, cough, myalgias due to cytokines
Testing: NP swab- direct AG test

Vaccine efficacy- both A and B reformulated yearly

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23
Q

RSV Bronchiolitis

resp droplets, infants, elderly

A

Clinical diag:
cough, tachypnea, labored breathing, hypoxia, irritable, poor feeding, emesis, adventitious sounds
Prevention:
Synagis (palivizumab)-> given to preemies < 29 wks GA

TX: Use of O2 if SpO2 <90%
bronchodilators- 1 time trial for severe disease or persistent labored breathing, SP02 less than 95%, respiratory failure

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24
Q

Human Metapneumovirus

A

Leading cause of Bronchiolitis
Incubation: contagious up to 2 wks
sxs: fever, coryza, wheezing, cough
Assoc: pneumonia, croup, URI w/ OM, asthma exacerbations, acute COPD exacerbatiuons in adults
Higher risk of more severe disease in YOUNGER INFANTS
TX: supportive
in development= vaccines and monoclonals

Parainfluenza 1 and 2= leading cause of croup

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25
Q

Adenoviruses

DNA virus

A

Clinical:
* URIs- pharyngitis and cold
* LRI- atypical pneumonia and bronchitis
* Keratoconjunctivitis
* gastroenteritis
* UTI, hemorrhagic cystitis
* stimulate proliferation of adipocyte stem cells

Asym or self limitnig
PCR is lab test
Adenovirus 14= LIFE THREATENING

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26
Q

Rhinovirus

MC common cold

A

> 100 serotypes
aerosal of resp droplets
affects nose and conjunctiva= UPPER RESPIRATORY- mostly just nose
SxS: sneezing, nasal discharge, sore throat, cough, headache

may play a role in asthma exacerbations in kids

NO GI tract bc kill it

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27
Q

Coronavirus

cause of common cold

A

SARS-COV-1- severe acute respiratory syndrome
* ATYPICAL PNEUMONIA

MERS-COV (middle east respiratory syndrome)
* SEVERE PNEUMONIA- camel is reservoir

Sxs: coryza, scratchy sore throat, low fever
no antiviral therapy or vaccine

28
Q

Covid -19

(disease name)

(SARS- COV-2)= Virus name

A

Patho: RNA virus
Virus binds to ACE-2 thru the receptor binding domain of its spike protein- present in many tissues

Resp manifestations:
* Killing of alveolar cells -> accumulate cellular debris blocking diffusion of o2 into capillaries causing hypoxia
* Killing of endothelial cells in capillaries lining alveoli-> causes blood clots and cytokine storm

Symptomatology: 1/3 pt asymp
cough, fever, myalgia, headache, dyspnea, sore throat, anosmia and ageusia in less than 10%

Disease severity:
mild= 81%
severe= 14
critical= 5%
fatality rate = 2.3%

29
Q

Covid severe disease RF

A
  1. Intrinsic factors- age, male, ethnicities
  2. Social factors- smoking, inactivity, substance use disorders
  3. Immune compromise- cancer, HIV, use of steroids
  4. Pulmonary conditions- asthma, chronic lung disease, cystic fibrosis, tb
  5. cardio/hemat conditions-heart failure, CAD, cardiomyopathies, TYPE A BLOOD
  6. neuro- cerebral palsy
  7. Endocrine- DM1&2, obesity, pregnancy
  8. Other- chronic kidney/liver disease
30
Q

Covid complications

A
  • Cardiac- arrhythmia, myocardial injury, heart failure, shock
  • thromboembolic- DVT and PE
  • Neurologic- encephalopathy- increased depression
  • inflammatory- cytokine release syndrome
  • long term sequelae- long Covid- fatigue, memory problems, dyspnea, chest pain, cough, cognitive deficits
31
Q

Enteric tract viruses

enteroviruses

outside GI tract- cause Diarrhea

A
  1. Poliovirus
  2. Coxsackie virus- Group A, B
  3. Norovirus
  4. Rotavirus
32
Q

Poliovirus

enterovirus

A

Transmit: fecal-oral route-> replicates in oropharynx and gut
travels to CNS via bloodstream ->motor neurons of spinal anterior horn cells->death of these neurons causes paralysis
Affects brainstem (“bulbar” polio)-> leads to respiratory paralysis

spectrum of infection:
1. asymptomatic 99%
2. abortive- mild fever, headache .8%
3. non-paralytic- aseptic meningitis w/ meningismus .15%
4. paralytic: flaccid paralysis .05%- signs of viral meningitis, back, neck, and muscle pain

Postpolio syndrome- yrs after acute illness-> deterioration of residual fxn of affected muscles

Vaccine: Killed IPV (salk) live attenuated vac OPV- DC bc rare reversion to virulence, can’t be given to immunodeficient, coinfection of GI tract

33
Q

Coxsackie virus

enterovirus

A

trans: fecal oral, resp aerosols
summertime virus
Type A: 23 serotypes 1-24 missing 23-> predilection for skin and mucous mem- handfootandmouth, hemorrhagic conjunctivitis
Type B: 6- for organs-myocarditis, pericarditis, pleurodynia
A&B: aseptic meningitis and common cold
Causes: acute flaccid paralysis-> resembles poliomyelitis

34
Q

Group A coxsackie

A
35
Q

Group B coxsackie

A

Pleurodynia- infxn of intercostal muscles
fever, severe pleuritic type chest pain

Myocarditis and Pericarditis
* fever
* chest pain
* signs of congestive heart failure

rare: pancreatitis and hepatitis

36
Q

Other entero causing diarrhea

Norovirus and rotavirus

A

Norovirus- Norwalk virus:
* most common cause of VIRAL GE in adults, MC in kids
* Transmission: fecal oral- close quarters cruise ships
* Sudden onset vomiting and watery diarrhea, low grade fever and abdominal cramping

Complications: CNS involvement- headache, meningismus, photophobia, obtundation

Rotavirus:
* common cause of viral GE in kids- vaccine has lowered incidence
* transmission: fecal oral
* sxs: n/v/d
* management: fluids
* vaccin avail

37
Q

Rhabdovirus and Arboviruses

rabies and arthropod borne illnesses

A
  1. Rabies virus
  2. Arbovirus
  3. West nile virus
38
Q

Rabies virus

rhabdovirus w/ skunk, raccoon, and bat reservoirs

A

Transmission:
saliva with bite of rabid animal
aerosolized bat excrement
transplanted corneas
Incubation: 2-16 wks depending on site of bite
retrograde axonal transport in sensory neurons to CNS

sxs:
* prodrome- fever, anorexia, paresthesia at bite site
* Progression- Furious and Dumb
* Furious form- agitation, delirium, seizures and hydrophobia= pharyngeal spasms - dont want to swallow
* Dumb form- ascending paralysis
* Eventual coma and death

Negri bodies in brain- intracellular masses of virions, unassembled viral components

Post exposure: passive (Ig in bite) and active immunization- vaccine

39
Q

Arboviruses

ARB- arthropod borne virus

A

Clinical picture:
1. encephalitis- eastern, western equine encephalitis, st. louis, california encephalittis, colorado tick fever, west nile encephalitis
2. Hemorrhagic fever: Yellow fever and Dengue hemorrhagic fever
3. Fever w/ systemic sxs: Zika fever, chikungunya fever

Yellow fever- afria and SA- mosquito
* sudden onset fever, headache, myalgias, photophobia, jaundice

dengue: break bone fever, SE USA
Sxs: flu like illness w fever, lymphadenopathy, severe myalgias and arthralgias, leukopenia, rash
can progress to hemorrhagic fever

40
Q

Arbovirus in US vs Outside

A

US: encephalitises
Outside: Yellow fever, dengue, zika virus

41
Q

West nile virus

bird and mosquito vector

A
  1. West nile fever
    * fever +/- low grade, headache, malaise, back pain, lack of appetite, myalgias
  2. west nile neuroinvasive disease
    * fever + meningitis (kids), encephalitis (older adults), flaccid paralysis, or mixed pattern of dx
42
Q

Zika virus

Aedes mosquito, sexual, or transplacentally

A

SXS: 80% asymp
* common: fever, myalgia, arthralgia, nonpurulent conjunctivitis, pruritic rash, headache, dyesthesia, retroorbital pain
* Occasional: gi sxs, mucous membrane ulcerations

Incidence: found in miami beach -> recommended that pregnant women avoid travel to these areas during epidemics

43
Q

Congenital zika syndrome

A

Severe MICROCEPHALY w/ partially collapsed skull
* ventriculomegaly- large
* thin, hypoplastic corpus callosum
* insuff proliferation and defective migration of early neurons
* concern for later congnitive issues even in bnabies without obvious problems

all in purple

44
Q

HIV

human immunodeficiency virus

A

Retrovirus- changes viral RNA to viral dna with REVERSE TRANSCRIPTASE
HIV- infects and kills CD4 t cells-> loss of cell mediated immunity
CXCR & CCR5 chemokine receptors- required for entry of HIV into cd4 cells

Sxs: Acute HIV syndrome= Flu like/mono like illness with high viremia
fever, weightloss, malaise, headache, myalgia, rash, lymphadenopathy, n/v, organomegaly, pancreatitis, sore throat, lethargy

Epidemiology: 82% male and 18% female-> bc msm and iv drug use
SEX DRUGS AND TRANSFUSIONS

Untreated infection: latency period varies tremendously, somedevelop AIDSA IN AS LITTLE AS A YEAR OR LESS

AIDS indicator disease: fungal, protozoal, viral and bacterial

Cant fight anything so catch everything

45
Q

Manifestations of AIDS

A
  1. Kaposi sarcoma
  2. Pneumocystis jirovecii pneumonia- diffuse through lungs
46
Q

HIV testing

A
  1. screening: HIV 1&2 AB AND p24 Ag-> positive
  2. HIVab differentiation immunoassay-> Positive on screening and Negative on AB diff= NAT
  3. Reactive NAT w/ negative or indeter. Ab diff= HIV1 infxn or Negative NAT w/ indeter. Ab diff= False positive

1st: screening and testing
2nd: HIV RNA viral load (PCR), CD4 count, and ART resistance assay (see what drugs to use)

47
Q

Parasites

Protozoa and Helminths

A

Parasites:
1. Protozoa- unicell
2. Helminths- multicell- Eosinophilia

48
Q

Protozoa

intestinal, urogen, blood and tissue

A
  1. Entamoeba histolytica- Amebic dysentery
  2. Giardia lamblia- Giardiasis
  3. Cryptosporidium hominis- Cryptosporidosis
  4. Trichomonas vaginalis- Trichomoniasis
  5. P. Falciparum or P. vivax- Malaria
  6. Toxoplasma gondii-Toxoplasmosis
  7. Trypanosoma cruzi- Chagas disease
49
Q

Entamoeba histolytica

A

Amebic dysentery- fecal oral
90% asymp
10% GI sxs:
* bloody mucus diarrhea
* lower abdominal discomfort
RF: MSM
DX: stool O&P

50
Q

Giardia lamblia

Giardiasis

A

Ingestion of cysts in fecal contam
50/50 asym and sxs:
* watery foul smelling diarrhea
* nausea
* anorexia
* flatulence
* abdominal cramps

DX: stool O&P with ELISA
purify water when camping

51
Q

Crytosporidium hominis

cryptosporidosis

A

Fecal oral
occurs in outbreaks
SXS: opportunistic infx in immunocomp-> watery diarrhea
self limited in immunocomp hosts
Chlorine tolerant

52
Q

Trichomonas vaginalis

trichomoniasis

A

Sexually transmitted
sxs: watery, foul smelling pale green frothy discharge with itching/burning
Dx: wet mount
tx: metronidazole

53
Q

Malaria

Plasmodia

A
  1. P. falciparum (blackwater fever)-> most severe
  2. P. vivax
  3. P. ovale
  4. P. malariae
    Anopheles female mosquito

SXS: fever (spikes to 105.8 F) & chills, headache, myalgia, arthralgia
fever progress to periodic cycles
Cycles= fever spikes, rigors, n/v, abdominal pain
PE: splenomegaly, hepatomegaly, prominent anemia
DX: Giemsa stain
untreated P. falciparum= brain and renal damage can lead to death

54
Q

Toxoplasmosis

toxoplasma gondii

A

Domestic cats
infxn: ingest cysts in meat, CAT FECES
Immunocompetant= Asymp or resembles mono (heterophile negative)
Immunocompro= life threatening disseminated disease, encephalitis
Congential= abortion, stillbirth: chorioretinitis or intracranial calcifications

T in TORCH- mother must be infected during pregnancy

BAD FOR PREGO

55
Q

Chagas disease

Trypanosoma cruzi

A

Trans: Reduviid bug
latin american countries-> immigrants and refugees come to US
Acute:
nonspecific= malaise, fever and anorexia OR anorexia OR Asymp
Chronic:
Cardiac: HF, dysrhythmia, thromboembolism, chest pain syndrome
GI: more common in southernmost geo, huge variation
if untx: cardiac complications
MC cause of non ischemic cardiomyopathy in Latin America
Testing: serology

56
Q

Helminthes

worms

A
  1. Tapeworms
    * T. solium and T. saginata
    * E. granulosus
  2. Intestinal roundworms
    * whipworm- trichuris
    * Ascarias - ascaris
    * Hookworm- necator
    * Pinworms- enterobius vermicularis
    * Trichinosis- trichinella spiralis
  3. Tissue roundworm
    * Larva migrans- toxocara or ancylostoma
57
Q

T. solium and T saginata

Tapeworms

A

Taenia solium- pork tapeworm:
1. Taeniasis (caused by adult worm)- asymp to anorexia and diarrhea-> undercooked pork
2. Cysticercosis (from larvae)- ingestion of eggs-> systemic infxn including brain

Taenia saginata- beef tapeworm
Asymp to mild GI sxs
undercooked beef
DX: O&P to find proglottids

58
Q

E. granulosus

echinococcus granulosus

A

Dog tape worm- dogs definitive host
Causes: liver cysts, lung cysts, cerebral cysts (abdominal, chest pain, hemoptysis, headache and focal neuro signs)
rupture of cyst-> anaphylaxis due to massive ag release

59
Q

Intestinal roundworms

WAH

A

Whipworm- trichuris- asx to diarrhea==== ingestion of worm eggs from food/water contam w/ human feces
Ascariasis-ascaris- GI sxs==============
Hookworm- necator- walking barefoot in soil= gi and pulmonary

South/southest USA, areas of contaminated soil

60
Q

Pinworms

intestinal roundworms

A

Enterobius vermicularis- exclusively human parasite
ingestion of worm eggs
perianal pruritis

Scotch tape technique to remove eggs

61
Q

Trichinosis

intestinal roundworms

A

Trichinella spiralis- raw pork, bear meat
Diarrhea few days after consuming undercooked meat

1-2 wks later:
fever, myalgia, eosinophilia, periorbital edema with subconjunctival hemorrhage

cardiac and cns disease

62
Q

Larva migrans

tissue roundworms

A

Visceral larva migrans: toxocara larvae
* dog as host
* ingestion of soil containing eggs-> migrate to brain, liver, and eyes

Cutaneous larva migrans: ancylostoma larvae
* penetration of skin by larvae-> walking barefoot in feces soil
* southern US

63
Q

Ectoparasites

bugs

A
  1. Scabies
  2. Pediculoses
64
Q

Scabies

sarcoptes scabiei var hominis

A
  • intense, generalized pruritic rash- worse at night
  • inflammatory pruritic papules, pustules, vesicles, and nodules
  • pathognomonic fiding is a burrow in hands, feet, or finger webs
65
Q

Pediculoses

lice

A

Capitis: mostly children
* pruritus MC
* small red papules under hairline
* erythema w/ honey colored crust

Pubis: sexually active

Patho (4 decks)

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