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CMED 311 > WEEK 4: MicroPara Correlates > Flashcards

WEEK 4: MicroPara Correlates Flashcards

1
Q

Bacterial etiologic agents that is usual in neonates?

A

E coli
Listeria monocytogenes
Strep agalactiae

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2
Q

Bacterial etiologic agents that is usual in 6 mos to 6 years old?

A

H. influenza serotype B

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3
Q

why is Hib the most virulent among A to F?

A

because it has pentose and others have hexoses

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4
Q

Bacterial etiologic agents that is usual in >6 years old?

A

Streptococcus pneumoniae

Neisseria meningitidis

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5
Q

CSF Features of bacterial meningitis?

A

High WBC with neutrophilic predominance
High protein (>150 pag preterm and premature; >100 pag term)
CSF sugar is 60-75% of RBS
Low glucose concentration (<20 in preterm, <30 in term)

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6
Q

leading causes of

meninigitis in infants

A

E.coli and group B streptococci

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7
Q

What antigen is present in E coli in meningitis?

A

K1

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8
Q

In PCR, we are not able to detect the fragments of the virus

A

F. we are able.

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9
Q

Granulomatosis infantiseptica
• 1st 4 days of life
 Causes the “’Crib Death”
• To manipulation of host cell action (actin) to propel it into
pseudopods that extend to adjacent host cells.
• Spreads from cell to cell with minimal contact with the host
immune system.

A

Listeria monocytogenes

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10
Q

• Immunocompetent and healthy children-consider if no
response to 1st line agents.
• Pregnancy- abortion, preterm birth, amniositis
• Neonates- late onset meningitis, conjunctivitis and
pneumonia.
• Immunocompromised- CNS infection, endocarditis, and
sepsis.
• Previous healthy and immunnocompetent children- rare,
associated with severe complications and high mortality rate.

A

Listeria monocytogenes

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11
Q

what drug passes through the BBB?

A

2nd Gen Cephalosporin

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12
Q

• Spore-forming toxins
• Sialic acid-rich capsular polysaccharide
• Surface proteins-interacts with human epithelial cells, binding
to extracellular matrix components, and/or evasion of host
immunity.

A

Streptococcus agalactiae (GBS)

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13
Q

Cleaves IgA present in the surface of mucosa, in moist

areas.

A

IgA protease

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14
Q

increases the virulence by participating

actively in the host invasion.

A

Lipooligosaccharide

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15
Q 
Capsule
• Adhesion proteins
• Pili
• The outer membrane proteins
• igA protease
A

Hib

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16
Q

T or F? Fastidious organisms are difficult to isolate in cultures.

A

True

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17
Q

Identify if endotoxin or exotoxin?: Fever, DIC, Shock

A

Endotoxin

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18
Q

Identify if endotoxin or exotoxin: no fever, incubation period is shorter

A

Exotoxin

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19
Q

Mech of resistance of N. Meningitidis?

A

Penicillinase production and they cleave penicillin

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20
Q

Adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection- typically by Neisseria meningitidis.
• DIC leads to massive bleeding into one or (usually) both adrenal glands.

A

WATERHOUSE-FRIDERICHSEN

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21
Q

consumption coagulopathy, all of clotting factors are consumed.

A

DIC

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22
Q

is the most common form of CNS tuberculosis and has very high morbidity and mortality

A

TB meningitis

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23
Q

TB meningitis pathophy?

A

TB travels through the bloodstream to the meninges where small abscesses (called microtubercles) are formed. When these abscesses burst, TB meningitis is the result.

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24
Q

The typical patient will present with several weeks of headache, fever, and a subacute alteration in mental status.

A

TB meningitis

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25
Q

Stages of TB meningitis?

A

Stage 1 - alert
Stage 2 - lethargic
Stage 3 - coma

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26
Q

bacterial work up TB meningitis?

A 
CSF GS/CS
India ink
AFB
Cell count
Differential count
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27
Q

If all workup for bacterial meningitis is negative but the pt has signs and symptoms, what is the dx?

A

Aseptic meningitis

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28
Q

T or F? CSF values are panic values because CSF is sterile.

A

T

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29
Q

what do we use when we culture fastidgious organism?

A

Chocolate agar plate

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30
Q

presence of encapsulated yeast cells indicate what in the India Ink?

A

Cryptococcus. we cannot conclude yet.

C. neoformans - for immunocompromised
C. Gatii - for immunocompetent

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31
Q

In CSF collection, what do we measure first?>

A

opening pressure in manometers

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32
Q

In CSF collection, what do we get in bottle 1?

A

CSF Proteins, sugar, LDH

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33
Q

In CSF collection, what do we get in bottle 2?>

A

Bacteriology

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34
Q

In CSF collection, what do we get in bottle 3?

A

cell diff count.

kasi need natin kunin yung least bloody to prevent alteration in hema

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35
Q

are DNA viruses that have properties of Latency/Dormancy

A

Herpes viruses

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36
Q

Viral meningitis agents?

A 
Caused by
o Enteroviruses
o HSV
o HIV
o West nile virus
o Varicella-Zoster virus
o Mumps
o Lymphocytic choriomeningitis virus
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37
Q

Most common causes of Viral meningitis?

A

Coxsackie, echovirus, other non-poliovirus enteroviruses

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38
Q

o Torulosis
o European Blastomycosis

what is the agent?

A

Cryptococcus neoformans

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39
Q

• Both differ from non pathogenic species by:
o Ability to grow at 37C
o Production of laccase (catalyzes melanin production)
• 22 strains: 5 serotypes (A-D & AD)
• 3 human variants

A

Cryptococcus

o Neoformans (AIDS &immunocompromised)
o Gatii, grubri (non-immunocompromised)
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40
Q

MOT: cryptoccoccus species

Pathophysio

A

inhalation of yeast cells;

Pathogenesis: inhaled -> alveolar spaces of host’s lung, establish colonies and produce capsule-> BV-> CNS

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41
Q

what agent has this virulence factors?

A

• Capsule
o Long unbranched polymenrs consisting of alpha 1,3 linked polymannose backbone with betalinked monomeric branches of xylose and glucoronic acid
• Laccase

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42
Q

o Painless pustules/papules/nodules, hemorrhagic, waxy, umbilicated & ulcerated.

what type of cryptococcosis

A

Cutaneous Cryptococcosis

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43
Q

o Acute:
immunocompromised patients asymptomatic to mild flu-like s/sx
o Chronic: lobar pneumonia, cavitations due to production of granulomas with encapsulated fungi at the center.

what type of cryptococcosis?

A

Pulmonary Cryptococcosis

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44
Q

o Mainly CNS: subacute/chronic meningitis
o S/Sx: visual loss, seizures, hydrocephalus, etc
o Other organs: endopthalmitis, chorioretinitis, conjunctivitis, sinusitis, pericarditis, gastritis, bone infection

what type of cryptococcosis?

A

Disseminated Cryptococcosis

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45
Q

What are the serotypes of cryptococcus?

A 
Serotype A- most human infections
• Serotype B- US West Coast, AIDS-rare
• Serotype C- Tropical areas *Philippines
• Serotype D- Europe
• Serotype AD
• C. neoformans -A, D or AD
• C. gattii- B or C
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46
Q

how to measure antibody titers in cryptococcus?

A

• Fluorescent Antibody Test
o tissue studies & serotyping cultures
• Whole Yeast Cell Tube Agglutination Test and EIA
o Cryptococcus in serum

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47
Q
  • Dome shaped, shiny white to tan, yellow to light pink or light brown mucoid colonies (+ capsule)
  • Yeast form ONLY!!!
  • *Dry and dull – age

What organism has this macroscopic morph?

A

Cryptococcus neoformans

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48
Q

o Thin-walled globose or oval-shaped
o Singly or in pairs with narrow points of attachment between the mother and daughter cells
 No mold form= MONOMORPHIC
o NO pseudohyphae nor true hyphae refractile mucopolysaccharide capsule

what organism has this microscopic morphology?

A

Cryptococcus neoformans

49
Q

Treatment for cryptococcus?

A

Combination of Amphotericin B with or without Flucytosine

50
Q

what can cause african sleeping sickness?

A

Trypnaosomes (hemoflagellates)

There must be a history of travel because we don’t have Kissing Bugs here

51
Q

what trypanosoma is C- shaped?

A

T. cruzi

52
Q

what trypanosoma is slender shaped?

A

T. gambiense; T. rhodesiense

53
Q

95% of Human African Trypanosomiasis (HAT) is caused by

A

gambiense; 5% rhodiense

54
Q

African sleeping sickness what organism?

A

Trpanosoma brucei complex

55
Q

vector of Trypanosoma brucei complex

A

tsetse fly or (glossina)

56
Q

subspecie of trypanosoma that is east african/ acute

A

T. brucei rhodesiense

57
Q

subspecie of trypanosoma that is West African /chronic

A

T. brucei gambiense

58
Q

daytime biters? night time biters?

A

tse tse flies - glossina species

night time - triatopic, kissing bug, cone nose bug

59
Q

Identify is West African or East African? T. Brucei gambiense

A

west

60
Q

Identify is West African or East African? Glossina morsitans group

A

east

61
Q

Identify if west african or east african? Primary reservoirs:
humans

A

West african

62
Q

Identify is West African or East African?
Chronic (late CNS
invasion) months to
years

A

west

63
Q

Identify is West African or East African? High parasitemia

A

east

64
Q

Identify is West African or East African? Rural population

A

west

65
Q

what stage of Tryponasoma disease is this?
• Fever, headache, ms/jt pains, malaise, anemia, myocardial inflammation, DIC, renal insufficiency

winterbottom sign

A

hemolymphatic stage

early stage

66
Q

what is winterbottom sign?

A

–posterior cervical lymphadenopathy – large, non-tender

67
Q
  • Apathy, behavioral changes, headache, sleep pattern changes, convulsion,tremors speech defects
  • Kerandel’s sign
  • Gambian > Rhodesian
  • Frontal lobe, pons, medulla, perivascular areas

what stage of trypanosoma infection?

A

• Meningoencephalitic stage; late (5 to 10 months)

68
Q

Kerandel’s sign?

A

deep, delayed hyperesthesia

69
Q

CSF findings in Meningoencephaltic stage of Trypanosoma infections

A 
Increase in :
▪ Cell count
▪ Opening pressure
▪ Protein concentration
▪ IgM levels (pathognomonic for the meningoencephalitic stage)
70
Q

Treatment in the first stage of Trypanosoma infection?

A

IV suramin (rhodesian and Gambian)

71
Q

Treatment for gambian?

A

IM Pentamidine

72
Q

treatment for trypanosoma infection if it is in CNS stage already?

A

IV melarsoprol; if ineffective: nitrofurazone oreflomithine (gambian only)

73
Q

transient clinical phenomenon that occurs in patients infected by spirochetes who undergo antibiotic treatment

A

Jarisch Herxheimer reaction

74
Q

what agent? Primary amoebic meningoencephalitis

A

Acanthamoeba / Hartmanella culbertsoni

75
Q 
• Motile trophozoites
o Amoeboid
o Flagellate (w/ 2 flagella) – shed flagella then resume amoeboid motility and reproduction
 Mga freeliving
• Non motile resistant cysts
A

Naegleria fowleri

76
Q

o Findings - Like fulminant bacterial meningitis
o Amoebae in exudates
o Diagnosis : swimming in thermal/stagnant water 3 to 6 days prior; CSF; histopath
o Prognosis: fatal within a week
o Treatment: none; Amphotericin B and Sulfadiazine

what parasite?

A

Naegleria fowleri

77
Q

Amoebic meningoencephalitis, uveitis and ulceration of cornea
• Active trophic forms
o No flagellate form
• Resistant cysts – resistant to chlorine and can withstand drying
• Slow movement of acanthopodia
 Acantho= meaning thorny

what parasite?

A

Acanthamoeba culbertsoni

78
Q

what are the species of Acanthamoeba species?

A
  • A. culbertsoni
  • A. polyphaga
  • A. castellanii
  • A. Astronyxis
79
Q

how to diagnose Acanthamoeba

A

Amoebae in CSF, scrapings from lesions in cases of corneal or cutaneous infections; cultures of material from those sources; stained vaginal smears; purulent discharge from infected ear

80
Q

Treatment of Acanthamoeba?

A

Amphotericin B and Sulfadiazine

81
Q

Determine of Acanthamoeba or Naegleria? Olfactory

neuroepithelium

A

Naegleria

82
Q

Determine of Acanthamoeba or Naegleria?

broken/ulcerated skin or eye; lungs or genitourinary tract

A

Acanthamoeba

83
Q

Determine of Acanthamoeba or Naegleria? faster course?

A

Naegleria

84
Q

Determine of Acanthamoeba or Naegleria? Granuloma formation?

A

Acanthamoeba

85
Q

Determine of Acanthamoeba or Naegleria? gradual onset and prolonged chronic course

A

Acanthamoeba

86
Q

Determine of Acanthamoeba or Naegleria? Chronically ill /

immunosuppressed

A

Acanthamoeba

87
Q

Determine of Acanthamoeba or Naegleria? broad pseudopods

A

Naegleria

88
Q

Determine of Acanthamoeba or Naegleria? sluggish motility

A

Naegleria

89
Q

Determine of Acanthamoeba or Naegleria? does not form flagellate stage?

A

Acanthamoeba

90
Q

Determine of Acanthamoeba or Naegleria? double walled cysts?

A

Acanthamoeba

91
Q

Determine of Acanthamoeba or Naegleria? may have pores or osteioles

A

Acanthamoeba

92
Q

Determine of Acanthamoeba or Naegleria? no encystment in tissue?

A

Naegleria

93
Q

Criteria of Amoeba?

A

Chromatin dot, central karyosome, peripheral chromatin

94
Q

Pathophysiology of Eosinophilic meningoencephalitis

A

• Eggs hatch in lung of rodent host → larvae migrate to trachea → swallowed → 1st stage larva expelled in feces → molluscan intermediate host and reach 3rd (infective) larval stage in 2 wks → ingested by rat/man → infective larvae migrate to brain → migrate to pulmonary arteries → bloodstream → gravid females lay ova

95
Q

 Not usually common because it is in Rats but humans can be infected as well.
 called rat lung worm.
 Barber’s pole appearance

A

Eosinophilic Meningoencephalitis

96
Q

Definitive host is rat, infection is via the ingestion of 3rd stage larva

A

Angiostrongylus cantonensis/ Parastronglyus cantonensis

97
Q

intermediate host of Angiostrongylus cantonensis/ Parastronglyus cantonensis

A

molluscan or freshwater
o snails / slugs
o infection via ingestion or active
o penetration of 1st stage larva

98
Q

what is paratenic host Angiostrongylus cantonensis/ Parastronglyus cantonensis

A

may act as reservoir hosts in which different larval stages can persist but not develop further –freshwater shrimp, crabs, flatworms and frogs

99
Q

humans and other mammals, birds – permit development from larval to subadult stage but are dead-ends for the parasite – these hosts are infected primarily through consumption of raw or undercooked intermediate or paratenic hosts, either intentionally or accidentally via contaminated produce.

A

Accidental host

100
Q

How does transmission to man in angiostrongylus cantonensis happen?

A

Ingestion of raw mollusk IH infected with the 3rd stage larva
o Ingestion of leafy vegetables of mollusk with 3rd stage larva
o Ingestion of a paratenic host, such as freshwater prawn or crab
o Drinking contaminated water

101
Q 
ALL STAGES ARE INFECTIVE TO MAN
• INVADES ALL NUCLEATED CELLS
• TRANSMISSION
o INGESTION OF OOCYSTS (infective stage)
o INGESTION OF INFECTED MEAT
o TRANSPLACENTAL
o BONE MARROW TRANSPLANTATION
o WHITE CELL TRANSFUSION
o ACCIDENTAL (LABORATORY)
A

Toxoplasma gondii

102
Q

Symptoms of acquired toxoplasmosis

A 
o RETINOCHOROIDITIS
o FEVER/LYMPHADENOPATHY
o HEADACHE
o MYALGIA
o RASHES
103
Q

Symptoms of transplacental (congenital) toxoplasmosis?

A 
o ABORTION/STILLBIRTHS
▪ PHYSICAL/ MENTAL DEFECTS
• INTRACRANIAL CALCIFICATION
• HYDROCEPHALY
• MICROCEPHALY
o DEATH CONVULSIVE/EPILEPTIC SEIZURES
104
Q

manifestation of immunodeficient patients with toxoplasmosis?

A

Encephalitis (Sabin Syndrome)

105
Q

A syndrome of toxoplasmosis like symptoms and extensive destruction of brain tissue, hydrocephalus, diffuse cerebral calcification, chorioretinopathy, microcephaly, mental
retardation, and degenerative changes of small retinal vessels.

A

Sabin Syndrome

106
Q

how to diagnose toxoplasmosis?

A

• IDENTIFICATION
o TISSUE IMPRINTS
o GIEMSA STAINING

• PARASITE ISOLATION
o PLACENTA
o VENTRICULAR FLUID
o PERITONEAL FLUID
o BUFFY COAT

• SEROLOGY
o IFA/ IHA
o EIA
o DOUBLE SANDWICH ELISA
o LAT
o SABIN FELDMAN DYE TEST based on the presence of certain
antibodies that prevent methylene blue dye from entering thecytoplasm of Toxoplasma

• PCR

107
Q 
Normal CSF:
Appearance -
Opening Pressure - 
WBC - 
Protein - 
Glucose -
A 
Appearance - Clear
Opening Pressure - 90-180 mmHg 
WBC - <8
Protein - 15-45
Glucose - 50-80
108
Q 
Bacterial Meningitis
Appearance -
Opening Pressure - 
WBC - 
Protein - 
Glucose -
A 
Appearance - turbid
Opening Pressure - Elevated
WBC - >1000 -2000, neutrophilic predominance
Protein - >200
Glucose - <40
109
Q 
Viral Meningitis
Appearance -
Opening Pressure - 
WBC - 
Protein - 
Glucose -
A 
Appearance - Clear
Opening Pressure - Normal
WBC - <300 lymphocytic predominance
Protein - <200 (slightly elevated)
Glucose - Normal
110
Q 
Fungal Meningitis
Appearance -
Opening Pressure - 
WBC - 
Protein - 
Glucose
A 
Appearance - clear
Opening Pressure - Normal -elevated 
WBC - <500
Protein - >200
Glucose - Normal to low
111
Q 
TB Meningitis
Appearance -
Opening Pressure - 
WBC - 
Protein - 
Glucose
A 
Appearance - clear
Opening Pressure - Inc, Dec, Spinal Block
WBC - 100 - 600, mixed or lymphocytic 
Protein - 500 - 300
Glucose - decreased
112
Q 
Acute syphilis
Appearance -
Opening Pressure - 
WBC - 
Protein - 
Glucose
A 
Appearance - Clear
Opening Pressure - Increased 
WBC - About 500 lymphocytic
Protein - Inc but less than 100
Glucose - normal
113
Q

Spreading of viral meningitis? bacterial?

A

viral - Saliva/ stool

bacterial - contact with fluids from the mouth or nose of a sick person

114
Q

Identify if meningococcal or meningitis? illness caused by neisseria meningitidis?

A

meningococcal

115
Q

Identify if meningococcal or meningitis? symptoms include headcahe, stiff neck, vomiting, nausea, rash, organ problems, sensitivity to light and DIC

A

meningococcal

116
Q

Identify if meningococcal or meningitis? death rate is variable, low with viral meningitis to as high as 73% to 95 %

A

meningitis

117
Q

Identify if meningococcal or meningitis? caused by virus, fungi, parasites, bacteria, cancer and lupus

A

Meningitis

118
Q

Identify if meningococcal or meningitis?
risk factors include young children of 6 months to 3 years and young people living in college dorm, military recruits etc

A

meningococcal

CMED 311 (47 decks)

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