WEEK 4: MicroPara Correlates Flashcards
1
Q
Bacterial etiologic agents that is usual in neonates?
A
E coli
Listeria monocytogenes
Strep agalactiae
2
Q
Bacterial etiologic agents that is usual in 6 mos to 6 years old?
A
H. influenza serotype B
3
Q
why is Hib the most virulent among A to F?
A
because it has pentose and others have hexoses
4
Q
Bacterial etiologic agents that is usual in >6 years old?
A
Streptococcus pneumoniae
Neisseria meningitidis
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)
6
Q
leading causes of
meninigitis in infants
A
E.coli and group B streptococci
7
Q
What antigen is present in E coli in meningitis?
A
K1
8
Q
In PCR, we are not able to detect the fragments of the virus
A
F. we are able.
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
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
11
Q
what drug passes through the BBB?
A
2nd Gen Cephalosporin
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)
13
Q
Cleaves IgA present in the surface of mucosa, in moist
areas.
A
IgA protease
14
Q
increases the virulence by participating
actively in the host invasion.
A
Lipooligosaccharide
15
Q
Capsule • Adhesion proteins • Pili • The outer membrane proteins • igA protease
A
Hib
16
Q
T or F? Fastidious organisms are difficult to isolate in cultures.
A
True
17
Q
Identify if endotoxin or exotoxin?: Fever, DIC, Shock
A
Endotoxin
18
Q
Identify if endotoxin or exotoxin: no fever, incubation period is shorter
A
Exotoxin
19
Q
Mech of resistance of N. Meningitidis?
A
Penicillinase production and they cleave penicillin
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
21
Q
consumption coagulopathy, all of clotting factors are consumed.
A
DIC
22
Q
is the most common form of CNS tuberculosis and has very high morbidity and mortality
A
TB meningitis
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.
24
Q
The typical patient will present with several weeks of headache, fever, and a subacute alteration in mental status.
A
TB meningitis
25
Stages of TB meningitis?
Stage 1 - alert
Stage 2 - lethargic
Stage 3 - coma
26
bacterial work up TB meningitis?
```
CSF GS/CS
India ink
AFB
Cell count
Differential count
```
27
If all workup for bacterial meningitis is negative but the pt has signs and symptoms, what is the dx?
Aseptic meningitis
28
T or F? CSF values are panic values because CSF is sterile.
T
29
what do we use when we culture fastidgious organism?
Chocolate agar plate
30
presence of encapsulated yeast cells indicate what in the India Ink?
Cryptococcus. we cannot conclude yet.
C. neoformans - for immunocompromised
C. Gatii - for immunocompetent
31
In CSF collection, what do we measure first?>
opening pressure in manometers
32
In CSF collection, what do we get in bottle 1?
CSF Proteins, sugar, LDH
33
In CSF collection, what do we get in bottle 2?>
Bacteriology
34
In CSF collection, what do we get in bottle 3?
cell diff count.
| kasi need natin kunin yung least bloody to prevent alteration in hema
35
are DNA viruses that have properties of Latency/Dormancy
Herpes viruses
36
Viral meningitis agents?
```
Caused by
o Enteroviruses
o HSV
o HIV
o West nile virus
o Varicella-Zoster virus
o Mumps
o Lymphocytic choriomeningitis virus
```
37
Most common causes of Viral meningitis?
Coxsackie, echovirus, other non-poliovirus enteroviruses
38
o Torulosis
o European Blastomycosis
what is the agent?
Cryptococcus neoformans
39
• 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
Cryptococcus
```
o Neoformans (AIDS &immunocompromised)
o Gatii, grubri (non-immunocompromised)
```
40
MOT: cryptoccoccus species
Pathophysio
inhalation of yeast cells;
Pathogenesis: inhaled -> alveolar spaces of host’s lung, establish colonies and produce capsule-> BV-> CNS
41
what agent has this virulence factors?
• Capsule
o Long unbranched polymenrs consisting of alpha 1,3 linked polymannose backbone with betalinked monomeric branches of xylose and glucoronic acid
• Laccase
42
o Painless pustules/papules/nodules, hemorrhagic, waxy, umbilicated & ulcerated.
what type of cryptococcosis
Cutaneous Cryptococcosis
43
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?
Pulmonary Cryptococcosis
44
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?
Disseminated Cryptococcosis
45
What are the serotypes of cryptococcus?
```
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
```
46
how to measure antibody titers in cryptococcus?
• Fluorescent Antibody Test
o tissue studies & serotyping cultures
• Whole Yeast Cell Tube Agglutination Test and EIA
o Cryptococcus in serum
47
* 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?
Cryptococcus neoformans
48
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?
Cryptococcus neoformans
49
Treatment for cryptococcus?
Combination of Amphotericin B with or without Flucytosine
50
what can cause african sleeping sickness?
Trypnaosomes (hemoflagellates)
There must be a history of travel because we don’t have Kissing Bugs here
51
what trypanosoma is C- shaped?
T. cruzi
52
what trypanosoma is slender shaped?
T. gambiense; T. rhodesiense
53
95% of Human African Trypanosomiasis (HAT) is caused by
gambiense; 5% rhodiense
54
African sleeping sickness what organism?
Trpanosoma brucei complex
55
vector of Trypanosoma brucei complex
tsetse fly or (glossina)
56
subspecie of trypanosoma that is east african/ acute
T. brucei rhodesiense
57
subspecie of trypanosoma that is West African /chronic
T. brucei gambiense
58
daytime biters? night time biters?
tse tse flies - glossina species
night time - triatopic, kissing bug, cone nose bug
59
Identify is West African or East African? T. Brucei gambiense
west
60
Identify is West African or East African? Glossina morsitans group
east
61
Identify if west african or east african? Primary reservoirs:
humans
West african
62
Identify is West African or East African?
Chronic (late CNS
invasion) months to
years
west
63
Identify is West African or East African? High parasitemia
east
64
Identify is West African or East African? Rural population
west
65
what stage of Tryponasoma disease is this?
• Fever, headache, ms/jt pains, malaise, anemia, myocardial inflammation, DIC, renal insufficiency
winterbottom sign
hemolymphatic stage
early stage
66
what is winterbottom sign?
–posterior cervical lymphadenopathy – large, non-tender
67
* 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?
• Meningoencephalitic stage; late (5 to 10 months)
68
Kerandel's sign?
deep, delayed hyperesthesia
69
CSF findings in Meningoencephaltic stage of Trypanosoma infections
```
Increase in :
▪ Cell count
▪ Opening pressure
▪ Protein concentration
▪ IgM levels (pathognomonic for the meningoencephalitic stage)
```
70
Treatment in the first stage of Trypanosoma infection?
IV suramin (rhodesian and Gambian)
71
Treatment for gambian?
IM Pentamidine
72
treatment for trypanosoma infection if it is in CNS stage already?
IV melarsoprol; if ineffective: nitrofurazone oreflomithine (gambian only)
73
transient clinical phenomenon that occurs in patients infected by spirochetes who undergo antibiotic treatment
Jarisch Herxheimer reaction
74
what agent? Primary amoebic meningoencephalitis
Acanthamoeba / Hartmanella culbertsoni
75
```
• Motile trophozoites
o Amoeboid
o Flagellate (w/ 2 flagella) – shed flagella then resume amoeboid motility and reproduction
Mga freeliving
• Non motile resistant cysts
```
Naegleria fowleri
76
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?
Naegleria fowleri
77
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?
Acanthamoeba culbertsoni
78
what are the species of Acanthamoeba species?
* A. culbertsoni
* A. polyphaga
* A. castellanii
* A. Astronyxis
79
how to diagnose Acanthamoeba
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
Treatment of Acanthamoeba?
Amphotericin B and Sulfadiazine
81
Determine of Acanthamoeba or Naegleria? Olfactory
| neuroepithelium
Naegleria
82
Determine of Acanthamoeba or Naegleria?
| broken/ulcerated skin or eye; lungs or genitourinary tract
Acanthamoeba
83
Determine of Acanthamoeba or Naegleria? faster course?
Naegleria
84
Determine of Acanthamoeba or Naegleria? Granuloma formation?
Acanthamoeba
85
Determine of Acanthamoeba or Naegleria? gradual onset and prolonged chronic course
Acanthamoeba
86
Determine of Acanthamoeba or Naegleria? Chronically ill /
| immunosuppressed
Acanthamoeba
87
Determine of Acanthamoeba or Naegleria? broad pseudopods
Naegleria
88
Determine of Acanthamoeba or Naegleria? sluggish motility
Naegleria
89
Determine of Acanthamoeba or Naegleria? does not form flagellate stage?
Acanthamoeba
90
Determine of Acanthamoeba or Naegleria? double walled cysts?
Acanthamoeba
91
Determine of Acanthamoeba or Naegleria? may have pores or osteioles
Acanthamoeba
92
Determine of Acanthamoeba or Naegleria? no encystment in tissue?
Naegleria
93
Criteria of Amoeba?
Chromatin dot, central karyosome, peripheral chromatin
94
Pathophysiology of Eosinophilic meningoencephalitis
• 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
Not usually common because it is in Rats but humans can be infected as well.
called rat lung worm.
Barber’s pole appearance
Eosinophilic Meningoencephalitis
96
Definitive host is rat, infection is via the ingestion of 3rd stage larva
Angiostrongylus cantonensis/ Parastronglyus cantonensis
97
intermediate host of Angiostrongylus cantonensis/ Parastronglyus cantonensis
molluscan or freshwater
o snails / slugs
o infection via ingestion or active
o penetration of 1st stage larva
98
what is paratenic host Angiostrongylus cantonensis/ Parastronglyus cantonensis
may act as reservoir hosts in which different larval stages can persist but not develop further –freshwater shrimp, crabs, flatworms and frogs
99
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.
Accidental host
100
How does transmission to man in angiostrongylus cantonensis happen?
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
```
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)
```
Toxoplasma gondii
102
Symptoms of acquired toxoplasmosis
```
o RETINOCHOROIDITIS
o FEVER/LYMPHADENOPATHY
o HEADACHE
o MYALGIA
o RASHES
```
103
Symptoms of transplacental (congenital) toxoplasmosis?
```
o ABORTION/STILLBIRTHS
▪ PHYSICAL/ MENTAL DEFECTS
• INTRACRANIAL CALCIFICATION
• HYDROCEPHALY
• MICROCEPHALY
o DEATH CONVULSIVE/EPILEPTIC SEIZURES
```
104
manifestation of immunodeficient patients with toxoplasmosis?
Encephalitis (Sabin Syndrome)
105
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.
Sabin Syndrome
106
how to diagnose toxoplasmosis?
• 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
```
Normal CSF:
Appearance -
Opening Pressure -
WBC -
Protein -
Glucose -
```
```
Appearance - Clear
Opening Pressure - 90-180 mmHg
WBC - <8
Protein - 15-45
Glucose - 50-80
```
108
```
Bacterial Meningitis
Appearance -
Opening Pressure -
WBC -
Protein -
Glucose -
```
```
Appearance - turbid
Opening Pressure - Elevated
WBC - >1000 -2000, neutrophilic predominance
Protein - >200
Glucose - <40
```
109
```
Viral Meningitis
Appearance -
Opening Pressure -
WBC -
Protein -
Glucose -
```
```
Appearance - Clear
Opening Pressure - Normal
WBC - <300 lymphocytic predominance
Protein - <200 (slightly elevated)
Glucose - Normal
```
110
```
Fungal Meningitis
Appearance -
Opening Pressure -
WBC -
Protein -
Glucose
```
```
Appearance - clear
Opening Pressure - Normal -elevated
WBC - <500
Protein - >200
Glucose - Normal to low
```
111
```
TB Meningitis
Appearance -
Opening Pressure -
WBC -
Protein -
Glucose
```
```
Appearance - clear
Opening Pressure - Inc, Dec, Spinal Block
WBC - 100 - 600, mixed or lymphocytic
Protein - 500 - 300
Glucose - decreased
```
112
```
Acute syphilis
Appearance -
Opening Pressure -
WBC -
Protein -
Glucose
```
```
Appearance - Clear
Opening Pressure - Increased
WBC - About 500 lymphocytic
Protein - Inc but less than 100
Glucose - normal
```
113
Spreading of viral meningitis? bacterial?
viral - Saliva/ stool
| bacterial - contact with fluids from the mouth or nose of a sick person
114
Identify if meningococcal or meningitis? illness caused by neisseria meningitidis?
meningococcal
115
Identify if meningococcal or meningitis? symptoms include headcahe, stiff neck, vomiting, nausea, rash, organ problems, sensitivity to light and DIC
meningococcal
116
Identify if meningococcal or meningitis? death rate is variable, low with viral meningitis to as high as 73% to 95 %
meningitis
117
Identify if meningococcal or meningitis? caused by virus, fungi, parasites, bacteria, cancer and lupus
Meningitis
118
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
meningococcal
