08.22 - Exotic and Biohazard Pneumonias (Miller) - Questions Flashcards Preview

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Flashcards in 08.22 - Exotic and Biohazard Pneumonias (Miller) - Questions Deck (73):
1

3 important properties of B Anthracis

Gram-positive rod; Capsule of d-glutamate; Spore former

2

D-Glutamate capsule

B Anthracis

3

Transmission of B Anthracis

Cutaneous contact with animals; Aerosolized spores

4

Woolsorter's Disease

B Anthracis

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Why does capsule of B Anthracis serve as virulence factor

Prevents direct recognition of bacterium via phagocytes

6

Mortality rate in untreated pulmonary anthrax

90-100 %

7

Timecourse of B Anthracis pnuemonic disease

Typically 4-6 days to onset, but can be up to 6 weeks

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Symptoms of Pneumonic Anthrax

Short prodromal period of cough, fever, aches; Then high fever, dyspnea, hypoxia, tachycardia

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Radiology of Pnuemonic Anthrax

Widened mediastinum with infiltrates and pleural effusions

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Widened mediastinum with infiltrates and pleural effusions

Radiology of Pnuemonic Anthrax

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Two causes of death in Anthrax

Block of pneumonic lymph vessels; Cytokine storm - Septic Shock

12

Dx of Pneumonic Anthrax

Test sample or measure titers

13

Tx of Pneumonic Anthrax

Cipro for up to 60 days

14

3 important properties of Brucella spp

Gram-negative coccobacillus w/out capsule; Intracellular; Livestock resoivoirs

15

Epidemiology of B Anthracis

Worldwide, Cattle and Sheep

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Epidemiology of Brucella

Everywhere but NA; Contaminated dairy products or animal secretions

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Imported dairy from goats in Mexico or Mediterranean

Brucella melitensis

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Pathogenesis of Brucellosis

Localize to reticuloendothelial system; Intracellular; Granuloma formation in lungs, Abscesses

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Radiology of Brucellosis

Pretty big granulomas in lungs

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Symptoms, Signs of Brucellosis

Fatigue, Weight Loss, Lymphadenopathy, Organomegaly, Pancytopenia

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Fatigue, Weight Loss, Lymphadenopathy, Organomegaly, Pancytopenia

Brucellosis

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Most frequent complication of Brucellosis

Osteomyelitis

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Osteomyelitis

Most frequent complication of Brucellosis

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Timecourse of Brucellosis

1-3 week incubation period with acute or gradual onset

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Dx of Brucellosis

Rarely cultured; Slide Agglutination Test; Titers

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Tx of Brucellosis

Tetracycline or Doxy + Rifampin

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Whitmore's Disease

Burkholderia pseudomallei

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3 important properties of B pseudmallei

Small, motile gram neg rod; Facultative intracellular; Environmental

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Epidemiology of B pseudomallei

Southest Asia; Environmental Bac

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Transmission of B pseudomallei

Inhalation of aerosolized bac from soil; Contaminated water or body fluids

31

Cases of meliodosis spike following

Rains --> Raindrops aerosolize the bac from soil

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Virulence factors of B pseudomallei

Capusle; Intracellular; Lysis; Actin network; Dormancy

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Capusle; Intracellular; Lysis; Actin network; Dormancy

Virulence factors of B pseudomallei

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Timecourse of Meliodosis

Varies, 2-3 days to many years

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Symptoms and Signs of Meliodosis

Flu-like + Cough; Can mimic TB on CXR

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CXR of Meliodosis

Can mimic TB: Small nodule and consolidations of upper lobe; Abscesses and cavitations

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Px of Meliodosis

20-50% mortality even if treated

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Dx of Meliodosis

Isolation of bac; Titers

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Tx of Meliodosis

Ceftazidime for 8 weeks - 6 months; Intrinsically resistant to many abx

40

3 important properties of Coxiella Burnetti

Gram neg bacillus; Obligate intracellular parasite; Enzootic (livestock)

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Epidemiology of Coxiella Burnetti

Almost every country with low incidence

42

Transmission of Coxiella Burnetti

Contaminated viscera of livestock or raw milk; Ticks; Aerosolized spore-like form

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Q-fever

Coxiella Burnetti

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Pathogenesis of Q Fever

C burnetti well adapted for survival within macrophages; One of the most infectious human pathogens

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Timecourse of Q Fever

Acute febrile illness; Atypical pneumonia for 2-4 weeks

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Signs and Symptoms of Q Fever

Typcially not severe, often resolves w/out tx; Sometimes liver and heart involvement

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Dx of Q Fever

Titers

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Tx of Q Fever

Most spontaneously resolve; Doxycycline

49

3 important properties of Francisella tularensis

Pleomorphic Gram neg rod; Obligate intracellular; Two biotypes

50

Transmission of F tularensis

Typically tick or blood-to-blood; Can be aerosol

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Virulence factors of F tularensis

Atypical LPS not recognized by TLR-4; May produce a capsule; Long period survival in water

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Pathogenesis of F tularensis

Extremely pathogenic; High mortality if inhaled; Can also disseminate to lungs

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Signs and Symptoms of F tularensis

Sudden onset flu-like symptoms; Prolonged low-grade fever and adenopathy; Ulceroglandular; CXR - Spotted infiltrates, lobar pneumonia, pleural exudation

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CXR of F tularensis

Spotted infiltrates in lungs, lobular pneumona, Pleura exudation

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Dx of F tularensis

No culture; Agglutination tests

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Tx of F tularensis

Streptomycin

57

3 important properties of Hantavirus

Bunyaviridae; Enveloped, trisegmented, SS, neg-sense RNA virus

58

Epidemiology of HPS

Healthy young adults; Rural areas

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Symptoms of HPS

Prodrome of flu-like symptoms; Rapid pulmonary edema, severe hypotension, respiratory failure

60

Transmission of Hantavirus (HPS)

Breathing air containing aerosolized rodent excrement

61

CXR of HPS

Distinctive bilateral pulmonary edema; Bilateral intersitial infiltrates

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Tx of HPS

Early, aggressive intensive support care

63

3 important properties of Yersinia pestis

Gram neg rod; Encapsulated, intracellular; Bipolar (Safety pin) staining

64

Bipolar (safety pin) staining

Yersinia Pestis

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Epidemiology of Y pestis

Endemic worldwide, but 99% of cases occur in SE Asia

66

Transmission of Y pestis

Rodents via fleas; Strikingly low ID50; Can be person-to-person via aerosol

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CXR of Y pestis

Lower lung zone airspace disease with bilateral pleural effusions

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Pathogenesis of Y pestis

Spreads to regional lymph nodes; Disseminates and form abscesses

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Reasons for the term black death

DIC and Cutaneous hemorrhage

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Primary life-threatening consequences Y pestis

Septic Shock and Pneumonia

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Symptoms of plaque

Fever, Headache, Hemoptysis, Dyspnea, Muscle weakness

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Dx of Y pestis

Smear and culture of blood or pus is best

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Tx of Y pestis

Streptomycin and Tetracycline