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CMBM Exam 4 Gopi > Immune compromised hosts 1 and 2 > Flashcards

Immune compromised hosts 1 and 2 Flashcards

0
Q

severe burns can lead to

A

decreased neutrophil function
at risk for SIRS
loss of protective barrier

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1
Q

what compromises a host?

A

defects or injury to physical barriers - serious burns, catheters
deficiencies in innate immunity - reduced number or function of neutrophils
deficiences in adaptive immunity - T cells, B cells and antibody

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2
Q

Burn infections -organisms?

A 
Pseudomonas Aeruginosa 
Staph aureus 
staph epidermidis 
stret pyogenes 
candida
aspergillus 
often polymicrobial
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3
Q

virulence factor of S. Aureus

A

toxins
invasive enzymes
capsule

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4
Q

virulence factor of Pseudomonas (gram neg)

A

LPS
pigments
invasive enzymes
antibiotic resistance

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5
Q

pathogenesis of burn wound

A

normal flora first invade
after 1 week in hospital will see pseudomonal or fungal
impt virulence factor - resistance to phagocytosis and enzymes that facilitate invasion

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6
Q

P. Aeru see infections in

A

CF - pneumonia
Catheterized pts - UTI, septisemia
Burn pts - wound infections, septisemia
Intubated pts - pneumonia, septicemia

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7
Q

Empiric treatment for pt with burn wound infection

A

Broad spectrum Penicillin

Vancomycin and Amp B

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8
Q

Ecthyma gangrenosum

A

in pts with pseudomonas septisemia
hemorrhagic necrosis of skin
lesions do not contain pus
rarely seen in other bacterial infections

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9
Q

Treat for burn wound infection of S. aureus

A

if MRSA - vancomycin, linezolid, stretogramins

if MSSA - Anti staph peni, or 1st or 2nd cephalosporin PLUS clindamycin

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10
Q

Treat for burn wound that has Pseudomonas

A

treat with two or more drugs
Extended spectrum penicillin with b lactamase inhibitor
carbapemens, aztreonam, fluoroquinolones (but watch the pt age), ceftazidime, cefepime, aminoglycoside

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11
Q

Treat for burn wound infection by Aspergillus

A

Voriconazole
capsofungin
Amp B

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12
Q

what makes infant immunocompromised?

A

decreased neutrophils, phagocytes, complement, NK cells, lymphocyte proliferation, cytokines, CTL response, expression of CD40L, and production Ig

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13
Q

symptoms of Listeria in pregnant woman?

A

nausea, vomiting, diarrhea, fever, malaise, back pain, and headache

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14
Q

Maternal infection of Listeria can affect pregnancy by

A

causing chorioamnionitis, premature labor, spontaneous abortion, or stillbirth

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15
Q

Baby contracts Listeria from mom, treat baby with?

A

DOC - Ampicillin PLUS gentamicin

DOC for adult - Ampicillin

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16
Q

42 yo female with pneumonia
Hx - asthma, takes corticosteriods
gram pos bacilli, coccobacilli and branching filaments - Nocarida

A

corticosteroid susceptible to infection
Lobar pneumonia with abscess - may mimc TB
fever, wt loss, chest pain. Can spread

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17
Q

Treat for asthma pt on cortiocosteriod with pneumonia for Nocardia?

A

TMP/SMX is DOC

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18
Q

23 yo AIDs pt with fever, night sweats, fatigue, diarrhea for 3 months. lost 22 lbs, short of breath, CD4 below 50. Has?

A

Mycobacterium Avium

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19
Q

Pathogenesis of M. Avium

A

disseminated MA in severely immune compromised
crosses mucosal epithelium and infects the resting Macs
Macs carry organism everywhere
infected Macs secrete cytokines - cytokine storm

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20
Q

M. Avium tx in AIDs pt?

A

Clarithromycin or Azithromycin PLUS ethambutol

21
Q

42 yo AIDS pt develops neurologic signs

A

AIDS dementia
Fungi - coccidiodes, cryptococcus, toxoplasma
CMV

22
Q

in AIDS pt with neuro signs, can see MLE

A

MLE is progressive multifocal leukoencephalopathy

weakness on one side - Hemiparesis

23
Q

JC virus in AIDS pt

A

Polyomavirus
pretty much everybody has it
causes PML in profoundly T cell suppressed pts

24
Q

PML - progressive multifocal leukoencephalopathy

A

onset of focal symptoms - behavioral, speech, cognitive, motor and visual impairment
aphasia, hemiparesis, ataxia, cortical blindness
causes focal areas of demylination throughout the brain
dx by PCR of CSF
no Tx - adjusting ART may help

25
Q

23 yo AIDS pt with fever, severe headache, stiff neck, nausea, and vomiting. CSF shows elevated protein, decreased glucose, 10 WBC/ul
yeast seen in india ink stain

A

Meningitis from Cryptococcus Neoformans

26
Q

Cryptococcal meninigitis

A

has thick Poly capsule
enter through inhalation, evades phagocytosis and Th1 cells
see in AIDS pts with CD4 under 100
causes diffuse pulmonary infiltrates, skin lesions and widespread visceral involvement

27
Q

Treat cryptococcus meningitis with?

A

Amp B and Flucytosine

maintanence with fluconazole until CD4 count increase to over 100 for more than 6 months

28
Q

AIDS pt with persistent high grade fever, wt loss, hepatosplenomegaly, mucocutaneous ulcers in mouth, and skin lesions. Find histoplasma

A

can get from contaminated soil with bat or bird droppings
most likely result of prior infection, was probably contained in granuloma, disseminated, initial infection has flu-like symptoms
chronic histoplasmosis leads to cavitations and hemoptosis

29
Q

Treament of Histoplasmosis in AIDS pt?

A

Amp B

maintain with Itraconazole until CD4 counts increase

30
Q

36 yo AIDS pt with fever and shortness of breath.
CD4 count at 120 and viral load is up.
See trophozoites and cysts from bronchial levage

A

Pneumocystis Jiroveci - pt did not take propholaxis for this (TMP/SMX)
extracellular pathogen controlled by phagocytic macs
replicates in the surfactant layer above the alveolar epithelium
proliferation continues and damages the basement membrane

31
Q

10 yo developed leukemia and is given chemo. week later develops diarrhea and painful mouth ulcers.

A

Pt is neutropenic - count below 500/ul
lacks localizing signs of inflammation because low on neutrophils
Less than 7 days of neutropenia - most likely bacterial - Staph, strept, Pseudmonas, Ecoli, Klebsiella,
More than 10 days neutropenic think - Candida or Aspergillus

32
Q

how would empirically tx the 10 yo leukemia pt with neutropenia?

A

Carbapenems
BSP and B lactamases
Vancomycin
Azole NOT Amp B (toxic) or capsofungin

33
Q

Find Candida in 10 yo leukemia pt with neutropenia? also seen in

A

T cell immune suppression, antibiotic therapy, anticancer therapy and neutropenia

34
Q

Disease associations in Candida

A

Thrush, vaginal yeast infections, esophagitis, candidemia, Hepatosplenic candidiasis

35
Q

Treatment of Candidemia

A

Capsofungin
Fluconazole
Voriconazole
Amp B

36
Q

52 yo AIDS pt with CD4 count at 15 develops Neuro symptoms. Causes?

A 
AIDS dementia 
JCV 
CMV 
Cryptococcus 
Toxoplasma 
Progressive Multifocal leukoencephalitis
37
Q

AIDS pt with CD4 count at 15, shows ring enhancing lesions. Associated with ?

A

B cell lymphoma
Toxoplasma
Cryptococcus
Brain is edematous and hemorrhagic necrosis

38
Q

Tx toxoplamsa in AIDS pts

A

Pyrimethamine /Sulfadiazine - inhibits folate
Leukovorin - folic acid to overcome BM suppression
for those who cannot have sulfa drugs - give clindamycin instead of pyrimethamine
Prevent in AIDS pt with TMP/SMX

39
Q

Clinical outcomes if toxoplasma crosses placenta?

A

hydrocephalus
microcephaly
intracranial calcification
chorioretinitis, strabismus, blindness, epilepsy, petechia, anemia, thrombocytopenia
CLASSIC TRIAD: chorioretinitis, hydrocephalus, cerebral calcifications

40
Q

Patients with severe T cell immune suppression other than AIDS

A

malignancies, leukemias, collagen-vascular diseases, and organ transplant recipients

41
Q

congenital toxo

A

triad: chorioretinitis, hydrocephalus and intracranial calcifications
Long term: deafness, visual impairment and learning disabilities

42
Q

Toxo in IC pts

A

Encephalitis

43
Q

83 yo with profuse, non bloody, watery diarrhea with nausea, vomiting and lower abdominal cramping. Oocytes stained with acid fast in stool. DX is cryptosporidium

A

from contaminated water, drinking water or swimming pool
resistant to chlorine
replicates in brush border

44
Q

Cryptosporidiosis in IC, treatment

A 
AIDS pts, infants and elderly 
Nitazonxanide in immune competent pts 
No tx for immunosuppressed 
AIDS pts, adjust the ART therapy 
Paromomycin maybe in some IC pts
45
Q

54 yo with leukemia on regimen with cortiocosteriods develops acute, severe abdominal pain. Accompanied by nausea, vomiting and diarrhea that is sometimes bloody. Find Strongyloides in stool.

A

Strongyloides - hookworm
escape from GIT into circulation and invade CNS, heart, urinary tract, endocrine glands
tx with Thiabendazole

46
Q

Skin and mucous membranes

A

candidal infections

burn infections - polymicrobial

47
Q

Gastrointestinal

A

CMV, strongyloids, cryptosporidium

48
Q

Respiratory - Pneumonia

A

Bacterial - Nocardia
Viral - CMV, herpes virus
Fungal - Histoplasma, Pneumocystis, Aspergillus

49
Q

Neurological

A

Meningitis - Cryptococcal,

Encephalitis - JCV, Toxo, CMV, HIV

50
Q

Occular

A

CMV

51
Q

Disseminated

A

M avium
Histoplasma
Candida
Aspergillus

CMBM Exam 4 Gopi (10 decks)

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