smear is first treated with aniline dye ( carbolfuchism) the red dye penetrates throught the bacterial cell wall where it binds to MYCOLIC acids.. 2. then slide is treated with alcohol and hydrochloric acid --- this dissolves the outer membrane and non tb bacteriabut the presence of MYOCOLIC acid prevents decolorization of bacteria. 3. counter stain methylyne blue is added ... non tb will stain blue

- infection HIV CD4 count low in nocardia infection --- weak acid fast

cvs 4 Flashcards by Hassan Khokhar

zero order kinetics

WATTP
Warfarin
Aspirin
Theophyline
Tolbutamied
Phenytoin

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constant amount of drug is metabolized

zero

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fraction metabolized

first order

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how many half lives to steady state

4 5

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which bugs stain with zheil nelson

Myocobacterium
Nocardia
Cryptosporidium oocyst

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M tb

gram +
acid fast
mycolic acid

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acid fast stain

smear is first treated with aniline dye ( carbolfuchism)
the red dye penetrates throught the bacterial cell wall where it binds to MYCOLIC acids..

then slide is treated with alcohol and hydrochloric acid — this dissolves the outer membrane and non tb bacteriabut the presence of MYOCOLIC acid prevents decolorization of bacteria.
counter stain methylyne blue is added … non tb will stain blue

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serpentine snake like virulence factor

cord factor

myocolic acid forms long BCFA / cord factor

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what prevents phagolysosome formation

sulfatides

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no rigid wall bugs

CREAM 
Chlamydia
Rickettsia
Ehrlichia
Anaplasma
Mycoplasma/ ureaplasma

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MTB replication takes place IN

alveoli

macrophages cannot destroy it initially

cell mediated immunity required — TH1—> IFNgamma—>macrophages—-> TNFalpha

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what can destroy MTB

acidification

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V/Q is low at

base

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Primary TB infection

inhalation
LOWER lobe
unchecked virulence factors

areas of infection — ghon focus in lower lobe

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what makes a ghon complex

ghon focus + I/L hilar lymph node

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what happens to ghon complex in few weeks

the granuloma gets fibrosed and calcified

this fibrosed and calcified ghon complex is known as RANKE COMPLEX

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reactivation of TB in which lobe

upper

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what is milary TB

progressive primary tb
failed immune resp
adrenal gland/liver

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M. scrofulaceum

scrofula cervical lymphadenitis

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M. marinarum

aquarium handlers

hand

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M. avium intracellulare

CD4 <100 HIV AIDS

txt —– azithromycin (macrolide)

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name a cachectin

TNF alpha

cough / hemoptysis weight loss

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PPD postive means

previous exposure / active infection

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PPD negatiev

infection
HIV CD4 count low
in nocardia infection — weak acid fast

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sarcoidosis CD4 CD8 ratio

INCREASED | CD4 ---- consumes NCG

gold standard tb test

IGRA quantiferon test langhwan giant cells ----- cd 14

catalase positive rod shape weakly acid fast

nocardia | branching filaments

SNAP mnemonic

Sulfonamide for nocardia | Penicillin for actinomyces

Nocardia

AEROBE weak acid fast like TB but NEGATIVE PPD brain disseminate

Actinomyces

ANAEROBE negative acid fast yellow sulfur granulation JAW infection dental PID

aerobic bacilli

listeria | corynebacterium

anaerobic bacilli

clostridium cutibacterium propionibacterium acne

branching filaments anaerobe

actinomyces

novobiacin + -

sensitive ---- S. epidermis | resistant----- saprophyticus

grows in 6.5 nacl bile and PYR +

enterococcus | subacute endocarditis after GU GI procedures

bacitracin sensitive PYR +

GAS pyoegnes

yellow sulfur granules

actinomyes

red

serratia

golden

s aureus

green

psueudomonas

orange sand in diapers

lesch nyhan

glove and stocking presentation

leprosy | armadillo reservoir

TH1 leprosy

early TUBERCULOID leprosy positive lepronin test ---- type 4 hsn hypopigmented plawues and hairless skin

TH2 leprosy

late Lepramatous Leprosy negative test disseminated

investigation of choice for leprosy

PCR and biopsy

treatment for leprosy

dapsone | rifampin

txt for lepromatous leprisy

dapsone rifampin clofozamine

Listeria can cause ..... in infants

infantiseptica ``` low CMI or def CMI facultative intracellar dairy products deli meat unpasteurized milk COLD GROWTH ``` from birth canal during delivery

actin polymerization

rocket tail | cell to cell migration listeria

meningitis in infants

GEL Group b E coli Listeria

other conditions cuased by listeria

amnionitis spontaneous abortions fetal death preamature birth

Bartonella henslae < 100

stellate star shaped granuloma | bacillary angiomatosis

kaposci sarcoma CD4 count

<500 HHV 8 lymphocitic infiltration SPINDLE CELLS purple lesions skin and GIT

oral thrush CD4 count

<500 nystatin scrape +ve

EBV hairy leukoplakia

CANNOT SCRAPE

HPV SCC strains

< 500 | 16 18 31 33

CD4 < 200

PCP JC------ oligodendrocyts CNS HIV dementia Histoplasma capsulatum ---- wtloss/ftgue/cgh

candida esophagitis CD4 count

<100 | FLUCONAZOLE

only azole to cross BBB

fluzonazole

linear ulcers in esophagus

CMV <100 | owl inclusions

CMV retinitis txt

cotton wool spots GANICYCLOVIR if fails then --- FOSCARNET

CD<100

``` candida esophagitis EBV prmary cell lymphoma cryptococcus CMV retinitis, esophagitis, colitis, encephalitis cryptosporidium toxoplasmosis --- multiple ring enhancing lesions withEDEMA MAC aspergillus --- prexisting cavities ```

ixodes tick

BAB Borrelia Anaplasma Babesia

lyme diseas 1 2 3

1. skin--- erythema migrans 2. muscle, heart, nerves---- 3rd deg block, bells palsy 3. bone---- arthritis, encephalopathy

teratment for lyme

doxycycline

txt lyme in pregnant / children

amoxicillin | ceftriaxone (CNS)---- 3rd gen

leptospirosis signs symptoms

myalgias erythematous conjunctiva photophobia HAWAIII

Weil disease

ictero hemorrhagic

conjunctival injection also a give away for which intoxication

marijuana