Keywords: 30-40 Flashcards Preview

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Flashcards in Keywords: 30-40 Deck (16):
1

30 Examples of antigenic or phase variation (6)

Plasmodium falciparum (malaria)

Borrelia burgdorferi (Lyme disease)

Neisseria meninigitidis (meningitis)

Salmonella (flagellar phase variation, food borne illness)

Haemophilus influenzae (respiratory infection)

Helicobacter pylori (gastric ulcers)

2

30 Microbes that escape the phagosome to live in the cytoplasm (4)

Listeria monocytogenes

Trypanasoma cruzi

Shigella

Rickettsia

3

32 Toxins:

Definition

Types of organisms that make toxins

Two types

Bacterial exotoxins
- Type
- Amount relative to endotoxin
- Bacterial cell toxin production
- Better toxin producers: gram+/-
- Good for...

Types
- Mycotoxin
- Neurotoxin
- Enterotoxin
- Hemolysin

biological molecules that can kill in small quantities

bacteria & some fungi & parasites

- Endotoxin: part of LPS or LOS, heat-stable
- Exotoxin: heat-labile

- proteins
- active in smaller amounts than endotoxin
- one bacterial cell can make >1 toxin
- gram+ bacteria are better toxin producers
- vaccine targets

- fungal
- nervous system
- GI system
- lyses RBCs

4

32 Drugs Against
Drugs with some activity against Pseudomonas

Resistance

For P-Ts, Carb not Erta & FQ not Moxi TACC PA

Piperacillin/tazobactam
Carbapenems (not Erta)
Fluoroquinolones (not Moxi)
Ticarcillin-clavulanate
Aztreonam
Cefepime
Ceftazidime
Polymyxins
Aminoglycosides

Quinolones, aztreonam, & others

5

32 Comparision of T-cell Stimulation by Conventional Antigens vs. Superantigens:

Conventional antigen
- T cell response
- Cytokine release
- Next
- Result

Superantigen
- T cell response
- Cytokine release
- Next
- Result

- small subset of T cells respond
- desirable release of cytokines like IL-2
- T cell : B cell interactions
- antibody formation

- massive T cell response
- excess release of IL-2, etc.
- strong release of TNF & other proinflammatory cytokines
- shock, fever

6

35 Most common health problems in travelers (4)

Main cause of morbidity

- diarrhea
- respiratory infections
- skin disorders
- febrile illnesses

accidents

7

35 Causes of the symptoms of infection in returned travelers:

1) Eco-challenge in Borneo

2) Swimming in Lake Malawi

3) Unprotected MSM in Amsterdam

4) Beach vacation in Bermuda

5) Camping in rural Cambodia

6) Exploring food from street vendors in Bangkok

7) Spelunking in Mexico

1) leptospirosis

2) schistosomiasis

3) HIV, Lymphogranuloma venereum, HSV, syphilis

4) cutaneous larva migrans

5) Japanese encephalitis

6) hepatitis A, E, typhoid fever

7) histoplasmosis

8

35 Duration:

Short exposure during travel increases the incidence of... (4)

Long exposure to the local environment or people increases the risk of... (2)

- influenza
- diarrhea,
- upper respiratory infections (URI’s)
- non-travel related illness

- tuberculosis
- parasitic diseases such as amebic liver abscess or strongyloidiasis

9

35 Causes of illness in returning travelers:

Most common (9)

Most urgent (4)
- All cause...

– Malaria
– Infected insect bite
– Diarrhea
– Upper respiratory illness (URI)
– Dengue
– Typhoid
– Chikungunya
– Hepatitis A
– Rickettsial infection

– Malaria
– Typhoid
– Amebic liver abscess
– Viral Hemorrhagic Fever

Fever

10

35 Common etiologies in returning travelers:

Fever (5)

Diarrhea
- Bacterial (4)
- Protozoa (3)
- Viral (2)

Confusion (4)

Jaundice (4)

- Malaria
- Dengue Fever
- Typhoid fever
- Acute schistosomiasis (Katayama fever)
- Leptospirosis

- E. coli, Salmonella, Shigella, Vibrio cholerae
- Giardia, Cryptosporidium, Entameba
- Norovirus, Rotavirus

- Viral encephalitis (Japanese encephalitis, West Nile virus)
- Meningococcal meningitis
- Typhoid fever
- Malaria


- Hepatitis A
- Hepatitis B
- Hepatitis E
- Yellow fever

11

36 Antiretroviral Therapy of HIV-1:

Nucleoside analog reverse transcriptase inhibitors (NRTIs)
- Mechanism of action
- Examples (5)
- Some known adverse effects (3)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Mechanism of action
- Examples (2)
- Some known adverse effects (3)

Protease Inhibitors (PIs)
- Mechanism of action
- Examples (2)
- Some known adverse effects (1)

Fusion Inhibitors
- Mechanism of action
- Examples (1)

Integrase inhibitors/ Integrase Strand Transfer Inhibitors (INSTI)
- Mechanism of action
- Examples (1)

Entry inhibitors
- Mechanism of action
- Examples (1)

Combination ARTs
- Examples (1)

Nu
- Bogus substrate for RT, terminates DNA chain
- Zidovudine, Lamivudine, Emtricitabine, Abacavir, Tenofovir
- Bone marrow suppression (Zid), renal insufficiency (Ten), hypersensitivity reaction (Aba)

No
- Non-competitive inhibitor, freezes enzyme so it can't catalyze polymerization
- Efavirenz, Nevirapine
- Dizziness, vivid dreams, rash

P
- Compete w/ normal substrate for binding protease, blocking its activity
- Ritonavir (pharmacologic booster), Atazanavir
- Mild hyperbilirubinemia

F
- Binds gp41 protein, blocks fusion of viral & host membrane, administered subcutaneously
- Enfuvirtide

I
- HIV integrase is essential for proviral DNA integration into host chromosomal DNA, well-tolerated
- Raltegravir

E
- Occupies the CCR5 HIV-1 co-receptor and blocks virus entry, not active against virus that can use the alternate CXCR4 HIV-1 co-receptor
- Maraviroc

C
- Atripla: Efavirenz, Tenofovir, & Emtricitabine

12

36 Antiretroviral Therapy of HIV-1:

Benefits of ART (5)

Antiretrovial Therapy
- Duration
- Recommended for... (5)

ART Drug Combinations
- Backbone
- Plus...
- Pregnant women

B
- Increases CD4+ T cell counts
- Delays progression
- Decrease risk for consequences of chronic immune activation
- Prolongs survival
- Decreases transmissibility

A
- Lifelong treatment, drug compliance necessary
- Symptomatic HIV/AIDS, CD4+ < 500, nephropathy, Hepatitis B, & pregnant women

A
- Dual NRTI backbone: Tenofovir + Emtricitabine
- Plus:
o An NNRTI: Efavirenz
o A Ritonavir-boosted protease inhibitor: Atazanavir or Darunavir
o An integrase inhibitor: Raltegravir
- For pregnant women: Efavirenz?

13

39 Pathogens that Establish a Persistent or Latent Infection:

Bacteria (2)

Protozoa (3)

Viral (10)

- Mycobacteria
- Treponema

- Plasmodium
- Toxoplasma
- Trypanosomes

- EBV
- HSV-1
- HSV-2
- CMV
- VZV
- KSHV
- HIV
- HBV
- HCV
- HPV

14

40 Immunologic Response to Vaccines:

Primary immune response

Upon challenge with a microbe...

Live vaccines

Subunit or killed vaccines

Most vaccines

Best case scenario

Safety issues (2)

Herd immunity (2)

- takes 7-10 days
- in the absence of an actual infection, the cells become memory cells

a secondary response, which is much faster and more robust, is mounted and the infection is eliminated or disease is averted

induce antibodies as well as effector T cells

induce antibody responses

inducing a strong antibody response that can inactivate the toxin or prevent viruses from entering cells

prior infection (once) protects against subsequent infection

- acellular pertussis vaccine is now used instead of the killed whole pertussis vaccine, because there are many fewer side effects
- inactivated polio vaccine is used now instead of live attenuated polio vaccine

- when a large group of people are vaccinated, there is little reservoir for the infectious agent
- some live vaccines can be passed to other, non-vaccinated individuals

15

40 Vaccines not available for some of the world’s biggest killers (8)

Tuberculosis
Malaria
HIV
Worm infections
Diarrheal diseases
Respiratory infections
Sexually transmitted diseases
Trypanosomal infections

16

40 Non-required Vaccines (4)

delivered to travelers to other countries as protection
- typhoid vaccine

delivered to at risk subpopulations in the US
- rabies vaccine, pneumococcal vaccine, anthrax

commonly used in other countries
- BCG

booster
- tetanus and pertussis