L32- Multi-system Infections III Flashcards
(37 cards)
list the common microbial multi-system infections contracted via inhalation, urine, and ingestion
Inhalation: Tularemia, F. tularensis (bacteria)
Urine contact: Leptospira, L. interrogans (parasite)
Ingestion:
- Brucellosis, B. spp. (bacteria)
- Echinococcosis, E. spp (parasite)
Tularemia:
- (1) pathogen
- (2) route of transmission
- (3) geographic predominance
- (4) season predominance
- (5) occupational predominance
1- Francisella tularensis
2- inhalation via animals (usually dead) — also ingestion or injection (skin, eye, mouth, lungs)
3- northern hemisphere
4- late spring - summer
5- hunting, trapping, lab workers, farm workers (winter mos)
describe the many microbial features of Francisella tularensis
- Gram- short rod
- strict aerobe in environment; facultative aerobe in cells
- evidence on intracellular survival in macrophages
- nutritionally fastidious
After entry of F. tularensis, it spreads to (1) and then will spread to (2). It primarily infects (3) cells and undergoes (4) within (3). (5) are the major target organs.
1- regional LNs
2- multiple organs via lymph or blood
3- macrophages after phagocytosis
4- LNs, lungs, liver, kidneys
F. tularensis:
- (1) can develop only from inhalation
- (2) can develop only from injection
1- hemorrhagic inflammation of airways –> bronchopneumonia
2- granulomatous inflammation, ulcerated lesion at injection site
F. Tularensis:
- (1) incubation period before (2) symptoms (common to all syndrome types)
- (3) list the syndrome, based on transmission – indicate syndrome with highest mortality
- (4) mortality rate
1- 2-5 days
2- undulant fever, chills, malaise (pulse-Temp. dissociation)
3:
- Inhalation: **Pneumonic- highest mortality
- Injection: ulcero-glandular (lowest), glandular, oculoglandular
- Ingestion: oropharyngeal, typhoidal
4- 5-30% depends on type
Ulceroglandular Tularemia:
- (1) transmission
- spreads via (2)
- (3) presentation
1- injection: scratch, abrasion
2- lymphatics
3- painful regional lymphadenopathy, ulcerated skin lesion
Glandular Tularemia:
- (1) transmission
- (2) presentation
1- injection
2- tender lymphadenopathy w/o evidence of local cutaneous lesions
Oculoglandular Tularemia:
- (1) transmission
- (2) presentation
1- injection: enters conjunctiva via rubbing eyes (contact with contaminated fluids)
2- unilateral, purulent conjunctivitis, corneal ulceration, lymphadenopathy
Oropharyngeal Tularemia:
- (1) transmission
- (2) presentation
1- ingestion: undercooked meat, contaminated water
2- stomatitis (oral/labial inflammation), exudative pharyngitis / tonsillitis, abdominal pain, lymphadenopathy, GI bleed, n/v
Pneumonic Tularemia, aka (1):
- (2) transmission
- (3) presentation
1- primary tularemia pneumonia
2- inhalation
3- dry cough, dyspnea, pleuritic-type chest pain, hilar adenopathy, bloody pleural effusion, ARDs
Typhoidal Tularemia:
- (1) transmission
- (2) presentation
1- ingestion (most severe)
2- bacteremia; secondary pneumonitis
Note- difficult to Dx b/c no ulcers, lymphadenopathy
Tularemia / F. tularensis Dx- indicate primary and alternative methods
-**direct IFA
- serodiagnosis: titers x2
- PCR, real time-PCR
Note- culture is difficult and risky for personnel
(1) is the common infection caused by contact with animal urine / soil, and possess the following microbial characteristics, (2). It is commonly found in (3) and requires (4) transmission.
Leptospirosis- L. interrogans
- thin, tightly coiled spirochetes
- motile- 2 periplasmic flagella
- obligate aerobes
- sensitive to heat, drying, chemicals
- Found in soil (alkaline environment) for 1-2 wks
- Enters penetrating breaks in skin / mucous membranes
Leptospira interrogans:
- multiplies in (1) cells, leading to (2) clinical syndrome
- early stages, parasite is found in (3)
- late stages, parasite is found in (4)
- (5) other DDx that it is often confused with
1- endothelium of small BVs
2- Weil Disease
3- CSF, blood
4- urine
5- Dengue
Leptospirosis:
- infection occurs through (1) transmission
- (2) initial Sxs, include timeline
- (3) 2nd phase Sxs, include timeline
1- enters thru skin abrasions / conjunctiva
2- 1-2wks: acute febrile illness
3- Weil disease: liver / kidney disease- hemorrhage, necrosis, organ dysfunction
list the types of Leptospirosis and associated symptoms
Primary:
- Bacteremic: flu-like, v/d, conjunctival suffusion, calf and lumbar pain
- Meningitic: like viral meningitis (nuchal rigidity, HA, n/v)
Secondary:
- Icteric: fever, hemorrhage, hepatic / renal impairment
- Pulmonary: ARDS
______ is the main method of diagnosis Leptospirosis
MAT- microscopic agglutination test (Ab detection / serology)
Of the common ingested microbes causing multi-system infections, (1) is related to unpasteurized foods and (2) is related to contaminated foods
1- Brucella spp.
2- Echinococcus
Brucellosis:
- (1) list the bacteria species
- (2) describe its basic features
- (3) methods of transmission
1- B. abortus, B. melitensis, B. suis, B. canis
2:
- Gram- coccobaccilli, aerobic
- small, non-motile, non-encapsulated
- requires complex growth media
3- *ingestion, direct contact (lab), inhalation
List the Brucella spp. causing Brucellosis, include:
- rank by pathogenicity
- geographic area
- natural host
B. melitensis: highest pathogenicity
- everywhere (including USA) besides Africa
- goats, sheep, camels
B. suis: high pathogenicity
-South Asia, pigs (swine)
B. abortus: moderate
- Africa, Asia, S. Amer.
- cattle (a-bovine)
B. canis: moderate
-dogs (canine)
describe the colonies Brucella spp. form in the body and how it relates to pathogenesis
Smooth: O chain/Ag of smooth LPS = virulence marker, indicates more serious disease (weak endotoxin)
Rough: switch is associated with dec virulence of bacteria and disease severity
In the body, Brucella spp. bacterium infect (1) cells which is then transferred to (2) cells, explain. Then, it travels to (3) organs before reaching (4) where it secreted proteins in order to form (5).
1- intracellular parasite of RES
2- macrophages via phagocytosis (inhibits lysosome-phagosome fusion)
3- spleen, liver, BM
4- LNs (via PMNs), kidneys
5- granuloma
______ bacteria infects humans in USA who consume unpasteurized milk / dairy products
B. melitensis
