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Microbiology Part 2 > Lec46 Opportunistic Infections > Flashcards

Lec46 Opportunistic Infections Flashcards

(48 cards)

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1
Q

What are opportunistic pathogens?

A
  • lack intrinsic virulence

- almost exclusively cause disease in individual with impaired host defense

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2
Q

What are principal pathogens?

A
  • have intrinsic virulence and cause regular disease in pts immunocompetent
  • occur with more frequency/severity in pts with impaired host defense
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3
Q

What are you at more risk for with defect in cell mediated immunity?

A

viral pathogens

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4
Q

What are you at more risk for with defect in neutrophils?

A

bacterial and fungal infections

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5
Q

How do you measure severity of neutropenia?

A

absolute neutrophil count

= WBC * (%neutrophils + %bands)

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6
Q

How do you restore immune function in neutropenic pt?

A
  • use GCSF or other growth factor
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7
Q

What are four different stains used for pneumocystis and what do they stain?

A

GMS stain: cyst forms in bronchioalveolar lavage
Wright-Giemsa stain: stains trophic forms in foamy exudate
Calcofluor white: stains fungal cyst wall
DFA: shows cysts sand trophic forms

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8
Q

What are two diseases to look out for in pt with CD4 < 50?

A
  • disseminated mycobacterium avium complex

- cytomegalovirus

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9
Q

When does HIV pt start to have high risk of PCP pneumonia?

A

at CD4 < 200

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10
Q

Pt with low CD4 and hypoxemia what should you think?

A

PCP pneumonia

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11
Q

What stain to find mycobacterium avium complex?

A

AFB stain

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12
Q

What are symptoms of MAC?

A

disseminated diseased in AIDS characterized by: bacteremia, fever/chills/sweat/weight loos/diarrhe, bone marrow suppress [anemia, low WBC]

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13
Q

How do you diagnose MAC?

A

use of special blood culture bottles and can take wks

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14
Q

How do you prevent MAC [mycobacterium avium complex]? Treat?

A

prevent: azithromycin prophylaxis
treat: 2-3 drug combo and restoration CD4

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15
Q

Fever/headache then seizure + ring enhancing lesions in brain with AIDS? What should you think?

A

cerebral toxoplasmosis

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16
Q

Fever/headache then seizure without enhancing lesions in brain with AIDS? What should you think?

A

cryptococcus neoformans [cryptococcus meningitis]

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17
Q

What are clinical findings of JC virus?

A
  • no disease in immunocompetent
    in AIDS: enters through resp tract and latent in kidney, reactivation –> viremia and infection of oligodendrocytes –> demyelinating disease
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18
Q

How is JC virus transmitted?

A

via respiratory tract

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19
Q

What is treatment for JC virus?

A

no treatment, poor prognosis

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20
Q

What are characteristics of JC virus?

Study These Flashcards
A
  • polyoma virus, non enveloped dsDNA virus, ubiquitous
21
Q

What is HIV prophylaxis for pulm TB? when do you give it?

Study These Flashcards
A
  • give isoniazid for 9 mos in pt with latent TB

- at any CD4 count

22
Q

What is neutropenia definition?

23
Q

What is HIV prophylaxis for PCP pneumonia? when do you give?

Study These Flashcards
A
  • TMP/SMX

- give when CD4 < 200

24
Q

What is HIV prophylaxis for CNS toxoplasmosis? when do you give?

Study These Flashcards
A
  • TMP/SMX

- for pt with seropositive toxoplasma with CD4 < 100

25
What is HIV prophylaxis for disseminated mycobacterium avium complex? when do you give?
- azithromycin | - when CD4 < 50
26
What 2 kinds of infections do you see at < 1 month after solid organ transplant?
- bacterial surgical site infection | - nosocomial infections
27
What kinds of infections do you see at 1-12 month after solid organ transplant?
PCP, CMV/EBV/HSV/VZV, listeria, noardia, toxoplasma, strongyloides, community acquired
28
What 2 kinds of infections do you see at >6-12 months after solid organ transplant?
- community acquired infections | - EBV
29
If you are treated for rejection after transplant what happens to risk of diseases?
- reset clock, at risk for the same diseases you were when you first got transplant [bacterial surgical site infection, nosocomial]
30
What is most common classic opportunistic infection in HIV?
PCP
31
What is prophylaxis for PCP in solid organ transplant recipient?
- TMP-SMX prophylaxis during period of high immunosuppression
32
What is prophylaxis for CMV in solid organ transplant recipient?
- prophylaxis: ganciclovir or valgancyclovir x 3-6 mos for all recipient - preemtion: monitor CMV PCR frequently, if PCR + start ganciclovir and decrease immunosuppression
33
What is prophylaxis for EBV in solid organ transplant recipient?
- monitor EBV pcr frequently, if + decrease immunosuppression
34
What is definitiona of neutropenia?
ANC < 500 cells/mm
35
What are major pathogens associated with neutropenia?
- gram negative bacteria [pseudomonas] - candida - aspergillus and other filamentous fungi --> esp with long duration of neutropenia
36
What do you do with pt with fever and neutropenia following chemo?
- initiate broad spectrum antibiotic with activity against pseudomonas [ex cefepime] - also can add: vancomycin for MRSA, aminolgycoside for gram neg, fluconazole for candida - if prolonged neutropenia --> give voriconazole in case of aspergillus
37
What are risk factors for infection following bone marrow transplant?
- neutropenia in pre-engraftment period --> get bacteria/fungi - immunosuppressants to prevent graft vs host --> see pathogens similar to those after solid organ transplant
38
What are possible causes of hematuria in pt with acute myeloid leukemia on treatment? [2 viruses]
- due to radiation therapy, chemotherapy | - due to infection: adenovirus, BK virus
39
What are characteristics of BK virus?
- ubiquitous, polyoma virus
40
What are clinical syndromes associated with BK virus?
- hemorrhagic cystitis following BMT | - hemorrhagic cystitis and renal graft loss following kidney transplant
41
What treatment for BK virus?
- no effective therapy, can use cidofovir | - critical to decrease immunosuppression
42
what are differences nocardia and actinomyces?
both: gram + rods, branching filamentous, slow-growing nocardia: strictly aerobic, weak acid fast actinomyces: facultative anaerobic, not acid fast
43
Toxoplasma transmission?
- parasite, host in nature is cats | - humans infected by cat stool --> contaminated by pet cat fecal oral, or via cow/pig meat that can be infected
44
What type of infections common in person with antibody deficiencies [ex hypogammaglobulinemia]?
- recurrent serious bacterial infections - chronic enteroviral infections - chronic diarrhea
45
what types of infections common in person with disorder of phagocytic function [chronic granulomatous disease]?
- s. aureus, burkholderia cepacia, nocardia candida, aspergillus
46
what type of infection occurs in person with T cell lymphocyte deficiency [SCID]?
- PCP
47
what type of infection occurs in person with hyper IgE?
recurrent severe Staph Aureus infections
48
what type of infection occurs in person with terminal complement deficiency?
recurrent neisseria meningitidis infection

Microbiology Part 2 (30 decks)

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