Flashcards in Micro Deck (174):
1
BCG vaccine
Variable efficacy in studies
Some studies say protects against miliary and TB meningitis
Given to at risk infants
Mycobacterium bovis
2
Mycobacterium avium-intracellulare
Bad for AIDS patients
3
Mycobacterium marinum
Fishtanks
Single clusters papules/plaques
4
Leprosy
Aka Hansen's disease.
Mycobacterium leprae and M. lepromatous
Skin depigmentation, sensory neuropathy
Tuberculoid form
Lepromatous form (worse)
Tends to affect peripheries (cooler temp)
Armadillo natural reservoir
5
Caseating granuloma differential
TB
Fungus (especially if they are from Minnesota)
6
Pneumonia
Inflamm alveoli
Lobar, interstitial, or broncho-pneumonia
Fever and chills, productive cough with yellow-green sputum, pleuritic CP and tachypnea, decreased breath sounds, dullness to percussion, elevated WBC count
7
Lobar pneum
Consolidation entire lobe on CXR
MCC: S. pneum (95%) and Kleb pneum
Stages:
1. Consolidation
2. Red hepatization
3. Grey hepatization
4. Resolution
8
Klebsiella pneumoniae as cause pneumonia
Enteric flora....so aspirated somehow.
Think drunks and physically disabled
CURRENT JELLY SPUTUM
9
Strep pneum as cause pneumonia
MCC community-acquired pneum and secondary pneum
Rusty colored sputum
10
Secondary pneumonia
Bacterial pneumonia superimposed on viral URTI
11
S. aureus as a cause pneumonia
2nd MCC secondary pneum.
Oft complicated by abscess or empyema (NB coagulase positive)
12
Pseudomonas aeruginosa as cause pneum
Associated with CF patients
13
Moraxelle catarrhalis as a cause of pneum
Assoc with COPD
14
H. influenzae as cause pneum
Comm cause secondary pneum and superimposed on COPD (smokers)
15
Legionella pneumophila as cause pneumonia
Community acquired...water source
Superimposed on COPD or immunocompromised
Silver stain
16
Causes bronchopneum
S aureus
H. flu
P. aerug
M. catarrhalis
Legionella
17
Bronchopneum on CXR
Patchy consolidation around bronchioles. Oft multifocal and B/L
18
Interstitial pneumonia
=Atypical pneum, "walking pneumonia"
Relatively mild upper resp sxs
**M pneum, Chlamydia pneum
College dorms, military recruits
Influenza in elderly, RSV in infants, Coxiella in farmers
19
Q fever
Coxiella burnetti
Atypical pneum with high fever
Farmers/vets...spores from ticks on cattle or in cattle placentas
20
Why is Coxiella unique?
Although Rickettsial organism, causes pneum, does not require arthropod vector, and does not produce skin rash
(As opposed to other rickettsial diseases)
21
Chlamydia psittaci
Birds.
22
RTI + AIDS
PCP
TB
Cryptococcus
23
RTI + neutropenia
Aspergillus/fungi
24
RTI + Splenectomy
Encapsultaed orgs: SHiN
25
Abx mild-mod CAP
Amoxicillin or macrolide
26
Abx: mod-severe CAP
Co-amoxiclav + clarithromycin
27
Macrolides
erythromycin, clarithromycin
Inhibit 50S subunit
28
Aminoglycosides
"GNATS"
Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin
Inhibit 30S subunit
29
Abx: Hosp-Acquired pneum
Cipro + Vanco
30
Abx: aspiration pneum
Cefuroxime + metronidazole
31
Abx: legionella
Macrolide + Rifampicin
32
Abx: pseudomonas pneum
Piperacillin + tazobactam
33
Abx: MRSA
Vancomycin
34
STIs with discharge
Gonorrhea
Chlamydia
Trichomonas
Candida
BV
35
STIs with ulceration
Syphilis
HSV
LGV
Chancroid
Donovanosis
36
STIs with Rashes, lumps, growths
Scabies
Pubic lice
Genital warts (HPV)
Molluscum contagiosum
37
PAINFUL genital ulcers
Herpes>chancroid
38
Painless genital ulcer
Syphilis>LGV and granuloma inguinale
39
Pregnant + gonorrhea
Opthalmia neonatorum
40
Tx: gonorrhea
250mg IV ceftriaxone
41
Dx-chlamydia
NAAT
42
Tx-chlamydia
Azithromycin 1g
(Can do 7d doxy but less compliance)
43
LGV
Lymphatic infection, Chlamydia trachomatis L1-L3
Developing world, MSM developed
Tx: doxy 100mg BD 21d
44
Syphilis
-bug
-Dx
Treponema pallidum
Majority cases in those with HIV
Dark-ground microscopy
VDRL, RPR
45
Primary syphilis
Ulcer
46
Secondary syphilis
Systemic sxs, rash
Can have neuro involvement
47
Tertiary syph
Gumma (granuloma), 2-20 yrs later
Aortitis
Neurosyph/tabes dorsalis, argyll robertson pupils
48
Tx-syph
IM Ben-pen
49
Jarisch-Heimer reaction
Fever, HA, myalgia in response to Abx for syph
50
Congenital syphilis
HSM, rash, fever, neurosyph, pneumonitis, hutchinson teeth
51
Chancroid
H. ducreyo (G-)
Tropical
Mult painful ulcers
52
Donovanosis
Granuloma inguinale
Klebsielle granulomatis (G-)
Africa, India, Aboriginal communities
Giemsa stain
Tx-azithro
53
Trichomonas
-cause
-Dx
-Tx
Trichomonas vaginalis
Dx-wet prep microscopy
Tx-metronidazole
54
BV
Gardnerella, decreased lactobacilli
Increased pH
Fishy odor, discharge
Whiff test (KOH prep), Gram stain, clue cells
Tx: metronidazole
55
Candidiasis
-sxs
-associations
-Tx
Thick white "cottage cheese" discharge, extremely itchy
May be associated with immunodeficiency, diabetes
Fluconazole
56
Molluscum contagiosum
dsDNA pox virus
Hands and feet in children
Adults-genital lesions, sexual contact
In adult=HIV until proven otherwise. Giant lesions if immunocompromised
Tx-trauma, cryotherapy
57
Genital warts
HPV 6,11
Oft asxs. Warts can recur after tx
Incubation: 3/52-8/12
Home tx: podophyllin cream
Clinic tx: cryotherapy, imiquimod
58
Superficial fungal infxn-diagnostic tool
Wood's lamp
59
Tinea versicolor
Caused by malassezia furfur.
Skin depigmentation
60
Dx candida
Culture, mannan Abs
Also beta-D-glucan
61
Dx-aspergillus
ELISA, PCR, beta-glucan
62
Dx-cryptococcus
Cryptococcal antigen in serum/CSF
63
TB
do this later
64
Meningitis-definition
Inflamm process of meninges and CSF
65
Meningoencephalitis-definition
Inflamm process of meninges and brain parenchyma
66
Routes of entry for CNS infections
Hematogenous spread
Direct implantation (instrumentation)
Local extension (secondary to infxn)
PNS to CNS, e.g. polio
67
Meningitis-Signs and Sxs
Fever, HA, stiff neck, brain fn disturbance
68
Causative agents-meningitis
N. men
S. pneum
H. flu
TB
Cryptococcus
69
Encephalitis-signs and symptoms
Brain function disturbance
70
Encephalitis-causes
HSV
Rabies, arboviruses, trypanosoes, prions, amoeba
71
Myelitis
Disturbance nerve transmission
Poliovirus
72
Neurotoxins
Paralysis, rigid (tetanus) or flaccid (botulism)
73
TB meningitis
Immunosuppressed pts
meninges and basal cisterns of brain and spinal cord
Can result in tuberculous granulomas, tuberculous abscesses
DON'T give steroids...call a specialist.
74
Aseptic meningitis
Most common CNS infection
HA, stiff neck, photophobia
Non-specific rash
No white cells and normal gluc in CSF
Coxsackie B and echoviruses =80-90%
Self-limiting and resolves in 2/52
75
Reportable GI infections
Campylobacter
Salmonella
Shigella
E. coli O157:H7
Listeria
Norovirus
76
Secretory diarrhea
No fever/low grade
No WBCs in stool
V cholerae
ETEC, EPEC, EHEC
77
Inflammatory diarrhea
Fever
WBC in stool (neutrophils)
C. jejuni
Shigella spp
Non-typhoidal salmonella
EIEC
78
Enteric fever
Gastroenteritis:
Fever
WBC in stool (mononuclear cells)
Typhoidal salmonella (S typhi, S paratyphi)
Yersinia spp
Brucella spp
79
Bloody diarrhea-gastroenteritis causes
Campylobacter, E. coli, shigella, salmonella (non-typhoidal), vibrio parahemolyticus
80
Cholera
Need high infective dose
Kills esp children and those on PPIs
Mimics adenylyl cyclase
81
C. perfringens food poisoning
Normal flora of colon, but not small bowerl--where enterotoxin acts (superantigen)
8-16 hr incubation
Watery diarrhea, crmaps, little vomiting lasting 24 hrs
82
C. difficile
Pseudomembranous colitis
Abx related--mainly cephalosporins, cipro, clindamycin
Forms pseudomembranous colitis ->toxic megacolon.
Tx: metronidazole, vanco, stop other unnec Abx, avoid PPIs if poss
83
Listeria monocytogenes
Outbreaks febrile gastroenteritis
Beta hemolytic TUMBLING MOTILITY
Watery diarrhea, cramps, HA, fever, little vomiting
Perinatal infxn: prem, neonatal bacteremia/meningitis
Tx: ampicillin, ceftriaxone, cotrimoxazole
84
Vibrio parahemolyticus
Ingestion raw/undercooked seafood
Major cause of diarrhea in Japan/Caribbean
85
Campylobacter
Curved, comma, or S shaped
Microaerophilic
C. jejuni grows at 42 C
Oxidase positive
Self limiting but sxs can last weeks
Only tx if immunocompromised (macrolide)
86
Vibrio cholerae
Contamination water and food from human feces
Colonization small bowel and secretion enterotoxin A/B causing persistent activation adenylate cyclase
Rice water stools without inflamm cells
87
Giardia lamblia
Trophozoite
Pear shaped
Ingestion of cyst from fecally contaminated water/food
Protein and fat malabsorption--foul smelling non-bloody diarrhea, cramps, flatulence, no fever
Dx: stool micro, ELISA, "string test"
Tx-metronidazole
88
Cryptosporidium parvum
Infects jejunum
Severe diarrhea in immunocompromised
Oocysts seen in stool
Tx: reconstitution immune system
89
Rotavirus
dsDNA
Replicates in mucosa small intestine
Secretory diarrhea, no inflamm
"ROTA=Right Out The Anus"
By age 6, most have Abs of at least one type
Two exposures result in lifelong immunity
90
Adenovirus
Non-bloody diarrhea. Usu
91
Hepatitis A
Fecal-oral transmission
Often subclinical
Tourists, MSM, sewage workers
Rise in ALT
Vaccine to MSM, travelers
92
Hepatitis B
Chronic carrier if >6/12
2-6mo incubation
93
G+ rods
Clostridium
Corynebacterium
Listeria
Bacillus
Mycobacteria
94
G+ branching filamentous
Actinomyces
Nocardia
95
Alpha hemolysis
S. pneum
Strep viridans
96
Beta hemolysis
S pyogenes
S agalactiae
97
Group B strep
S pyogenes
98
Group A strep
S. agalactiae
99
Gamma hemolysis
Enterococci
100
S. pneum is most comm cause of which diseases?
"MOPS"
Meningitis
Otits media
Pneumonia
Sinusitis
101
Corynebacterium diphtheriae
Causes diphtheria: pseudomembranous pharyngitis, LAD, myocarditis, arrhythmias.
Toxoid vaccine
102
Gram negative rods
H. influenzae
Pasteurella
Brucella
Bordetella pertussis
103
Gram negative--comma shaped
C. jejuni
V. cholerae
H. pylori
104
Gram neg rods
Klebsiella
E coli
Enterobacter
Serratia
Shigella
Salmonella
Proteus
Yersinia
Pseudomonas
105
Legionnaire's disease
Legionella pneumophila
Severe pneumonia, fever, GI and CNS symptoms
Hyponatremia
106
Pontiac fever
Legionella pneumophila
Mild flu-like illness
107
Pseudomonas aeruginosa
Grape-like odor
Wound/burn infections, sepsis, external otitis (swimmer's ear), UTI, drug use, diabetic osteomyelitis
108
Typhoid
Salmonella typhi
Rose spots on abdo, fever, HA, diarrhea
Can remain in GB as carrier state
109
Yersinia
Mesenteric adenitis, resembling Crohn's or apendicitis
110
H pylori
Urease positive, creating alkaline environment
RF for peptic ulcers, gastric adenocarcinoma, lymphoma
111
Spirochetes
Borrelia
Leptospira
Treponema
112
Bartonella
Cat scratch disease
113
Borrelia burgdoferi
Lyme disease
114
Borrelia recurrentis
Relapsing fever
115
Ehrlichia chafeensis
Ehrlichiosis
Lone Star ticks
116
Fransisca tularensis
Tularemia
Rabbits
117
pasteurella multocida
Cellulitis
Animal bites
118
Treatment for all rickettsial diseases
Doxycycline
119
Mucor, Rhizopus spp
Mucormycosis in DKA, leukemic pts
120
Palms and soles rash-ddx
Rocky Mountain spotted fever
Coxsackie A (hand, foot, and mouth)
Secondary syphilis
121
Rickettsial diseases
Rocky Mountain spotted fever
Typhus
Ehrlichiosis
Anaplasmosis
Q fever
122
Herpes viruses
HSV1, 2
EBV
VZV
CMV
HHV6-roseola
HHV8-Kaposi's
123
DNA viruses
Hepadna
Herpes
Adeno
Pox
Papilloma
Polyoma
Parvo
All double stranded except parvo
124
HBsAg
HBV infection
125
anti-HBs
Immunity to HBV
126
HBeAg
Active viral replication, infectivity
127
Anti-HBeAg
Low transmissibility
128
Marker immunization to HBV
anti-HBs
129
Bloody diarrhea
Campylobacter
EHEC
EIEC
Shigella
Salmonella
E. histolytica
Yersinia enterocolitica
130
Watery diarrhea
C diff
C perfringens
ETEC
Protozoa
V cholerae
Viruses (noro, rota)
131
Positive nitrites on urine dip
Gram negative bacteria
132
Positive leukocyte esterase on urine dip
Bacteria
133
ToRCHeS infections
Cross placenta
Toxo
Rubella
CMV
HIV, HSV2
Syphilis
134
Blueberry muffin rash in neonate
Congenital rubella, congenital CMV
135
Abx, antivirals, antifungals to avoid in pregnancy
Sulfonamides
Aminoglycosides
Fluoroquinolones
Clarithromycin
Tetracyclines
Ribavirin
Griseofulvin
Chloramphenicol
136
Flying saucer cysts on methensmine silver stain
PCP
137
Which bug causes hyponatremia
Legionella
138
Tumbling motility
Listeria
139
Entamoeba histolytica
Flask shaped ulcers in colon, cecum
Dysentery, weight loss, liver abscess
140
HHV-8
Kaposi's
Primary effusion lymphoma
Castleman's
141
HIV treatment regimen
Two NRTIs
One NNRTI or PI
142
Phialophora verrucosa
Saprophyte on rooting wood.
Warty lesion resembling cauliflower
143
Tinea corporis
Ringworm
144
Cerebral Negri bodies (inclusion bodies)
Pathognomonic for rabies
145
Fite stain
Leprosy
146
Acyclovir-mech
Guanosine analogue.
Phosphorylated by viral thymidine kinase
147
When do infants get Men C vaccine?
3m, 4m, 12m
148
When do infants get PCV?
2m, 13m
149
Visceral leishmaniasis
L. Donovani, l. Infantum
Kala-azar
Fever, splenomegaly, can get hepatomegaly.
Can get blackened skin/hyperpigmentation
May closely resemble malaria
150
Cutaneous leishmaniasis
L. Major, L. Tropica
Itchy papule that becomes ulcer with raised edges.
Heals within 8m, leaving depigmented scar.
Most common type leishmaniasis
151
Mucocutaneous leishmaniasis
L. braziliensis
Destructive and disfiguring facial lesions.
May start in same way as cutaneous but years later, ulceration in mucous membranes and mutilation.
152
Novy-macneal-michelle medium
Leishmaniasis
153
First Hep B antibody to appear after infection
HBsAg
154
C diff treatment
14 days metronidazole PO
Can repeat if doesn't work
Then use vanco
Vanco if severe, ileus
155
Sporadic CJD
"Demented LAMB":
Dementia around age 65
LMN signs
Akinetic mutism
Myoclonus
Cortical blindness
EEG for dx
156
Test for variant CJD
Tonsillar biopsy
157
LP in CJD
Looks for protein 14-3-3
158
Features if variant CJD
Younger (ave age 26)
Median survival longer (14m versus 4m)
Psych before neuro features
159
CSF findings: bacterial, viral, TB meningitis
Bacterial has neutrophils, increased protein, decreased glucose
Viral has high lymphos
TB like viral but very high protein
160
Spontaneous bacterial peritonitis
Boozers with ascites and signs infection
MCCs are E. coli, enterococci
Tx with cefotaxime or third gen ceph
161
Significant factor in whether or clears HCV
Virus genotype.
Type 1 harder to clear
162
Sleeping sickness
Africa
Tsetse fly
Trypanosomes
When crosses BBB, causes neuro sxs like disturbed sleeping patterns
Tx with pentamidine, suramin
163
Trypanosoma brucei gambiense
West and central Africa.
Gradual onset
More common
164
Trypanosoma brucei rhodiense
South and East Africa.
Rapid onset (weeks to months)
165
Tx-Chagas
Benzimidazole or nifurtimox
166
Plasmodium knowlesi
SE Asia/Borneo
Daily fever
167
Sporozites
What mosquito injects into bloodstream
168
Merozites
Sporozites that have multiplied in liver
Contain shizonts ("diamond rings")
169
Hypnozoites
Dormant forms in liver
Vivax, oval
170
Tx-falciparum
Admit
Quinine and doxy 5-7 days
Or
Co-artem 3 days
Or
Malarone 3d
171
Malarone
Atorvaquone-proguanil
172
Tx-non-falciparum malaria
Chloroquine (kills RBC parasites)
Then primaquine (kills hynozoites)
173
Maurer's clefts
Seen in falciparum
174