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Flashcards in Micro: Things I don't know Deck (101):
1

HPV
1. genome
2. capsid
3. envelope

1. small circular dsDNA
2. icosahedral capsid: self assemble
3. non-enveloped: contributes stability of virus on skin and fomites

2

L1

protein capsid of HPV used for vaccine

3

laryngeal papilloma

HPV 6 and 11
infants/young children
benign warts in respiratory tract
complication: respiratory distress leading to death
Tx: multiple surgeries
prevention: remove genital warts in pregnancy

4

epidermodysplasia verruciformis

HPV infection in someone with inherited defect in cellular immunity
warts on face, trunk, limbs throughout life and non-metastatic tumors

5

HPV genital warts

condyloma acuminata
condyloma plana

6

SPI

subclinical papilloma infection
HPV infection that can lead to CA

7

5% acetic acid

HPV
brush on infected area to detect SPI: turns warts white
reveals dysplasia: use to take colposcopy

8

pap smear

HPV
detects koilocytotic squamous epithelial cells

9

cofactors in the development of cervical cancer in women with HPV

smoking
co-infection with herpes simplex

10

Dx of HPV

CANNOT be grown in cell culture
1. clinical appearance
2. abnormal Pap, colposcopy to look for dysplasia
3. HPV DNA detection test

11

Tx of HPV: methods for removal

remove warts (does NOT eradicate virus so can return)
2. BCA, TCA
3. cryotherapy
4. LEEP
5. podofilox
6. imiquimod
7. intralesional IFN injections

12

BCA: bichloroacetic acid
TCA: trichloroacetic acid

brush on warts: denatures proteins
Tx: HPV
AE: irritated/burned surrounding skin

13

cryotherapy

liquid nitrogen to physically disrupt wart (be careful not to freeze to deep: causes scarring)
Tx: HPV

14

LEEP (loop electrosurgical excision procedure)

removes dysplastic cervical cells
Tx: HPV

15

HSV
1. genome
2. capsid
3. envelope

1. large: dsDNA (has viral DNA pol)
2. icosohedral
3. yes

16

Where does HSV reside in latency?
1. HSV 1
2. HSV 2

peripheral sensory neurons: maintained EXTRACHROMOSOMALLY
1. trigeminal ganglia
2. sacral ganglia

17

HSV replication cycle

1. viral attachement
2. pH-independent plasma membrane fusion
3. release of nucleocapsid that migrates to the nucleus
4. genome is released
5. IMMEDIATE EARLY transcription/translation: makes transcriptional regulators to modify host RNA pol
6. production of EARLY PROTEINS: replicate viral genome: include viral THYMIDINE KINASE and viral DNA POL
7: LATE PROTEINS: capsomeres, envelope, STRUCTURAL proteins
8. virus assembly in NUCLEUS (NUCLEAR INCLUSIONS)
9. virus buds from plasma membrane

18

syncitia

HSV
infected cells fuse with adjacent non-infected cells to form giant cells with more than one nucleus
Mechanism: viral glycoproteins are also present on plasma membrane of infected cells late in infection

19

Dx of HSV

Tzanck smear

20

Tzanck smear

HSV
cells from ulcerous lesion reveal multinucleated giant cells with nuclear inclusion bodies

21

LAT (latency-associated transcript)

HSV
only gene expressed in latency
prevents apoptosis of infected neuron

22

What causes HSV to reactivate?
What effect does this have?

decline in cell mediated immunity
kills infected neuron and recurrent epithelial infection occurs

23

HSV 1 diseases

1. gingivostomatitis
2. herpes labialis (FEVER BLISTER)
3. herpetic whitlow (finger vesicle)
4. KERATITIS
5. conjunctivitis
6. blepharitis
7. ENCEPHALITIS

24

HSV 2 diseases

1. CERVICITIS
2. VULVAR VESICLES
3. vaginal vesicles
4. urethritis
5. PENILE VESICLES
6. perianal vesicles
7. MENINGITIS
8. encephalitis

25

gingivostomatitis

PRIMARY HSV
vesicles on lips, tongue, facial skin around mouth
FEVER, HEADACHE

26

fever blister

RECURRENT HSV
vesicles in some of the same sites as primary after stress
FEVER, HEADACHE

27

How do you determine primary from recurrent HSV genital vesicles?
Sx of both?

difficult; Hx
recurrent: fewer lesions that heal more quickly; more frequent soon after primary infection (diminishes over time)

28

genital HSV Sx

1. vesicles (penis, external/internal vagina; can cause urethritis, cervicitis, vaginitis)
2. flu like
3 itching, buringin in infected area
4. muscle aches of legs, buttocks

29

prodrome symtoms

Sx that can tip HSV sufferer of an impending recurrent infection

30

Can you get HSV if partner doesn't have vesicles?

yes
virus sheds in absence of recurrent vesicles ant after lesions are unapparent

31

HSV blepharitis, conjunctivitis

PRIMARY ocular HSV infection
CHILDREN
Sx: small vesicles/pustules around eye lid

32

HSV keratitis

SECONDARY ocular HSV infection
Sx: red painful eye, blurred vision, photophobia
if untreated: corneal scarring

33

HSV encephalitis

RARE (not more common in immune compromised)
adults: recurrent HSV1
neonates: primary HSV2
Sx: headache, fever, CONFUSION, SEIZURES
high MORTALITY

34

HSV meningitis

PRIMARY HSV2
Sx: headache, STIFF NECK, vomiting
usually resolves

35

Neonatal HSV

1st/2nd week postpartum
best outcome: infection limited to SKIN, MOUTH, EYES
severe: most DIE or have significant sequelae
1. ENCEPHALITIS: SEIZURE, IRRITABILITY, COMA
2. disseminated: organ failure (check liver enzymes)

36

When do neonates get infected with HSV?

What is the chance of transmission if mother is undergoing a primary vs. secondary infection?

What precautions should be taken to prevent transmission from mother to infant?

most: DELIVERY
5%: transplacental

primary: 30%
secondary: 2-3% (maternal Ab are protective)

C-section if herpatic lesions are present

37

Dx of HSV
1-4: general
5: keratitis
6: meningitis
7: encephalitis
8: neonatal

1. PCR of vesicles (most important)
2. culture (7-10 days): CYTOPATHIC EFFECT (CPE); old gold standard
3. serology (only indicates past infection unless Ig-type specific)
4. TZANCK smear
5. keratitis: slit lamp examination
6. meningitis (aimed at ruling out bacterial origin): CSF used for PCR/culture
7. encephalitis: PCR/SOUTHERN BLOT (normal EEG rules out HSV as cause)
8. neonatal: check liver enzymes for disseminated disease

38

HSV Tx

NO cure
1. ACYCLOVIR
2. vidarabine, trifluorodine
3. FOSCARNET
4. DOCOSANOL

39

foscarnet

MOA: pyrophosphate analog: blocks viral DNA pol
NO phosphorylation required
Tx: HSV when ACV fails

40

docosanol

OTC for cold sores
MOA: moodiness host cell membrane so virus envelope cannot fuse with PM
Tx: oral HSV

41

vidarabine, trifluorodine

eye drops
MOA: inhibit DNA pol
Tx: HSV keratitis

42

When do you give oral vs. IV acyclovir?

Tx: HSV
oral: genital outbreak/prevention
IV: encephalitis, neonatal

43

Treponema pallidum
1. disease
2. type of microbe
3. source of antigen for serological test
4. pathology

1. syphilis
2. motile spirochete: thin peptidoglycan with inner/outer membrane (outer has mostly lipoproteins and lipids rather than LPS)
3. rabbit testes
4. host cellular inflammatory response (also humoral response that is not able to eliminate infection); LATENCY

44

primary syphilis

PAINLESS hard CHANCRE at site of entry
non-tender INGUINAL LYMPHADENOPATHY

45

secondary syphilis

1-2 months later
systemic: disseminated
Sx: fever, headache, non-tender DIFFUSE SWOLLEN NODES, mouth and genital lesions (SNAIL TRACK), RASH that eventually includes SOLES and PALMS and/or wart lesions (CONDYLOMATA LATA) on perineum/anal region

may have ALOPECIA, MILD MENINGITIS, liver involvement

46

tertiary syphilis

ENDARTERITIS
almost any organ system
1. CV: AORTIC VALVE REGRUGITATION
2. skin/bone: GUMMA
3. CNS: meningitis (asymptomatic or acute syphilitic), meningovascular (can infarct cerebral vessels), paresis (many spirochetes in cerebral cortex/meninges: personality changes, INSANITY, paranoia), TABES DORSALIS (demylization of posterior columns/dorsal roots): SHUFFLES when walking, lightening pains
patient is NOT infectious
few spirochetes detected in lesions

47

syphilis Dx

1. serology: RPR, VDRL, FTA--ABS
2. dark field microscopy of chancre
CANNOT: culture

48

Syphilis Tx

PENICILLIN: Pen G
pregnant women: desensitize her and give PENICILLIN)
ALT (resistance): macrolides, azithromycin

49

congenital syphilis

can have still birth or spontaneous abortion; may have symptoms at birth, may develop years later
1. disseminated infection
2. late congenital syphilis

50

early latent syphilis
1. Sx
2. serology
3. relapse?
4. infectious?

1-2 yr period after secondary infection
1. no
2. positive
3. may relapse to secondary syphilis
4. pregnant woman may pass infection in utero

51

late latent syphilis
1. Sx
2. serology
3. relapse?
4. infectious?

follows early latent syphilis: 1-2 years post infection and may last lifetime
1. no
2. positive
3. no
4. not infectious even to fetus

52

disseminated congenital syphilis

transmitted transplacentally after 1st trimester via blood
Sx: SNUFFLES, SNAIL TRACK lesions, CONDYLOMA LATA, HEPATOSPLENOMEGALY, BULLOUS RASH

53

late congenital syphilis

develops over years: starts around age 2
Sx: bone abnormalities (frontal bossing, SABER SHINS), vision defects (GUN BARREL SIGHT), HUTCHINSON'S TRIAD (notched incisors, keratitis, deaf)

54

rapid plasma reagin (RPR) test

syphilis: SENSITIVE
antigen: cardiolipin
mix serum with cardiolipin: look for agglutination (pos. test)
decreases with Tx (can see antibiotic efficacy)

55

fluorescent treponemal antigen-absorbed (FTA-ABS) test

syphilis: SPECIFIC
antigen: pathogenic T. pallidum
1. Pt. serum is mixed with non-pathogenci treponemes to remove cross reacting Abs against normal spirochete flora
2. mix serum with T. pallidum fixed on slide
3. add fluorescent dye tagged with goat-antihuman Ig
4. positive: fluorescent staining spirochetes using fluorescence microscope in dark
stays elevated after Tx

56

general disease research laboratory (VDRL) test

syphilis
antigen: cardiolipin
cheap and sensitive serology test

57

Haemophilis ducreyi

PAINFUL SOFT CHANCRE
ragged, raised

58

Chlamydia trachomatis (Ct)
1. microbe type
2. forms
3. virulence

1. obligate INTRACELLULAR G (-) parasite
2. two forms: EB, RB
3. intracellular, causes INFLAMMATION (HSP)

59

Neiserria gonorrhoeae (gonococcs, GC)
1. microbe type
2. pathology/virulence

1. NO capsule
2. LPS causes INFLAMMATION, PILI and outer membrane surface proteins (antigenic variation), IgA1ase

60

Ureaplasma urelyticum

mycoplasma: NO cell wall
urethritis/cervicitis

61

Dx of Ct and GC

NAAT (nucleic acid amplification test) on urine or exudates

62

sequela for Ct and GC

PID

63

newborn infection of
1. Ct
2. GC

1. conjunctivitis, PNA
2. conjunctivitis (rare due to prophylaxis)

64

EB (elementary body)

C. trachomatis
metabolically inert but infectious

65

RB (reticulate body)

C. trachomatis
grows in membrane bound vacuole (inclusion body) in CYTOPLASM of MUCOSAL EPITHELIAL cells

66

pili

GC
attachement
antigenic variation: varying pilS insert into pilE

67

pilS

GC
vary
silent with no promoter

68

pilE

GC
expression locus with promoter

69

GC, Ct lower genital tract infections

cervicitis, urethritis (GC can disseminate from this, Ct can't)

70

GC, Ct upper genital tract complications

1. SALPINGITIS, PID
2. epididymitis
3. perihepatitis (FITZ-HUGH-CURTIS: VIOLIN STRING adhesions of liver)
4. prostatitis (GC only?)

71

Other sites of: GC, Ct

1. rectal
2. conjunctivitis
3. Reiters' syndrome
GC only: PHARYNGITIS, DISSEMINATED

72

disseminated GC

SEPSIS with RASH, FEVER, SEPTIC ARTHRITIS
also can have: endocarditis, meningitis

73

Reiters' syndrome

Ct mostly, occasionally GC
reactive, non-septic arthritis (immune response related) following bacterial enterocolitis

74

Sx of urethritis in men
1. GC
2. Ct
3. both

need lab Dx to differentiate
1. purulent penile discharge
2. less purulent, milky discharge
3. DYSURIA, itching at distal urethra

75

Sx of cervicitis

GC, Ct
dysuria, white discharge from endocervix

76

PID
1. organisms
2. organs effected
3. Sx
4. Tx
5. complications

1. GC, Ct, mycoplasma, Non-STD anaerobes
2. endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis
3. Sx: lower abdominal pain (dull to severe), adnexal tenderness, cervical motion tenderness, fever, may have cervicitis or vaginal bleeding
4. Tx: DOXYCYLINE and CEFOXITIN
5. ectopic pregnancy, chronic pelvic pain

77

Ct: infant pneumonia

afebrile, STACCATO cough with TACHYPNEA
CXR: hyperinflation with bilateral infiltrates
eosinophilia, elevated IgM
conjunctivitis at same time suggests Ct

78

Dx of Ct

1. GOLD STANDARD: NAAT
2. gram stain: no cocci, PMNs (only accurate in males, not females)
3. culture in tissue rarely done
4. rapid antigen test

79

Dx of GC

1. gram stain: G- in PMNs (only accurate in males, not females)
2. GOLD STANDARD: THAYER-MARTIN medium for complicated infections: grows GC (antibiotics to get rid of other organisms); also gram stain, OXIDASE POS.
3. NAAT
4. rapid antigen test

80

Tx of GC

must treat for GC and Ct
IM CEFTRIAXONE and AZT (for Ct)
CANNOT give fluoroquinolone

81

Tx of Ct

AZITHROMYCIN
ALT: doxycycline (CI in infant, children, pregnancy; 10 day regimen decreases compliance); erythromycin

82

How can you prevent GC in eyes of newborn?

silver/nitrate topical antibiotics
does NOT work for Ct

83

lymphogranuloma venereum (LGV)

Ct: L1-3
Sx: SWOLLEN LYMPH NODES with suppuration, ULCER at site of entry
RARE in US

84

trachoma

non-STD Ct infection
can cause blindness
Asia, Middle East, Africa

85

Dx of vaginitis and vaginosis

microscopic
rapid examination of discharge

86

candidiasis: candida albicans and C. glabrata
1. microbe type
2. discharge type
3. disease

MOST COMMON
1. fungus
2. scant, white, clumped
3. vaginitis

87

gardnerella vaginalis
1. microbe type
2. discharge type
3. disease

1. bacteria
2. GRAY, adherent (coats vagina); FISHY odor
3. bacterial vaginitis (BV)

88

mobiluncus spp.
1. microbe type
2. disease

1. bacteria
2. bacterial vaginitis (BV)

89

What is the key factor allowing overgrowth of Candida and bacterial vaginosis (BV)?

disturbance of normal flora that maintain low pH and produce H2O
ex: antibiotics, DM, sex, douching, initial use of IUD, menses, pregnancy, tight fitting undergarments

90

Trichomoniasis vaginalis
1. microbe type
2. discharge type
3. disease

1. single cell protozoan: FRANK PATHOGEN
2. profuse FROTHY YELLOW, FISHY odor
3. urethritis, vaginitis

91

Which microbe that causes vaginalis is sexually transmitted not part of the normal flora?

Trichomoniasis vaginalis
reason it is a FRANK pathogen

92

bacterial vaginosis (BV)

NO single causative agent: caused by combination of anaerobes

93

Sx of vaginosis

VAGINAL DISCHARGE (malodorous for BV)
dysuria, itching (in Trichomonal or candidiasis; not mentioned for BV)

94

cystitis Sx

dysuria, suprapubic pain, leukocytes in urine, significant bacteria in urine

95

pyelonephritis Sx

cystitis Sx
PLUS: FEVER, FLANK PAIn
CASTS in urine

96

Dx of bacterial vaginosis (BV)
1. odor
2. discharge
3. pH
4. micro
5. Sx
6. inflammation

1. whiff test: FOUL odor after KOH addition (FISHY)
2. dirty white or GRAY (homogeneously coats vaginal wall)
3. above 4.5
4. CLUE cells
5. NO dysuria or vaginal discomfort
6. no

97

Dx of candidiasis vaginosis

1. pungent but not foul
2. COTTAGE CHEESE (white and clumped)
3. 4.5 or below (normal)
4. KOH: BRANCHING HYPHAE
5. extreme ITCHING, dysuria
6. leukocytes

98

Dx of Trichomonas vaginosis

1. whiff test: may be malodorous
2. FROTHY YELLOW(GREEN)
3. above 4.5
4. TWITCHING TRICHOMONADS (size of PMNs); PMNs
5. itching, dysuria
6. leukocytes
STRAWBERRY CERVIX

99

Tx of Trichomonal vaginitis

oral metronidazole
Tx partner too

100

Tx of BV

oral metronidazole for 7 days

101

Tx of vaginal candidiasis

topical and oral azoles