Opportunistic Infections- Dr. Moscatello Flashcards Preview

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Flashcards in Opportunistic Infections- Dr. Moscatello Deck (103):
1

What constitutes a compromised host?

More than or equal to one defect in the bodies natural defense against microbial inbaders

2

What are compromised hosts at risk for?

Increased likelihood of suffering from severe and life threatening infections

3

What is a primary deficiency?

Something that's inherited or congenital

4

What a secondary deficiency?

Something due to underlying disease state or results from treatment from disease

5

What are 2 examples of innate primary immunodeficiencies?

Complement or phagocytic deficiencies

6

What are 4 examples of secondary innate immunodeficiencies?

Burns, trauma, surgery, or obstruction

7

What are 3 examples of adaptive primary immunodeficiencies?

T-cell, B-cell, and combined immunodeficinces

8

What are 6 examples of adaptive secondary immunodeficiencies?

Malnutrition, AIDS, cancer, transplantations, stress, pregnancy

9

If you have a C3 complement deficiency, what organisms are you likely to get infection from?

Enterobacteriaceae, Gram positive cocci, Haemophilus influenzae, Pseudomonas aeruginosa

10

Who is likely to get neisseria infections?

People with MAC complement deficiencies

11

What type of bacterial infections do people with chronic granulomatous disease get?

CATALASE POSITIVE BACTERIA

-Enterobacteriaceae, Staphylococcus, Pseudomonas aeruginosa, Aspergillus, Mucor (Rhizopus)

12

Who is at risk of infections with these bugs?
Streptococcus pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Acinetobacter baumanii

Leukocyte Adhesion Deficiency Patients

13

Why do burns cause secondary innate deficiencies?

They damage the cutaneous microbial barrier and vascularized tissue

14

How do organisms gain access to blood in a trauma or surgery and what can this lead too?

Via wound or GI
-Lead to sepsis and shock

15

What things do obstruction affect that can cause a secondary innate deficiency?

Urine flow, ciliary action, and peristalsis

16

What type of bacterial infections are common in burns?

1. Pseudomonas aeruginosa
2. S. Aureus
3. Coagulase negative Staph
4. Enterobacteriaceae

17

What type of fungal infections are common in burns?

1. Candida (localized)
2. Aspergillus
3. Mucor (disseminated)

18

What types of viral infections are common in burn patients?

Herpes... but these are uncommon

19

What % of nosocomial infections are catheter related?

40%

20

What kind of bacteria can cause bacteremia due to catheters (obstruction)?

1. E. Coli
2. K. Pneumoniae
3. Proteus
4. Pseudomonas
5. Yeast
6. Enterococci
7. S. Epidermidis

21

What does X-linked agammaglobulinemia cause?

No B cells in the periphery

22

What bugs are seen in X-linked agammaglobulinemia?

1. S. Pneumoniae
2. H. Influenzae

23

In Hyper-IgM syndrome and selective IgA deficiency where do you see bacterial infections?

At mucosal surfaces

24

What types of viruses are seen with Hyper-IgM syndrome and selective IgA deficiency?

Non-enveloped (B19 and norovirus)

25

What does DiGeorges syndrome affect?

T-cells

26

What kind of pathogens affect DiGeorges patients?

Viruses and fungi

27

In SCID (combined immunodeficiency) what types of infections would you see?

Bacteria, viruses, fungi, parasites

28

What is required to ensure growth, maintenance, and specific functions?

Cellular balance between supply of nutrients and energy and the body's demand for them

29

What types of cells are affected by malnutrition?

T cell and B cell immunity

30

What was the progression of HIV?

Asymptomatic Infection -->
Persistent, generalized lymphadenopathy -->
Symptomatic -->
AIDS defining conditions

31

Did you review the charts of pulmonary, GI, and Cutaneous infections in patients with HIV?

GO DO IT

32

What CD4 levels do you see pneumocystis jiroveci with?

50-200

33

What CD4 levels will you see cryptococcus neoformans in an HIV patient?

Under 100

34

What CD4 levels will you see toxoplasma gondii in an HIV patient?

Under 200

35

What are some other CNS infections seen in HIV patients?

TB, syphillis, listeria, HIV, systemic fungi

36

Did you review the infections associated with malignancy chart?

GO DO IT

37

What are infections in the first month post-transplant generally related to?

Surgery

38

What exacerbates infections post-transplant in the first month?

Immunosuppression

39

What types of infections are seen in the first month post-transplant?

Wound infections, nosocomial pneumonia, UTI, bacteremia, colitis, and VRE

40

What is the most common viral infection seen in first weeks post-transplantation?

HSV

41

What causes infection post-transplantation from 2-6 months?

Immunosuppression

42

After 6 months post transplantation, where do infections come from?

Community acquired infections

43

What types of infections are seen 6 months post transplantation?

Influenza, UTI, pneumococcal pneumonia, VZV reactivation, HBV, HCV, CMV, HHV-6, HHV-8, EBV

44

When are bacterial infections in transplant patients generally seen?

First month after transplant

45

List some bacterial infections seen commonly in the first month after transplant?

P. qeruginosa, S. marcescens, E. cloacae, MRSA, VRE, Legionella, Nocardiosis

46

What type of virus reactivates in many transplant recipients?

HERPES

47

What is the most common and most important infection in solid organ transplants?

CMV

48

What % of all transplant develop symptomatic CMV infections?

20-60%

49

When is the risk greatest for CMV infection post-transplant?

With a CMV seropositive donor to a seronegative recipient

50

When is CMV post-transplant commonly seen?

A few months after transplants

51

What are some symptoms of CMV infection post transplant?

Fever, pneumonia, GI ulcers, hepatitis, intersitial pneumonitis*

52

What type of transplant is VZV seen in 5-10%?

Renal

53

True or False, HSV is a viral infection seen post-transplant?

TRUE

54

What 2 things can EBV cause post-transplant?

Mononucleosis and PTLD

55

What 2 things can BK virus cause post-transplant?

Polyomavirus
Renal disease

56

What viruses are community acquired rather than reactivation of latent viruses in viral infections post-transplant?

Influenza A and B, RSV, Parainfluenza 1, 2, 3, and adenovirus

57

What are the 5 fungal infections seen post-transplant?

1. Candida: Oral, esophageal, vaginal, disseminated
2. Aspergillus
3. Cryptococcus
4. Coccidiodes
5. Histoplasmosis

58

What is seen in toxoplasmosis infections?

Ring enhancing lesions

59

What is seen in cryptococcus neoformans infections?

Encapsulated yeasts

60

What is a major opsonin to remove bacteria from the blood?

C3b

"B binds Bacteria"

61

What is made from C5-C9?

MAC

62

What part of neisseria makes it susceptible to complement mediated lysis?

The lipooligosaccharide

-Complement can't lyse gram + or gram - bacteria because they have lipopolysaccharide

63

What enzyme is deficient in chronic granulomatous disease?

NADPH oxidase

64

What are some catalse positive bacteria?

SPANS KEC
S. Aureus
Pseudomonas
Aspergillous
Nocardia
Serratia

Klebsiella
E. Coli
Candida

65

Do you see pus in LAD?

NO... the neutrophils can't adhere to vascular endothelium so there is no pus or abscess

66

What can bacterial infections post burn lead to?

Sepsis

67

What are the 2 most common bacterial infections after a burn?

Pseudomonas (blue/green pus with a grape smell)
S. Aureus

68

What is the most common community acquired cause of UTI?

E. Coli

69

What is the most common cause of nosocomial UTI?

Still E. Coli, but Klebsiella, Pseudomonas, Proteus can also be more common causes

70

What is mutated in X-linked agammaglobulinemia?

BTK... the cells can't mature in the BM so you have no B cells in the peripery

71

Why are people with X-linked agmmaglobulinemia more susceptible to encapsulated bacteria?

Because they need antibodies to remove these and you can't make antibodies because you don't have B cells

72

What causes Hyper-IgM sndrome?

Mutation in CD-40L so there is no class switching

73

What is the most common B cell disorder?

Selective IgA deficiency (no IgA)

74

What causes DiGeorge's?

Failure of development of the 3/4 branchial pouch and aplasia of the thymus and parathyroid

75

Who gets opportunistic infections?

HIV, CA, and Transplant

76

What are T-cell levels in AIDS defining conditions?

Under 200

77

What kind of antibodies are seen in HIV patients?

Ones to p24 and enveloped antigens

78

True or False: Early on in HIV, the immune system is "winning"

TRUE

The virus hides out in macrophages, ect. while T-cells are eventually destroyed and start falling

79

In the symptomatic stage of HIV, what kind of diseases are seen?

Indicator disease like thrush, esophagitis, and recurrent yeast

80

With full blown AIDS, what are the T-Cell counts?

Under 200

81

Why do antibodies to p24 decrease over time?

As T-cells are destroyed, there is less class switching and IgG,which is required for the p24 antibody

82

Why do antibodies to Env Ag stay steady with the progression of HIV?

This is susceptible to antigenic drift,so it changes over time
-The immune system uses IgM to deal with this which doesn't require T-cells, so it can keep up

83

What does cryptococcus neoformans cause?

Meningitis

84

What does toxoplasma gondii cause?

Encephalitis

85

If you have had your spleen removed, what kind of bacteria are you susceptible too?

Encapsulated ones

86

What do AIDS patients with reactivated CMV get?

Retinitis and interstitial pneumonia

87

Where can VZV go if you are immunosuppressed that can cause issues?

CNS- Encephalitis

88

What does JC cause

Progressive multifocal leukoencephalopathy

89

What 2 types of candida can patients get post transplant?

Albicans or Grabata

90

Why is aspergillous so bad in an IC patient?

Because it's so hard to treat... is the treatment or the aspergillous going to kill the patient

91

Owl's Eye Inclusion?

CMV

92

Dented Helmets (or a condom)?

P. Jiroveci- PCP

93

What is persistent diarrhea from?

PARASITE

94

What do cryptosporidium, isospora, and microsporida all have in common?

Acid fast oocysts in stool

95

What is the watery HIV diarrhea dx most likely going to be 90% of the time?

Crypto

96

What is seen in the stool of isospora?

Huge, elliptical oocysts (similar to giarhdia, causes malabsorption)

97

Acid-Fast Bacillia with a CD4 count over 200?

TB

98

Acid-Fast Bacilla with a CD4 cound 75+?

Thinking Mycobacterium avum

99

If something is India Ink + (it had a capsule)?

Crypto

100

Antibodies against B. Henselae with lesions?

Bacillary angiomatosis

101

What else is on the ddx for with an HIV patients with lesions?

Kaposi sarcoma or bacillary agiomatosis (Bacillary is raised)

102

45 degree branching hypae that are septate?

Aspergillosis

103

90 degree angles with non-septate hyphae that is RIBBON like?

MUCOR

Think ketoacidotic patient with sinusitis