Opportunistic Infections- Dr. Moscatello Flashcards by Gretchen Hackett

What constitutes a compromised host?

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

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What are compromised hosts at risk for?

Increased likelihood of suffering from severe and life threatening infections

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What is a primary deficiency?

Something that’s inherited or congenital

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What a secondary deficiency?

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

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What are 2 examples of innate primary immunodeficiencies?

Complement or phagocytic deficiencies

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What are 4 examples of secondary innate immunodeficiencies?

Burns, trauma, surgery, or obstruction

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What are 3 examples of adaptive primary immunodeficiencies?

T-cell, B-cell, and combined immunodeficinces

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What are 6 examples of adaptive secondary immunodeficiencies?

Malnutrition, AIDS, cancer, transplantations, stress, pregnancy

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

Enterobacteriaceae, Gram positive cocci, Haemophilus influenzae, Pseudomonas aeruginosa

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Who is likely to get neisseria infections?

People with MAC complement deficiencies

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

CATALASE POSITIVE BACTERIA

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

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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

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Why do burns cause secondary innate deficiencies?

They damage the cutaneous microbial barrier and vascularized tissue

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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

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

Urine flow, ciliary action, and peristalsis

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What type of bacterial infections are common in burns?

Pseudomonas aeruginosa
S. Aureus
Coagulase negative Staph
Enterobacteriaceae

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What type of fungal infections are common in burns?

Candida (localized)
Aspergillus
Mucor (disseminated)

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What types of viral infections are common in burn patients?

Herpes… but these are uncommon

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What % of nosocomial infections are catheter related?

40%

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

E. Coli
K. Pneumoniae
Proteus
Pseudomonas
Yeast
Enterococci
S. Epidermidis

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What does X-linked agammaglobulinemia cause?

No B cells in the periphery

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What bugs are seen in X-linked agammaglobulinemia?

S. Pneumoniae

2. H. Influenzae

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

At mucosal surfaces

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

Non-enveloped (B19 and norovirus)

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What does DiGeorges syndrome affect?

T-cells

What kind of pathogens affect DiGeorges patients?

Viruses and fungi

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

Bacteria, viruses, fungi, parasites

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

What types of cells are affected by malnutrition?

T cell and B cell immunity

What was the progression of HIV?

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

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

GO DO IT

What CD4 levels do you see pneumocystis jiroveci with?

50-200

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

Under 100

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

Under 200

What are some other CNS infections seen in HIV patients?

TB, syphillis, listeria, HIV, systemic fungi

Did you review the infections associated with malignancy chart?

GO DO IT

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

Surgery

What exacerbates infections post-transplant in the first month?

Immunosuppression

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

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

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

HSV

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

Immunosuppression

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

Community acquired infections

What types of infections are seen 6 months post transplantation?

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

When are bacterial infections in transplant patients generally seen?

First month after transplant

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

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

What type of virus reactivates in many transplant recipients?

HERPES

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

CMV

What % of all transplant develop symptomatic CMV infections?

20-60%

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

With a CMV seropositive donor to a seronegative recipient

When is CMV post-transplant commonly seen?

A few months after transplants

What are some symptoms of CMV infection post transplant?

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

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

Renal

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

TRUE

What 2 things can EBV cause post-transplant?

Mononucleosis and PTLD

What 2 things can BK virus cause post-transplant?

Polyomavirus | Renal disease

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

What are the 5 fungal infections seen post-transplant?

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

What is seen in toxoplasmosis infections?

Ring enhancing lesions

What is seen in cryptococcus neoformans infections?

Encapsulated yeasts

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

C3b "B binds Bacteria"

What is made from C5-C9?

MAC

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

What enzyme is deficient in chronic granulomatous disease?

NADPH oxidase

What are some catalse positive bacteria?

``` SPANS KEC S. Aureus Pseudomonas Aspergillous Nocardia Serratia ``` Klebsiella E. Coli Candida

Do you see pus in LAD?

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

What can bacterial infections post burn lead to?

Sepsis

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

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

What is the most common community acquired cause of UTI?

E. Coli

What is the most common cause of nosocomial UTI?

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

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

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

What causes Hyper-IgM sndrome?

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

What is the most common B cell disorder?

Selective IgA deficiency (no IgA)

What causes DiGeorge's?

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

Who gets opportunistic infections?

HIV, CA, and Transplant

What are T-cell levels in AIDS defining conditions?

Under 200

What kind of antibodies are seen in HIV patients?

Ones to p24 and enveloped antigens

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

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

Indicator disease like thrush, esophagitis, and recurrent yeast

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

Under 200

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

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

What does cryptococcus neoformans cause?

Meningitis

What does toxoplasma gondii cause?

Encephalitis

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

Encapsulated ones

What do AIDS patients with reactivated CMV get?

Retinitis and interstitial pneumonia

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

CNS- Encephalitis

What does JC cause

Progressive multifocal leukoencephalopathy

What 2 types of candida can patients get post transplant?

Albicans or Grabata

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

Owl's Eye Inclusion?

CMV

Dented Helmets (or a condom)?

P. Jiroveci- PCP

What is persistent diarrhea from?

PARASITE

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

Acid fast oocysts in stool

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

Crypto

What is seen in the stool of isospora?

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

Acid-Fast Bacillia with a CD4 count over 200?

Acid-Fast Bacilla with a CD4 cound 75+?

Thinking Mycobacterium avum

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

Crypto

Antibodies against B. Henselae with lesions?

Bacillary angiomatosis

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

Kaposi sarcoma or bacillary agiomatosis (Bacillary is raised)

45 degree branching hypae that are septate?

Aspergillosis

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

MUCOR Think ketoacidotic patient with sinusitis

Opportunistic Infections- Dr. Moscatello Flashcards

(103 cards)