Flashcards in Opportunistic Infections- Dr. Moscatello Deck (103):
What constitutes a compromised host?
More than or equal to one defect in the bodies natural defense against microbial inbaders
What are compromised hosts at risk for?
Increased likelihood of suffering from severe and life threatening infections
What is a primary deficiency?
Something that's inherited or congenital
What a secondary deficiency?
Something due to underlying disease state or results from treatment from disease
What are 2 examples of innate primary immunodeficiencies?
Complement or phagocytic deficiencies
What are 4 examples of secondary innate immunodeficiencies?
Burns, trauma, surgery, or obstruction
What are 3 examples of adaptive primary immunodeficiencies?
T-cell, B-cell, and combined immunodeficinces
What are 6 examples of adaptive secondary immunodeficiencies?
Malnutrition, AIDS, cancer, transplantations, stress, pregnancy
If you have a C3 complement deficiency, what organisms are you likely to get infection from?
Enterobacteriaceae, Gram positive cocci, Haemophilus influenzae, Pseudomonas aeruginosa
Who is likely to get neisseria infections?
People with MAC complement deficiencies
What type of bacterial infections do people with chronic granulomatous disease get?
CATALASE POSITIVE BACTERIA
-Enterobacteriaceae, Staphylococcus, Pseudomonas aeruginosa, Aspergillus, Mucor (Rhizopus)
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
Why do burns cause secondary innate deficiencies?
They damage the cutaneous microbial barrier and vascularized tissue
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
What things do obstruction affect that can cause a secondary innate deficiency?
Urine flow, ciliary action, and peristalsis
What type of bacterial infections are common in burns?
1. Pseudomonas aeruginosa
2. S. Aureus
3. Coagulase negative Staph
What type of fungal infections are common in burns?
1. Candida (localized)
3. Mucor (disseminated)
What types of viral infections are common in burn patients?
Herpes... but these are uncommon
What % of nosocomial infections are catheter related?
What kind of bacteria can cause bacteremia due to catheters (obstruction)?
1. E. Coli
2. K. Pneumoniae
7. S. Epidermidis
What does X-linked agammaglobulinemia cause?
No B cells in the periphery
What bugs are seen in X-linked agammaglobulinemia?
1. S. Pneumoniae
2. H. Influenzae
In Hyper-IgM syndrome and selective IgA deficiency where do you see bacterial infections?
At mucosal surfaces
What types of viruses are seen with Hyper-IgM syndrome and selective IgA deficiency?
Non-enveloped (B19 and norovirus)
What does DiGeorges syndrome affect?
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 -->
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?
What CD4 levels will you see cryptococcus neoformans in an HIV patient?
What CD4 levels will you see toxoplasma gondii in an HIV patient?
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?
What exacerbates infections post-transplant in the first month?
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?
What causes infection post-transplantation from 2-6 months?
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?
What is the most common and most important infection in solid organ transplants?
What % of all transplant develop symptomatic CMV infections?
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%?
True or False, HSV is a viral infection seen post-transplant?
What 2 things can EBV cause post-transplant?
Mononucleosis and PTLD
What 2 things can BK virus cause post-transplant?
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
What is seen in toxoplasmosis infections?
Ring enhancing lesions
What is seen in cryptococcus neoformans infections?
What is a major opsonin to remove bacteria from the blood?
"B binds Bacteria"
What is made from C5-C9?
What part of neisseria makes it susceptible to complement mediated lysis?
-Complement can't lyse gram + or gram - bacteria because they have lipopolysaccharide
What enzyme is deficient in chronic granulomatous disease?
What are some catalse positive bacteria?
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?
What are the 2 most common bacterial infections after a burn?
Pseudomonas (blue/green pus with a grape smell)
What is the most common community acquired cause of UTI?
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?
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"
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?
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?
What does toxoplasma gondii cause?
If you have had your spleen removed, what kind of bacteria are you susceptible too?
What do AIDS patients with reactivated CMV get?
Retinitis and interstitial pneumonia
Where can VZV go if you are immunosuppressed that can cause issues?
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?
Dented Helmets (or a condom)?
P. Jiroveci- PCP
What is persistent diarrhea from?
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?
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)?
Antibodies against B. Henselae with lesions?
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?