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MSU AZ Micro 2

Worms, Respiratory: viral, RTI, cough, pneumonia, TB, Diarrhea

What organism has an elongated body that is tapered at both ends, is covered in a cuticle, and has separate sexes in all species? Nematodes
Nematode eggs and larvae live where? In the environment
Nematode larvae and adults live where? In humans
What is the common name for Enterobius vermicularis? Pinworm
What is the route of transmission for Enterobiasis/pinworm? Human-to-human or environmental
In what patient population is Enterobiasis/pinworm most commonly a problem? Pediatrics
What is the most significant clinical feature of Enterobiasis/pinworm infection? Perianal pruritis
What diagnosis technique and collection technique is used to diagnose Enterobiasis/pinworm? Eggs detected on perianal skin; Cellophane/Scotch tape can be used to collect worms
Which two nematode species are transmitted via soil ingestion? Ascaris lumbricoides (Ascariasis), and Trichuris trichiura (Trichuriasis)
Which soil-transmitted nematode has the following life cycle: ingested eggs- larva hatch in small intestine- carried to liver- larva migrate to heart- then to alveolar sacs of lungs- then up trachea- swallowed- adults develop in sm. intes- penetrate/block Ascaris lumbricoides/Large intestine roundworm
Which soil-transmitted nematode has the following life cycle: ingested eggs- larva hatch in small intestine- migrate to colon- adults mature in colon- cause prolapsed colon? Trichuris trichiura/Whipworm
What is the common name for Ascaris lumbricoides? Large intestine roundworm
What is the common name for Trichuris trichiura? Whipworm: adults look like a whip
Which soil-transmitted organism can cause Loeffler's syndrome? Ascaris lumbricoides/Large intestine roundworm
Which soil-transmitted organism may have colon-related symptoms of pain, diarrhea, irritation, or rectal prolapse covered with worms? Trichuris trichiura/Whipworm
What nematodes penetrate the skin? Hookworms and Strongyloides stercoralis
What clinical signs are seen with hookworms? Continual blood loss. Others depend on host nutrition
What clinical signs are seen with Strongyloidiasis? Malabsorption, hyperinfection if immunocompromised
What diagnostic strategies are used to diagnose hookworm or Strongyloides infection? Detect hookworm eggs or Strongyloides larvae in the feces
What is the first intermediate host of Trematodes? Snails
Which nematode has a flattened, leaf-like body, is hermaphroditic, and has oral and ventral suckers? Trematode
What is the common name for Clonorchis sinensis? Chinese liver fluke
How is Clonorchis, the Chinese liver fluke, commonly transmitted? From raw, smoked, pickled, salt-cured, and dried fish
Where in the human body does Clonorchis, the Chinese liver fluke live? Biliary ducts
Which 3 types of worms migrate up the trachea, and are swallowed to infest the small intestine? Ascaria lumbricoides (Large intestinal roundworm), hookworms, and Strongyloides stercoralis
What cancer is commonly associated with chronic Clonorchiasis (Chinese liver fluke) infection? Cholangiocarcinoma
What diagnostic strategies are used for Clonorchiasis (Chinese liver fluke)? Liver disease, geographic history, eggs in feces
Which tapeworm is commonly found in pork? Taenia solium
Which tapeworm is commonly found in beef? Taenia saginata
What clinical characteristics may be seen with Taenia (tapeworm) infections? Cysticercosis: blindness, seizures
What diagnostic strategies are used for Taenia (tapeworm) infections? Proglottids/eggs in feces
What is the common name for Diphyllobothrium latum? Fish tapeworm
Which tapeworm is considered a zoonosis? Diphyllobothrium latum (Fish tapeworm... occurs in many fish-eating mammals worldwide)
Which tapeworm has an avidity for Vitamin B12, but does not often cause megaloblastic anemia? Diphyllobothrium latum (Fish tapeworm)
Which diagnostic strategies are used for Diphyllobothrium latum (fish tapeworm)? Possible megaloblastic anemia with dietary history, and eggs in feces
Nasal discharge/obstruction, sneezing, cough malaise, throat discomfort for 2-4 days, and no fever likely indicate what condition? The cold (Acute Respiratory Disease)
A patient is diagnosed with the cold (Acute Respiratory Disease). What information is important to tell the patient about their treatment? Infection is usually benign and self-limited. Treatment will be symptomatic
Which intranasal treatment has been advised against for use in treating the cold/ARD? Zicam/ intranasal zinc remedies ("Cold-Eeze")
What 3 infectious agents are common causes of the cold/ARD? Adenovirus (+unknown viruses = 30=40%), Rhinovirus (25%), Coronavirus (10%)
What season are Rhinoviruses most common? Winter
What is the major vector for transmission of Rhinoviruses? Hands: person-to-person contact
What is the best technique for controlling spread of Rhinovirus? Hand washing and disinfecting objects
What new medication is effective in halting Rhinovirus infection, but has not been approved for mass use yet? Picovir (Pleconaril)
What is the defining feature to differentiate Influenza serotypes A, B, and C? Nucleocapsid proteins
Which Influenza serotype is the worst? Type A
Which Influenza serotype is a cause of epidemics and its seriousness should not be over-looked? Type B
What membrane component of Influenza viruses allow for attachment to a host cell? H hemagglutinin
What membrane component of Influenza viruses allow for viral penetration and release from infected cells? N neuraminidase
A patient presents with an abrupt onset (after a 1-2 day incubation period) of fever, aches, chills, and a cough that will persist for about 1 week . What might be the cause for this? Influenza infection
What is the biggest worry with Influenza infection? Complications... RELAPSE.
What are 4 worrisome complications associated with Influenza infection? Primary influenza viral pneumonia; Secondary bacterial pneumonia by Strep. pneumoniae, Staph. aureus, or Haemophilus influenza type B; Reyes Syndrome, Guillain Barre Syndrome (demyelination)
What 3 diagnostic techniques are used for Influenza? Clinical findings if in an epidemic situation, otherwise: viral isolation from throat nasopharyngeal swab, or rapid test kit for influenza virus antigens (False negatives occur especially early in course when antigen levels may be low)
What 2 medications are available to stop Type A influenza virus only as prophylaxis in immuno-deficient/compromised patients? Amantadine and Rimantadine
What 2 medications are available to stop Type A and B influenza viruses? Oseltamivir and Zanamivir
What mechanism of viral proliferation do Amantadine and Rimantadine, Type A influenza viral targets, inhibit? Viral uncoating and penetration
What mechanism of viral proliferation do Oseltamivir and Zanamivir, Type A and B influenza viral targets, inhibit? Spreading/Release of virus
What is the seasonal influenza virus usually formulated with? 2 most prevalent Type A viruses, and the most prevalent Type B virus
When are Influenza vaccines typically administered? Fall/October, before the typical flu season begins
What 7 population groups are targeted for Influenza vaccines? CARE GIVERS. 65+. Nursing home residents/chronic care housing facilities. Adults/Children with chronic lung/Cardiovascular disorders. Kids with asthma. Adults/Kids with debilitating chronic diseases/immunosuppression. Peds on aspirin (Reyes risk)
What are the two causes for influenza antigenic variation? Antigenic drift and antigenic shift
What is the difference between antigenic drift and antigenic shift in influenza viruses? Antigenic drift describes a point mutation in influenza H or N proteins, producing only minor variation. Antigenic shift involves recombination, which shift the entire genome of H or N genes.
Which influenza antigenic variation type are the most severe, and allow for pandemics to occur? Antigenic shifts: H or N genes undergo recombination
What season is Influenza most common in? Winter
What form of Chlamydiae is the infectious, non-growing form responsible for dispersal? Elementary Body (EB)
What form of Chlamydiae is the growing/vegetative form? Reticulate Body (RB)
What is the most causative organism of infant pneumonia? Chlamydiae trachomatis, from infected mother
What is the causative organism of bronchitis, pneumonia, and sinusitis that is also associated with atherosclerosis? Chlamydiae pneumoniae
Which Giardia lamblia stage is the feeding/vegetative state, tear-drop shaped, is dorsoventrally flattened, has 2 nuclei, and acts as an adhesive disc? Trophozoite
Which Giardia lamblia stage is environmentally resistant, infectious, oval-shaped, has a hyaline appearance due to a chitin cyst wall, and has 2-4 nuclei? Cyst
Which Giardia lamblia stage is ingested? Cyst
Where in the human body does the Giardia lamblia trophozoite reside? Duodenum to feed on epithelial mucous secretions
How many trophozoites does 1 Giardia lamblia cyst produce?" 2
An 8 year old child presents with intermittent, watery, non-bloody diarrhea and abdominal cramps that have persisted for several weeks. Abdomen is slightly distended. What is the likely diagnosis? Giardia lamblia
How many cysts must be ingested for Giardia lamblia infection to occur? 100
If children infected with Giardia lamblia don't present with diarrhea/flatulence/intestinal pain/steatorrhea (fatty stool) = asymptomatic, what is another concern? Malabsorption/Vitamin B12 deficiency
Which human immunity cell type/antibody is giardiacidal? IgA **Human milk
How is Giardia lamblia most likely transmitted? Waterborne transmission, fecal contamination, beaver fecal contamination
In what age group is Giardia lamblia most prevalent? Children
What is the definitive diagnostic technique for Giardia lamblia? GSA (Giardia-specific antigen). Also, multiple stool samples, but that is slow and unreliable since presence of trophs/cysts in stool is dependent upon intermittent viral shedding.
What are 3 potential treatments for Giardia lamblia? Tinidazole, Albendazole (DOC, few S/E in kids), Metronidazole (DOC)
Which stage of Entamoeba histolytica has 1 nucleus and a central endosome? Troph
Which stage of Entamoeba histolytica is round/oval in shape, has 4 nuclei, and a blunt chromatoidal bar? Cyst
Which life cycle stage is the infective stage of Entamoeba histolytica? Cyst
Where does the Entamoeba histolytica troph reside in humans? Colon, caecum, or extraintestinal/liver.
A stool sample from a patient with diarrhea shows a cell with RBCs inside. What is the most likely causative organism? Entamoeba histolytica
A patient is hospitalized for RUQ pain, a low-grade fever that has persisted for 6 months, and bouts of bloody diarrhea. What is the most likely diagnosis? Entamoeba histolytica
Why does Entamoeba histolytica require serious medical attention? It can cause death due to peritonitis (gut perforation), cardiac failure, and exhastion, intestinal ulcers, and liver abscesses
What is the route of transmission of Entamoeba histolytica? Fecal contamination, water and foodborne, flies
What diagnostic techniques are used for diagnosing Entamoeba histolytica? Positive ELISA test, amoeba in stool with 4 nuclei, acid-fast positive, CT scan might reveal a 3 cm cyst-like structure/possible liver abscess
What is the treatment for Entamoeba histolytica? Albendazole + iodoquinol or Metronidazole + iodoquinol
What non-invasive parasite looks similar to Entamoeba histolytica? Entamoeba dispar
Which 2 causative organisms present diarrhea, fever, malaise, and is self-limiting, but serious in immunocompromised individuals? Cryptosporidium parvum and C. hominis
What is the DOC for Cryptosporidium infection? Nitazoxanide
What is the route of transmission of Cryptosporidium? Person-to-person/fecal, contaminated water
What causative organism would cause diarrhea, cramps, low-grade fever, and are seen as large, acid-fast, autofluorescing, oocysts? Cyclospora cayetanensis
What are 5 potential causative organisms of otitis/sinusitis? Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae
What is the common causative organism of Streptococcus pharyngitis? Streptococcus pyogenes
What is the causative organism of Diptheria? Corynebacterium diphtheriae
What is the causative organism of whooping cough? Bordetella pertussis
What are 4 predisposing factors of otitis externa? Moisture (swimmer's ear), insertion of foreign objects, trauma, and chronic skin diseases
What are to 2 most common causative organisms of otitis externa? Pseudomonas aeruginosa and Staphylococcus aureus
A patient presents with otalgia and otorrhea. Upon culture, the bacteria is a gram-negative bacilli that produces non-fluorescent blue pigment (Polycyanin), and fluorescent green pigment (Polyverdin). What is the likely causative organism? Pseudomonas auruginosa...Otitis externa. **Wood's lamp = fluorescence glows
A patient presents with otalgia and otorrhea. Upon culture, the bacteria is a gram positive cocci in clusters, is coagulase positive, and Beta hemolytic. What is the likely causative organism? Staphylococcus aureus...Otitis externa
When would you given oral antibiotics rather than topical for otitis externa? If fever is present
What are the 3 most common causative organisms, in order, of otitis media and sinusitis? Strep. pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
A patient presents with fluid/pus behind the tympanic membrane or sinus inflammation. A culture reveals a gram-positive, lancet-shaped diplococci, encapsulated, and is alpha-hemolytic. What is the causative organism? Streptococcus pneumoniae
A patient presents with fluid/pus behind the tympanic membrane or sinus inflamation. A culture reveals a gram-negative coccobacilli. What is the causative organism? Haemophilus influenzae
A patient presents with fluid/pus behind the tympanic membrane or sinus inflamation. A culture reveals a gram-negative diplococci that is oxidase positive. What is the causative organism? Moraxella catarrhalis
A patient presens with fever, sore throat, difficulty swallowing, patchy gray-white tonsilar exudates, enlarged cervical lymph nodes. Culture reveals a G- streptococci that is Beta hemolytic and catalase negative. What is the causative organism? Streptococcus pyogenes... Streptococcal pharyngitis
What are the 4 virulence factors of Streptococcus pyogenes? Capsule, M protein, Lipotechoic acid, and extracellular toxins/enzymes
What 2 post-infectious sequelae associated with Streptococcus pharyngitis? Rheumatic fever (self-limiting arthritis and heart valve damage), acute glomerulonephritis
During what season is strep throat most prevalent? Winter-spring
A patient has sudden malaise, low-grade fever, exudative pharyngitis, lymphadenitis, a thick gray-black pseudomembrane, a non-healing ulcer & possibly bull neck. Culture shows G+ pleomorphic bacilli, club-shaped/Chinese letters. What is the organism? Corynebacterium diphtheriae
A culture has Gram positive pleomorphic bacilli that are club-shaped and have metachromatic granules. What is the likely organism? Corynebacterium diphtheriae
What 3 culture mediums are used to diagnose Corynebacterium diphtheriae? Blood agar (to rule out hemolytic streptococcus), Loeffler's medium, and cysteine-tellurite (diphtheria grows as black colonies)
What is the treatment for diphtheria? Obtain diphtheria antitoxin from CDC to neutralize exotoxin; treat with antibiotics: penicillin or erythromycin
What are the 6 Pertussis virulence factors? Adhesins: filamentous hemagglutin (attached to epithelial cells), agglutinogens (attach to host cells). Exotoxins: Pertussis, adenyate cyclase, dermonecrotic, and tracheal
Which stage of pertussis has inflammation of mucous membranes and presents with nasal congestion, a runny nose, sore throat, low-grade/no fever, and a non-productive cough for 1-2 weeks? Catarrhal stage
During which stage of pertussis are patients highly contagious? Catarrhal stage
Which stage of pertussis has coughing attacks/spasms... a paroxysmal cough with a whooping sound, lasting 1-2 minutes up to 50x/day, often followed by vomiting? Paroxysmal stage
What is the theory behind the whoop sound in the paroxysmal stage of pertussis? Epithelial cells are extruded = prevents mucous clearance = excess mucous causes airway restriction
Which stage of pertussis has a decreased number and severity of paroxysmal coughs over 3-4 weeks? Convalescent stage/recovery
What are 11 complications associated with the paroxysmal/whooping cough stage of pertussis? Dehydration, weight loss, insomnia, subconjunctival hemorrhage, petechiae, hernias, rectal prolapse, urinary incontinence, rib fx, pneumothorax, and subdural hematoma
What are 4 secondary complications possible during the convalescent/recovery stage of pertussis? Pneumonia, encephalopathy, seizures, and death
What definitive diagnostic techniques are used for pertussis? Culture on Bordet-Gengou medium, PCR
A 6-18 month old patient presents with a fever, hoarseness, a barking cough, rhinitis, sore throat, and SOB. What is a likely diagnosis? Croup by Parainfluenza virus
Which agent is a paramyxovirus with 4 known serotypes, enveloped, nonsegmented, ssRNA? Parainfluenza virus
What is the physiological explanation behind the barking cough heard with croup? The inflammatory response to infection causes tracheal constriction (STEEPLE SIGN) below the vocal cords
What is the MOST COMMON cause of croup? Infection by Type 1 parainfluenza virus
What season has the highest cases of croup? Fall-Winter
What are 2 complications seen with croup? Otitis media, Parotitis
What 2 diagnostic techniques are used for croup? Direct FAB test, and viral isolation from throat swab
What is the treatment for croup? Supportive
A patient presents with a cough, dyspnea, cyanosis, and sometimes croup. What is the likely causative organism? Respiratory Syncytical Virus
What diagnostic tecnhiques are available for Respiratory Syncytical Virus? Rapid antigen tests, immunofluorescence assay
What treatment is available for high-risk Respiratory Syncytical Virus? Monoclonal immune globin (Palivizumab)
What is the most common causative agent of lower respiratory tract infections in children younger than 4? Respiratory Syncytical Virus
When is the worst time of year to be born in reference to Respiraory Syncytical Virus? 3-4 months prior to RSV season (winter)
A patient presents with sudden onset of a high fever (>103*F), shaking chills, a productive cough with green-yellow-brown sputum, pleurisy, chest pain, SOB, and consolidation on CXR with well-defined densities. What might the diagnosis be? Typical Bacterial Pneumonia
A patient presents with a gradual onset of a low fever (<103*F), non-productive/paroxysmal cough, HA, body aches, joint pain, abdominal pain, and patchy infiltrates on CXR. What might the diagnosis be? Atypical Bacterial Pneumonia
What 3 organisms are prevalent in causing pneumonia in patients with no known predisposing factors? Mycoplasma, Streptococcus, Chlamydophilia
What 2 organisms are prevalent in causing pneumonia in alcoholic patients? Streptococcus, Klebsiella
What 4 organisms are prevalent in causing pneumonia in patients with underlying disease? Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, and Staphylococcus aureus
What 2 organisms are prevalent in causing pneumonia in patients requiring ventilation? Klebsiella pneumonia or Pseudomonas aeruginosa
What organism is prevalent in causing pneumonia in patients with travel/job exposure? Legionella pneumophilia
What are the microbiological lab test results for Strep. pneumoniae? G+ lancet-shaped diplococcus, encapsulated if virulent, and alpha hemolysis
What is the most common causative organism of community acquired pneumonia? Strep. pneumoniae
What is the common entry mechanism of S. pneumoniae into the respiratory tract? Aspiration
What are the microbiological lab test results for H. influenzae? G- short bacillus with Lipo-Oligosaccharide and fimbriae
Which strain of H. influenzae is responsible for pneumonia? Nonencapsulated/ nontypable
What part of the respiratory tract, specifically, does H. influenzae reside as normal flora? Mucous membranes
What 4 conditions in patients are at high risk for H. influenzae infection? Debilitated hosts: asthmatics, COPD, smokers, or immunocompromised
What diagnostic techniques are used for H. influenzae? CXR (patchy infiltrates), signs/symptoms, and Gram stain results
Which pnemonia-causing bacteria is the smallest of the free-living bacteria, is pleiomorphic in shape, lacks a cell wall, contains sterols in the membrane and has a "fried egg" appearance? Mycoplasma pneumoniae
Which organism is the most common cause for atypical pneumonia? M. pneumoniae
What is released by M. pneumoniae to cause epithelial damage and ciliostasis? H2O2 and O2 radicals
What 2 diagnostic techniques are helpful for M. pneumoniae? CXR (interstitial, patchy infiltrates),Serology
What is the DOC for M. pneumoniae? Azithromycin
Which pneumonia-causing bacteria are very tiny, non-motile, coccoid-shaped, G-, obligate intracellular parasites that are found within intracytoplasmic inclusions? Chlamydophilia pneumoniae
Which pneumonia-causing bacteria replicate by entering the cell as an elementary body, reorganizing into a reticulate body, multiplying by binary fission, condense back into elementary bodies, & cause cell lysis to release themselves into the environment? Chlamydophilia pneumoniae
What diagnostic technique is used for Chlamydophilia pneumoniae? Serology
What is the DOC for Chlamydophilia pneumoniae? Doxycycline
A thin, pleomorphic, G- bacillus with fimbriae, a single, polar flagellum that produces Beta-lactamase, and is catalase and oxidase positive is likely which organism? Legionella pneumophilia
What is the mechanism of inoculation in humans by Legionella pneumophilia? Associated with water; Inhale aerosols: bacteria then survive intracellularly
What 2 conditions is Legionella pneumophilia known to cause? Pontiac fever and Legionnaires' Disease
A patient with fever, chills, malaise, myalgia, headache, and no sign of pneumonia has been confirmed to be infected with Legionella pneumophilia. What is the diagnosis/disease? Pontiac fever = self-limiting
A patient with abrupt onset of fever, chills, a dry/non-productive cough, HA, and GI/neurological symptoms is confirmed to be infected with Legionella pneumophilia. What is the diagnosis? Legionnaires' Disease
Where does Legionella pneumophilia survive out in nature? In protozoans
What is the gold standard for Legionella pneumophilia diagnosis? Culture
What is the DOC for Legionella pneumophilia treatment? Levofloxacin
Which gram negative encapsulated bacillus causes an aggressive necrotizing, community-acquired, lobar (commonly upper lobe pneumonia), inoculated by aspiration? Klebsiella pneumoniae
A patient presents with acute high fever, chills, flu-like symptoms, a productive cough with thick, blood-tinged "currant jelly" sputum, and pleuritic chest pain. What is a likely causative organism? Klebsiella pneumoniae
What 3 patient populations are at risk for Klebsiella pneumoniae infection? Alcoholics, COPD patients, Diabetics
What is the DOC for Klebsiella pneumoniae? Aminoglycosides/ Cephalosporins
A G-, oxidase-positive, aerobic bacilli that has pili, a mucoid capsule, secretes A-B exotoxin, secreted pyocyanin and pyoverdin, and has a fruity odor is isolated from a patient with pneumonia symptoms. What is the organism? Pseudomonas aeruginosa
Toxicity from LPS and Endotoxin A, progressive cyanosis, and empyema formation are commonly associated with what pneumonia-causing organism? Pseudomonas aeruginosa
Which pneumonia-causing organism is considered normal flora in hospitals? Pseudomonas aeruginosa
What is the diagnostic technique for Pseudomonas aeruginosa? C&S (many strains are drug-resistant)
A G+, grape-like clustered, Catalse positive, Coagulase positive, Beta lactamase producing organism is isolated from a pneumonia patient. What is the organism? Staph aureus
Which pneumonia-causing organism often colonizes after a viral respiratory infection, and can result in abscess formation? Staph aureus
What people are the reservoir for Staph aureus? Nasal carriers
How does Staph aureus respiratory transmission occur? Aspiration, hematogenous spread
What diagnostic techniques are used to confirm Staph aureus as the causative organism of a pneumonia infection? CXR (abscesses, pneumatoceles, consolidation), C&S (often multi-drug resistant)
What 3 organisms cause tuberculous mycobacterial infections? Mycobacterium tuberculosis, Mycobacterium bovis, and Mycobacterium africanum
What 3 organisms cause non-tuberculous mycobacterial infections? Mycobacterium avium, Mycobacterium intracellulare, and Mycobacterium kansasii
What are the 4 reasons why TB is so difficult to eradicate? Patient compliance with long term therapy, antibiotic resistance, co-infection with HIV, and difficulty identifying the organism
What is the O2 requirements of Mycobacterium tuberculosis? Obligate aerobe
Describe the process and results of Acid-staining mycobacterium tuberculosis. Ziehl-Neelsen/Kinyoun stains are used, causing the acid-fast Mycobacterium tuberculosis to turn red. Auramine/Rhabdamine fluorescent stain can also be used
Which organisms are obligate aerobes, acid-fast, bacilli/rod-shaped, non-motile, and are heat sensitive/killed by pasteurization? Mycobacterium tuberculosis
Which 2 media are specific for Mycobacterium tuberculosis, and what will the colonies look like? Middlebrooks and Lowenstein-Jensen: colonies are "Ruff, Buff, and Tuff"
What virulence factor from Mycobacterium tuberculosis inhibits cytokine release (neutrophil migration and damages host cell mitochondria? Cord factor
Which virulence factor of Mycobacterium tuberculosis inhibits phagolysome formation, promoting intracellular growth? Sulfatides
Which virulence factor of Mycobacterium tuberculosis suppresses T-Cell activity and INF-gamma production? LAM
What is the bacterial actions during Primary tuberculosis infection, and what are the clinical signs/symptoms? M. tuberculosis enter macrophages of alveoli and multiply/lyse macrophages or are carried to lymph nodes = resembles bacterial pneumonia with acute inflammatory reaction and exudative lesions
Describe the process behind caseous necrosis/tissue destruction with the immune system's attack on Mycobacterium tuberculosis primary infection? Macrophages present MTB antigens to T-Cells = T-Cells become sensitized = multiply, go to infection, attract/activate macrophages. Macrophages produce lytic enzymes (POI and RNI)
What Mycobacterium tuberculosis antigens do macrophages present to T-Cells for sensitization? ESAT-6 and CFP-10
What lytic enzymes are produced when macrophages destroy MTB during primary infection? ROI (Reactive oxygen intermediates) and RNI (Reactive Nitrogen Intermediates)
What causes the production of lesions in MTB primary infection? Granulomas/Tubercles (Macrophages + multinucleated giant cells + fibroblasts + collagen fibers) with caseous necrosis coalesce
Describe the initiation of latent TB in the primary infection stage. Low-activity MTB cells within granulomas cause low oxygen levels and low pH within. Immune system is content with MTB containment and low activity = ONLY WHEN CELL MEDIATED IMMUNITY (sensitized T-cells/active macrophages) IS EFFECTIVE
What is the result of ineffective cell-mediated immunity in primary MTC infection? MTB proliferation continues, lung tissue is destroyed, Miliary tuberculosis: loss of organ/tissue function *Pott's Disease (destruction of vertebral bodies)
When is a Tuberculin skin test (*PPD, TST, or Mantoux test) able to give a positive reading? 2-6 weeks after infection
When is IFN-gamma detection blood tests (QuantiFERON, T-SPOT) able to give a positive reading for MTB? 2-6 weeks after infection
Which Mycobacterium species are weakly G+, strongly acid-fast, and ubiquitous (Live in water, ocean, soil, plants, etc.)? M. avium and M. intracellulare
What is the leading cause of non-tuberculosis mycobacterium infections? AIDS
What is the second leading cause of non-tuberculosis mycobacterium infection? M. kansasii from tap water
Lady Windermere's Syndrome is associated with what condition? Pulmonary MAC (nontuberculosis mycobacterium)
In what class of mycobacterium infections are the infections always new/never reactivated latent infection? Non-tuberculosis mycobacterium/ MAC infections
What symptom is commonly seen with non-tuberculosis mycobacterium, but not with TB? Diarrhea. Other symptoms: fever, weight loss, night sweats
When is non-tuberculosis mycobacterium MAC called disseminated MAC (DMAC)? When granulomas are not effective at containing the infection (esp. with HIV pts), and infection can occur in any tissue/organ = enlargement followed by dysfunction
What is the difference in treatment for non-tuberculosis mycobacterium-infected HIV patients with MAC infection and without MAC infection? With MAC: Clarithromycin/ Azithromycin + Ethambutol + Rifabutin. Without MAC: Clarithromycin/ Azithromycin
In addition to drug therapy, what else might be useful in the treatment of non-tuberculosis mycobacterium? Surgical excision of lymph nodes/ lobes of lungs
What 3 symptoms may help to differentiate inflammatory diarrhea from non-inflammatory diarrhea? Fever, tenesmus, blood
What organism is commonly associated with Hemolytic Uremic Syndrome? E. coli O157:H7 **Shiga-toxin-producing
What are the classic symptoms associated with Shiga-toxin producing E. coli O157:H7? No fever, bloody stool, abdomen tenderness
When should diarrhea testing be performed? With moderate-severe diarrhea/illness, or if inflammatory diarrhea is suspected
What is the priority in acute diarrhea management? Rehydration
What symptomatic treatment options are available for diarrhea? Loperamide/Imodium (inhibits peristalsis and secretions **not for inflammatory diarrhea), Bismuth subsalicylate (Pepto-Bismol)
What is the empiric DOC antibiotic for diarrhea and under what conditions is it indicated? Ciprofloxin when pt is at risk for complications or inflammatory diarrhea without suspicion of enterohemorrhagic E.coli or C. diff infection
Which diarrhea-causing pathogen is commonly associated with hospitalization and antibiotic use? C. diff
What are the 3 most common pathogens for typical pneumonia? Strep. pneumo, H. influenza, M. cattathalis
What are the 4 pathogens that commonly cause atypical pneumonia? Mycoplasm pneumoniae, Chlamydophilia spp., Bordatella pertussis, Legionella
What is the first line antibiotic choice for community-acquired pneumonia in an otherwise healthy patient? Macrolides: Azithromycin, Clarithromycin. Or Tetracyclines: Doxycycline
Which antibiotics are typically used in pneumonia patients with comorbidities such as COPD, drug use, alcoholics? Respiratory fluoroquinolone: Levofloxacin, Moxifloxacin
When should a patient with pneumonia be hospitalized? If they have more than one of the CURB criteria: Confusion, BUN> 19 mg/dL, Respirations >30/min, BP <90/60, Age 65+
What is the empiric therapy for hospital-acquired pneumonia? Varies according to the institution and it's specific pathogens
Created by: mccullough87