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ID Labs 1

Infectious Disease

FTA-ABS, MTA-TP: to dx: Syphilis
catalase pos GNR, facultative intracellular parasite Legionella
Motile, oxidase-pos GNR +/- polysaccharide slime prodn, blue-green pus: Pseudomonas
Nonmotile facultative anaerobe GNR, contains endotoxic lipopolysaccharide, does not produce H2S: Shigella
large GNR, produces mucoid capsule on agar Klebsiella
Legionella will only grow on: charcoal yeast extract agar w/iron & cysteine
Mildly GN, fried egg colonial morphology on special media: Mycoplasma pneumoniae
Giant Multinucleated cells Herpes virus (Genital)
Tzank Smear Herpes virus (Genital)
Gram negative intracellular diplococci = Gonorrhea
bacterial meningitis: CSF turbid to purulent; high pressure; high WBC w/segs; pro: 100-500; low glucose
viral meningitis: CSF normal pressure; WBC <1000 (lymph/mono); pro & glu normal
granulomatous meningitis: CSF high pro, low glu, lymphocytosis
granulomatous meningitis: dx studies Cx to dx but takes weeks; CT/MRI: enhancement of meninges, poss hydrocephalus
brain abscess: dx studies CT/MRI, then LP (CSF usu polymicrobial)
Lymphocyte pleomorphism; heterophile Ab: EBV
Gram-positive encapsulated box-shaped rods in chains (box cars) = B. anthracis
Gram-neg pleomorphic bacillus = B. pertussis
CMV labs lymphocytosis or leukopenia; intracytoplasmic inclusions (owl eyes) on tissue bx
Orbital cellulitis sinus xray & CT (soft tissue infiltration)
Chronic sinusitis MRI > CT for malig; CT > Waters view xray for sinus opacification
HIV labs +ELISA & Western blot; anemia, leukopenia, low pltateles, polyclonal hypergammaglobulinemia, high chol
What are the 4 methods for diagnosis of HIV Detect antibodies to the virus, detect viral p24 antigen, detect viral nucleic acid, culture HIV virus
What is the most widely used method to diagnose HIV Detection of antibody to HIV
Most common cause of false positive tests for HIV in low risk pts Recent immunization
Initial screening for HIV = EIA enzyme immunoassay (ELISA)
What is the confirmatory test for HIV (done after the screening test) Western blot or IFA (Immunofluorescence Assay)
HIV requirement: Patient must be informed of HIV testing; informed consent/ counseling no longer required nationally
HIV Detuned testing both sensitive & low-sensitivity tests; if only 1 is pos = recent infxn
HIV p24 test free antigen or bound antigen/Ab complexes; detectable 2-6 weeks post infection
HIV p24 to dx: viral Rx, neonatal infxn, detect HIV before seroconversion, dz progression
HIV viral load reflects Rx response better than CD4; detects transplacental transmission
95% of HIV-infected patients test positive within: 6 weeks of infection
Counts predictive of risk fo opportunistic infection or malignancy in absence of HIV tx CD4 <200 and CD4 lymph <14%
Best test for dx of HIV before seroconversion and to monitor disease progression & response to tx HIV viral load
HIV-positive patients may also test positive for: PPD, RPR, VDRL, CMV, toxyplasma IgG, hepatitis, Pap
gold standard for imaging for acute sinusitis CT
EBV labs Granulocytosis in first week, then lymphocytosis & many ATLs. +/- high AST/ALT & bili. Heterophile Ab pos within 4 weeks of onset. IgM rises & falls, IgG pos for life.
Mumps labs Serum IgM is diagnostic (may be delayed in immunized pt). May see high amylase, mild ARF.
Rabies labs DFA stain of bx / necropsy tissue (back of neck is 60-80% sensitive). RT-PCR or viral isolation from CSF/saliva also definitive
SARS on CT Ground glass opacities +/- focal consolidations
SARS dx testing RT-PCR for SARS-CoV in urine, stool (most likely pos), nasal secretions often neg early and variably positive by day 14. Serologies may be neg x3 weeks
West Nile virus labs IgM capture ELISA on serum/CSF. Acute & convalescent IgM titers may confirm acute infxn. PCR for blood donor screening. There is no vax.
Anthrax diagnosis Cx of skin lesion, blood, pleural fluid, CSF with box cars on microscopy. Widened mediastinum on CXR
Campylobacter labs Dark-field or phase contrast microscopy: GN, S-shaped or seagull-shaped bacteria
Sigmoidoscopy shows punctate areas of ulceration and inflamed mucosa in infection with: Shigella
Created by: Abarnard
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