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Infectious Disease 2

UWORLD + FA Infectious Disease/Micro Review

QuestionAnswer
Syphilis histopathology description Proliferative ENDARTERITIS with a surrounding PLASMA CELL infiltrate.
Most clinical manifestation of syphilis are due to: Localized tissue ischemia resulting from ENDARTERITIS
What is the clinical manifestation of Syphilis in the Primary Phase? Painless genital ulcer (chancre)
What are some Secondary syphilis manifestations? - Diffuse rash (palms and soles) - Lymphadenopathy (epitrochlear) - Condylomata lata - Oral lesions, hepatitis
What is Condylomata lata? Painless, wart-like, elevated plaques, on moist areas such as scrotum and perineum, seen in Secondary Syphilis.
What are the clinical manifestations of Tertiary Syphilis? - CNS (tabes dorsalis, dementia), - Cardiovascular (aortic aneurysms, aortic insufficiency), - Cutaneous (gummas)
Papillomatous epidermal hyperplasia with cytoplasmic vacuolization. HPV warts histological description
What serotypes of HPV cause warts? HPV 6 & 11
Septal PANNICULITIS with multinucleated giant cells Erythema Nodosum
Description of Kaposi sarcoma (histo): Dysplastic spindle-shaped cells surrounding areas of angioproliferative.
What is acantholysis? Detached keratinocytes
Acantholysis with superficial dermal infiltrate is seen in? Pemphigus vulgaris
What does a prolonged (over 3-6 months) HBeAg marker indicate? Chronic HBV infection
What marker indicates a decrement in HBV infection infectivity? The elevated levels of Anti-HBeAg levels.
The vanishing or disappearance of _____________________ indicates a low infectivity statues. HBeAg
What HBV marker is indicative of high infectivity status? HBeAg
If infection does not progress into chronic disease, which HBV infection marker is the one to disappear first? How long? HBsAg should vanish in 3-6 months
What is the asymptomatic incubation period of HBsAg? 6-8 weeks
When does Anti-HBcAg appears? Shortly before symptoms appearance
Person vaccinated against HBV is positive for __________________, only. Anti-HBs antibody
What are the two most common SE of Isoniazid therapy in latent TB infections? 1. Neurological deficits ( prevented with Pyridoxine) 2. Hepatotoxic: 2a --> Mild hepatic dysfunction ( elevated AST/SGOT, ALT/SGPT) 2b --> Frank hepatitis --> fever, anorexia, and possible hepatic failure.
What are the Week 1 clinical manifestations of Typhoid Fever? Rising (progressively) fever, Bacteremia, and Relative-bradycardia (pulse-temperature dissociation)
Week 2 of Typhoid Fever is manifested by developing _____________________ and ___________________ on trunk and abdomen. Abdominal pain; ROSE SPOTS
What are the late (Week 3) clinical manifestations of Typhoid fever? Hepatosplenomegaly and Intestinal bleeding and perforation
What is organism that causes Typhoid Fever? Salmonella typhi or Paratyphi
What is the MC mode of transmission of Salmonella Typhi? Ingestion of contaminated food or water contaminated with feces
What are the key characteristics of Salmonella Typhi Fever? 1. Progressive fever with relative bradycardia 2. Rose spots on abdomen and trunk
ESBL stands for: Extended-Spectrum Beta lactamases
ESBL may be produced by ________________________ bacteria. Gram negative
ESBL-bacteria is often resistant to: Cephalosporins and other beta lactam antibiotics
How does ESBL-bacteria acquire resistance to beta-lactam antibiotics? Plasmid conjugation
What is the best treatment for ESBL-producing bacteria? Carbapenems
What are 2 common Echinocandins? Caspofungin and Micafungin
What is the mode of action for Caspofungin? Inhibit synthesis of polysaccharide glucan (B-glucan), which is essential component of fungal cell wall
What antifungals act on the cell wall? Echinocandins
Amphotericin B, Nystatin, and azoles act by disrupting the ___________________. Cell membrane
Flucytosine inhibits fungal _________________ and _____________, halting __________________ and ___________________, respectively. DNA & RNA; Replication & Protein synthesis
What are the functions of DNA pol I: 1. Remove RNA primers via 5' to 3' exonuclease activity 2. Replace RNA primers with DNA, via 5' to 3' polymerase activity
What function or characteristic is unique to DNA polymerase I? 5' to 3' exonuclease activity
What is the role or function of Primase? To create RNA primers
Who removes RNA primers? DNA pol I
What is the "proofreading" activity of DNA pol I and III? 3' to 5' exonuclease activity
Autoimmune inflammation of Exocrine glands (lacrimal, salivary, and vaginal) Sjogren syndrome
Immune-destruction of the lacrimal and salivary glands Sjogren syndrome
Sjogren patients are positive for what antibodies? anti-Ro (SSA) and anti-La (SSB)
Term used to describe severe dry mouth? Common pathology associated. Sjogren syndrome is characterized by XEROSTOMIA
What is a complication of the Xerostomia seen in Sjogren's syndrome? The decrease salivary flow leads to increased rate of dental caries and other oral infections (thrush).
What is the histopathological description of Sjogren syndrome tissue? Lymphocytic infiltrate, wth germinal centers
Keratoconjunctivitis sicca Sjogren syndrome
Sjogren syndrome is presents with __________________, ______________, and bilateral _________________ enlargement Keratoconjunctivitis sicca, Xerostomia; Parotid
Enteroviral infection may cause: Hand-Foot-and-Mouth Disease and Herpangina
What is a rare, but severe, complication of Coxsackievirus type A infection? Myocarditis
What is Herpangina? Seen in? Oral ulcerations seen in Enteroviral infection with Coxsackie A virus.
Oval-shaped vesicles on palms and soles A; vesicles and ulcers in oral mucosa Coxsackie A virus infection
What is a dinguiguehing difference between C. perfringens and C. Septicum? C. perfringens gas gangrene is caused by a previous trauma, whichle C. Septicum is not associated with traumatic lesion.
What is the main risk factor for C. septicum infection? Underlying COLONIC MALIGNANCY
Spore-forming, exotoxin-producing, gram + bacterium C. perfringens and C. septicum
What is the leading cause of foodborne gastroenteritis? Non-typhoidal salmonella
What are some common complications of Non-Typhoid salmonella infection? Osteomyelitis --> spread to long bones Mycotic aneurysm --> spread to vasculature Endocarditis --> spread to Heart
What kind of food is often associated with Salmonella contamination? Poultry (chicken) products
Invasion of enterocytes, lead to massive neutrophil-mediated inflammatory response in lamina propria/ Peyer's Patches --> control infection. Non-Typhoid Salmonella pathogenesis
Typhoidal Salmonella pathogenesis is described as: Invasion of enterocytes causes a BLUNTED neutrophil response due to CAPSULAR ANTIGEN Vi --> extensive intracellular replication in macrophages leading to the spread through lymphatics and RES.
What are the most important manifestations of Entameba Histolytica infection? 1. Colitis (diarrhea, bloody-stool with mucus) 2. Liver abscess (RUQ pain, fever)
What possible organism is indicated by Flask-shaped colonic ulcers during Colonoscopy? Entameba Histolytica
1. Microcephaly, craniofacial disproportion 2. Neurological abnormalities (Spasticity and seizures) 3. Ocular abnormalities Congenital ZIKA syndrome
What are common findings in neuroimaging of Zika-infected patient? Calcifications, VENTRICULOMEGALY, Cortical thinning
How are atypical (reactive) lymphocytes activated? Acticarted by cytotoxic T-cells and NK cells
What intracellular infections are manifested with Reactive lymphocytes? HIV, CMV, Toxoplasmosis, EBV-mononucleosis (MC)
What is contained in reactive lymphocytes? Cytotoxic granules, made of Perforin and granzymes
Required growth factors for H. influenzae culture X (hematin) and V (NAD+)
Co-culture of __________________ and __________________, produces the _______________________. H. influenzae and S. aureus; Satellite phenomenon.
The ____________ of S. aureus provides the ___________________ growth factors required by H. influenzae. B-hemolysis; X (hematin) and V (NAD+)
Prolonged use of tampons and/or wound packing, leads to development of _______________________________. Toxic Shock Syndrome
What organism is usually involved in Toxic Shock Syndrome? Staph aureus
The superantigen in Staph aureus infection TSST-1
______________ (superantigen) binds to ________ on __________ WITHOUT processing and ___________________ activate T-cells, leading to massive release of _________________________, leading to clinical symptoms of S. aureus TSS. TSST-1; MHC-II on APCs; NON-specifically; inflammatory cytokines (TNF-a, IL-6, INF-g, etc).
Activation of TLRs is often seen in gram_________________ bacteria, leading to rapid onset of __________________ and fever. Gram negative; Hypotension
Gentamicin is a common _____________________. Aminoglycoside
What is the MC mode of resistance to aminoglycosides? Antibiotic (aminoglycoside)-modifying enzymes
What is the role or function of antibiotic-modifying enzymes? Add chemical groups to antibiotics, leading to diminished ability to bind to the 16S ribosomal RNA within the 30S ribosomal subunit.
Acetyl, adenyl. and phosphate Antibiotic-modifying enzyme groups
Penicillins most common way of resistance is: Beta-lactamase, ESBL
Vancomycin MC resistance is due to: Mutated peptidoglycan cell wall (D-ala-D-lac)
Mutated DNA gyrase MC mode of fluoroquinolone resistance
Tetracyclines most commonly acquired resistance via: Impaired influx / Increased efflux
Decreased uptake or Increased efflux out of bacterial cells by plasmid-encoded transport pumps Mechanism of Tetracycline resistance
What kind of antibiotics' mechanism of resistance is produced by a mutated RNA polymerase? Rifamycins
Universal HBV vaccination would lead to -----> Decline in HCC cases
DHFR is: Dihydrofolate reductase
DHFR is inhibited by these drugs: 1. TMP (bacteria) 2. MTX (humans) 3. Pyrimethamine (Protozoa)
Inhibition of DHFR prevents the conversion of _______________ acid into _______________. Dihydrofolic acid into THF
The sulfonamides work a step ______________ the action of TMP, MTX and Pyrimethamine. before
TMP is paired with ____________ ( ___________-___________) creating a "______________________" SMX; (TMP-SMX); Sequential blockade
Pyrimethamine inhibits _________________ in ________________, thus making excellent for treatment of __________________ and ___________. Parasitic DHFR in protozoa; Malaria and Toxoplasmosis
CCR5 inhibitor Maraviroc
Enfuvirtide is a __________________________ used in HIV replication antiviral panel. Fusion inhibitor
What are some common Protease Inhibitor in the HIV antiviral drugs? Saquinavir, Ritonavir
What suffix is associated with HIV Protease inhibitors? --navir
Common NRTI and NNRTIs? Efavirenz, Tenofovir, lamudivine
Suffix seen in HIV Integrase inhibitors? --gravir
---__________________, suffix of _______________ inhibitors, and _--________, suffix in __________________ Inhibitors. --gravir --------> Integrase inhibitors --navir ---------> Protease inhibitors
Raltegravir is a : HIV integrase inhibitor
MoA of Raltegravir Disrupts HIV genome integration, preventing synthesis of viral mRNA.
What kind of HIV antiviral drugs prevent the synthesis of viral (HIV) mRNA? Integrase inhibitors
Adverse effect of all HIV Integrase inhibitors Increased level of Creatine Kinase (CK)
What medication is this HIV patient most likely taking, if blood serum shows elevated levels of creatine kinase? Raltegravir
Methylation of the aminoglycoside-binding portion of the ribosome Common way of Aminoglycoside mechanism of resistance
Non-sterile gloves, gowns, and private room Contact precautions
Contact precautions are needed in what infections? Methicillin-RESISTANT Staph aureus (MRSA), VRE, and other parasitic infections
What kind of meaures is required to prevent MSSA (nosocomial) transmission? Hand hygiene is sufficient
Patient with active TB requires ______________________ precautions. Isolation
Group A Streptococcus is ___________________________. Strep pyogenes
What kind of conditions are precipitated by a Strep pyogenes infection? 1. Strep Skin Infection (IMPETIGO) 2. Streptococcal pharyngitis
Streptococcal impetigo may lead to the development of ___________ and _____________. ARF (acute Rheumatic fever); PSGN
Streptococcal pharyngitis only develops ___________________. ARF (acute Rheumatic fever)
Methylation of 23S rRNA-binding site prevents binding of drug. Mechanism of Resistance in Macrolides
Bacterial transferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation. Mechanism of Resistance in Aminoglycosides
Chloramphenicol mode of resistance: Plasmid-encoded acetyltransferase inactivates the drug.
What enzyme is inhibited by Sulfonamides and Dapsone? Bacterial dihydropteroate synthase
Mutated or altered bacterial Dihydropteroate synthase. Mechanism of Resistance in Sulfonamides
Clinical presentation of Non-bullous impetigo PAINFULL, non-itchy pustules and honey-crusted lesions
What are the most common organisms that cause Non-bullous impetigo? Staph aureus and Strep pyogenes
HSV-6 infection is known as _____________________. Roseola
Fever for 3-5 days, and once subsided, apparition of erythematous, blanching, maculopapular truncal rash. Roseola (HSV-6 infection)
What is MCC of febrile seizures? HSV-6 infection
Pattern seen in roseola rash Neck and Trunk ------> Face and extremities
How is the rash spread pattern in Rubella and Measles? Cephalocaudal spread (Starts at forehead and goes down)
Unique spots in Rubella? Forchheimer spots in Soft Palate
Distinguishing and pathognomic spots in Measles? Koplik spots in buccal mucosa
What does a CENTRIPETAL rash pattern means? Rash starts EXTREMITIES and moves to the TRUNK
A CENTRIFUGAL rash spread is the one starting at the ____________ and extending to the __________________. Trunk -------> Extremities
What conditions/disorder display a centripetal rash? 1. Coxsackie A (Hand-Foot-Mouth Disease) 2. RMSF (Rocky Mountain Spotty Fever) (only rickessi) 3. Syphilis
Which bacterial family and species display a centrifugal rash pattern? Rickettsial (prowazekii, typhi, tsunamushi)
RMSF rash involves the ______________ and ____________. Rickettsial _______________ is the causative organism of RSMF. Wrist and ankles. Rickettsii
Mnemonic CARS is used for? Centripetal rash conditions (Coxsackie A, RMSF, and Secondary Syphilis). Involves wrist, soles, and palms. Remember you drive CARS with PALMS and SOLES
MC organisms that cause Atypical pneumonia? Mycoplasma and Chlamydia infectections
Mycoplasma has __________________, while Chlamydia has a _____________________. Mycoplasma ------No cell wall Chlamydia ---------> Modified cell wall
Effects of Mycoplasma lack of cell wall? 1. Not able to gram stain 2. Ineffective to the treatment with Beta-lactam antibiotics
What is the most proper treatment for Atypical Pneumonia? Macrolides and Tetracyclines (Protein synthesis inhibitors)
CXR with Bilateral PATCHY infiltrates Atypical Pneumonia
__________________ pneumonia has a CXR ________________ infiltrate finding. Legionella
What are the main two Atypical Pneumonia causative organism? What other is much less common? Main two are Mycoplasma and Chlamydia; Legionella is rarely seen causing atypical pneumonia.
CXR of fungal pneumonias Lobar, nodular, or cavitary infiltrates
Curved, gram negative, free-living bacterium that grows in marine environments Vibrio vulnificus
Mode of transmission of V. vulnificus? 1. Ingestion of raw seafood (oysters) 2. Wound contamination
What type of people is at increased risk of developing a serious complication by V. vulnificus infection? Liver disease patients or those with Iron overload
What are serious complications seen in V. vulnificus infection? Sepsis and NECROTIZING FASCIITIS
What is the treatment for Gardnerella (bacterial) vaginosis? Metronidazole or Clindamycin
____________________ vaginitis is treated with ___________________, and also the partner. Trichomonas; Metronidazole
What is the treatment (drug) used for Candida vaginitis? Fluconazole
Bacterial vaginosis (Gardnerella): White discharge + clue cells + "fishy odor" + ph >4.5
Green-yellow vaginal discharge + Malodorous discharge + elevated vaginal pH (>4.5) and treated with Metronidazole. Dx? Trichomoniasis
"Cottage-cheese" like vaginal discharge is seen in? Candida vaginitis
What is the normal pH range for the vagina? 3.8 -- 4.5
INH inhibits _______________________ synthesis, in the treatment of _____. it is known it has to be processed by mycobacterial __________________. mycolic acid; TB; CATALASE PEROXIDASE
What RIPE drug is involved with Catalase Peroxidase? Isoniazid
What are the main side effects of Ganciclovir therapy? Neutropenia, Anemia, and Thrombocytopenia
What are the main clinical uses for Ganciclovir? CMV colitis and CMV retinitis
MoA seen in ganciclovir? Inhibits viral DNA synthesis by blocking CMV DNA polymerase
What is the treatment of Gonorrhea? Azithromycin + Ceftriaxone
Staphylococcal foodborne illness are due to: Preformed Enterotoxin
Washing hands prior to preparing food helps to___________________ Prevent contamination
How does ensuring proper refrigeration storage for food help to prevent a Staphylococcal entero illness? Prevents bacterial proliferation/ enterotoxin production
How quickly are GI symptoms of Staphylococcal foodborne illness presented? 3-4 hours
Undercooked beef is often associated with: EHEC infection ---> bloody diarrhea and HUS
Shiga-toxin Seen in Shigella and EHEC
Time elapsed for initial symptoms of an EHEC infection? 3-4 days
What drugs are used in the treatment of MRSA? 1. Vancomycin 2. Daptomycin 3. Linezolid
Daptomycin mechanism of action 1. Causes the DEPOLARIZATION of bacterial cellular membrane and, 2. Inhibition of DNA, RNA, and protein synthesis.
What are the main side effects of Daptomycin therapy for MRSA? 1. Elevated levels of Creatine phosphokinase (CPK) 2. Increased incidence of myopathy
Vancomycin is usually the 1st line of treatment of _____________, Vancomycin is seen with increased risk of developing ______________ and _________________. MRSA; Nephrotoxicity ; Red Man Syndrome
What can inactivate Daptomycin? Pulmonary surfactant
Binding to bacterial 23S ribosomal RNA of the 50S subunit, leading to the prevention of forming the 70S initiation complex, required for proper bacterial protein translation. Linezolid mode of action
What are the main side effects seen with Linezolid? 1. Thrombocytopenia 2. Optic Neuritis 3. Increased risk of Serotonin syndrome if co-administered with a Serotonin agonist such as Citalopram.
Common 3 NNRTIs? Nevirapine, Efavirenz, and Delavirdine
What NNRTis are contraindicated in pregnant women? Delavirdine and Efavirenz
NNRTI do not require ___________________________ and are considered ________________________ inhibitors of the HIV RT. Intracellular phosphorylation; Allosteric
Efavirenz is associated with development of ____________________ and ______ symptoms. Vivid dreams and CNS symptoms
What diseases are associated with IXODES tick? Lyme Disease (Borrelia burgdorferi) and Babebiosis (babesia microti)
Key clue of Babebiosis Intraerythrocytic pleomorphic ring forms (Maltese crosses) seen in PBS
Maltese crosses Babebiosis
AEDES mosquito transmits __________________ and _______________. Dengue and Malaria
What area of the USA is associated with dense Ixodes tick population? Northeastern USA
What are other names for Inactivated vaccines? Killed or Component Vaccines
What is generated by a killed vaccine? Humoral response (only) against extracellular viral antigens, preventing viral entry to the cell.
Inactivated vaccines prevent the ____________________ to the cell. Viral entry
Contrary killed vaccines, the Live-Attenuated vaccines produce: Strong cell-mediated immune response that KILL VIRAL CELLS, in addition to providing a humoral response.
Foscarnet is used for ____________ and ___________ infections. HIV and HSV
Pyrophosphate analogue Foscarnet
Foscarnet is _______________________ analogue, used in __________ and __________ viruses. Pyrophosphate; HIV and HSV.
What are the 2 main clinical uses for Foscarnet? 1. CMV retinitis/colitis when Ganciclovir fails in AIDS patients 2. Acyclovir-resistant HSV
Mode of action seen with Foscarnet? Binds and inhibits to: 1. Reverse transcriptase in HIV 2. DNA polymerase in Acyclovir-resistant HSV infection
What side effects are presented with Foscarnet? Nephrotoxicity, and electrolyte imbalances leading to Seizures
What electrolyte imbalances are developed in Foscarnet antiviral therapy? Hypo/Hypercalcemia, Hypo/Hyperphosphatemia, Hypokalemia, and Hypomagnesemia ==> SEIZURES
What is the best way to prevent vertical HIV transmission to the fetus? Antiviral therapy to all HIV pregnat women
Broad, NON-septate hyphae with right-angle branching Mucor spp histological description
Mucormycosis is presented as: Facial pain, headache, and black necrotic eschar in diabetic patient with DKA
How is the best way to confirm dx of Mucormycosis? Histological examination of affected tissue (mucosa)
45 degree angle branching-------> 90 degree angle branching -----> Aspergillus fumigatus Mucor specie
The hyphae in Mucormycosis is _________________________, while the one describe in Aspergillosis is ____________________. NON-septate; Septate
What virus is causative of Progressive Multifocal Leukoencephalopathy? JC virus
What is seen in CT of brain in a patient with Progressive Multifocal Leukoencephalopathy? White matter lesions with NO ENHANCEMENT/Edema
T2-weighted MRI with white matter lesions and no associated edema or enhancement. Dx? PML by JC virus
Pt presents with confusion, paresis, ataxia, seizures, all progressed slowly over several years. Patient is HIV positive, with inconsistent antiviral therapy. PML by JC virus
Brain imaging of EBV infection: Single-enhancing lesion, seen in Primary Lymphoma
Toxoplasmosis brain imaging shows: Multiple-ring enhancing lesions with surrounding edema
What are the two main brain enhancing lesions? Toxoplasmosis (multiple) and Primary solitary Lymphoma (single + EBV)
Persistence of HBsAg over 6 months Chronic HBV infection
HBV surface glycoproteins HBsAg
What HBV serologic markers are present in acute infection? HBsAg, HBeAg, and anti-HBc IgM
HBV polypeptide HBeAg
Increased viral replication and infectivity of HBV infection is indicated with increased levels of ____________________ serologic marker. HBeAg
Anti-HBc IgM: - First sign of acute HBV infection - Only serologic marker present in the WINDOW PHASE
Presence of Anti-HBs indicates: 1. Cleared infection or immunity 2. Confers long-term immunity
Cleared infection of HBV is indicated by presence of ____________. Anti-HBs antibody
The increase presence of Anti-HBe antibody indicates? Decreased viral replication and infectivity
What antibody is not present after vaccination for HBV? Anti-HBc IgG
Large, sporulating, gram positive rod, encased by antiphagocytic polypeptide capsule Bacillus anthrasis
What is the main component of the capsule in B. anthracis? D-glutamic acid
What is caused by B. anthracis? Pulmonary anthrax
Clinical manifestations of Pulmonary anthrax: Hemorrhagic MEDIASTINITIS, shock and death, caused by B. anthracis infection.
What are the MC ways of Ascaris Lumbricoides infection: Transmission via contaminated food and water
The__________________ travels from the _____________ all the way to the _________________. Ascaris lumbricoides; Small intestine ; Pulmonary alveoli
What is the collection of pulmonary symptoms called in Ascaris lumbricoides? Loeffler syndrome
Transient, eosinophilic pneumonitis with pulmonary symptoms Loeffler syndrome
What is the most common treatment for A. lumbricoides infection? Albendazole
Created by: rakomi