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FirstAid Microbio
First Aid Microbiology
| Question | Answer |
|---|---|
| What Structure gives rigid support and protects agains osmotic pressure | Peptidoglycan |
| Peptidoglycan - composition | Sugar backbone with cross-linked peptide side chains |
| Peptidoglycan - function | Gives rigid support, protects against osmotic pressure |
| Cell wall/Cell membrane found in which type of bacteria? | gram positive |
| Major surface antigen of gram positive bacteria | Cell Wall/Cell membrane (Teichoic acid induces TNF and IL-1) |
| Teichoic acid is found | in cell wall/cell membrane of gram positive bacteria - is major surface antigen, and induces TNF and IL-1 |
| Outer membrane found in which type of bacteria? | Gram negative |
| Major surface antigen of gram negative | Outer membrane - contains the endotoxin (lipopolysaccharide). Lipid A induces TNF and IL-1 |
| Composition of endotoxin | Lipopolysaccharide |
| Site of oxidative and transport enzymes in bacteria | Plasma membrane |
| Site of protein synthesis in bacteria | Ribosome (50S and 30S) |
| Periplasm | the space between the cytoplasmic membrane and outer membrane in gram-negative bacteria |
| Where are beta-lactamases in bacteria? | In periplasm of gram negative bacteria |
| What bacterial structure protects agains phagocytosis? | Capsule |
| What are bacterial capsules composed of? | Polysaccharide (except for Bacillus anthracis, which contains D-glutamase) |
| The function of the pilus/fimbrai in bacteria | mediates adherence of bacteria to cell surface. sex pilus forms attachment between 2 bacteria during conjugation. |
| Composition of bacterial pilus/fimbria | Glycoprotein |
| Function of Flagellum in bacteria | motility |
| Composition of bacterial flagellum | protein |
| Significance of bacterial spores | Provide resistance to dehydration, heat, and chemicals. Contain dipicolinic acid |
| What gives bacteria resistance to dehydration, heat, and chemicals | the keratin-like coat, containing dipicolinic acid of SPORES |
| Contains a variety of genes for antibiotic resistance, enzymes, and toxins | Bacterial Plasmid (made of DNA) |
| Glycocalyx - function | mediates adherence to surfaces, especially foreign surfaces (eg: indwelling catheters) |
| Glycocalyx - composition | polysaccharide |
| IgA proteases - function | Allow some organisms to colonize mucosal surfaces (S.pneumo, N.meningitidis, N.gonorrhoeae, H.influenza) |
| Organisms that contain IgA proteases | S. pneumo, N. meningitidis, N. gonorrhoeae, H. influenza |
| The only test that allows visualization of organisms in a sample from a patient: | Direct Flourescant Antibody |
| Indirect Fluorescant Antibody Test | Used to see if patient has antibodies agains a certain pathogen |
| Direct Fluorescant Antibody Test | Used to directly see if an organism is present within a patient |
| Structures within bacterial cell walls that are common to both gram positive and gram negative bacteria | Flagellum, Pilus, Capsule, Peptidoglycan, Cytoplasmic membrane |
| Structures in cell wall unique to gram positive organisms | Teichoic acid, Cell wall |
| Structures in cell wall unique to gram negative organisms | Endotoxin/LPS (outer membrane), Periplasm |
| Mnemonic to remember bugs that do not gram stain well | These Rascals May Microscopically Lack Color (Treponema, Rickettsia, Mycobacteria, Mycoplasma, Legionella pneumophila, Chlamydia) |
| Stain for Treponema | Is too thin to be visualized using traditional gram stain. Use darkfield microscopy and fluorescent antibody staining |
| Stain for Rickettsia | Is an Intracellular parasite - so does NOT stain well. |
| Stain for Mycobacteria | B/c wall has a high lipid content - it requires Acid-Fast stain |
| Stain for mycoplasma | Does not have a cell wall so does NOT gram stain well |
| Stain for Legionell pneumophilia | Is primarily intracellular so does NOT gram stain well. Need silver stain |
| Stain for Chlamydia | Is an intracellular parasite so does NOT gram stain well. Also Lacks muramic acid in cell wall |
| Bacteria that lacks muramic acid in cell wall | Chlamydia |
| During the Lag phase of bacterial growth curve | There is metabolic activity without division |
| Phases of Bacterial growth curve | Lag phase, Log phase, Stationary phase, Death phase |
| During the Log phase of the bacterial growth curve | there is Rapid cell division |
| During the Stationary phase of the bacterial growth curve | Nutrient depletion slows growth |
| During the Death phase of the bacterial growth curve | Prolonged nutrient depletion and buildup of waste products lead to death |
| Exotoxins - source | Certain species of some gram-positive and gram-negative bacteria |
| Endotoxins - source | cell wall of most gram-negative bacteria |
| Are exotoxins secreted from cell? Endotoxins? | Exotoxins = Yes. Endotoxins = No. |
| Chemical composition of exotoxins | Polypeptides |
| Composition of endotoxins | Lipopolysaccharide |
| Location of genes for exotoxins | Plasmid or bacteriophage |
| Location of genes for endotoxins | Bacterial chromosome |
| The toxicity of exotoxins is high or low? | High (fatal dose is on the order of 1 mcg) |
| The toxicity of endotoxins is high or low? | Low (compared to exotoxins) - fatal dose is on order of hundreds of mcg |
| General clinical effects of endotoxins | Fever and shock |
| General mode of action of endotoxins | TNF and IL-1 |
| Antigenicity of exotoxins | Induces high-titer antibodies called antitoxins |
| Antigenicity of endotoxins | Poorly antigenic |
| What types of vaccines are used to protect agains exotoxins? | Toxoids |
| What types of vaccines are used to protect against endotoxins? | NO vaccine available! No toxoids formed |
| Heat stability of exotoxins | Destroyed rapidly at 60C (except staphylococcal enterotoxin) |
| Heat stability of endotoxins | Stable at 100C for 1 hour |
| Typical diseases caused by exotoxins | Tetanus, Botulism, Diphtheria |
| Typical diseases caused by endotoxins | Meningococcemia, sepsis by gram negative rods |
| Mnemonic to remember Bugs that secrete exotoxins | Some Stinking Bugs Are Very Deadly Because They Secrete PolyPeptide Exotoxins (S.aureus, S.pyogenes, B.pertussis, Anthracis, Vibrio cholerae, Diphtheriae, Botulinum, Tetani, Shigella, Perfringens, Pseudomonas, E.coli) |
| Bugs that make superantigens | S.aureus, and S.pyogenes |
| TSST-1 | From S.aureus. Causes toxic shock syndrome. Causes fever, rash, and shock. |
| Enterotoxins | S.aureus. Causes food poisoning. |
| Scarlet-fever erythrogenic toxin | S.pyogenes. Is a Toxic-Shock-Like toxin (fever, rash, shock) |
| Bind directly to MHC II and T-cell receptor, activating large number of T cells to stimulate release of IFN-gamma, and IL-2. | Superantigens (S.aureus, S.pyogenes) |
| AB Toxins - | Are ADP ribosylating toxins that interfere with host cell function. B is binding component. A is active component which alters protein function. (Diptheria, Vibrio cholera, E.coli, Bordetella pertussis) |
| What does B component of AB toxin do? | B = Binding. Binds to a receptor on the surface of host cell enabling endocytosis (ADP ribosylating toxins) |
| What does the A component of AB toxin do? | A = Active. Component attaches an ADP-ribosyl to a host cell protein (ADP ribosylation) altering protein function. |
| ADP ribosylating Toxins - Organisms (5) | Corynebacterium diphtheriae, Vibrio cholerae, E.coli, Pseudomonas, Bordetella pertussis |
| Toxins that inactivate EF-2 | Corynebacterium diphtheriae, Pseudomonas (exotoxin A) |
| Inactivates elongation facto (EF-2) causing pharyngitis and "pseudomembrane" in throat | Corynebacterium diphtheriae |
| ADP ribosylation of G protein stimulates adenylyl cyclase; increasing pumping of Cl- H20 into gut | Vibrio cholerae |
| Mechanism of rice-water stools | Vibrio cholerae: ADP ribosylation of G protein stimulates adenylyl cyclase increaseing the pumping of Cl- and H20 into the gut |
| Heat-labile vs. Heat-stabile toxin | E.coli. Heat labile toxin stimulates Adenylate Cyclase. Heat-stable toxin stimulates guanylate cyclase. "Labile like the air, Stable like the ground." |
| Mechanism of Bordetella pertussis | Stimulates adenylate cyclase; causes whooping cough; inhibits chemokine receptor causing lymphocytosis |
| Alpha Toxin | Clostridium perfringens. Causes gas gangrene; gets double zone of hemolysis on blood agar |
| C. tetani inhibits? | inhibitory neurotransmitter glycine. causes lockjaw |
| C.botulinum inhibits? | Acetylcholine, causing anticholinergic symptoms and CNS paralysis |
| Floppy baby | C. botulinum toxin. Found in canned food and honey. |
| Shiga toxin | Produced by Shigella and also E.coli O157:H7. Cleaves host cell rRNA and enhances cytokine release causing HUS. |
| Streptolysin O | A hemolysin made by S.pyogenes |
| ASO antibody | Rheumatic fever (against streptolysin O) |
| Lipopolysaccharide found in cell wall of gram negative bacteria | Endotoxins |
| Are endotoxins heat stabile or labile? | Stabile |
| Endotoxins mode of Action | Activate macrophages (IL-1, TNF, NO), Activate Complement (C3a, C5a), Activate Hageman factor (causing coagulation cascade which can lead to DIC) |
| Fermentation Patterns of Neisseria | MeninGococci ferment Maltose and Glucose, Gonocci ferment Glucos |
| Pigment producing bacteria | S.aureus (yellow), Pseudomonas aeruginosa (blue-green), Serratia marcescens (Red) |
| Gram +, Cocci, Clusters, Catalase +, Coagulase + | S.aureus |
| Gram +, Cocci, Clusters, Catalase +, Coagulase -, Novobiocin Sensitive | S.epidermidis (SEnsitive = S.Epidermis) |
| Gram +, Cocci, Clusters, Catalase +, Coagulase -, Novobiocin resistant | S.saprophyticus (Resistant = Strong = Saphrophyticus) |
| Gram +, Cocci, Chains, Catalase -, Alpha (green) hemolysis, Capsule, Optochin sensitive, Bile soluble | S.pneumoniae |
| Gram +, Cocci, Chains, Catalase -, Alpha (green) hemolysis, No capsule, Optochin resistant, Not bile soluble | Viridans streptococci (S.mutans) |
| Alpha (green) hemolytic streptococci | S. pneumoniae, or S. mutans (viridans) |
| How to tell between Alpha (green) hemolytic streptococci | Capsule, +Quelling, Optochin sensitive, Bile soluble = S. pneumo. No capsule, Optochin resistant, not bile soluble = S.mutans |
| Gram +, Cocci, Chains, Catalase -, Beta (clear) hemolysis, Bacitracin sensitive | Group A Strep (S.pyogenes) |
| Gram +, Cocci, Chains, Catalase -, Beta (clear) hemolysis, Bacitracin resistant | Group B Strep (S.agalactiae) |
| How to tell between different Beta (clear) hemolytic streptococci | Bacitracin sensitive = Group A Strep (S.pyogenes). Bacitracin resistant = Group B Strep (S.agalactiae) |
| Gram +, Cocci, Chains, Catalase -, Gamma (no) hemolysis | Enterococcus (E.faecalis and Peptostreptococcus) |
| Gram -, Cocci, Maltose fermenter | N.meningitidis |
| Gram -, Cocci, Maltose non-fermenter | N.gonorrhoeae |
| Gram -, "Coccoid" rods | H.influenza, Pasteurella, Brucella, Bordetella |
| Gram +, Bacilli, Spore Forming, ANerobic | Clostridium (Tetani, Botulinum, Difficile, Perfringens) |
| How to distinguish between Clostridium species | All are Catalse and Dismutase -. C.tetani = motile. C perfringens has two zones of hemolysis, and non-motile. |
| Gram +, Bacilli, Spore Forming, Aerobic | Bacillus spp. (Anthracis, and Cereus) |
| Gram +, Bacilli, Non-spore forming, Anaerobic | Actinomyces, Propionibacterium, Lactobacillus, and Bifidobacterium |
| Gram +, Bacilli, Non-spore forming, Aerobic | Corynebacterium diptheriae, Listeria monocytogenes, Tropheryma whipplei, Erysipelothrix rhusiopathiae |
| Gram +, Cocci, Chains, Catalase -, Strict Anaerobe | Peptostreptococcus |
| Gram -, Bacilli, Lactose fermenter, Fast fermenter | Klebsiella, E.coli, Enterobacter |
| Gram -, Bacilli, Lactose fermenter, Slow fermenter | Citrobacter, Serratia |
| Gram -, Bacilli, Lactos Non-fermenter, Oxidase - | Shigella, Salmonella, Proteus |
| Gram -, Bacilli, Lactose non-fermenter, Oxidase + | Pseudomonas |
| Chocolate agar with factors V (NAD) and X (hematin) | H.influenza |
| Thayer-Martin media | N.gonorrhoeae |
| Bordet-Gengou (potato) agar | B. pertussis |
| Tellurite plate | C.diphtheriae |
| Loffler's medium | C.diptheriae |
| Blood agar | C.diptheriae |
| Lowenstein-Jensen agar | M.tuberculosis |
| Pink colonies on MacConkey's agar | Lactose-fermenting enterics |
| CHarcoal yeast extract agar buffered with increased iron and cysteine | Legionella |
| Sabouraud's agar | Fungi |
| Congo red | Amyloid; apple-green birefringence in polarized light (b/c of Beta-pleated sheets) |
| Giemsa stain | Borrelia, Plasmodium, Trypanosomes, Chlamydia |
| PAS stain | Stains glycogen, mucopolysaccharides. Is used to diagnose Whipple's disease |
| Ziehl-Neelsen | Acid fast bacteria |
| India ink | Cryptococcus neoformans |
| Silver stain | Fungi, PCP, Legionella |
| Bacterial Genetics: Direct cell-to-cell transfer | Conjugation |
| What type of DNA is transferred during conjugation | Chromosomal or plasmid |
| Bacterial genetics: Phage-mediated cell to cell DNA transfer | Transduction |
| Transduction | Phage-mediated cell to cell DNA transfer |
| What type of DNA is transferred in Transduction | Any gene in generalized transduction. Only certain genes in specialized transduction |
| Bacterial Genetics: Purified DNA taken up by a cell | Transformation |
| Transformation is? | When purified DNA is taken up by a cell. Can occur in prokaryotic or eukaryotic cells. |
| What type of DNA is transferred in Transformation | Any DNA |
| Bacterial Genetics: DNA transfer to same or another chromosome or plasmid within a cell | Transposition |
| Transposition is? | DNA transfer to same or another chromosome or plasmid within a cell. Can occur in prokaryotes or eukaryotes |
| Nature of DNA transferred in Transposition | DNA sequences "jumping genes" |
| What types of transfer procedure can eukaryotes undergo? | Transformation or Transposition |
| What type of transfer procedure (bacterial genetics) can prokaryotes undergo? | Conjugation, Transduction, Transformation, and Transposition. |
| Which bacteria have the genetic code for their toxin encoded in a lysogenic phage? | Lysogeny: Botulinum toxin, Cholera toxin, Diphtheria toxin, Erythrogenic toxin of Strepcococcus pyogenes |
| Mnemonic to remember obligate aerobes | Nagging Pests Must Breathe (Nocardia, Pseudomonas, Mycobacterium tb, Bacillus) |
| Which bacteria use an O2 dependent system to generate ATP? | Obligate Aerobes (Nocardia, Pseudomonas, Mycobacterium TB, Bacillus) |
| What part of lungs is Mycobacterium TB found? | Apices of the lung (b/c it is an obligate aerobe, and the apices of the lung have the highest PO2) |
| Obligate anerobe organisms | Clostridium, Bacteriodes, Peptostreptococcus, Actinomyces |
| How do Obligate aerobes work? | Use an O2-dependent system to generate ATP |
| Which organisms lack catalase and/or superoxide dismutase? | Obligate anaerobes. The lack of catalase and/or superoxide dismutase makes them susceptible to oxidative damage |
| Characteristics of Obligate anaerobes | Generally foul smelling (short-chain fatty acids), are difficult to culture, and produce gas in tissue (CO2, and H2O). Are generally normal flora in GI tract |
| Mnemonic to remember Obligate Intracellular bugs | stay inside (cells) when it is Really Cold (Rickettsia, Chlamydia) |
| What is important about Obligate Intracellular bugs? | They cannot make their own ATP (Rickettsia, Chlamydia) |
| Mnemonic to remember Facultative Intracellular bugs | Some Nasty Bugs May Live FacultativeLY (Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella, Yersinia) |
| Encapsulated Bacterial Organisms | Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Klebsiella pneumonia. "Some Have Nice Kapsule" |
| Quelling reaction | positive in bacteria who have capsules. Qwelling = Swelling |
| Bacterial capsule component | Made of Polysaccharide. |
| Function of Bacterial Capsule | An antiphagocytic virulence factor |
| What do Pneumovax, HiB, and Meningococcal vaccines have in common? | All are encapsulated bacteria. Capsule serves as antigen in vaccines. |
| Who forms spores? | Only certain gram-positive organisms form spores when nutrients are limited |
| Spore-forming organisms | Aerobic: Bacillus anthracis, B.cereus. Anaerobic: Clostridium spp. |
| Do spores have metabolic activity? | NO |
| Special component of spores | Dipicolinic acid in core. Helps protect against destruction by heat and chemicals |
| How kill spores? | Autoclave |
| Alpha-hemolytic bacteria | 1. Streptococcus pneumoniae (catalase -, optochin sensitive) 2. Viridans streptococci (catalse -, optochin resistant) |
| Beta-hemolytic bacteria | 1. Staphylococcus aureus (catalase/coagulase +) 2.Streptococcus pyogenes (catalase -, bacitracin sensitive) 3.Steptococcus agalactiae (catalase -, bacitracin resistant) 4.Listeria monocytogenes (tumbling motility, meningitis newborns, unpasteurized milk) |
| Only gram positive organism with endotoxin | Listeria monocytogenes (found in soft cheese, deli meats, refrigerated). Tumbling motility |
| Function of catalase | Degrades H202, an antimicrobial product of PMNs. H202 is a substrate for myeloperoxidase. |
| Protein A | Staph aureus. Protein A is a virulence factor. It binds Fc-IgG, inhibiting complement fixation and phagocytosis |
| What type of immune response is elicited to TSST? | TSST is a super antigen that binds MHC II and T-cell receptor, resulting in polyclonal T-cell activation. Will have a HIGH level of T cell cytokines. |
| Food poisoning from S.aureus | Is due to ingestion of preformed enterotoxin. Is rapid-onset food poisoning. |
| Scalded skin syndrome | Due to exfoliative toxin (s.aureus) |
| Acute bacterial endocarditis | Staph aureus (IV drug user) |
| Streptococcus pyogenes causes: | 1. PYOGENIC: pharyngitis, cellulitis, impetigo. 2. TOXIGENIC: scarlet fever, toxic shock syndrome. 3. IMMUNOLOGIC: rheumatic fever, acute glomerulonephritis. |
| Consequences of untreated Strep pyogenes | PHaryngitis gives you rheumatic PHever and glomerulonePHritis |
| Jones Criteria for Rheumatic Fever | No "RHEUM for SPECCulation" (Subcutaneous nodules, Polyarthritis, Erythema marginatum, Chorea, Carditis) |
| How increase host defenses against Step pyogenes? | Antibody to M protein enhances host defenses against S.pyogenes |
| How detect recet S.pyogenes infection? | ASO titer |
| Strep pneumo is the most common cause of? | MOPS - Meningitis, Otitis Media, Pneumonia, Sinusitis |
| Sepsis in sickle cell anemia or post splenectomy | Streptococcus pneumoniae |
| Rusty sputum pneumonia | Streptococcus pneumonia |
| How does strep pneumo protect itself? | It is encapsulated. Acts by inactivating complement to protect itself from opsonization. |
| What helps prevent bacteria from being immediately shed from mucosal surfaces? | IgA protease. Found on Strep pneumo, H.influenza, N.meningitidis, N.gonorrhoeae |
| Group B streptococci | Strep agalactiae (bacitracin resistant, Beta-hemolytic) |
| Pneumonia, meningitis, and sepsis in babies | Streptococcus agalactiae |
| Enterococci | Enterococcus faecalis, and E.faecium |
| Common cause of UTI and subacute endocarditis | Enterococci (Enterococcus faecalis and E.faecium) |
| Lancefield grouping of enterococci is based on? | C carbohydrate on the bacterial cell wall |
| Commonly affects prosthetic devices and catheters | Staphylococcus epidermidis |
| Commonly contaminates blood cultures | Staphylococcus epidermidis |
| How do biofilms form? | By altering the surface tension of liquids (staph epidermidis) |
| Common cause of dental caries | Strep mutans (viridans) |
| Common cause of subacte bacterial endocarditis | Strep sanguis (viridans) |
| How remember optochin differentiation b/t alpha-hemolytic strep | S.pneumon is optochin sensitive. Viridans strep "live in the mouth becase they are not afraid OF-THE-CHIN" (optochin resistant) |
| Clostridia categorization | Gram-positive, spore-forming, obligate anaerobic bacilli that make exotoxins |
| Blocks glycine release from Renshaw cells in the spinal cord | Tetanus toxin |
| Flaccid paralysis | From Botulinum toxin blocking ACh release |
| Lecithinase | Alpha-toxin of Clostridium perfringens |
| Cytotoxin | An exotoxin that kills enterocytes. C.difficile. Commonly secondary to clindamycin or ampicillin use |
| ABCDEFG of Corynebacterium diptheriae | ADP ribosylation, Beta-prophage, Corynebacterium, Diptheriae, Elongation Factor 2, Granules (metachromic) |
| Pseudomembranous pharyngitis | Corynebacterium diphtheriae |
| Beta-prophage exotoxin | Corynebacterium diptheriae. Exotoxin inhibits protein synthesis via ADP ribosylation of EF-2. |
| Looks like chinese letters on culture | Corynebacterium diptheriae |
| The only bacterium with a protein capsule | Bacillus anthracis |
| If come in contact with Anthrax | Get Malignant pustule (painless ulcer); can progress to bacteremia and death |
| If inhale Anthrax | Get flulike symptoms that rapidly progress to fever, pulmonary hemorrhage, and shock. |
| Wollsorter's disease | Inhalation of Anthrax spores from contaminated wool |
| Black skin lesions | Bacillus anthracis - vesicular papules covered by black eschar |
| Anthrax toxin | 1) Lethal factor (releases TNF-beta, and IL-1). 2) Edema factor |
| Bacterial Rods forming long branching filaments resembling fungi | Actinomyces and Nocardia |
| Gram + aerobe that causes oral/facial abscesses with "sulfur granules" that may drain through sinus tracts in skin | Actinomyces |
| Gram-positive, weakly acid fast aerobe in soil causing pulmonary infection in ICH | Nocardia asteroides |
| Txt for Nocardia vs. Txt for Actinomyces | SNAP: Sulfa for Nocardia, Actinomyces use Penicillin |
| Facial abscesses draining through sinus tracts after bar brawl | Actinomyces |
| Mycetoma in ICH | Nocardia (mycetoma = brain and kidney abscesses) |
| Why are gram-negative bugs resistant to penicillin? | Gram-negative outer membrane layer inhibits entry of penicillin G and vancomycin. Gram-negatives are susceptible to penicillin derivatives such as ampicillin |
| Lipooligosaccharide endotoxin | N.meningitidis |
| N.gonorrhea vs. N.meningitidis | GONOCOCCI (No polysaccharide capsule, No maltose fermentation, No vaccine). MENINGOCOCCI (Yes polysaccharide capsule, Yes maltose fermentation, Yes vaccine) |
| Causes gonorrhea, septic arthritis, neonatal conjunctivitis, PID | N.gonorrhoeae |
| Causes meningococcemia and meningitis. Waterhouse-Friderichsen syndrome | N.meningitidis |
| Mnemonic to remember clinical manifestations of Haemophilus influenza | HaEMOP - Epiglottitis, Meningitis, Otitis media, and Pneumonia |
| Culture medium for H.influenza | Chocolate agar with factors V (NAD) and X (hematin). Mnemonic: When a child has "flu," mom goes to five (V) and dime (X) store to buy some chocolate |
| Most invasive type of H.influnza | Capsular type B (Vaccine contains type B capsular polysaccharide conjugated to diphtheria toxoid or other protein) |
| DOC of H.influenza meningitis | Ceftriaxone. Use Rifampin prophylaxis in close contacts. |
| H.influenza vaccine | Given between 2 and 18 months. Contains type B polysaccharide conjugated to diptheria toxoid or other protein |
| Mnemonic to remember the Enterobacteriaceae | "Citizens Eat Kitkats Every Seventh daY. Some People May Prefer Salad." (Citrobacter, E.coli, Klebsiella, Enterobacter, Serratia, Yersinia, Shigella, Proteus, Morganella, Providencia, Salmonella) |
| Mnemonic to remember characteristics of Enterobacteriaceae | "COFFEE" (Capsular, O antigen/Oxidase -, Flagellar antigen, Ferment glucose, Electron reducers of nitrate-nitrite, Enterobacteriaceae) |
| Somatic O antigen | Polysaccharide of endotoxin, found in enterobacteriaceae |
| Virulence of Enterobacteriaceae | the capsular K antigen is related to the virulence of the bug |
| Presents as pneumonia in alcoholics and diabetics. Red currant jelly sputum | Klebsiella. Note it also is a common cause of nosocomia UTIs |
| The 3A's of Klebsiella | Aspiration pneumonia, Abscess in lungs, Alcoholics |
| Pink colonies on MacConkey's agar | Lactose-fermenting enteric bacteria |
| Mnemonic to remember which enterobacteriaceae ferment lactose | "laCtose is KEE" (Klebsiella, E.coli, Enterobacter, and Citrobacter) |
| Salmonella vs. Shigella | Both are non-lactose fermenters, both invade intestinal mucosa and cause dysentery. Salmonella is motile (Salmon swim) and has animal reservoir. Shigella is non motile and is transferred via Food, Fingers, Feces, and Flies. Shigella is much more virulent. |
| Symptoms of what bacterium can be prolonged with antibiotic txt | Salmonella |
| What bacterium is commonly transmitted from pet feces (puppies), contaminated milk, or pork? | Yersinia enterocolitica. (outbreaks are very common in day-care centers) |
| What bacterium can mimic Crohn's disease or appendicitis? | Yersinia enterocolitica |
| Food poisoning from seafood | Vibrio parahaemolyticus and Vibrio vulnificus |
| Food poisoning from reheated rice | Bacillus cereus |
| Food poisoning from meats, mayonnaise, custard | Staph aureus |
| Food poisoning from reheated meat dishes | Clostridium perfringens |
| Food poising due to improperly canned foods (bulging cans) | Clostridium botulinum |
| Food poisoning from undercooked meat (cheeseburger) | E.coli 0157:H7 |
| Food poisoning from poultry, meat, and eggs. | Salmonella |
| What organisms cause bloody diarrhea? | Campylobacter, Salmonella, Shigella, Enterohemorrhagic E.coli, Enteroinvasive E.coli, Yersinia enterocolitica, C.difficile, Entamoeba histolytica |
| Bloody diarrhea from a comma- or S-shaped organism growing at 42C and oxidase positive | Campylobacter |
| Bloody diarrhea from gram -, motile, lactose negative bacteria | Salmonella |
| Gram -, non-motile, lactose negative, low ID50 organism causing bloody diarrhea | Shigella |
| Shiga-like toxin | Enterohemorrhagic E.coli (bloody diarrhea) |
| Organism causing bloody diarrhea. Picked up at daycare. Presents as pseudoappendicitis | Yersinia enterocolitica |
| Bloody diarrhea after clindamycin administration | C.difficile (pseudomembranous colitis) |
| Causes of Watery Diarrhea | Enterotoxigenic E.coli, Vibrio cholerae, C.perfringens, Protozoa (Giardia, Cryptosporidium), Viruses (Rota, Adeno, Norwalk) |
| Classic traveler's diarrhea | Enterotoxigenic E.coli (no preformed toxin) |
| Rice-water diarrhea | Vibrio cholerae (comma shaped organism) |
| cAMP inducing bacteria | Vibrio cholera, Pertussis, E.coli, Bacillus antracis |
| Mechanism of Vibrio cholera toxin | Is a cAMP inducer. It permanently activates Gs. "turns the 'on' on." |
| Mechanism of Pertussis toxin | A cAMP inducer. Permanently disables Gi. "turns the 'off' off. |
| Mechanism of E.coli heat labile toxin | A cAMP inducer. Ribosylates Gs protein to permanently activate AC thus increasing cAMP. |
| Mechanism of Bacillus anthracis toxin | The edema factor is a cAMP inducer. Acts as a bacterial Adenylate cyclase increasing cAMP. |
| Culture for Legionella pneumophila | Charcoal yeast extract culture with iron and cysteine. (Think of a French leegionnaire (soldier) with his silver helmet, sitting around a campfire (charcoal) with his iron dagger - he is no sissy (cysteine) |
| Stain for Legionella pneumophilia | Silver stain. (Think of a French leegionnaire (soldier) with his silver helmet, sitting around a campfire (charcoal) with his iron dagger - he is no sissy (cysteine) |
| DOC for Legionnaires' disease | Erythromycin |
| Transmission of Legionella | Aerosol transmission from environmental water source habitat |
| Mnemonic to remember clinical manifestations of Pseudomonas | PSEUDOmonas: Pneumonia (especially in CF), Sepsis (black lesions on skin), External otitis (swimmer's ear), UTI, Drug use and Diabetic Osteomyelitis. Also associated with wound and burn infections and hot tub folliculitis. |
| Aerobic gram-negative rod. Non-lactose fermenting. Oxidase + | Pseudomonas aeruginosa |
| Pyocyanin | A blue-green pigment produced by Pseudomonas aeruginosa. |
| Produces both an endotoxin and exotoxin A. | Pseudomonas. Endotoxin (fever, shock). Exotoxin A (inactivates EF-2) |
| Txt of Pseudomonas aeruginosa | Aminoglycoside plus extended-spectrum penicillin (eg: piperacillin and ticarcillin) |
| Common cause of gastritis and up to 90% of duodenal ulcers | Helicobacter pylori |
| Urease positive organisms | H.pylori and Proteus |
| Gram negative curved-rod with polar flagella. Urease positive | H.pylori |
| Does H.pylori cause an acidic or alkaline environment? | Alkaline |
| Txt of H.pylori | Triple therapy: 1) bismuth, metronidazole, and either tetracycline or amoxicillin. or 2) (more expensive) metronidazole, omeprazole, and clarithromycin |
| Mnemonic to remember Zoonotic bacteria | "Bad Bugs From Your Pet" (Borrelia burgdorferi, Brucella spp, Francisella tularensis, Yersinia pestis, Pasteurella multocida) |
| Undulant fever | Brucella spp. "Unpasteurized dairy products give you Undulant fever" |
| Prarie dog vector | Yersinia pestis (also caused by flea bites, or rodents) |
| Cellulitis post animal bite | Pasteurella multocida |
| What could give one fever, chills, malaise, and an ulceroglandular (eschar) | A rabbit bite. Francisella tularensis. Remember b/c St. Francis loved rabbits. |
| Infection as site of tongue piercing | Fusobacterium spp |
| Positive whiff test | Gardnerella vaginalis |
| Greenish vaginal discharge with fishy smell | Gardnerella vaginalis |
| DOC for Gardnerella vaginalis | Metronidazole |
| If suspect Pasteurella multocida, what do you do with the wound? | Make sure to NOT suture. |
| A pleomorphic, gram-variable rod causing vaginosis | Gardnerella vaginalis |
| Clue cells | Gardnerella vaginalis |
| Positive PPD | Current TB infection, Past exposure to TB, BCG vaccination |
| Negative PPD | No TB infection, or immunocompromised (steroids, malnutrition, AIDS) |
| Primary TB localizes where | Ghon complex focus usually in lower lobes. Also affects the hilar nodes |
| Possible results of Primary TB infection | 1) Heals by fibrosis - have immunity and hypersensitivity. 2) Progressive lung disease - HIV and malnuorished pts. 3) Severe bacteremia - miliary tb. 4) Preallergic lymphatic or hematogenous dissemination - dorman tb bacilli in several organs - 2ndary TB |
| Secondary TB infection location | Usually in apex of lung. Causes a fibrocaseous cavitary lesion. Caused by reinfection. |
| What are the signs of extrapulmonary TB? | CNS (parenchymal tb or meningitis), VERTEBRAL BODY (Pott's dz). LYMPHADENITIS, RENAL, GI |
| What is a Ghon complex? | Primary TB. Lobar and perihilar lymph node involvement |
| Types of Mycobacteria | 1) Mycobacteria TB 2) Myocobacteria kansasii 3) M.scrofulaceum 4) M.avium-intracellulare 5) M.leprae 6) M.marinum |
| PPD is what type of hypersensitivity | Type IV |
| Acid-fast organism causing disseminated disease in HIV | Mycobacteria avium-intracellulare |
| Hot-tub lung | Mycobacterium avium-intracellulare |
| Armadillo reservoir | Mycobacterium leprae (Leprosy) |
| Classic TB sx | Night sweats, weight loss, hemoptysis |
| Which type of Hansen's disease is worse? | Two types of Leprosy: Lepromatous and Tuberculoid. Lepromatous is worse |
| Why is lepromatous leprosy worse than tuberculoid leprosy | Lepromatous has failed cell-mediated immunity. Tuberculoid is self-limited |
| Chronic disease with hypopigmented skin and loss of sensation that prefers cooler areas of skin | Hanson's dz (leprosy) |
| Txt for Leprosy | Dapsone, Rifampin, Clofazamine |
| Toxicity of dapsone | Hemolysis and methemoglobinemia |
| Leonine facies | Lepromatous leprosy (LEpromatous = LEthal) |
| Gram -, obligate intracellular organisms that infect vascular endothelium | Rickettsiae |
| Classic Triad of Rickettsiae | Headache, fever, rash |
| Transmission of Rickettsiae | All except Coxiella are transmitted by an arthropod vector and cause headache, fever, and rash. Coxiella is an atypical rickettsia because it is transmitted by aerosol and causes penumonia. |
| DOC for Rickettsial infections | Tetracycline |
| Rat flea vector | Endemic typhus (R.typhi) |
| Centrifugal rash (outward) | Endemic typhus (R.typhi) - "TyPHus has centriPHugal rash" |
| Centripetal rash (inward) | Rocky mountain spotted fever (R.rickettsii). "sPotted fever is centriPetal" |
| Human body louse | Epidemic typhus (R.prowazekii) |
| Positive Weil-Felix | Rickettsial diseases (except Q fever) |
| Rash on palms and soles migrating to wrists, ankles, and trunk. Headache and fever. | Rocky Mountain spotted fever (R.rickettsii) |
| Palm and Sole Rash | Rocky Mountain spotted fever, Syphilis, and Coxsackievirus A infection |
| Reaction that assays for antirickettsial antibodies which cross react with Proteus antigen | Weil-Felix reaction (negative for Q fever) |
| Insidious onset of headache, non-productive cough, with X-ray showing diffuse interstitial infiltrate | Mycoplasma pneumoniae |
| Eaton's agar | Mycoplasma pneumoniae |
| Only bacterial membrane containing cholesterol | Mycoplasma pneumoniae (no cell wall) |
| DOC for mycoplasma pneumoniae | Tetracycline or erythromycin (bugs are penicillin resistant because they have to cell wall) |
| Small, non-motile, obligate intracellular (need ATP/NAD from host) bacteria/parasites that cause mucosal infections | Chlamydiae |
| Two forms of Chlamydiae | 1. Elementary body (small and dense) which Enters cell via Endocytosis. 2) Initial or Reticulate body, which Replicates in cell by fusion |
| Reactive arthritis, conjunctivitis, and nongonococcal urethritis | Chlamydia trachomatis |
| Peptidoglycan wall that lacks muramic acid | Chlamydia |
| Parrot fever | Chlamydia psittaci |
| Atypical pneumonia with positive Giemsa | Chlamydia pneumonia or C.psittaci |
| What type of hypersensitivity is caused by Chlamydia salpingitis? | Type IV hypersensitivity (TH1 lymphocyte response) |
| Types A, B, C of Chlamydia trachomatis | ABC = Africa/Blindness/Chronic infection (common cause of blindness in Africa) |
| Types D-K of Chlamydia trachomatis | Urethritis/PID, ectopic pregnancy, neonatal pneumonia, or neonatal conjunctivitis. (remember that ABC causes African Blindess/Chronic infections, and L causes Lymphogranuloma venereum. D-K causes everything else) |
| Types L1, L2, and L3 of Chlamydia Trachomatis | Lymphogranuloma venereum (L=L) |
| How txt neonatal chlamydial conjunctivitis | Erythromycin eye drops |
| Positive Frei test | Lymphogranuloma venereum (acute lymphadenitis) of Chlamydia trachomatic (type L) |
| Bacterial BLT | Spirochetes (BLT = Borrelia, Leptospira, and Treponema) |
| Dark-field microscopy | Treponema |
| Looks like ice-hooks on electron microscopy | Leptospira interrogans (a spirochete) |
| Rat-bite fever | Streptobacillus monilliformis (erythematous rash with discrete 1-4mm macules on extremities (including palms, soles and face) |
| bull's eye rash | Borrelia burgdoferi (Lyme dz) |
| 3 stages of Lyme dz | 1) Erythema chronicum migrans, flulike sx. 2) Neurologic and cardia manifestations. 3) autoimmune migratory polyarthritis |
| Erythema chronicum migrans | Lyme disease |
| Mnemonic for manifestations of Lyme dz | BAKE a key Lyme pie: Bell's palsy, Arthritis, Kardiac block, Erythema chronicum migrans |
| DOC for lyme disease | Tetracycline, Doxycycline, or penicillins |
| Painless bumps on arm of tropical population | Yaws = Treponema pertenue |
| Primary syphilis | Presents with painless chancre |
| Secondary syphilis | Disseminated disease with constituitional symptoms, maculopapular rash (palms and soles), condylomata lata |
| Tertiary syphilis | Gummas, aortitis, neurosyphilis (tabes dorsalis), Argyll Robertson pupil |
| Broad based ataxia, positive Romberg, Charcot joints, stroke w/o hypertension | Neurosyphilis (tabes dorsalis) |
| Saber shins, saddle nose, deafness | Congenital syphilis |
| FTA-ABS vs. VDRL | FTA-ABS: more specific, earliest positive, remains positive the longest. VDRL: cheapest, titer will fall late in disease |
| Nonspecific antibody that reacts with beef cardiolipin | VDRL |
| Mnemonic to remember false positives of VDRL | VDRL: Viruses (mono, hepatitis), Drugs, Rheumatic fever and rheumatic arthritis, Lupus and leprosy |
| Eukaryotes with cell wall | Fungi |
| Budding yeast with pseudohyphae in culture at 20C; germ tube formation at 37C | Candida albicans |
| DOC for Candida albicans | Nystatin for superficial infections. Amphotericin B for serious systemic infection |
| Systemic mycoses from Southwestern United States, California | Coccidioidomycosis |
| Only systemic myocosis w/no yeast form | Coccidiodes immitis (forms mold and spherules |
| Rounded spherules filled with endospores | Coccidiodes immitis |
| Found in sand of arid environment. Dust storms | Coccidiodes immitis |
| Systemic mycosis found in Mississippi and Ohio river valleys | Histoplasmosis |
| Systemic mycosis found east of Mississippi River and Central America | Blastomycoses |
| Systemic mycosis transmitted by bird or bat droppings | Histoplasmosis |
| Tiny yeast inside macrophages. "Captain's wheel" appearance | Histoplasmosis |
| Broad-based, budding yeast | Blastomycosis |
| Characterizations of dimorphic fungi | Mold in soil at lower temperatures. Yeast in tissue at higher temperatures (except coccidiomycosis which is a spherule in tissue) |
| DOC for Systemic mycoses | Local infection: Ketoconazole or Fluconazole. Systemic: Amphotericin B |
| Sabouraud's agar | Fungi |
| Cutaneous mycoses | Tinea versicolor, Tinea nigra, Tinea pedis/cruris/corporis/capitis. |
| Hypopigmented skin lesions in hot, humid weather | Malassezia furfur (tinea versicolor) |
| DOC for Tinea versicolor (Malassezia furfur) | Topical miconazole, selenium sulfide |
| Brownish spot infecting keratinized layer of skin | Cladosporium werneckii (Tinea nigra) |
| DOC for Tinea nigra (Cladosporium werneckii) | Salicylic acid |
| Dermatophytes | Microsporum, Trichophyton, and Epidermophyton |
| Epidermophyton | Infects skin and nails |
| Microsporum | Infects hair and skin |
| Trichophyton | Infects hair, skin, and nails |
| Mnemonic to remember types of Ringworm | "3C's at the PUB" (Cruris, Corporis, Capitis, Pedis, Unguium, Barbae) |
| Characteristics of Ringworm | Itchy, red, raised, scaly patches that may blister and ooze. Patches have sharply defined edges. Are often redder around the outside with normal skin tone in the center creating the appearance of a ring. |
| How diagnose Ringworm | KOH, Sabouraud's agar, Wood's lamp |
| Germ tubes at 37C | Candida |
| 45 degree angle branching septate hyphae | Aspergillus |
| Rare fruiting bodies | Aspergillus |
| 5-10 um yeasts with wide capsular halo | Cryptococcus |
| Narrow-based unequal budding | Crytococcus |
| Irregular broad (empty-looking) nonseptate hyphae, wide-angle branching | Mucor |
| Opportunistic fungal infections | Candida albicans, Aspergillus funigatus, Cryptococcus neoformans, Mucor and Rhizopus |
| Mold with irregular nonseptate hyphae branching at wide angles (>90) | Mucor and Rhizopus |
| Frontal lobe abscess in ketoacidotic diabetic | Mucormycosis |
| Causes pneumonia in ICH due to over-replication of type II pneumocytes and over-production of surfactant | Pneumocystis carinii |
| Diffuse interstitial pneumonia in AIDS patients | PCP |
| Is PCP a protozoa or yeast? | Yeast |
| Cysts and intracystic bodies on methenamine silver stain of lung tissue | PCP |
| DOC of PCP | TMP-SMX, Pentamidine, Dapsone |
| When start prophylaxis for PCP in AIDS pt? | When CD4 drops <200 cells/mL |
| Manifestations of Aspergillus infection | 1) Allergic bronchopulmonary mucus plugs 2) Fungus balls (aspergilloma) 3) Invasive Aspergillosis |
| Urease positive, pigment production on niger seed agar | Cryptococcus neoformans |
| Latex agglutination test detects polysaccharide capsular antigen | Cryptococcus neoformans. |
| A heavily encapsulated, non-dimorphic yeast found in soil and pigeon droppings | Cryptococcus neoformans |
| India Ink | Cryptococcus neoformans |
| Subcutaneous fungal infections | Sporothrix schenckii and Pseudallescheria boydii |
| Dimorphic fungus that lives on vegetation and is traumatically introduced into skin, typically by a thorn | Sporothrix schenckii (rose gardener's disease) |
| Local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis) | Sporothrix schenckii |
| Cigar-shapped budding yeast | Sporothrix schenckii |
| DOC for Sporothrix schenckii | Itraconazole or Potassium iodide |
| Clinical manifestations of Entamoeba histolytica | Amebiasis: bloody diarrhea (dysentery), liver abscess, RUQ pain |
| DOC for Entamoeba Histolytica | Metronidazole and Iodoquinol |
| How is entamoeba histolytica transmitted | Fecal-oral (or anal-oral sexual contact). Cysts in water |
| How do you diagnose Entamoeba histolytica | Serology and/or trophozoites or cysts in stool |
| Bloating, flatulence, and foul-smelling diarrhea after a camping/hiking trip | Giardia lamblia |
| How is Giardia lamblia transitted? | Cysts in water |
| How do you diagnose Giardia lamblia? | Look for the Trophozoites or cysts in the stool |
| What will a colonic biopsy of a patient with Entamoeba histolytica show? | Ulcers in the colon w/o inflammatory response. Flask-like ulcers in the submucosa. |
| DOC in Giardia lamblia | Metronidazole |
| Severe diarrhea in AIDS pts. Mild watery diarrhea in non-HIV pts. | Cryptosporidium |
| How do you diagnose Cryptosporidium | Cysts on acid-fast stain |
| How is Cryptosporidium transmitted? | Cysts in water (fecal oral) |
| Presents with prolonged realapsing watery diarrhea, abdominal cramps, and fever after eating rasberries | Cyclospora cayetanensis |
| Commonly contaminates berries (rasberries, and strawberries) | Cyclospora cayetanensis |
| How do you diagnose Cyclospora cayetanensis | Acid fast cysts in stool (not as acid fast as Cryptosporidium parvum). Also it causes UV epifluorescence. |
| How txt Cryptosporidium? | No txt |
| Commonly causes brain abscesses in HIV patients | Toxoplasma (ring enhancing brain lesions) |
| How is toxoplasma transmitted? | Oocysts in cat feces, or tissue cysts in undercooked meat. Also transplacentally |
| What is DOC for toxoplasma | TMP-SMX |
| What is the vector for malaria? | the Anopheles mosquito |
| What are the types of Malaria? | Plasmodium Vivax, P.ovale, P.malariae, P.falciparum |
| Classic presentation of malaria | Cyclic fever, headache, anemia, splenomegaly |
| Which type of malaria can cause severe cerebral infection? | Plasmodium falciparum |
| How is relapse of malaria prevented? | Primaquine (relapse occurs in P.vivax, and P.ovale) |
| What is recrudescence? | Relapse of malaria, but not from liver. Seen in P.falciparum |
| Which type of malaria requires Duffy factor? | P.vivax |
| Which type of malari infects reticulocytes? | P.vivax and P.ovale. Falciparum infects RBCs in all stages of maturation. Malariae infects only mature RBCs |
| Which type of malaria infects mature RBCs? | P.malariae |
| Which type of malaria infects RBCs in all stages of maturation? | P.falciparum |
| In malaria life cycle: Mosquitos inject what type of cells into blood? | Sporozoites |
| Hypnozoites are present in which types of malaria? | P.vivax, P.ovale |
| Which type of malaria cells are released from the liver? | Merozoites |
| Schizonts are present in what part of the malaria life cycle? | Schizonts are part of the erythrocyte cycle. Merozoites are released from liver into blood. Schizonts are in RBCs - cause RBC rupture releasing gametocytes which are taken up by another mosquito. |
| Gametocytes of malaria are matured and fertilized into sporozoites where? | Maturation and fertilization occur in the mosquito. Released sporozoites migrate to the salivary gland of the mosquito. |
| Foul-smelling, greenish vaginal discharge, causing itching and burning | Trichomonas vaginalis. |
| How diagnose Trichomonas vaginalis? | Trophozoites (motile) on wet mount. Vaginal discharge pH > 4.5 |
| Risks of Trichomonas vaginalis | Increases risk of preterm birth and HIV infection |
| "Strawberry cervix" | Trichomonas vaginalis. |
| How txt Trichomonas vaginalis? | Metronidazole |
| Vector is the Reduviid bug (kissing bug) | Trpanosoma cruzi (Chagas' disease) |
| Characteristics of Chagas' disease | Dilated cardiomyopathy, megacolon, megaesophagus |
| Romano's sign | Periorbital edema in Chagas' disease |
| How diagnose Chagas' disease? | Trypomastigotes in smooth muscle, GI tract, and blood smear |
| How does Trypansoma cruzi avoid immunity? | Antigenic variation (VSG - variant surface glycoprotein) surface Ag |
| Tsete fly | Vector of Trypanosoma gambiense and T.rhodesiense (African Sleeping Sickness) |
| DOC in Trypanosoma cruzi | Nifurtimox |
| Winterbottom's sign | Posterior cervical adenopathy in Afrcan Sleeping Sickness |
| DOC in treating Typanosoma gambiense or T.rhodesiense | Suramin for blood born disease or Melarsopro for CNS penetration |
| Sandfly | Vector for Leishmania donovani (Visceral leishmaniasis or kala-azar) |
| Where do the promastigotes of Leishmaniasis reproduce? | Macrophages (this is how diagnose - look for amastigotes in the macrophages) |
| Kala-azar | Visceral Leishmaniasis: fever, pancytopenia, hepatosplenomegaly |
| How diagnoses Leishmaniasis | Look for macrophages containing amastigotes |
| What is DOC for Leishmaniasis? | Sodium stibogluconate |
| Iodes nymph | vector for Lyme disease and Babesia microti |
| Babesiosis | Fever and anemia |
| Maltese cross of blood smear | Babesiosis |
| How txt Babesia? | Quinine, clindamycin |
| Rapidly fatal meningoencephalitis common acquired through the cribriform plate when diving into a freshwater lake | Naegleria |
| How diagnose Naegleria? | Amebas in spinal fluid |
| Sudden onset of sever fatal Praimary Amebic Meningoencephalitis (PAM) | Naegleria fowleri |
| How txt Naegleria fowleri? | No txt |
| Cestodes | Tapeworms (have long flattened body, proglottid body segments (self-contained hermaphroditic reporduction units), no gut |
| Species of tapeworms (cestodes) | Taenia saginata, Diphyllobothrium latum, Taenia solium, Echinococcus granulosus |
| Undercooked pork tapeworm; larvae cause mass lesion in the brain, cysticercosis | Taenia solium |
| Calcified cysticerci on CT or MRI | Taenia solium |
| Beef tapeworm | Taenia saginata |
| Txt of choice for Taenia solium | Praziquantel/niclosamide. Albendazole for cysticercosis |
| Hydatid cysts | "Cysts w/in cysts" - common in Echinococcus granulosus |
| Cystic rupture causing anaphylaxis | Echinococcus granulosus |
| Shepard with multiple cysts | Echinococcus granulosis |
| Dog/sheep life cycle. | Echinococcus granulosis |
| Treatment of choice for Echinococcus granulosus | Albendazole |
| In treating echinococcus granulosus cysts, is aspiration a good method? | Aspiration contraindicated because of risk of cystic rupture |
| Trematodes | Flukes. Have a blind alimentary canal, and dorsal and ventral suckers |
| Species of Trematodes (Flukes) | Schistosoma, Clonorchis sinensis |
| Diphyllobothrium latum | Fish tapeworm |
| Helminth cause of Vit B12 deficiency | Diphyllobothrium latum (b/c fish tapeworm eats it in jejunum) |
| Host of schistosoma spp | Snails in water |
| How is schistosoma transmitted | Through skin of humans |
| Intense pruritic rash at entry site followed by granulomas, fibrosis, and inflammation of the liver and spleen | Schistosoma spp |
| Common cause of bladder cancer in Japan | Schistosoma spp |
| DOC for Schistosoma | Praziquantel |
| Chinese liver fluke | Clonorchis sinensis |
| Cholangitis leading to cholangiocarcinoma | Clonorchis sinensis |
| Transmission of clonorchis sinensis | Eating undercooked fish |
| DOC in Clonorchis sinensis | Praziquantel |
| Transmitted by undercooked crab meat | Paragonimus wetermani (Lung fluke) |
| Lung Fluke | Paragonimus westermani |
| Trematode mimicking TB | Paragonimus westermani (lung mass - leading to 2ndary bacterial infection) |
| Treatment of choice for Paragonismus westermani | Praziquantel |
| Nematodes | Roundworms (wormlike, tubular alimentary tracts) |
| Hookworm | Necator americanus and Ancylostoma duodenale |
| Ancylostoma duodenale | Hookworm |
| Transmission of Ancylostoma duodenale | Commonly known as Hookworm. Larvae penetrate skin of feet. |
| Clinical manifestations of Ancylostoma duodenale | Commonly known as hookworm. Intestinal infections can cause anemia (in intestine) |
| DOC in Ancylostoma duodenale | Mebendazole/pyrantel pamoate |
| Giant Nematode (roundworm) | Ascaris lumbricoides |
| Most common helminth in the world | Ascaris lumbricoides |
| Nematode presenting with distended abdomen, or intestinal obstruction | Ascaris lumbricoides |
| DOC in Ascaris lumbricoides | Mebendazole/pyrantel pamoate |
| Pinworm | Enterobius Vermicularis |
| Enterobius vermicularis | Pinworm |
| Nocturnal pruritic ani/vulvae | Pinworm (Enterobius vermicularis) |
| DOC in Enterobius vermicularis | Mebendazole/pyrantel pamoate |
| What is only Nematode that has larvae present in feces? | Strongyloides stercoralis (allows for autoinfection) |
| How are Strongyloides stercoralis transmitted | Larvae in soil penetrate the skin |
| Clinical manifestations of Strongyloides stercoralis | Cause intestinal infection. Red, raised, serpiginous lesions on buttock and lower back. Can cause hyperinfection (entercolitis, and widespread dissemination) |
| DOC in treating Strongyloides stercoralis | Ivermectin/thiabendazole |
| Helminth infection resulting in periorbital edema, muscle pain and weakness | Trichinella spiralis |
| DOC in Trichinella spiralis | Thiabendazole |
| How diagnose Trichinella spiralis? | Muscle biopsy |
| Roundworm (nematode) found in drinking water causing skin inflammation and ulceration | Dracunculus medinensis |
| DOC in Dracunculus medinensis | Niridazole |
| Deer (crysops) fly | Vector for Loa Loa |
| Also known as Eye worm (b/c can see worm crawling in conjunctiva) | Loa loa |
| DOC in Loa loa | Diethylcarbamazine |
| Female blackfly | Vector of Onchocerca volvulus (African River blindness) |
| River Blindness | Onchocerca volvulus |
| DOC in Onchocerca volvulus | Ivermectin (I=Eye) |
| Night-biting female mosquito | Wuchereria bancrofti (Elephantiasis) |
| Elephatiasis | Wuchereria bancrofti |
| Causes blockage of lymphatic vessels resulting in lymph node scarring | Wucheria bancrofti (Elephantiasis) |
| Causes rectal prolapse | Trichuris trichiura (Whipworm) |
| Visceral larva migrans | Toxocara canis (eggs passed in dog feces) |
| Ocular larva migrans | Toxocara canis (granulomas - if in retina = blindness) |
| DOC in Toxocara canis | Diethylcarbamazine |
| DOC in Wuchereria bancrofti | Diethylcarbamazine |
| Parasite Hints: Brain cysts, seizures | Taenia solium (cysticercosis) |
| Parasite Hints: Liver cysts | Echinococcus granulosus |
| Parasite Hints: B12 deficiency | Diphyllobothrium latum |
| Parasite Hints: Biliary tract disease | Clonorchis sinesis |
| Parasite Hints: Hemoptysis | Paragonismus westermani |
| Parasite Hints: Portal hypertension | Schistosoma mansoni |
| Parasite Hints: Hematuria, bladder cancer | Schistosoma haematobium |
| Parasite Hints: Microcytic anemia | Ancylostoma, Necator |
| Parasite Hints: Perianal pruritis | Enterobius |
| Only single-stranded DNA virus | Parvoviridae (Parvovirus B19) |
| All DNA viruses are linear except: | Papovavirus (HPV, JC, BK), and Hepadnaviruses (HepB) - both are circular |
| Only RNA virus that is double-stranded | Reoviridae (Rotavirus). "Repeatovirus = Reovirus" |
| Naked (non-enveloped) DNA viruses | "PAP" (as in you have to be naked for a PAP smear): Parvoviridae (remember ssDNA), Adenovridae, and Papovaoviridae (BK, JC, HPV) |
| Enveloped DNA viruses | HPH: Hepadnaviridae (HepB), Poxviridae, and Herpesviridae |
| Naked viral genome infectivity: Infectious naked viruses | Nake nucleic acids of most dsDNA (except Poxviruses and HBV) and (+) sense ssRNA viruses are infectious |
| Naked viral genome infectivity: Non infectious naked viruses | Naked nucleic acids of (-) strand ssRNA and dsRNA viruses are not infectious |
| How do viruses acquire their envelope? | Generally, enveloped viruses acquire their envelopes from plasma membrane when they exit from cell. Exceptions are herpesviruses, which acquire envelopes from nuclear membrane |
| Virus ploidy: All viruses are: | Haploid (1 copy of DNA or RNA). Exception are retroviruses which have 2 identical ssRNA molecules (diploid) |
| Only diploid virus | Retroviruses (HIV) - have 2 identical ssRNA molecules |
| All DNA viruses replicate where? | In the nucleus (except poxvirus - replicates in cytoplasm) |
| All RNA viruse replicate where? | In the cytoplasm (except influenza virus and retroviruses (nucleus) |
| Mnemonic to remember DNA viruses | HHAPPPy viruses: Hepadna, Herpes, Adeno, Pox, Parvo, Papova |
| All DNA viruses are icosahedral except: | Pox viridae (complex - brick shaped). "Pox in a Box" |
| All DNA viruses replicated in the nucleus except: | Pox viridae (carries its own DNA-dependent RNA polymerase) |
| Categorization of Hepadnavirus | Enveloped, dsDNA, partial circular |
| Medical importance of Hepadnavirus | Hepatitis B: can be acute or chronic hepatitis, there is a vaccine available, is not a retrovirus but does have a reverse transcriptase. |
| Categorization of Herpesviruses | dsDNA, linear, enveloped (note: only enveloped viruse to acquire envelope from nuclear membrane - remember, most get from plasma membrane) |
| Types of Herpesviruses | HSV1 (oral lesions, keratoconjunctivitis), HSV2 (genital lesions), VZV (chickenpox, zoster, shingles), EBV (mono, burkitt), CMV (ICH, congenital dfts), HHV6 (roseola - exanthem subitum), HHV8 (kaposi's sarcoma) |
| Which type of Herpesvirus generally presents with oral lesions? | HHV-1 usually is the culprit of cold-sores. HSV1 can sometimes also cause genital lesions. HSV2 generally presents as genital lesions (with some oral lesions) |
| Which Herpesvirus presents with genital lesions? | HSV2 (sometimes also causes oral lesions). HSV1 is usally oral (and some genital) lesions |
| A herpetic lesion on nurses finger | Herpetic whitlow (from physical exam of person's mouth with herpes) |
| What is most common type of congenital herpes? | HSV2 (75%) |
| Categorization of Adenovirus | dsDNA virus, linear, naked (part of PAP - other nakeds are Parvo and Papova) |
| Common clinical manifestations of Adenovirus | Febrile pharyngitis (sore throat), Pneumonia, Conjunctivitis - "pink eye" |
| What causes "pink eye"? | Adenovirus |
| Categorization of Parvovirus | ssDNA (the only one!), linear, negative sense, naked |
| Why does a physician have to closely monitor a fetus of a mom exposed to Parvovirus B19? | Can cause hydrops fetalis! |
| Can cause an aplastic crises in patients with sickle cell disease | Parvovirus B19 |
| "Slapped cheek" | Parvovirus B19 |
| Parvovirus B19 is aka? | Erythema infectiosum (fifth disease) |
| Categorization of Papovavirus | dsDNA, circular, naked |
| Types of Papovavirus | HPV, JC, BK |
| Which types of HPV can lead to cancer? | HPV 16, 18, 31, 45 can predispose to cervical, penile, and anal cancer |
| How is HPV transmitted? | Direct contact (sexual and non-sexual, minor trauma, and maternal-fetal |
| Condyloma acuminata from? | HPV 6-11. most common viral STD. |
| What regulatory genes does HPV inactivate? | Rb, and p53 |
| Progressive multifocal leukoencephalopathy is caused by? | JC virus (a Papovavirus). Presents as demyelination of CNS, hemiparesis, cognitive problems, visual field defects. |
| How does PML present? | Demyelination of CNS, hemiparesis, cognitive problems, and visual field defects in ICH. Is a subcortical lesion that doesn't enhance with contrast on MRI |
| How does BK virus present | Asymptomatic in immunocompetent hosts. In ICH can have hemorrhagic cystitis, and renal transplant rejection |
| What is the smallest DNA virus? | Parvovirus (also is ssDNA!) |
| What is the largest DNA virus? | Poxvirus |
| Categorization of Poxvirus | dsDNA, linear, brick-shaped, enveloped |
| Types of Poxvirus | Smallpox, Vaccinia, Molluscum contagiosum |
| What is the only DNA virus that replicated in the cytoplasm? | Poxvirus |
| How tell between smallpox and chicken pox? | SMALLPOX: prodrome fever 2-4 day b/f rash, all pocks at same stage, pocks are deep seated, firm pustules, lesions on face, palms, and soles. CHICKENPOX: no prodrome, pocks at different stages, "dew drops on rose petal", mostly on trunk (few palms/soles) |
| Molluscum Contagiosum | A pox viruse. Have umbilicated skin lesions with eosinophilic cytoplasmic inclusion bodies |
| Positive vs. Negative Sense | Positive sense RNA produces a negative sense intermeidate to produce a genomic duplictate. Negative sense RNA produces a positive sense intermediate to produce a genomic duplicate |
| Categorization of Picornaviruses | non-enveloped, ssRNA, positive sense, linear, icosahedral |
| Which RNA viruses are naked? | Reoviruses, Picornaviruses, Calciviruses, Herpeviridae. "Rachel Plays Her Clarinet naked" |
| What is the only double-stranded RNA virus | Reovirus - of which Rotavirus is most famous |
| Salk/Sabin vaccines | for Polio virus (a Picornavirus) |
| Echovirus can cause? | Aseptic meningitis |
| Types of Picornaviruses | Poliovirus, Echovirus, Rhinovirus, Coxsackievirus, Hepatitis A virus (PERCH) |
| Most common cause of the common cold | Rhinovirus (a Picronavirus - ssRNA, +, linear, icosahedral) |
| Coxsackie A16 | Hand, foot, and mouth disease |
| Coxsackie B | myocarditis |
| Common cause of summer meningitis | Coxsackie virus (aseptic) |
| Sudden onset of RUQ pain, fever, dark urine, and light stool after an international trip | Hepatitis A (picornaviridae, ssRNA non-enveloped) |
| Causes of Chronic Hepatitis | HBV, HCV, HDV |
| Categorization of Calciviruses | Non-enveloped, ssRNA, +, linear, Icosahedral |
| Star of David appearance on EM | Norwalk virus (a Calcivirus) - common cause of gastroenteritis |
| Outbreak on cruise ship | Norwalk viruse (a Calcivirus - ssRNA, naked) - found on any type of food (common on shellfish). very infectious |
| Categorization of Reovirus | Non-enveloped, dsRNA, linear segmented, double icosahedral (only dsRNA virus!) |
| Colorado Tick Fever | A Reovirus (dsRNA), presents similar to Rocky Mountain spotted fever |
| #1 cause of fatal diarrhea in children | Rotavirus (a Reovirus - dsDNA). |
| How diagnose Rotavirus? | Look for VP6 antigen in stool. Also know that is dsRNA |
| How remember enveloped, ssRNA, + sense viruses? | "Cons Rob From Tourists" (Coronaviruses, Retroviruses, Flaviviruses, Togaviruses) |
| Categorization of Flaviviruses | Enveloped, ssRNA, + sense, linear |
| Types of Flaviviruses | HCV, Yellow fever, Dengue fever, St. Louis encephalitis, West Nile Virus |
| Fever with jaundice | Yellow fever (flavivirus). Transmitted by aedis aegypti mosquito |
| Break bone fever | Dengue fever (a flavivirus) |
| Dengue virus has tropism for which type of cells? | Striated muscle - causing break bone fever |
| Culex mosquito/Birds in life cycle | St. Louis encephalitis, and West Nile virus |
| Older individual bitten by a mosquito causing encephalitis | West Nile virus |
| Categorization of Togaviruses | Enveloped, ssRNA, positive sense, linear (part of 'Cons Rob From Tourists') |
| Types of Togavirus | Rubella (German measles), Eastern equine encephalitis, Western equine encephalitis |
| What is the only Togavirus that is not transmitted via arthropod? | Rubella (German measles) |
| Which is more severe WEE or EEE? | EEE is more severe (mortality approx 30% in those who develop encephalitis). Both are Togaviruses |
| Congenital Rubella | Purpura (blueberry muffin rash), Deafness, Cataracts, Heart defects (PDA), Retardation, Retinopathy |
| Latino pregnant women comes in with 3 day rash that began at her face and descended. What do you worry about? | Rubella (German measles) - can cause congenital rubella!!! |
| Categorization of Retroviruses | Enveloped, ssRNA, positive sense, linear. Have reverse transcriptase (HIV) |
| Categorization of Coronaviruses | Enveloped, ssRNA, positive sense, linear. Have Helical capsid (all others in this group of Cons Rob From Tourists are Icosahedral) |
| Types of Coronaviruses | SARS and Common cold |
| SARS | Triphasic course. 1) Fever, myalgia 2) Cough, dyspnea 3) Recurrent fever, progressive infiltrates |
| How to remember the Enveloped, ssRNA, negative sense viruses | Real Foes Are Better Paralyzed Or Dead (Rhabdoviruses, Filoviruses, Arenaviruses, Bunyaviruses, Paramyxoviruses, Orthomyxoviruses, Deltavirus) |
| Categorization of Orthomyxoviruses | Enveloped, ssRNA, negative sense |
| Only clinically important Orthomyxoviruses | Influenza virus |
| Influenza virus | An orthomyxovirus (ssRNA, -, enveloped) |
| What are the major antigens of the influenza virus? | H and N |
| How does influnza virus evade the immune system? | 1) Antigenic drift (gradual alteration of H and/or N w/in subtype which occurs in both A and B viruses). 2) Antigenic shift (appearance in human population of new subtype of A virus from animal reservoir like swine) |
| Antigenic drift | Gradual alteration (point mutations) of H and/or N w/in subtype which occurs in both A and B viruses |
| Antigenic shift | Appearance in human population of new subtype of A virus (from animal reservoir like swine) |
| Categorization of Parmyxoviruses | Enveloped, ssRNA, negative sense, linear. |
| Types of Paramyxoviruses | PaRaMyxovirus: Parainfluenza, RSV, Measles, Mumps |
| Parainfluenza virus | A Paramyxovirus (ssRNA, enveloped, negative sense). Commonly causes croup (PIV1). PIV3 is second leading cause of bronchiolitis and pneumonia in infancy. PIV4 is asymptomatic or mild cold. |
| Croup | Parainfluenza virus 1 (a Paramyxovirus). Presents with a barking cough, and respiratory stridor |
| How does Parainfluenza virus type 3 present? | Second leading cause of bronchiolitis and pneumonia in infancy |
| Bronchiolitis in babies | RSV |
| DOC for RSV | Ribavirin |
| Which Paramyxovirus carries an RNA dependent RNA polymerase? | RSV |
| Antigeninc derterminants of RSV | F (fusion), G (attachment) |
| Measles | A Paramyxovirus (ssRNA, enveloped, negative sense, linear). Aka: Rubeola. 3C's: Cough, Coryza, Conjunctivitis. Also Koplick spots. Maculopapular rash which starts head, and spreads downward |
| Cough, Coryza, Conjunctivitis | Measles |
| Rash that spreads like a paintcan poured on someone | Measles |
| Slowly progressive central nervous system disease with mental deterioration and incoordination many years after measles | SSPE (Subacute Sclerosing Panencephalitis) |
| Parotid gland swelling | Mumps |
| Orchitis | Mumps |
| Categorization of Rhabdoviruses | Enveloped, ssRNA, negative sense, linear. Only one is Rabies |
| Rabies | Rhabdovirus (ssRNA, enveloped, negative sense) |
| Negri bodies | Rabies |
| Bullet-shaped, linear genome | Rabies (ssRNA, negative sense, Rhabdovirus) |
| Virus begins in striated muscle, ascends neurons to CNS where it spreads peripherally from CNS along neurons | Rabies |
| Concentrates in salivary glands | Rabies |
| How does Rabies present? | 1) FURIOUS: hydrophobia, hallucinations, agitation, biting. 2) DUMB: ascending flaccid paralysis |
| What is mortality of Rabies? | 100% (if not treated) |
| How treat Rabies? | Rabies immunoglobulin and vaccine within 48-72 hours |
| Categorization of Filoviruses | Enveloped, ssRNA, negative sense, linear. (part of Real Foes Are Better Paralyzed Or Dead) |
| Types of Filoviruses | Ebola virus, Marburg virus |
| Hemorrhagic fevers resulting in DIC and Death | Ebola and Marburg virus (Filoviruses) |
| Categorization of Arenaviruses | Enveloped, ssRNA, negative sense, circular. |
| Types of Arenaviruses | LCV (lymphocytic choriomeningitis), Lassa Virus |
| Lymphocytic Choriomeningitis Virus | Arenavirus. Has "sand" granuels due to ribosomes. Causes meningitis from aerosolization of murine feces/urine. |
| Lassa Virus | Arenavirus. Has "sand" granuels due to ribosomes. Classic presentation is bleeding, neck/face swelling, and shock |
| How is Lassa virus transmitted | Rodent to human or human to human. |
| Meningitis spread by mice | LCV (Arena virus) |
| Categorization of Bunyaviruses | Enveloped, ssRNA, negative sense, circular. |
| Types of Bunyaviruses | California encephalitis, Sandfly/Rift Valley Fevers, Crimean-Congo hemorrhagic fever, Hantavirus |
| Pulmonary syndrome after exposure to deer mouse | Hanta virus |
| Hepatitis D virus | Deltavirus. Enveloped, ssRNA, negative sense, circular. |
| Live attenuated vaccines induce what type of immunity? | Humoral and cell-mediated immunity |
| Killed vaccines induces what type of immunity? | Humoral |
| What vaccines are Live attenuated? | Measles, Mumps, Rubella. Sabin, VZV, Yellow Fever, Smallpox, Adenovirus |
| What vaccines are killed | Rabies, Influenza, Salk (polio), and HAV. Mnemonic: RIP Always. SalK=Killed |
| Egg based vaccines | Flu, MMR, Yellow fever (FRY an egg) |
| Recombinant vaccines | HBV (antige = recombinant HBsAg) |
| What is Recombination | Exchange of genes between 2 chromosomes by crossing over within regions of significant base sequence homology |
| Exchange of genes between 2 chromosomes by crossing over within regions of significant base sequence homology | Recombination |
| What is Reassortment? | When viruses with segmented genomes (eg influenza virus) exchange segments. High frequency recombination. Cause of worldwide pandemics. |
| When viruses with segmented genomes (eg: influenza virus) exchange segments. High frequency recombination. Cause of worldwide pandemics. | Reassortment |
| What is Complementation? | When 1 of 2 viruses that infect the cell has a mutation that results in a nonfunctional protein. The nonmutated virus "complements" the mutated one by making a functional protein that serves both viruses |
| When 1 of 2 viruses that infect the cell has a mutation that results in a nonfunctional protein. The nonmutated virus makes a functional protein that serves both viruses. | Complementation |
| What is Phenotypic mixing? | Genome of virus A can be coated with surface proteins of virus B. Type B protein coat determines the infectivity of the phenotypically mixed virus. However, the progency from this infection has a type A coat and is encoded by its type A genetic material. |
| Genome of virus A can be coated with surface proteins of virus B. Type B protein coat determines the infectivity of the phenotypically mixed virus. However, the progeny form this infection has a type A coat and is encoded by its type A genetic material. | Phenotypic mixing |
| Negative stranded viruses | Rhabdovirus, Filovirus, Arenavirus, Bunyavirus, Paramyxovirus, Orthomyxovirus, Deltavirus. "Real Foes Are Better Paralyzed Or Dead" |
| Segmented viruses | Bunyavirus, Orthomyxovirus, Arenavirus, Reovirus. "BOAR" |
| Picornavirus types | Poliovirus, Echovirus, Rhinovirus, Coxsackievirus, HAV. "PEARCH on a peak" |
| Are Picornaviruses large or small? | Small. PicoRNAvirus = small RNA virus |
| How are Picornaviruses manufactured? | RNA is translated into 1 large polypeptide that is cleaved by proteases into functional viral proteins |
| Important facts about Rhinovirus | Nonenveloped RNA virus (Picornavirus). Cause of common cold. >100 serotypes |
| Most important cause of infantile gastroenteritis | Rotavirus (segmented dsRNA virus) |
| Major cause of acute diarrhea in the US during winter | Rotavirus (segmented dsRNA) |
| Virus causing villous destruction with atrophy leading to decreased absorption of Na+ and water | Rotavirus (dsRNA, segmented, Reovirus) |
| Mnemonic to remember clinical consequences of Mumps | Mumps makes your parotid glands and testes as big as POM-poms. (P=parotitis, O=orchitis, M=meningitis) |
| Virus containing hemagglutinin and neuraminidase antigens | Influenza virus |
| What type of vaccine is the influenza vaccine? | Killed |
| Genetic shift | (Pandemic) Reassortment of viral genome (such as when human flu A virus recombines with swine flu A virus) |
| Genetic drift | (Epidemic) Minor changes based on random mutation |
| Which is more deadly Genetic shift, or Genetic drift? | Sudden Shift is more deadly than graDual Drift |
| Txt of choice for Influenza virus | Amantadine and Remantadine useful for influenza A. Zanamivir and Oseltamivir are useful for both influenza A and B |
| How does Rubella cause deafness? | Deafness is due to failure of cochlea and spiral ganglion to develop |
| Travels to the CNS by migrating in a retrograde fashion up nerve axons | Rabies virus |
| Arboviruses | Viruses transmitted by ARthropods. Flavivirus, Togavirus, and Bunyavirus. "Fever Transmitted by Bites" |
| What is the reservoir for Yellow Fever? | Monkey or human reservoir |
| High fever, black vomitus, and jaundice | Yellow fever |
| Councilman bodies in the liver | Yellow fever |
| Mnemonic to remember the types of Herpes | Get herpes in a CHEVrolet: CMV, HSV, EBV, VZV |
| Clinical manifestations of HSV-1 | Gingivostomatitis, keratoconjunctivits, temporal lobe encephalitis, herpes labialis |
| How is HSV-1 transmitted? | Respiratory secretions, saliva |
| Clinical manifestations of HSV-2 | Herpes genitalis, neomatal herpes |
| How is HSV-2 transmitted? | Sexual contact, perinatal |
| Clinical manifestations of VZV | Varicella-zoster (shingles), encephalitis, pneumonia |
| How is VZV transmitted? | Respiratory secretions |
| What are the clinical manifestations of EBV? | Infectious mononucleosis, Burkitt's lymphoma |
| How is EBV transmitted? | Respiratory secretions, saliva |
| What are the clinical manifestations of CMV? | Congenital infection, mononucleosis (negative monospot), pneumonia |
| How is CMV transmitted? | Congenital, transfusion, sexual contact, saliva, urine, transplant |
| What are the clinical manifestations of HHV-8 | Kaposi's sarcoma in HIV patients |
| How is HHV-8 transmitted? | Sexual contact |
| Monospot test | heterophile antibodies detected by agglutination of sheep RBCs |
| Abnormal circulating cytotoxic T cells (atypical lymphocytes). Reacting against infected B cells | Mononucleosis |
| A smear of an opened skin vesicle to detect multinucleated giant cells | Tzank test (looking for HSV1,HSV2, and VZV). "Tzanck heavens I do not have herpes" |
| HAV | (RNA picornavirus) transmitted primarily by fecal oral route. Short incubation (3 weeks). No carriers |
| Mnemonic to remember Hep A | Hep A: Asymptomatic (usually), Acute, Alone (no carriers, and naked ssRNA) |
| HBV | DNA hepadnavirus. Transmitted primarily by parenteral, sexual, and maternal-fetal routes. Long incubation (3 months). Carriers. Reverse transcription occurs, however, the virion enzyme is a DNA-dependent DNA polymerase |
| Which Hepatitis virus can undergo reverse transcription? | HBV (however, the virion enzyme is a DNA-dependent DNA polymerase) |
| HCV | RNA flavivirus. Transmitted primarily via blood and resembles HBV in its course and severity. Carriers. Common cause if IV drug use hepatitis in the US. |
| Common cause of IV drug use Hepatitis in the US | HCV (RNA flavivirus) |
| Mnemonic to remember importance of Hep C | Hep C: Chronic, Carriers, Cirrhosis, Carcinoma. |
| HDV | Deltavirus. A defective virus that requires HBsAG as its envelope. Carriers |
| HEV | (RNA Calcivirus). Transmitted enterically and causes water-borne epidemics. High mortality rate in pregnant women. |
| Hepatitis to worry about in pregnant women | HEV (high mortality!) |
| Which hepatitis viruses are transmitted fecal-orally? | A and E. "The vowels hit your bowels" |
| Mnemonic to remember importance of Hep D | Hep D: Defective, Dependent on HBV |
| Mnemonic to remember importance of Hep E | Hep E: Enteric, Expectant mothers, Epidemics. |
| Which hepatitis viruses predispose a patient to chronic active hepatitis, cirrhosis, and hepatocellular carcinoma? | HBV and HCV |
| Best test to detect active hepatitis A? | IgM HAVAb. (IgM antibody to HAV) |
| Antigen found on surface of HBV | HBsAg (continued presence of antigen indicates carrier state) |
| The presence of this antigen indicates continued carrier state of Hepatitis B | HBsAg |
| Which antibody indicates immunity to Hepatitis B | HBsAb (antibody to HBsAg) |
| Antigen associated with core of HBV | HBcAg |
| Hepatitis B test that is positive during window period | HBcAb (antibody to Hepatitis B core antigen) |
| IgM HBcAb is indicative of what? | an indicator of recent disease |
| What is an important indicator of HBV transmissibility? | HBeAg. "BEware" |
| What indicates low HBV transmissibility? | HBeAb |
| HBeAb | Indicates low transmissibility of HBV |
| HBeAg | Indicates high transmissibility of HBV |
| HBcAb | Antibody to HBcAg. indicates during window period. |
| HBsAb | Indicates immunity to HBV |
| HBsAg | indicates carrier state of HBV, or early incubation period of HBV. |
| During the incubation period of HBV what will be positive? | HBsAg |
| During the Prodrome, or Acute disease phase of HBV what will be positive? | HBsAg, HBcAb |
| What is only serologic marker during window period? | HBcAb |
| What serologic markers indicate complete recovery from HBV | HBsAb, HBcAb (IgG) |
| What serologic markers indicate acute HBV? | HBsAg, HBcAb (IgM) |
| What serologic markers indicate the chronic carrier state of HBV? | HBcAb (IgG), HBsAg |
| What does the gp41 protein do in HIV? | It is an envelope protein (other is gp120). More specifically it acts during fusion of the viral envelope and cell membrane |
| What does gp120 protein do in HIV? | It is an envelope protein (other is gp41). More specifically it is the envelope protein which binds to CD4. |
| What does the p24 protein do in HIV? | is a rectangular neuclocapsid protein |
| Is the HIV genome haploid or diploid? | Diploid (2 molecules of RNA) |
| What does the p17 protein do in HIV? | It is a matrix protein |
| An RNA dependent DNA polymerase | HIV |
| Presumptive diagnosis of HIV is made with? | ELISA (sensitive, high false-positive rate, and low threshold) - can RULE out test. Positive results are then confirmed with Western blot assay (specific, high false-negative rate and high threshold) - Rule IN diagnosis |
| Which test has a high sensitivity for HIV? | ELISA (can rule out) - usually is inital test |
| Which test has a high specificity for HIV? | Western blot assay (can rule in HIV) - usually used to confirm a positive ELISA |
| What tests allow physicians to monitor the viral load of HIV? | HIV PCR |
| AIDS diagnosis | = < 200 CD4+, HIV positive with AIDS indicatior contition (eg: PCP), or CD4/CD8 ratio <1.5 |
| CCR5 mutation | If homozygous allows immunity to HIV. If heterozygous, have a slower HIV course. (1% Americans homozygous, 20% heterozygous) |
| CXCR1 mutation | Rapid progression in AIDS |
| Reservoirs of HIV during latent phase of infection | Follicular dendritic cells in germinal centers of lymph nodes |
| Serologic markers of Acute HIV infection | Virus p24 antigen, High CD4 cells, Increasing number of Anti-p24, and Anti-gp120 antibodies |
| Serologic markers of latent HIV infection | Anti-p24 antibodies, Anti-gp120 antibodies, Still have high number of CD4 cells |
| Serologic markers of Progressive HIV infection | Decreasing number of CD4 lymphocytes, Decreasing amt of anti-p24 antibodies, and anti-gp120 antibodies, increasing amount of viral p24 antigen |
| What are opportunistic infections of the Brain in AIDS? | Cryptococcal meningitis, toxoplasmosis, CMV encephalopathy, AIDS dementia, PML (JC virus) |
| Opportunistic infections affecting the eyes of AIDS patients | CMV retinitis |
| Opportunistic infections affect the mouth and throat of AIDS patients | Thrush, HSV, SMV, oral hariy leukoplakia (EBV) |
| Opportunistic infections affecting the Lungs of AIDS patients | PCP, TB, Histoplasmosis |
| Opportunistic infections affecting the GI tract of AIDS patients | Cryptosporidiosis, MAC complex, CMV colitis, non-Hodgkin's lymphoma (EVB) |
| Opportunistic infections affecting the Skin of AIDS patients | Shingles (VZV), Kaposi's sarcoma (HHV-8) |
| Opportunistic infections affecting the Genitals of AIDS patients | Genital herpes, warts, and cervical cancer (HPV) |
| Primary CNS lymphoma | An intermediate to hight grade B cell lymphoma associated with EBV affecting AIDS patients. Presents with seizures, HA, cranial nerve deficits, and multicentric lesions sometimes involving the meninges. |
| Infectious agents that do not contain RNA or DNA | Prions (consist only of proteins) |
| Spongiform encephalopathy | Prion disease |
| Types of Prion disease | Creutzfeldt-Jakob disease, Kuru, Scrapie, and Mad Cow disease |
| Conformation of prions | Normal prions have alpha-helix conformation. Pathologic prions (like CJC) are beta-pleated sheets |
| Dominant normal flora of the Skin | Staphylococcus epidermidis |
| Dominant normal flora of the Nose | Staphylococcus aureus |
| Dominant normal flora of the Oropharynx | Viridans streptococci |
| Dominant normal flora of a dental plaque | Streptococcus mutans |
| Dominant normal flora of the colon | Bacteriodes fragilis > E.coli |
| Dominant normal flora of the vagina | Lactobacillus, colinized by E.coli and group B strep |
| Common causes of pneumonia in Children 6wks - 18 yrs | Viruses (RSV), Mycoplasma, Chlamydia pneumoniae, Strep pneumoniae |
| Common causes of pneumonia in Adults (18-40yrs) | Mycoplasm, Chlamydia pneumoniae, Strep pneumo |
| Common causes of pneumonia in Adults (40-65yrs) | S.pneumo, H.influenza, Anaerobes, Viruses, Mycoplasma |
| Common causes of pneumonia in Elderly | S.pneumo, Viruses, Anaerobes, H.influenza, Gram-negative rods |
| Pneumonia (hospital acquired) | Staphylococcus, gram-negative rods |
| Pneumonia in immunocompromised | Staphylococcus, gram-negative rods, fungi, viruses |
| Aspiration pneumonia | Anaerobes |
| Pneumonia in alcoholic/IV drug user | S.pneumoniae, Klebsiella, Staphylococcus |
| Post-viral pneumonia | Staphylococcus, H.influenza |
| Neonatal pneumonia | Group B streptococci, E.coli |
| Atypical pneumonias | Mycoplasma, Legionella, Chlamydia |
| MCC meningitis newborns | Group B streptococci |
| MCC meningitis Children (6mo-6yrs) | Streptococcus pneumoniae |
| MCC meningitis Adults (6yrs-60yrs) | N.meningitidis |
| MCC meningitis Elderly (60+) | S.pneumoniae |
| Causes of meningitis in HIV positive individuals | Cryptococcus, CMV, toxoplasmosis, JC virus |
| What type of meningitis has Increased opening pressure, Increased PMNs, Increased protein, and Decreased glucose | Bacterial |
| What type of meningitis has Increased opening pressure, Increased lymphocytes, Increased protein, and decreased glucose | Fungal/TB |
| What type of meningitis has Normal to Increased opening pressure, Increased number of lymphocytes, Normal protein, and Normal glucose | Viral |
| Bacterial Meningitis CSF findings | Increased opening pressure, Increased number of PMNs, Increased amt of protein, Decreased glucose |
| Fungal/TB meningitis CSF findings | Increased opening pressure, Increased number of lymphocytes, Increased amt of Protein, Decreased glucose |
| Viral meningitis CSF findings | Normal or increased opening pressure, Increased number of lymphocytes, Normal amt of protein, Normal glucose |
| MCC of Osteomyelitis | S.aureus |
| Osteomyelitis in sexually active individual | N.gonorrhoeae (rare), septic arthritis is more common |
| Osteomyelitis in diabetics and drug addicts | Pseudomonas aeruginosa |
| Osteomyelitis in Sickle cell disease | Salmonella |
| Osteomyelitis in persons with prosthetic replacement | S.aureus and S.epidermidis |
| Vertebral Osteomyelitis | Mycobacterium tuberculosis (Pott's disease) |
| UTIs in ambulatory pts | E.coli (50-80%), S.saprophyticus (10-30%), Klebsiella (8-10%) |
| UTIs in hospital pts | E.coli, Proteus, Klebsiella, Serratia, Pseudomonas |
| Predisposing factors to UTIs | Flow obstruction, kidney surgery, catherterization, gynecologic abnormalities, diabetes, pregnancy |
| Fever, chills, flank pain, and CVA tenderness | Pyelonephritis |
| Dysuria, frequency, urgency, suprapubic pain | Urinary tract infection |
| UTI bug producing a red pigment. Is often nosocomial and drug resistant | Serratia marcescens |
| UTI bug is 2nd leading cause of community-acquired UTI in sexually active women | Staphylococcus saprophyticus |
| UTI bug showing metallic sheen on EMB agar | E.coli (is the leading cause of UTI) |
| UTI bug that is often nosocomial and drug resistant | Enterobacter cloacae |
| UTI bug that has a large mucoid capsule and viscous colonies | Klebsiella pneumoniae |
| UTI bug that is motile, causing "swarming" on agar. also produces urease and is associated with struvite stones | Proteus mirabilis |
| UTI bug producing a blue green pigment and fruity odor. is usually nosocomial and drug resistant | Pseudomonas aeruginosa |
| Mnemonic to remember UTI bugs | SSEEKPP (Serratia marcescens, S.saprophyticus, E.coli, Enterobacet cloacae, Klebsiella, Proteus, Psedomonas) |
| Leukocyte esterase positive | Indicates bacterial |
| Nitrite test positive | Indicated gram-negative |
| Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge | N.gonnorrhoeae |
| Painless chancre | primary syphilis |
| Fever, lymphadenopathy, skin rashes, codylomata lata | secondary syphilis |
| Gummas, tabes dorsalis, general paresis, aortitis, argyll robertson pupil | tertiary syphilis |
| Painful penile, vulvar, or cervical ulcers | Genital herpes (HSV2) |
| Urethritis, cervicitis, conjunctivitis, Reiter's syndrome, PID | Chlamydia Trachomatis (D-K) |
| Ulcers, lympadenopathy, rectal strictures | Lymphogranuloma venereum (Chlamydia trachomatis L1-L3) |
| Vaginitis, strawberry-colored mucosa | Trichomonas vaginalis |
| Genital warts, koilocytes | Condylomata acuminata (HPV 6 and 11) |
| Painful genital ulcer, inguinal adenopathy | Chancroid (Haemophilus ducreyi) |
| Noninflammatory, malodorous vaginal discharge (fishy smell), positive whiff test, clue cells | Bacterial vaginosis (Gardnerella vaginalis) |
| Chandelier sign | Cervical motion tenderness in Pelvic inflammatory disease |
| Top causes of PID | Chlamydia trachomatis (subacute, often undiagnosed), Neisseria gonorrhoeae (acute, high fever) |
| Cervical motion tenderness, purulent cervical discharge | PID |
| Salpingitis is a risk factor for: | Ectopic pregnancy, infertility, chronic pelvic pain, and adhesions |
| Nosocomial infections: Newborn nursery | CMV, RSV |
| Nosocomial infections: Urinary catherterization | E.coli, Proteus mirabilis |
| Nosocomial infections: Respiratory therapy equipment | Pseudomonas aeruginosa |
| Nosocomial infections: Work in renal dialysis unit | HBV |
| Nosocomial infections: Hyperalimentation | Candida albicans |
| Nosocomial infections: Water aerosols | Legionella |
| Highest yield hints: Pus, empyema, abscess | S.aureus |
| Highest yield hints: Pediatric infection | H.influenza (including epiglottitis) |
| Highest yield hints: Pneumonia in cystic fibrosis, burn infection | Pseudomonas |
| Highest yield hints: Branching rods in oral infection | Actinomyces israelii |
| Highest yield hints: Traumatic open wound | Clostridium perfringens |
| Highest yield hints: Surgical wound | S.aureus |
| Highest yield hints: Dog or cat bite | Pasteurella multocida |
| Highest yield hints: Currant jelly sputum | Klebsiella |
| Highest yield hints: Sepsis/meningitis in newborm | Group B strep |
Created by:
tommyparisi
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