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Opportunistic pathogen
trasnmitted as STD, Transfusion/ transplantation, oral,
congenital
Lymphotropic
latent in T cells .
Structure: Delicate outer envelope. Glycoprotein (gp) 120 Retroviridae: “retrovirus” because it uses
(Ag and receptor specificity high amount of antigenic reverse transcriptase. Four subfamilies: know
shift). Very limited host and species range. This gp-120 LENTIVIRINAE (slow replicating) causes
continuously changes so it is difficult to treat (no vaccine). AIDS
TRANSMISSION : Sexual (anal and vaginal). Oral sex less infectious than other STDs.
Peri-natal. Blood: IV drug users, needle stick injury, blood transfusions.
Risks are slight unless close intimate contact and/or transfer of semen, blood, vaginal
secretions. Problem: long, prodromal asymptomatic period (infectious before identifiable
symptoms).
Delicate outer membrane: can’t stick, wont get the infection!
Not likely by: casual contact, touching, kissing (even open mouth), coughing, sneezing,
inset bites, water, food, utensils, toilets, swimming pools, public baths
Opportunistic fungi,
Associated with: Cause Disease iff:
-Dimorphic but unlike other mycotic agents
defective T cell immunity only , immunocompromised, broad spectrum
only present in hyphae in body
Candida Spp hypoparathyroidism, hypoadrenals ,glucose ABCS, dietary imbalance , endocrine
-no yeast cells
imbalances changes, pH changes
-detect after treatment of KOH 10%
disruption of normal bacterial ecology -Diseases are not contagious
NO dimorphism in pathogenesis ,
encapsulated yeast ,
Acidic mucopolysaccharide capsule Virulence factors:
Cryptococcus spp
-Ubiquitous capsule (anti-phagocytic)
-pigeon droppings (desiccated alkaline rich, N2
rich, hypertonic
Included with fungi only because of molecular
Oxygen
Pneumocystis traits , Opportunistic infection, found in
has features like protozoans ABCs
jirovecii (carinii) rodents, Transmission thru respiratory droplets
(increased risk if immuno suppressed)
Moribillovirus: measles
Similarities in family: Enveloped, form syncytia, replicate
virus - "rubeola", animal immunity from reinfection
in cell cytoplasm, transmitted via respiratory droplets
disease.
adult infectin is more severe than
children. VERY infections (less than Tx:sympomatic only no viral
Paramyxovirus:
mumps related to parainfluenza virus 2. one serotype mostly in school age 5-14 yr old. Increae risk of measles or Chicken pox). Spread by agents. Prevention: control almost
parainfluenzae and Mumps
(like measles) spread with crowding and in winter direct contactor respiratory secretions imposs due to virus ubiquitous and
mumps viruses
Life long resiistance to infection (like infectxion is subacute
measles)
Paramyxoviridae
family Tx: zinc lozengges every 2-4
hours. Max 60 mg. too high will
lower immune system. Engestol
VERY congagious, tranmitted by hands
ubiquitous, almost everyone in NA is infected RSV, #1 cause of severe lower (heel product decreases sore
Pneumovirus: smaller nuceocapsid more fragile ( to freezing) than other fomites and respiratory secretions.no
by age 4. epidemics EVERY winter in cold repiratory infection in young throat for flu virus) also
respiratory syncitial paramyxoviruses. Pathology due to direxct invasion of systemic spread/veremia . No long
temperate climate ( hot humid summerns in children ( day care and nurseries) homeopathic eupatorium .
virus "RSV" respiratory epithelium (syncythia) term immunity (unlike measles or
Hong Kong) #2 cause of parainfluenza Amost impossible and too
mumps)
ubiquitous to control. Good
vacines n/a. better prevention via
gloves, masks etc
ENVELOPED
TRANSMISSION = parenteral (blood Universal blood screening, reduce
FLAVIVIRUS (like west nile virus)
transfusion, drug users, piercings, tatoos) - risk behaviours
Inactivated by DETERGENTS
HCV rarely sexual or perinatal
M'C cause of NON-ALCOHOLIC LIVER DZ in USA
Vaccine difficult due to HIGH
Only get partial immunity after recovery
Close link with HIV VIRAL HETEROGENEITY
Delta Agent = viral parasite ie. NEEDS HBV as HELPER
HDV
virus
TRANSMISSION = Fecal-oral (m'c in
HEV Severe in PREGNANT women
developing nations)
NOTE - Leisheid ran
out of time with
Hepatitis lecture so said
that we only have to
know a couple of points
for Hep D and Hep E.
These points are
include in this
document.
Microbe System Condition Signs and Symptoms Contagious? DDX and Lab DX
"Spaghetti and meatballs" organism
Non-itchy, hypopigmented lesions on upper torso, arms, after KOH prep. Wood's lamp (+).
Malassezia furfur Skin (superficial) Tinea (pityriasis) versicolor abdomen Use this to DDX from vitiligo
(long name we don't need to
Skin (superficial) Tinea nigra Well demarcated lesions on palms and soles Dark pigmented yeast cells
know)
don’t need name Skin (superficial) Black Piedra Dark, hard nodules along infected hair shaft
don't need name Skin (superficial) White Piedra Soft, pasty white growth on hair shaft
don't need name Skin (cutaneous) Tineas Named for part of body they affect
Primary histopasmosis: acute, self-limiting influenzae-
CXR: residual calcified lesions in
Histoplasma capsulatum Systemic Acute histoplasmosis like illness. Complications: mediastinal fibrosis, ocular NO
lung, LN: "coin lesions"
histoplasmosis syndrome.
Serious retinal condition. Leading cuase of blindness in
Histoplasma capsulatum Eye Ocular histoplasmosis syndrome 20-40 year olds. Get "histo spots" bilaterally. MC'ly no NO
visual loss
Microscopy: 10% KOH prep with
Disseminated via lymphatics. Increased risk if cell- silver or Giemsa stain. Serological:
mediated immunity is impaired. Can look like TB! Fever, skin tests (like TB test), but there are
Histoplasma capsulatum Systemic Progressive histoplasmosis (chronic) NO
night sweats, weight loss with destructive (caseating) too many false positives. Cultures:
necrosis, lung lesions. slow growing (1-2 weeks) and
spores are infectious.
CXR: no residual calcified lesions,
Blastomyces dermatides Systemic Acute blastomycosis Bronchopneumonia, drenching sweats. NO
unlike histoplasmosis.
Skin test and serology: too many
TB or cancer-like!!! May present with skin lesions: slowly
false positives. Microscopy:
Blastomyces dermatides Systemic Chronic blastomycosis exanding ulcerative or verrucous lesions on face and NO
biopsy/histology of KOH-prepped
mucocutaneous borders of nose and mouth.
tissue sample. Culture (?).
Skin test antigens (like TB): Use 2-4
weeks after symptoms. Antigens
Most commonly asymptomatic. 40% mild, febrile to
are Coccidiodin and Spherulin.
moderately severe respiratory disease (much higher
Coccidiodes immitis Systemic Coccidiodomycosis NO CXR: Egg-shell lesions. Tissue
than histo). In disseminated form of disease (<<1%),
biopsy: spherules. Culture:
erythema nodosum with arthralgia.
CAUTION: Infectious. Leading
cause of lab-acquired infections.
Yes: infectious from
Oral Herpes LESIONS: "Dews drops on a rose petal" prodrome even to
Herpes (HSV) Oral Cavity (Herpes Simplex/Herpes Secondary infections are less severe, more loca;lized crusted lesions (wear
Gingivastomatitis) and shorter in duration than primary infection. gloves when
examining)
Lab Tests in general for HSV:
HSV Eyes Ocular Herpes/Herpes Keratitis Corneal Ulcers Yes
HSV Extremities Herpetic Whitlow Infectious lesions on fingers and wrists. Yes TZANCK SMEAR - look for
Sudden onset of nuchal rigidity, blinding headache, SYNCTIA. This test is not specific
HSV-2 Systemic Meningitis Yes
nausea and photphobia for HSV, also tests for VZV and HIV
Seizures, space occupying lesions (SOL) - cause
HSV-1 CNS Encephalitis Yes
destruction of temporal lobe. COWDRY TYPE A INCLUSION
STD - 3 to 5 days after contact. BODIES - positive with HSV and
Signs/SX = regional lymphadenopathy and painful VZV
HSV-1 and HSV-2 Genitourinary Genital Herpes Yes
shallow ulcers on genitals
RECURRENT with prodrome of burning & tingling. CHARACTERISTIC CPEs
Pruritis, vaginal or cervical mucoid discharge. Pain with
HSV-1 and HSV-2 Genitourinary Genital Herpes - Female intercourse. Slight increased risk of cervical cancer in
adulthood.
HSV-1 and HSV-2 Genitourinary Genital Herpes - Male Dysuria and/ro dyspaerunia
HSV Systemic Neonatal HSV Acquired in utero or during vaginal birth. Often fatal.
Scarring
Cytomegalovirus syndromes congenital cytomegalic inclusion disease M/C viral agent of congenital disease in U.S
cns microencephaly / hearing loss
skin rash
other hepatosplenomegaly Clinical signs and symptoms too
toxoplasmosis, other, rubella virus, CMV, herpes vague to be that useful and often
simplex/histoplasmosis ASYMPTOMATIC
•TORCH syndrome Conditions!27:27
-Tissue biopsy: Conditions!G43 eye
nucleus -cell culture:
characterisitic CPE in diploid
FIBROBLAST cells (best Dx).
Conditions!H26
Clinical signs and symptoms too
vague to be that useful and often
ASYMPTOMATIC
Conditions!27:27
Cause: infected cervix, colostrums or milk. Two -Tissue biopsy: Conditions!G43 eye
peri-natal outcomes: (1) no clinical disease (2) clinical disease if nucleus -cell culture:
immunocomprimised characterisitic CPE in diploid
FIBROBLAST cells (best Dx).
child/adult
heterophile (-) and “mono-like” infection (mono is
heterophile +). Very common cause of failure of KI Conditions!H26
transplants.
Culture:
Mycotoxicoses hypersensitivity
on Saboraud agar
pneumonitis
Aspergillus spp allergic bronchopulmonary aspergillosis associated with asthma (10-20%)
-Tissue biopsy:
10% KOH prep of sputum
A chronic clinical situation, minimal distress, hemoptysis fungus ball on CXR that moves with
Aspergillus spp Aspergillus secondary colonization
fungus ball on CXR that moves with dependency dependency
Chronic sinusitus due to Aspergillus colonization of
Aspergillus spp Paranasal granuloma
paranasal sinuses
rapidly fatal if not treated
Aspergillus spp Apergillosus systemic disease