Micro Chart Test 3

Types

Morphology

4 different classifications: 1) Superficial - only outermost skin and hair. E.g. black and white piedra, tinea versicolor, tinea nigra

Fungi are classified as eukaryotes. Share many characteristics with higher organisms: becomes a problem when trying to treat

Epidemiology

Virulence Factors

Diseases

Prevention/ Treatment

2) cutaneous - infect layers of Either monomorphic or diporphic epidermis, hair and nails. Most tineas. depending on species and conditions Fungus (in general) 3) Submucotaneous. Dermis and subQ tissue.

1) filamentous - molds with hyphae (mycelium iff group). MC at lower temp and free living

4) Systemic - invade internal organ MC'ly from lung foci of infection. E.g. histoplasmosis, blastomycosis, coccidiomycoses

2) unicellular - yeasts. MC at higher temp and when parasitizing tissue Adapted to live on outermost, non-living layer of skin

Malassezia furfur (pityriasis ovale) Superficial mycoses

Phaeoannuellomycoses wernickii (Exophilia wernickii) Piedraia hortae

No immune reaction

Black piedra White piedra Termed tineas. Further named according to body part.

Wood's lamp (+) Deeper layers of skin, hair and nails evoke inflammatory immune response In dermis and sub Q tissue. Fascia, muscle and bone. MC'ly due to tissue trauma. Rare in developed countries.

Subcutaneous mycoses Mycotic agents: cause disease in healthy humans. Either strict or opportunistic pathogens. Either: Monomorphic: cryptococcus neoformans. Dimorphic: thermal Systemic mycoses dimorphism.

Easy to diagnose and responds well to treatment

Tinea nigra

Just cosmetic

3 main genera: Microsporum, Trichophyton, Epidermophyton. Cutaneous mycoses Mistakenly termed dermatophytes

Might be very difficult to treat. May have to cut out tissue.

MC'ly respiratory tract as initial foci of infection

MC'ly develop mild acute or asymptomatic lung infections Also can develop chronic disease or sub-clinical (latent) infections

Histoplasma capsulatum

Histoplasma capsulatum

Tinea (pityriasis) versicolor

Saprobic phase (on dead tissue). In N2 rich soil. Parasitic phase - in macrophages of MPS/ RES. (looks like yeast and multiplates in mononuclear phag system)

agricultural belt - N2 soil

Inhale hyphal fragments

MC found in "histo belt". (Ohio/ Mississippi River valley to S. Ont/Que.)

Convert to yeast form and replicate in macrophages --> travel to lymphatics

Primary histoplasmosis Ocular histoplasmosis syndrome.

Also areas of a lot of bird (starling/ chichen) and bat excrement. Closely related to K. capsulatum Blastomyces dermatides

Coccidiodes immitis

Dimorphic - 37C, tissue, multinucleated sperule "sporangia" New World Disease

Inhale conidia phargocytosed by Endemic areas overlap those of Histoplasmosis macrophages - convert to yeast replicate in macrophages unknown reservoir - unlike H. capsulatum it is Carried by lymphatics rarely cultured from soil Can cause diseases in animals Dust clouds at construction sites or crop dust during farming Endemic in soils of hot, dry, semi-arid areas. Extensively spread via dust storms. In San Jaouquin Valley in Cali MC in males: 25-55

Acute Blastomycosis Chronic Blastomycosis

Coccidiodomycosis

VIRUS INTRO NOT IN CHART - see very beginning of note package and beginning of viruses!!

-azole drugs treat fungal infections

Group of 8 DNA viruses grouped together due to their common virion morphology and mode of replication

Adherence, Entry: envelope fuses with host cell membrane, Transport to nucleus Replication Outcomes: 1) Lytic infections, 2) latent infections, 3) Persistent infections, 4) Immortalizing infections

Large, enveloped, linear dsDNA corse

Herpesviridae family

HSV-1 and HSV-2

Infect and replicate in mucoepithelial cells

HSV-1 infects above the waist, hsv-2 infects below the waist

Lytic infections at site, persistent infections in macrophages and lymphocytes, and latent infections in nerve ganglia and salivary glands

Herpes simplex virus

Like Herpes simplex: causes blisterlike lesions (but different sizes and Also termed Herpes Virus III stages, deeper, more painful and can cause scarring), establish latent infections in nerves, CMI Unlike HSV: spread via respiratory Cause of Chicken pox (varicella) and route, no detectable lesions at site of Shingles (herpes zoster) entry Varicella Zoster virus

4M's: Mixing & Matching of Mucous Membranes (vesicle fluid, saliva, vaginal secretions)

Herpes simplex infection

Avoid contact with mucocutaneous lesions: infectious from prodrome even to crusted lesions - gloves!

HSV-1: early on in life. Horizontal: oral contact, auto-inoculation to eye or Herpetic keratitis (ocular herpes) mouth HSV-2: later on in life. Horizonal: sexual practices. Vertical: ascenting in utero Herpetic Whitlow infection or during vaginal birth Meningitis. Encephalitis Genital herpes Neonatal Herpes simplex infection

Very contagious - contagious from 48 hrs, before symptoms until all the lesions are completely dry

Primary infection: 2-4 days after: to lympatics

Chicken pox (varicella)

Peak occurrence of chicken pox: spring time and 5-10 years old

Secondary viremia: thoracic fever.

Reye's syndrome

Peak occurrence of shingles: adult pop esp >65 (10-20%). Active herpes zoster can cause chicken pox in susceptible child or adult but will NOT cause shingles.

VZV becomes latent in dorsal root or cranial root ganglia Reactivated in older adults and immunocompromised - migrates back along dermatome --> shingles

Healthy kids: not treated, relatively mild disease that gives life-long immunity

Shingles (herpes zoster) Herpes zoster opthalmicus Ramsey Hunt syndrome (Herpes zoster oticus)

contains both mRNA and DNA --> unlike other viruses

Cytomegalovirus

A gamma herpesvirus

URT - lymphotropic - infected cells Opportunistic pathogen - rarely causes disease (leukocytes, lymphocytes) spread CMV in immuno-competent hosts throughout the body Similar to Herpesviridae: 1) syncytia, 2) Transmitted as STD, transfusion/ latent state, 3) reactivation in transplantation, oral, congenital immunosuppressed state Can be latent in T cells, macrophages, other cells

Very common virus Transmitted MC'ly by saliva or from contaminated glassware - "kissing disease" To cause neoplasms - need other cofactors Imminity to EBV is lifelong

EBV mild disease in children

human herpes virus 6

Human Herpes virus 7

Ubiquitous. Cause life long infections

Ultimate B lymphocyte pathogen. Mitogenic and immortalizing Limited host range and tissue trophism

Lymphotropic

healthy immune system, safe sex practices

MOST common asymptomatic Mononucleosis (heterophile Ab negative, unlike EBV) Congenital - cytomegalic inclusion disease Multisystem symptomatic disease (when immunocompromised) Monomucleosis African Burkitt's Lymphoma

latent or lytic infections Nasopharyngeal carcinoma 3 outcomes: lytic, latent, or immortalization Infection first in oropharynx, shed in *old word for mono (for saliva - saliva remains infectious for homeopathy) = glandular fever months after clinical recovery Iiff overactive immune system --"infectious mono" iff lack of immune response --"lymptoma" e.g. burkitt's T cell response - atypical lymphocytes Downey cells

latent infection in t cells orphan disease in search of a disease although linked to febrile illness with potential convulsions in children Very common - 75% Prevents HIV-1 from getting into CD4 cells can this be a HIV vaccine

mc viral cause of congenital defects

Roseola infantum Mononucleosis type illness Orphan disease

Control is impossible - virus is uniquitous and is shed from saliva of healthy people

Human herpes virus Gammavirus like EBV 8 Retroviridae

4 main subfamilies: 1) Oncornavirinae 2) Lentivirinae - HIV-1, HIV-2 3) Spumavirinae 4) Endogenous viruses 2 types: HIV-1 and HIV-2

Affects peripheral blood lymphocytes, B Cause of Kaposi's sarcoma in cells, vascular endothelial cells, AIDs patients - high incidence after perivascular spindle cells KI transplant

found only in Italy, greece, Aftrica One of the most studied viruses

Delicate outer envelope - hard to get!

very limited host and species range

gp120 - initially attaches to CD4 receptor on macrophages. Later attaches to CD4 receptor on Th cells and CXCr4 (fusin) chemokine receptors

gp120 (Ag and receptor specificity leads to high amount of antigenic drift). Changes all the time!

Sexual intercourse (anal/vaginal) - HIV enters and infects Langerhands DC's in epithelium or GIT?

chemokine co-receptors - very important for establishing infection and increasing liklihood of developing AIDS

HIV

Allopathic treatment: RT inhibitors, Protease inhibitors, Peptide T-20 and T-1249

Increased risk with anal sex - only one layer of Attachment fo specific cells - fusion of colonic cells. Cells might have certain coenvelope receptors Transmission: Sexual - anal and vaginal. Less infectious than other STDs. 7% if oral sex with Makes dsDNA recently infected man. RT (reverse transcriptase) is very error Peri-natal - from birth prone Blood: IV drug users, needle stick injuries, integrated into host chromosome by blood transfusions integrase Initial huge paranoia: risks are slight unless Can also spread between cells close intimate contact and/ or transfer of syncitia semen, blood, vaginal secretions

HIV

HIV+ does not mean you have Aids! CD4+: CD8+ tells status and staging of Aids

Safe sex - latex condoms only! Safe needle practices! Two part vaccine

Problem: long, prodromal asymptomatic period. Inactivates key elements of immune Infectious before identifiable symptoms. system - inactivates CD4+ T cells Not likely by: casual contact, touching, kissing, coughing, sneezing, insect bites, water, food, utensils, toilets, swimming pools… HIV-1: 70% men. 42% homosecual men. Geveloping countries: relative increase among heterosexuals. HIV-2: mostly west africa

Opportunistic fungi

Cause disease iff: immunocompromised, trauma, ABC's, dietary imbalance, endocrine changes, pH changes

Hypervariable regions - antigenic drift of Evated immune system by: gp120 Latent infection - unique promotor/ enhancer regions (LTRs) direct: cytotoxicity of CD4+ t cells Indirect - induces apoptosis p24 at early and late stages (core of virus) Diseases associated with disruption of normal bacterial ecology in the body

dimorphic but unlike other mycotic agents only present in hypae in body Diseases are not contagious (no yeast cells) Detect morphology after treatment with 10% KOH

Candida

no yeast-like form - only a mold form (form spore bearing hyphae) Aspergillus

Extremely common

Supression of immune system:

Oral candidiasis: "Thrush" Veginal candidiasis: "Yeast infection" Chronic Mucocutaneous Candidiasis (CMC) Disseminated candidiasis

Aspergillosus flavus (on peanuts, corn and other grains) produces aflatoxin very potent carcinogen: hepatocellular carcinoma

strict pathogen (unlike Candida)

Mycotoxicoses hypersensitivity pneumonitis Aspergillus Secondary colonization Paranasal granuloma Aspergillosus systemic disease

Ubiquitous: soil, pigeon droppings (dessicated NO dimorphism in pathogenesis alkaline rich, N2 rich, hypertonic), poultry farms, Capsule (anti-phagocytic) (unlike other systemic mytotic agents) eucalyptus trees Encapsulated yeast Included with fungi only because of Opportunistic infection - common in molecular traits environment also found in rodents (not reservoir for human Has features like protozoans disease) Transmission is via respiratory droplets Increased risk if immunosuppressed

Cryptococcus spp.

Pneumocystis carinii

3 main genera separated due to differences in VAP activity and gene arrangement: Paramyxoviridae family

Enveloped

Cryptococcosis (also BusseBuschke disease or torulis) Cryptococcosis meningitis Pneumonia Extrapulmonary

Oxygen ABCs

Paramyxoviridae family

1) Morbillovirus - measles virus "rubeola", animal disease 2) Paramyxovirus - parinfluenzae and mumps viruses 3) Pneumovirus - respiratory syncytial virus **use homeopathic engystol against this

Penetrate cell by fusion (form cyncytia) Replicate in cell cytoplasm Transmitted via respiratory droplets One of the MC causes of death in childern 1-5

In paramyxovirus family

99.5% decrease since vaccine

Morbillovirus

Very contagious - 85% infection rate, 95% chance of disease development Uinqueness of measles: Nearly all people infected become unwell and develop disease Very characteristic "pathognomic" clinical presentation only 1 serotype

In paramyxovirus family

Ubiquitous

Parainfluenzae virus Transmission is person to person and respiratory droplets MC in infants and children <5 Only affects umans - adult infection more severe than children

In paramyxovirus family

Paramyxovirus

Complete resistance to re-infection highly contagious - 85% Big contrast in disease severity with proper nutrition, access to health care etc. 4 serotypes: Types 1-3: 2nd most common cause of severe respiratory distress in infants and young children, can cause croup Initial site of infection is the upper respiratory tract - epithelial cells. Usually contained here and rarely becomes systemic (unlike measles/ mumps) Only partial immunity (unlike measles) Very infectious (but less than measles or chicken pox) infect upper respiratory tract epithelial cells. Infect parotid gland via viremia or Stenson's duct --> Parotitis Life-long resistance to infection (like measles)

Measles

Control: MMR vaccine

Pneumonia Giant cell pneumonia Post infectious encephalis Sub-acute sclerosing panencepahalitis Atypical measles

Laryngitis

Treat symptoms only

Parainfluenzae Croup Mumps

Symtpmatic only, no anti-viral agents

Orchitis Oophoritis Pancreatitis Meningitis. Arthritis

RSV

In paramyxovirus family

No hemagglutinin

Infection localized to upper or lower Ubiquitous - virtually everyone in NA is infected respiratory tracts. No systemic spread/ by age 4 (very contagious) viremia

Form syncytia

Epidemics in every winter in cold, temperate climate #1 cause of severe lower respiratory tract infection in young children (Day cares, nurseries) Common cold causes: 1) rhinorhea virus. 2) coronavirus 3) RSV Transmitted via hands, fomites and respiratory secretions

No long term immunity

URI with marked rhinorrhea Bronchiolitis OM

Control: almost impossible. Too ubiquitous and good vaccines are not available Other treatment: euphorbium compositum (good for RSV and rhinovirus) Zn - decrease RSV replication, but in high doses depresses immune system

Family togavirus

Rubivirus

rubeolla = measles

Enveloped

Always symptomatic. Range from mild childhood diseaes "German measles" to severe causes heterologous intereference congenital defects

unlike other togaviruses: respiratory tropism and no detectable cytopathology (no lysis)

humans are only host

less contagious than measles or mumps or varicella

spread via respiratory secretions or transplacental increased risk of harmful disease if pregnant

Rubella Polyarthritis Rubella congenital

Smallest of Dna viruses (only 22nm)

In all countries

cause of erythema infectiosum (5th disease) to aplastic crisis to arthritis

naked capsid virus

MC in 4-10 year olds in late spring and winter

MC'ly asymptomatic

Erythema infectiousum Parvovirus B19 fetal infection

Parvovirus very resistant to drying, acid/base, MC spread from respiratory droplets or close high salt etc contact to blood products binds P antigen on rbc's, erythrocyte progenitor cells, vascular endothelium and fetal myocytes

Hepatitis

Aplastic crisis Arthritis

currently 7 viruses grouped together because they all cause liver damage 1) HAV - picornavirus --> infectious hepatitis 2) HBV - hepadnovirus --> serum hepatitis 3) HCV - flavivirus 4-7) D-F Naked icosahedral ssRNA genome extremely stable capsid Not stable to chlorine

HAV

enveloped, small circular, partly dsDNA

Ingested (contaminated shellfish, clams, Differences from HBV: oysters) HAV can not initiate a chronic infection slow replication, transient viremia Pathology due to immune mediated hepatocyte HAV not associated with hepatic CA damage rarely get immune complex related rash 40-60% of acute hepatitis in USA and polyarthritis Person-to-person, fecal-oral and sewage rarely fatal (fulminant hepatitis) contaminated food/water (often traceable source, can live in water for many months) 1 month incubation --> abrupt onset of icteric symptoms fecal-oral spread MC'ly in blood or blood products (serum differences from HAV: hepatitis)

unusally stable for an enveloped virus Chronic carrier - test + for HbsAg 2 occasions over 1/3 of the world is infected HBV

Usually treatment is not required self-limiting Prevention difficult because rash or arthralgia stages are not infectious (immune complex mediated)

hepDNA vuris transmitted by blood/needles/STD/perinteral longer incubation (3 months) and then insidious onset of symptoms can get chronic hepatitis carriers can cause primary hepatocellular carcinoma (PHC) not as resistant

Hepatitis A

Avoid uncooked shellfish Chlorine treatment of water

Hepatitis B

Microbe

System

Condition

Signs and Symptoms

Superficial mycoses

Malassezia furfur (pityriasis ovale)

Skin

Tinea (pityriasis) versicolor

Superficial mycoses

Phaeoannuellomycoses wernickii (Exophilia wernickii)

Skin

Tinea nigra

MC asymptomatic. Well demarcated, macular lesions on palms/soles.

Superficial mycoses

Piedraia hortae

Hair

Black piedra

Hairs of scalp, mustache, beard, groin. Direct or sexual contact.

Superficial mycoses

Trichosporon beigelii

Hair

White piedra

Hairs of scalp. Direct contact only.

Systemic mycoses

Histoplasma capsulatum

Systemic

Primary histoplasmosis

Systemic mycoses

Histoplasma capsulatum

Eye

Ocular histoplasmosis syndrome.

Blastomycosis

Skin

Acute Blastomycosis

Blastomycosis

Systemic

Chronic Blastomycosis

Coccidiodomycosis

Herpes simplex

Coccidiodomycosis

Lipophilic, yeast-like organism. Non-itchy hypopigmented telsions on upper torso, arms, abdomen. Dry chalky and scale easily.

Only 5% of people get it. 10 day incubation. Acute, self limiting influenzae like illness (fever, malaise, dry cough, lymphatenopathy. Resolve completely with some residual calcified lesions (coin lesions). Not contagious.Complications: overly aggressive immune response. Mediastinal fibrosis. Progressive: Disseminate via lumphatics. Increased risk if impaired CMI. TB-like iff chronic: fever, night sweats, weigh loss with destructive (caseating necrosis) lung lesions. Serious retinal condition. Leading cause of blindness in 20-40 year olds. Often misdiagnosed. "Histo spots" bilaterally. MC'ly no visual loss but can be activated to cause visual changes (4 kinds) 45 day incubation. Bronchopneumonia. Drenching sweats, No residual calcified lesions (unlike Histo). Not contagious. Skin lesions are slowly expanding ulcerative or cerrucous lesions with a granulous base on face and mucocutanoues borders of nose and mouth.

DDX and Lab Dx "spaghetti and meatballs" organisms after KOH prep. Wood's lamp (+). DDX with vitiligo. Characteristically dark pitmented yeast cells and hyphal fragments on KOH prep Dar, hard nodules along infected hair shaft Soft, pasty white growth on hair shaft. Microscopy: 10% KOH prep with silver or Giemsa stain. Serological: skin test: too many false (+). Cultures: slow growing (1-2 weeks) and spores are infectious. DNA probes. Direct ELISA.

Skin test and serology - too many false (+). Microscopty - biopsy/ histology of KOH prepped tissue. Culture. No tuberculat macroconidia in saprobic phase (unlike H. capsulatum). CXR.

TB or cancer like Skin test antigens. Skin test 2-4 weeks after symptoms. Coccidiodin. Spherulin. (for both 1) MC'ly asymptomatic. 2) 40% of infected people get mild, febrile to phases)Complement fixation. CXR moderately severe respiratory disease. Not contagious. 3) <5% - progressive "egg shell" lesions. Tissue Biopsypulmonary disease. 4) <<1% - disseminated disease. Erythema nodosum with staining and microscopy for arthralgia. spherules. Culture - CAUTION infectious - leading cause of lab infections! Skin break - localized primary infection in mucosa. Vascular lesions (damage due to viral immonopathology and apparent healing). Then retrograte transport to neuron nucleus - latent infection. Stress (emotional, fever, direct sunlight, menstruation / hormones, immunosuppresion). Lesions: "dew drop on rose petal". Secondary infection is more localized and shorter duration than primary infection.

Skin

Herpes simplex infection

Herpes simplex

Eye

Herpetic keratitis (ocular herpes)

Herpes simplex

Skin

Herpetic Whitlow

Herpes simplex

Systemic

Meningitis.

Herpes simplex

Brain

Encephalitis

Herpes simplex

Reproductive

Genital herpes

Herpes simplex

Systemic

Neonatal Herpes simplex infection

Varicella zoster virus

Skin

Chicken pox

Varicella zoster virus

Systemic

Reye's syndrome

Varicella zoster virus

Neural

Shingles

Recurrence of latent VZV infection. Prodrome: severe pain in localized nerve area. 3-5 days later: gradual development of small red macules, closely spaced, MC'ly in thoracic area or trigeminal nerve area, unilateral. Post herpetic neuralgia: long term (months to years) severe recurring burning or itching pain, hyperesthesia. Unlike herpex simplex: lesions are various sizes.

Varicella zoster virus

Neural

Varicella zoster virus

Neural

Herpes zoster opthalmicus Ramsey Hunt syndrome (Herpes zoster oticus)

CN V (facial) and CN III (ocular changes - cornal ulcers - blindness) painful lesions along CN VIII (severe otalgia, hearing loss, vertigo, vesicular lesions along external ear canal) and lesions along CN V (Bell's palsy)

Unilateral, recurrent. Can lead to dendritic corneal ulcers --> permanent damage Herpes infection of finger HSV-2 - often a complication of genital herpes. Sudden onset of nuchal rigidity, blinding H/A, nausea, photophobia. Seizures, signs of SOL (space occupying lesion), cause destruction to temporal lobe. MC cause of sporadic encephalitis. Caused by HSV-1 (10& orogenital sexual practices) and HSV-2 (90%). STD 3-7 days after contact. Regional lymphadenopathy, painful shallow ulcers. Recurrent (2-3 weeks or rarely) prodrome of burning/tingling. Female: pruritis, vaginal or cervial mucoid discharge. Increased risk of cervical CA in adulthood and HIV. Male: dysuria and/or duspaerunia. Acquired in utero or during vaginal birth or post-natal (family members or hospital personnel). Devastating, often fatal. Affects CNS, lungs, liver. One of the 5 childhood exanthems: rubella, roseola, 5th disease, measles/rubeola. Inhalation: maculopapular rash ("dew drop on rose petal"), intense pruritus, rapid development and spread from back/chest to scalp. Within 12 hours: successive crops of lesions. Prolonged low grade fever. extremem irriability/malaise. Much more harmful to adults - scarring. More severe on trunk than extremeties, also on mouth, conjunctiva, vagina. complications: 1) secondary bacterial infections.2) Reye's syndrome, CNS symptoms. Can occur after chicken pox, enterocirus, EBV, influenzae B, aflatoxin (peanuts), pesticide. ASA associated - do NOT give aspirin to a child with chickenpox.

Tzanck smear: look for Syncytia (fused membrane, not specific, also for: HSV, VZV, HIV, paramyxovirus.Cowdry Type A inclusion bodies (HSV or VZV). Characteristic CPE (cyto pathological effect)

Tzanck smear: giant, multinucleate cells - syncytia. Cowdry Type A inclusion bodies: "drop like masses of acidophilic material surrounded by a clear halo within the nucleus"

MC viral agent of congenital disease in US. Clinical disease in 10%: microencephaly, hearing loss(SNL) rash, hepatosplenomegaly. Fetus is infected either: placenta or recurrent mother infection - ascending infection from cervix. Infectection of fetus or newborn by any of the TORCH agents. Toxoplasmosis, other, rubella virus, cytomegalovirus, histoplasmosis. Outcome is abortion, stillbirth, or premature delivery. Fever, lethargy, poor feeding…..

Cytomegalovirus

Systemic

congenital - cytomegalic inclusion disease

Cytomegalovirus

Systemic

TORCH syndrome

Cytomegalovirus

Eye

Peri-natal

Through vaginal birth with infected cervix or colostrum or milk. 2 outcomes: asumptomatic or symptomatic if immunocompromised. Very common cause of failure of KI transplants. IFF immunocompromised: Retinitis: "pizza pie retina" --> scotoma, "blind spot". Esophagitis: mimic CRC esophagitis

EBV

Systemic

Mononucleosis

kissing disease - heterophile (+) mono. Symtoms: high fever, malaise, pharyngitis, tonsils with whitish exudate, lymphadenopathy, hepatosplenomegaly, fatige. Spleen rupture - avoid contact sports, hepatitis. Cyclic recurrent disease. (if lasts over 6 months) EbV induced lymphoproliferative dease(looks like leukemia)

EBV

Systemic

African Burkitt's Lymphoma

EBV

Systemic

Nasopharyngeal carcinoma

EBV

Oral

Hairy oral leukoplakia

HHV-6A

Skin

Roseola infantum

HHV-6A

Systemic

Mononucleosis type illness

HIV

Systemic

Candida

Oral

Candida

Reproductive

Candida Candida

Systemic

Aspergillus

Respiratory

HIV

Oral candidiasis: "Thrush"

Aspergillus Secondary colonization

Aspergillus

Paranasal granuloma Systemic

Cryptococcus spp

Respiratory

Cryptococcus spp

Systemic

Pneumocystis carinii

Respiratory

Pneumocystis carinii

Systemic

Heterophile (-) mono. Clinical signs and symptoms too vague to be that useful. Biopsy: owl's eye nuclease. Cell culture: characteristic CPE in diploid fibroblastic cells Triad of: fever, pharyngitis and lymphadenopathy for 1-4 weeks. Downey cells. Monospot test (+) Heterophile Abs - polyclonal activation of B cells produces wide reportoire of abs that recognize "paul Bunnel" Ags on horse, sheep, cow, RBCs but not guinea pig

Heterophile (-) mono.

Initial screen: indirect ELISA for gp120 or gp41 (2x to confirm). New- Ora Quick Rapid HIV-1 Ab test. Western blot: for gp120 or p24 or p31 proteins. Active viral replication (Recent infection or late stage) - direct ELIZA for p24, viral load in Rt or in blood via PCR. Culture - difficult, looking for syncitia

Microscopy: tissue scrapings treated with 10% KOG. Culture: confirm + Focal which patches on oral mucosa, palate and tongue that bleed when microscopy - grow on Sabourad agar. scraped off. Red flad for AIDS iff thrush in adults NOT receiving corticosteriod Germ tube test - unique to Candida therapy or broad spectrum ABC's. Spp. Serology: high titer of fungal glycoprotein Abs in recent or active infection or Candida specific mannan

Common female disease - change in vaginal flora or STD. Erythema ("beefy Veginal candidiasis: "Yeast infection" red")/ inflammation vagina/ vulva. Thick white or curd-like discharge. Intense pruritus. Chronic Mucocutaneous Candidiasis Group of treatment resistant superficial Candida infections - no organ (CMC) involvement Disseminated candidiasis spread to many organs - must be immunocompromised Mycotoxicoses hypersensitivity Allergic broncophulmonary asperfillosis associated with asthma (10-20%) pneumonitis

Aspergillus

Aspergillus

Tumor cells are from lymphocytes and contain EBV DNA. Malaria is a cocarcinogen. Large lesions - osteolytic - on jaw Epithelial cell tumor. Co-factor: ingested nitrosamines. Opportunistic infection in HIV AIDS patients. Vertically ribbed keratinized plaques on lateral borders of the tongue Rapid onset of high fever. Fever subsides and then get maculopapular rash. Also termed exanthum subitum. progression time of HIV to aids. Assoc with neurological disorders: might be linked to MS, cronic fatigue. Acute retroviral syndrome: viremia. Mono-like syndrome (heterophile -), mucocutaneous sores. Illness subsides spontaneously. 60%+ become asymptomatic. Mouth ulcers, oral candidiasis, EBV-like. Mid stage - ACR (AIDS related complex). Insiduous onset - weight loss. Night sweats, fatigue,opportunistic infections AIDS: 1) presence of anti-HIV gp120 abs, 2) decreased CD4+ t cells, 3) wasting syndrome 4) presence of opportunistic infections. Primary defence against opportunistic pathodens is progressively diminised. Diseases: hairy oral leukoplakia, oral thrush, kaposi's sarcoma, pneumocystis pneumonia, CMV retinitis AIDS related dementia: sub-acute encephalopathy. Slow, progressive deterioration of mental abilities. Can minic alzheimer's disease

Confirm by isolating CMV from child's urine in 1st week of life.

Aspergillus colonizes pre-existing cavity. Minimal distress, hemoptysis. Chronic sinusitus due to Aspergillus colonization of paranasal sinuses. Invasive disease that is rapidly fatal if not treated. Increased risk with severe neutropenia. Affect CNS, heart.

Fungus ball on CXR - moves with dependency

Culture on Saroraud agar. Tissue biopsy: 10% KOH of sputum. Microscopy: examine CSF after MC self-limiting mild pulmonary infection. Can lead to pulmonary nodule treating with 10% KOH and India ink. Cryptococcosis (also Busse-Buschke which mimics carcinoma or pnemonia with diffuse pulmonary infiltrates (mc in Serology: look for capsular Ags disease or torulis) males) (unlike other systemic mycoses that look for Abs) MC cause of fungal meningitis. Insidious onset of HA, low grade pyrexia, focal Cryptococcosis meningitis neurological changes. Immunocompromised also get skin lesions or osteolytic bone lesions (e.g. lymphoma) Microscopy: typical octonucleate Pneumonia Non-specific. Plasma cell infiltrates with "ground glass appearance" cysts.CXR: diffuse infiltrates with ground glass appearance Extrapulmonary In AIDS - eye, ear, liver, bone marrow Aspergillosus systemic disease

Morbillovirus

Systemic

Measles

Morbillovirus Morbillovirus Morbillovirus

Respiratory Respiratory Neural

Pneumonia Giant cell pneumonia Post infectious encephalis

Morbillovirus

Neural

Morbillovirus

Systemic

Parainfluenzae virus

Respiratory

Laryngitis

Parainfluenzae virus

Respiratory

Parainfluenzae

Parainfluenzae virus

Respiratory

Croup

Paramyxovirus Paramyxovirus Paramyxovirus

Reproductive GI GI

Orchitis Oophoritis Pancreatitis

Paramyxovirus

Systemic

Meningitis.

Paramyxovirus

Skeletal

Arthritis

RSV

Respiratory

URI with marked rhinorrhea

RSV

Respiratory

Bronchiolitis

Rubivirus

Systemic

Rubella

Rubivirus

Skeletal

Polyarthritis

Paramyxovirus

MC clinical only - pathognomic. Cough, coryza, conjunctivitis, photophobia. 2 days later: Koplik's spots "grains Microscopy: syncytia. Serology: 4x of salt surrounded by a red halo". 1-2 days later - rash, maculopapular increase in measles specific IgMs descending rash. MC self limiting with no complications suggest recent infection Rarely occurs but is MC cause of mortality from measles IFF T cell deficient children immunopathological - demyelinate neurons

Sub-acute sclerosing panencepahalitis charaterized by changes in personality, behaviour, memory, movement Atypical measles

Mumps

Rubivirus

Rubella congenital

Parvoirus

Erythema infectiousum

Parvoirus

Parvovirus B19 fetal infection

Parvoirus

Aplastic crisis

Parvoirus

Arthritis

HAV

Hepatitis A

Response to vaccine - abrupt onset of more severe symptoms. Get increased imunopathologic response. range from mild cold-like URI to bronchitis and pneumonia. Milder disease in older children and adults DDX epiglottitis (caused by H. Laryngeotracheobronchitis - "sound worse than they look". Seal bark - harsh influenzae). "Look worse than they brassy cough. MC self limiting - 48 hours. Xray: steeple sign. Lab Dx: sound" Medical emergency, drooling. Serology >>false -. Presence of syncytia. Hamadsorb guinea pig RBCs. Xray: thumb sign. Test samples from saliva, urine or MC'ly asymptomatic (unlike measles). Bilateral parotitis. CSF. Elevated amylase (bc pancreatitis). Hemadsorption. Testicular swelling. MC unilateral, can lead to sterility if bilateral. Unexplained abdominal pain. might be a link to juvenile onset DM H/A, stiff neck, drowsiness, unsteadiness when walking. #1 cause of aseptic meningitis in non immunized (non bacteria) Rare cause of polyarthritis in young men 4x increase in anti-RSV indicates In older children/adults disease OM also is common. These 2 in infants. "3 day measles" regional lymphadenopathy (esp sub-occipital glands). Spread to skin: rash - small erythematous nodules that spread from face to trunk/limbs, gone in 3 days. Rubella disease has similar severity even if immunosuppressed. Mores severe in adults than children due to more vigorous immunopathology. MC in adult females. Symmetrical polyarthritis of fingers, ankles, wrists and knees Increased risk (70% babies infected) if mother infected in 1st trimester (if 4th Difficult to diagnose clinically. Highly month just sensorineural deafness). Iff no maternal Abs teratogenic effects. specific anti-rubella IgMs. NO Classic triad: eyes, ears, heart. Also microencephaly, IDDM. Highly CULTURE - no characteristic CPE. infectious for 1st few months of life. Nonspesific URI (looks like influenza). 2-7 days later develop a "slapped cheek rash" which fades after 4 days but spreads to trunk and limbs (lacey/ RIA or ELIsa for B19 specific Abs. IgG reticulate appearance). Biphasic: 1) Infectious stage. 2) Immune mediated comes later but persists for life stage: recurrent rash (immune mediated) that is <sunlight, <exercise,