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ID Lab Notes Exam4
What are the diagnostic tests for Syphilis?
What kind of reaction is a gumma?
Type IV hypersensitivity
What's the clinical presentation of primary syphilis?
Single painless chancre on penis/scrotum/vulva/cervix
Produce central ulcer
Present 3 wks post infection; resolve in 3-6 wks
What's the clinical presentation of secondary syphilis?
Widespread mucocutaneous lesions of oral cavity, palms, soles
Present 2-10 wks post chancre
What's the histological presentation of primary syphilis?
plasma cells, macrophages, endothelial activation -> fibrosis
Spirochetes (silver stain/immunofluorescence)
What's the histological presentation of secondary syphilis?
Plasma cell infiltrate and enarteritis
Less intense inflammation
What's the presentation of tertiary syphilis?
Presentation after 5 yrs latency
Cardiovascular (aortitis/aprtic valve insufficency)
Neuro (tabes dorsalis)
Benign (gummas in bone, skin, mucosa, upper airway)
What is the Jarisch Herkheimer Reaction?
High syphilis bacterial load
Massive exotoxin release
Fever, Rigus, HOTN, leukopenia
What's the histological pattern in syphilis?
Perivascular infiltrlate (plasma cells) in dermis
What's a diagnostic stain for fibrosis from gummas?
Trichrome stain (tertiary syphilis)
What are the stages of Lyme disease?
1. Acute illness (lymphadenitis/targetoid rash)
2. Dissemination (CNS/Cardiac)
3. Chronic (Arthritis, neuropathy)
What are clinical presentations of Clostriduium sp?
C. dificile - Pseudomembranous colitis
C. perfungens - gas gangrene
What's the gross hallmark of pseudomembranous colitis?
Abundant plaque like adhesions on mucosa; necrotic debris
What's the mechanism of C. dificile damage to colon?
Toxin a/b -> cytokine production
Host Cell Apoptosis
What oragnisms cause destruction of bowel mucosa?
Shigella (distal colon)
Salmonella (blunting/vascular conjestion)
Yersinnia, Cholerae, Jejuni
What are severe complications of bacterial entercolitis?
Who needs Tx?
Barier destruction, fluid loss, perforation
Elderly & young pts
What's the process for determining skin/soft tissue infection?
1. ID organism
2. Urgency (depth/life/limb)
What's the pathogenesis of C. perfringens?
a-toxin -> destroy cell membranes/matrix proteins
HOTN/renal failure/organ dysfunction
What toxin is related to C. Tetani?
Bblock release of GABA (spastic paralysis)
What's the toxin related to C botulinum?
prevent ACh release (flaccid paralysis)
What's the characteristic rash pattern of RMSF?
Distal --> Central
Palms & soles
If you have a pt with DIC what tests do you order?
Fibrin split products and d-dimer
What's the rickettsia triad?
Fever, headache, rash
What's the diagnostic test for RMSF?
Indirect fluorescent antibody or skin biopsy with immune staining (7-10 days post disease onset)
How is RMSF trasmitted?
Rickettsiapox - mite
Other rickettsia - ixodid tick
What's the pathogenesis of RMSF?
Blood borne -> endothelial invasion
What are complications of RMSF?
Interstitial pneymona & myocarditis
Renal failure -> death
Brain microinfarcts, skin necrosis
What's the clinical presentation of Ehrlichiosis?
Cytoplasmic inclusion appearing like mulberry
Abrupt headache, fever, malaise, rash
What's the complication of Rickettsia prowazeki?
Typhus fever/nodule in brain
Focal microglial proliferation of Tcells and macrophages
What types of patients are seen with Candida infection?
Immunocompromised patients (prego, DM, HIV)
What are clinical examples of candida infection?
Vaginits, thrush, diaper rash
What do you see histologically on Candida infection?
Budding yeast /pseudohyphe
What are hematogenous disease caused be Candida?
Blood, heart, meninges, kidney, lung, spleen, joints
What types of fungi cause pulmonary infections?
Histoplasma - ohio & mississippi
Coccidioides - southwest
Blasomycosis - southeastern
What are diagnositc techniques for fungal infections (superficial, deep, disseminated)
Superficial - KOH
Deep - biopsy with silver/PAS
Disseminated - multiple cultures
What organism produces the soap-bubble lesion?
What's the organ involvement of Asperfillus; what does it look like?
Wages of necrosis Lung, heart
Acute angle branching
Which Hb types are protective against malaria?
What's special about the Negative Duffy Ag?
Protective against Vivax
What are complications of malaria?
Hepatosplenomegally, Congestion/edema (pulmonary, renal, cerebral)
What's characteristic of Babesia
Maltese Crosses in cells
Northeast exposure to ixoides tick
What's the cause of overwhealming malaria parasitemia?
RBCs become sticky and adhere to endothelial surface
What are the serotypes of chlamydia?
What are genital diseases caused by C. trachomatis?
NGU, epididymitis, mucopurulent cervicitis, PID, proctitis
What is Lymphogranuloma venereum?
Mixed granulomatous/PMN response to C. trachomatis
Chlamydia inclusions in cytoplasm
What is trachoma? How's it transmitted?
Eye --> eye
What is the Elementary/Reticulate body?
What's Reiter's disease?
C. trachomatis complication (HLA-B27)
Pee, see, knee