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Anesaki spp. Gastritis, gastric ulcer, gastric MOT: fondness of eating raw fish (e.g.
CA Japanese restaurant)
TX: fiberoptic gastroscopy with forceps
extraction of the mass containing the worm
Brugia malayi Malayan lymphatic filariasis Seen more in children than adults
Elephantiasis is below the knee, not
the whole lower extremity
Has a more rapid course
MOT: bite of anopheles, aedes, culex and
mansonia
Lab diagnosis: Thick and thin blood
smear (taken at close to midnight)
(NOTE: only thick blood smear for W.bancrofti)
DOC: Diethylcarbamazine (DEC)
Alternative: Ivermectin
st
Chlam ydia psittaci Psittacosis 1st week: mimics typhoid fever
nd
―parrot fever‖ 2 week: pneumococcal pneumonia
(atypical pneumonia) meningitis, encephalitis, hepatitis, m yocarditis
Acquired from bird droppings
Tx: doxycycline/tetracycline
DOC: Metronidazole,
not PCN G (a known inhibitory of GABA, just
like Tetanospasmin)
Heat stable; cannot survive in the presence of
oxygen (obligate anaerobe); hence,
hyperbaric oxygenation is part of the
management
Spores are very resistant to heat and usual
antiseptics (phenol); can survive autoclaving
at 121˚C for 10-15 minutes
Diagnosis: History and Clinical findings
Vaccine: DPT
DOC: Penicillin
Dengue virus Break bone fever Vector: Aedes aegypti (with white speckles)
Gastrocnemius m yalgia
Periorbital edema
DEN-2 & DEN-3: the two ―Asian genotypes‖
Dracunculiasis
MC in the U.S.A.
Helicobacter pylori Peptic and duodenal ulcer Urease (+) in urease breath test
disease Exhibits urease motility, mucinase invasive
Gastritis Penetrates gastric mucous layer
Risk factor for gastric Biopsy of the ulcer
carcinoma (type 1 carcinogen)
Gastric B-cell lymphoma
Tx: {bismuth (used to be)} amoxicillin +
metronidazole+ clarithromycin +
omeprazole
Hookworms Ancyclostoma duodenale (old Filariform larvae in soil penetrate the skin
world) “ground itch”
Enter the bloodstream and migrate to the
Necator americanus (new lungs
world) Become adult in the small intestine and attach
to the wall via teeth (ancylostoma) and
cutting plates (necator) blood loss
microcytic (iron deficiency) anemia
th
Human Herpes virus HHV-6 6th disease; roseola infantum
Human Papilloma HPV1,2 & 4: plantar warts Condyloma acuminata (other name for
Virus anogenital warts)
(a Papovirus) HPV6 & 11: anogenital
warts, laryngeal warts in Koiloc ytes: enlarged keratinocytes with clear
children haloes around shrunken nuclei
DNA Papovirus
DOC: Mefloquine
No human-to-human transmission
Vaccine: MMR
Leonine facies
Microscopic “pack of cigar” appearance
nd
Neisseria Gonorrhea 2nd MC sexually transmitted organism
gonorrhoeae Oxidase (+); no capsule;
Ophthalmia neonatorum Virulent factors: Pili, IgA protease, OM
proteins, Endotoxin
Septic arthritis knee pain Gram (-) “coffee bean” diplococci
Cervicitis PID Crede’s prophylaxis: 1% Silver nitrate
Urethritis, epididymitis in solution or 1% tetracycline ointment or solution
males or 0.5% erythrom ycin drops withon one hour
Anorectal lesions after birth, as prophylaxis against opthalmia
Pharyngitis in anal-oral sex neonatorum
Thayer Martin agar
(NOTE: non-pathogenic strains of Neisseria do
not grow in Thayer-Martin)
N. gonorrhea ferments glucose
N. meningitides ferments maltose
DOC: Penicillin
Ceftriaxone 250mg IM for PCN resistant or
Spectinom ycin 2gm IM or Cefixime 400mg po
Both partners must be treated!
DOC: Trimethoprim-sulfamethoxazole or
Pentamidine (aerosol)
Pityrosporum ovale Malasezzia furfur Hypopigmented spots on the chest and back
Pityriasis Affected areas do not darken in the
Tinea versicolor s un
Common among adolescent and in
young males
―lipid-dependent” – requires fat to grow
with many sebaceous glands (dandruff,
itching)
“spaghetti and meatballs” appearance of
budding yeast cells and hyphae
DOC: Ceftazidime
Rabies virus Family: Rhabdoviridae Incubation period: 3-4 weeks to 3-4 months
Genus: Lyssavirus Domestic dogs
Sylvatic rabies rabbits
Bullet-shaped capsule
“Negri bodies”
Rectal biopsy:
proctosigmoidoscopy bite of the
granulomatous lesion
Sporothrix schenckii Rose gardener’s disease Dimorphic fungus (has a yeast and a mold
form)
“cigar-shaped” yeast
(NOTE: cigar-packed microscopic appearance is in
Mycobacterium leprae)
Vibrio cholerae Cholera Gram (-); oxidase (+); single polar flagellum
01-Eltor serotype Choleragen toxin
Medium: Thiosulfate citrate bile salt
sucrose agar (TCBS) in alkaline pH up to 9
Has two subunits: A & B(responsible for
binding)
“fish in stream” colonies
“Rice water” stools or “pea soup”
stools with fishy smell
Washerwoman’s hands (loss of skin
elasticity)
Dehydration: the MC cause of death
DOC: tetracycline
Yellow fever virus Yellow fever MOT: aedes mosquito (arthropod-borne virus)
( a Flaviviridae) Vaccine is attenuated
Yersinia pestis Plague (3 forms:) Facultative anaerobe with bipolar staining and
Pneumonic plague produces V and W antigens “safety
Septicemic plague pin” appearance
Bubonic plague Justinian Plague in 542 A.D.; Black Death
SOME SHORTCUTS
CYSTS
Binucleated cyst Dientamoeba fragilis
Hydatid cyst Echinococcus granulosus
DRUG S
Albendazole Echinococcus granulosus
Strongyloides stercoralis
Giemsa and W right stain For staining blood or bone marrow films
UNPASTEURIZED Brucella
MILK Listeria monocytogenes
ACNE
altered expression of hormones
Androgens stimulate the enlargement of the sebaceous glands and the resulting production of
more oil
in the androgen-altered hair follicles, the cells lining the cavity shed more frequently, stick
together, mix with the excess oil that is being produced, and pile up in clumps inside the cavity
the bacteria contain enzymes that can degrade the oil from the oil glands into what are known as
free fatty acids
A hallmark of acne is often the pus that is exuded from the crusty sores on the skin.
can be stimulated by factors other than the altered hormone production of puberty; external
environment, particularly a warm and moist one, is one factor
Oil production can be slowed in the presence of 12-cis-retinoic acid (Accutane)
benzoyl peroxide is very active against Proprionibacterium acnes
there is no ―cure‖ for acne; the bacteria that cause it are normal flora
ACTINOMYCES Ac
rod-like in shape; Gram positive
are not able to form the dormant form known as a spore; are able to grow in the absence of
oxygen
are normal residents of the mouth, throat, and intestinal tract
formation of an abscess—a process ―walling off‖ the site of infection as the body responds to the
infection—and by swelling
the symptoms and appearance of the infection is reminiscent of a tumor or of a tuberculosis
lesion
the slow growth of the bacteria can make the treatment of infection with antibiotics very difficult
colonies of Actinom yces are often described as looking like bread crumbs
ADENOVIRUSES
have twenty sides; called icosahedrons
contain deoxyribonucleic acid (DNA) as their genetic material; DNA encodes 20 to 30 proteins
infect the membranes that line the respiratory tract, the eyes, the intestines, and the urinary tract
respiratory and intestinal illnesses and conjunctivitis (commonly called ―pink eye‖); also, a more
severe eye malady called keratoconjunctivitis
eye infections are very contagious and are typically a source of transmission
produce proteins that interfere with host‘s anti-oncogenes;
by disrupting the anti-oncogene proteins, this stop signal is eliminated, continued and
uncontrolled growth of the cell tumor is produced.
adenoviruses have become important as one of the central triggers of cancer development
most children will have antibodies to at least four types of adenovirus
AEROBES
Bacteria, yeasts, fungi, and algae are capable of aerobic growth
Those that absolutely require oxygen are known as obligate aerobes.
Facultative aerobes prefer the presence of oxygen but can adjust their metabolic machinery so as
to grow in the absence of oxygen.
Microaerophilic organisms are capable of oxygen-dependent growth but cannot grow if the
oxygen concentration is that of an air atmosphere (about 21% oxygen). The oxygen content must
be lower.
common food source for microorganisms is the sugar glucose
pyruvic acid (from glucose) is broken down via a series of reactions that collectively are called the
tricarboxylic acid cycle, or the Kreb‘s c ycle
A principle product of the Kreb‘s cycle is a compound called nicotinamide adenine dinucleotide
(NADH2) that feed into another chain of reactions of which ox ygen is a key
Oxygen is the final electron acceptor in the process
an electron acceptor other than oxygen: alternate acceptors is nitrate, and the process involving it
is known as denitrification
complete breakdown process yields 38 molecules of adenine triphosphate (ATP) for each
molecule of the sugar glucose
fermentative type of energy generation is a fall-back mechanism to permit the organism‘s survival
in an ox ygen-depleted environment
HIV - AIDS
Retroviruses: their genetic material is RNA instead of DNA
Patients with AIDS most often die from opportunistic infections
HIV retrovirus uses an enzyme called reverse transcriptase to make a DNA copy of its genetic
material. The single strand of DNA then replicates and, in double stranded form, integrates into
the chromosome of the host cell where it directs synthesis of more viral RNA
the inner core of the AIDS virus, which is called the nucleocapsid, is held together by structures
known as “zinc fingers”
HIV destroys the immune system by invading lymphocytes and macrophages, replicating within
them, killing them, and spreading to others
these viruses mutated to HIV in the bodies of humans who ate the meat of monkeys, and
subsequently caused AIDS
a fifteen-year-old male with skin lesions who died in 1969 is the first documented case of AIDS
first spread in the United States through the homosexual community by male-to- male contact
HIV is transmitted in bodily fluids: through sexual contact, specifically vaginal and anal
intercourse, and oral to genital contact (small abrasions during sexual intercourse), direct
injection with an infected needle among intravenous drug users who share needles, through
breast-feeding, transfusions of infected blood or blood-clotting factors
Infected individuals pass HIV-laden macrophages and T lymphocytes in their bodily fluids to
others
a person who has had another sexually transmitted disease is more likely to contract AIDS
test for HIV-1 that is called Enzymelinked immunosorbant assay (ELISA)
monitored by the declining number of particular antibodies called CD4-T lymphocytes and by the
amount of HIV in the patient‘s blood
diagnosis of AIDS in which the CD4 T-cell count is below 200 cells per cubic mm of blood, or an
opportunistic disease has set in
the cocktail combines zidovudine (AZT), didanosine (ddi), and a protease inhibitor
reverse transcriptase, mistakenly incorporates the drugs into the viral chain, thereby stopping
DNA synthesis
Proteases are enzymes that are needed by HIV to reproduce, and when protease inhibitors are
administered, HIV replicates are no longer able to infect cells
saquinaviras, the first protease inhibitor to be used in combination with nucleoside drugs such as
AZT; other protease inhibitors: ritonavir and indinavir
are not cured due to the persistence of inactive virus left in the body
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe idiosyncratic
reactions, most commonly triggered by medications, which are characterized by fever and
mucocutaneous lesions leading to necrosis and sloughing of the epidermis. SJS and TEN are
distinguished chiefly by severity and percentage of body surface involved.
Stevens-Johnson syndrome — SJS is the less severe condition, in which skin sloughing is limited to
less than 10 percent of the body surface; characterized by a prodrome of malaise and fever, followed by
the rapid onset of erythematous or purpuric macules and plaques. The skin lesions progress to epidermal
necrosis and sloughing. Mucosal membranes are affected in 92 to 100 percent of patients, usually at two
or more distinct sites (ocular, oral, and genital).
Toxic epidermal necrolysis — Toxic epidermal necrolysis (TEN), or Lyell's syndrome, involves
sloughing of greater than 30 percent of the body surface area. TEN also begins with a prodrome of fever
and malaise, although temperatures are typically higher than those seen with SJS, often exceeding 39
degrees Celsius. Mucous membranes are involved in nearly all cases. The skin lesions are widely
distributed erythematous macules and patches, although about 50 percent of cases begin with diffuse
erythema. In the early stages, skin pain may be prominent and out of proportion to clinical findings. The
skin lesions progress to full-thickness epidermal necrosis leads. The ultimate appearance of the skin has
been likened to that of extensive thermal injury.
SJS/TEN overlap syndrome — SJS/TEN overlap s yndrome describes patients with involvement of
greater than 10 percent, but less than 30 percent of body surface area.
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