Micro: opportunistic infections (didnt know it was done already) Flashcards by Gretchen Hackett

What is a compromised host?

greater than 1 defect in the bodies natural defense
can be defect with innate or adaptive

they have an increased likelihood of suffereing from severe, life threatening infections

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In general, what are primary deficiencies?

inherited, congenital

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In general, how do secondary deficiencies arise?

d/t underlying diseases or from a treatment from disease

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Give examples of primary innate immunodeficiencies?

complement and phagocytic deficiency

something that’s wrong with the body’s immune system

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Give examples of secondary innate immunodeficiencies?

Burns- Damage to skin –> 1st barrier to infection and vascular tissue

Trauma/Surgery- organism goes into blood via wound, GI –> sepsis and shock

Obstruction- urine flow via catheter –> UTI , ciliary action, peristalsis

from another source

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Give examples of primary adaptive immunodeficiencies?

T-cell, B-cell, and combined immunodeficiencies

These usually manifest as peds diseases

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Give examples of secondary adaptive immunodeficiencies?

Malnutriition, AIDS, cancer, transplantation, stress, pregnancy

All these are immunosuppression

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What deficiency is C3 and what is it?

A complement deficiency
Affects all immune pathways

C3 is missing –> C3b missing –> no opsonization –> can’t remove bacteria

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What are some bacteria that are involved in C3 complement deficiency?

Enterobacteriaceae
Gram positive cocci
Haemophilus influenzae
Pseudomonas aeruginosa

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MAC (membrane attack complex), which complements are involved?

C5-9

which cause defects in cell surfaces –> cell death

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What is the most common recurrent infection with MAC deficiency?

recurrent bacterial meningitis from N. meningitidis

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Chronic granulomatous disease (CGD) occurs with which deficiency and what is it?

Phagocytic deficiency

NADPH oxidase is deficient which leads to a recurrent infection with catalase positive bacteria

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What are some bacteria assocaited with CGD?

Enterobacteriaceae
Staphyococcus
Pseudomonas aeruginosa
Aspergillus
Mucor (Rhizopus)

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Leukocyte adhesion deficiency (LAD) occurs with which deficiency and what is it?

Phagocytic deficiency

A defect in LFA-1 integrin protein which allows neutrophils to make their way out of the blood stream by adhering to receptors on the apical surface of endothelial cells in the infected areas –> recurrent infections

No pus, no abscess develops

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What are some bacteria assocaited with LAD?

Gram pos. cocci, Gram neg. rods

Strep pneumoniae
S. aureus
S. epidermidis
Klebsiella pneumoniae
Enterobacter cloacae
Pseudomonas aeruginosa
Acinetobacter baumanii

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Most common organism associated with burn wound infections?

P. aeruginosa (50%) and S. aureus (50%)

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What are other types of infections associated with burn wound infections?

Bacterial infection : coag neg. staph, enterobacteriaceae

Fungal infection: candida (localized), Mucor (disseminated), Aspergillus

Viral infections: herpes, uncommon

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What are other types of infections associated with burn wound infections?

Bacterial infection : coag neg. staph, enterobacteriaceae

Fungal infection: candida (localized), Mucor (disseminated), Aspergillus

Viral infections: herpes, uncommon

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In obstruction, what constitutes 40% of nosocomial infections?

catheters –> always check for UTI

common source of bacteremia

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In obstruction, what constitutes 40% of nosocomial infections?

catheters –> always check for UTI

common source of bacteremia

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Most common organism associated with obstruction infections?

E.coli

its teh most common community and HAI

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Most common organism associated with obstruction infections?

E.coli

its teh most common community and HAI

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T-cell Primary adaptive immunodeficiencies?

DiGeorges*

Viruses, fungal pathogens

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What are other organisms associated with Obstruction infection?

mostly nosocomial: 
-K.pneumoniae (drug resistant)
Proteus
-Pseudomonas (drug resistant 
yeast
Enterococci
S.epidermidis

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B-cell Primary adaptive immunodeficiencies?

X-linked agammaglobulinemia - most common -No B cells in the periphery -S.pneumoniae, H.influenzae Hyper-IgM syndrome, selective IgA deficiency -Bacterial infections at mucosal surfaces Non-enveloped viruses (B19, norovirus)

Malnutrition affects T-cell or B-cell immunity?

BOTH, t-cell and b-cell immunity

T-cell Primary adaptive immunodeficiencies?

DiGeorges | Viruses, fungal pathogens

Combined immunodeficiency Primary adaptive immunodeficiencies?

SCID – susceptible to just about anything | Bacteria, viruses, fungi, parasites

Malnutrition is..?

secondary adaptive immunodeficiency an imbalance supply of nutrients and energy and the body's demand to ensure growth, maintenance, and specific function

Malnutrition affects which immunity?

BOTH, t-cell and b-cell immunity

Which patients are HIV mostly seen in?

AIDS, cancer, transplant pt

Persistent, generalized is what stage of HIV?

asymptomatic infection

what is the algorithm for HIV symptomatic?

lymphadenopathy→symptomatic→AIDS defining conditions AIDS: T-cell count is <200

what are the clinical stages of HIV?

acute, asymptomatic, symptomatic, AIDS

What happens in acute stage?

the p24 levels peak early BUT also drops quickly | that's why the immune system is able to keep the virus "in check" at first, then it goes all ape shit

What happens in asymptomatic stage?

CD4 levels decrease No trace of p24 protein Ab to env Ag begin to rise slowly Ab to p24 rise and plateaus

What happens in symptomatic stage?

CD4 levels decrease even more Increase of p24 protein Ab to env Ag plateaus Ab to p24 decrease with CD4 levels

What happens in AIDS?

T-cell count <200

what are the most common pulmonary infections for HIV pt with >= 200 cell count? (There are more on the chart she gave us but I wrote the ones she read off )

S.pneumoniae, H.influenzae, Mycobacterium tuberculosis

what are the most common pulmonary infections for HIV pt with 50-200 cell count?

``` Pneumocystis jiroveci Cryptococcus, Aspergillus, Mycobacterium kansasii + S.pneumoniae, H.influenzae, Mycobacterium tuberculosis ```

what are the most common pulmonary infections for HIV pt with <50 cell count?

``` CMV + Pneumocystis jiroveci Cryptococcus, Aspergillus, Mycobacterium kansasii + S.pneumoniae, H.influenzae, Mycobacterium tuberculosis ```

What is special about Ab to env Ag?

susceptible to ANTIGENIC DRIFT | so immune system needs to always keep up

what are the most common pulmonary infections for HIV pt with >= 200 cell count? (There are more on the chart she gave us but I wrote the ones she read off )

S.pneumoniae, H.influenzae, Mycobacterium tuberculosis

what are the most common GI infections for HIV pt with <50 cell count?

``` HSV CMV M. avium intracellulare + Cyrptosporiudium Isospora Cyclospora + Candida oral hairy leukoplakia - EBV HHV-8 C.difficile ```

what are the most common pulmonary infections for HIV pt with >= 200 cell count?

``` CMV + Pneumocystis jiroveci Cryptococcus, Aspergillus, Mycobacterium kansasii + S.pneumoniae, H.influenzae, Mycobacterium tuberculosis ```

what are the most common GI infections for HIV pt with >= 200 cell count? (There are more on the chart she gave us but I wrote the ones she read off )

Candida oral hairy leukoplakia - EBV HHV-8 C.difficile

what are the most common GI infections for HIV pt with 50-200 cell count?

``` Classic parasites: -Cyrptosporiudium -Isospora -Cyclospora + Candida oral hairy leukoplakia - EBV HHV-8 C.difficile ```

what are the most common GI infections for HIV pt with <50 cell count?

``` HSV CMV M. avium intracellulare + Cyrptosporiudium Isospora Cyclospora + Candida oral hairy leukoplakia - EBV HHV-8 C.difficile ```

what are the most common cutaneous infections for HIV pt with > 500 cell count?

S. aureus S.pyogenes Tineas

what are the most common cutaneous infections for HIV pt with 250-500 cell count?

VZV (zoster) | HSV

what are the most common cutaneous infections for HIV pt with < 250 cell count?

``` Bartonella HHV-8 CMV Leishmania Molluscum contagiosum Candida Scabies disseminated fungal infections ```

What are the two most common pathogens associated with CNS issues? (for HIV pt)

Cryptococcus neoformans (<200 cells/mm3)

The other CNS infections?

``` TB Syphillis Listeria HIV systemic fungi ```

Which BACTERIAL infection is generally seen in the first month after transplant?

P. aeruginosa, S. marcescens and E.cloacae MRSA, VRE Leginella, Nocardiosis Basically gram - rods and gram + cocci

What is generally seen in the first month of post transplantation?

``` nosocomial infections most common viral is HSV seen within first weeks surgery related UTI immunosuppression exacerbates ```

What is seen 2-6 months post transplantation?

immunosuppression

What is seen after 6 months post transplantation?

Community acquired infections UTI VZV reactivation things seen after discharged from hospital

Which bacterial infection is generally seen in the first month after transplant?

P. aeruginosa, S. marcescens and E.cloacae MRSA, VRE Leginella, Nocardiosis Basically gram - rods and gram + cocci

What are the other FUNGAL infections? post transplant

Cryptococcus -For HIV mostly Coccidiodes Histoplasmosis

What s/s do post transplant CMV pt get?

interstitial pneumonitis | AIDS pt also get retinitis

What are the other viral infections post transplant?

VZV, HSV, EBV - mono BK virus - renal disease Influ A and B, adenovirus - respiratory infections

What are the 2 most common FUNGAL infections post transplant?

Candida | Aspergillus -->very bad news for IC pt.

Acid fast oocysts, parasites

small circular acid fasts --> cryptosporia parvum huge, elliptical acid fasts --> isosporia isospora clincally looks like giardia b/c it causes malabsorption

Owl's Eye?

CMV

Dented helmets, condoms?

PCP (pneumocystis pneumonia) | aka PJP

HIV pt with PERSISTENT diarrhea

ALWAYS cryptosporia!! Persistent diarrhea --> Parasite

Acid fast oocysts, parasites

small circular acid fasts --> cryptosporia parvum huge, elliptical acid fasts --> isosporia isospora clincally looks like giardia b/c it causes malabsorption

HIV pt, excessive weight loss, CD4 count is 75, Acid fast bacilli

M. avium intracellulae

HIV, severe headache

CNS issues: Toxoplasma --> "ring enhancing" lesions Crytococcus neoformans --> encapsulating yeast --> leading form of meningitis in AIDS pt

What do you see in pt with Mucor

IC pt with respiratory infection Labs: ketoacidosis diabetic and sinusitis 90 degrees, nonseptae hyphae

sickle cell anemia, tachy, hypotension, fever Labs: leukocytosis with left shift encapsulated gram + cocci blood agar - alpha hemolysis

some kind of sepsis is going on - encapsulated bacteria S. pneumo

HIV, multi-colored lesions

Kaposi = HHV-8 (which is most common) | Bacillary angiomatosis = Bartonella (B. henselae)

IC pt with respiratory infection Labs: neutropenia sputum negative for bacterial growth septae at 45 degrees

Aspergillosis

IC pt with respiratory infection Labs: ketoacidosis diabetic and sinusitis 90 degrees, nonseptae hyphae

Mucor

Micro: opportunistic infections (didnt know it was done already) Flashcards

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