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117 Cards in this Set
- Front
- Back
Cardiovascular Barriers to infection
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Blood low in Fe
Bacteria don't grow Phagocytic cells clear bacteria |
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Normal Flora in cardio system
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None
|
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Lymphatic system
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very permeable
fixed macrophages clear baxter both types lymphs T cells and b cells RES |
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Bacteremia
-where? -gets in how? |
presence of bacteria in blood
-gets in through invasive procedures and wounds |
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2 types of bacteremia?
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1. absence of identifiable source
2. spread from 1 source of infection -many bacteria can lead to sepsis under right circumstance |
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Symptoms of bacteremia
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self-limiting
no symptoms |
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Lymphangitis
-inflammation of lymph vessel |
APC go to present to lymph nodes and cause inflammation they travel in lymphatic system and vessels become inflamed and cause streaking
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Septicemia
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Uncontrolled proliferation in blood
sepsis |
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Signs and symptoms of septicemia
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-bacterial siderophores steal Fe
-increase bacterial growth -fever, chills, increased hr, breathing |
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Severe Sepsis
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-inflammatory response causes decrease bp
-hypotension earmark with sepsis -must be treated with fluids -cause must be identified -body wide inflammation and blood not getting to organs |
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Septic shock (worst)
-mortality rate? -leads to? |
BP can be controlled by fluids
vessel constriction decreased blood flow leads to organ failure 20-40% mortality rate |
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Endocarditis
-what is it? |
Inflammation of inner layer of heart and valves
|
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Predisposition for endocarditis
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-altered or abnormal heart architecture
1. trauma (MI, surgery, prosthetic valves) 2. Congenial heart disease 3. Rheumatic fever (immune response to GAS) |
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Exposure to bacteria for Endocarditis
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-major dental surgery
-open heart surgery/genitourinary procedure -body piercing (susceptibility) -IV drug use (adherence strong, in mouth so not washed away) |
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2 types of endocarditis
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Acute- outside sudden high fever and high fatality
Subacute- inside, slower onset, daily mild fever for months with heart murmur |
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Endocarditis symptoms
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fatigue, general discomfort (malaise), headache, night sweats, heart murmur
splinter hemorrhages appear under fingernails |
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Diagnosis for sepsis and endocarditis
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-blood culture
-broth culture (aerobic and anaerobe) -# of cells present in septic blood often <100ml |
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Treatment for endocarditis and septicimia
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Antibiotic and then something more specific
|
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causes of sepsis and endocarditis
Staph aureus and Strep epi -gram stain? |
found of skin
-gram + cocci in clusters |
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Epidemiology of S. Aureus
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-normal flora so opportunistic nosocomial
-tooth extractions -MRSA -Pos op. surgical sepsis |
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Epidemiology of S. Epidermidis
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-40% nosocomial sepsis, linked to iv catheters
- make biofilm, adherence and grow on needle |
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Diagnosis of S. aureus
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culture
staph aureus -beta hemo, cat + coat + S. Epi -gamma, cat +, coag- (STREP cat-) |
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Treatment of S. Aureus
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penicillin with tooth extractions
MRSA treat with vancomycin |
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Cause of endocarditis
-viridans streptococci (oral) -gram stain? |
-gram + cocci in chains
- alpha hemolytic -one of leading cause of endocarditis -normal flora in mouth, infected during dental procedures -CAT - -optichin resistant vs sensitive |
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Cause of endocarditis enterococci
-gram stain? Catalase? -2 main species |
gram + cocci, D carb
Cat - aerotolerant E. faecalis (80-90%) (gut flora) E faecium (5-10%) |
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epidemiology of enterococci
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-3rd leading cause of endocarditis
-prothetic valve endocarditis mainly -naturally drug resistant HARD to TREAT |
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Cause of sepsis streptococcus pyogenes
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Group a Strep
Gram + cocci |
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Virulence factors of Strep Pyogenes
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Capsule
Hyaluronidase DnAse leukocidins m protein streptolysins |
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Puerperal Sepsis
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childbed fever
-nosocomial infection of uterus -transmitted by hands and instruments of dr -prevent with hand washing -rare now |
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Lemierre's syndrom
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abscess secondary to GAS strep throat infection (eats holes through throat)
VF: streptolysin, Hyaluronidase allow invasiveness -cause infected clot in jugular and travel to lung or heart and be fatal -reemergence |
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Rheumatic fever
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original pharyngitis infection
-autoimmune complication of strep throat GAS infection and then antibodies to M protein Type II hypersensitivity |
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Symptoms of rheumatic fever
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arthritis
misdirected immune response fever M protein is self like and leads to heart damage |
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Epidemiology of rheumatic fever
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early century killed children
declining due to loss of virulence reemergence of virulent serotypes in Us reinfection renews immune attack and worsens heart each time |
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Diagnosis of S. pyogenes
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B-hemolytic on blood agar
Bacitracin senseitive Cat - A carb |
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Treatment for rheumatic fever
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high rid patients get Benzathin Penicillin G and anyone with a history of rheumatic fever
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Prevention of rheumatic fever
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hand washing
treat strep throat |
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Cause of sepsis Group B strep Agalactiae
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Sepsis of newborns
-moms vaginal infection spread during delivery -baby septic within day and mom has no symptoms |
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Diagnosis of Group B strep
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Culture
-B hemo -Cat - Lancefield group b |
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Treatment of group B strep
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Antibiotics during delivery
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Prevention of group b strep
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Check pregnant women for group b at 35-37 weeks
rectal and vaginal |
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Endotoxic shock
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Cause of sepsis
Gram- rods LPS most likely cause of septic shock (20%) |
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Symptoms of shock
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increase heart rate and respiration
weak pulse dehydration, cold DIC |
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Treatment for shock
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Maybe antibiotics, maybe not, dead cell better than non-dead cell if LPS available
Vasopressors to control blood pressure |
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Protein C in septic shock treatment
|
is an important player in the body's response to inflammation and systemic sepsis
-reduce production of thrombin -inhibits influence of tissue factor on clotting system, shuts down clotting |
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Gram + endotoxic shock
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less common and less severe
LTA |
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Plague
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Uncommon cause of sepsis (zoonotic)
-yersinia pestis -facultative intracellular -gram - bacilli Black death |
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Plague disease
-symptoms -how do you get it? -mortality rate? |
Bubonic -flea bite-buboes in armpits and groin (inflammation) mortality 50-75% -death w/in week if septic Pneumonic -infects lungs -mortality 100% -person to person |
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Epidemiolog of plague
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Bubonic
Reservoir-rat Vector -rat flea Due to over-crowding Pneumonic Human to human aerosol Slvatic plague-flea associated with told rodent or bite by flea touched by wild rodent |
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Virulence factors of plague
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1. YOP gene necessary for attachment to host cells
2. Plasminogen activator 3. Capsule-inhibit phagocytosis Last 2 needed to cause disease in mice and survive in flea |
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History of plague
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-oldest recoded infection disease
|
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Diagnosis of plague
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Fluorescent antibody
culture PCR |
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Treatment for plague
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antibiotics
|
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Prevention for plague
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Live attenuated vaccine
Get rid of flea and rat recovery offers immunity |
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Brucellosis
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Uncommon causes of sepsis associated with animals
- 3 species -gram - bacilli undulant fever (up and down) |
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Epidemiology of Brucellosis
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Foodborne infections
-unpast. goat cheese -exposure to disease animal tissue so someone comes in contact with raw meat -no person to person -farmers and vets |
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Symptoms of brucellosis
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-septicemia: muscular pain and sweating.
Duration varies from a few weeks to many months/years |
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Treatment for brucellosis
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prolonged antibiotics
|
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Prevention
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Vaccine animals
|
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Tularemia GNR
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uncommon cause of sepsis related to animals
-francisella tularensis (rabbits and rodents) -potential agent of bioterrorism Gram -- rod -due to skinning water ticks dust and mowing |
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Symptoms of tularemia
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headache
backache ulcerative lesion conjunctivitis Pulmonary |
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Anthrax
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uncommon causes of sepsis zoonotic
-bacillus anthracis Gram + bacilli spore former -herbivorous animals ingest soil in water or on vegetation |
|
1.Cutaneous antrax (wool sorters disease)
2.GAstrointestinal antrax |
1. most cases
skin lesion-ruptures scabs sheered sheep and dusty wool 2. undercooked food with spores bloody diarrhea |
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Inhalation anthrax
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breath in spores
mortality very high septic shock LTA gram + |
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Epidemiology of anthrax
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-imported disease associated with animals
-bio warfare |
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Antrax virulence factors
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capsule
anthrax toxin -edema factor -lethal factor -protective antigen |
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A-B subunit toxin for anthrax
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PA protective antigen
EF edema factor LF lethal factor |
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Diagnosis of anthrax
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Culture
-protect against airborne spores PCR |
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Treatment for anthrax
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antibiotics
|
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Prevention for anthrax
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1. vaccine for animals (live attenuated)
2. Vaccine for humans military inactivated form of protective antigen |
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Q fever
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uncommon cause of sepsis zoonotic
-coxiella burnetti in domestic animals |
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Cat scratch
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uncommon causes of sepsis zoonotic
bartonella sp cat bite or scratch |
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Lyme disease
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borrelia burgdorferi
Spirochete |
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Lyme disease
-rash? -symptoms? |
75% rash target rash
-flu like symptoms -if untreated 75% will develop later manifestations |
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Complications of lyme disease
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due to immune response
-arthritis (primary) -heart disease -neurological |
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Epidemiology of lyme disease
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reservoir is field mice
vector is deer tick (tick wants the deer, we get it from tick) |
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Diagnosis of Lyme disease
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sign and symptoms Rash
ELISA PCR Not done clinically culture Bacterial |
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Treatment of lyme disease
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antibiotics
|
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Prevention of lyme disease
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control tick population
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Typhus fever 1
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Aka louse borne typus
from body lice so rare -rickettsia prowazekii -obligate intracellular bacteria -arthropod vector -human body louse lice Too tiny for gram stain |
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Typhus fever cause 2
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Tick borne typhus or rocky mountian spotted fever (rickettsia rickettsii)
-rash on palms and soles of feet -vector is wood tick -delayed diagnosis but rarely fatal -serology only late in disease -no vacc -control tick polulationE |
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epidemiology of rocky mountain spotted fever
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-every louse has to feed on somebody who has typhus to give it to someone else
-A tick with rocky mountain will have babies who are already infected |
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Human Immunodeficiency Virus
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Retrovirus so has reverse transcriptase
-similar to SIV STD primarily -infection of t cells which are circulation in blood |
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HIV Primary infection
-symptoms |
Acute Retroviral syndrome
-flu or mono-like symptoms -viral infection of T lymphocytes, CD4 helper cells and macrophages |
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HIV secondary infection
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Latency
-meidan time 10-11 year few have rapid progression 2-3 years really persistence bc active virus production |
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AIDs disease
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immune systems ability to control infectious or malignant disorders is destroyed
relentless production of HIV proteins elimination of host cells destruction of immune system Death |
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ARC (AIDS related complex)
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Die from infection bc of lack of Cd4 T cells
immunocompromised Kaposi's sarcoma Mycobacteria pneumocystis herpes zoster toxoplasma histoplasmosis |
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Epidemiology of HiV
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STD.
IV drug use contaminated needles transfusions organ transplants |
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Diagnosis of HIV
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Indirect ELISA (detect 20 days after infection)
Confirmation with PCR or western blot |
|
Treatment of AIDs
|
cocktail combination of 3
|
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Prevention of HIV
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Condoms
Education |
|
Epstein barr virus HHV 4
|
AKa burkitts' lymphoma
-most common cancer of african children -in areas with endemic malaria -malaria impairs immune response of EBV |
|
Infectious mononucleosis
|
Disease 4-7 week incubation
lymphocytosis fever sore throat |
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Epidemiology of inectious mononucleosis
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Young adults 15-25
saliva transmitted kissing disease |
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Diagnosis of mononucleosis
|
mono spot tests for heterophile antibodies (antibodies produced during EBV infection)
|
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Treatment for mononucleosis
|
self limiting/none
|
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Prevention of mononucleosis
|
permanent immunity of you have gotten mono through E barr
|
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Yellow fever
|
Disruption of clotting factors, supportive treatment
accompanied by jaundice mosquito |
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Dengue fever
|
breakbone fever, sever pain
mostquito |
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Ebola
|
massive hemorrhage rash
vector unknown |
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Lassa Fever
|
chest pain and deafness as long as term sequelae
|
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Hanta virus
|
human exposure to dried rodent urin
pulmonary syndrome SE when people sweeping warehouse and breath drown in your own fluid |
|
West Nile Virus
|
Carried by virus
Arbovirus Mostquito |
|
Symptoms of West Nile Virus
|
asymptomatic or mild illness sometimes with headache
-encephalitis in rare cases Not seen in US before 1999 |
|
Toxoplasmosis
|
Tocoplasma gonii
parasitic Associated with AIDS Pregnant women ingest cyst of parasite due to liter box, can cross placenta and infect baby None to few symptoms |
|
Toxoplasmosis
|
-majority of world population infected
mostly with no symptoms and normal immune system keeps away illness -AIDS immune suppressed have severe neurological impairment -Congenital infection (stillborn, brain and vision problems) |
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Epidemiology of toxoplasmosis
|
outdoor cats, sandboxes, and children
-accidentally ingest cat feces rat or undercooked meat -pork lamb venison contaminated water fomites organs or blood |
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Diagnosis of Toxoplasmosis
|
TORCH panel
Toxoplasma specific antibodies |
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Treatment for toxoplasmosis
|
Treat only immune suppressed, pregnant, and congenitally infected
-antiparisitic treatment |
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Malaria
|
Apicomplexa protozoan
-caused by plasmodium species -intracellular in RBS |
|
Symptoms of malarial disease
|
malaise, fatigue, vague aches, and nausea with diarrhea or not
next symptoms have bouts of chills, fever, and sweating, -occur at 48-72 hour intervals RBC lysis leading to anemia RBC stick clog tissue damage |
|
Epidemiology of malaria
|
10 million cases/yr
2 million death/yr mosquito US rare, tropical arease |
|
Diagnosis of Malaria
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identify parts of life cycle in peripheral blood smear
|
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Treatment for malaria
|
Drug resistance is big problem
Quinine Chloroquine Artemisinin as last line of defense |
|
Prevention of malaria
|
control mosquito population
netting enriched pesticide |
|
Lymphatic filariasis
|
worms transmitted by bite of mosquito
invade and reproduce in lymphatic system often asymptomatic can cause blockage of lymphatic vessel and lymphadema and elephantiasis |
|
Diagnosis of filariasis
|
detection of worms in blood
microfilariae specific antibodies |
|
Treatment of Filariasis
|
Anti-filarial drugs will not resolve lymphedema and elephantiasis
surgery |