What are the diagnostic tests for Syphilis?
- Screening: VDRL/RPR
- Diagnostic: FTS
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)
- No STI
What is the Jarisch Herkheimer Reaction?
- High syphilis bacterial load
- Bacterial treatment
- Massive exotoxin release
- CYTOKINE STORM
- 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. cellulitis
- C. perfungens - gas gangrene
- C. botulism
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)
- 3. Intervention
What's the pathogenesis of C. perfringens?
- a-toxin -> destroy cell membranes/matrix proteins
- Sudden onset
- Edema/Gas bubble
- 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?
- botulims toxin
- 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
- Increase permeability
- HOTN, thrombocytopenia
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
- Body Louse
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?
- A-C: trachoma
- D-K: urethritis
- L1-3: LGV
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
- HSV confusion??
What is trachoma? How's it transmitted?
- Chronic conjunctivitis
- Eye --> eye
What is the Elementary/Reticulate body?
- EB: Infectious
- RB: Intracellular
What's Reiter's disease?
- C. trachomatis complication (HLA-B27)
- Pee, see, knee