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What are the diagnostic tests for Syphilis?
- Screening: VDRL/RPR
- Diagnostic: FTS
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What kind of reaction is a gumma?
Type IV hypersensitivity
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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
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What's the clinical presentation of secondary syphilis?
- Widespread mucocutaneous lesions of oral cavity, palms, soles
- Present 2-10 wks post chancre
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What's the histological presentation of primary syphilis?
- plasma cells, macrophages, endothelial activation -> fibrosis
- Spirochetes (silver stain/immunofluorescence)
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What's the histological presentation of secondary syphilis?
- Plasma cell infiltrate and enarteritis
- Less intense inflammation
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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
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What is the Jarisch Herkheimer Reaction?
- High syphilis bacterial load
- Bacterial treatment
- Massive exotoxin release
- CYTOKINE STORM
- Fever, Rigus, HOTN, leukopenia
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What's the histological pattern in syphilis?
Perivascular infiltrlate (plasma cells) in dermis
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What's a diagnostic stain for fibrosis from gummas?
Trichrome stain (tertiary syphilis)
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What are the stages of Lyme disease?
- 1. Acute illness (lymphadenitis/targetoid rash)
- 2. Dissemination (CNS/Cardiac)
- 3. Chronic (Arthritis, neuropathy)
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What are clinical presentations of Clostriduium sp?
- C. dificile - Pseudomembranous colitis
- C. cellulitis
- C. perfungens - gas gangrene
- C. botulism
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What's the gross hallmark of pseudomembranous colitis?
Abundant plaque like adhesions on mucosa; necrotic debris
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What's the mechanism of C. dificile damage to colon?
- Toxin a/b -> cytokine production
- Host Cell Apoptosis
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What oragnisms cause destruction of bowel mucosa?
- Shigella (distal colon)
- Salmonella (blunting/vascular conjestion)
- Yersinnia, Cholerae, Jejuni
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What are severe complications of bacterial entercolitis?
Who needs Tx?
- Barier destruction, fluid loss, perforation
- Elderly & young pts
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What's the process for determining skin/soft tissue infection?
- 1. ID organism
- 2. Urgency (depth/life/limb)
- 3. Intervention
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What's the pathogenesis of C. perfringens?
- a-toxin -> destroy cell membranes/matrix proteins
- Sudden onset
- Edema/Gas bubble
- HOTN/renal failure/organ dysfunction
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What toxin is related to C. Tetani?
- Tetanospasmin
- Bblock release of GABA (spastic paralysis)
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What's the toxin related to C botulinum?
- botulims toxin
- prevent ACh release (flaccid paralysis)
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What's the characteristic rash pattern of RMSF?
- Distal --> Central
- Palms & soles
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If you have a pt with DIC what tests do you order?
Fibrin split products and d-dimer
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What's the rickettsia triad?
Fever, headache, rash
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What's the diagnostic test for RMSF?
Indirect fluorescent antibody or skin biopsy with immune staining (7-10 days post disease onset)
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How is RMSF trasmitted?
- Rickettsiapox - mite
- Other rickettsia - ixodid tick
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What's the pathogenesis of RMSF?
- Intracellular
- Blood borne -> endothelial invasion
- Increase permeability
- HOTN, thrombocytopenia
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What are complications of RMSF?
- Interstitial pneymona & myocarditis
- Renal failure -> death
- Brain microinfarcts, skin necrosis
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What's the clinical presentation of Ehrlichiosis?
- Cytoplasmic inclusion appearing like mulberry
- Abrupt headache, fever, malaise, rash
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What's the complication of Rickettsia prowazeki?
- Typhus fever/nodule in brain
- Focal microglial proliferation of Tcells and macrophages
- Body Louse
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What types of patients are seen with Candida infection?
Immunocompromised patients (prego, DM, HIV)
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What are clinical examples of candida infection?
Vaginits, thrush, diaper rash
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What do you see histologically on Candida infection?
Budding yeast /pseudohyphe
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What are hematogenous disease caused be Candida?
Blood, heart, meninges, kidney, lung, spleen, joints
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What types of fungi cause pulmonary infections?
- Histoplasma - ohio & mississippi
- Coccidioides - southwest
- Blasomycosis - southeastern
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What are diagnositc techniques for fungal infections (superficial, deep, disseminated)
- Superficial - KOH
- Deep - biopsy with silver/PAS
- Disseminated - multiple cultures
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What organism produces the soap-bubble lesion?
Cruptococcus neoformans
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What's the organ involvement of Asperfillus; what does it look like?
- Angioinvasive
- Wages of necrosis Lung, heart
- Acute angle branching
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Which Hb types are protective against malaria?
HbS, HbC
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What's special about the Negative Duffy Ag?
Protective against Vivax
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What are complications of malaria?
Hepatosplenomegally, Congestion/edema (pulmonary, renal, cerebral)
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What's characteristic of Babesia
- Maltese Crosses in cells
- Northeast exposure to ixoides tick
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What's the cause of overwhealming malaria parasitemia?
- RBCs become sticky and adhere to endothelial surface
- Microinfarcts
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What are the serotypes of chlamydia?
- A-C: trachoma
- D-K: urethritis
- L1-3: LGV
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What are genital diseases caused by C. trachomatis?
NGU, epididymitis, mucopurulent cervicitis, PID, proctitis
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What is Lymphogranuloma venereum?
- Mixed granulomatous/PMN response to C. trachomatis
- Chlamydia inclusions in cytoplasm
- HSV confusion??
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What is trachoma? How's it transmitted?
- Chronic conjunctivitis
- Eye --> eye
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What is the Elementary/Reticulate body?
- EB: Infectious
- RB: Intracellular
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What's Reiter's disease?
- C. trachomatis complication (HLA-B27)
- Pee, see, knee
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