4 Path- Infections

olola's version from 2017-02-09 00:38


Question Answer
Gram positive anaerobesStreptococcus, Staphylococcus
Gram positive aerobic bacilliMycobacteria
Gram negative coiled helicalSpirochetes (Treponema pallidum)
Gram positive anaerobic filamentous rodsActinomyces (A. israelii, A. naeslundii, A. odontolyticus)
examples of ProteobacteriaBartonella henselae, Afipia felis -- both cause cat scratch disease
"ray fungus"Actinomyces -- bacterial infection

Bacterial, Fungal, or Viral?

Question Answer
Impetigobacterial (Gram positive anaerobes -- Strep. Pyogenes, Gram neg anaerobes -- Staph aureus); tx: penicillin, good prognosis
Tuberculosisbacterial (Gram positive aerobic bacilli -- M. tuberculosis)
Syphilisbacterial (Treponema pallidum- Gram neg helical spirochete)
Cat-scratch diseasebacterial (Bartonella henselae 80%, Afipia felis 20%)
Histoplasmosisfungal (infected bird droppings)
Chicken pox, Shingles (recurrent)viral (Varicella-Zoster virus)
Oral Hairy Leukoplakia (aka HIV-Keratosis)viral (Epstein-Barr virus)
Herpanginaviral (group A Coxsackie virus)
Hand, foot and mouth diseaseviral (group A Coxsackie virus)

diagnostic tests

Question Answer
silver stain (Warthrin's Starry)used to identify Treponema pallidum which causes syphilis
acid fast stain (Ziehl Neelson)identify TB
dark field illuminationidentifies chancre characteristic of Primary stage of Syphilis, develops after incubation period of 21 days
immunoperoxidase reactionidentifies syphilis
Screening tests for Syphilis (primary and secondary stages)VDRL, RFR, FTA-BS, MHA-TP
dimorphic fungi (Big Blue Broad Based Budding yeast)Blastomyces dermatides (At room temperature (24°C) it takes the mycelial form (conidium, pl conidia, showing like a lollipop). Only the conidial form is infectious. Yeast in infected people, therefore, cannot be transmitte)
small septate, branching at acute angleAspergillosis (A. fumigatus, A. flavus)
fungus ball in lungsAspergillosis (A. fumigatus, A. flavus)
non-septate, branching at 90º angleMucormycosis
biopsy showing multinucleated epithelial cellsHerpes
Swollen cells w/ nuclei exhibiting “nuclear beading”Oral Hairy Leukoplakia (caused by Epstein-Barr virus)
Does serum testing show syphilis in primary syphilis? secondary syphilis? tertiary syphilis?primary NO; secondary YES; Tertiary YES
Most common screening test for syphilis (not stain, to be clear)VDRL (Venereal disease research laboratory)
T/F: Tertiary syphilis may appear even after apparent successful treatment of primary infectionTrue
T/F: Treatment and resolution of primary syphilis ensures that the condition is resolved and will not progress to subsequent stagesFalse (resolved treated syphilis can return years later as tertiary syphilis)

signs & symptoms

Question Answer
primary stage of syphilis21 days, CHANCRES, serology tests are usually negative, dx through dark field illumination
secondary stage of syphilis2-6 months after infection, syphilids, maculopapular rash, condyloma lata, highly contagious, patchy alopecia, hair loss from lateral third of eyebrows; serology test is postive and highly contagious
tertiary stage of syphilisgumma (gummatous necrosis), oronasal lesions, systemic infection (CNS, cardiovascular, visceral organs)
condylomata lata (genital warts)secondary syphilis
tx for syphilislong-acting Penicillin therapy
Congenital syphilisskin rash, saber shins, orofacial cleft, frontal bossing, saddle nose, rhagades (fissures, cracks, or linear scars in the skin, especially at the angles of the mouth and nose), Hutchinson's triad (blindness, deafness, dental anomalies)
hutchinson's triadfor Congenital Syphilis Blindness, Deafness, Dental anomalies (Hutchinson incisors, mulberry molars)
sulfur granulesActinomyces
Actinomycosis bacterial infectionsVisceral (pulmonary, abdominal, vaginal), Cervicofacial (55%), Cerebral
lumpy jaw diseaseCervicofacial Actinomycosis
pain, swelling, draining pus- can be caused by traumatic incidents, extractions, periapical infectionsCervicofacial Actinomycosis
osteomyelitisCervicofacial Actinomycosis
skin papular lesions, low-grade fever, malaise, headache, lymphadenopathy drainingCat-Scratch disease
burning sensationAtrophic Candidiasis
Acute forms of Oral CandidiasisThrush (pseudomembranous candidiasis), Atrophic (erythematous)
Chronic forms of Oral CandidaisisHyperplastic (Candidal leukoplakia)- microscropic exam required to rule out epithelial dysplasia
Special forms of CandidaisisAngular cheilitis (Perleche), Median Rhomboid Glossitis (asymptomatic), Chronic mucocutaneous candidiasis (skin, nails, mucosa), Endocrinopathy-associated Candidiasis
infected bird droppings, Ohio-Mississippi river valleyHisplasmosis
calcified hilar and mediastinal nodes, calcified lung nodules, granular erythematous non-healing ulcersHistoplasmosis
skin rash, scaly and crusting, hyperkeratotic and ulcerative lesionsBlastomycosis (differential diagnosis with Squamous cell carcinoma)
small septate, branching at ACUTE angleAspergillosis (A. fumigatus, A. flavus)
non-septate, branching at 90 degree angleMucormycosis
Angio-invasive, block blood vessels resulting in ischemic necrosis and tissue destructionMucormycosis
Ramsay-Hunt syndromecaused by Varicella-Zoster virus (Herpes 3), Shingles of the ear along with paralysis of ipsilateral facial & auditory nerves, hearing deficits, vertigo, tinnitus
Lesions seen on lateral borders of tongue, white w/ hair-like surfaceOral Hairy Leukoplakia (caused by Epstein-Barr virus, Herpes 4), has no malignant potential
Erythematous macules on on lateral/dorsal surfaces of the Fingers and Toes; tongue, buccal and labial mucosa, gingival, soft palate of mouthHand, foot and mouth disease (caused by Coxsackie group A virus)
Ghon focusMyco. Tuberculosis
caseous necrosisMyco. Tuberculosis
Pott's diseasevertebral TB- spinal collapse and fusion
lupus vulgariscutaneous TB
ScrofulaMycobacterial cervical lymphadenitis, lymphadenitis of the cervical lymph nodes associated with TB
group A Coxsackie virusesaffect oropharynx with vesicle type lesions- Herpangina, Hand foot and mouth disease
group B Coxscakie virusescasue upper respiratory tract infections
cornflake lesionsimpetigo (Staph aureus, Strep pyogenes)
3 types of patient that most at risk for Pseudomembranous CandidiasisNewborns, HIV/AIDS patients, & Uncontrolled diabetics
type of candidiasis most commonly associated with removable prostheses and burning sensationAtrophic Candidiasis


Question Answer
tx for TBIsoniazid, Rifampin for 18-24 months; resistant strains in AIDS patients
tx for syphilislong-acting penicillin therapy
tx for Actinomycosissurgical debridement, high daily dose of Penicillin for 10 days, large lesions may need IV-penicillin
tx for Cat-Scratch diseasesome cases antibiotic therapy- 90% of cases run a benign, self-limited course
tx for CandidiasisNystatin (oral suspension), Clotrimazole (Mycelex troches), Fluconazole/Diflucan (systemic tablets)
tx for Angular ChelitisMycostatin/Triamcinolone Acetnide (Mycolog II Cream)
tx for Denture-borne Candidiasis3% Alkaline Hypochlorite (may have harmful effects on dental alloys), 2% Sodium Benzoate (most effective)
tx for HistoplasmosisAmphotericin B for acute forms in HIV pts
tx for BlastomycosisAmphotericin B
tx for AspergillosisAmphotericin B, Azole systemic therapy