Microbiology Exam 4 Diseases

AIDS Treatment

"HAART" highly active anti-retroviral therapy and cART combination anti-retroviral therapy -RT inhibitors = block RDDP and sow viral replication -Integrase inhibitors = block transformation of host genome -Protease inhibitors = block maturation/release of virus particles -Expensive, long course, resistance, efficacy unknown, doesn't treat latent

SoCVD: Ebola Virus HFVs

1) 5 species of Ebola virus : Tai Forest (Ivory Coast), Sudan, Zaire, Reston and Bundibugyo 2) Virons are filamentous (6 or U shape) 3) BUD from host cells (non-lytic) 4) People are infectious as long as their blood and secretions contain the virus

SoCVD: Septicemias P.aeruginosa: Disease Spectrum

1) ALMOST ANYTHING - adaptable and versatile 2) P.aeruginosa infections that lead to septicemia -BURN WOUND INFECTIONS -- wet, open -CYSTIC FIBROSIS INFECTIONS -- heavy mucous -NOSOCOMIAL INFECTIONS -- wet hospital 3) Other diseases of P.aeruginosa that lead to invasiveness -Endocarditis, wound infections, pneumonia, septicemia -"Swimmer's ear"/"Pseudomonas HotFoot" -Onycholysis (nail infections) -UTI, Folliculitis, bone infections -CORNEAL INFECTIONS -ECTHYMA GANGRENOSUM -- similar to NF 4) SUSCEPTIBILITY TESTING (INFECTION CONTROL AND EDUCATION)

SoCVD: HIV/AIDS and Clinical Progression

1) Clinical Stage 1 -- initial infection: VAGUE, FLU-LIKE SYMPTOMS that soon disappear (high levels --> latent) -T cell count of 500+ (asymptomatic) -2-15 years (number of T cells in blood is steadily decreasing as virus has low level replications 2) Clinical Stage 2 -- MORE NUMEROUS, BUT MILD OPPORTUNISTIC INFECTIONS (PCP, FUNGAL INF/PNEUMO) mild weight loss, sick longer -T cell count 200<x<500 3) Clinical Stage 3 -- AIDS: fatigue, diarrhea, weight loss, and neurological changes, RARE INFECTIONS OR NEOPLASMS, IMMUNODEFICIENT SYNDROMES (BURKITT'S/KAPOSI'S), protected fever, fatigue, sore throat, and night sweats, lesions in brain, meninges, spinal column, and peripheral nerves -T-cell count x<200

SoCVD: Septicemias P.aeruginosa: Epidemiology and VFs

1) G (-) = ENDOTOXIN LPS 2) LOTS of adhesion molecules 3) CAPSULE made of alginate 4) ELASTASE destroys connective tissue 5) EXOTOXIN A and EXOTOXIN S for direct tissue damage (protein synthesis inhibitors) similar to diptheria toxin 6) HIGHLY MULI-DRUG resistant 7) Lives anywhere, but prefers wet/moist environments and body locations regardless of temperature ("hot tub bug"; normal flora -- opportunistic) 8) Transmission = ANYWAY IT PLEASES -LEADING CAUSES OF NOSOCOMIAL INFECTION 9) STRICT AEROBE and always produces pigment

InfDisResp (U/LRT): Croup

1) General information and description: 2) Signs and symptoms: Mimic common cold but as infection progresses, inflammation of URT VOICEBOX AND WINDPIPE, can spread to bronchi -Leads to BARKING cough or hoarseness -When very swollen stridor squeaking noise upon inhalation -May be worse at night or when upset/crying 3) CC: PARAINFLUENZA VIRUS 4) VFs: Viral 5) Diagnosis/differentiation: Sounds, CXR with helpful ID - STEEPLE SIGN (NARROWING OF TRACHEA) 6) Treatment plan: Treat symptoms and monitor airflow/breathing, cool mist humidifiers and "outdoors" 7) Adverse effects:

InfDisResp (LRT): Pneumonia Nosocomial pneumonias HAP

1) General information and description: 2) Signs and symptoms: 3) CC: STREPTOCOCCUS PNEUMONIAE (#1 common) -Others: E.coli, S.aureus, P.aeruginosa, H.flu 4) VFs: 5) Diagnosis/differentiation: 6) Treatment plan: 7) Adverse effects:

InfDisResp (LRT): Pneumonia Community Acquired Pneumonia CAP

1) General information and description: 2) Signs and symptoms: "Rust" colored sputum common 3) CC: STREPTOCOCCUS PNEUMONIAE (#1 common) -Gram + latent shaped diplococci -Small mucoid colonies with alpha hemolysis -Others: H.flu, Neisseria spp., E.coli, S.aureus 4) VFs: Capsule 5) Diagnosis/differentiation: 6) Treatment plan: Cephalosporins 7) Adverse effects:

SoCVD: Lyme Disease EARLY LOCALIZED DISEASE

1) General information and description: 2) Signs and symptoms: Not painful, EM lesions occasionally burn or itch and are hot to tough, fatigue, neck stiffness, myalgias, arthralgias, lymphadenopathy 3) CC: 4) VFs: 5) Diagnosis/differentiation: 6) Treatment plan: 7) Adverse effects:

SoCVD: Toxic Shock Syndrome

1) General information and description: 2) Signs and symptoms: Sudden high fever and low blood pressure (hypotension) -Vomiting/diarrhea, confusion, seizures, headaches, and muscle aches -Rash resembling a sunburn particularly on palms and soles ("BOILED LOBSTER RASH"; PEELING OF SKIN ON HANDS AND FEET) 3) CC: Almost ANY bacteria can cause -STAPH AUREUS (toxemia): often associated with tampon usage or contraceptive sponges - TOXIC SHOCK SYNDROME TOXIN (TSST-1) = SUPERANTIGEN -STREP PYOGENES (bacteremia with toxemia): often introduced with puncture wounds - SPEA AND SPEC TOXINS = SUPERANTIGENS -GRAM - BACTERIA from LPS release ("septic shock" - no toxins found) 4) VFs: 5) Diagnosis/differentiation: 6) Treatment plan: 7) Adverse effects: MOF

InfDisResp (URT): Rhinitis

1) General information and description: "Common cold" 2) Signs and symptoms: Sneezing, scratchy throat, runny nose -Begin 2-3 days after infection -Generally NOT accompanied by fever -Due to immune response, not virus 3) CC: RHINOVIRUS 4) VFs: Penetrate mucous and attach to cells -Binds sialic acid residues + ICAM -Over 200+ serotypes, highly mutable 5) Diagnosis/differentiation: Appearance 6) Treatment plan: Aeresol droplet control, chicken soup and rest 7) Adverse effects:

InfDisResp (URT): Acute Otitis Media

1) General information and description: "Ear infections" 2) Signs and symptoms: Sensation of fullness or pain in the ear, loss of hearing, pus/inflammatory fluid response in the middle ear -Infections continue to Eustachian tubes 3) CC: Streptococcus pneumoniae, Haemophilus influenzae 4) VFs: CAPSULE 5) Diagnosis/differentiation: Appearance, screaming child 6) Treatment plan: NONE IS NOT PREFERRED (72 HOUR 'WATCHFUL WAITING' -B lactams -Vaccination (HiB, Pneumovax/Prevnar) 7) Adverse effects: Untreated or severe infections can lead to eardrum rupture or meningitis

SoCVD: Necrotizing Faciitis (NF)

1) General information and description: "Flesh eating disease" -Rare infection of the deeper layers of the skin and subcutaneous tissues, easily spreading across the facial plane within the subcutaneous tissue (uses bloodstream) -Death and necrosis of tissue, often requires debridement -Often after trauma 2) Signs and symptoms: Signs of inflammation may not be apparent if the bacteria are deep within the tissue 3) CC: Streptococcus pyogenes or staphylococcus aureus (toxin mediated) -NEW EMERGING CAUSE: Vibrio vulnificus (waterborne gram -) TSS connection -NEW EMERGING CAUSE: Aeromonas hydrophila (waterborne gram -) 4) VFs: 5) Diagnosis/differentiation: 6) Treatment plan: 7) Adverse effects:

SoCVD: Tularemia

1) General information and description: "RABBIT FEVER" 2) Signs and symptoms: Headache, backache, fever, chills, malaise, and weakness -Progresses to ulcerative skin lesions, swollen LN, conjunctival inflammation, sore throat, intestinal disruption, pulmonary involvement -Vector = tick bite -Most common among hunters and persons consuming infected wild game meat 3) CC: Francisella tularensis (gram -) 4) VFs: Intracellular, highly infections (ID50 = 1-10) -Potential bioweapon categoryA 5) Diagnosis/differentiation: 6) Treatment plan: Aminoglycosides (Gent, Kan) 7) Adverse effects: Debilitating, fatal if inhalation exposure

InfDisResp (URT): Pharyngitis

1) General information and description: "STREP THROAT" 2) Signs and symptoms: Inflammation of the throat, pain and swelling, reddened mucosa, swollen tonsils, bad breath, potential for white packets of inflammatory pus/products, may affect speech and swallowing 3) CC: -CC #1: Most common VIRAL (LESS SEVERE, hoarseness) -CC #2: Streptococcus pyogenes (GAS CAUSES 1/3 PHARYNGITIS - NF BUT ACTIVE IS BEST SPREAD CHANCE) -CC #3: FUSOBACTERIUM NECROPHORUM - gram neg rare (young), idential to GAS but reported as "non-GAS" 4) VFs: -M PROTEIN (1, 3, 5, 6, 12, 18, 19, 24) with adhecin and WBC evasion mechanism and responsible for serotype and sequelae determinant -CC #2: look at other slides 5) Diagnosis/differentiation: Appearance, rapid strep testing 6) Treatment plan: -CC #3: PEN BUT NOT Z PACKS -CC #2: B-lactams with anti B-lactamase (Augmentin) 7) Adverse effects: -CC #2: look at other slides -CC #3 can lead to Lemierre's syndrome (blood infection)

InfDisResp (URT): Sinusitis

1) General information and description: "Sinus infection" 2) Signs and symptoms: Nasal congestion, pressure above nose or in forehead, feeling of headache or toothache, facial swelling/tenderness common -Often follow common cold -WHITE, BROWN, GREEN, OR YELLOW COLOR OPAQUE DISCHARGE (bacterial) 3) CC: Bacterial, viral, and fungal agents -NORMAL FLORA (RECURRENCE) 4) VFs: BIOFILMS, PERSISTENCE, MIXED INFECTIONS 5) Diagnosis/differentiation: Appearance, occasional radiology 6) Treatment plan: BROAD SPEC antibiotics (Z pack, augmentin, erythro) 7) Adverse effects:

InfDisResp (LRT): Common Fungal Pneumonias ASPERGILLUS FUMIGATIS

1) General information and description: "The black mold" - can be normal flora or opportunistic pathogen -Large increase in AIDS patients 2) Signs and symptoms: Systemic aspergillosis - black lesions 3) CC: 4) VFs: 5) Diagnosis/differentiation: Appearance - "septate branching hyphae" LIGHTING AND BROCCOLI 6) Treatment plan: Azoles, ampho b 7) Adverse effects: Pneumonia, lung infection

InfDisResp (LRT): Atypical Pneumonia

1) General information and description: "Walking pneumonia" 2) Signs and symptoms: Asymptomatic to mild cough and malaise to fever, muscle ache, severe fatigue 3a) CC/VF #1: -CC #1: CHLAMYDIA PNEUMONIAE - gram n/a -VF #1: OBLIGATE INTRAcellular; ID biphasic lifecycle 3b) CC/VF #2 -CC #2: MYCOPLASMA PNEUMONIAE - gram n/a -VF #2: OBLIGATE EXTRAcellular (TIP ADHESION STRUCTURE) - lack PPG so no cell wall; smallest free-living bacterium; ID colonies grow slow and resemble fried eggs 5) Diagnosis/differentiation: Symptomatic 6) Treatment plan: Macrolides or tetracyclines 7) Adverse effects: Repeated infections correlated with increased risk of atherosclerosis

InfDisResp (U/LRT): Pertussis

1) General information and description: "Whooping cough" -LONG recovery phase of weeks/months (secondary infection with other microorganisms) -OBLIGATE pathogen -Aerosol transmission -HIGHLY contagious 2) Signs and symptoms: Appears with cold-like symptoms, progresses to PAROXYSMAL stage -Severe and uncontrollable coughing usually with a whoop sound, but may be absent in infants 3) CC: Bordetella pertussis (G - coccobacilli) 4) VFs: Toxins -TRACHEAL CYTOTOXIN (CT): AB toxin, kills ciliated nasopharynx cells -PERTUSSIS TOXIN (PT): upregulate cAMP in cells by blocking the inhibitory subunit of the G protein responsible for downregulation of cAMP - REVERSE EFFECT 5) Diagnosis/differentiation: Sound, throat culture 6) Treatment plan: Z pack starting point, Erythromycin, vaccine (DPT) - 5 BOOSTERS 7) Adverse effects: Violent coughing spasms can result in burst blood vessels in the eyes, vomiting, cracked ribs

InfDisResp (LRT): Tuberculosis

1) General information and description: #1 INFECTIOUS CAUSE OF DEATH WORLDWIDE; FOREIGN BORN 2) Signs and symptoms: 3) CC: Mycobacterium tuberculosis or mycobacterium avium intracellulare (MAC) 4) VFs: "CORD FACTOR" and proton pump = allow INTRACELLULAR growth 5) Diagnosis/differentiation: Gram N/A with heavy lipid content -"ACID FAST" staining (slim red snapper rods with segmentation) -"BREADCRUMB" colonies -Tuberculin testing (PPD) -Chest x-rays (CXR) -Direct identification of acid-fast bacilli (AFB) -Culture isolation + antimicrobial susceptibility testing -"Quant-iFeron GOLD" 6) Treatment plan: 7) Adverse effects:

InfDisResp (LRT): Common Fungal Pneumonias HISTOPLASMA CAPSULTUM

1) General information and description: Acquired from bird droppings, bat caves, and some SOIL locations -ENDEMIC (rural population from field plowing and chicken coops) -Causes lung mycosis with slower progression to pneumonia disease (asymptomatic or cold-like) 2) Signs and symptoms: 3) CC: 4) VFs: 5) Diagnosis/differentiation: SMALL, OVAL BUDDING YEASTS INSIDE MO -Lung disease can appear as "SNOWSTORM" CXR 6) Treatment plan: Azoles, ampho b 7) Adverse effects: Suspect disseminated histoplasmosis in HIV cases

SoCVD: Lyme Disease EARLY DISSEMINATED DISEASE

1) General information and description: Acute neurologic or cardiac involvement usually occurs weeks to several months after the tick bite Bilateral cranial nerve palsies 2) Signs and symptoms: Meningitis, cranial neuropathy, motor or sensory radiculoneuropathy facial never affected, bilateral cranial nerve palsies, conjunctivitis 3) CC: 4) VFs: 5) Diagnosis/differentiation: 6) Treatment plan: Tetracycline, doxycycline, prevent from spreading 7) Adverse effects:

InfDisResp (LRT): Pneumonia

1) General information and description: Anatomical diagnosis -Inflammatory condition of the lung in which liquid fills the alveoli 2) Signs and symptoms: -Begin with upper respiratory tract symptoms, runny nose and congestion and fever -Onset of lung symptoms: chest pain, fever, cough, discolored sputum 3) CC: WIDE VARIETY OF MICROORGANISMS -Almost any bacteria -Viral pneumonias are usually milder than bacterial 4) VFs: 5) Diagnosis/differentiation: 6) Treatment plan: 7) Adverse effects:

SoCVD: Cat-Scratch Fever and Cat-Bite Cellulitis

1) General information and description: Any animal wound -Starts as classic cellulitis - hot, tight reddened INFLAMMATION underskin lesions w occasional cluster of small papules -Moves to capillaries or lymphatics - swollen lymph nodes with pus ('tracks' up vessels in limbs) 2) Signs and symptoms: 3) CC: -C.S.Fev = Bartonella henselae (gram - intracellular) -C.B.Cel = Pasturella multocida (gram - coccobacilli w bipolar safety pin staining, CAPSULE, P.multocisa toxin destroys connective tissue and allows for invasion) 4) VFs: 5) Diagnosis/differentiation: 6) Treatment plan: Most simple cellulitis is self-limiting, some require antibiotics -Immunocompromised need aggressive therapy 7) Adverse effects: -Immunocompromised risk systemic spread -BACILLARY ANGIOMATOSIS - vascularproliferative disease (blood blisters) -BACILLARY PELIOSIS HEPATITIS - blood-filled cavities in liver -ENDOCARDITIS - moving through blood stream

InfDisResp (LRT): Bronchitis

1) General information and description: As the inflammation of the bronchial tubes progresses = excessive mucus production, chest pains, heavy breathing, SOB and wheezing -Must R/O for PNEUMONIA -Having symptoms for loner terms (3+mo) confirm it to be chronic 2) Signs and symptoms: Extreme coughing, nasal congestion, fever, fatigue 3) CC: -CC #1: VIRUS INFECTION (influenza, RSV, hMPV) -CC #2: BACTERIAL INFECTION (S.pneumonia, H.influenzae, Mycoplasma, Klebsiella) -CC #3: ENVIRONMENTAL/IMMUNOLOGICAL (smoke, allergens, pollutants, irritants) 4) VFs: 5) Diagnosis/differentiation: Bronchial wash to find agent, CXR 6) Treatment plan: Normally self-limiting, but severe infection may need admission for O2, IV fluids, ventilation -Symptomatic treatment with inhalers (albuterol, bronchodilators or occasionally steroidal) 7) Adverse effects: Pneumonia

SoCVD: Plague

1) General information and description: BUBONIC PLAGUE "black death" -Bacterium injected through a flea bite -Lymphatic infection, causes inflammation an necrosis of the LN -SEPTICEMIC PLAGUE: when the case progresses to massive bacterial growth in the blood -PNEUMONIC PLAGUE: respiratory disease -ENDEMIC to W/SW US -From fleas, contact with wild animals 2) Signs and symptoms: -Swollen lesion called BUBO usually in the groin or axilla -Fever, chills, headache, nausea, weakness, and tenderness of the bubo, DIC, subcutaneous hemorrhage/purpura, tissue necrosis 3) CC: Yersinia pestis (gram -) 4) VFs: low ID (3-50), Top T3SS ("syringe injector") 5) Diagnosis/differentiation: 6) Treatment plan: Aminoglycoside antibiotics, vaccine available for high risk individuals 7) Adverse effects: HIGH mortality -- death in 2-4 days

InfDisResp (U/LRT): Influenza

1) General information and description: Begins in the URT -Virus replication --> cell death --> sloughing of cells into airway and inflammation (acute confines infection of virus; H1N1) -Cell breakdown products + CYTOKINE STORM responsible for SYSTEMIC SYMPTOMS 2) Signs and symptoms: Rapid onset, headache, chills, dry cough, body aches, FEVER (BUT H1N1 VARIABLE), stuffy nose, and sore throat from draining 3) CC: Influenza virus (Orthomyxovirus) types A and B 4) VFs: Mutability, HEMAGGLUTININ (HA) and NEURAMINIDASE (NA) CAPSID PROTEINS -Spikes for attachment and entry to host cells -HxNx typing 5) Diagnosis/differentiation: Symptomatic, very few further testings although H/N typing is increasing 6) Treatment plan: Infections are self limiting, but severse infection may give antivirals (Relenza, Tamiflu) "BEST GUESS" vaccine yearly for anyone +6mo (INACTIVE) or LAIV (FluMist, 5yr+) for mucosal protection 7) Adverse effects: Serious cases may also affect the LRT (SECONDARY BACTERIAL INFECTION)

SoCVD: Ebola Virus

1) General information and description: CURRENT OUTBREAK = INTENSE VIREMIA -Spread blood/secretion/needle/close contact -Quicker spread through hospital (aerosol) 2) Signs and symptoms: Fever, headache, joint/muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite -Rash, red eyes, hiccups, cough, sore throat, chest pain, difficulty breathing, difficulty swallowing, impaired kidney and liver function 3) CC: Ebola virus, marburg virus (- sense RNA) 4) VFs: Unknown 5) Diagnosis/differentiation: Low white blood cell and platelet counts and elevated liver enzymes 6) Treatment plan: No known beyond supportive 7) Adverse effects: AGGRESSIVE VIREMIA = clotting (DC) leading to bleeding inside/outside of the body -LETHALITY ~50-90%

InfDisResp (LRT): Aggressive Pneumonias Pontiac Fever

1) General information and description: Caused by breathing in weakened or dead L.pneumo bacteria -"Simple/regular" pneumonia only -Water aerosol only 2) Signs and symptoms: 3) CC: Legionella pneumophila (gram -) 4) VFs: HIGHLY virulent; lives in water (A/C cooling towers, water storage, sprinkler systems - chlorine resistant) 5) Diagnosis/differentiation: CBYE agar 6) Treatment plan: Immediate antibiotics 7) Adverse effects:

SoCVD: Zika Virus Microcephaly

1) General information and description: Condition where baby's head is much smaller than expected (baby's brain has not developed properly) -GREATER TISK DURING 1ST TRIMESTER -Isolated or in combination with other birth defects 2) Signs and symptoms: Seizures, developmental delay, problems with speech and other developmental milestones, intellectual disability, movement and balance problems, feeding problems, hearing loss, vision problems 3) CC: 4) VFs: RECEPTOR PROTEIN AXL (normally involved in cell vision in developing human brain cells) -- not only protein linked to Zika 5) Diagnosis/differentiation: 6) Treatment plan: 7) Adverse effects:

SoCVD: Dengue Fever

1) General information and description: GLOBAL INCIDENCE HAS GROWN DRAMATICALLY IN RECENT DECADES 2) Signs and symptoms: SUDDEN HIGH FEVER (104-105 @ 4-7 days after mosquito bite) -FLAT, RED RASH -SECOND RASH measles like -INCREASED SKIN SENSITIVITY and VERY UNCOMFORTABLE ("BONEBREAK FEVER") 3) CC: Dengue virus (+RNA virus) 4) VFs: Viral, mosquito borne, high titer VIREMIA -Increased virulence due to ANTIBODY DEPENDENT ENHANCEMENT OF VIRAL REPLICATION 5) Diagnosis/differentiation: 6) Treatment plan: 7) Adverse effects: MORE SEVERE DISEASE UPON RE-EXPOSURE -Hemorrhagic bleeding

InfDisResp (URT): Diphtheria

1) General information and description: Infection with sore throat, lack or appetite or low-grade fever 2) Signs and symptoms: -PSEUDOMEMBRANE forms on the tonsils or pharynx, ASPHYXIATION -Systemic - toxin attacks CNS and cardiac tissue 3) CC: Corynebacterium diphtheriae (G + rod) 4) VFs: TOXIN - NO invasion -- A/B toxin attacks protein synthesis 5) Diagnosis/differentiation: -Gram stain of "chinese character" or "XY pattern", ELEK TEST, Tinsdale agar (black colonies) -Appearance, rapid strep test 6) Treatment plan: ANTI-TOXIN + PEN or ERY, vaccine (DPT) 7) Adverse effects: Extreme fatigue, dementia, and eventual death that looks very much like an MI (dead cardiac tissue)

SoCVD: Endocarditis

1) General information and description: Inflammation of the endocardium, usually referring to an infection of the valves of the heart -MICROBE ATTACHMENT AND GROWTH ("VEGETATIONS") -May follow infection of any prosthetic devices (catheters, joint replacements, artificial heart valves) or drug use 2) Signs and symptoms: Fever, anemia, abnormal heartbeat, symptoms similar to heart attack, petechiae rash (Osler's nodes/Janeway lesions) and under the fingernails (splinter hemmorage) may be present 3) CC: Staphylococcus epidermidis (Coag-neg Staph) -CC #2: Oral Streptococci (S.mutans or S.oralis) -CC #3: "high power" pathogens like S.aureus, GAS, etc 4) VFs: Biofilm formation 5) Diagnosis/differentiation: (-) for coagulase enzyme 6) Treatment plan: Complete removal of prosthetic, long term antibiotics 7) Adverse effects:

SoCVD: Infectious Mononucleosis

1) General information and description: Mono "kissing disease" 2) Signs and symptoms: MANY ONLY COLD LIKE SYMPTOMS -SORE THROAT, high fever, lymphadenopathy -Gray-white exudates in throat, skin rash, enlarged spleen/liver -Sudden leukocytosis -Fatigue -Bells palsy 3) CC: EPSTEIN-BARR VIRUS (EBV) 4) VFs: Infects B-cells, latency 5) Diagnosis/differentiation: 6) Treatment plan: None, rest, no heavy exercise or intimate contact 7) Adverse effects: -Spleen damage/rupture -Potential reactivation as Burkitt's lymphoma (B-cell cancer)

InfDisResp (URT): Enterovirus D68

1) General information and description: More severe than common cold -"Summer colds" or "pre-flu" 2) Signs and symptoms: Sneezing, scratchy throat, runny nose -Low grade fever 3) CC: ENTEROVIRUS STRAINS -Endogenous and exogenous infection 4) VFs: Viral -100+ serotypes 5) Diagnosis/differentiation: Appearance 6) Treatment plan: Aerosol droplet control, chicken soup, rest -Watch/educate about respiratory collapse -Supportive care 7) Adverse effects: Serious for immunocompromised

InfDisResp (U/LRT): RSV infection

1) General information and description: Most prevalent cause of respiratory infection in newborn age group 2) Signs and symptoms: Fever lasting ~3 days, rhinitis, pharyngitis, and otitis 3) CC: RESPIRAORY SYNCYTIAL VIRUS (RNA VIRUS) 4) VFs: Produces giant multinucleated cells (SYNCTIA) -"TRIPLE WHAMMY OF RSV" = syncytial + inflamm + remodeling 5) Diagnosis/differentiation: Bronchial or nasal wash to find syncytial cells 6) Treatment plan: Mild infections are self-limiting, but severe infection may need admission for O2, IV fluids, ventilation, and antivirals (RIBAVIRIN) 7) Adverse effects: -More serious infections give symptoms of croup like coughing, wheezing, dyspnea, rales -Severe disease under age 6 mo - easily spread by adults (LRT involvement; pneumonia; "blueing" from airway inflammation)

InfDisResp (LRT): Aggressive Pneumonias LEGIONNAIRES DISEASE

1) General information and description: Multifocal necrotizing pneumonia 2) Signs and symptoms: Headache, fever, chills, non productive cough --> Multifocal necrotizing pneumonia (productive cough, chest pain, vomiting, confusion/delerium, diarrhea) 3) CC: 4) VFs: 5) Diagnosis/differentiation: 6) Treatment plan: 7) Adverse effects: SHOCK, MOF, DEATH, MORTALITY RATE ~50%

SoCVD: Lyme Disease LATE DISEASE

1) General information and description: Occurs moths to a few years after onset infection and may not be preceded by a history of early localized or disseminated lyme disease 2) Signs and symptoms: Arthritis, mild neurologic syndrome called lyme encephalopathy 3) CC: 4) VFs: 5) Diagnosis/differentiation: 6) Treatment plan: 7) Adverse effects:

SoCVD: Septicemias

1) General information and description: Occurs when organisms actively multiplying in the blood 2) Signs and symptoms: FEVER and HYPOTENSION are prominent symptoms -Ill, low blood pressure, may have an altered mental state, shaking, chills, gastrointestinal symptoms, increased breathing rate and respiratory alkalosis 3) CC: MANY DIFFERENT BACTERIA and a few FUNGI can cause this condition (GAS and PSEUDOMONAS AERUGINOSA) 4) VFs: 5) Diagnosis/differentiation: P.aerug grows on almost any media, colonies are GREENISH or BLUISH color, "FRUITY" or "GRAPE-LIKE" odor -Identify by FLORESCENCE (+) and OXIDASE testing (+) 6) Treatment plan: Treat aggressively with several antibitotics 7) Adverse effects:

InfDisResp (U/LRT): Coronaviruses "Middle East Respiratory Syndrome" MERS

1) General information and description: Person to person, close contact spread, rapid progressions 2) Signs and symptoms: Mild cough/resp/cold-like to SWIFT, SEVERE ACUTE RESPIRATORY COLLAPSE -Fever, cough, shortness of breath 3) CC: NOVEL CORONAVIRUS or MERS-COV 4) VFs: Unknown -Super spreaders -Poster children for rapid transmission/pandemic 5) Diagnosis/differentiation: Lab tests for MERS-CoV 6) Treatment plan: Supportive to relieve symptoms 7) Adverse effects: Eventual progression to LRT and pneumonia or pneumonia-like symptoms -MERS mortality ~50%

InfDisResp (U/LRT): Coronaviruses "Sudden Acute Respiratory Syndrome" (SARS)

1) General information and description: Person to person, close contact spread, rapid progressions 2) Signs and symptoms: Mild cough/resp/cold-like to SWIFT, SEVERE ACUTE RESPIRATORY COLLAPSE -Fever, cough, shortness of breath 3) CC: SARS CORONAVIRUS 4) VFs: Unknown -Super spreaders -Poster children for rapid transmission/pandemic 5) Diagnosis/differentiation: 6) Treatment plan: Supportive to relieve symptoms 7) Adverse effects: Eventual progression to LRT and pneumonia or pneumonia-like symptoms -SARS mortality ~15% (immunocomp/elderly)

InfDisResp (LRT): Common Fungal Pneumonias PNEUMOCYSTIS JIROVECII

1) General information and description: Pneumocystis pneumonia (PCP) or pneumocystosis -Lower sputum than other pneumonias unless secondary bacterial infection -RECENT LARGE INCREASE IN HIV/AIDS PATIENTS 2) Signs and symptoms: Most cases begin cold-like but progress uncontrolled 3) CC: 4) VFs: 5) Diagnosis/differentiation: HIV test; appearance "crushed pingpong balls" on methenamine silver strain 6) Treatment plan: Azoles, ampho b 7) Adverse effects:

InfDisResp (LRT): Pneumonia KLEBSIELLA PNEUMONIAE CRKP

1) General information and description: Pneumonia, bloodstream infections, would or surgical site infections, meningitis, infections via ventilators or IV catheters, and patients extended antibiotic regimens 2) Signs and symptoms: 3) CC: Gram - bacillus, normal flora of gut and feces 4) VFs: -Highly mucoid carbohydrate capsule ("string test") -Production of carbapenemase enzyme (BLAKPC OR NDM-1) 5) Diagnosis/differentiation: RED JELLY LOOKING 6) Treatment plan: -Increasing antibiotic resistance to carbapenem class 7) Adverse effects: High rates of morbidity and mortality (prolonged hospitalization)

SoCVD: Lyme Disease

1) General information and description: Rash disease spread by ticks -Evolves into a slowly progressive syndrome that mimics neuromuscular and rheumatoid conditions -STAGES 2) Signs and symptoms: "Post lyme disease syndrome" - headache, fatigue and arthralgias that may persist for months after treatment (symptoms improve gradually over 6mo-1 year) 3) CC: Borrelia burgdorferii (spirochete) 4) VFs: Motility, adhesion, antigen shifting 5) Diagnosis/differentiation: 6) Treatment plan: Doxycycline or b-lactams (1st), Cefotaxime or ceftriaxone (2nd) -Administered ~3-4 weeks -Corticosteroids for inflammatory 7) Adverse effects:

InfDisResp (LRT): Aggressive Pneumonias HANTAVIRUS

1) General information and description: SPREAD BY RODENT DROPPINGS but PERSON TO PERSON TRANSMISSION POSSIBLE -Respiratory --> pneumonia --> dead 2) Signs and symptoms: 3) CC: 4) VFs: 5) Diagnosis/differentiation: FROM CDC 6) Treatment plan: 7) Adverse effects: Hantavirus Pulmonary Syndrome HPS -Cytokine storm -Large edema formation due to massive immune response -40% mortality rate

SoCVD: Zika Virus

1) General information and description: Spread through mosquitos, sexual transmission, perinatal, in utero, transfusion transmission -NOT LIKELY CARRIES/CHRONIC -NOT DEADLY -MOST WON'T KNOW THEY HAVE DISEASE BECAUSE ASYMPTOMATIC -SUBCLINICAL HAS NOT BEEN ASSOCIATED WITH SERIOUS CONSEQUENCES YET 2) Signs and symptoms: Similar to dengue and chikungunya -Fever, rash (maculopapular), joint pain, conjunctivitis w possible muscle pain and headache (MILD) 3) CC: ZIKA VIRUS (SSRNA, FLAVIVIRIDAE FAMILY) 4) VFs: LIPID MEMBRANE, NEUROTROPHIC? -VECTOR-BORNE VIA ANDES SPP MOSQUITOS, PRIMATE AND NON-HUMAN RESERVOIRS 5) Diagnosis/differentiation: 6) Treatment plan: No vaccine to prevent but treat symptoms with rest, fluids, tylenol/fever reducers, no aspirin 7) Adverse effects: -Guillain-Barre Syndrome -Microencephaly in developing baby -Autoimmune disorder - acute disseminated encephalomyelitis, resembling MS with additional edema of brain and spinal cord

SoCVD: Ehrlichiosis

1) General information and description: Tick bite disease 2) Signs and symptoms: Mimics RMSF -- sustained fever, chills, headache, muscle pain -USUALLY NO RASH 3) CC: -E.chaffiensis (HME) - Human Monocytic Ehrlichia (Mo, DC) -E.equi (HGE) - Human Granulocytic Ehrlichia (No, Masts, etc) -Identical infections but infect DIFFERENT IMMUNE CELL TYPES 4) VFs: Intracellular pathogen 5) Diagnosis/differentiation: 6) Treatment plan: Tetracycline, limit tick exposure and proper removal/disinfection 7) Adverse effects: Cardiovascular disruption, restlessness, delirium, convulsions, tremor, coma

SoCVD: Rocky Mountain Spotted Fever (RMSF)

1) General information and description: Tick bite disease 2) Signs and symptoms: Sustained fever, chills, headache and muscle pain -SPOTTED RASH within 2-4 days (spread FROM EXTREMITIES TO TRUNK) -Cardiovascular disruption, restlessness, delirium, convulsions, tremor, and coma 3) CC: Rickettsia rickettsii 4) VFs: Obligate intracellular pathogen -REPLICATED IN ENDOTHELIAL CELLS (blood vessel lining) 5) Diagnosis/differentiation: 6) Treatment plan: Tetracycline, limit tick exposure and proper removal/disinfection 7) Adverse effects: 20% MORTALITY RATE IF UNTREATED -Kidney failure, GI problems, heart complications

SoCVD: Malaria

1) General information and description: Vector-borne transmission (mosquitoes) 2) Signs and symptoms: Cyclic fevers (fever-chills-fever-chills), anemia, fatigue 3) CC: Plasmodium falciparum (parasite) 4) VFs: None known 5) Diagnosis/differentiation: "CIRCLES" -- ring form, schizonts -"thick and thin" blood smears 6) Treatment plan: Quinine (expensive) or with mosquito netting/repellents and water source cleanup 7) Adverse effects: Neurological damage (high intracranial pressure) and abnormal posturing in kids

InfDisResp (U/LRT): Metapneumovirus

1) General information and description: hMPV -Most common in children and older adults (acute respiratory tract infection that is found commonly as INFLUENZA NEGATIVE, RSV NEGATIVE) 2) Signs and symptoms: Similar to Influenza: rapid onset headache, chills, dry cough, body aches, fever, stuffy nose, and sore throat 3) CC: Metapneumovirus (Paramyxovirus) 4) VFs: Unknown 5) Diagnosis/differentiation: DFA, (direct immunofluorescence) PCR 6) Treatment plan: Treat symptoms, not virus 7) Adverse effects:

InfDisResp (LRT): Tuberculosis Issues of Antibiotic Resistance

1) High levels of patient noncompliance are common due to long course treatments -DIRECTLY OBSERVED THERAPY (DOTs) -Incarceration also an option but a cause 2) MDR-TB (MULTIDRUG-RESISTANT TB) 3) XDR-TB (EXTENSIVELY DRUG-RESISTANT TB) 4) TDR-TB (TOTALLY DRUG RESISTANT TB)

InfDisResp (U/LRT): Influenza Variation

1) Influenza virus (Orthomyxovirus) Types A and B -SEGMENTED genome of 8 strands of RNA -Allows reassortment of fragments + mutations 2) Yearly flu strain changes (mutations) = ANTIGENIC DRIFT -Minor mutations in H, N, or both -Reduced host immune response to virus -Produces most seasonal influenza strains 3) Epidemic strain changes (reassortment) = ANTIGENIC SHIFT -"Shuffling" of genome in multiple virus infected hosts, RNA exchange between different viruses -More likely to produce pandemic strains or lead to new strains (H1N1 or H5N1)

InfDisResp (LRT): Tuberculosis THREE STAGES

1) Primary: Initial infection that is controlled and goes dormant -'Flulike' with mild fever -Positive for PPD, negative for CXR - not very contagious -FORMATION OF GRANULOMAS/TUBERCLES = hard calcified lesions of infected cells and M.tb (DORMANCY); lower central areas of the lungs as granulomas -ID50 ~ 10 -Mo ingest M.tb which then escape the phagolysosomal destruction -Killing of CD*+ T cells needed, leaves cell debris, need for more Mo -More M.tb infection 2) Secondary: Active infection, contagious, reactivations -Fever, coughing with BLOOD TINGED SPUTUM, NIGHT SWEATS, WEIGHT LOSS -"Consumption" -Positive for PPD and CXR -REACTIVATION/ESCAPE causes large immune response mediated by T cells; EXTENSIVE INFILTRATION in upper lungs/bronchi and marked tubercles -Cytokine release from Tcells results in CASEOUS (LIQUIFYING) NECROSIS "COTTAGE CHEESE LUNG") and spread out to lungs to other tissues 3) Disseminated (Miliary or "Pots Disease"): Spread of M.tb out of lungs to other tissues -Destructive lesions in spine and bone structure, humps, etc

InfDisResp (URT): Pharyngitis S pyogenes: Complications of Strep Throat

1) Scarlet Fever -Erythrogenic toxin production -Sandpaper like rash and high fever, school aged children 2) Rheumatic fever -X reaction between streptococcal M protein and heart muscle -Occurs about 3 weeks after pharyngitis has subsided -Damage to heart valves and circulatory system, arthritis in many joints 3) Glomerulonephritis -Formation of antigen-antibody complexed in the glomeruli (T3HS) -Characterized by nephritis and kidney failure/function 4) TSS and necrotizing fasciitis

InfDisResp (LRT): Tuberculosis Treatment and Prevention

1) Sunshine and outdoors (heat and UV sensitive) 2) "Cocktail treatment": LONG TERM treatment with antibiotics -RISE = rifampin, isoniazid, streptomycin, and ethambutol -Now adding pyrazinamide (RIPES) + aminoglycosides (RIPESAg) -NON-COMPLIANCE -- antibiotic resistance problematic 3) Prevention: education and detection 4) Vaccine: Bacille-Calmette-Guerin (BCG) -Not used in US

InfDisResp (URT): Pharyngitis S pyogenes: VFs

1) Surface antigens -LIPOTEICHOIC ACID (LTA) -M PROTEIN -HYALURONIC ACID (HA) 2) Extracellular Toxins -STREPTOLYSINS: streptolysin O (SLO) and streptolysin S (SLS) for hemolysis -ERYTHROGENIC TOXIN: rash, fever typical of scarlet fever 3) Superantigens -SPEA/SPEC activate T cells and induce tumor necrosis factor cytokine-mediated damage

SoCVD: Ebola Virus HEMORRHAGIC FEVER VARIANTS

1) Viral protein involvements 2) Coagulation abnormalities (GI bleeding, rash, hematological irregularities such as lymphopenia and neutrophilia) -Cytokines released when reticuloendothelial cells encounter virus --> exaggerated inflammatory response not protective -Damage to liver, massive viremia --> DIC blocking blood flow -Virus eventually infects microvascular endothelial cells and compromised vascular integrity (terminal stages include diffuse bleeding and hypotensive shock)

InfDisResp (U/LRT): Influenza Vaccination

Best Prevention: Hygiene + vaccination 1) Inactivated seasonal vaccine (injection) -3-5 different viruses resembling variants predicted in the coming flu season (70-90% effective against those strains) -6 mo+ -Standard side effects and risks 2) Live attenuated seasonal vaccine (LAIV): FluMist -Stimulates secretory immunity, but not as effective as we had hoped -5-49 years 3) Intradermal vision vaccine (FluZone ID) -2-3 viruses, efficacy is protective but % unknown -5-60 years -Higher side effects, same risks, LESS antigen, thimerosal (Hg) FREE