Define the Following Terms
Content
Define the following terms: Antigen -Any definable moiety Hapten - < 6000 D Immunogen - > 6000D Only known immunogenic lipid Cardiolipin #1 factor for immunogenicity variability What is the carrier effect? Using a known immunogenic substance with an attached hapten in the hopes that the body will recognize the hapten Macrophages Process antigens by? Macrophages Engulf, Digest, and present haptens on the variable Beta chain of MHC II. When this happens the invariant chain is pushed out of the way and the macrophage begins making IL-1. What is the only cell that releases IL-1? What is IL-1's function? IL-1 is Responsible for? fever and all feelings of sickness. It starts the immune response by recruiting more macrophages and T-Cells. Hot to fight infection Detergent Impairs Adhesion Antiseptic # of Pathogens Disinfectant #of Pathogens Sterilization Kills Spores How to kill spores 121 Degree vaporized heat for 15 min. How do disinfectants & Antiseptics work? They kill pathogens by dissolving the cell membrane Humoral Response B-Cells PMN Cell Mediated Response T-Cells Macrophages Cell-Mediated vs- Humoral Bacteria elicit a Humoral response and everything else elicits a cell medicated respose.
Name the macrophage Brain Microglia Lung Type I Pneumoncite Liver Kupfer Cells Spleen RES Kidney Messangial Cell Lymph Node Dendritic Cell Bone Osteoclasts Skin Langerhans CT Schistocyte Giant Cell, Epithelioid Timeline for all infections 1st 24hr - Swelling 24hr PMN show up PMN s peak at day 3 If bacterial PMN's remain If not, T-Cells/MO show up at day 4 & peak at day 7 Fibroblasts show up at day 7 & peak at one month Fibroblasts takes 3-6 months to finish scarring. Cell-Mediated order of Infx Virus - CMV, EBV Fungus Microbacterium Protozoa Parasite Neoplasm Nutrition affect? Cell mediated before Humoral MCC of death in all cancers Bacterial Infection except cervical cancer where MCC of death is RENAL FAILURE. % of Lukenias that are B-cell 98% MC T-Cell Immune diseases DiGeoge s Prednisone Cyslsporine Wiscott Aldrich SCID HIV T-Cell Lukenia
T-Cell Lymphoma Mucocutaneois Candidiasis
MC B-Cell Immune diseases Bruton s Wiscott-Aldrich SCID B-Cell Lukemia B-Cell Lymphoma JOB Selective IgA Def Selective IgG2 Def Multiple Myeloma Heavy Chain Disease CVID MC PMN Immune diseases CGD Nutropenia MC M0 Immune diseases CGD Chediak-Higashi Two T-Cell Lympmonas Mycosis Fungoides Sezary blood Clue for T-Cell Lymphomas Crenated cells Clues for Hairy Cell Lukemia Sunburst appearance Fried Egg appearance TRAP positive Name the defect in DiGeorge Failure 3rd & 4th pharyngeal arches to develop Name the defect in Mucocutaneous Candidiasis Chronic infection with candida Name the defect in SCID Adenisine deaminase deficiency Name the defect in Wiscot-Aldridge Defect in Class switching
Name the defect in JOB syn. Hyper IgE due to class switching problem Name the defect in CGD NADPH oxidase deficiency. Features of DiGeorge's Absent Thymus Absent Inferior Parathyroid Decreased Ca2+ Tx: Transplant Thymus Immunoprivaledged Sites (Due to no Lymphatic flow): Thymus Testes Brain Cornea Clues for Kleinfelters Tall man with small testes Clues for Fragile X Short man with large testes. What gene protects from HIV CCR5 MCC proteins found in HIV Gp120 Attach to CD4 receptor Pol gene - Integrates HIV RNA Reverse Transcriptase - Transcribe RNA p17/p24 - Used for Assembly gp41 - Surface marker Fastest in HIV population Heterosexual black female Elderly Reason Men pass HIV easier HIV Loves mucosa so easier for men to pass to women. Reason Harder for preadolescents to contract due to decreased vaginal pH HIV enters body and attacks? Vessel Vasculitis/Kaposi Brain- HIV Dementia Testes - Testicular Lymphoma
Describe Kaposi Sarcoma Violatious Nodules How HIV Attaches to Cervix Likes CD4 receptor Female cervix is rich in CD4 receptors Cells that HIV attacks T-Cells and Macrophages What happens to other Cells? B-Cells and neutrophils will undergo hyperplasia leading to increased B-Cells and hyper-gammaglobulins Normal CD4 count CD4 800-1200 When do you start HIV Rx CD4 count < 500 PCP presents at CD4 of? Less than 200 Treatment for PCP Trimethaprin/Sulfamethoxazole If allergic to sulfa drugs use Pentamidine (Aerosole) MAI presents at CD4 of ? Less than 100 Treat MAI with Clarithromycin. Screening ELIZA - Antibody If positive, prove with Wesern Blot If Negative with PCR (Most Specific test) SCID Defect in Adenine Deaminase Affects T-Cells and B-Cells Wiscott-Aldridge Defect in Class switching (CD 40 cells - IL-4 responsible) Fair skin with xema and thrombocytopenia
Mechanism of Cyclosporin Inhibit prodction of IL-2 by T-Cells which inhibits Calcinurua Defect in Bruton's B-cells present but 2nd messanger (Tyrosine Kinase) does not work Clues for JOB Syndrome Hyper IgE Red hair female Clues for Selective IgA Def. MCC of Anaphylaxis in transfusions Clues for Selective IgA Def. MC Subtype Infx from encapsulated organisms MCC of every "PENIA" viral infection Drugs
Patient who have fevers and are either neutropenic, CF, DM, and Burn patients are susceptible to Staph aureus nad Pseudomonas infections cover Staff once nad Psudomonas twice. If fever persists add Amphoteracin B Myeloperoxidase Deficiency NADPH Oxidase deficiency (Chronic Granulomatous Disease) (-) NBT test LAZY LEUKOCYTE SyNDROME PMN slow and lethargic
WBC - White Blood Count à Leukocytes Normal White cell count 4-12 K Explain Demargination CBC represents only 10% of white cells in circulation 90% are marginated against the vascular endothelium 95% of these marginated cells are mature (PMNs). Less than 5% are Blasts.
You can call them back into circulation Called demargination. Define Demargination Recruiting marginated white cells back into circulation What hormones cause demargination Stress Epinepherine Cortisol Abx(Stress -vs- infx) Stress -demargination Infx(Bacterial -vs-Viral) Infection Lekemoid Rxn Extreme Stress Incr. Incr. Incr. Incr. Incr. Incr. Incr.
Incr.
Incr.
Incr. < 5%
Incr. > 5%
Leukemia
Whenever you biopsy a lymphnode, you are looking for cancer, specifically LYMPHOMA. When the entire Bone Marrow is involved (ALL CELL LINES) this is myelodisplastic Syndrome. Steps in Chemotaxis Pavementing Selectins - Select out of circulation Integrins (I-CAM 1) -A nchor to vascular endothelium Flattening Marginate Walking Diapedesis - looking for gap between cells Migrate WBC concentrations Never Neutrophils 60% Let Lymphocytes 30% Mom Monocytes 8% Eat Eosinophils 2% Beans Bands/Basophils <1% Steps in Gram Staining COME - Crystal Violet IN Iodine AND Alcohol STAIN Safrinin
IN AND STAIN
à Stains Gm(+) peptidoglycan Iodine à Sealant (Mordant) - Seal to Gm(+) Alchohol à Was off excess from Gm(-) Saffrin à Paint Gm(-) pink
In ACID FAST - The opposite occurs - pathogen is stained PINK and others are stained BLUE Acid Fast Organisms Mycobacterium Nocardia Cryptosporidium Gm(+) with Endotoxin Listeria Features of Gram Negative 1 Peptidoglycan layer Outer membrane Endotoxin (LPS) Where is O-Antigen located? In the Periplasmic Space Endotoxins Virulence Cuase by Lipid-A Most variable part of LPS Core Bugs with Exotoxin E. Coli Pseudomonas Vibrio Bordetella Pertussis BACTERIAL KILLING PMNs 1st to show up @ 24 hours and peak @ 3 days PMNs bring in Myeloperoxidase which converts oxygen and water to peroside: O2 + H2O à H2O2 (Peroxide) denatures proteins Primaryly gm(+) Some bacteria have catalase which breaks down peroxide to water : O2 + H2O à H2O2 à 2H2O (e.g Staph, Pseudomonas, Nisseria) Free Radicals - High energy bonds, kill anything in site PMNs also bring in NADP -Oxidase (Oxygen burst - day 7) which make bleach:
O2 + H2O à O OH HOCl- à H2O2 Super oxide dismutase breaks bleach into peroxide
Most Infx become anaerobic at day ? Most infections become anaerobic at day 7 due to oxygen burst Day 1-3 staph Aureus Day 4-7 Strep Left shift of CBC means Immature Cells Why do you need young PMN s Young PMN have greatest amount of Myeloperoxiase (BANDS) Calculate Absolute Neutrophil Count (ANC) (% PMN + % BANDS) * WBC Normal ANC < 2500 Neutropenic < 1500 Moderate Neutropenia < 1000 Severe Neutropenia Patients Susceptipble to staph and Psuedomonas Neutropenia Burn Diabetics Monocytes are precursors to Macrophages MCC of monocytosis S - Salmonella Typhi T - TB E - EBV L - Listeria Monocytogenes S - Syphilis
Allergic Reactions Primary Response
1st time you come into contat with allergen
IgE
Secondary Response 2nd time you come into contact with allergen IgE (1 Fab and 1 Fc) buries Fc portion into mast cell and causes degranulation. Eosinophils moderate Mast cell response Released by Mast Cells Histamine SRS-A
EOS chemotactic factor Released by EOS Histaminase Heparin Arylsulfatase Mechanism of Heparin Is the cofactor for ATIII which inhibits Thrombin and factors 9, 10, 11, and 12. What is a therapeutic INR 2-3 times normal Monitor Heparin with PTT Causes of Eosinophilia N - Neoplasm A Astham/Allergies A - Addisons C Collagen vascular dz P Parasites Biopsy a looking for Lymphoma Clues for Hodgkins + Reed Steinberg Cells Young person Hodgkins Staging 1 - 1 group Lymph nodes 2 - 2 nodes same side 3 - 2 nodes different sides 4 - Metastasis A - Without Symptoms B - With Symptoms Hodgekins Lymphomas MC - Nodular Sclerosis Best - Lymph predominant Worst - Lymphocyte depleted Int- Histiocytic/Lymphocytic Rx for Hodgkins Lymphoma A - Adiamycin
B - Bleomycin V - Vinblastine D - Dacarbazine Clues for Non-Hodgkin s - Reed Steinberg Cells MCC in GI tract (ileum) AIDS - CNS and TESTES MC Non-Hodgkins Follicular Lymphoma (t 14/8) Most notorius Non-Hodgekin Burketts Where do US Patients Burketts? Ileum African Patients Burketts In Jaw associated with EBV
With other cancer is ass with EBV? Nasopharyngeal Carcinoma Describe Non-Hodgkins Starry Sky appearance (t 8/4 BCL-2) Clues for Mycosis Fungoides Fungal rash with crenated Lymphocytes. Rules for Leukemias 98% - B-Cell Leukemic Line destroys others Increased WBC and increase BLASTS > 5% Acute - Bone Marrow Chronic - Periphery (Mature) Lymphobast Myeloblastic Lymphocytes (T and B Cells) PMN, Monocytes, Macrophages
Men tend to get Cancer 0-30yo 50yo and older Women tend to get cancers Age 30-50
MCC Ages for Leukemias ALL 0-15yo AML 15-30yo CML 30-50yo CLL > 50yo Clues for ALL TDT - Lymphoblastic marker CALLA - good prognosis Ages 1-10 - good prognosis Treat with Prednisone Clues for AML Auer Rods - Stains with sudan black and leukocyte alk phos. Clues for CML When macrophages go, you increase this line Philadelphia Chromosome (t 9/22) CLL No Markers
) PROMYELOBLASTIC DIC - M3 staging
MC Pathogens on the skin Staph. Aureus Strep. Pyogenes. Strep. Epidermitis Propionobacterium Acne MCC of All skin Infections Staph Aureus. Which skin Infx is not Staph Lymphangitis Impetigo Necrotizing Fascitis Eryselalis
Scarlet Fever What causes LINES? Strep. Pyogenes. Cellulites vs- Erysipelas Cellulite- flat and blanch Erysipelas-Raised/not blanched 3 features of Scarlet Fever? Sandpaper Rash Strawberry Tongue Rash on Palms and Soles. Bullus Impetigo vs- Impetigo Impetigo Strep Bullous Impetidgo Staph Clue for Impetigo Honey crusted lesion Define the Following: Carbuncle - Boil (firm) Furuncle C + follicle Folliculitis - Pus at hair follicle Cellulitis - Area of redness Panniculitis - Pannus Oompholitis - Belly button Mastitis Breast Infx caused by Staph Epi? Shunt infection Central Line infection MCC Acne? Proprionobacterion Acne Women & adolescents have more acne because ? Proprionic acid is stimulated by progesterone, which is high in women and adolescents
Rx for Proprionobacterion Expose to air OXY5/OXY10 Pads Antibiotic
Retina - Isotretinoin Pathogens in Mouth S. Pyogens S. Pneumonia H. Influenza Neisseria Meningiococcus 3 with IgA protease S. Pneumonia H. Influenza Neisseria Meningiococcus Obligate Aerobic organisms: Must Breathe, Clean, Fresh air Must - Mycobacterium Breathe - Bacillis Clean C. diphtheria Fresh - Frenciella Moral Infx start after a viral infection because? Organisms live in the mouth and are normally innocuous because the cilia beat the organism up and they are swallowed. Viral infections paralyze the cilia and lead to infections by these organisms. Does skin or throat Strep cause PSGN? Either can cause PSGN Does skin or throat Strep cause Rheumatic Fever? Throat Strep Jones Criteria Polyarteritis Carditis Subcutaneous Nodules Erythema Migranata Syndenham Chorea Pathogens found under gum: Streptococcus Peptostreptococcus Actinomyces Fusobacterium Strep Veridans Strep Mutans Strep Sanguis Strep Salivarius
Bug with "Sulfur Granules"? Actinomyces Israelii 2 Fusobacterium diasease? Vincent's Angina - Painful ulcer in the back of the throat Trench Mouth MCC SBE Strep Veridans What bacteria cause carries? Strep Mutans Septic Emboli from SBE Brain - Mycotic Aneurysm Retina - Roth Spots Fingertips - Oslers Spots Toes - Janeway Lesions Under nail beds - Splinter Hemorrhages 5 Urease (+) pathogens H. Influenza Proteus Pseudomonas Cryptococcus Ureoplasma Urolytica MCC found in Stomach H. Pylori 2 ulcers H.Pylori Causes Gastric - 70% Duodenal - 90% Most Abundant in sm Intestine? E.Coli 4 vit which E. Coli makes Biotin Folic Acid Panthothenic Acid Vit K Vit E. Coli helps absorb B12
Most abundant gas in the colon? Carbon dioxide Gases responsible for the smell in flatulence? Methane and sulfur Pathogens found in the terminal ileum/colon? Clostridia Dificile Clostridia Malanogocepticus Strep Bovis Bacteroides Fragilis E.Coli Proteus Serratia Marscescens Actinobacter Citrobacter Pseudomonas Klebsiella Pathogens causing colon cancer? Strep Bovis Melanogocepticus Most abundant organism in the colon? Bacteroides Fragilis Name the Pathogen: Red Pigment Serratia Multiple cerebral abscesses - Citrobacter Colonizes everyone after a 48hr stay in the hospital - Pseudomonas Seen in alcoholics - Klebsiella Normal Rectum Flora anGEL Group B Strep E. Coli Listeria Staph Aureus Enzymes Catalase ß-Lactamase Coagulase Staphylokinase Erythrodermotoxin Lipase Hyaluronidase Collagenase
Staph Aureus toxins TSST - Fever, Shock, Red, Rash on Palms and Soles SSSS - (+) Nykolsky Exfolatoxin - Scalded skin Enterotoxin - dairy products. 5 bugs and their colors Strep. Veridans - Green Staph. Aureus - Gold Pseudomonas - Blue-Green Serratia Mecansus - Red Staph. Epidermitis - White Infx caused by Staph Epi Central Line Infections Shunt Infections Infx by Saprophyticus? UTI in women 5-10 & 18-24 Antibiotic to Rx Epidermidis Vancomycin. Palms and Soles SSS- Staph Aureus Syphilis - Treponema Pallidum Scarlet Fever - Strep Pyogens TST - Strep Pyogenes RMSF - Borellia Bergudorfi Kawasaki Coxsakie Hand/Foot/Mouth Who gets Pneumovax? Greater than 65 yo Sickle Cell > 2yo Sickle Cell with end organ damage. Give the DOC for: Staph Epi. Vancomycin Pyogenes Apmicillin Agalactiaceae Ampicillin Nitrate Negative UTI? Enterococcus MMC of Meningitis by age 0-2mos GEL
2mos-10yr 10yr -21yr >60yrs
SHN Neissaria Strep Pneumo
Only Gm(+)diplococci Strep Pneumo Kidney bean Shaped Normal Flora in rectum Group B Strep E.Coli Neissaria Meningitidis MCC of PSGN Strain 12 - Group A Strep (Pyogenes) Differentiate Strep strains by Their M-Protein. Give the strep class Group A Pyogenes Group B Agalactiaceae Group D Enterocossus Pregnant woman s rectum culture returns (+) for Group B Strep. Rx with? Ampicillin Infx caused by Group C Strep Pharyngitis Infx caused by Group D Strep SBE Spore formers Clostridium Bacillis 5 causing heart block Chaga's Disease Legionella Lymes Diptheria Salmonella Typhi 4 features of spores: Formed in harsh environment Not replicating -release toxin
Do not like heat D-dipacolonic acid membrane Membrane of Bacillus has? Poly D-glutamic acid 3 factors in Bacillus Anthracis Protective factor Lethal Factor Edema factor Infx caused by B. Anthracis Cutaneous - malignant pustule Pulmonary - Wool sorter's disease Bacillus Cereus causes? Gastroenteritis associated with Chinese fried rice C. Dificile causes Pseudomembranous colitis associated with antibiotic use C. Botulinum Causes Botulism Children honey & molases Adults - Canned foods C. Tetani causes Lockjaw in association with dirty wounds. C. Perfringins causes Gas gangrene Best Rx for C.dif colitis Vancomycin Current Rx for C.Dif colitis Metronidazole
Botulinum toxin works by Inhibiting presynaptic release of Ach. C.Tetanus work by? INH release of Gly from S.C. What works like C. Tetanus? Strychnine
1st step to treat dirty wound Tetanus Anti-toxin C. Perfringins Infection Gas Gangrene Treatment for Gas gangrene Immediate Amputation Air emboli hurt by Causing Ventricular Outlet Obstruction Treatment for VOO L. Lateral Decubitus Chest PT on Right Associated with Holiday Ham & Turkey? Clostridium Clostridium associated with colon cancer? Melanosepticus
What bacteria Looks like Chinese letters? Coreynebacterium Most bacteria acquire their toxins through ? Transduction. ADP ribosylation of EF-2 Diptheria ADP ribosylation of Gi ADP ribosylation of Gs Only acid fast GM(+) NOCARDIA Clues for Nocardia Attack Diabetic s Sinuses & Lungs. Behaves like a fungus. Only Gm(+) with endotoxin Listeria Illness caused by listeria Gastroenteritis in adults
Clues for Listeria Raw Cabbage Spoiled Milk Migrant workers 5 - cause monocytosis: Salmonella TB EBV Listeria monocytogenes Syphilis 3 bugs Caused illness in 8hrs Bacillus Staph aureus Clostridium Reason for illness in 8 hrs Preformed toxins
Name the macrophage Brain Microglia Lung Type I Pneumoncite Liver Kupfer Cells Spleen RES Kidney Messangial Cell Lymph Node Dendritic Cell Bone Osteoclasts Skin Langerhans CT Schistocyte Giant Cell, Epithelioid Timeline for all infections 1st 24hr - Swelling 24hr PMN show up PMN s peak at day 3 If bacterial PMN's remain If not, T-Cells/MO show up at day 4 & peak at day 7 Fibroblasts show up at day 7 & peak at one month Fibroblasts takes 3-6 months to finish scarring. Cell-Mediated order of Infx Virus - CMV, EBV Fungus Microbacterium Protozoa Parasite Neoplasm Nutrition affect? Cell mediated before Humoral MCC of death in all cancers Bacterial Infection except cervical cancer where MCC of death is RENAL FAILURE. % of Lukenias that are B-cell 98% MC T-Cell Immune diseases DiGeoge s Prednisone Cyslsporine Wiscott Aldrich SCID HIV T-Cell Lukenia
T-Cell Lymphoma Mucocutaneois Candidiasis
MC B-Cell Immune diseases Bruton s Wiscott-Aldrich SCID B-Cell Lukemia B-Cell Lymphoma JOB Selective IgA Def Selective IgG2 Def Multiple Myeloma Heavy Chain Disease CVID MC PMN Immune diseases CGD Nutropenia MC M0 Immune diseases CGD Chediak-Higashi Two T-Cell Lympmonas Mycosis Fungoides Sezary blood Clue for T-Cell Lymphomas Crenated cells Clues for Hairy Cell Lukemia Sunburst appearance Fried Egg appearance TRAP positive Name the defect in DiGeorge Failure 3rd & 4th pharyngeal arches to develop Name the defect in Mucocutaneous Candidiasis Chronic infection with candida Name the defect in SCID Adenisine deaminase deficiency Name the defect in Wiscot-Aldridge Defect in Class switching
Name the defect in JOB syn. Hyper IgE due to class switching problem Name the defect in CGD NADPH oxidase deficiency. Features of DiGeorge's Absent Thymus Absent Inferior Parathyroid Decreased Ca2+ Tx: Transplant Thymus Immunoprivaledged Sites (Due to no Lymphatic flow): Thymus Testes Brain Cornea Clues for Kleinfelters Tall man with small testes Clues for Fragile X Short man with large testes. What gene protects from HIV CCR5 MCC proteins found in HIV Gp120 Attach to CD4 receptor Pol gene - Integrates HIV RNA Reverse Transcriptase - Transcribe RNA p17/p24 - Used for Assembly gp41 - Surface marker Fastest in HIV population Heterosexual black female Elderly Reason Men pass HIV easier HIV Loves mucosa so easier for men to pass to women. Reason Harder for preadolescents to contract due to decreased vaginal pH HIV enters body and attacks? Vessel Vasculitis/Kaposi Brain- HIV Dementia Testes - Testicular Lymphoma
Describe Kaposi Sarcoma Violatious Nodules How HIV Attaches to Cervix Likes CD4 receptor Female cervix is rich in CD4 receptors Cells that HIV attacks T-Cells and Macrophages What happens to other Cells? B-Cells and neutrophils will undergo hyperplasia leading to increased B-Cells and hyper-gammaglobulins Normal CD4 count CD4 800-1200 When do you start HIV Rx CD4 count < 500 PCP presents at CD4 of? Less than 200 Treatment for PCP Trimethaprin/Sulfamethoxazole If allergic to sulfa drugs use Pentamidine (Aerosole) MAI presents at CD4 of ? Less than 100 Treat MAI with Clarithromycin. Screening ELIZA - Antibody If positive, prove with Wesern Blot If Negative with PCR (Most Specific test) SCID Defect in Adenine Deaminase Affects T-Cells and B-Cells Wiscott-Aldridge Defect in Class switching (CD 40 cells - IL-4 responsible) Fair skin with xema and thrombocytopenia
Mechanism of Cyclosporin Inhibit prodction of IL-2 by T-Cells which inhibits Calcinurua Defect in Bruton's B-cells present but 2nd messanger (Tyrosine Kinase) does not work Clues for JOB Syndrome Hyper IgE Red hair female Clues for Selective IgA Def. MCC of Anaphylaxis in transfusions Clues for Selective IgA Def. MC Subtype Infx from encapsulated organisms MCC of every "PENIA" viral infection Drugs
Patient who have fevers and are either neutropenic, CF, DM, and Burn patients are susceptible to Staph aureus nad Pseudomonas infections cover Staff once nad Psudomonas twice. If fever persists add Amphoteracin B Myeloperoxidase Deficiency NADPH Oxidase deficiency (Chronic Granulomatous Disease) (-) NBT test LAZY LEUKOCYTE SyNDROME PMN slow and lethargic
WBC - White Blood Count à Leukocytes Normal White cell count 4-12 K Explain Demargination CBC represents only 10% of white cells in circulation 90% are marginated against the vascular endothelium 95% of these marginated cells are mature (PMNs). Less than 5% are Blasts.
You can call them back into circulation Called demargination. Define Demargination Recruiting marginated white cells back into circulation What hormones cause demargination Stress Epinepherine Cortisol Abx(Stress -vs- infx) Stress -demargination Infx(Bacterial -vs-Viral) Infection Lekemoid Rxn Extreme Stress Incr. Incr. Incr. Incr. Incr. Incr. Incr.
Incr.
Incr.
Incr. < 5%
Incr. > 5%
Leukemia
Whenever you biopsy a lymphnode, you are looking for cancer, specifically LYMPHOMA. When the entire Bone Marrow is involved (ALL CELL LINES) this is myelodisplastic Syndrome. Steps in Chemotaxis Pavementing Selectins - Select out of circulation Integrins (I-CAM 1) -A nchor to vascular endothelium Flattening Marginate Walking Diapedesis - looking for gap between cells Migrate WBC concentrations Never Neutrophils 60% Let Lymphocytes 30% Mom Monocytes 8% Eat Eosinophils 2% Beans Bands/Basophils <1% Steps in Gram Staining COME - Crystal Violet IN Iodine AND Alcohol STAIN Safrinin
IN AND STAIN
à Stains Gm(+) peptidoglycan Iodine à Sealant (Mordant) - Seal to Gm(+) Alchohol à Was off excess from Gm(-) Saffrin à Paint Gm(-) pink
In ACID FAST - The opposite occurs - pathogen is stained PINK and others are stained BLUE Acid Fast Organisms Mycobacterium Nocardia Cryptosporidium Gm(+) with Endotoxin Listeria Features of Gram Negative 1 Peptidoglycan layer Outer membrane Endotoxin (LPS) Where is O-Antigen located? In the Periplasmic Space Endotoxins Virulence Cuase by Lipid-A Most variable part of LPS Core Bugs with Exotoxin E. Coli Pseudomonas Vibrio Bordetella Pertussis BACTERIAL KILLING PMNs 1st to show up @ 24 hours and peak @ 3 days PMNs bring in Myeloperoxidase which converts oxygen and water to peroside: O2 + H2O à H2O2 (Peroxide) denatures proteins Primaryly gm(+) Some bacteria have catalase which breaks down peroxide to water : O2 + H2O à H2O2 à 2H2O (e.g Staph, Pseudomonas, Nisseria) Free Radicals - High energy bonds, kill anything in site PMNs also bring in NADP -Oxidase (Oxygen burst - day 7) which make bleach:
O2 + H2O à O OH HOCl- à H2O2 Super oxide dismutase breaks bleach into peroxide
Most Infx become anaerobic at day ? Most infections become anaerobic at day 7 due to oxygen burst Day 1-3 staph Aureus Day 4-7 Strep Left shift of CBC means Immature Cells Why do you need young PMN s Young PMN have greatest amount of Myeloperoxiase (BANDS) Calculate Absolute Neutrophil Count (ANC) (% PMN + % BANDS) * WBC Normal ANC < 2500 Neutropenic < 1500 Moderate Neutropenia < 1000 Severe Neutropenia Patients Susceptipble to staph and Psuedomonas Neutropenia Burn Diabetics Monocytes are precursors to Macrophages MCC of monocytosis S - Salmonella Typhi T - TB E - EBV L - Listeria Monocytogenes S - Syphilis
Allergic Reactions Primary Response
1st time you come into contat with allergen
IgE
Secondary Response 2nd time you come into contact with allergen IgE (1 Fab and 1 Fc) buries Fc portion into mast cell and causes degranulation. Eosinophils moderate Mast cell response Released by Mast Cells Histamine SRS-A
EOS chemotactic factor Released by EOS Histaminase Heparin Arylsulfatase Mechanism of Heparin Is the cofactor for ATIII which inhibits Thrombin and factors 9, 10, 11, and 12. What is a therapeutic INR 2-3 times normal Monitor Heparin with PTT Causes of Eosinophilia N - Neoplasm A Astham/Allergies A - Addisons C Collagen vascular dz P Parasites Biopsy a looking for Lymphoma Clues for Hodgkins + Reed Steinberg Cells Young person Hodgkins Staging 1 - 1 group Lymph nodes 2 - 2 nodes same side 3 - 2 nodes different sides 4 - Metastasis A - Without Symptoms B - With Symptoms Hodgekins Lymphomas MC - Nodular Sclerosis Best - Lymph predominant Worst - Lymphocyte depleted Int- Histiocytic/Lymphocytic Rx for Hodgkins Lymphoma A - Adiamycin
B - Bleomycin V - Vinblastine D - Dacarbazine Clues for Non-Hodgkin s - Reed Steinberg Cells MCC in GI tract (ileum) AIDS - CNS and TESTES MC Non-Hodgkins Follicular Lymphoma (t 14/8) Most notorius Non-Hodgekin Burketts Where do US Patients Burketts? Ileum African Patients Burketts In Jaw associated with EBV
With other cancer is ass with EBV? Nasopharyngeal Carcinoma Describe Non-Hodgkins Starry Sky appearance (t 8/4 BCL-2) Clues for Mycosis Fungoides Fungal rash with crenated Lymphocytes. Rules for Leukemias 98% - B-Cell Leukemic Line destroys others Increased WBC and increase BLASTS > 5% Acute - Bone Marrow Chronic - Periphery (Mature) Lymphobast Myeloblastic Lymphocytes (T and B Cells) PMN, Monocytes, Macrophages
Men tend to get Cancer 0-30yo 50yo and older Women tend to get cancers Age 30-50
MCC Ages for Leukemias ALL 0-15yo AML 15-30yo CML 30-50yo CLL > 50yo Clues for ALL TDT - Lymphoblastic marker CALLA - good prognosis Ages 1-10 - good prognosis Treat with Prednisone Clues for AML Auer Rods - Stains with sudan black and leukocyte alk phos. Clues for CML When macrophages go, you increase this line Philadelphia Chromosome (t 9/22) CLL No Markers
) PROMYELOBLASTIC DIC - M3 staging
MC Pathogens on the skin Staph. Aureus Strep. Pyogenes. Strep. Epidermitis Propionobacterium Acne MCC of All skin Infections Staph Aureus. Which skin Infx is not Staph Lymphangitis Impetigo Necrotizing Fascitis Eryselalis
Scarlet Fever What causes LINES? Strep. Pyogenes. Cellulites vs- Erysipelas Cellulite- flat and blanch Erysipelas-Raised/not blanched 3 features of Scarlet Fever? Sandpaper Rash Strawberry Tongue Rash on Palms and Soles. Bullus Impetigo vs- Impetigo Impetigo Strep Bullous Impetidgo Staph Clue for Impetigo Honey crusted lesion Define the Following: Carbuncle - Boil (firm) Furuncle C + follicle Folliculitis - Pus at hair follicle Cellulitis - Area of redness Panniculitis - Pannus Oompholitis - Belly button Mastitis Breast Infx caused by Staph Epi? Shunt infection Central Line infection MCC Acne? Proprionobacterion Acne Women & adolescents have more acne because ? Proprionic acid is stimulated by progesterone, which is high in women and adolescents
Rx for Proprionobacterion Expose to air OXY5/OXY10 Pads Antibiotic
Retina - Isotretinoin Pathogens in Mouth S. Pyogens S. Pneumonia H. Influenza Neisseria Meningiococcus 3 with IgA protease S. Pneumonia H. Influenza Neisseria Meningiococcus Obligate Aerobic organisms: Must Breathe, Clean, Fresh air Must - Mycobacterium Breathe - Bacillis Clean C. diphtheria Fresh - Frenciella Moral Infx start after a viral infection because? Organisms live in the mouth and are normally innocuous because the cilia beat the organism up and they are swallowed. Viral infections paralyze the cilia and lead to infections by these organisms. Does skin or throat Strep cause PSGN? Either can cause PSGN Does skin or throat Strep cause Rheumatic Fever? Throat Strep Jones Criteria Polyarteritis Carditis Subcutaneous Nodules Erythema Migranata Syndenham Chorea Pathogens found under gum: Streptococcus Peptostreptococcus Actinomyces Fusobacterium Strep Veridans Strep Mutans Strep Sanguis Strep Salivarius
Bug with "Sulfur Granules"? Actinomyces Israelii 2 Fusobacterium diasease? Vincent's Angina - Painful ulcer in the back of the throat Trench Mouth MCC SBE Strep Veridans What bacteria cause carries? Strep Mutans Septic Emboli from SBE Brain - Mycotic Aneurysm Retina - Roth Spots Fingertips - Oslers Spots Toes - Janeway Lesions Under nail beds - Splinter Hemorrhages 5 Urease (+) pathogens H. Influenza Proteus Pseudomonas Cryptococcus Ureoplasma Urolytica MCC found in Stomach H. Pylori 2 ulcers H.Pylori Causes Gastric - 70% Duodenal - 90% Most Abundant in sm Intestine? E.Coli 4 vit which E. Coli makes Biotin Folic Acid Panthothenic Acid Vit K Vit E. Coli helps absorb B12
Most abundant gas in the colon? Carbon dioxide Gases responsible for the smell in flatulence? Methane and sulfur Pathogens found in the terminal ileum/colon? Clostridia Dificile Clostridia Malanogocepticus Strep Bovis Bacteroides Fragilis E.Coli Proteus Serratia Marscescens Actinobacter Citrobacter Pseudomonas Klebsiella Pathogens causing colon cancer? Strep Bovis Melanogocepticus Most abundant organism in the colon? Bacteroides Fragilis Name the Pathogen: Red Pigment Serratia Multiple cerebral abscesses - Citrobacter Colonizes everyone after a 48hr stay in the hospital - Pseudomonas Seen in alcoholics - Klebsiella Normal Rectum Flora anGEL Group B Strep E. Coli Listeria Staph Aureus Enzymes Catalase ß-Lactamase Coagulase Staphylokinase Erythrodermotoxin Lipase Hyaluronidase Collagenase
Staph Aureus toxins TSST - Fever, Shock, Red, Rash on Palms and Soles SSSS - (+) Nykolsky Exfolatoxin - Scalded skin Enterotoxin - dairy products. 5 bugs and their colors Strep. Veridans - Green Staph. Aureus - Gold Pseudomonas - Blue-Green Serratia Mecansus - Red Staph. Epidermitis - White Infx caused by Staph Epi Central Line Infections Shunt Infections Infx by Saprophyticus? UTI in women 5-10 & 18-24 Antibiotic to Rx Epidermidis Vancomycin. Palms and Soles SSS- Staph Aureus Syphilis - Treponema Pallidum Scarlet Fever - Strep Pyogens TST - Strep Pyogenes RMSF - Borellia Bergudorfi Kawasaki Coxsakie Hand/Foot/Mouth Who gets Pneumovax? Greater than 65 yo Sickle Cell > 2yo Sickle Cell with end organ damage. Give the DOC for: Staph Epi. Vancomycin Pyogenes Apmicillin Agalactiaceae Ampicillin Nitrate Negative UTI? Enterococcus MMC of Meningitis by age 0-2mos GEL
2mos-10yr 10yr -21yr >60yrs
SHN Neissaria Strep Pneumo
Only Gm(+)diplococci Strep Pneumo Kidney bean Shaped Normal Flora in rectum Group B Strep E.Coli Neissaria Meningitidis MCC of PSGN Strain 12 - Group A Strep (Pyogenes) Differentiate Strep strains by Their M-Protein. Give the strep class Group A Pyogenes Group B Agalactiaceae Group D Enterocossus Pregnant woman s rectum culture returns (+) for Group B Strep. Rx with? Ampicillin Infx caused by Group C Strep Pharyngitis Infx caused by Group D Strep SBE Spore formers Clostridium Bacillis 5 causing heart block Chaga's Disease Legionella Lymes Diptheria Salmonella Typhi 4 features of spores: Formed in harsh environment Not replicating -release toxin
Do not like heat D-dipacolonic acid membrane Membrane of Bacillus has? Poly D-glutamic acid 3 factors in Bacillus Anthracis Protective factor Lethal Factor Edema factor Infx caused by B. Anthracis Cutaneous - malignant pustule Pulmonary - Wool sorter's disease Bacillus Cereus causes? Gastroenteritis associated with Chinese fried rice C. Dificile causes Pseudomembranous colitis associated with antibiotic use C. Botulinum Causes Botulism Children honey & molases Adults - Canned foods C. Tetani causes Lockjaw in association with dirty wounds. C. Perfringins causes Gas gangrene Best Rx for C.dif colitis Vancomycin Current Rx for C.Dif colitis Metronidazole
Botulinum toxin works by Inhibiting presynaptic release of Ach. C.Tetanus work by? INH release of Gly from S.C. What works like C. Tetanus? Strychnine
1st step to treat dirty wound Tetanus Anti-toxin C. Perfringins Infection Gas Gangrene Treatment for Gas gangrene Immediate Amputation Air emboli hurt by Causing Ventricular Outlet Obstruction Treatment for VOO L. Lateral Decubitus Chest PT on Right Associated with Holiday Ham & Turkey? Clostridium Clostridium associated with colon cancer? Melanosepticus
What bacteria Looks like Chinese letters? Coreynebacterium Most bacteria acquire their toxins through ? Transduction. ADP ribosylation of EF-2 Diptheria ADP ribosylation of Gi ADP ribosylation of Gs Only acid fast GM(+) NOCARDIA Clues for Nocardia Attack Diabetic s Sinuses & Lungs. Behaves like a fungus. Only Gm(+) with endotoxin Listeria Illness caused by listeria Gastroenteritis in adults
Clues for Listeria Raw Cabbage Spoiled Milk Migrant workers 5 - cause monocytosis: Salmonella TB EBV Listeria monocytogenes Syphilis 3 bugs Caused illness in 8hrs Bacillus Staph aureus Clostridium Reason for illness in 8 hrs Preformed toxins
