[mtle] immunosero pt. 4

syphilis

bacterial infection caused by T. pallidum subsp. pallidum transmitted through sexual contact, blood transfusion (with whole blood refrigerated <72 hrs), transplacental route

wasserman antigen

syphilis antigen for SCREENING test; also known as CARDIOLIPIN; phospholipid (diphosphatidyl glycerol); derived from host

treponemal antigen

syphilis antigen for CONFIRMATORY test; has two types REITER strain (non-virulent) and NICHOL strain (virulent)

treponemal antibodies

syphilis antibodies produced against antigen of organisms themselves; specific for outer membrane protein, endoflagellar protein

IgM treponemal antibodies

specific treponemal antibodies predominant in EARLY or UNTREATED EARLY latent syphilis

IgG treponemal antibodies

specific treponemal antibodies predominant AFTER early immune response to infection; GREATEST elevation seen in SECONDARY syphilis

reagin antibodies

non treponemal antibodies; anti-cardiolipin antibodies or anti-lipoidal; produced by infected individuals agains components of their own bodies

primary syphilis

-stage of syphilis; presence of HARD CHANCRE; stage lasts for 1-6 weeks

-HIGHLY contagious serum in 30% of cases become serologically active after 1 week and 90% become reactive after 3 weeks

-MORE sensitive in RPR but also in FTA-ABS

hard chancre

painless firm lesion at site of entry seen 10-90 days after infection present in PRIMARY syphilis

secondary syphilis

-stage of syphilis; MOST contagious stage; disseminated organisms; observed after 1-2 months after primary chancre appears

-presence of CONDYLOMATA LATA; symptoms are lymphadenopathy (enlargement of lymph nodes), malaise, fever, pharyngitis, rash on skin and mucous membrane

-ALL serologic tests detect infection

condylomata lata

wart-like lesions in moist areas of body present SECONDARY syphilis

latent syphilis

stage of syphilis; ASYMPTOMATIC; patients are noninfectious except for pregnant women; diagnosis can only be made by SEROLOGIC methods

early latent syphilis

type of latent syphilis; <1 yr of infection

late latent syphilis

type of latent syphilis; >1 yr of infection

tertiary syphilis

stage of syphilis; symptoms are NEUROSYPHILIS, TABES DORSALIS, GUMMAS (granulomas); affect CVS resulting to aortic aneurysm, aortic regurgitation, angina pectoris due to ELASTIN degradation

neurosyphilis

most COMMON complication in tertiary syphilis but can occur after primary syphilis

tabes dorsalis

degeneration of lower spinal cord and general paresis of chronic progressive dementia seen in TERTIARY syphilis

gummas (granulomas)

areas of granulomatous inflammation that are most often found on bones, skin, or subcutaneous tissue seen in TERTIARY syphilis

dark-field microscopy

direct detection of spirochetes; primary and secondary syphilis diagnosed by demonstrating presence of T. pallidum in exudates from skin lesions

serous fluid from lesion

specimen used in dark-field microscopy

corkscrew

characteristic morphology of treponemes in DARK-FIELD microscopy

flexing

characteristic motility of treponemes in DARK-FIELD microscopy

direct fluorescent antibody test (treponemes)

type of fluorescent antibody test; use fluorescent-labeled antibody conjugate to T. pallidum

indirect fluorescent antibody test (treponemes)

type of fluorescent antibody test; use antibody specific for T. pallidum a second labeled anti-immunoglobulin antibody; LIVE specimens are NOT required but cross-reacts with other T. pallidum subsp.

nontreponemal test

serologic test; used for syphilis screening and monitoring therapy; determine presence of REAGIN; principle is FLOCCULATION

venereal disease research laboratory (VDRL)

NONtreponemal test; principle is rapid slide microflocculation; sample used os serum or CSF (to detect neurosyphilis)

cardiolipin (diphosphatidyl glycerol)

component of VDRL antigen; serves as ANTIGEN

lecithin

component of VDRL antigen; helps neutralize anticomplementary properties of cardiolipin; enhances sensitivity of reaction

cholesterol

component of VDRL antigen; increases effective reactive surface and complement fixing capacity of cardiolipin with reagen

56 C for 30 mins

patient serum for VDRL testing is heated at this temperature and time to inactivate complement

56 C for 10 min

patient serum for VDRL testing is heated at this temperature and time to reinactivate when >4 hours has elapsed

qualitative serum VDRL

delivery needle used have 18 gauge; NO bevel; 60/mL drops

quantitative serum VDRL

delivery needle used have 19 or 23 gauge; WITH or WITHOUT bevel; 75 or 100/mL drops

CSF VDRL

delivery needle used have 21 or 22 gauge; NO bevel; 100/mL drops

180 rpm for 4 mins

speed and duration of card rotation in serum VDRL test

180 rpm for 8 mins

speed and duration of card rotation in CSF VDRL test

no clumps

NON reactive reporting for VDRL microscope

small clumps

WEAKLY reactive reporting for VDRL microscope

medium to large clumps

REACTIVE reporting for VDRL microscope

rapid plasma reagin (RPR)

NONtreponemal test; recommended for screening of syphilis; principle is flocculation or charcoal agglutination

disodium salt of EDTA

component of MODIFIED VDRL antigen; prevents oxidation of lipids

charcoal

component of MODIFIED VDRL antigen; used as visualizing agent

phosphate

component of MODIFIED VDRL antigen; used as buffer

thimerosal

component of MODIFIED VDRL antigen; used as preservative

choline chloride

component of MODIFIED VDRL antigen; used to inactivate complement; eliminates need for heating like in VDRL

18 mm circle RPR card

slide used for RPR

100 rpm for 8 mins

speed and duration of card rotation in RPR test

serum RPR

delivery needle used 20 gauge; WITHOUT bevel; 60/mL drops

treponemal test

serologic test; detects presence of treponemal antibodies

fluorescent treponemal antibody absorption test (FTA-ABS)

TREPONEMAL test; principle is indirect immunofluorescence; slides used for this have nichols strain of T. pallidum fixed to them

1) dilution of heat inactivated patient serum is incubated with sorbent consisting of extract of nonpathogenic treponemes (reiter strain) -> removes cross-reactivity with treponemes other than T. pallidum

2) antihuman immunoglobulin conjugated with fluorescein is used

hemagglutination tests (treponemes)

TREPONEMAL test; employs blood cells coated with T. pallidum antigens

treponema pallidum hemagglutination test

type of hemagglutination test; use TURKEY ERYTHROCYTE

MICROhemagglutination assay for T. pallidum

type of hemagglutination test; use TANNED SHEEP ERYTHROCYTE

hemagglutination treponemal test for SYPHILIS

type of hemagglutination test; use GLUTARALDEHYDE-STABILIZED TURKEY ERYTHROCYTE

smooth matte at bottom of well

REACTIVE reporting in hemagglutination test for syphilis

compact button of cells

NON-reactive reporting in hemagglutination test for syphilis

particle agglutination (serodia TP-PA test)

TREPONEMAL test; patient serum or plasma is diluted in microtiter plates and incubated with either T. pallidum-sensitized gel particles as a control

T. pallidum subsp. pertenue

other treponemes causing YAWS (non-veneral disease of skin and bones)

T. pallidum subsp. endemicum

other treponemes causing BEJEL (lesions in oral cavity, oral mucosa, skin, bones, nasopharynx)

T. carateum

other treponemes causing PINTA (skin ulcer)

salmonellosis

bacterial infection caused by Salmonella spp. (Salmonella enteritidis, Salmonella typhi) transmitted through INGESTION; humans are the ONLY HOST of typhoid fever

Salmonella enteritidis

bacteria most COMMON cause of Salmonellosis in North America

Salmonella typhi

bacteria caused TYPHOID FEVER (enteric fever) which is the MOST SEVERE form of salmonellosis; antibodies appear 7-10 days after infection

carrier

asymptomatic; continuously pass organisms and infect others

Salmonella typhosa

bacteria that resists phagocytosis producing SPIC which inhibits fusion of lysosomes with phagosome

O antigen

salmonella antigen; thermoSTABLE SOMATIC antigen; polysaccharide in nature; ENDOtoxin

H antigen

salmonella antigen; FLAGELLAR antigen; protein in nature

Vi antigen

salmonella antigen; CAPSULAR antigen; second somatic antigen that can occur independently of O antigen; associated with VIRULENT strain; indicative of CARRIER state

bacterial culture (salmonella)

GOLD standard for detecting typhoid fever

widal test (febrile agglutination test)

-serological test; principle is DIRECT agglutination; use SOMATIC SALMINELLA ANTIGEN

-reporting by SMALLEST quantity of serum that exhibits 2+ of 50% agglutination is considered titer and should be the one reported

typhidot test (dot enzyme immunoassay)

serological test; detects serum antibody to antigen dotted on nitrocellulose membrane

(+) IgM, (+/-) IgM/IgG

DEFINITE or ACUTE typhoid fever produce what results in typhidot test?

(+) IgG

PREVIOUSLY SUCCESSFULLY TREATED case of typhoid fever, REINFECTION with typhoid fever, typhoid CARRIER produce what results in typhidot test?

typhidot-M

dot enzyme immunoassay for detection of specific IgM to Salmonella typhi

rickettsia

small bacteria that live in lice, fleas, ticks, and mites that transmit infection to humans; cause rocky mountain spotted fever, epidemic typhus, rickettsial pox

weil felix reaction

detect rickettsia; principle is direct agglutination; febrile agglutinin test based on cross reaction of heterophile antibodies produced in response to rickettsial infection with antigens in three strain of Proteus

OX-2 and OX-19

antibodies produced against rickettsial antigen cross reacts with ____ strains of Proteus vulgaris

OX-K

antibodies produced against rickettsial antigen cross reacts with _____ strains of Proteus mirabilis

1:80

values of titer SUSPICIOUS of rickettsia

1:160

values of titer INDICATIVE of rickettsia

R. prowazekii

rickettsia caused by EPIDEMIC TYPHUS

R. typhi

rickettsia caused by MURINE TYPHUS

R. tsutsugamushi

rickettsia caused by SCRUB TYPHUS

(4+) OX-19, (+) OX-2, (-) OX-K

epidemic typhus (R. prowazekii) and murine typhus (R. typhi) will produce what weil felix reactions?

(-) OX-19, OX-2, (2+) OX-K

scrub typhus (R. tsutsugamushi) will produce what weil felix reactions?

Streptococcus pyogenes

bacteria causing upper respiratory infections, scarlet fever (due to erythrogenic toxin), skin infections, complications or sequalae (rheumatic fever and glomerulonephritis)

lipoteichoic acid

virulence factor of S. pyogenes that adheres to epithelial cells which induce infection

protein F

virulence factor of S. pyogenes that adheres to epithelial cell

M protein

virulence factor of S. pyogenes that is anti-phagocytic which MIMICS protein of heart valves; associated with strains that cause rheumatic fever

streptolysin O

virulence factor of S. pyogenes; oxygen LABILE and expresses maximal activity under anaerobic conditions

streptolysin S

virulence factor of S. pyogenes; oxygen STABLE; responsible for hemolytic zones around streptococcal colonies growing on surface

anti-streptolysin O titer

detect S. pyogenes disease; based on neutralization of hemolytic activity of streptolysin O

no hemolysis

POSITIVE result for anti-streptolysin O titration test

hemolysis

NEGATIVE results for anti-streptolysin O titration test

titer

reciprocal of HIGHEST dilution in which POSITIVE reaction occur

166 todd units or below

titer considered NORMAL in ASO titration test

240 todd units

titer considered MODERATELY ELEVATED in ASO titration test for ADULTS

320 todd units

titer considered MODERATELY ELEVATED in ASO titration test for CHILDREN

tube 13

tube containing RBC control in ASO titration test; NO hemolysis; if hemolyzed, specimen is hemolyzed in the first place

tube 14

tube containing SLO reagent control; COMPLETE hemolysis; if not hemolyzed, reagent is expired