Math 200 Exam 4

Name of Infectious Agent Cause: Genus and species

**C**haracteristics of infectious agent

**S**ymptoms and disease manifestations

**P**athogenesis and virulence factors

**D**iagnosis

**T**reatment, vaccines, and prevention

**E**pidemiology, transmission, and incidence

Nervous System Infections

Central nervous system (CNS)

* CSF (cerebrospinal fluid)
* Blood-brain barrier

Abscess

Encephalitis

Meningitis

Peripheral nervous system

Anatomy of Central Nervous system

N: Meningitis(preschool) Hemophilus influenzae b (Hib)

C: Gram - coccobacillus

S: Adult triad: fever, stiff neck, neurological signs(headache, photophobia, nausea, vomiting)

P: Antiphagocytic (polyribosylribitol phosphate) PRP capsule, serotype b

D: CSF: cloudy, culture-ID, serology; culture requires X (hemin), V (NAD) Chocolate agar is required.

T: Ceph3rd until antibiotic susceptibility test (AST), then switch antibiotics (ampicillin). Maternal IgG lasts for 3m. HibTITER (2,4,6m) is a PRP conjugate with diphtheria toxoid

E: URT: 1-4% child carriers: #2 cause worldwide; in U.S., 1.3/100,000 since 1990; 6% will be fatal; 20% permanent hearing loss or other long-term sequalae.

N: Meningococcal Meningitis (teen) Neisseria meningitidis

C: Gram-diplococcus

S: Adult triad, rash, permanent neurological damage, disseminated intravascular coagulation (DIC); high mortality even if treated

P: Polysaccharide capsule, pili. 5 serotypes; IgA1 protease cleaves IgA1 into Fab and Fc

D: CSF: cloudy, culture-ID, serology

T: 3rd generation cephalosporin; prophylactic antibiotics (rifampin or ciprofloxacin) & vaccines for epidemics; Polyvalent capsular vaccine (A,C,Y,W135) for high-risk groups ages 11-55 (Menactra); Bexsero (ages 12-23 for serotype B)

E: URT(airborne): institutional carriers: #1worldwide; WVU May 2005, November 2006-January 2007, Spring 2009, Fall 2009, Fall 2010 (\~1000 cases in US/year)

N: Meningitis (over 40y)Streptococcus pneumoniae

C: Gram + diplococcus, big capsule

S: Adult triad. Otitis media

P: 85 SSS (Specific Soluble Substance) capsule serotypes

D: CSF: cloudy, culture -hemolytic, sensitive to optochin, Quellung test

T: Vancomycin + Cephalosporins; even so, mortality 30%; Pneumovax for 2y and up is polyvalent 23 SSS capsular vaccine; Prevnar 13 is polyvalent for 13 serotypes.

E: URT; carriers; #1 in USA; mortality about 30%

N: Viral Meningitis Viral Meningoencephalitis

* Enterovirus 40%
* Mumps virus 15%
* Misc. virus 30%
* Polyomavirus
* HSV-1(high mortality)
* Low mortality; no specific therapy

N: Cryptococcal Meningitis Cryptococcus neoformans

C: yeast with budding capsule

S: chronic meningitis

P: capsule is virulence factor

D: encapsulated yeast found in CSF with India Ink stain or ELISA, latex agglutination test for antigen

T: amphotericin B + fluconazole + flucytosine for weeks/months E: via respiratory route from bird feces; not communicable

N: Rabies Rabies virus

C: ss()RNA, large bullet shaped virus

P: wound→incubation→PNSCNS→brain

D: Fluorescent AB test of biopsy of nape of neck, Negri bodies (inclusions in animal brain, RT-PCR in saliva)

T: postexposure RIG (-globulin), and HDCV (human diploid cell vaccine), 4-6 inj. IM (1 dose of RIG and 5 doses HCDV (0, 3, 7, 14, and 28 days); treatment should begin within 2 days of bite/exposure

T: preexposure HDCV, 3 IM (0, 7 and 21 days) for high risk

E: zoonoses for all mammals (fig. 19.15); inhalation by spelunkers; corneal grafts; 2018: 4951 cases reported (92% wild animals, 8% domestic), highest incidence in summer

E: humans: 1-2 deaths/year (4 in 2011, 1 in 2012, 2 in 2013; 1 in 2014; 3 in 2015; 0 in 2016; 2 in 2017; 3 in 2018; 5 in 2021)

West Nile Virus

C: Flavivirus, (+) ss RNA Virus

S: 20% fever, headache and body aches: 1 out of 150: encephalitis: 5% mortality

P: Mosquito bite→viremia→encephalitis

D: Symptoms; detection of IgM antibody to virus in serum

T: Supportive therapy

E: Culex mosquito transmits; birds, horses, other mammals act as reservoirs

E: 2016: 2038 cases, 94 deaths, 1 case in WV; 2017: 1937 cases, 115 deaths, 1 case in WV; 2018: 2647 cases, 167 deaths, 1 case in WV; 2019: 958 cases, 54 deaths; 2020: 557 cases, 38 deaths; 2021: 2695 cases, 191 deaths; 2022: 639 cases, 66 deaths.

N: La Crosse Encephalitis La Crosse Virus (LACV

C: ss(+)RNA

S: fever, headache, body aches, encephalitis, 5-10% mortality

P: mosquito bite → viremia → brain

D: Detection of virus-specific IgM

T: no specific treatment

E: Arthropod Borne (ARBO)(Aedes mosquito); reservoir insmall mammals; eastern U.S.; Usually

N: Zika Virus

C: Flavivirus; ss (+) RNA Virus, enveloped

S: Fever, rash, joint pain, conjunctivitis, myalgia, headache several days to a week

P: Mosquito bite viremia (in blood for 1 week); microcephaly & fetal brain defects, Guillain-Barre syndrome

D: Symptoms; Virus detection in urine & blood (PCR)

T: Supportive therapy

E: Aedes mosquito transmits to humans, monkeys; sexual intercourse (found in semen for 2-10 wks after infection; vertical; 2016: 4496 cases in US (185 endemic); 2019: 28; 2020: 4 cases in US.

N: Toxoplasmosis Toxoplasma gondii

C: protozoan (sporozoan) (fig. 19.12)

S: not serious (mild) in healthy individuals, but not serious (mild) in healthy individuals, but causes brain damage causes brain damage in uteroin utero and AIDS patients and AIDS patients

P: intracellular intracellular

D: history and symptoms

D: serology tests(ELISA) and(ELISA) and indirect F-Ab

T: Pyrimethamine and sulfadiazine

E: mice →house cathouse cat (doesn’t get sick) →feces →women at risk during pregnancy

N: Tetanus (trismus, lockjaw, tetany)Clostridium tetani

C: Gram + rod, terminal endospore, anaerobic

S: hyperflexis of masseter muscle

P: tetanospasmin toxin blocks glycine and GABA (neurotransmitter) release

D: history of puncture wound

T: Tetanus Immunoglobulin (TIG), debride, curare, Pen G, booster; tetanus toxoid (formalized tetanospasmin ); DTaP administered at 2,4,6,15m and school; booster every 10y is DTaP

E: ubiquitous, especially rusty nails;

E: tetanus neonatorum in unvaccinated mothers; elderly lose immunity, < 50/y USA, ww 290,000 died from it in 2006. mortality (50%); 2017: 33 cases; 0 reported since 2017.

E: Clinical disease does not confer immunity. Why?

N: Botulism Clostridium botulinum

C: Gram + rod, endospore, anaerobic

S: flaccid paralysis and respiratory failure; infant botulism associated with honey

P: botulinum toxin A (A-H) blocks presynaptic acetylcholine release D: history of ingesting home canned food; detect in left-over food with ELISA

T: polyvalent A,B,E horse antitoxin from CDC; toxoid vaccination of lab workers

E: green beans; vichyssoise; smoked meats

E: 2018: 242 cases in US (67% infant botulism)

N: Polio (poliomyelitis) Polio virus

C: ss(+)RNA, icosahedral (20 sides), small, naked

S: paralytic in 1% of infections

P: enteric→viremia→PNS?→CNS (motor neurons)

D: Cell culture, then DNA fingerprinting or whole genome sequencing

T: no efficacious therapy; Since2001: Trivalent Inactivated Polio Vaccine(TIPV) (Salk vaccine): 2, 4, 9-16 mos, and 4-6 yearslate 1990’s-2001:2+2 vaccine: 2 Trivalent Inactivated Polio Vaccine (TIPV)at 2 and 4m; 2 Trivalent Oral Polio Vaccine (TOPV) at 6 and 12m;1963 –late 1990’s: TOPV (Sabin)

E: fecal-oral epidemiology (swimming in contaminated water); TOPV cases in immunosuppressed

N: v-Creutzfeldt-Jakob disease (v-CJD) Prion

C: Infectious protein, PrPC→ PrPSC

S: Progressive degeneration of brain function

P: Prion protein causes the misfolding of PrPCPchronic, non-inflammatory

D: behavioral changes, dementia; EEC/MRI scans

T: none

E: Kuru in Fore tribe in Papua New Guinea Bovine spongiform encephalopathy (mad cow disease), Scrapie in sheep, CWD in deer, elk, moose

E: v-CJD (UK:178, France:28, Ireland: 4, U.S.: 4, Spain: 5, Netherlands: 3, Canada: 2, Italy: 3, Portugal: 2, Japan: 1, Saudi Arabia: 1, Taiwan: 1 = 232 cases since 1996.

E: Decontamination a problem, autoclaving alone does not render noninfectious, Recommendations: incinerate if possible, soak in 2N NaOH for 1 hour followed by autoclaving at 132°C for 1 hour African

N: African Trypanosomiasis Trypanosoma brucei

C: protozoan hemoflagellate

S: African sleeping sickness

P: ARBO→blood→CNS→death in 6-18m

D: history and symptoms stained blood/CSF smears

T: pentamidine, suramin, eflornithine, arsenic solution

E: tsetse flies are vectors and animals are reservoirs

Cardiovascular System Infections

Septicemia, sepsis and septic shock

Lymphangitis

Systemic diseases

C: Septicemia (Sepsis)gram positive

C: ***Staphylococcus aureus*** **(catalase +; coagulase +)**

  ***S. epidermidis***                **(catalase +; coagulase -)** ***Enterococcus faecalis*** **(Group D Strep)  (catalase -)**                                                   

S: **secondary to respiratory or wound infections** 

P: **diabetics, post-surgical nosocomials, etc.**

D: **blood cultures (gram stains, catalase and coagulase tests, other biochemical tests)**

C: Septicemia (Sepsis)gram positive

T: **Oxacillin or 3rd or 4th gen cephalosporin, because 95% of** ***S. aureus*** **produce b-lactamase; vancomycin for MRSA**



T: **piperacillin/ aminoglycoside for group D** ***Strep***



E: **1st, 4th and 2nd most common respectively;  (yeasts are 3rd)**



E: **1.7 million cases/year with 270,000 deaths in U.S. for both gram + & gram -**

C: Septic shock    (septicemia) (sepsis)     gram negative

C: ***Escherichia coli & Pseudomonas aeruginosa***                                 

S: **fever and shock (hypotension = ¯BP) secondary to a primary** ***E. coli*** **UTI**

P: **LPS (endotoxin) ® IL-1 (endogenous pyrogen) ® TNFa ® DIC**

D: **symptoms, gram stain of blood, culture, ID:  lactose ferment:**  ***E. coli***   **+ ,**  ***P. aeruginosa***  **-**

T: **piperacillin plus an aminoglycoside** 

**5th in frequency after gram positives and yeasts**

**C: Endocarditis (acute)**          ***Staphylococcus aureus***

C: **Gram-positive cocci in clusters**                               

S: **heart valve damage** , **acute fever, 50% mortality**   

P: **toxins, protein A, coagulase**

D: **catalase +, coagulase +  to differentiate it from**    ***S. epidermidis***

T: **oxacillin or vancomycin for MRSA**          

E: **frequent in intravenous drug abusers; 20% of acute caused by** ***S. aureus***         

C: Subacute Bacterial Endocarditis (SBE) Streptococcus sanguinis & mutans

C: **normal oral flora, account for 40% of all SBE**                               

S: **heart valve damage ® heart murmurs ® congestive heart failure**   

P: **often in rheumatic fever patient (next slide) or patient with previous heart valve damage**

D: **a hemolytic streps (viridans group)**

T: **a Streps are pen sensitive, but use  piperacillin + gentamicin because of** ***Enterococcus faecalis***

E: **tooth brushing; venous catheters;  also caused by** ***S. epidermidis*** **(CNS) and** ***Enterococcus faecalis*** **(group D strep)**      

**C: Rheumatic Fever**   ***Streptococcus pyogenes***     

C: **group A Strep (GAS)**                               

S: **polyarthritis and carditis 1-4wk after untreated streptococcal pharyngitis and tonsillitis**  

P: **autoimmune disease (non-suppurative delayed sequelae) caused by sensitization to M protein and cross-reactions with heart valve tissue**

D: **Symptoms, ELISA for pharyngitis**

T: **can be prevented with pen G and V if  treatment  commences within 10d;   also, treat for 10d**        

E: **children (winter); carriers (5%); contagious**

Schistosomiasis (688-690) Schistosoma mansoni

C: **Blood fluke, trematode**

S: **fever, chills, nausea, abdominal pain, malaise, pipestem fibrosis (chronic)**

P: **Snails  →  cercariae  →  swimmer’s itch →blood →heart and liver →  adult flukes mate and lay eggs→   tissue damage          intestinal lumen → defecation into water →  miracidium →snails→**

D: **stool examination for eggs**

T: **praziquantel**

E: **275M infected worldwide in tropics**

C: Tularemia (Rabbit fever) Francisella tularensis

C: **gram - rod**                               

S: **glandular fever**    

P: **wound with local inflammation and small ulcer at infection site>intracellular>lymphatic >( 1 week) ulceroglandular suppuration > septicemia, pneumonia, abscesses > 30% mortality in untreated cases**

P: **low infective dose (10 organisms)**

D: **symptomatic, culture dangerous, serodiagnosis**

T: **gentamicin; vaccine for high risk individuals** 

E: **zoonoses: reportable to CDC , also communicable via rabbits, hard ticks, deer flies; see following figure**

E: **1738 cases reported in humans 2005-2015; 100-200/year; 2020: 150 cases**

E: **1-5% of rabbits in US infected**

C: Brucellosis (Undulant fever) Brucella abortus

C: **gram - rod**                               

S: **chronic (up to 6 m), recurrent Fever of Unknown Origin (FUO) (fever, chills, malaise, night sweats and nighttime fevers) incubation period (7-21 days)**   

P: **intracellular in phagocytic cells**

D: **symptomatic, serodiagnosis**

**T: doxycycline and gentamicin for 6 w**

C: Anthrax Bacillus anthracis

C: **gram + rod; endospores                   aerobic!**            

S: **Cutaneous anthrax: Cutaneous lesion (black eschar) > septicemia > pulmonary symptoms> death (20%)**

S: **Inhalation anthrax: Vague respiratory symptoms, septicemia, massive edema, shock, respiratory failure, death (>80%)**

S: **GI anthrax: nausea, vomiting (blood), diarrhea**

P: **Capsule, toxin (edema factor, lethal factor, protective antigen)**

D: **History of animal contact >cutaneous lesion (black eschar) > septicemia> post mortem**

D: **Inhalation: chest x-ray of widened mediastinum, organism in blood, CSF, nonhemolytic on blood agar, Medusa head colony,**   **capsule on India ink stain, nonmotile**

T: **Penicillin G, ciprofloxacin, doxycycline (60 days); vaccine for high risk professions (military, veterinarians, animal contact professions)**

E: **Contagious zoonoses, herbivorous animals (goats, cattle, sheep),  woolsorters disease,  livestock  products; Koch’s Postulates;   Pasteur germ warfare  (bioterrorism)**

C: Plague (bubonic plague) Yersinia pestis

C: **gram - rod**

S: **lymphadenopathy (bubo; fig. 20.4)> sepsis and fever> black skin> mortality 50-75% by day 4 due to toxin**

P: **pneumonic plague (Black Death) 100% mortality history, symptoms** **and gram stain**

T: **streptomycin or gentamicin**

E: **rat is reservoir;**

* **vector is oriental rat flea**                                                 
* **~15/y in NM and CA (see next slide); April 2006 – case in Los Angeles (urban)**

**endemic in ground squirrels and prairie dogs in West bioterrorism**

C: Lyme Disease (borreliosis) Borrelia burgdorferi

C: **spirochete**

S: **bull’s-eye rash,  flu-like symptoms a couple weeks later;  affect heart,  facial paralysis, meningitis**

P: **and arthritis (months later)**

D: **history, symptoms and ELISA**

T: **doxycycline**           

E: **vector is deer tick (fig.  20.10); reservoir is field mouse ;   distribution (next slide)**

E: **tick check, DEET**

E: **vaccine pulled from market**

E: **~30-40,000 cases/ year in U.S.**

E: **2018: 33,666 cases**

**2019: 34,945 cases (1588 inWV**

C: Rocky Mountain Spotted Fever Rickettsia rickettsii

C: **gram - coccobacillus, obligate ATP energy parasite**

S: **high fever and hemorrhagic rash (1 week) > meningitis > 20% mortality**

**(5% with treatment)**

P: **intracellular**

D: **history and symptoms (not culturable)**

  **Serological testing; PCR**

T: **doxycycline**

E: **vector is wood tick/dog tick, transovarian; distribution in NC, VA and MD, WV (southeastern US, Appalachian area)**

  **1000 cases/yr (90% of all rickettsial disease in US)**                                     

C: **Infectious** __**Mono**__**nucleosis     EBV  (Epstein-Barr virus or HHV4)**  

C: **dsDNA   HerpesVirus**                                

S: **Fever of Unknown Origin (FUO)**

S: **(mild), pharyngitis, tonsilitis, fatigue and lymphadenopathy in 30-77% of patients** 

P: **B-cell lymphocytosis**

   **(also T-cells)** **(mononucleosis)**

D: **ELISA   (monospot and heterophile are nonspecific)**

  **Fluorescent antibody test that detects virus-specific IgM**

T: **none**

E: **kissing (15-20% of adolescents are secretors) (as are 85% of symptomatic patients); salivary secretions**

E: **Burkitt’s lymphoma in African children  correlation with malaria infection**

C: CMV Infection Cytomegalovirus (CMV

C: **dsDNA Herpes virus group, HHV-5**                                



S: __**mono**__**nucleosis (#2 cause); birth defects: 30% fetuses die** ***in utero*****; major AIDS opportunist**  



P: **low virulence in mono; kills AIDS patients**



D: **Monoclonal Ab to viral antigen, lymphocytosis, DNA probes**



T: **ganciclovir (in AIDS: ganciclovir-resistant strains)**



E: **15% chance of mono by kissing; 8,000/y**



  **congenital infections in USA;  reactivation infection in 50% of AIDS patients**

C: **Hemorrhagic Fevers Viral**

u**Yellow fever (590)     jaundice**   ***Aedes*** **mosquito   (ARBO)** 



u**Dengue fever (590)**    ***Aedes*** **mosquito   (ARBO)**



u**Chikungunya fever (590)  Aedes mosquito   (ARBO)**



u**Ebola fever    (589-590)       zoonoses bats (high   mortality)**



u**Lassa fever    (590)     zoonoses   rodent**

C: Malaria Plasmodium vivax (4 species

C: **protozoan  (sporozoan)**                                



S: **violent paroxysm>cold stage (1h) > 41oC  fever (3-5h) > sweat (10h) > normal(48h)**  

P: **obligate intracellular parasite [liver  stage > erythrocytic (RBC) stage]** 

D: **history and symptoms; blood smears (RBCs**



T: **primaquine for liver stage;  chloroquine for erythrocytic stage (*****P. falciparum resistance);*** **prophylaxis is recommended when traveling to endemic areas**                        



E: ***Plasmodium falciparum*****: most deadly**

E: **female** ***Anopheles*** **mosquitoes (sexual stage); In 2020: m**

C Chagas Disease Trypanosoma cruzi

C: **protozoan hemoflagellate**



C**: intracellular blood flagellate (Mastigophora)**



S: **Chagas Disease**



P: **ARBO®blood®myocardium®40% mortality** 



D: **history and symptoms, blood smear**



T: **nifurtimox for 90-120 days**              

E: **reduviid bug or kissing bug;                                                          20M infected in Central and S. America**

**Respiratory Infections**  \n **Upper Respiratory Tract**

•**sinusitis**



•**common cold**



•**pharyngitis**



•**tonsillitis**                  



•**epiglottitis**



•**laryngitis**



**Defense mechanisms (616)**

* **secretory IgA**
* **mucosal cell turnover**
* **normal flora are a strep**

Respiratory InfectionsLower Respiratory Tract

Bronchitis

lung

**“pneumonia”**



**Defense mechanisms**

* **mucociliary escalator**
* **no protective normal flora**

R: Strep Pharyngitis (strep throat) Streptococcus pyogenes

C: **group A (GAS gram +, b-hemolytic cocci in chains**                                                                                                        

S: **erythema, fever, pain, suppuration,                                                  fig. 21.3**

P: **80 M types (antiphagocytic) for recurrent infections. Streptokinase, streptolysin (s = b-hemolysis), erythrogenic toxin**

D: **diagnosis not possible without labs: swab to direct ELISA and culture. b-hemolysis,  catalase  (-),  bacitracin sensitive**

T: **80% of pharyngitis has viral etiology.               Penicillin V for 10d to prevent delayed sequelae only: rheumatic fever**                                                                                                       

E: **URT (5-20% carriers), communicable, winter.   scarlet fever caused by erythrogenic toxin coded for by a lysogenic phage (page 623-624)**

R: Sinusitis

C: **Any bacteria found in normal flora of URT, often mixed infection (*****Hemophilus influenzae, Streptococcus pneumoniae,*** **etc)**



S: **Nasal congestion, pressure, headache, toothache, green/yellow nasal discharge**



P: **Previous allergies, viral infection, structural problem of sinuses**



D: **Based on clinical presentation**



T: **Broad spectrum antibiotics**



E: **Normal flora**

R: Diphtheria (625-627) Corynebacterium diphtheriae

C: **gram + rod (fig. 21.8)    club shaped V & X**  

S: **leather-like gray pseudo-membrane on glottis ® lymphadenopathy® myocarditis**   

P: **bacteria not very invasive, diphtheria toxin (b-phage is a lysogenic/temperate/or prophage) is an AB toxin that acts on peptide chain elongation factor (EF2)**

D: **symptoms (pseudomembrane), culture & ID (gram + club, etc)**

T: **antitoxin and Pen G (to eliminate carrier state)**

E: **communicable, humans only, URT, fomites.  Prophylaxis for unvaccinated and elderly contacts is benzathine penicillin. Vaccine: Regular DTaP immunization is 2, 4, 6, and 15 mos and before start  of school, followed by boosterevery 10 yrs**

R: Otitis Media two causes of pneumonia

C: ***Streptococcus pneumoniae***  **(gram + diplococcus)**                        ***Hemophilus influenzae***        **(gram - coccobacillus)**                        

S: **middle ear (fig. 21.2) ® earache, hearing loss, meningitis**   

P: **nasopharyngeal ® eustachian tube ® middle ear ® hematogenous ® meningitis**

D: **bulging eardrum (Figure 21.2)**

T: **amoxicillin, tubes** 

E: **pre-schoolers  > 60% of all middle ear infection Pneumovax vaccine for** ***S. pneumoniae***      

**R: Common Cold  (rhinitis)                                       Rhinovirus**    **(618-619)**

C: **ssRNA(+), icosohedral, non-enveloped,           ~100 serotypes cause 50%**



S: **catarrhea (inflamed mucosa), rhinorrhea (runny nose), coryza (runny nose), etc.**   



P: **no viremia; complications common in elderly**



P: **IgA defense; interferon-a**



D: **symptomatic**



T: **symptomatic, zinc gluconate lozenges, vitamin C**           



E: **aerosolized URT secretions and fomites;                               3-4/y for children; 1/y for adults in winter**

**Whooping Cough (pertussis)**                                            ***Bordetella pertussis***

C: **gram - coccobacillus**                                 

S: **catarrhal (URT) ® LRT ® coughing paroxysm ® whoop ® convalescence with cough for 5-6 wk**

P: **Pertussin is an AB toxin that ­ cAMP.  Tracheal cytotoxin kills ciliated epithelial cells.  Bacterial fimbriae (FHA=filamentous hemagglutinin) adhere to cilia of bronchial epithelial cells**

D: **culture (fastidious) and ID, (but no X or V factors like** ***Haemophilus*****), F-Ab test, PCR**

T: **erythromycin will render patient noninfectious, it will not cure the patient; so prevention with  DTaP is stressed. (post-vaccination encephalopathy was associated with old vaccine (DTP);  ACEL-IMUNE (DTaP)  is the new vaccine; it is only FHA; now recommended for individuals up to age 60**

E: **communicable, human, URT, >10,000/y USA; 100 with CNS paralysis; 15 die (0. 5 M worldwide); infection leads to good immunity; immunization immunity probably wanes by early adulthood**

E: **November-December 2004: Local outbreak in Preston, Monongalia and Marion counties >35 cases, 1 death; Spring-Fall 2010: local outbreak; 2010: California epidemic with 5 deaths; 2012: 48,277 cases with 18 deaths in US; 2013: 28,639 cases; 2014: 32,971; 2015: 20,762 cases; 2016: 17,972; 2017: 15,808; 2018: 15,609; 2019: 18,617.**

Pneumonia (typical) (Pneumococcus) Streptococcus pneumoniae

C: **gram + diplococcus with a capsule (fig21.19a)**                                                                                               

S: **bronchial or lobar**

S: **sudden onset fever (102-5°F), rigors, severe breathing difficulty, severe chest pain, rusty sputum**

P: **capsular polysaccharide has  85 SSS (specific soluble substance) types, also used in diagnosis specific Quellung test**

D: **of lobar pneumonia by dullness to percussion, Xray, purulent sputa, staining, blood culture ®**  a strep **sensitive to optochin**



T**cephalosporins, (PBP resistance so do sensitivities); Pneumovax (23 SSS) covers most common 80% of types**

E: **URT carriers (5-25%); under 2 y and over 65 y: mortality 4M/y 8000 children/d**  

**Atypical Pneumonia (walking)** \n **several bacteria and viruses**

u***Hemophilus*** **influenzae**  

•**alcoholics, malnourished, diabetics    ceftriaxone**

u***Mycoplasma pneumoniae (*****639)** 

•**young adults and children  erythromycin**

u***Legionella pneumophila***  **(640)** 

•**men > 50, heavy smokers, alcohol abusers  erythromycin**

u**RSV (Respiratory Syncytial Virus) (628-629)** 

•**infants and children       ribavirin**

**Nosocomial Pneumonia**   \n **several bacteria**

u***Staphylococcus aureus*** 

•**secondary pneumonia in elderly (to influenza)** 

•**50% mortality  oxacillin**

u***Pseudomonas aeruginosa***

• **pipericillin + aminoglycoside**

u***Klebsiella pneumoniae*** 

• **cephalosporin**

**COVID-19** \n **SARS-CoV-2**

C: **Coronovirus;  enveloped  (+) RNA virus**



S: **Fever, cough, sore throat, shortness of breath, loss of taste & smell, GI symptoms, pneumonia**



P: **Novel, Attaches to angiotensin-converting enzyme -2 on respiratory cells**



D: **RT-PCR; Molecular assays; Antibody tests**



T: **Supportive & symptomatic therapy; Paxlovid; remdesivir; Bebtelovimab & dexamethasone; Vaccines (Pfizer, Moderna, Johnson & Johnson);**



E: **Contagious URT; possibly fecal-oral**

A 36-year-old person from the displaying number of personality changes. They have become extremely forgetful. Over the next several months their condition deteriorates to where they have forgotten almost everything. They eventually lapse into a coma and die several weeks later. On autopsy of their brain demonstrates spongiform deterioration. Their death is most likely from___.

v-Creutzfeldt-Jakob disease

Septic shock caused by Escherichia coli will produce ______ in a patient.

a rapid drop in blood pressure and a high fever

Which of the following respiratory illnesses has an upper respiratory phase and a lower respiratory phase associated w/ the infection?

pertussis

The most common causes of Subacute Bacterial Endocarditis (SBE) in at-risk patients is ______.

escherichia coli and other intestinal flora

a person with poliomyelitis became infected when they_____.

ingested through food or water contaminated with human waste

a person visits their family physician with a one-week history of headache, internal pressure in the facial region, and nasal congestion with green to yellow nasal discharge. This morning they arose to aching upper teeth. The history includes having hay fever allergies to a variety of pollens. What condition is this person most likely suffering from?

sinusitis

Infection with Francisella tularensis is most commonly associated with

contact with the blood and secretions of an infected rabbit

all of the following diseases have viral cause except

undulant fever

rhinoviruses are a major cause of

the common cold

a one-year-old child has been brought to the emergency room. The child appears limp w/ flaccid paralysis, dropping eyelids, and appears to have difficulty in swallowing and breathing. The mother reveals she has recently changed to a more organic way of cooking and is using small amounts of honey in place of sugar in their meals. She is extremely proud that she has not bought any store bought baby food and is making her own baby food from the family meals. This child is most likely suffering from ______.

infant botulism

Which of the following organisms causes malaria and how is it transmitted?

plasmodium vivax causes it and is transmitted by the bite of the anopheles mosquito

Meningitis caused by cryptococcus neoformans can be easily and quickly diagnosed by _____.

observing budding yeasts w/ large capsules in an india ink preparation of the CSF

Which of the following causes of meningitis is noncommunicable?

cryptococcues neoformans - bird droppings

Someone w/ meningitis will experience _____.

stiff neck, high fever, severe headache, and photophobia

Which of the following clinical syndromes would you expect to find in someone suffering from malaria?

shaking chills and very high fevers followed by drenching sweats approximately every 48 hrs

The wife of a dairy farmer presents to her family physician with a 6-month history of nocturnal fevers, chills, malaise, night sweats, and weight loss. Her husband has been experiencing the same syndrome. The woman divulges that a number of the calves at the farm have been born dead. Her history includes helping her husband and his crew handle the dead calves and their mothers and drinking unpasteurized milk and eating cheese made from this milk from the farm. This couple is most likely infected with_____.

brucella abortus

Which of the following biological samples is used to diagnose septicemia?

blood

Repeated prolonged coughing episodes followed by a “whoop” sound are a clinical indication that a person may be infected with ____?

bordetella pertussis

A person works in a tannery where they tan imported cow hides into leather. One morning, they notice a painless, slightly swollen bump resembling a mosquito bite on their hand. Two days later, it develops into a painful 2-cm ulcer and soon develops a black scab (eschar) in the center. They see their family physician who examines and cultures the lesion. Gram positive endospore-forming rods are cultured from the sit. Nonhemolytic “Medusa-head” colonies are produced when it is centered on blood agar. This person is most likely suffering from ____.

cutaneous anthrax

Treatment w/ primaquine is necessary to eradicate the liver stage of ____.

Plasmodium vivax

Which of the following organisms is the most common cause of atypical pneumonia in usually healthy young adults?

Mycoplasma pneumoniae

A forty-year-old person is seen in a California clinic w/ a deep dirty puncture wound in their foot. They tell the doctor that they had all of their tetanus immunizations and they received the most recent booster just 2 years previously. What would be the appropriate treatment for this person to prevent tetanus now and in the future?

clean out wound and perscribe oral antibiotics. No immunizations. they should follow up in 8 years for next booster

Which of the following organisms produces a highly fatal hemorrhagic disease that begins with fever, diarrhea, and vomiting but progresses quickly to severe internal bleeding and organ failure?

ebola virus

A recently-adopted 5-year-old child from Ukraine complains of a sore throat, swollen lymph nodes in the neck, and a low grade fever. Examination of the throat reveals a very adherent gray leather-like pseudomembrane across the back of the throat. Gram stain of the “membrane” demonstrates gram-positive rods arranged as X’s and V’s microscopically. What organism is this child infected with?

Corynebacterium diphtheriae

Someone with Chagas Disease is infected with ____.

Trypanosoma cruzi

Eradication of the Culex mosquito in an area would greatly reduce the number of cases of _____.

West Nile encephalitis

Someone infected with Toxoplasma gondii probably became infected when they had contact with the infectious feces of _____.

cats

Which of the following diseases does not involve transmission by a mosquito?

chagas disease

Infection with Cytomegalovirus is associated with _____.

mononucleosis in healthy people, birth defects in congenital infections, and death in AIDS patients

Negri bodies would be observed in the brain of a person who has ____.

rabies

Two very ill people camping in Arizona for the past week are found by some hikers. The hikers call the authorities and the EMTs transport the campers to the nearest hospital. The EMTs notice a number of dead prairie dogs in the area and bag one of them to show to animal control personnel. The campers have a high fever and very swollen lymph nodes in their armpit and groin. A gram-negative rod is isolated from the patients. What are these people infected with and how did they get it?

infected oriental rat fleas from the prairie dog transmitted yersinia pestis to them

Which of the following animals plays an important role in the transmission of Schistosoma mansoni?

snail

Which of the following diseases does not have a vaccine to prevent it?

infectious mononucleosis

What is Rheumatic Fever?

Trypanosoma brucei causes ___ and is transmitted by the _____.

Which of the following clinical syndromes would you expect to find in someone infected with Epstein-Barr Virus?

If a mother is infected with _____ during pregnancy, there is a high probability that the newborn will be born with microcephaly and brain damage.

Which of the following clinical syndromes indicates otitis media?

A person is brought into the Emergency Room with a very high fever, severe headache and a rash that first appeared on the extremities and then spread to the torso. The rash is prominent on the palms of the hands and the soles of the feet. This person frequently hikes the mountains and trails near their home in Virginia. This person is most likely suffering from _____.

A bull’s eye rash followed by flu-like symptoms a couple weeks later and eventually the development of arthritis, heart problems, and facial paralysis are associated with infection by _______.

Which of the following respiratory conditions is generally not a communicable disease?

Cerebrospinal fluid (CSF) is commonly used to diagnose _____.

Which of the following organisms does not cause disease by the toxin it produces?

Which of the following organisms does not cause a zoonosis?

A 60-year-old person is brought to the Emergency Room complaining of difficulty in breathing and chest pain. They have a body temperature of 103 degrees F. Chest x-ray indicates fluid in both lungs and the chest sounds dull to percussion. A gram stain of purulent sputum reveals many neutrophils with gram-positive diplococci. Further laboratory tests indicate a catalase-negative organism that produces alpha-hemolysis when grown on blood agar and is sensitive to optochin. This person is most likely suffering from _____.

Which of the following diseases does not involve an arthropod as a possible means of transmission?

Which of the following respiratory illnesses is a lower respiratory tract infection?

Which of the following diseases is not transmitted by the Aedes mosquito?

Antibiotic treatment for streptococcal pharyngitis is recommended because _____.

A 50-year-old person is seen in the ER complicating of stiff neck, high fever, severe headache, eyes sensitive to light, nausea and vomiting. A gram stain of the CSF demonstrates neutrophils containing encapsulated gram-positive diplococci. The most likely cause of this person’s illness is _____.

1\. Someone with rabies will have ______ in their brain.

Negri bodies