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Week 1 - Day 3 notes


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What are the other complications other than infant pneumonia,urethritis, trachoma of Chlamydia infection?
1. PID (usu. asymmptomatic - important to treat because it can scar falopian tube -cause ectopic pregnancy etc)
2. Epididmyitis in men
3.Reiter's syndrome - inflamm. arthritis of large joints, young men,uveitits,conjunctivitis.
4. Fitz-Hugh-Curtis Syndrome : inflamm. of liver capsule
5. Lymphogranuloma Verereum: similar to Haemophilus ducreyi.
what is Lymphogranuloma Venereum? how is it different from Haemophilus ducreyi-which cause Chancroid?
1.Sexually transmitted disease of C. trachomatis (L1-3 serotypes)
2.Painless ulceration on genital-heals spontaneously
3. Then,Regional Lymph node enlarge in 2months - tender and may bust,drain pus

(All these occur quicker in H. Ducreyi-unilateral lymphnodes as well and Ulcer and enlarged lymph node co-exist)
1.What is the difference between typical pneumonia(Strep pneumonia) and atypical pneumonia?
2.List causes of Atypical?
1. In typical-sicker pt, hacking cough, yellow sputum with pus, Consolidated lung -WBC - heard on lung exam and seen on x-ray
Atypical- no sputum,lung exam close to normal, dry hacking cough, lung x-ray inflitrates, (fever,headache)
2. viruses, Mycoplasma, Chlamydia psittaci, Chlamydia pneumoniae
Route of transmission of these 2 pneumoniae causing bugs - Chlamydia Psittaci and Chlamydia Pneumoniae?
C. Psittaci - Birds
C. Pneumoniae - person to person
Describe Rickettsia (the other small bug)?
1. g-rod non motile obligate intracellular organism (like Chlamydia)
How is Rickettsia different from Chlamydia?
1. Uses vectors (except for Q fever)
2. Replicates freely in cytoplasm (not endosomes)
3. Tropism for Endothelial (unlike Columnar epithelium)
4. Causes Rash, high fevers,bad headaches
Name the Rickettsia vectors and their disease?
1. Tick - Rocky Mountain Fever
2. Louse- Epidemic typhus
3. Flea - Endemic typhus
what is Brill Zinsser disease?
Latent form of Rickettsia Prowazeki infection that was untreated with Antibiotics.
What is the vector and the disease caused by Rickettsia Prowazekii?
1. Louse
2. Epidemic typhus (killed 1/3 of napoleon's men)
Define Epidemic and Endemic diseases?
1. Epidemic - Sudden onset and rapid spread infection to a large population.
2. Endemic - Infectious disease that is persistent in a population.
What disease does Rickettsia Typhi cause and what is the vector, reservoir?
1. Endemic typhus
2. Flea -vector
3. Rodents -Reservoir
Like bubonic plague - kill the fleas and rats (not just the rats)
Clinical sx of Rickettsia typhi (endemic typhus), Tx?
1. fever,headache, maculopapular rash, serious but not as bad as T.prowazekii(epidemic typhus)
2. Doxycycline or Cloramphenicol
Cause of Scrub Typhus,Vector and what part of the world found in?
1. Rickettsia Tsutsugamushi-rash,scrab at bite site, high fever
2. Larvae of mite
3. Asia
Cause of Trench fever, Vector,Sx and Why is not named as part of the Rickettsia genus?
1. Bartonella quintana(5)
2. Lice (like R. prowazekii)
3. High fevers, rash, headache,back and leg pain. Relaspe 5dys
4.Rickettsia like but no an obligate intracellular organism
Cause of Cat-scratch disease, Sx, and name another disease caused by bug in AIDs patient?
1. Bartonella Henselae
2.Cat bite or scratch
3. Sx: enlarged regional lymph node,low-grade fever, resolves -n months
4. Bacillary Angiomatosis - small blood vessel formed in skin and organs of AIDs pt.
What does Coxiella burnetti (Rickettsia group) cause, Sx, transmission? This bug is similar to what other bugs?
1. Q-fever
2. The only rickettsial infection to cause pneumonia. Also cause sudden fevers, soaking sweats, NO RASH!
3. Forms endospores - so inhaled rather than bites from tick
1.What disease is Ehrilichiosis similar to?
2. Disease to what other animal (loves to lick)
3. Vector
1. Similar to Rocky Mountain fever - rash is rare only about 20% of time.
2. Disease of dogs (and humans)
3. Tick
Obligate intracellular bacterium that is tropic for columnar epithelial cells of conjunctiva, cervix, and lung.
two forms of chlamydia during its life cycle.
Elementary body (extracellular) / initial body (intracellular form)
Treatment for chlamydial infections
tetracycline / erythromycin
leading cause of preventable blindness in the world. Causes blindness over years
Chlamydia trachomatis primarily affects what two areas of the body?
eyes, genitals.
Most common cause of urethritis
Why will penicilin not work against chlamydia.
it has no peptidoglycan layer
Chlamydia infection is associated with ------- ------, an inflammatory arthritis of large joints commonly occuring in young men. Also uveitis, conjunctivitis, urethritis is seen with this condition.
Reiter's syndrome
Fitz-Hugh-Curtis syndrome is an infection of what?
liver capsule (perihepatitis)
Chlamydia species found in birds. Causes atypical pneumonia in humans.
Chlamydia psittaci
Rickettsia require arthropod vectors except for ------ ----.
Q fever agent (Coxiella burnetti)
While chlamydia parasitize columnar epithelium, rickettsia have a tropism for ------- cells. That's why you get rashes with rickettsial diseases.
endothelial (hence the rashes)
Name the the test for rickettsial infection using antigens from strains of Proteus
Weil-Felix reaction
Name that disease: Severe headache, conjunctival redness, fever, rash on palms, soles spreading to trunk. Hx of camping in Georgia.
Agent of RMSF
Rickettsia ricketsii
Rickettsia akari causes -------. There is a dramatic response to what drug?
rickettsial pox . Doxycycline
Cause of endemic typhus
Rickettsia typhi
Cause of epidemic typus
Rickettsia prowazekii
Cat scratches pt --> regional lymphadenopathy --> low grade fever, malaise --> usu resolves in a few months without complications. What is the organism?
Bartonella (Rochalimaea henselae)

(also causes Bacillary angiomatosis in AIDs patients)

(same group with Rickettsia, Trench fever (bartonella quintana)- this transmitted by louse as well)
In contrast to the other rickettsia, the agent that causes Q fever is acquired by ------ ------ and not by an arthropod bite.
spore inhalation from tick feces and cattle hide
A disease like RMSF, but in which the rash is not common
How do spirochetes replicate?
transverse fission
If untreated, patients with syphilis will progress through 3 stages, with a latent period between stages -- and --.
2(secondary) and 3(tertiary)
Name the stage of syphilis.- Gummas of skin and bone, aortitis, neurosyphilis
Name the stage of syphilis. Painless chancre, nontender lymphadenopathy (regional)
Primary stage
What are the manifestations of secondary syphilis?
rash on palms and soles, condyloma latum, CNS, eyes, bones, kidneys, and/or joints may be involved.
Painless, solitary, granulomatous lesions on skin
gummas. Also occur in bone.
How do aortic dissections occur as a result of syphilis?
syphilis destroys small arterioles (vasa vasorum) --> tunica media necroses --> dissection
1.Name two bacteria that cause subacute meningitis?
2.Describe subacute meningitis as opposed to acute meningitis?
1.Treponema(syphillis), Mycobacterium (TB)
Subacute: High lymphocyte*,low glucose,high protein.
Acute: High PMN, low gluc.,high protein.

Subacute there is a predominance of lymphocytes.
If the posterior columns are damaged in tabes dorsalis, what will the the clinical sign?
ataxia from loss of proprioception and vibratory sense.
What will result from the loss of DRG in neurosyphilis?
loss of reflexes, pain and temp sensation
Describe the argyl-robertson pupil.
constricts during accommodation, but does not react to light
What condition is this: 1 year old presents with osteitis, (seen on X ray); widespread rash; condyloma latum
Early congenital syphilis
Which cranial nerve is classically affected in late congenital syphilis?
8th nerve
The bone and teeth are involved in late congenital syphilis. What is the deformity of the nose called?
saddle-nose deformity
If the VDRL is negative, but the FTA-ABS is positive, what does that indicate?
successfully treated syphilis
What is this: after treatment for syphilis, a pt develops mild fever, chills, malaise, headache, and muscle aches. This condition resolves on its own.
Jarisch-Herxheimer reaction
Endemic syphilis is transmitted by sharing eating utensils in what part of the world?
desert regions of mid east and africa
----- nerve palsy may be seen in early disseminated lyme dz.
7th nerve palsy (bell's )
Most common heart abnormality in Lyme disease.
heart block (av block)
Treatment for syphilis
What do you give for syphilis if the pt is allergic to penicillin?
erythromycin or doxycycline
What do you give for syphilis if the pt is pregnant and allergic to penicillin?
erythromycin (don't give doxy)
Tx for Lyme
Doxycycline, penicillin
The rashes from rickittesia are due to what inflammatory process?
What are the requirements of Rickettsia as an obligate intracellular bacteria?
NAD and CoA (except for Coxiella -Qfever)
What is the best Tx for Rickettesial infections
What are the key differences of Coxiella (Q fever) other than not being an intracellular bacteria?
1. No Rash
2. Aerosol (instead of tick bite)
3. Negative Weil-Felix (proteus antigenic rxn)
4. Does not have Rickettsia as genus name. Coxiella burnetii
Difference in Rash distribution in Rocky spotted mountain fever (R. rickettsia) and the Typhus fevers?
RSMF - centripetal (out--> in)
Typhus -CentrPHugal (in -->out)
Name the 3 genera of Spirochetes and example for each?
1. Treponema - syphillis
2. Borrelia - Lyme disease
3. Leptospira - Weil's disease

all have 6 axial filaments,transverse fission, very small(except for Borrelia-big),g-
C. Trochomatis D,K serotype causes?
1. urethritis
3.Neonatal pneumonia and conjunctivitis
Which is a better test for Treponemes (e.g syphillis) - FTA-ABS or VDRL?
1.FTA-ABS (find the antibody- ABSolutely)
VDRL -less specific, false + (mono,hepatitis,drugs,Rheumatic fever,RA,SLE,and leprosy)

1. Sensitive (early detection)
2. + for long time
3. Most specific
What are associated with late congenital syphillis?
1. Neurosyphillis - same as adults (8nerve common)
2. Saddle nose (bone involvement)
3. Saber Shins
4. Hutchinson's teeth
5. Mulberry molars
6. Eye disease
When can you prevent congenital syphillis?
Tx of mother with Abx before the fourth month of gestation
what is the bacteria that causes syphillis?
Treponema pallidum
There are 3 subspecies of T.pallidum that are non-veneral. Name them and what they cause?
T. endemicum - Endemic syphillis (middle east)
T. pertenue- Yaws
T. Carateum -Pinta (dicoloration, no gummas)

T.E and T.P cause gummas of skin, skin ulcers in all even T.Carateum.
The tertiary stage dont involve the aorta and CNS
What causes lyme disease?
How many stages are there in lyme disease?
1. Borrelia burgdorferi
2. 3 Stages
a. Early localized stage
b. Early desseminated stage
c. Late stage
Clinically define the 3 stages of lyme disease?
Stage 1: Erythema chronium migrans
Stage 2:
i.muliple ECM
ii. Neulogic - aseptic meningitis, cranial nerve palsies (bell's), peripheral neuropathy
iii. Cardiac: transient Heart block
iv. Brief Arthritis attacks
3.Late stage:
i. Chronic Arthritis
Borrelia genus cause lyme disease, name another disease by this genus and the complete bug name?
Borrelia Recurrentis - Relasping fever
(due to antigenic variation during infection)
The only two genera that are acid fast bacteria
Mycobacteria, Nocardia
Acid fast bacteria stain in ------ color.
What is Mtb's oxygen requirement?
obligate aerobe
The name for a mycolic acid bound to a carbohydrate, forming a glycolipid
A mycoside formed by the union of 2 mycolic acids with a disaccharide. Only found in virulent strains of Mtb?
What is the virulence activity of this factor?
1.cord factor
2. Cord factor inhibits neutrophil migration and damages mitochrondria
3. Also activates TNF in mice
If cord factor is injected into mice, ----- (a cytokine) is released, leading to rapid weight loss.
TNF or cachectin. In people, this cachexia may be confused with malignancy related cachexia
Mycobacterium leprae like cooler temperatures, so the infection is primarily of the ----.
skin. Spares warm areas of skin (axillae, groin)
What determines the severity of the disease cauased by M. leprae?
Host's cell-mediated immunity
Most severe form of leprosy, in which hosts cannot mount an immune response.
Lepromatous leprosy.
What will be the result of the lepromin skin test in tuberculous leprosy? In lepromatous leprosy?
TL = positive. LL = negative
Size of +PPD skin induration in normal patients?in immunocomprimised patients?
1. 10mm
2. 5mm
To rule out false negative PPD? how can you test for the Hypersensitivity type IV rxn in a patient?
1.Inject with Chlamydia or mumps antigens.
2. In an anergic patient will still test negative therefore confirming the PPD test is not reliable)
Lymph node TB is called?
Scrofula (most common extrapulmonary manifestation of TB)- location normally at the cervical lymph node
What is Pott's disease?
TB infection of the skeletal body of the vertebra (discs destroyed)
What are the manifestation of TB in the CNS?
1.Subacute meningitis (other bug-Treponema)
2. Granuloma in brain
List the organ system involved in TB?
1. Pulmonary
2. Miliary (disseminated - every organ possible even lung- millet seed granulomas)
3.Skeletal (pott)
4. Lymph
5. Pericardial and pleural infection
6.Kidney - sterile pyuria (hard to culture), RBC and WBC in urine
7. Joints
What animal holds the reserve of M. Leprae that causes Hansen's disease(leprosy)in the U.S.? Tx?
2. long term oral dapsone (toxicity: hemolysis, methemoglobinema)
alt. Tx: Rifampin or clofazimine and dapsone
why will penicillin not work against mycoplasma?
no peptidoglycan cell wall
Two species of mycoplasma
Mycoplasma pneumonia, Ureaplasma urealyticum

These guys have no cell wall (just a cell membrane) and they are really small, smaller than the largest viruses.
Mycoplasma pneumonia causes what kind of pneumonia?
walking (atypical)
Does walking pneumonia cause a dry or productive cough?
atypical pneumonias cause a dry cough
What simple bedside test can be performed to test for the presence of antibodies to mycoplasma?
How does it work?
1.cold agglutinin test
2. Cold agglutinin antibodies to RBC cross react at 4oC with antigens found on mycoplasma pneumonia.
Clumps in the cold, unclumps in warm temp
Normally, AB to Antigens to RBC are not made.
To grow mycoplasma, the medium must be rich in ----?
Describe mycoplasma colonies on agar?
1.cholesterol and nucleic acids
2. It grows and gives a fried egg appearance(tiny dome colonies).
Ureaplasma urealyticum breaks down urea into CO2 and ammonia, just like what other bacterium?
Proteus mirabilis, H.pylori
In addition to U. urealyticum, what other bacteria cause urethritis?
N. gonorrhea, Chlamydia trachomatis
Define the cell membrane of mycoplasma?
Stocked with sterols (like cholesterol)
Name the two Rickettsia related bugs that cause disease carried by louse?
1. Rickettsia Prowazekii (Epidemic typhus)
2. Bartonella quintana (trench fever)
What are gummmas in Syphillis?
These are granulomas in skin and bone which necrose and become fibrotic.
What are the Rule of sixes for Syphillis?
1.6axail filaments
2. 6week incubation b4 chancre
3. 6week for chancre to heal
4. 6weeks for secondary stage
5. 66% of patient resolve after secondary stage
6. 6years for tertiary to develop
Is Syphillis part of the TORCHES disease? These are bugs that can cross the placenta.
The rest are

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