Micro FUO – Microbiology – Flashcards
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| what are the 5 steps in the inflammatory response |
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| 1. damaged tissue release histamine 2. capillaries leak and release phospcytes and clotting factors 3. phagocytes engulf bacteria, dead cells, debris 4. platelets move out of capillaries to seal wound 5. serum proteins move in: complement, clotting, IL |
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| what 5 things does IL-1 do |
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| vasodilation activate lymphocytes destories tissue Fecer production of IL-6 |
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| what 3 things does TNFa cause |
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| increase permeability shock fever |
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| what 3 things does IL-6 cause |
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| lymphocyte activation fever increase acute phase protein production |
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| what does CXCL8 do |
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| chemotactic factor for neutrophils, basophils, T cells |
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| what does IL-12 do (2) |
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| activate NK cells differentiate T into Th1 |
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| explain how a fever forms |
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| infection or toxin release of IL-1, tnf, IL-6 go to thermoregulatory receptors of hypothalamus and induce vasoconstriction and cause brain to have behavorial changes that increase temperature |
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| what are the two main events in the acute phase |
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| injury induces mast cells and IL which tell hypothalamus to cause fever and adrenal cortex to make cortisol which acts on liver to make proteins and complements to induce immune supression injury signals for marrow to make PMN which use diapediases with ICAM to get to inflammatory site |
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| whatis the criteria for FUO |
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| fever > 38.3(101F) for 3 weeks or more without diagnosis despite invesitigation |
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| what is the first step in FUO tx and two ways to accomplish it |
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| improve diagnosis: serology and imaging |
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| what are the five general categories of cause for FUO |
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| cancer connective tissue disorder autoimmune fastitious/munchausen drugs infection |
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| what are the 4 categories of infection that cause FUO |
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| bacterial viral parasite fungal |
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| what are 5 cancers that cause FUO |
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| renal liver hodgkins lymphoma non-hodgkins lymphomc leukemia |
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| what is the difference between hodgkins and non-hodgkins lymphoma |
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| hodgkins: B cells, reed-sternberg cells non: T or B cells, NK rarley |
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| what are two CT dissorders that cause FUO |
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| juvenile RA stills disease |
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| what is the cause of Stills disease (4) |
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| HLA B17, HLA B18, HLA B35, HLA DR2 |
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| why does stills disease cause feer (3) |
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| post infection with Y. enterocolitica, mycoplasm pneumo reactive athritis |
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| what are the two main symptoms of stills disease |
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| fever rash |
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| what are 6 autoimmune conditions that cause fever |
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| giant cell arteritis polymylagia rheumatic polyarteritis nodosa chrons sarcoidosis SLE |
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| what is sarcoidosis |
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| pulmonary hilar lymphadenopathy, arteritis, granuloma |
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| what is giant cell arteritis |
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| CMI causes inflammation causing cytokine damage of arterial vessel wall and multinucleated giant cells |
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| what causes giant cell arteritis (2) |
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| HLA DR4 or DRB103 |
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| what are common manifestations of munchausen in FUO (4) |
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| by proxy (child abuse) young adults with healthcare knowledge manipulation of thermometer injection of foreign material |
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| what are 7 categories of drugs that cause FUO |
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| antimicrobials H1 and H1 antagonists antieplieptic drugs NSAIDS and slicylates antiarthythmic antithyroid antihypertensive |
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| what are 15 bacterial causes of FUO |
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| TB salmonalla typhi (enteric fever) lyme disease syphillis relapsing fever leptospirosis interrogans rat bite fever - spirilum minus brucellosis chalmydophila psittaci rickettsia anaplasmosis erchichiosis anaplasmosis Q fever - coxiella vurnetti whipples disease - tropheryma wipplei legionella bartonella |
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| what are 10 viral causes of FUO |
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| mono CMV influenza adenovirus parvovirus measles mumps HIV hepatitis hemorrhagic fever |
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| what are the three hemorrhagic fevers, why are they not commonly a FUO |
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| ebola, lassa, congo onset is dramatic |
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| what are 4 parasites that cause FUO |
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| malaria: babesiosis trypanosomiasis: T. brucei ameobic abscess: E. histolytica (invasive diarrhea) toxoplasmosis gondii |
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| what are 5 fungal causes of FUO |
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| candidiasis albicans cryptococcosis neoformans aspergillus systemic fungi: H. capsulatum, C. immitis |
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| what are 5 hidden infections that can present with FUO |
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| osteomyelitis occult abscess enerocarditis pericarditis myocarditis |
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| what is the most common cause of osteomyelitis in adults and kids |
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| S. aureus adults influenza B in kids |
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| where do occult abscesses usually show up (4) |
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| intra abdominal dental liver renal |
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| if someone is a veterinarian, what are you going to make sure to include in teir FUO work up (3) |
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| leprospirosis brucellosis Q fever |
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| if someone has traveled recently, what are you going to make sure to include in teir FUO work up (4) |
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| typhoid RMSF malaria C. immitis |
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| what are three things you need to look at on a physical exam for FUO work up |
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| bone/joints nodes murmurs |
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| what are 4 important questions in a FUO history |
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| do you work with animals have you treveled have you had dental procedures what meds are you on |
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| what are 3 criteria when taking a blood culture sample |
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| draw from three sites at three different times before antibiotic start |
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| define endocarditis |
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| infection or inflammation of chamber, septum, or valve lining |
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| who is the most common endocarditis patient and what part of the heart is affected |
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| elderly men with mitral (2nd aortic) valve problem |
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| what is the number 1 cause of endocarditis and why |
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| S. aureus because it can damage IN TACT valves due to ENZYMES and ANTI-PHAGOCYTIC properities |
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| what are some procedures or activities that can increase risk of endocarditis |
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| prostatic valves central line placement bite wounds IV drug use dental surgery endoscopy/colonoscopy trans-esophageal ECHO gingivitis |
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| what are 4 heart defects that increase risk for endocarditis |
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| valve defect aortic stenosis tertaology of fallo VSD |
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| what infection has a complication of endocarditis |
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| strep - rheumatic fever/heart disease |
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| what are the two most common cause of endocarditis, why |
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| S. aureus S. epidermiditis normal skin flora |
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| what are 4 criteria for acute endocarditis |
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| days long rapid destruction sepsis valve is in tact and not damaged |
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| what is the most common cause fo acute endocarditis, what are 3 other causes |
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| S. aureus coag negative staph oral strep enterococcus |
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| what are 2 criteria for subacute endocarditis |
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| weeks to months damaged valve |
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| what are two possible causes fo subacute endocarditis |
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| congenital disease dental surgery / bad oral hygeine |
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| what are the two most common causes of subacute endocarditis. what are thre more |
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| HAECK, C. burnetti (animal profession) S. viridans, enterococcus. coagn neg staph |
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| what is the most common cause of endocarditis in someone with a mechanical steel heart device for <60d(3) |
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| staph, GNR, candidia |
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| what is the most common cause of endocarditis in someone with a bioprosthetic heart device for >1y (3) |
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| staph a-strep enterococci |
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| what are the most common causes of endocarditis in a IV drug user |
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| S. aureus, strep, pseudomonas, candidia, enterics from flora |
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| what is teh most common location for infection in an IV drug user |
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| tricuspud (>mitral>aortic) |
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| what are the two most common nosocomial causes of endocarditis |
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| staph enterococci |
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| what are the three most common introduction methods for nosocomial endocarditis |
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| IV catheter swan-ganz hemodialysis |
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| why is staph and strep a common cause of endocarditis |
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| oral and skin flora |
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| what non-HAECK GI and mouth flora are common causes of endocarditis (4) |
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| enterococcus S. bovis/galloyticus E. coli P. aeruginosa |
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| what does HAECK stand for, what are the commonalities they share |
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| H. parainfluenza and arthrophilus Actinobacillus actinomycetemcomitans Cardiobacteroi, hominis Ekienella corrodens Kigella species fastitious gram negative rod in mouth associated with bite wounds |
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| how can S pyogens and P aeurgnosa be identified |
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| B hemolysis |
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| how can S. aureus be identified |
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| coag positive |
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| how can enterococcus be identified |
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| non hemolytic or slightly B hemolytic |
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| how can s. vididans be identified |
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| B hemolytic |
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| 12 signs of endocarditis |
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| SOB fever, chills fatigue murmur swelling weight loss night sweats cough chest pain splinter hemorrhage: nail beds osler's nodes: finger tip tender janeway spots: palms and soles, painless roth spots: retinal hemorrhages (immune complexes) |
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| what is the mortality rate of endocarditis |
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| 20-25% |
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| what are 6 complications of endocarditis |
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| venturi effect bacteremmia/fungemia pneumonia pyelonephritis immune system caused damage CHF |
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| what is the venturi effect |
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| turbulence or trauma causes embolism on low pressure side of valve |
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| what valves get less damage with venturi effect, why |
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| tricuspid and pulmonary because they are low pressure |
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| what are the 4 parts to endocarditis tx |
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| oxygen hemodialys antifungal/antibiotics - long term to removal biofilms valve removal or replacement |
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| define myocarditis |
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| infection or inflammation of cardiac muscle (myocytes, vascular tissue, autonomic nerves, interstitum) |
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| what are 6 signs of myocarditis |
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| heart failure chest pain arrhythmia flu like pulmonary congestion or hypertension |
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| what are the non-infectious causes of myocarditis (9) |
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| collagen diseases: SLE, RA, JRA thyotoxicosis drugs: cocaine, OH, heavy metals hypersensitivity automimmune disease |
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| what are the 7 viral causes of myocarditis |
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| enterovirus: cosackie A/B influenza edenovirus MMR CMV EMB |
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| what are the 7 bacterial causes of myocarditis |
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| B. burdorgeri C. dyptheria GPC rickettsia salmonella mycoplasma spirochetes |
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| what are 7 parasitic causes of myocarditis |
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| t. crysi T. bruci plasmodia trichinella toxoplasmosis ascarias filariasis |
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| T. crusi: disease, transmission |
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| chagas kissing bug |
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| T. bruci: disease, transmission |
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| afican SS tsetse fly |
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| three fungal causes of myocarditis |
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| candidia aspergillus systemic: coccidioides immitis |
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| define pericarditis |
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| infection or inflammation of pericardium |
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| 8 non-infectious causes of pericarditis |
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| collagen diseases: RA, SLE reactive arthritis heart attack renal disease malignancy drug idiopathic |
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| signs of acute pericarditis 8 |
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| chest pain fever dyspenia weakness edema dry cough friction rub tamponade |
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| what are the three parts to tamponade |
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| increased jugular pressure hypotension pulsus paradoxus: decrease systemic GP in inspiration |
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| what are 4 signs of chronic pericarditis |
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| ankle swelling abdominal swelling SOB heart failure |
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| what are the causes of infective pericarditis |
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| same as endocarditis and myocarditis |
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| what labs are done in suspicion of pericarditis |
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| CRP, ESR, CBC, chem cardiac enzymes, isoenzymes, troponin (exclude MI) serology for vuruses, SLE, rA ECG, sonogram |
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| define suppurative thrombophlebitis |
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| jugular, pelvic, intra-abdominal, or cranial infection |
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| what are 8 causes of suppurative thrombophlebitis |
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| IV, drug use, dialysis infection embolism septic artheitis osteomyelitis skin and oral flora |
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| define leimerres disease |
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| septic jugular vein thrombophlebitis |
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| what are the 10 causes of leimerres disease |
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| vincents anginia pharyngitis tonsilitis dental infection anaerobic pharyngitis embolism abscess septic arthritis osteomyelitis liver abscess |
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| what is anaerobic pharyngitis caysed by |
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| fusobacterium necrophorum/ gram negative anerobic rod |
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| how does strep cause endocarditis |
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| post strep infection causes typ II hypersensitivty and complexes build on heart tissue |
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| how does C. perfringens and C. diptheriae cause myocarditis |
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| exotoxins cause gangrene due to sugar metabolism in muscle |
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| how does S. aureus cause endocarditis |
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| toxic shock (SEB) |
