STDs

Question 1

Bacterial Vaginosis

Answer 1

• Polymicrobal infection of anaerobic bacteria
• Gardenella vaginalis-_{^{mycoplasma hominis, mobiluncus, prevotella}}
  
  • _{^{Vaiginalis is found 100% of vaginosis}}
  • _{^{Gram variable-Pleomorphic rods}}
  • _{^{Normal vagina flora <u>(90% healthy flora Lactobacillus Gram + rods)</u>}}
• Cause: _{^{balance between normal flora resulting in overgrowth of anaerobic bacteria}}
  
  • _{^{<u>Increases risk of STDs</u>-<strong>HSV, Chlamydia, gonorrhea</strong>}}
• Symptoms: White/gray discharge w/milk-like appearance _{^{(unpleasant order stronger after sex)}}
  
  • _{^{<strong>MINIMAL prevaginal itching/irritation</strong>}}
• Diagnosis (3 of 4 +)-_{^{<strong>Thin homogenous discharge</strong>,<strong> pH greater than 4.5</strong>, <strong>Clue cells</strong>(R<u>ough cell membrane)</u>, <strong>Whiff test </strong><u>(mix of discharge &amp; 10% KOH=order</u>)}}
• Treat: Metronidazole w/probiotics-Lactobacillus
  
  • _{^{Acidification treatment-<strong>Boric acid</strong>}}

Question 2

Vulvovaginal Vacdidiasis

Answer 2

• Candida albicans-Yeast w/Pseudohyphae
  
  • _{^{<strong>Normal body flora (Skin, mouth, vagina, GI)</strong>}}
• Disease due to overgrowth of increased sugar, decrease in normal flora or pH change
• High risk-_{^{Diabetes, Antibiotic use, pregers, birth control pills}}
• Disease: Thick curd/cottage cheese discharge
• Contains epi cells & mass yeast/pseudohypha
• INTENSE itching of vulva w/redness of vagina/labia
  
  • _{^{<strong>Ferments alcohol=Irratation/itching</strong>}}
• Treat: Antifungal Nystatin _{<strong>^{(no need to treat partners)}</strong>}
• Diagnose: Germ-test tube test @ 37 for 90min

Question 3

Trichomoniasis

Answer 3

• Flagellated protozoans
• _Symptoms: _
• Itching & burning (Strawberry cervix)
• Watery foul-smelling, greenish foamy discharge
• Urethritis w/dysuria _{^{<strong><u>(men/women)</u></strong>}}
• Cervix demonstrates tiny micro hemorrhages
• Diagnosis: Wet mount MOTILE trichomonads
• Treat: Metronidazole

Question 4

PID

Answer 4

• _Infection & inflammation of upper part of female repro _
• Endometritis-inflammation of inside lining of uterus
• Salpingitis-Inflammation of fallopian tubes
  
  • _{^{<strong>Scarring/adhesions=Ectopic pregers/infertility</strong>}}
• Tubo-ovarian adscesses
• Pelvic peritonitis-Inflammtion inside ab cavity surrounding female repro organs
• Symptoms:
  
  • Moderate fever
  • Bilateral lower ab pain-_{^{aggravated by body movement}}
  • Increased discharge & irregular bleeding
  • Nausea/Vomiting

Question 5

Neisseria Gonorrheae (General)

Answer 5

• Gram (-) diplococcis (covered w/pili)-Bean shaped
• Facultative intracellular-Oxidase/catalase (+)
• Ferments glucose NOT MALTOSE
• Transmission: Sexual & neonatal
• High Risk: Def of C6-C9 _{^{(risk of disseminated infections)}}
• Disease:
• Genirourinary tract, eye, rectum, throat _{^{(oral sex)}}
  
  • _{^{Local neutrophilic response}}-_{^{<strong>Purulent discharge</strong> <u>(white-yellow)</u>}}
• Urethritis-Thick creamy grey/white _{^{(pain urinating)}}
  
  • _{^{Men show symptoms w/in <u>5 days</u> & 50% of women shown asyptomatic}}
• Cervicitis-Discharge thick grey/white, bleeding between menstrual periods, painful intercourse (bleeding)

Question 6

Neisseria Gonorrheae (proteins)

Answer 6

• Surface proteins-
• Pilin _^(pili): Initial binding to epi cells & antiphagocytic
• Opa _{^{(outermembrane)}}: Mediates firm adhesion to eukaryotic cells
• Rmp _{^{(outermembrane):}} Formation of ineffective Ab block bactericidal Ab against pilin & LOS
• Por _{^{(outermembrane porin)}}: promotes intracellular survival preventing phagolysosome formation in neutrophils
• LOS _{^{(outermembrane lipooligosacc)}}: Elicits inflammatory response, triggers realase of pro-inflamm cytokines

Question 7

Neisseria Gonorrheae (Pathogenesis)

Answer 7

• Virulence factors:
• IgA proteases-Evade mucosal immunity
• Antigenic heterogeneity:
• Exsistence of multiple varieties-Pili, por, opa, LOS
  
  • _{^{<strong>Ag switching (phase variation)</strong>}}
• Pili & Opa switch in same isolate-_{^{Programmed gene rearrangement}}
• Receptors for transferrin-_{^{Helps to absorb iron <u>(competes w/host)</u>}}
• Repeared infection-_{^{Lack of protective immunity due to Ag variation}}

Question 8

Gonococcal Disease (upper repro)

Answer 8

• Men:
• Epididmyitis-inflammation leads to swelling of scrotum-Leads to sterility
  
  • _{^{Coiled spermatic ducts <u>mature/store Sperm</u> between testis & Vas}}
• Women (PID):
• Endometritis & Salpingitis-Tubo-ovarian abscesses/scarring leads to sterility
• Vulvovaginitis-Prepubertal women _{^{(due low kerantinization)}}
• Fitz-Hugh Curtis syndrome _{^{(complication of PID)}}-
• Acute perihepititis infection from tube to liver _{^{<strong>(thin layer connective tissue capsule)</strong>}}
• Severe pain in Upper right ab _{^{(over gallbladder)}} w/tenderness & Peritoneal inflammation
• Laproscopy:“violin string” adhesions _{^{(capsule & peritoneum)}}

Question 9

Gonococcal Disease (Systemic)

Answer 9

• Procititis _{^{(rectal infection)}} & pharyngitis=_{^{<strong>Among homosexual men</strong>}}
• Opthalmia neonatorum: eye infection in newborns
  
  • _{^{assoc w/septicaemia @ 2-5 days after birth}}
• Conjunctivits: Adults (autoinfection)
• Disseminated infections _{^{(local infections NOT treated)}}:
• Bacterimia _{^{(blood infection)}} Leads to-
  
  • Meningitis _^(brain)
  • Endocarditis _^(heart)
  • Arthritis _{^{(joint infection)}} common in adults
• Skin lesions seen on extremities (bacterimia)

Question 10

Gonnococcal Diagnosis

Answer 10

• Evaluation of presenting symptoms & sex history
• HIsto: Gram stain of exudates _{^{(urethra, cervix, rectum, pharynx)}}
• PMNs phagocytosed w/Gram- diplococci indicative of gonorrheal infection.
• Culture:Thayer Martin/New York city medium
• Choco agar + antibiotics organism require 5% CO2
  
  • Specimens collected w/Ca+2 alginate swab
  • _{^{<strong>N. meningitis also (+) NYC media</strong>}}
• Biochem test-Ferments glucose NOT maltose
  
  • _{^{Used to differ <u><strong>N. meningitidis</strong></u>}}

Question 11

Gonnococcal Treatment

Answer 11

• Resistance to common Antiobios
  
  • _{^{Plasmid-mediated <u>beta-lactamase </u>production}}
• 3rd gen Cephalosprins _{^{(ceftriaxone, Ceftixime, Cefotaime)}}
• Doxycycline or Erythromycin=Co-infection w/chalmydia trachomatis
• Sex partners should be treated/consulted
• Vaccine: hard to develop due to Ag variation
• Screening Annually: _{^{Women younger 25 sexually active}}
• Chemoprophylaxis: prevent ophthalmia in neonates
  
  • _{^{<em><strong>Silver nitrate <u>(not used due to diff in storage)</u></strong></em>, Erythromycin, Tetracycline}}

Question 12

Chalmydia Trachomatis (General)

Answer 12

• Obligate intracellular _{^{(ADP dependent)}} bacteria
• Cell wall w/no muramic acid _{^{<strong>(does NOT gram stain)</strong>}}
• Energy dependent=Biphasic growth cycle
  
  • Elementary body & Reticulate body
    
    • _{^{<u><strong>EB=</strong></u>Infectous stage/metab inactive & <u><strong>RB=</strong></u>Metab active}}
• _^​​Inclusion body-EB & or RB inside cell vesicle
  
  • More than 15 serotypes (A-L)
• Trachomatis _{^{(A, B, C)-}}Hand to eye fomites=Trachoma
  
  • _{^{Turns eyelids inward & corneal scarring-<u>Blindness</u>}}
  • _{^{<u><strong>Inclusion conjunctivitis-</strong></u>newborns bilateral swelling}}

Question 13

Chalmydia Trachomatis (pathogenesis)

Answer 13

1. Infects non-ciliated comlumnar/cubodial epi cell of mucosal layer _{^{(EB attaches to cell surface w/endocytosis)}}
2. EB _^(endosome) no fusion to lysosome & reorganizes to RB
3. RB replicates by binary fission-Eventual lysis of cells
4. Clinical manifestations=Destruction of cells & host inflammatory response (Granuloma formation)

Question 14

Chalmydia Trachomatis (Gential Disease)

Answer 14

• Serotype D-K _{^{(most common <u>bacterial STD</u> in US)}}
• Reiter’s syndrome-Autoimmune _{^{(Can’t pee, see, climb a tree)}}
• Follicular palpebral conjunc-_{^{inclusion conj contains lymphoid follicles}}
• Men: Urethritis w/watery discharge
  
  • Epididymitis _{^{(Back of testi storage/mature of sperm)}}
  • Proctitis _^(rectum)
• Women: Cervicitis & Urethritis w/watery discharge
  
  • PID-lead to infertility or ectopic pregers
  • Fitz-Hugh-Curtis syndrome
• Infants:
  
  • pneumonia-4-11 weeks after birth
  • Inclusion conjunctivitis-5-14 days after birth

Question 15

Chalmydia Trachomatis (Diagnosis/Treat)

Answer 15

• Histo: Giemsa Inclusion bodies _{^{(obligate intracellular)}}
• Culture: NAAT _{^{(nucleic acid amplification test)}}
• Treat: Doxycycline or Azithromycin
• Prevention:
• Erythromycin _^(macrolide) expecting mothers
• Annual screening-Women 25 yrs younger sexually acitve
• Treat sexual partners

Question 16

Genital Mycoplasma

Answer 16

• Genitallium, Homins, Ureaplasma Urealyticum
• Cell wall less _{^{(sterol in membrane)}}-Smallest living organism
• Ureplasma _{^{(urease +)}} needs urease in culture
  
  • _{^{Associated with kidney stones}}
• Found in genitourinary tract sexual active adults
  
  • _{^{<em><strong>Ureaplasma & Homins</strong></em> are part of normal flora}}
• Disease:
• Non-gonococcal _{^{(watery discharge)}}Chlamydial urethritis-PID
• Homins-Assoc w/Postabortal-postpartum fever
  
  • _{^{<strong>Resistant to erythromycin</strong>}}
• Treat: Doxycline
• Diagnosis: A8 agar _{^{<strong>(Yeast/Blood)</strong>}}-“Fried egg”
• No gram stain=NO cell wall

Question 17

Syphilis (general)

Answer 17

• Spirochete-endoflagella _{^{(axial filament)}}-Cell wall like Gm- _{^{(too thin to gram stain)}}-DARK field
  
  • _{^{Does not grow on culture-<strong><u>extracellular pathogen</u></strong>}}
• Transmission-Sex-Kissing/Transplacental _{^{(3 yrs from infection)}}
• Through broken skin _{^{(mucus membranes)}}
• Virulence factors:
• Cell wall-Endotoxin
• Additional outer sheath glycosaminoglycan covers surface antigens
• Hyaluronidase-_{^{degrades hyaluronic acid allows for spread into tissues}}
• Produces Abs cross react w/Cardiolipin _{^{(Mitochondria)}}

Question 18

Syphilis (Primary)

Answer 18

• 30% of cases resolve spont
• 30% remain serological latent (+ but no symptoms)
• 1/3 progress to tetiary (very destructive)
• Primary: Chancres _{^(ulceration)} one or more @ site of entry
• Painless hard ulcer w/raised borders _{^{<u><strong>(heals 2 months)</strong></u>}}
• Regional lymph-firm, non suppurative, presist for months _{^{(Even w/healing of chancres)}}
  
  • HIGHLY infectious stage

Question 19

Syphilis (Secondary)

Answer 19

• Skin/mucous membrane lesions & systemic disease
• Pt is infectious @ this stage
• Lesions-Macular(flat), Papular(raised), pustule, nodular
  
  • Painless _{^{<em><strong>(Scaling, firm, <u>RED-BROWN)</u></strong></em>}}
  • Palms & Soles BUT no presentation in face
  • Papulosquamos __{^{(papules & scales)}} _Trunk
  • Mucous patches-mouth/tongue
  • “Snail track” buccal & genitalia
• Condyloma lata-Wart-like appearance on moist areas of skin (angogenital, axilla & mouth)
• Systemic disease-Flu-like, lymphadenopathy, liver, kidney, joints, brain

Question 20

Syphilis (Tertiary)

Answer 20

• Latent-test + for syphilis w/no symptoms
  
  • _{^{Some pts heal spontaneously OR can relaspe to 2 or progress to 3}}
• Tertiary-Chronic inflammation w/tissue destruction
  
  • Appears years after initial infection _{^{<strong>(10-40 yrs)</strong>}}
• Non-contagious BUT highly destructive _{^{(Spirochete found in CSF)}}
• Gummatous-Granulomatous lesions/Painless _{^{(NO spirochete)}}
• Cardiovascular syphilis
• Destructive joint disease
• Neurosyphilis-Psychosis, dementia, Seizures _{<strong>^{(category 1)}</strong>}
• Myelopathy _{^{<u><strong>(tabes dorsalis-</strong></u>demylenation of dorsal columns)}}
• Optic nerve destruction _{^{(<u><strong>Argyll-Robertson</strong></u>-bilateral irreg shape small pupils)}}

Question 21

Syphilis (cong)

Answer 21

• Early symptoms: 2-6 weeks after birth
  
  • _{^{Nasal discharge, skin/mucous membrane lesions & rashes w/failure to thrive}}
• Generalized eruption on healthy child _{^{(macular lesions on soles)}}
• Late: Appears after 2 years of age
• Early damage to developing structures _{^{(teeth & long bones)}}
• “Hutchinson’s Teeth”-effects incisors _{^{(screwdriver shape)}}
• Infection to nasal bone _{^{(destruction to septa)}}-Saddle Nose
• Growth retardation-seperation of epiphysis
  
  • _{^{<strong>Other manifestations mimic Tertiary</strong>}}
• Interstitial Keratitis-_{^{inflammation of connective tissue corneas}}
• Can result-Miscarriage & stillborn

Question 22

Syphilis (Diagnosis)

Answer 22

• Specimen: Lesions, CSF, blood
• Histo: Detection of Siprochete
• Dark field-UNstained live spirochetes
• Bright field-Silver staining technique
• DFA-TP-Highly specific
• Serology: anti-treponemal Abs (late syphilis)
• VDRL or RPR use of cardiolipin as Ag
  
  • _{^{Easy, rapid, inexpensive <u><strong>(99% second stage+)</strong></u>}}
  • _{^{<strong>False + = Tissue diseases, Mono, Malaria, Leprosy, Infective endocard</strong>}}
• Tremonemal tests-FTA-ABS, MHA-TP, TP-PA
  
  • Treponema as Antigen

Question 23

Syphilis (Treponemal)

Answer 23

• Use of Antigens specificto TP
  
  • _{^{<strong>Used to confirm RPR or VDRL tests w/syphilis</strong>}}
• Not useful in pts following treatment (+ for life)
• FTA-ABS-Immunofluoresence & killed treponemas fixed to slide
• Agglutination-Particles coated w/trepanemal Ags
  
  • Inert particle _{^{(color coated w/TP ags)}}
  • RBC _{^{(coated w/TP ags)}}
• TP-PA-Treponema pallidium particle assay
  
  • Gelatin particles in microtiter agglutination
• MHA-TP-RBC attached w/TP spec Ags-_Microhema test in presence of Ab specific to TP_

Question 24

Syphilis (Treatment)

Answer 24

• Penicillin-Long acting benzathine _{^{(Single dose for primary)}}
  
  • _{^{<strong>Allergic pts=Erthromycin & Tetracycline</strong>}}
• Can cross placenta=prevent cong infections
• “Jarisch-Herxheimer” rxn:
• Sudden massive destruction of spirochetes massive release of LPS
  
  • Fever, hypotension, rigors
• NO vaccine

Question 25

Non-conventional treponemes

Answer 25

* Non-sexual transmission & Regional * **_Endemic/Bejel_** * ***Transmission:*** Sharing drinks or foods (utensils) * Skin lesions around oral mucosa * Bone & skin granuloma-***LATER presentation*** * ***Region:*** Desert in Africa/Middle East * ***_Yaws_*** * Later development of gummas** _{^{(granuloma skin & bones)}}** * ***Region:*** Tropical & Desert of SA, Africa, Asia * ***_Pinta:_*** * Primary & Secondary lesions * ***Limited to skin-*****__{^{Late=Blue variety}}_** * Healed lesions leave skin depigmented-**__{^{"White patches"}}_** * ***Region:*** Central & South America

Question 26

Lymphogranuloma Venereum

Answer 26

* Infectous agent-**_Chlamydia trachomatis (L1-3)_** * Obligate intracellular bacteria **_{^{(lack muramic acid-cell wall)}}** * _{^{Does NOT gram stain}} * _{^{Bi-phasic growth cycle (EB-RB)}} * **_Diagnosis:_** Cytoplasmic ***inclusion bodies*** * **_Treat_**: Doxycycline & Azithromycin * **_Symptoms:_** * Genital ulcer-***Painless lesions*** _{^{(unoticed for days)}} * Extensive swelling of ***Inguinal lymph***-**__{^{Drainage issues}}_** * Blockage of lymph lower body=***Elephantiasis*** * Common in ***hot climates***

Question 27

Chancroid-Soft Chancre

Answer 27

* Infectous agent-**_Haemophilus ducreyi _** * Gram(-) rod, ***Chain former***, LOS cell wall * Capnophile _{^{(requires CO2)}} grows in choco agar * **_Symptoms:_** ***"EXTERMELY painful"*** * ***Genital ulcerations***-Begin as papules progress to pustules ("Soft chancres") * _{^{Lesion begins solitary-Autoinoculation multiple lesions}} * **_Men-_**Appears on glans/shaft or anus * **_Women-_**Appears on cervix, vagina or perianal * **_Tender inguinal lymphademopathy_**-may rupture & leave chornic fistlae-**_"Bubo"_**

Question 28

Chancroid (Clinical)

Answer 28

* **_Diagnose:_** Gram staining MAY reveal chains or coccobacilli * ***Dark field exam*** rule out Syphilis **_{^{(tests +)}}** * ***PCR & Antigen detection***-BEST choice * **_Treat:_** Penicillin resistant * Drug of choice-***Cephalosporins*** * ***Drainage*** of fluctant lymphadenopathy may be required

Question 29

Granuloma Inguinale (general)

Answer 29

* Infectious agent: _Klebsiella granulomatis_ **_{^{(Obligate Intracellular)}}** * Gram(-) rod - Grows well in culture **(egg yolk)** * **_HIGH risk:_** Sex & possible GI * Africa, Papua new guina, India, Caribbean * Homosexual men in USA * **_Symptoms _{^{(90% symptomatic)}}:_** * Papule on penis/labia or Anal * _{^{Extra genital lesions are common=Lips, face, neck}} * ***Lesions are PAINLESS***-beefy red open sores that slowly enlarges-***Foul smell*** * Regional lymphdenopathy **_{^{(inguinal regions NO lymph involvement)}} ** * **_Pseudo-buboes_**-Subcutaneous granulomas * Results in ***extensive Scarring***

Question 30

Granuloma Inguinale (Clinical)

Answer 30

* **_Diagnose:_** Tissue biopsy & microscopic * Demonstrates ***mononuclear cells w/intracytoplasmic vacuoles*** * Vacuoles-Bacteria **(Donovan bodies)** * **_Treat-_**Tetracycline

Question 31

HIV (General)

Answer 31

* Enveloped-diploid (+) sense RNA * **_{^{(reverse transcriptase-RNAdependent-DNApolymerase)}}** * **_Proteases/Integrase_**-w/host chromosome & replicate through DNA Intermediate * HIV-1 (worldwide) & HIV-2(West Africa) * ***HIV-1 group M has Several subtypes*** * Divisions based on _{^{envelope antigens & Gag genes (capsid/matrix)}} * **_Transmission-HIV infected cells_**=macrophages, lymphocytes, spermatozoa **__{^{(no FREE virus transmission)}} _** * **_{^{Mother-child=Delivery or breast feeding}}** * ***HIV + inflammatory STD*** **_{^{(syphilis, gonorrhea, Herpes)}}**=High risk

Question 32

HIV (Long term survivor)

Answer 32

* Still infected BUT do not progress to HIV infected cells * **_Mutated CCR5-_**receptor for virus * **_{^{Heterogenous=Slow progression & Homo=Resistance}}** * **_HLA alleles-_**HLA-A 6802, 0202, B18 * _{^{Show COMPLETE resistance to HIV infection}} * _{^{HLA class 1 & 2}} * HIV viruses mutated ***nef gene***=Long term survival

Question 33

HIV Structure

Answer 33

* **_Envelope Glycoproteins _{^{(coded by evelope gene gp160)}}:_** * ***gp120***-Attaches to CD4 * ***gp41***-binds to CCR5/***CXCR4 fusion*** w/host cell membrane * **_Enzymes _{^{(Coded by Polymerase gene p160)}}:_** * ***Protease***-cleaves precursor polypeptides * ***Reverse transcriptase***-Viral RNA-Viral DNA **__^(latency)_** * **_Capsid protein:_** P24 used in diagnosis **_{^{(coded by p53)}}** * **_Nucleic acid:_** +ssRNA-2 copes * **_Anti-HIV drugs_** target-gp41 **_^(fusion)** STOPS all enzymes * Enfuvirtide

Question 34

HIV-Pathogenesis

Answer 34

* Any cell expressing CD+4 **_{^(CCR5/CXCR4)}** can be infected * **Gp-120** recognizes CD4 and binds ***chemokine receptor*** * CCR-5** _{^{(macrophages, dendritic, microgila)-}}**Carried to lymph * CXCR4 **_^(Tcell)** * Viral envelope ***fused*** to host cell through **_gp41_** * _{^{Reverse transcriptase moves to nucleus}} * _{^{Viral DNA + Host gentic info=Provirus}}  * _{^{Integrase enzyme cleaves}}  * Lytic infection of CD4 T-cells=***Immunosupression*** * Killing of CD-4 cells by CD-8 __{^{(Less 200 T-cells)}}_ * HIV reduces MHC-1 **__{^{(nef/tat gene)}}_**=***Avoids attack by CD-8*** * **_Latent phase_**=**__{^{in lymph multiplying in follicular dendritic cells}} _**

Question 35

HIV-Staging (one)

Answer 35

* **_1-primary infection _{^{(acute phase)}}_**=Asymptomatic * Incubation 1-3 weeks-**_Mono-like symptoms_** * **_{^{Fever, headache, sore throat, malaise, meningitis}}** * **_Rash-_**Small pink papules/macules over majority of body _{^{(NO palms/soles)}} * ***HIGHLY infectous stage***-__{^{Virus found in large conc in genital fluids}}_ * **_Viremia=_**High lvls of p24 **_^(capsid)** & viral DNA in blood * **_Asyptomatic=_** 10 years or 2 years in children * __{^{Virions can start to multiply=Killing immune cells in lymph or can lay dorment}}_ * _{^{Decline in CD+4 T cells & P24/viral RNA}}  * _{^{Normal CD4 count above 500}}

Question 36

HIV staging (2 & 3)

Answer 36

* **_Stage 2-AIDS related complex _^(ARC)_**-Symptomatic * Persistent fever, ***weight loss, fatigue, night sweats***, lymphadenopathy * **_Present w/oppurtunistic infections _{^{CD count 200-400:}}_** * **_{^{Diarrhea longer than a month}}** * Karposi sarcoma ***(HHV-8)***, cadidiasis, ***Hairy leukoplakia (EBV)*** * **_Stage 3-Full blown=HIV +_** * _{^{Fewer than 200 CD4+ & P24/viral RNA HIGH in serum}} * Life-threatening infections by opportunistic pathogens * _{^{Pneumocystis Jirovecii, Atypical mycobacterial infections (avium complex)}}  * **_Malignancies_**-Karposi sarcoma **_{^{(purple/red skin lesions-HSV8)}} ** * **_AIDs related dementia_**-Microglial cells _(confusion, forgetfulness, seizures, coordination) _

Question 37

HIV Diagnosis

Answer 37

* Serology through antiviral Ab * ELISA, ***RAPID Ab Test*** **_{^{(urine, saliva, blood)}}** * **_Western blot_**-used as confirmation of + ELISA * Detects Ab against viral Ags **_{^{(gp41 +120/160 or p24+120/160)}}** * ***Serology (-)*** during window period **__{^{(asymptomatic=1)}}_** * **_Viral load-_**Detect viral nucleic acid/viral proteins * **_{^{Large # of Viral RNA & P24 = Early or Late}}** * **_Viral RNA-RT-PCR_**: **_{^{Reverse transcriptase polymerase chain rxn}}** * Detect viral protein-**P24** * **_CD-4_** count-Staging disease * **_{^{Used to intiatre therapy & determine treatment success}}**

Question 38

HIV-Treatment

Answer 38

* **_Reverse-Transcriptase inhibitors_**-Inhibit virus multiplication * Nucleoside/nucleotide-NRTI * Non-nucleoside-NNRTI * **_Protease inhibitors-_**PI inhibit viral multiplication * Highly active anti-retroviral treatment **(HAART)** * _{^{combo treatments}} * **_Biding & fusion inhibitors:_** * ***Enfuviritide*** _{^{(mimics gp41)}}=Blocks ***gp41 *** * ***Maraviroc***=Blocks CCR5 * **_Integrase inhibitors_**-Isentress (stop latency)

Question 39

Cytomegalovirus (HHV-5)

Answer 39

* Ds DNA eveloped (isosahedral)-**_{^{Lytic, persistent, & latent infection}}** * Forms multinucleated ***syncytia w/basophilic inclusion*** body **(Owl's eye)** * **_Humans 80% sero-(+)_** samples isolated from saliva, tears, urine, stool, ***semen*** **_{^{(highest conc)}}** * **_Transmission:_** Transplacental, intrauterine, breat milk. Sexual contact * **_High risk:_** immunocompromised, AIDS, transplant pts, chemo pts * Responsible for ***kidney transplant failures***

Question 40

Cytomegalovirus (pathogenesis)

Answer 40

* Lytic infection of epi cells & others * Latent state & persistent infection w/in T-cells, endothelial cells & _monocyte-macrophages _ * **"Downey Cells"-**_{^{Atypical macrophages}} * Occur more frequently in **_Immunocompromised_** * Inhibiting expression of MHC1/2 _{^{(ex HIV)}} * Multisymptomatic-**_{^{Pneumonia, retinitis, colitis, meningitis}}** * **_{^{Reactivation-occurs}} ** * Asymptomatic mother** _{^{(virus can still shed-Serogegative)}}** infects infant interuterine-**_Transplacental infection:_** * __{^{Microcephaly, Periventricular calcificaion,}} __^Jaundice * _^Rash=B__{^{lue Berry muffin lesions}}_ * **_Perinatal infection_ (during birth)=NO disease**

Question 41

Cytomegalovirus (Diagnosis)

Answer 41

* **_Histo:_** demonstrates cytomegalic cell **(enlarged)** * Contains dense central basophilic inclusion body=**_OWL's eye_** * **_Serolgy:_** Detect ***IgM*** * **_Treat:_** Gancicovir __{^{(inhibits viral DNA poly)}}_ * Diagnosis in infants can be found up to ***2-3 weeks after birth*** * ***Infects 0.5-2.5% of all newborns & can cause still births***

Question 42

Human Papilloma Virus (Warts)-general

Answer 42

* Ds *_CIRCULAR DNA-NON-enveloped_* * _{^{Isocahedral replicates in nucleus}} * Several types**_ _{^{(show tissue preference)}}_** * Humans can be infected w/***more than 1 type*** * **_High risk: _** * *Genital HPV*-Unprotected sex * Skin warts common w/children & young adults * _{^{Infects/replicates in sqaumos epi cells (skin & mucous membranes)}} * _{^{Induces cell prolif=benign outgrowth "warts"}} * **_{^{Hyperplasia of prickle cells & excess production of keratin}} ** * **_16 & 18 are oncogenic (cervix, penis, anus)_** * **_{^{Protein E-6 inactivates P53}}** * **_{^{Protein E-7 inactivates p105RB (retinoblastoma)}}**

Question 43

Molluscum Contagiosum (pox virus)-General

Answer 43

* **_{^{DNA Double enveloped Virus / Brick like}}** * **_{^{DNAdep-RNA poly (replicate in cytoplasm)}}** * **_{^{Strictly HUMAN pathogen}}** * **_Transmission:_** Direct contact or fomites **__{^{(sharing towels, swimming pools, showers)}}_** * **_High risk:_** Children & Adults with active sex lives * Causes *_Hyperplasia of epithelial cells _* * **_{^{Cells have inclusion bodies seen=Warts}}** * **_Disease (2-8 weeks): "Cutaneous warts"_** * **_{^{Appear in clusters-Small, firm, white, flesh-colored (pearl like) bumps}} ** * **_{^{Dimple in center}}** * **_{^{Cheesy white material @ pit}}** * **_^Painless** * **_{^{Appear on lower ab (pubis, genitalia) in ADULTS}}** * **_{^{Appear on trunk or extremties in CHILDREN}}**

Question 44

Herpes SImplex (HSV 1/2)-General

Answer 44

* Surface glycoproteins made by viral genes * _{^{Lipid bilayer from the host cell}} * ***Tegument=***initiation of viral replication * Ds Linear DNA/Enveloped * ***Cytopahtic effect=***Change in nuclear structure & margination of chromatin * **_{^{Cowdry type A (intranuclear inclusion bodies)}}** * **_{^{Causes fusion of cells=Syncytia (avoid immunity)}}** * **_Transmission:_** Contact through secretions of lesions * **_{^{Contact w/saliva (Type 1), sexual/transplacental (Type 2)}}** * **_{^{Life long infection=Asymptomatic shedding}}** * 3 infection phases: * ***Initial lytic-***Actively multiplies & kills cells * ***Latent infection-***Neurons *_(sensory ganglion)_*=Inactive * ***Reactivation-***Exits neurons to infect/Kill epithelial cells