CGD

NADPH oxidase def

Mutation in phox gene
Causes defect in respiratory burst
Susceptible to cat (+) organisms
NTB test = negative
Normal resp burst NTB test = positive

Agammagloblunemia
Def in Btk
Stays in Pre-B cell stage
Staph, strep pneumo, heamophilius, gram (-) rods, Giardria, polio
Hyper IgM syndrome
Defect in isotype switching (T cells affected)
Decrease in IgG, IgA, IgE
Increased levels of IgM
DiGeorge
Absent thymus
No T cells
Viruses, candida, intracellular bacteria susceptible
SCID
Multiple infections w/ viruses, candida, bacteria
ADA defect***
Rag1 and Rag 2 defect
Wiskott-Aldrich
Defect in cytoskeletal proteins (actin)
WASP protein defect
Presents as TIE (thrombocytopenia, infections, eczemamay say
excoriation of skin)
purpuric lesions, recuuring gasto infections, IgA and IgE are elevated
Selective IgA
Severe anaphylaxis
Low IgA

Neutropenia*** Chemotherapy

Aspergillus, candida, Mucor/zygo, Pseudomonas, Staph, Gram Rods

Aspergillus
- look at branching hyphae, BAL or tissue biopsy
Candida (HIV, diabetics, antibiotics)
- Oval yeast like budding cells
- Pseduophypae
- Germ tube @ 37 degrees Celsius (true hyphae)
- DOC: Nystatin
- Elderly diabetic woman w/ vaginal thrush, HIV pt w/ oral thrush,
woman with UTI and was on antibiotics
Mucor/zygomyxes/Rhizopus
- Uncontrolled diabetes
- Chemeotherapy
- Ketoacidosis
- Affects mainly sinuses (ptosis, nasal discharge)
- NO septate
- Ribbon shaped wide hyphae
Pseudomonas
- Diabetics: malignant otitis externa
- Erthythema gangronsum (bacteria enters blood stream)
- Cystic Fibrosis
- Blue green pigment, fruity odor, ox (+), NLF on maconkeys agar
- Blue green pigment, oxidase positive, nonlactose fermenting
***Mechanism

Skin infections: ENZYMES(ASE) ELASTASE + EXOTOXIN A.. Helps it

to spread!!!
Inhibit protein synthesis of host cell!!!!!
Cystic Fibrosis: Algenate producing
Antipseudomonal: TCP(Pipercillin in combo with tazobactam),
Ceftazadine, Aminoglycosides
RESISTANCE: KNOW 3 FEATURES : PORIN,
METHALLOBETALACTAMASES, EFFLUX PUMP
of action of azoles and polyenes (Nystatin and amphotericin B)***

MOA: Binds to ergosterol and creates pores in membrane

Immunosuppression
T Cells
HIV
CMV infection: Pneumonia, Esophagitis*, chorioretinitis, intranuclear
inclusions (owls eye)
Pneumocystis (SILVER STAIN): round to oval about 5 um. Cannot be grown
on artificial medium
- If pt is on prophalyxis (TMP-SMX) CMV is most likely answer

 Toxoplasma
- HIV
- Cerebral manifestations ( multiple ring enhancing lesions)
- IgG levels elevated
- CD4 < 100
- Most of the time it is due to reactivation
- From cat poop oocysts
- Meat tissue bradyzoites tachyzoites
- Cat is DEFINITIVE host
- Pregnant woman damage maximum in 1st trimester IgM
elevated
- IgM in cord blood suggest infection of fetus
Nocardia
- From environment (inhaled)
- Lesions seen In lungs goes to brain
- Partially acid fast
- Filamentous
- Aerobic
- Responds to sulfa.
- May be seen in CGD***
Cryptococcus
HIV, transplant, immunosuppressive
- Cerebral meningitis
- Spherical budding cells w/ prominent polysaccharide capsule
- Acquired by inhalation
- Chronic meningitis in HIV pts
- Microscopy (India ink in CSF, and mucicaramine in tissue) and latex
agglutination test
- Produces melanin (virulence factor)
- TX: Amphotericin and Flucytosine (inhibits RNA and DNA)
Mycobacterium
MAC
-

Acid fast
Found in environment
CD4 < 50
Sensitive to cipro/azithro

Listeria

AIDs
Cell mediated immunity
Congenital
Tumbling motility
Grows in 4 degrees celsius
Actin tail moves from cell to cell

 Listerolysin escapes from phagocytes

Inhibit phagolysosome junction
Pregnant women: immunocompetent flu like symptoms w/ diarrhea,
lymphadenopathy
Granulomas
Group B strep (agalactaie)

Gram (+)
Cat (-)
BR
CAMP (+)
Capsulated

Syphilis

Mucosal membranes (primary)

Secondary: rashes, mucosal lesions
Tertiary: Gummas, tabes dorsalis, argyll Robertson pupil
Diagnosis: Dark ground (primary/secondary)
VDRL: all stages
Highly infective . Antibodies last for a lifetime

H. ducreyi

Urethritis:
Gonococcal(short)
Dissemeniated>>> progressive arthritis, joints, skin lesions (SEPTIC arthritis
you will see BACTERIA)
Know MEDIA AND SELECTIVITY
Chlamydia(long)>> Reiters syndrome(immune mediated) joint fluid produce
NO BACTERIA!!! Obligate intracellular(cannot make ATP) no peptidoglycan
muramic acid