INFECTIOUS DISEASES

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INFECTIOUS DISEASES
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AAA
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Categories of INFECTIOUS AGENTS

• Prions
• Viruses
• Bacteriophages, Plasmids, Transposons
• Bacteria
• Chlamidiae, Rickettsiae, Mycoplasmas
• Fungi Yeasts, Hyphae
• Parasites Protozoa, Worms, Arthropods

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PRIONS, BSE (Cows), CJD, Kuru
(Humans) NON-Nucleic Acid PrP Prion
Protein Diagnostic Test
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Bovine Spongiform Encephalitis, Creutsfeldt-Jakob
Disease
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VIRUSES

• Less than ½ micron, usually MUCH less
• DNA/RNA CORE (genome)
• Protein CAPSID (protein NA coat)
• Sometimes a lipid ENVELOPE
• Limited number of genes coding for all other
  structures
• NO consistent naming system

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BACTERIOPHAGESPLASMIDSTRANSPOSONS

• INFECT BACTERIA, but may make a bacteria more
  difficult to treat because it may increase its
  virulence or its susceptibility to antibiotics

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BACTERIA

• GRAM staining with CRYSTAL VIOLET
• POSITIVE THICK wall, ONE phospholipid layer
• NEGATIVE THIN wall, TWO phospholipid layers
• SHAPE
• COCCI (balls)
• BACILLI (rods)
• OXYGEN requirements
• AEROBIC (NEED O2)
• ANAEROBIC (do NOT NEED O2)

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ChlamydiaeRickettsiaeMycoplasmas

• Like Bacteria, but..
• NO cell wall (mycoplasma MANY pneumonias)
• NO ATP (chlamydia STD, worldwide blindness)
• NO life outside a cell (obligate intracellular,
  rickettsiae RMSF)

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FUNGI

• YEASTS, HYPHAE
• CANDIDA, by far, the MOST PREVALENT ONE
• DERMATOPHYTES, (tinea), i.e., epidermophyton,
  trichophyton, microsporum
• DEEP FUNGI (GRANULOMAS)
• HISTOPLASMOSIS
• BLASTOMYCOSIS
• COCCIDIOMYCOSIS

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YEASTS, HYPHAE
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PARASITES

• PROTOZOA
• META-ZOA (HELMINTHS)
• ECTO-PARASITES, i.e., ARTHROPODS

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PROTOZOA
SINGLE CELL INTESTINAL or BLOOD

• PLASMODIUM (MALARIA)
• LEISHMANIA
• ENTAMOEBA
• TRYPANOSOMA
• TOXOPLASMA
• GIARDIA

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HELMINTHS (ROUNDnematode), TAPEcestode)

• Roundworms, Tapeworms
• Complex Life Cycles sexual, asexual
• ROUNDWORMS (nematodes) ASCARIS, TOXOCARA (VLM),
  STRONGYLOIDES, ENTEROBIUS
• TAPE(FLAT)WORMS (cestodes) TAENIA (solium vs.
  saginata), DIPHYLLOBOTHRIUM, Hymenolepsis

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Ascaris life cycle
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ARTHROPODSINSECTS/ARACHNIDS

• LICE
• BEDBUGS
• FLEAS
• MITES
• TICKS
• SPIDERS

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CLASS INSECTA
C R A B
L O U S E
L O U S E
BEDBUG
FLEA
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CLASS ARACHNIDA
TICK LARVAL MITE ADULT MITE
BLACK WIDOW?
BROWN lt--RECLUSE
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SCABIES
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BARRIERS

• ALL ANATOMIC MUCOSAL POSSIBILITIES
• SKIN
• GI
• RESPIRATORY
• UROGENITAL

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SPREAD
SAME AS TUMOR?

• DIRECT EXTENSION
• LYMPHATICS
• BLOOD
• NERVE

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RELEASE(TRANSMISSION)

• SKIN SHEDDING
• COUGHING/SNEEZING
• URINE
• FECES
• BLOOD
• VECTORS, e.g., insects, zoonosis
• STDs (Sexually Transmitted Diseases)

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IV/R
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INFECTIVITY, GENERAL

• AGENT? HOST CELL
• AGENT? TOXINS? NECROSIS
• AGENT?HOST CELLULAR REACTION?DAMAGE/DEATH

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INFECTIVITY, VIRAL

• ATTACHMENT
• ENTRY
• TRANSCRIPTION
• TRANSLATION
• INCLUSIONS
• REDUCED HOST CELL FUNCTION
• CELL INJURY, LYSIS, DEATH
• LATENCY
• NEOPLASM?

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INFECTIVITY, BACTERIAL

• ADHERENCE
• ENTRY
• TOXINS
• ENDO, Gram - , bacterial components
• EXO, Gram -/, secreted proteins

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IMMUNE EVASION

• INACCESSIBILITY to host defense (Mr. Myagi)
• VARYING (mutating) antigens
• SHEDDING antigens
• RESISTING INNATE (NATURAL) immunity
• IMPAIRING T-CELLS

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INFECTIONSof IMMUNOSUPPRESSED HOSTS

• Protozoal/Helminthic Cryptosporidium, PCP
  (Pneumocystis Carinii Pneumonia), Toxoplasmosis
• Fungal Candida, and the usual 3
• Bacterial TB, Nocardia, Salmonella
• Viral CMV, HSV, VZ

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DIAGNOSTIC TECHNIQUES

• DIRECT PATHOGEN IMAGING
• GRAM STAIN
• SPECIAL (NOT HE) STAINS
• AGAR, e.g., CULTURES
• TISSUE CULTURE, CPE (CytoPathological Effect)
• ANTIBODIES (SEROLOGY)
• PCR, POLYMERASE CHAIN REACTION, e.g., viral
  LOAD

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CELLULAR HOST RESPONSES

• SUPPURATIVE (NEUTROPHILS, PMNs) (cultures may be
  positive)
• MONO-NUCLEAR, i.e., Lymphocytes, Macrophages
  (i.e., Monocytes), GRANULOMAS
• FIBROSIS
• HEMOSIDERIN
• CALCIFICATION

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ACUTE APPENDICITIS
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ABSCESS
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CHRONIC MONONUCLEAR INFLAMMATION
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GRANULOMA
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FIBROSIS
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H E M O S I D E R I N
H E
PRUSSIAN BLUE
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Calcification
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The 4 Biggies

• VIRAL
• BACTERIAL
• FUNGAL
• PARASITIC

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VIRAL

• TRANSIENT, ACUTE, e.g. Measles, Mumps, Polio,
  West Nile
• CHRONIC LATENT (HERPES FAMILY), HSV, CMV, VZ
• CHRONIC (HEPATITIS), Hep A, B, C
• TRANSFORMING (Epstein-Barr EBV, Human
  Papilloma, HPV)

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BACTERIAL

• Gram
• Gram-
• MYCO-bacteria
• SPIROCHETES
• ANAEROBIC
• OBLIGATE INTRACELLULAR

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FUNGAL

• YEASTS
• CANDIDA
• CRYPTOCOCCOSIS
• MOLDS (HYPHAL)
• ASPERGILLIS
• MUCORMYCOSIS (ZYGOMYCOSIS)

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PARASITES

• PROTOZOA (GI, BLOOD)
• METAZOA (WORMS)

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VIRAL

• TRANSIENT, ACUTE
• Measles Skin, Lung, GI, Cornea, Brain
• Mumps Parotitis, Orchitis, Pancreas, CNS
• Polio Myelitis (Anterior horn motor neurons)
• West Nile (arbo-) Meningoencephalitis

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VIRAL

• CHRONIC LATENT (HERPES FAMILY), HSV, CMV, VZ
• Herpes Simplex Virus
• CytoMegalo Virus
• Varicella-Zoster Virus

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HSV
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CONGENITAL IMMUNOSUPPRESSED
BASOPHILIC
CMV pneumonia
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VZ Virus
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VIRAL

• CHRONIC (HEPATITIS), Hep. A, B, C
• A, Mildest, most universal
• B, Most dangerous in the acute phase, but most
  are SUB-clinical
• C, Most common cause of persistent transaminitis

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NORMAL LIVER
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ACUTE VIRAL HEPATITIS
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VIRAL

• TRANSFORMING
• Epstein-Barr, EBV, lymphoma
• Human Papilloma, HPV, cervical cancer
  (squamous cell)

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PHARYNX NODES SPLEEN LIVER HETEROPHILE
MONONUCLEOSIS, caused by EBV
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MALIGNANT cells on PAP smear, caused by HPV
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BACTERIAL

• Gram (Staph, Strep)
• Gram- (rods)
• MYCO-bacteria (TB)
• SPIROCHETES (SYPHILIS)
• ANAEROBIC (ABSCESSES)
• OBLIGATE INTRACELLULAR

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BACTERIAL

• Gram cocci (Staph, Strep)

SKIN RESPIRATORY TRACT
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S T A P H
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STREP SKIN RESPIRATORY
ERISIPELAS
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GRAM POSITIVE RODS

• DIPTHERIA
• LISTERIA
• ANTHRAX------?
• NOCARDIA
• CLOSTRIDIUM

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GRAM NEGATIVE COCCI

• Neisseria
• GONORRHEA
• MENINGITIS

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GRAM NEGATIVE RODS

• Bordetella pertussis
• Pseudomonas aeruginosa
• Klebsiela/Aerobacter
• Yersinia pestis (plague)
• Hemophilus ducreyi (chancroid)
• E. COLI

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MYCOBACTERIA(acid fast)

• Tuberculosis
• Atypical mycobacteria, the most important of
  which is MAC (Mycobacterium Avium Intercellulare
  Complex, in HIV patients)
• Leprosy

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MORE ACID-FAST BACILLI, AFB (MAC)
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SPIROCHETES

• SYPHILIS (Treponema pallidum)
• RELAPSING FEVER (Borrelia sp.)
• LYME DISEASE (Borrelia burgdorferi)

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SYPHILIS

• PRIMARY (CHANCRE)
• SECONDARY (MANY skin manifestations)
• TERTIARY (GUMMAS, CNS, BONE)
• CONGENITAL

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ANAEROBES

• Clostridium (Gram bacillus)
• Cause of many/most cases of gas gangrene

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OBLIGATEintracellular bacteria

• Chlamydia trachomatis
• Conjunctivitis
• LGV (LymphoGranuloma Venerium)
• Urethritis
• Rickettsia (Rocky Mountain Spotted Fever, Typhus)
• Mycoplasma (very common cause of pneumonias)

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RMSF
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FUNGAL

• YEASTS
• CANDIDA
• CRYPTOCOCCOSIS
• MOLDS (HYPHAL)
• ASPERGILLIS
• MUCORMYCOSIS (ZYGOMYCOSIS)

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Candida albicans

• Oral
• Vaginal
• Esophageal
• All of the above are moist non-keratinized
  squamous mucosa
• Immunocompromised, e.g., HIV, Diabetes

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Budding Yeasts and PSEUDO hyphae
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Budding cryptococcal yeasts, India ink prep, CSF
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MOLDS

• Aspergillus
• Zygomycosis (Mucormycosis)

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DERMATOPHYTES(TINEAS)(superficial fungi)

• EPIDERMOPHYTON
• MICROSPORUM
• TRICHOPHYTON

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SIGNIFICANT FUNGI(deep)

• HISTOPLASMOSIS
• BLASTOMYCOSIS
• COCCIDIOMYCOSIS

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PROTOZOA

• MALARIA (Plasmodium sp., of which falciparum is
  the most serius)
• Babesiosis, transmitted by deer tick
• Leishmaniasis
• Trypanosomiasis (sleeping sickness)
• Chagas disease (also a trypanosome)
• Entamoeba histolytica

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GAMETOCYTES Are COMMON And SAUSAGE shaped
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S C H U F F N E R S D O T S
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Affected RBCs are NOT enlarged NO SCHUFFNERs
DOTS
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S CHUFFNER S DOTS comets
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TRYPANOSOMIASIS
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METAZOA(ROUNDworms/FLATworms)

• Strongyloides (microscopic roundworm)
• Tapeworms (Beef, Pork, flatworm)
• Trichinosis (larva in skeletal muscle)
• Schistosomiasis (bladder cancer)
• Filariasis (elephantiasis)
• VERY OFTEN, COMPLEX LIFE CYCLES

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Ascaris life cycle
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