Types Morphology
4 different classifications: 1) Fungi are classified as eukaryotes.
Superficial - only outermost skin and
hair. E.g. black and white piedra, tinea
versicolor, tinea nigra
2) cutaneous - infect layers of
epidermis, hair and nails. Most tineas. depending on species and conditions
Fungus (in general)
3) Submucotaneous. Dermis and
subQ tissue.
4) Systemic - invade internal organ
MC'ly from lung foci of infection. E.g.
histoplasmosis, blastomycosis,
coccidiomycoses
Malassezia furfur (pityriasis ovale)
Phaeoannuellomycoses wernickii
Superficial mycoses
(Exophilia wernickii)
Piedraia hortae
3 main genera: Microsporum,
Trichophyton, Epidermophyton.
Cutaneous mycoses Mistakenly termed dermatophytes
Subcutaneous
mycoses
Mycotic agents: cause disease in
healthy humans. Either strict or
opportunistic pathogens. Either:
Monomorphic: cryptococcus
neoformans. Dimorphic: thermal
Systemic mycoses dimorphism.
Histoplasma capsulatum
Histoplasma
capsulatum
Blastomyces
dermatides
Coccidiodes immitis
Epidemiology
Share many characteristics with
higher organisms: becomes a problem
when trying to treat
Either monomorphic or diporphic
1) filamentous - molds with hyphae
(mycelium iff group). MC at lower
temp and free living
2) unicellular - yeasts. MC at higher
temp and when parasitizing tissue
Saprobic phase (on dead tissue). In
N2 rich soil.
Parasitic phase - in macrophages of
MPS/ RES. (looks like yeast and
multiplates in mononuclear phag
system)
Closely related to K. capsulatum
Dimorphic - 37C, tissue,
multinucleated sperule "sporangia"
New World Disease
VIRUS INTRO NOT IN CHART - see very beginning of note package and beginning of viruses!!
Virulence Factors Diseases Prevention/ Treatment
Adapted to live on outermost, non-living layer of Easy to diagnose and responds
Tinea (pityriasis) versicolor
skin well to treatment
No immune reaction Tinea nigra
Just cosmetic Black piedra
White piedra
Termed tineas. Further named
Wood's lamp (+)
according to body part.
Deeper layers of skin, hair and nails
evoke inflammatory immune response
In dermis and sub Q tissue. Fascia, muscle and Might be very difficult to treat. May
bone. have to cut out tissue.
MC'ly due to tissue trauma. Rare in developed
countries.
MC'ly respiratory tract as initial foci of infection
MC'ly develop mild acute or asymptomatic lung
infections
Also can develop chronic disease or sub-clinical
(latent) infections
agricultural belt - N2 soil Inhale hyphal fragments Primary histoplasmosis
MC found in "histo belt". (Ohio/ Mississippi Convert to yeast form and replicate in
Ocular histoplasmosis syndrome.
River valley to S. Ont/Que.) macrophages --> travel to lymphatics
Also areas of a lot of bird (starling/ chichen) and
bat excrement.
Inhale conidia phargocytosed by
Endemic areas overlap those of Histoplasmosis macrophages - convert to yeast - Acute Blastomycosis
replicate in macrophages
unknown reservoir - unlike H. capsulatum it is
Carried by lymphatics Chronic Blastomycosis
rarely cultured from soil
Can cause diseases in animals
Dust clouds at construction sites or crop dust
during farming
Endemic in soils of hot, dry, semi-arid areas. -azole drugs treat fungal
Coccidiodomycosis
Extensively spread via dust storms. infections
In San Jaouquin Valley in Cali
MC in males: 25-55
 Group of 8 DNA viruses grouped
together due to their common virion
morphology and mode of replication
Herpesviridae family
HSV-1 and HSV-2
HSV-1 infects above the waist, hsv-2
infects below the waist
Herpes simplex virus
Also termed Herpes Virus III
Cause of Chicken pox (varicella) and
Shingles (herpes zoster)
Varicella Zoster virus
Cytomegalovirus
A gamma herpesvirus
EBV
human herpes virus
6
Human Herpes virus
7 Very common - 75%
Large, enveloped, linear dsDNA corse
Like Herpes simplex: causes blister-
like lesions (but different sizes and
stages, deeper, more painful and can
cause scarring), establish latent
infections in nerves, CMI
Unlike HSV: spread via respiratory
route, no detectable lesions at site of
entry
contains both mRNA and DNA -->
unlike other viruses
Infect and replicate in mucoepithelial cells
Lytic infections at site, persistent infections in
macrophages and lymphocytes, and latent
infections in nerve ganglia and salivary glands
Very contagious - contagious from 48 hrs,
before symptoms until all the lesions are
completely dry
Peak occurrence of chicken pox: spring time
and 5-10 years old
Peak occurrence of shingles: adult pop esp >65
(10-20%).
Active herpes zoster can cause chicken pox in
susceptible child or adult but will NOT cause
shingles.
URT - lymphotropic - infected cells
Opportunistic pathogen - rarely causes disease
(leukocytes, lymphocytes) spread CMV
in immuno-competent hosts
throughout the body
Similar to Herpesviridae: 1) syncytia, 2)
Transmitted as STD, transfusion/
latent state, 3) reactivation in
transplantation, oral, congenital
immunosuppressed state
Can be latent in T cells, macrophages, other
cells
Very common virus
Transmitted MC'ly by saliva or from
contaminated glassware - "kissing disease"
To cause neoplasms - need other cofactors
Imminity to EBV is lifelong
mild disease in children
Ubiquitous. Cause life long infections
orphan disease in search of a disease although
linked to febrile illness with potential
convulsions in children
Prevents HIV-1 from getting into CD4 cells -
can this be a HIV vaccine
Adherence, Entry: envelope fuses with
host cell membrane, Transport to
nucleus
Replication
Outcomes: 1) Lytic infections, 2) latent
infections, 3) Persistent infections, 4)
Immortalizing infections
4M's: Mixing & Matching of Mucous Avoid contact with mucocutaneous
Membranes (vesicle fluid, saliva, Herpes simplex infection lesions: infectious from prodrome
vaginal secretions) even to crusted lesions - gloves!
HSV-1: early on in life. Horizontal: oral
contact, auto-inoculation to eye or Herpetic keratitis (ocular herpes)
mouth
HSV-2: later on in life. Horizonal: sexual
practices. Vertical: ascenting in utero Herpetic Whitlow
infection or during vaginal birth
Meningitis.
Encephalitis
Genital herpes
Neonatal Herpes simplex infection
Healthy kids: not treated, relatively
Primary infection: 2-4 days after: to
Chicken pox (varicella) mild disease that gives life-long
lympatics
immunity
Secondary viremia: thoracic fever. Reye's syndrome
VZV becomes latent in dorsal root or
Shingles (herpes zoster)
cranial root ganglia
Reactivated in older adults and
immunocompromised - migrates back Herpes zoster opthalmicus
along dermatome --> shingles
Ramsey Hunt syndrome (Herpes
zoster oticus)
mc viral cause of congenital healthy immune system, safe sex
defects practices
MOST common asymptomatic
Mononucleosis (heterophile Ab
negative, unlike EBV)
Congenital - cytomegalic inclusion
disease
Multisystem symptomatic disease
(when immunocompromised)
Control is impossible - virus is
Ultimate B lymphocyte pathogen.
Monomucleosis uniquitous and is shed from saliva
Mitogenic and immortalizing
of healthy people
Limited host range and tissue trophism African Burkitt's Lymphoma
latent or lytic infections Nasopharyngeal carcinoma
3 outcomes: lytic, latent, or
immortalization
Infection first in oropharynx, shed in
*old word for mono (for
saliva - saliva remains infectious for
homeopathy) = glandular fever
months after clinical recovery
Iiff overactive immune system
--"infectious mono"
iff lack of immune response
--"lymptoma" e.g. burkitt's
T cell response - atypical lymphocytes -
Downey cells
Lymphotropic Roseola infantum
latent infection in t cells Mononucleosis type illness
Orphan disease
 Affects peripheral blood lymphocytes, B Cause of Kaposi's sarcoma in
Human herpes virus
Gammavirus like EBV found only in Italy, greece, Aftrica cells, vascular endothelial cells, AIDs patients - high incidence after
8
perivascular spindle cells KI transplant
Retroviridae 4 main subfamilies: One of the most studied viruses
1) Oncornavirinae
2) Lentivirinae - HIV-1, HIV-2
3) Spumavirinae
4) Endogenous viruses
gp120 - initially attaches to CD4
HIV+ does not mean you have
Delicate outer envelope - hard to receptor on macrophages. Later
2 types: HIV-1 and HIV-2 very limited host and species range HIV Aids! CD4+: CD8+ tells status and
get! attaches to CD4 receptor on Th cells
staging of Aids
and CXCr4 (fusin) chemokine receptors

gp120 (Ag and receptor specificity
leads to high amount of antigenic
drift). Changes all the time!
HIV
Opportunistic fungi
dimorphic but unlike other mycotic
Candida agents only present in hypae in body Diseases are not contagious
(no yeast cells)
Detect morphology after treatment
with 10% KOH
no yeast-like form - only a mold form
(form spore bearing hyphae)
Aspergillus
NO dimorphism in pathogenesis
Cryptococcus spp. (unlike other systemic mytotic agents)
Encapsulated yeast
Included with fungi only because of
molecular traits
Pneumocystis carinii Has features like protozoans
3 main genera separated due to
differences in VAP activity and gene Enveloped
arrangement:
Sexual intercourse (anal/vaginal) - HIV enters
and infects Langerhands DC's in epithelium or
GIT?
Increased risk with anal sex - only one layer of
colonic cells. Cells might have certain co-
receptors
Transmission: Sexual - anal and vaginal. Less
infectious than other STDs. 7% if oral sex with Makes dsDNA
recently infected man.
Peri-natal - from birth
Blood: IV drug users, needle stick injuries,
blood transfusions
Initial huge paranoia: risks are slight unless
close intimate contact and/ or transfer of
semen, blood, vaginal secretions
Problem: long, prodromal asymptomatic period. Inactivates key elements of immune
Infectious before identifiable symptoms. system - inactivates CD4+ T cells
Not likely by: casual contact, touching, kissing,
coughing, sneezing, insect bites, water, food,
utensils, toilets, swimming pools…
HIV-1: 70% men. 42% homosecual men.
Geveloping countries: relative increase among
heterosexuals.
HIV-2: mostly west africa
Cause disease iff: immunocompromised,
trauma, ABC's, dietary imbalance, endocrine
changes, pH changes
Extremely common
strict pathogen (unlike Candida)
Ubiquitous: soil, pigeon droppings (dessicated
alkaline rich, N2 rich, hypertonic), poultry farms, Capsule (anti-phagocytic)
eucalyptus trees
Opportunistic infection - common in
environment
also found in rodents (not reservoir for human
disease)
Transmission is via respiratory droplets
Increased risk if immunosuppressed
chemokine co-receptors - very Allopathic treatment: RT inhibitors,
important for establishing infection and Protease inhibitors, Peptide T-20
increasing liklihood of developing AIDS and T-1249
Attachment fo specific cells - fusion of Safe sex - latex condoms only!
envelope Safe needle practices!
Two part vaccine
RT (reverse transcriptase) is very error
prone
integrated into host chromosome by
integrase
Can also spread between cells -
syncitia
Hypervariable regions - antigenic drift of
Evated immune system by:
gp120
Latent infection - unique promotor/
enhancer regions (LTRs)
direct: cytotoxicity of CD4+ t cells
Supression of immune system:
Indirect - induces apoptosis
p24 at early and late stages (core of
virus)
Diseases associated with disruption of
Oral candidiasis: "Thrush"
normal bacterial ecology in the body
Veginal candidiasis: "Yeast
infection"
Chronic Mucocutaneous
Candidiasis (CMC)
Disseminated candidiasis
Aspergillosus flavus (on peanuts, corn
and other grains) produces aflatoxin - Mycotoxicoses hypersensitivity
very potent carcinogen: hepatocellular pneumonitis
carcinoma
Aspergillus Secondary colonization
Paranasal granuloma
Aspergillosus systemic disease
Cryptococcosis (also Busse-
Buschke disease or torulis)
Cryptococcosis meningitis
Pneumonia Oxygen
Extrapulmonary ABCs

Paramyxoviridae
family
 1) Morbillovirus - measles virus -
Paramyxoviridae "rubeola", animal disease
family 2) Paramyxovirus - parinfluenzae and
mumps viruses
3) Pneumovirus - respiratory syncytial
virus **use homeopathic engystol
against this
In paramyxovirus family
Morbillovirus
In paramyxovirus family
Parainfluenzae virus
In paramyxovirus family
Paramyxovirus
RSV In paramyxovirus family
Penetrate cell by fusion (form
cyncytia)
Replicate in cell cytoplasm
Transmitted via respiratory droplets
Very contagious - 85% infection rate,
One of the MC causes of death in childern 1-5 Measles Control: MMR vaccine
95% chance of disease development
99.5% decrease since vaccine Uinqueness of measles: Pneumonia
Nearly all people infected become
Giant cell pneumonia
unwell and develop disease
Very characteristic "pathognomic"
Post infectious encephalis
clinical presentation
Sub-acute sclerosing
only 1 serotype
panencepahalitis
Complete resistance to re-infection Atypical measles
highly contagious - 85%
Big contrast in disease severity with
proper nutrition, access to health care
etc.
4 serotypes: Types 1-3: 2nd most
common cause of severe respiratory
Ubiquitous Laryngitis Treat symptoms only
distress in infants and young children,
can cause croup
Initial site of infection is the upper
respiratory tract - epithelial cells.
Transmission is person to person and
Usually contained here and rarely Parainfluenzae
respiratory droplets
becomes systemic (unlike measles/
mumps)
MC in infants and children <5 Only partial immunity (unlike measles) Croup
Only affects umans - adult infection more Very infectious (but less than measles Symtpmatic only, no anti-viral
Mumps
severe than children or chicken pox) agents
infect upper respiratory tract epithelial
cells. Infect parotid gland via viremia or Orchitis
Stenson's duct --> Parotitis
Life-long resistance to infection (like
Oophoritis
measles)
Pancreatitis
Meningitis.
Arthritis
Infection localized to upper or lower Control: almost impossible. Too
Ubiquitous - virtually everyone in NA is infected
No hemagglutinin respiratory tracts. No systemic spread/ URI with marked rhinorrhea ubiquitous and good vaccines are
by age 4 (very contagious)
viremia not available
Other treatment: euphorbium
Epidemics in every winter in cold, temperate
Form syncytia No long term immunity Bronchiolitis compositum (good for RSV and
climate
rhinovirus)
#1 cause of severe lower respiratory tract Zn - decrease RSV replication, but
infection in young children (Day cares, OM in high doses depresses immune
nurseries) system
Common cold causes: 1) rhinorhea virus. 2)
coronavirus 3) RSV
Transmitted via hands, fomites and respiratory
secretions
 Always symptomatic. Range from mild
Family togavirus Enveloped childhood diseaes "German measles" to severe causes heterologous intereference Rubella
congenital defects
unlike other togaviruses: respiratory
less contagious than measles or
Rubivirus rubeolla = measles tropism and no detectable humans are only host Polyarthritis
mumps or varicella
cytopathology (no lysis)
spread via respiratory secretions or
Rubella congenital
transplacental
increased risk of harmful disease if pregnant
cause of erythema infectiosum (5th Usually treatment is not required -
Smallest of Dna viruses (only 22nm) In all countries Erythema infectiousum
disease) to aplastic crisis to arthritis self-limiting
Prevention difficult because rash
or arthralgia stages are not
naked capsid virus MC in 4-10 year olds in late spring and winter MC'ly asymptomatic Parvovirus B19 fetal infection
infectious (immune complex
Parvovirus mediated)
very resistant to drying, acid/base, MC spread from respiratory droplets or close
Aplastic crisis
high salt etc contact to blood products
binds P antigen on rbc's, erythrocyte
progenitor cells, vascular endothelium Arthritis
and fetal myocytes
currently 7 viruses grouped together
because they all cause liver damage
1) HAV - picornavirus --> infectious
hepatitis
Hepatitis
2) HBV - hepadnovirus --> serum
hepatitis
3) HCV - flavivirus
4-7) D-F
Ingested (contaminated shellfish, clams,
Naked icosahedral ssRNA genome Differences from HBV: Hepatitis A Avoid uncooked shellfish
oysters)
extremely stable capsid slow replication, transient viremia HAV can not initiate a chronic infection Chlorine treatment of water
Pathology due to immune mediated hepatocyte
Not stable to chlorine HAV not associated with hepatic CA
damage
rarely get immune complex related rash
40-60% of acute hepatitis in USA
HAV and polyarthritis
Person-to-person, fecal-oral and sewage
contaminated food/water (often traceable rarely fatal (fulminant hepatitis)
source, can live in water for many months)
1 month incubation --> abrupt onset of
icteric symptoms
fecal-oral spread
enveloped, small circular, partly MC'ly in blood or blood products (serum
differences from HAV: Hepatitis B
dsDNA hepatitis)
unusally stable for an enveloped virus Chronic carrier - test + for HbsAg 2 occasions hepDNA vuris
transmitted by
over 1/3 of the world is infected
blood/needles/STD/perinteral
HBV
longer incubation (3 months) and then
insidious onset of symptoms
can get chronic hepatitis carriers
can cause primary hepatocellular
carcinoma (PHC)
not as resistant
 Microbe
Malassezia furfur (pityriasis
Superficial mycoses
ovale)
Phaeoannuellomycoses
Superficial mycoses
wernickii (Exophilia wernickii)
Superficial mycoses Piedraia hortae
Superficial mycoses Trichosporon beigelii
Systemic mycoses Histoplasma capsulatum
Systemic mycoses Histoplasma capsulatum
Blastomycosis
Blastomycosis
Coccidiodomycosis
Herpes simplex
Herpes simplex
Herpes simplex
Herpes simplex
Herpes simplex
Herpes simplex
Herpes simplex
Varicella zoster virus
Varicella zoster virus
Varicella zoster virus
Varicella zoster virus
Varicella zoster virus
System Condition Signs and Symptoms DDX and Lab Dx
"spaghetti and meatballs" organisms
Lipophilic, yeast-like organism. Non-itchy hypopigmented telsions on upper
Skin Tinea (pityriasis) versicolor after KOH prep. Wood's lamp (+).
torso, arms, abdomen. Dry chalky and scale easily.
DDX with vitiligo.
Characteristically dark pitmented
Skin Tinea nigra MC asymptomatic. Well demarcated, macular lesions on palms/soles. yeast cells and hyphal fragments on
KOH prep
Dar, hard nodules along infected hair
Hair Black piedra Hairs of scalp, mustache, beard, groin. Direct or sexual contact.
shaft
Hair White piedra Hairs of scalp. Direct contact only. Soft, pasty white growth on hair shaft.
Only 5% of people get it. 10 day incubation. Acute, self limiting influenzae like
illness (fever, malaise, dry cough, lymphatenopathy. Resolve completely with Microscopy: 10% KOH prep with silver
some residual calcified lesions (coin lesions). Not contagious.Complications: or Giemsa stain. Serological: skin test:
Systemic Primary histoplasmosis overly aggressive immune response. Mediastinal fibrosis. Progressive: too many false (+). Cultures: slow
Disseminate via lumphatics. Increased risk if impaired CMI. TB-like iff growing (1-2 weeks) and spores are
chronic: fever, night sweats, weigh loss with destructive (caseating necrosis) infectious. DNA probes. Direct ELISA.
lung lesions.
Serious retinal condition. Leading cause of blindness in 20-40 year olds.
Eye Ocular histoplasmosis syndrome. Often misdiagnosed. "Histo spots" bilaterally. MC'ly no visual loss but can be
activated to cause visual changes (4 kinds)
Skin test and serology - too many
45 day incubation. Bronchopneumonia. Drenching sweats, No residual false (+). Microscopty - biopsy/
calcified lesions (unlike Histo). Not contagious. Skin lesions are slowly histology of KOH prepped tissue.
Skin Acute Blastomycosis
expanding ulcerative or cerrucous lesions with a granulous base on face and Culture. No tuberculat macroconidia in
mucocutanoues borders of nose and mouth. saprobic phase (unlike H.
capsulatum). CXR.
Systemic Chronic Blastomycosis TB or cancer like
Skin test antigens. Skin test 2-4
weeks after symptoms. Coccidiodin.
Spherulin. (for both
1) MC'ly asymptomatic. 2) 40% of infected people get mild, febrile to
phases)Complement fixation. CXR -
moderately severe respiratory disease. Not contagious. 3) <5% - progressive
Coccidiodomycosis "egg shell" lesions. Tissue Biopsy-
pulmonary disease. 4) <<1% - disseminated disease. Erythema nodosum with
staining and microscopy for
arthralgia.
spherules. Culture - CAUTION -
infectious - leading cause of lab
infections!
Tzanck smear: look for Syncytia
Skin break - localized primary infection in mucosa. Vascular lesions (damage
(fused membrane, not specific, also
due to viral immonopathology and apparent healing). Then retrograte
for: HSV, VZV, HIV,
transport to neuron nucleus - latent infection. Stress (emotional, fever, direct
Skin Herpes simplex infection paramyxovirus.Cowdry Type A
sunlight, menstruation / hormones, immunosuppresion). Lesions: "dew drop
inclusion bodies (HSV or VZV).
on rose petal". Secondary infection is more localized and shorter duration
Characteristic CPE (cyto pathological
than primary infection.
effect)
Unilateral, recurrent. Can lead to dendritic corneal ulcers --> permanent
Eye Herpetic keratitis (ocular herpes)
damage
Skin Herpetic Whitlow Herpes infection of finger
HSV-2 - often a complication of genital herpes. Sudden onset of nuchal
Systemic Meningitis.
rigidity, blinding H/A, nausea, photophobia.
Seizures, signs of SOL (space occupying lesion), cause destruction to
Brain Encephalitis
temporal lobe. MC cause of sporadic encephalitis.
Caused by HSV-1 (10& orogenital sexual practices) and HSV-2 (90%). STD
3-7 days after contact. Regional lymphadenopathy, painful shallow ulcers.
Reproductive Genital herpes Recurrent (2-3 weeks or rarely) prodrome of burning/tingling. Female: pruritis,
vaginal or cervial mucoid discharge. Increased risk of cervical CA in
adulthood and HIV. Male: dysuria and/or duspaerunia.
Acquired in utero or during vaginal birth or post-natal (family members or
Systemic Neonatal Herpes simplex infection
hospital personnel). Devastating, often fatal. Affects CNS, lungs, liver.
One of the 5 childhood exanthems: rubella, roseola, 5th disease,
measles/rubeola. Inhalation: maculopapular rash ("dew drop on rose petal"),
Tzanck smear: giant, multinucleate
intense pruritus, rapid development and spread from back/chest to scalp.
cells - syncytia. Cowdry Type A
Within 12 hours: successive crops of lesions. Prolonged low grade fever.
Skin Chicken pox inclusion bodies: "drop like masses of
extremem irriability/malaise. Much more harmful to adults - scarring. More
acidophilic material surrounded by a
severe on trunk than extremeties, also on mouth, conjunctiva, vagina.
clear halo within the nucleus"
complications: 1) secondary bacterial infections.2) Reye's syndrome, CNS
symptoms.
Can occur after chicken pox, enterocirus, EBV, influenzae B, aflatoxin
Systemic Reye's syndrome (peanuts), pesticide. ASA associated - do NOT give aspirin to a child with
chickenpox.
Recurrence of latent VZV infection. Prodrome: severe pain in localized nerve
area. 3-5 days later: gradual development of small red macules, closely
Neural Shingles spaced, MC'ly in thoracic area or trigeminal nerve area, unilateral. Post
herpetic neuralgia: long term (months to years) severe recurring burning or
itching pain, hyperesthesia. Unlike herpex simplex: lesions are various sizes.
Neural Herpes zoster opthalmicus CN V (facial) and CN III (ocular changes - cornal ulcers - blindness)
Ramsey Hunt syndrome (Herpes painful lesions along CN VIII (severe otalgia, hearing loss, vertigo, vesicular
Neural
zoster oticus) lesions along external ear canal) and lesions along CN V (Bell's palsy)
 MC viral agent of congenital disease in US. Clinical disease in 10%:
congenital - cytomegalic inclusion microencephaly, hearing loss(SNL) rash, hepatosplenomegaly. Fetus is Confirm by isolating CMV from child's
Cytomegalovirus Systemic
disease infected either: placenta or recurrent mother infection - ascending infection urine in 1st week of life.
from cervix.
Infectection of fetus or newborn by any of the TORCH agents.
Toxoplasmosis, other, rubella virus, cytomegalovirus, histoplasmosis.
Cytomegalovirus Systemic TORCH syndrome
Outcome is abortion, stillbirth, or premature delivery. Fever, lethargy, poor
feeding…..
Heterophile (-) mono. Clinical signs
Through vaginal birth with infected cervix or colostrum or milk. 2 outcomes:
and symptoms too vague to be that
asumptomatic or symptomatic if immunocompromised. Very common cause
Cytomegalovirus Eye Peri-natal useful. Biopsy: owl's eye nuclease.
of failure of KI transplants. IFF immunocompromised: Retinitis: "pizza pie
Cell culture: characteristic CPE in
retina" --> scotoma, "blind spot". Esophagitis: mimic CRC esophagitis
diploid fibroblastic cells
Triad of: fever, pharyngitis and
lymphadenopathy for 1-4 weeks.
kissing disease - heterophile (+) mono. Symtoms: high fever, malaise,
Downey cells. Monospot test (+)
pharyngitis, tonsils with whitish exudate, lymphadenopathy,
Heterophile Abs - polyclonal activation
EBV Systemic Mononucleosis hepatosplenomegaly, fatige. Spleen rupture - avoid contact sports, hepatitis.
of B cells produces wide reportoire of
Cyclic recurrent disease. (if lasts over 6 months) EbV induced
abs that recognize "paul Bunnel" Ags
lymphoproliferative dease(looks like leukemia)
on horse, sheep, cow, RBCs but not
guinea pig
Tumor cells are from lymphocytes and contain EBV DNA. Malaria is a co-
EBV Systemic African Burkitt's Lymphoma
carcinogen. Large lesions - osteolytic - on jaw
EBV Systemic Nasopharyngeal carcinoma Epithelial cell tumor. Co-factor: ingested nitrosamines.
Opportunistic infection in HIV AIDS patients. Vertically ribbed keratinized
EBV Oral Hairy oral leukoplakia
plaques on lateral borders of the tongue
Rapid onset of high fever. Fever subsides and then get maculopapular rash.
HHV-6A Skin Roseola infantum
Also termed exanthum subitum.
progression time of HIV to aids. Assoc with neurological disorders: might be
HHV-6A Systemic Mononucleosis type illness Heterophile (-) mono.
linked to MS, cronic fatigue.
Acute retroviral syndrome: viremia. Mono-like syndrome (heterophile -),
mucocutaneous sores. Illness subsides spontaneously. 60%+ become
asymptomatic. Mouth ulcers, oral candidiasis, EBV-like. Initial screen: indirect ELISA for gp120
Mid stage - ACR (AIDS related complex). Insiduous onset - weight loss. Night or gp41 (2x to confirm). New- Ora
sweats, fatigue,opportunistic infections Quick Rapid HIV-1 Ab test. Western
blot: for gp120 or p24 or p31 proteins.
HIV Systemic HIV AIDS: 1) presence of anti-HIV gp120 abs, 2) decreased CD4+ t cells, 3) Active viral replication (Recent
wasting syndrome 4) presence of opportunistic infections. Primary defence infection or late stage) - direct ELIZA
against opportunistic pathodens is progressively diminised. Diseases: hairy for p24, viral load in Rt or in blood via
oral leukoplakia, oral thrush, kaposi's sarcoma, pneumocystis pneumonia, PCR. Culture - difficult, looking for
CMV retinitis syncitia
AIDS related dementia: sub-acute encephalopathy. Slow, progressive
deterioration of mental abilities. Can minic alzheimer's disease

Microscopy: tissue scrapings treated

with 10% KOG. Culture: confirm +
Focal which patches on oral mucosa, palate and tongue that bleed when microscopy - grow on Sabourad agar.
Candida Oral Oral candidiasis: "Thrush" scraped off. Red flad for AIDS iff thrush in adults NOT receiving corticosteriod Germ tube test - unique to Candida
therapy or broad spectrum ABC's. Spp. Serology: high titer of fungal
glycoprotein Abs in recent or active
infection or Candida specific mannan

Common female disease - change in vaginal flora or STD. Erythema ("beefy

Candida Reproductive Veginal candidiasis: "Yeast infection" red")/ inflammation vagina/ vulva. Thick white or curd-like discharge. Intense
pruritus.
Chronic Mucocutaneous Candidiasis Group of treatment resistant superficial Candida infections - no organ
Candida
(CMC) involvement
Candida Systemic Disseminated candidiasis spread to many organs - must be immunocompromised
Mycotoxicoses hypersensitivity
Aspergillus Respiratory Allergic broncophulmonary asperfillosis associated with asthma (10-20%)
pneumonitis
Fungus ball on CXR - moves with
Aspergillus Aspergillus Secondary colonization Aspergillus colonizes pre-existing cavity. Minimal distress, hemoptysis.
dependency
Aspergillus Paranasal granuloma Chronic sinusitus due to Aspergillus colonization of paranasal sinuses.
Invasive disease that is rapidly fatal if not treated. Increased risk with severe
Culture on Saroraud agar. Tissue
Aspergillus Systemic Aspergillosus systemic disease
neutropenia. Affect CNS, heart. biopsy: 10% KOH of sputum.
Microscopy: examine CSF after
MC self-limiting mild pulmonary infection. Can lead to pulmonary nodule treating with 10% KOH and India ink.
Cryptococcosis (also Busse-Buschke
Cryptococcus spp Respiratory which mimics carcinoma or pnemonia with diffuse pulmonary infiltrates (mc in Serology: look for capsular Ags
disease or torulis)
males) (unlike other systemic mycoses that
look for Abs)
MC cause of fungal meningitis. Insidious onset of HA, low grade pyrexia, focal
Cryptococcus spp Systemic Cryptococcosis meningitis neurological changes. Immunocompromised also get skin lesions or osteolytic
bone lesions (e.g. lymphoma)
Microscopy: typical octonucleate
Pneumocystis carinii Respiratory Pneumonia Non-specific. Plasma cell infiltrates with "ground glass appearance" cysts.CXR: diffuse infiltrates with
ground glass appearance
Pneumocystis carinii Systemic Extrapulmonary In AIDS - eye, ear, liver, bone marrow
 MC clinical only - pathognomic.
Cough, coryza, conjunctivitis, photophobia. 2 days later: Koplik's spots "grains
Microscopy: syncytia. Serology: 4x
Morbillovirus Systemic Measles of salt surrounded by a red halo". 1-2 days later - rash, maculopapular
increase in measles specific IgMs
descending rash. MC self limiting with no complications
suggest recent infection
Morbillovirus Respiratory Pneumonia Rarely occurs but is MC cause of mortality from measles
Morbillovirus Respiratory Giant cell pneumonia IFF T cell deficient children
Morbillovirus Neural Post infectious encephalis immunopathological - demyelinate neurons
Morbillovirus Neural Sub-acute sclerosing panencepahalitis charaterized by changes in personality, behaviour, memory, movement
Response to vaccine - abrupt onset of more severe symptoms. Get increased
Morbillovirus Systemic Atypical measles
imunopathologic response.
Parainfluenzae virus Respiratory Laryngitis
range from mild cold-like URI to bronchitis and pneumonia. Milder disease in
Parainfluenzae virus Respiratory Parainfluenzae
older children and adults
DDX epiglottitis (caused by H.
Laryngeotracheobronchitis - "sound worse than they look". Seal bark - harsh
influenzae). "Look worse than they
Parainfluenzae virus Respiratory Croup brassy cough. MC self limiting - 48 hours. Xray: steeple sign. Lab Dx:
sound" Medical emergency, drooling.
Serology >>false -. Presence of syncytia. Hamadsorb guinea pig RBCs.
Xray: thumb sign.
Test samples from saliva, urine or
Paramyxovirus Mumps MC'ly asymptomatic (unlike measles). Bilateral parotitis. CSF. Elevated amylase (bc
pancreatitis). Hemadsorption.
Paramyxovirus Reproductive Orchitis Testicular swelling. MC unilateral, can lead to sterility if bilateral.
Paramyxovirus GI Oophoritis Unexplained abdominal pain.
Paramyxovirus GI Pancreatitis might be a link to juvenile onset DM
H/A, stiff neck, drowsiness, unsteadiness when walking. #1 cause of aseptic
Paramyxovirus Systemic Meningitis.
meningitis in non immunized (non bacteria)
Paramyxovirus Skeletal Arthritis Rare cause of polyarthritis in young men
4x increase in anti-RSV indicates
RSV Respiratory URI with marked rhinorrhea In older children/adults
disease
RSV Respiratory Bronchiolitis OM also is common. These 2 in infants.
"3 day measles" regional lymphadenopathy (esp sub-occipital glands).
Spread to skin: rash - small erythematous nodules that spread from face to
Rubivirus Systemic Rubella trunk/limbs, gone in 3 days. Rubella disease has similar severity even if
immunosuppressed. Mores severe in adults than children due to more
vigorous immunopathology.
MC in adult females. Symmetrical polyarthritis of fingers, ankles, wrists and
Rubivirus Skeletal Polyarthritis
knees
Increased risk (70% babies infected) if mother infected in 1st trimester (if 4th
Difficult to diagnose clinically. Highly
month just sensorineural deafness). Iff no maternal Abs teratogenic effects.
Rubivirus Rubella congenital specific anti-rubella IgMs. NO
Classic triad: eyes, ears, heart. Also microencephaly, IDDM. Highly
CULTURE - no characteristic CPE.
infectious for 1st few months of life.
Nonspesific URI (looks like influenza). 2-7 days later develop a "slapped
cheek rash" which fades after 4 days but spreads to trunk and limbs (lacey/
RIA or ELIsa for B19 specific Abs. IgG
Parvoirus Erythema infectiousum reticulate appearance). Biphasic: 1) Infectious stage. 2) Immune mediated
comes later but persists for life
stage: recurrent rash (immune mediated) that is <sunlight, <exercise, <hot
water, <stress.
Iff seronegative mother is infected in 2nd or 3rd trimester. Hydrops fetals
Parvoirus Parvovirus B19 fetal infection
(dropsy) - massive edema in the fetus.
Especially if SCA or thalassemia - chronic hemolytic anemia. Not developing
Parvoirus Aplastic crisis
RBC's for 5-7 days. Fever, malaise, myalgia, chills, pruritus.
Symmetrical, transient polyarthritis - presents just like rubella arthritis.
Parvoirus Arthritis
Increased risk in female adults. Unlike RA - no RF.
Children: often asymptomatic (only 1-2% get jaundice). Adults: abrupt onset Patient history - source of infection.
HAV Hepatitis A of fever/chills. Symptoms decrease in 4-6 days. Jaundice in 67%. 99% full Acute or recent: anti HAV igM by
recovery. 1-3/1000 progress to fulminant hepatitis. ELISA or RIA