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microbiology > Systems > Flashcards

Systems Flashcards

1
Q

Normal flora of tissues

A

Skin - S. epidermidis
Nose - S. epidermidis; colonized by S. aureus
Oropharynx - Viridans group strep
Dental plaque - S. mutans
Colon - B. fragilis > E. coli
Vagina - Lactobacillus; colonized by E. coli/GBS
C-section babies have no flora, colonized after birth

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2
Q

Bugs causing food poisoning:

  • Reheat rice
  • Canned food/honey
  • Reheated meat
  • Undercooked meat
  • Poultry/eggs
  • Meats/mayo/custard
  • Shellfish/wounds from water or shellfish
A
  • B. cereus - reheated rice
  • C. botulinum - improperly canned foods (bulging can) = preformed toxin; honey spores
  • C. perfringens - reheated meat dishes
  • EHEC (O157:H7) - undercooked meat
  • Salmonella - poultry, meat, eggs
  • S. aureus - Meats, mayo, custard; performed toxin
  • V. parahaemolyticus/V. vulnificus - contaminated seafood (shellfish) or wounds from water/shellfish
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3
Q

Bugs causing diarrhea: bloody vs. watery

A

Bloody diarrhea (ChEEESSY)

  • Campylobacter
  • E. histolytica
  • EHEC (enterohemorrhagic)
  • EIEC (enteroinvasive)
  • Salmonella
  • Shigella
  • Y. enterocolitica

Watery diarrhea (CCEPVV)

  • C. difficile
  • C. perfringens
  • ETEC (enterotoxigenic)
  • Protozoa
  • V. cholerae
  • Viruses
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4
Q

Causes of bloody diarrhea

A

“ChEEESSY”

  • Campylobacter - oxidase +, comma-shaped, grows at 42C
  • E. histolytica - protozoan, amebic dysentery, liver abscess
  • EHEC (enterohemorrhagic) - O157:H7 mutation, makes Shiga-like toxin (inhibit 60S subunit on ribosome = cell death); can cause HUS
  • EIEC (enteroinvasive) - invades colonic mucosa
  • Salmonella - lactose neg, oxidase neg, flagellar motility (animal reservoir; poultry/eggs)
  • Shigella - lactose neg, oxidase neg, very low ID50 –> makes shiga-toxin
  • Y. enterocolitica - day-care breakout, pseudoappendicitis
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5
Q

Causes of water diarrhea

A

“CCEPVV”

  • Clostridium difficile - pseudomembranous colitis, caused by abx. Sometimes bloody diarrhea
  • Clostridium perfringens - myonecrosis and gas gangrene
  • ETEC (enterotoxogenic) - Traveler’s diarrhea; heat-labile (HL) and heat-stable (ST) toxins
  • Protozoa - Giardia, cryptosporidium (in immunocompromised)
  • V. cholerae - comma-shaped gram neg, grows in alkaline environment (sensitive to pH); rice-water diarrhea, often from infected seafood
  • Viruses - rotavirus, norovirus
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6
Q

Causes of pneumoniae by age

A
  • Neonates (<4wks): GBS, E. coli (think vagina)
  • Kids (4wk-18yo): Viruses (RSV), Mycoplasma, C. trachomatis (0-3yo), C. pneumoniae (school-aged), S. pneumoniae
  • Runts May Cough Chunky Sputum
  • Adults (18-40yo): mycoplasma, C. pneumoniae, S. pneumoniae
  • Adults (40-65yo): S. pneumoniae, H. influenzae, Anaerobes, Viruses, Mycoplasma
  • Elderly: S. pnuemoniae, Influenza virus, Anaerobes, H. influenzae, Gram-neg
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7
Q

Special groups of pneumoniae

  • Alcoholic/IV drug user
  • Aspiration
  • Atypical
  • CF
  • Immunocompromised
  • Nosocomial
  • Postviral
A
  • Alcoholic/IV drug user - S. pneumoniae, Klebsiella, Staph
  • Aspiration - anerobes
  • Atypical - mycoplasma, legionella, chlamydia
  • CF - pseudomonas, S. aureus, S. pneumoniae
  • Immunocompromised - Staph, enteric gram-neg rods, fungi, viruses, PCP (HIV)
  • Nosocomial - Staph, pseudomonas, enteric gram-neg rods
  • Postviral - staph, H. influenzae, S. pneumoniae
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8
Q

Common causes of meningitis by age

A
  • Newborn (0-6mo): GBS, E. Coli (think vagina), Listeria
  • Kids (6mo-6yr): S. pnuemoniae, N. meningiditis, HiB, Enterovirus
  • 6-60yo: S. pneumoniae, N. meningitidis (#1teens), enterovirus, HSV
  • > 60yo: S. pneumoniae, Gram-neg rods, Listeria
  • HiB meningitis much lower since vaccine introduction!
  • Viral - enterococcus (Coxsackie), HSV2, HIV, West Nile, VZV
  • In HIV - cryptococcus, CMV, toxo (brain absces), JC virus (PML)
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9
Q

Tx for meningitis

A

Ceftriaxone + vanc empirically

- Add ampicillin if suspect listeria (very old/young)

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10
Q

CSF findings in meningitis

A

Bacterial: incr openingP, high PMNs, incr protein, decr sugar

Fungal/TB: incr openingP, high lymphocytes, incr protein, decr sugar

Viral: normal/incr opening P, high lymphocytes, normal/incr protein, normal sugar

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11
Q

Osteomyelitis

A

*Most in kids, high CPR/ESR; subtle on XR, cavity on MRI

  • S. aureus - most common
  • Neisseria gonorrhea - rare, more often causes septic arthritis
  • Pseudomonas, serratia –> DM/IV drug users
  • Salmonella - sickle cell
  • S. aureus/S. epidermidis - prosthetic jt replacement
  • M. TB (Pott) - vertebral involvement
  • Pasteurella - cat/dog bites
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12
Q

UTI = cystitis

A

Ascession of microbes from urethra to bladder
- Dysuria, frequency, urgency, suprapubic pain, WBCs (NOT WBC casts) in urine

  • Males - infants with cong defects, vesicourethral reflex
  • Elderly -enlarged prostate
  • Females - 10x more common (short urethra w/ fecal flora)

Other risks: obstruction, kidney surgery, catheterization (pseudomonas), GU malformation, DM, pregnancy

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13
Q

Pyelonephritis

A

Accession of microbes from bladder to kidney

- Fever, chills, flank pain, CV tenderness, hematuria, WBC casts

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14
Q

UTI bugs

A
  • E. coli - most common, green metallic sheen on EMB agar
  • S. saphrophyticus - 2nd cause in sexually active women
  • Klebsiella - 3rd cause, large mucoid capsule + viscous colonies
  • Serratia m. - red pigment; nosocomial/drug-resistant
  • Enterobacter - nosocomial/drug-resistant
  • Proteus - motility –> “swarming” on agar, urease, struvite stones
  • Pseudomonas aeruginosa - blue-green pig/fruity odor; nosocomial/drug-resistant
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15
Q

Labs with UTI

A
  • WBC = UTI
  • WBC casts = pyelonephritis
  • LE+ = bacterial UTI
  • Nitrate+ = gram-neg UTI
  • Urease = urease-producing bugs (Proteus, Klebsiella, H. pylori)
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16
Q

Vaginal infections

A

Bacterial vaginosis - no inflammation, thin/white discharge with fishy odor

  • Gardernella, clue cells, pH >4.5
  • Tx = metronidazole

Trichomonas vaginalis - inflammation, frothy, grey-green, foul-smelling discharge

  • Motile trichomonads, pH >4.5
  • Tx = metronidazole; treat sexual ptnr

Candida vulvovaginitis - inflammation, thick, white, “cottage cheese” discharge

  • Pseudohyphae, pH nl (4-4.5)
  • Tx = -azoles
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17
Q

ToRCHeS infections

A

ToRCHeS

  • Toxo
  • Rubella
  • CMV
  • HIV
  • HSV-2
  • Syphilis
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18
Q

Congenital toxo

A

Get from cat feces/undercooked meat

  • Maternal - asx, LAD rarely
  • Neonatal - triad = chorioretinitis, hydrocephalus, intracranial calcifications
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19
Q

Congenital rubella

A

Respiratory droplets

  • Maternal - rash, LAD, arthritis
  • Neonatal - triad = PDA, cataracts, deafness +/- blueberry muffin rash
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20
Q

Congenital CMV

A

Sex, organ transplant

  • Maternal - asx or mono-like illness
  • Neonatal - hearing loss, sz, petechial rash, blueberry muffin rash
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21
Q

Congenital HIV

A

Sex, needle stick

  • Maternal - depends on CD4
  • Neonatal - recurrent infections, chronic diarrhea
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22
Q

Congenital HSV-2

A

Skin, mucous membrane contact

  • Maternal - asx or herpetic (vesicular) lesions
  • Neonatal - encephalitis, herpetic (vesicular lesions)
23
Q

Congenital syphillis

A

Sex

  • Maternal - primary = chancre; secondary = dissem rash
  • Neonatal - stillbirth, hydrops fetalis; if survives, have facial abnormalities (notched = Hutchingsons teeth, saddle nose, short maxilla, saber shins, CN VIII deafness
24
Q

Red rashes of childhood

A

“CHuMP = Red Small Vesicles”

  • Coxsackievirus type A
  • HHV-6
  • Measles virus
  • Parvovirus B19
  • Rubella virus
  • Strep pyogenes
  • VZV
25
Q

Coxsackievirus type A rash

A

Hand-foot-mouth disease

  • Vesicular rash on palms/soles
  • Vesicles/ulcers on oral mucosa
26
Q

HHV-6 rash

A

Roseola

  • Macular rash over body several days after high fever
  • Can get febrilze szs; always in infants
27
Q

Measles virus

A

Measles (rubeola)

  • Paramyxovirus
  • Rash preceded by CCCK (cough, coryza, conjunctivitis, Koplik spots (blue-white) on buccal mucosa
  • Starts at head, moves down
28
Q

Parvovirus B19

A

Fifth disease = erythema infectiosum

  • P antigen in bone marrow (erythrocyte precursors); get from IgG/IgM-complex deposits
  • “Slapped cheek” rash on face
  • Hydrops fetalis in pregn women
29
Q

Rubella virus

A

Rubella

  • Rash starts on head –> moves down = fine truncal rash
  • Postauricular LAD
30
Q

Strep pyogenes

A

Scarlet fever
- Erythematous, sand-paper like rash with fever/sore throat

*GAS

31
Q

VZV

A

Chickenpox

- Vesicular rash starting on trunk –> spreads to face/extremities with diff aged lesions

32
Q

STDs

A
  • AIDS - OIs, kaposi sarcoma, lymphoma
  • HIV
  • Chancroid - painful genital ulcer, inguinal adenopathy
  • Haemophilus ducreyi (“so painful you “do cry”!”)
  • Chlamydia - urethritis, cervicitis, conjunctivitis, reactive arthritis, PID
  • Chlmaydria trachomatis (D-K)
  • Condylomata acuminata - genital warts, koilocytes
  • HPV 6 and 11
  • Genital herpes - painful penil/vulvar/cervical vesicles + ulcers; systemic = fever, HA, myalgia
  • HSV2 (HSV1 less common)
  • Gonorrhea - urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge
  • Neisseria gonorrhoeae
  • HBV - jaundice
  • Lymphogranuloma venereum - lymphatic infection; painless genital ulcers, painful LAD (buboes)
  • C. trachomatis
  • Syphilis (primary-tertiary) - painless chancre, fever/LAD/rash/condylomata, gummas/tabes dorsalis, paresis, aortitis, Argyll Robertson pupil (diff stages)
  • Treponema pallidum
  • Trichomoniasis - vaginitis, strawberry cervix, motile in wet prep
  • Trichomonas vaginalis
33
Q

Pelvic inflammatory disease

A

PID

  • Chlamydia trachomatis (subacute) = most common, Neisseria gonorrhoeae (acute)
  • CMT (chandelier sign), purulent discharge
  • Salpingitis, endometritis, hydrosalpinx, tubo-ovarian abscess
  • Salpingitis = risk for ectopic, infertility, chronic pelvic pain, adhesions
  • (Fitz-Hugh-Curtis syndrome - infection of liver capsule, ‘violin string’ adhesion of peritoneum to liver)
34
Q

Nosocomial infections

A
  • Candida albicans - hyperalimentation
  • CMV/RSV - newborn nursery
  • E. coli, proteus - urinary cath
  • HBV - renal dialysis worker
  • Legionella - water aerosols
  • Pseudomonas - resp therapy equipment (and burns)
35
Q

Bugs infecting immunized kids

A
  • Rash - rubella/measles
  • Meningitis - HiB, polio
  • Epiglottitis - HiB (fever, dysphagia, drooling, cherry red epiglottis, thumbprint sign on XR)
  • Pharyngitis - Corynebacterium diptheriae (gray oropharyng exudate = pseudomembrane, can obstruct throat)
36
Q

Hint: asplenic pt

A

Encapsulated microbes = SHiN

- S. pneumoniae»HiB > N. meningiditis

37
Q

Hint: branching rods in oral infection, sulfur granules

A

Actinomyces israelii

38
Q

Hint: Chronic granulomatous disease

A

Catalase + bacteria (esp S. aureus; S. epidermiditis, S. saphyophyticus)

39
Q

Hint: “Currant jelly” sputum

A

Klebsiella

40
Q

Hint: Dog/cat bite

A

Pasteurella

41
Q

Hint: Facial nerve palsy

A

Borrelia burgdorferi (Lyme)

42
Q

Hint: Fungal infection in diabetic/immunocompromised

A

Mucor/Rhizopus spp.

43
Q

Hint: Health care provier

A

HBV (needle stick)

44
Q

Hint: Neutropenic pts

A

Candida albicans (systemic), aspergillus

45
Q

Hint: Organ transplant recipient

A

CMV

46
Q

Hint: PAS+

A

Tropherym whipplei (Whipple disease)

47
Q

Hint: Pediatric infection

A

H. influenzae (epiglottitis)

48
Q

Hint: Pneumonia in CF/burn

A

Pseudomonas

49
Q

Hint: Pus, empyema, abscess

A

S. aureus

50
Q

Hint: Rash hands/feet

A

Coxsackie A, Treponema pallidum, Rickettsia rickettsii

51
Q

Hint: Sepsis/meningitis in newborn

A

GBS

52
Q

Hint: Surgical wound

A

S. aureus

53
Q

Hint: Traumatic open wound

A

Clostridium perfringens

microbiology (7 decks)

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