9-9 Anaerobic Bacteria & Chlamydia/Mycoplasma/Legionella

Question 1

A: Gas Gangrene occurs with [Clostridium _______] and occurs with [TRAUMA TO _______ TISSUE]. Give an example

B: Type ___ toxin is the most common cause. How does this toxin work? (2)

B2: Can this bacteria produce ENDOtoxin?

C: Onset of [Gas Gangrene] Time

D: Tx (3)

Answer 1

A: Gas Gangrene occurs with [Clostridium Perfringens] and occurs with [TRAUMA TO DEVITALIZED TISSUE]. (such as Deep penetrating military wounds)

B: Type A toxin is the most common cause = [Phospholipase C Lecithinase] that lyses inflammatory cells, causes [myonecrosis] and is hemolytic

B2: Can also produce ENDOtoxin if germinated in large #

C: [Rapid Onset of 6-72 Hr]

D: Tx

1) [IV Penicillin]
2) DEBRIDEMENT
3) Clindamycin for PCN allergic pts

Question 2

A: Sx of [Clostridium Tetani] infection (4)

B: Which sx occurs when [Orbicularis Oris] muscle involuntarily increases its ____

C: Tx (3)

Answer 2

1. [Trismus Lockjaw]
2. [Risus Sardonicus] “Evil Smile”
3. Opisthotonus
4. Potential Respiratory Obstruction

B: [Risus Sardonicus] occurs when [Orbicularis Oris] muscle involuntarily increases its tone

C: Tx

“Tetanus HAS a tx”

1. [Human Tetanus Immunoglobulin]
2. Airway Support
3. Sedation

Question 3

[Clostridium Botulinum]

A: Which serotypes cause human dz (4)

B: -[Clostridium Botulinum] toxin is coded by a _______ -It Inhibits _____ release —> [_______ _______ Paralysis] -[Clostridium Botulinum] toxin is [_______ _______ Sensitive]

C: Sx (4)

D: Other Dx this can be confused with: (4)

E: Tx

Answer 3

[Clostridium Botulinum]

A: (Serotypes A / B / E / F) cause human dz

B: -[Clostridium Botulinum] toxin is coded by a BACTERIOPHAGE -Inhibits AcH release —> [DESCENDING Flaccid Paralysis] -[Clostridium Botulinum] toxin is [Heat Labile Sensitive]

C: -[nausea / diarrhea] -dry mouth -[DESCENDING Flaccid Paralysis w/ normal HR and temp] - [Wound Botulism]

D: Other Dx this can be confused with: TEMg

1. [Myasthenia Gravis] 2. [Eaton Lambert] 3. [Tick Paralysis] 4. [Guillarin - Barre]

E: Tx Antitoxin

Question 4

[Clostridium Difficile]

Tx (5)

Answer 4

Tx for [Clostridium Difficile]

1. Metronidazole PO
2. Vancomycin PO
3. Cholestyramine (binds to Toxin)
4. [Colon Resection]
5. Lactobacillus transfer via [fecal enema]

Question 5

Propionobacterium acnes - PBA

A: _____[fast/slow] growing AnAerobe that’s a Common Contaminant in _____ _____

B: – Cause of infection: (3)

C: Treatment

D: Which abx is contraindicated

Answer 5

Propionobacterium acnes- PBA (single)
A: • Slow growing AnAerobe that’s a Common Contaminant in blood cultures

B: – Cause of infection:

• Prosthetic devices or hardware
• Opportunistic infections
• Acne

C: Treatment – if indicated
• Penicillin

D: DO NOT USE metronidazole!!

Question 6

[Bacteroides Fragilis] Family:
A: Characterisitics (4)

B: Hallmark of [Bacteroides Fragilis] Infection =_______

B2: Why does this sx form?

C: Virulence Factors (3)

D: Endotoxin?

Answer 6

[Bacteroides Fragilis] Family:

“Bacteroides characteristics are EF’N Nuts!”

A: Characterisitics

1) ENRICHED MEDIA NEEDED
2) Flora of Colon

3) Non-Spore forming
4) Non-Motile
B: Hallmark of [Bacteroides Fragilis] Infection = [MIXED Abscess w/aerobes and AnAerobes]

B2: Abscess is [encapsulated pus] and inflammatory rxn to infection

C: Virulence Factors= CPS

• SOD [super oxide dismutase] –> O2 tolerance
• Catalase
• [Polysaccharide capsule]

D: has a DEFECTIVE ENDOTOXIN

Question 7

A1:Where are [Bacteroides Fragilis] more commonly recovered from during infection? (4)

A2: What is the AnAerobe to Aerobe mix?

Answer 7

[Bacteroides Fragilis] are most commonly recovered from
*Intraabdominal infections (more AnAerobe)
*Female Genital Tract (more AnAerobe)
*[Skin and Soft Tissue Infections] (more AnAerobe)

*Aspiration PNA (MIXED)

Question 8

A: [______ ______] are the 2nd caused of Brain Abscess

A2: The Infection is (mixed vs. single)
•
B: Where do they normally reside (3)?

C: Gram Stain? [Aerobic vs. AnAerobe]?

D: Pathogensis = ______ formation – VERY SIMILAR TO ______ but are [non-encapsulated] and require ______ media

E: Mechanism?

Answer 8

A: [Prevotella species] are the 2nd caused of Brain Abscess

A2: Infection is (mixed)
•
B: Residents of
1. Mouth (Prevotella melaninogenica)
2. GI Tract (Prevotella bivia and disiens)
3. Pelvis

C: Gram negative / strict AnAerobes

D: Pathogenesis = abscess formation – VERY SIMILAR TO BACTEROIDES but are [non-encapsulated] and require enriched media

E: mechanism unknown

Question 9

Fusobacterium (mixed or single) – nucleatum
A: Dzs (6)

B: Tx (3)

Answer 9

Fusobacterium (mixed or single) – F. nucleatum
Dzs:

“Fusobacterium can B L E A C H You! and you Treat it with PAM”

1. Brain Abscess
2. Lung Abscess
3. Empyema
4. Aspiration PNA
5. Chronic Otitis Media
6. Hepatic Abscess

B: Tx = PAM

*Piperacillin + Tazobactam

* [Ampicillin + Sulfabactam]

*Metronidazole

Question 10

Fusobacterium (mixed or single) – NECROphorum

A: Dz (2)

B: What’s special about this one?

C: Tx (3)

Answer 10

– [Fusobacterim NECROphorum]
• Lemierre’s syndrome/ post anginal sepsis
• widespread metastatic infection

B: Highly virulent – POTENT ENDOTOXIN

C: Tx PAM

*Piperacillin + Tazobactam

*[Ampicillin + Sulfabactam]

*Metronidazole

Question 11

A: BACTEROIDES ABX (4)

B: Which Abx CAN’T you use

Answer 11

What are the Abx for Bacteroides:

[PAM + Carbapenem]

1) Piperacillin + Tazobactam
2) [Ampicillin + Sulfabactam]
3) Metornidazole
4) Carbapenems

B: CAN’T USE PENICILLIN

Question 12

3 Strains of Chlamydia

Answer 12

[Chlamydia trachomatis]

[Chlamydia pneumoniae] –> WAP [Walking Atypical PNA]

[Chlamydia Psittaci] (acquired from inhaling Parrot droppings)

Question 13

**[Chlamydia Trachomatis - (A to C)] can cause ________

A1. ________ and ________—> scarring and vascularization
A2: LEADING CAUSE OF ________ WORLDWIDE

B: Tx (3)

Answer 13

**[Chlamydia Trachomatis - (A to C)] can cause TRACHOMA

A1. [Chronic Conjunctivitis] and [Eyelid curling]—> scarring and vascularization
A2: LEADING CAUSE OF BLINDNESS WORLDWIDE

B: Tx = “You need SAT to treat [Chlamydia (A-C)] “
1. [Tetracycline 1% Ointment] (also use for [Neonatal Inclusion Conjunctivitis] from (D-K))

2. Azithromycin
3. Surgery

Question 14

How do you lab dx [Chlamydia Psittachi] ?

Answer 14

Complement Fixation -4 Fold INC or IgM > 1:16

Question 15

A: What’s the Smallest organism grown in cell free medium?

B: What can you stain it with, if desired?

C: Pathogenesis of this organism

Answer 15

[MycoPLASMA Pneumoniae]

B: Fluorescent Antibodies

C: Binds to [oligosaccharide receptors] and Acts like a superantigen, recruiting [TNF/ IL1/ IL6] —> INFLAMMATORY RESPONSE

Question 16

[Mycoplasma HOMINUS]
A: Common isolate in ________ _______ and is the
Cause of fever following ______ or _______

B: Sx (4)

C: What do you diagnose with

D: Tx (3)

E: DO NOT USE _______

Answer 16

Mycoplasma hominus
A: Common isolate in bacterial vaginosis and is the
Cause of fever following abortion or [post partum endometritis]

B: Associated with:

“NOTS get Mycoplasma HOMINUS”

• [tubo-ovarian abscess]
• salpingitis
• Opportunistic infection
• [Neonatal CNS Problems]

C: Diagnosis: mycoplasma broth

D: Treatment:
*tetracycline,
*clindamycin,
*chloramphenicol;

E: DO NOT USE MACROLIDES

Question 17

3 Demographics at risk for Legionella Infection

Answer 17

1. Transplant Organ Recipient
2. Cigarette Smoking
3. Chronic Lung Dz

Question 18

Legionella Pathogenesis

A: Transmission

B: Pathogenesis

C: How does it kill cells?

D: Immunity for this?

E: What Microscopy do you use for Legionella?

Answer 18

Legionella: Pathogenesis
A: infectious AEROSOLS

B: [Legionella OMP (porin)] binds to [C3b complement receptor] on [mononuclear phagocytes] —> Phagocytosis
-After Phagocytosis, Legionella inhibits phagolysosome fusion→intracellular multiplication

C: Kill cell with lysis of vacuole

D: Immunity – Cell mediated
– Requires sensitized T-cells to activate macrophages

E: [DieterLe Silver Stain]