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Dermatology > Microbiology > Flashcards

Microbiology Flashcards

1
Q

what is virulence based on?

A

the genetics of the organism

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2
Q

what is virulence?

A

the capacity of a microbe to cause damage to the host

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3
Q

what is adhesin?

A

enables binding of the organism to host tissue

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4
Q

what is invasin?

A

enables the organism to invade a host cell/tissue

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5
Q

what is impedin?

A

enables the organism to avoid host defenses i.e. barriers

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6
Q

what is aggressio?

A

causes damage to the host directly

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7
Q

what is modulin?

A

induces damage to the host indirectly i.e. induces host’s own immunity system to turn on the host

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8
Q

name the virulence factors

A 
adhesin
invasin
impedin
aggressin
modulin
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9
Q

where is Staph. aureus found on the body as a commensal organism?

A

anterior nares & perineum

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10
Q

what is a virulence factor?

A

an ability of the organism which enables it to survive

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11
Q

what is the pathogenicity of staph. aureus?

A

can cause:
superficial lesions
systeimic problems
toxinoses

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12
Q

name two types of adhesins

A

fibrinogen-binding

collagen-binding

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13
Q

name an impedin

A

being a superantigen

PVL

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14
Q

what is a Panton-Valentine Leukocidin (PVL)?

A

a specific toxin for leukocytes associated with severe skin infections
assoc. with CA-MRSA

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15
Q

what two main conditions is PVL responsible for?

A

necrotising pneumonia & contagious severe skin infections

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16
Q

what are the clinical features of necrotising pneumonia?

A

necrotising haemorrhagic pneumonia
acute respiratory distress
refractory hypoxaemia
multi-organ failure

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17
Q

what type of symptoms usually precede necrotising pneumonia?

A

influenza like syndrome

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18
Q

how does narcotising pneumonia progress?

A

rapidly

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19
Q

name a suprantigen

A

TSST-1, causes a massive release of cytokines & an inappropriate immune response

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20
Q

what is the diagnostic criteria for toxic shock?

A

fever
diffuse macular rash & desquamation
hypotension
3+ organ systems involved

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21
Q

what does streptococcus pyogenes cause?

A

GAS

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22
Q

which skin infections does streptococcus pyogenes cause?

A

impetigo
cellulitis
necrotising faciitis

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23
Q

what is Lancefeild grouping?

A

a method of grouping catalase-negative, coagulase-negative bacteria based on the carbohydrate composition of bacterial antigens found on their cell walls

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24
Q

which Lancefeild group are streptococcus pyogenes in?

A

group A

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25
Q

how is group A of the lance field system further divided?

A

by the M protein antigens

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26
Q

what are the M1 & M3 protein antigens on streptococcus pyogenes?

A

the major serotype

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27
Q

what are the M3 & M18 protein antigens on streptococcus pyogenes?

A

severe invasive disease

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28
Q

what is impetigo?

A

usually found on the face, is an infection immediately below the surface (in the stratum corneum). highly contagious through contact with discharge on the face.

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29
Q

what is cellulitis?

A

a general term for infection deeper in the skin, in the dermis, not associated with necrosis

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30
Q

what is erysipelas?

A

a localised range of spreading subcutaenous skin infections with fever, rigours and nausea

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31
Q

how does necrotising fasciitis come about?

A

invasive strep. A strains penetrate mucous membranes & develop in lesions which rapidly destroy connective tissue

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32
Q

name a toxin responsible for tissue/cell destruction?

A 
hemolysins 
streptolysin S (SLS)
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33
Q

how is SLS toxic to cells?

A

is a pore forming cytolysin

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34
Q

how does toxic shock like syndrome come about?

A

through pyrogenic exotoxins as a complication of invasive infections which can be caused by Strep. pyogenes

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35
Q

explain what transient flora are?

A

harmless organisms that live on the skin until it is washed & tired effectively

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36
Q

where are S. epidermidis found?

A

100% colonisation on skin & mucous membrane

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37
Q

when will S. epidermidis cause an infection?

A

in the immunocompromised, associated with foreign devices like catheters

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38
Q

what does a coagulase do?

A

promotes the formation of clots

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39
Q

what does fibrinolysin do?

A

promotes the dissolution of clots

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40
Q

what skin conditions can Staph. aureus cause?

A 
rash
folliculitis
abscess
carbuncles 
impetigo 
scalded skin syndrome
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41
Q

what is a carbuncle?

A

a multi-follicle abscess

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42
Q

what is community acquired Staph. aureus likely to cause?

A

rash
abscesses
carbuncles

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43
Q

what does the presence of collagen-binding protein in an organism mean?

A

that it is likely to affect specific sites such as bone

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44
Q

do most staph. aurues in the community have fibrinogen or collagen-binding properties?

A

fibrinogen-binding properties

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45
Q

what is a toxin?

A

a single protein component that has a specific affect on the body

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46
Q

why can’t necrotising pneumonia be supplemented with oxygen?

A

as the tissue needed to absorb the oxygen has already been destroyed

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47
Q

how does menstrual toss shock syndrome come about?

A

from the tampon becoming infected with S. aureus from the perineum being inserted into the body and then travelling into the bloodstream causing massive infection. S. aureus presumably got into the body via the perineum.

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48
Q

if an organism is very encapsulated, what would you expect to see in terms of virulence?

A

the organism to be very virulent

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49
Q

what does staphylococcus look like on gram stain?

A

gram positive cocci in clusters

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50
Q

which 2 types of staphylococcus are important?

A

staph. aureus

coagulase negative staph

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51
Q

how is staph aureus distinguished from all other staph. species?

A

is coagulase positive

i.e. produces enzymes including coagulase, an enzyme that clots plasma

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52
Q

where does staph. aureus cause infections?

A

can cause infections anywhere but specifically:

  • wound
  • skin
  • joints
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53
Q

which antibiotic should be given in an staph. aureus infection?

A

flucloxacillin

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54
Q

which toxins do some strains of staph. aureus produce?

A

enterottoxin
SSSST
PVL

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55
Q

what does enterotoxin do to the body?

A

causes food poisoning

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56
Q

what is SSSST?

A

staph. scalded skin syndrome toxin

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57
Q

how does PVL work?

A

punches holes in the membranes of leukocytes

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58
Q

what does PVL usually cause in the UK?

A

abscesses

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59
Q

what are coagulase negative staphs usually?

A

skin commensals

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60
Q

what factor makes it difficult for white cells to attack coagulase negative staph?

A

they produce a slime

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61
Q

what does staph. saprophyticus cause?

A

urinary tract infection in women of child-bearing age

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62
Q

what do streptococcus species look like on gram stain?

A

gram positive cocci in chains

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63
Q

how are streptococcus species classified?

A

by hamolysis on blood agar

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64
Q

what is beta-haemolysis?

A

complete haemolysis

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65
Q

what is alpha-haemolysis?

A

partial haemolysis

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66
Q

what is gamma-hamolysis?

A

no haemolysis

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67
Q

are beta-haemolytic strep. pathogenic or not?

A

pathogenic organisms

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68
Q

name a toxin that beta-haemolytic strep. produce that damages tissue?

A

haemolysin

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69
Q

how are beta-haemolytic strep. further classified?

A

by antigenic structure on surface (serological grouping) - group A or B

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70
Q

give examples of infections caused by group a strep.

A

throat infections

severe skin infections

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71
Q

give an example of an infection caused by group b strep.

A

meningitis in neonates

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72
Q

wha are the 2 important categories of alpha-haemolytic strep?

A

strep. pneumoniae

strep. viridans

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73
Q

what is strep. pneumoniae?

A

a pathogen

the commonest cause of pneumonia

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74
Q

what are strep. viridans?

A

commensals of the mouth, throat & vagina

rarely cause infection

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75
Q

name a non-haemolytic strep species

A

enterococcus species

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76
Q

what do enterococcus species do?

A

commensal of bowel

common cause of UTIs

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77
Q

what does dry skin mean in terms of defence against infection?

A

causes desiccation of micro-organisms

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78
Q

what does sebum do in terms of defence against infection?

A

inhibits bacterial growth

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79
Q

what do gram positive organisms have which mean they are unlikely to dry up?

A

a very thick cell wall

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80
Q

what competitive bacterial flora are present on the skin?

A

staphylococcus epidermidis
corynebacterium sp.
proprionbacterium sp.

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81
Q

what bacterial skin infections are caused by staph aureus?

A 
boils & carbuncles
minor skin sepsis 
cellulitis 
infected eczema 
impetigo 
wound infection 
staphyloccal scalded skin syndrome
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82
Q

which of boils & carbuncles need antibiotics?

A

carbuncles need antibiotics, boils don’t

83
Q

what bacterial skin infections are caused by strep pyogenes (group A strep)?

A 
infected eczema
impetigo 
cellulitis 
erysipelas
necrotising fasciitis
84
Q

how are bacterial skin infections diagnosed?

A

using a swab of the lesion if the surface is broken
by pus or tissue if deeper lesion
+/- blood cultures, if aprorpriate

85
Q

what is first line treatment of strep. pyogenes?

A

penicillin

86
Q

what is treatment of necrotising fasciitis?

A

life-threatening condition, requires immediate surgical debridement & antibiotics

87
Q

how does necrotising fasciitis spread?

A

along fascial planes below skin surface causing rapid tissue destruction

88
Q

what would you see on the skin surface in necrotising fasciitis?

A

very little to see on skin surface but severe pain

89
Q

what are the two types of necrotising fascitiis?

A

type 1 - mixed anaerobe & coliforms

type 2 - group A strep infection

90
Q

when is type 1 necrotising fasciitis usually found?

A

usually post-abdominal surgery

91
Q

when would you swab a leg ulcer?

A

if signs of cellulitis or infection are present

92
Q

which organisms are worth treating in leg ulcers?

A

strep. pyogenes (group A), staph. aureus, other beta-haemolytic strep, anaerobes especially in diabetics

93
Q

what does tinea mean?

A

ringworm

94
Q

where is tinea capitis found?

A

scalp

95
Q

where is tinea barbae found?

A

beard

96
Q

where is tinea corporis found?

A

body

97
Q

where is tinea manuum found?

A

hand

98
Q

where is tinea unguium found?

A

nails

99
Q

where is tinea cruris found?

A

groin

100
Q

where is tinea pedis found?

A

foot

101
Q

are males or females more commonly affected by dermatophyte infections?

A

males

102
Q

which age group does tinea capitis affect?

A

children (scalp ringworm)

103
Q

which sex do foot & groin ringworm mainly affect?

A

men

104
Q

where does anthropophilic fungi come from?

A

from other infected humans

105
Q

where does zoophilic fungi come from?

A

animals

106
Q

where does geophilic fungi come from?

A

soil

107
Q

how is trichophyton rubrum transmitted & how often is it seen in the lab?

A

human-human

accounts for majority of dermatophyte lab isolates

108
Q

how is trichophyton mentagraphytes transmitted & how often is it seen in the lab?

A

human-human

next most common dermatophyte lab isolate

109
Q

how is microsporum canis transmitted & how often is it seen in the lab?

A

cats/dogs-humans

only an occasional lab isolate

110
Q

how are dermatophyte infections diagnosed?

A

clinical appearance
woods light
skin scrapings, nail clippings, hair

111
Q

how do you treat dermatophyte infections in small areas?

A

clotrimazole cream or similar

topical nail paint

112
Q

how do you treat dermatophyte infections on the scalp?

A

terbinafine oraly

itraconazole orally

113
Q

where does candida infect on the skin?

A

skin folds where area is warm & moist

under breasts, groin areas, abdominal skin folds, nappy areas

114
Q

how is candida skin infection diagnosed?

A

swab for culture

115
Q

how is candida infection treated?

A

clotrimazole cream

oral fluconazole

116
Q

what organism causes scabies?

A

sarcoptes scabiei

117
Q

what is the incubation period of scabies?

A

up to 6 weeks

118
Q

what does scabies feel & look like?

A

intensely itchy rash affecting finger webs, wrists & genital area

119
Q

how do you treat scabies?

A

malathion lotion applied overnight to whole body & washed off next day
benzyl benzoate

120
Q

what age group should benzyl benzoate be avoided in?

A

children

121
Q

what organism causes head lice?

A

pediculus capitis

122
Q

what organism causes body louse?

A

pediculus corporis

123
Q

what name is given to body louse

A

Vagabond’s disease

124
Q

what organism causes pubic louse?

A

phthirus pubis

125
Q

what symptom are lice associated with?

A

intense itch

126
Q

how are lice treated?

A

malathion

127
Q

what organism are chickenpox & shingles due to?

A

both due to varicella zoster virus

128
Q

who gets chickenpox?

A

children

129
Q

what happens in chickenpox?

A

generalised rash & fever

130
Q

what does the chickenpox virus do after the symptoms are gone?

A

virus establishes latency in sensory nerve roots

131
Q

when chickenpox is reactivated what does it come back as?

A

shingles

132
Q

when does shingles occur?

A

typically in old age

133
Q

how does the singles rash appear on the body?

A

dermatomal

134
Q

how does chickenpox appear & disappear?

A

macules -> papules -> vesicles -> scabs -> recovery

135
Q

what are the symptoms of chickenpox?

A

fever
itch
rash

136
Q

what complications can occur in chickenpox?

A
  • secondary bacterial infection
  • pneumonitis
  • haemorrhagic
  • scarring, absent or minor
  • encephalitis
137
Q

what are the predictors of severity in chickenpox?

A

extremes of age

depressed cell mediated immunity

138
Q

when does neonatal VZV occur?

A

secondary to chickenpox in mother in late pregnancy

139
Q

what risk is associated with neonatal VZV?

A

higher mortality

140
Q

how is neonatal VZV prevented in susceptible women?

A

prevention with varicella zoster immune globulin

141
Q

who does shingles occur in?

A

elderly & immunocompressed

142
Q

what does shingles feel & look like?

A

tingling pain -> erythema -> vesicles -> crusts

143
Q

in which age group is the pain of shingles worse?

A

greater with increasing age

144
Q

what does the pain in shingles feel like?

A

neuralgic in character

145
Q

is scarring common in shingles?

A

no

146
Q

which nerve does shingles affect?

A

trigeminal

147
Q

what can occur after ophthalmic zoster?

A

scarring & red eye

148
Q

when can ophthalmic zoster occur in children?

A

if chickenpox in utero or if they become immunocompromised

149
Q

which dermatome does shingles occur in adults?

A

thoracic & lumbar

150
Q

which dermatome does shingles occur in children?

A

sacral & cervical

151
Q

what is Ramsay-Hunt syndrome?

A

vesicles & pain in auditory canal & throat

facial palsy

152
Q

what is ramsay-hunt syndrome due to?

A

irritation of the 8th cranial nerve

153
Q

what symptoms are associated with irritation of the 8th cranial nerve?

A

deafness
vertigo
tinnitus

154
Q

what is in the chickenpox vaccination?

A

live attenuated vaccine

155
Q

what is used as a vaccination for shingles?

A

Same attenuated VZV used in chickenpox vaccine can be used in high titre preparation in elderly to reduce impact of shingles

156
Q

what does herpes simplex virus cause?

A

primary gingivostomatitis

extensive ulceration in & around the mouth

157
Q

who does herpes simplex virus affect?

A

pre-school children

158
Q

how long does herpes simplex virus last?

A

around a week

159
Q

what happens in recurrence of herpes simplex virus?

A

a blistering rash at the vermillion border which can spread

160
Q

what does herpes simplex virus type 1 cause?

A

main cause of oral lesions, causes half of genital herpes & causes encephalitis

161
Q

what does herpes simplex virus type 2 cause?

A

is a rare cause of oral lesions, causes half of genital cases & causes encephalitis/disseminated infection

162
Q

which antiviral is used in VSV & HSV?

A

aciclovir

163
Q

which lab tests are done to confirm VSV & HSV?

A
  • swab with viral transport medium

- antibody tests

164
Q

what does erythema multiforme look like?

A

target lesions with erythema

165
Q

what can trigger erythema multiforme?

A

many triggers including drug reactions & some infections (HSV & mycoplasma pneumoniae bacterium)

166
Q

what does molluscum contagiosum look like?

A

fleshy, firm, umbilicated pearlescent nodules 1-2mm diameter

167
Q

how long does molluscum contagiosum last?

A

self-limiting but take moths to disappear

168
Q

which age group is molluscum contagiosum common in?

A

common in children

169
Q

how can molluscum contagiosum be treated?

A

with local application of liquid nitrogen

170
Q

which virus causes warts?

A

human papilloma virus

171
Q

which age group are warts commonest in?

A

children

172
Q

how long do warts last?

A

self-limiting & uncomplicated

173
Q

what other disease does HPV cause?

A

genital warts
cervical cancer
head & neck cancer

174
Q

what does herpangina cause?

A

blistering rash at back of mouth

175
Q

what is herpangina caused by?

A

enterovirus e.g. cocksackie virus & echovirus

176
Q

how long does herpangina last?

A

self-limiting

177
Q

how is herpangina diagnosed?

A

swab of lesion & sample of stool for enterovirus for PCR

178
Q

who is hand, foot & mouth disease common in?

A

in children, usually family outbreaks

179
Q

what causes hand, foot & mouth disease?

A

enteroviruses

180
Q

what does erythema infectiosum look like?

A

a slapped cheek

181
Q

what happens as the facial rash fades in erythema infectiosum?

A

a lacy macular rash on the body appears

182
Q

what complications can occur in parvovirus B?

A

spontaneous abortion
aplastic crises
chronic anaemia

183
Q

what is an aplastic crisis?

A

sudden drop in haemoglobin seen in patens with short red cell like span

184
Q

how is parvovirus B confirmed in the lab?

A

by antibody testing

185
Q

what is orf?

A

a virus of sheep, “scabby mouth”

186
Q

what does orf look like?

A

firm, fleshy nodule on hands

187
Q

who is orf found in?

A

farmers

188
Q

how long does orf last?

A

self-limiting

189
Q

how orf confirmed, clinically or by the lab?

A

clinically

190
Q

how many phases of infection are there of syphilis?

A

3

191
Q

describe the primary phase of infection of syphilis

A

chancre - painless ulcers at site of entry

192
Q

describe the secondary phase of infection of syphilis

A
  • red rash over body
  • prominent on soles of feet & palms of hands
  • “snail track” ulcers on mucous membranes
193
Q

describe the tertiary phase of infection of syphilis

A

affects the CNS, CVS etc

194
Q

what is syphillis due to?

A

sexually transmitted infection with bacterium treponema pallidum

195
Q

how is syphilis diagnosed?

A

by blood tests or swab of chancre for PCR

196
Q

how is syphilis treated?

A

using injections of penicillin

197
Q

what is the vector used in lyme disease?

A

ticks

198
Q

what causes lyme disease?

A

borrelia burgdoferi

199
Q

how does lyme disease present early on?

A

erythema migrans

200
Q

how does lyme disease present later on?

A

heart block
nerve palsies
arthritis

201
Q

how do you treat lyme disease?

A

doxycycline or amoxicillin

202
Q

when is lab confirmation of lyme disease used?

A

mainly for late presentations

203
Q

what is the lab confirmation for lyme disease?

A

blood test for antibody to organisms

204
Q

what is the pathogenic feature of lyme disease?

A

the rash; erythema migrans

Dermatology (16 decks)

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