Renal Exam 2 Flashcards
Escherichia coli
lab tests
E. Cola’s soda fountain
gram (-) bacillus
Facultative Anaerobe
oxidase (-)
catalase (+)
Green metallic** sheen on **EMB agar
Ferments Lactose (+) → pink on MacConkey’s agar
Encapsulated
Escherichia coli
VF
E. Cola’s soda fountain
- Main VF are Capsular K antigen and Flagellar H antigens.
* causes neonatal meningitis only if has the K antigen
- E. coli is leading cause of gram (-) sepsis by LPS endotoxin in outer cell membrane
- Fimbriae lead to UTI’s (#1 cause of UTI’s)
Escherichia coli
Major pathotypes of E. coli
E. Cola’s soda fountain
* Enterohemorrhagic E. coli (EHEC)
* Enterotoxigenic E. coli (ETEC)
Enteropathogenic E. coli (EPEC)
Enteroinvasive E. coli (EIEC)
Enteroaggregative E. coli (EAEC)
Adherent-Invasive E. coli (AIEC)
Escherichia coli
Enterohemorrhagic E. coli (EHEC)
E. Cola’s soda fountain
Severe Hemorrhagic Colitis caused by strain 0157:H7.
Common cause is undercooked meat.
Causes bloody diarrhea with little to no fever but mucosal inflammation or invasion..
EHEC is the only E. Coli that does not ferment sorbital.
Shiga-like Toxin inhibits ribosomes at the 60s position → can cause hemolytic uretic syndrome (HUS)
Escherichia coli
Shiga-like Toxin
E. Cola’s soda fountain
Shiga-like Toxin is from the Enterohemorrhagic (EHEC) strain of E. coli
Shiga-like Toxin inhibits ribosomes at the 60s position → can cause hemolytic uretic syndrome (HUS)
Shiga-like Toxin damages endothelial cells of capillaries in the glomerulus → platlets adhere to damaged endothelial cells → ⬇ platelet count → causing thrombocytopenia → platelet clumps hemolysis RBC’s
Escherichia coli
Enterotoxigenic E. coli (ETEC)
E. Cola’s soda fountain
“Traveler’s Diarrhea”
Heat Labile toxin → produces cAMP (symp effects)
Heat Stable toxin → produces cGMP (p.s. effects)
Watery DIarrhea
Escherichia coli
Treatment
E. Cola’s soda fountain
TMP/SMX or fluoroquinolones
Klebsiella, Enterobacter, Serratia
lab tests
(common to all three)
Hospital room scene
gram (-) bacilli
Ferments Lactose → turns pink on MacConkeys
Klebsiella, Enterobacter, Serratia
Enterobacter ddx
Shared traits
gram (-) bacilli
Ferments Lactose → turns pink on MacConkeys
Hospital room scene
Very motile
Klebsiella, Enterobacter, Serratia
Serratia ddx
Shared traits
gram (-) bacilli
Ferments Lactose → turns pink on MacConkeys
Hospital room scene
Very motile
Red pigment when cultured
(like a pink ring around shower or bright red)
Catalase (+)
Klebsiella, Enterobacter, Serratia
Klebsiella ddx
Shared traits
gram (-) bacilli
Ferments Lactose → turns pink on MacConkeys
Hospital room scene
* 3 A’s!!! (Alcoholics, Abscesses, Aspiration)
* sputum that is red color
Klebsiella is Immotile
Urease (+)
Polysaccharide capsule
Cavatary “TB like” lesions
Klebsiella, Enterobacter, Serratia
Treatment
Hospital room scene
Multi Drug Resistant Carbopenam
or
Clindamycin
Proteus mirabilis
lab tests
The god of the public restroom
gram (-) bacillus
Facultative Anaerobe
Swarming motillity when plated
urease (+)
H2S (+)
Proteus mirabilis
signs and symptoms
The god of the public restroom
Stag horn calculi, kidney stones
(urease → ⬆ pH → kidney struvite stones → stag horn calculi on imaging)
Pain
UTI’s
FIshy Odor
Proteus mirabilis
Treatment
The god of the public restroom
Sulfonamides
Pseudomonas
lab tests
The suiters of pseudo Mona
gram (-) bacillus
obligate Aerobe
oxidase (+)
catalase (+)
Blue green pigment when plated (from Pyocyanin and pyoverdin, may even turn wounds blue)
Encapsulated
Pseudomonas
signs and symptoms
The suiters of pseudo Mona
* Thrives in aquatic environments (HOT TUB FOLLICULITIS)
- ⬆ risk if pt has Chronic Granulomatous Disease
- Fruity grape like odor
- May turn wounds blue (from Pyocyanin and pyoverdin)
- Most common gram (-) Nosocomial Pneumonia
- Osteomyelitis in IV drug users and diabetics
- UTI’s (catheters!)
- Burn patients are especially susceptile
- Ecthyma gangrenosum
- Otitis Externa (Swimmers ear)
Pseudomonas
Respiratory failure in who?
The suiters of pseudo Mona
Respiratory failure in CF patients.
Most common gram (-) Nosocomial Pneumonia.
(CL- channels dysfunctional in CF)
Pseudomonas
MOA
The suiters of pseudo Mona
Exotoxin A
Ribosolation of EF2** → inhibition of protein synthesis and cell death
Pseudomonas
Treatment
The suiters of pseudo Mona
Piperacillin (penicillin)
amingoglycosides
and Fluoroquinolones
Staphylococcus saprophyticus
lab tests
Beauty and the Plumber
gram (+) cocci
catalase (+)
coagulase (-)
urease (+)
S. Saprophyticus = Novobiocin resistance
Staphylococcus saprophyticus
signs and symptoms
Beauty and the Plumber
UTI’s
in
Sexually Active Females
Neisseria species overview
lab tests
Noir Series
gram (-) Diplococci
Oxidase (+)
Grows on Chocolate agar
Inhibited on Blood agar
Thayer martin (AKA VPN) is selective agar enriched with vancomycin, polymixin, and nystatin
*Carbohydrate fermentation (+) ddx with Moraxella catarrhalis which is also gram (-) diplococci but is carb ferm (-)
Neisseria species overview
MOA
Noir Series
MAC defiency
Unable to form the MAC complex due to complex c5-c9 being inhibited, leads to increased Neisseria infections.
Neisseria species overview
VF
Noir Series
Pilli allow the attachment to surfaces and display antigenic variation
IgA protease will cleave IgA at its hinge point, facilitating survival along mucosal surfaces.
Neisseria gonorrhea
Treatment
The Violinists last Clap
3rd generation cephalosporin
-ceftriaxone
Treat for chlamydia coinfection
-macrolide Zpack
Neisseria gonorrhea
MOA
The Violinists last Clap
STI
NOT encapsulated
Facultative intracellular
Invade PMN’s
(Polymorphonuclear leukocytes; Neutrophils, eosinophils, and basophils)
Neisseria gonorrhea
Signs and symptoms
The Violinists last Clap
Effects genitalia first
May cause Polyarthritis, often in knee and is asymmetric
Males:
causes urethritis, prostatis, and orchiditis
Females:
PID (Pelvic Inflammatory DIsease) → purulent white discharge
Fitz Hugh Curtiss syndrome → Violin string like lesions in liver from spread into peritoneum
Neisseria gonorrhea
Delivery / Birth
The Violinists last Clap
Can be passed on to the baby during delivery
N. gonorrhea causes conjunctivitis within 5 days of birth
* vs chlamydia which is usually > 7 days after birth
Chlamydia Trachomatis, Pneumonia, and Psittaci
lab tests
The pirates of Calam Island
gram indeterminate (does not gram stain)
use Giemsa stain or NAAT test (aka PCR)
obligate intracellular (cannot create its own ATP, like ricketsia)
Lacks muramic acid in the cell wall.
Elementary and Reticulate bodies.
Chlamydia Trachomatis, Pneumonia, and Psittaci
Elementary vs. Reticulate bodies.
The pirates of Calam Island
Elementary bodies:
1st stage of life cycle outside of cell. The infectious form! Elementary enters the eukaryotic cell and is taken up by phagosomes.
Reticulate bodies:
Dividing form! Reticular replicates to form inclusion bodies seen under microscope in cells when infected.
*After bacteria replicate with its host cells, they leave the cell and become elementary stage again
Chlamydia Trachomatis
3 main groups of C. Trachomatis
The pirates of Calam Island
3 main groups of C. Trachomatis
- A-C → Blindness
- D-K → STI
- L1-L3 → LGV
* “Can’t see, Can’t pee, Can’t climb a tree” (Reiter’s syndrome)
Chlamydia Trachomatis
Blindness group of C. Trachomatis
The pirates of Calam Island
C. trachomatis A-C → Blindness
Trachoma is the leading cause of blindness in the world!
Transmission is usually from hand to eye contact, but can also be from fomites (objects like clothes or phones)
* mnemonic “A-_C (see) with your eyes_”
Chlamydia Trachomatis
STI group of C. Trachomatis
The pirates of Calam Island
C. trachomatis D-K → STI
- Most common bacterial STI in the U.S.
- Watery discharge (vs. Gonorrhea with mucoprulent).
- Can lead to PID w/o symptoms or ectopic pregnancies.
- If mother has it during delivery can lead to neonatal conjunctivitis and pneumonia. Presents in 1-2 weeks (vs. Gonorrhea in 2-4 days) as possible staccato cough (short sudden bursts with breath inbetween) or conjunctivitis.
Chlamydia Trachomatis
LGV group of C. Trachomatis
The pirates of Calam Island
C. trachomatis L1-L3 → LGV (Lymphogranuloma Venerum)
(also is an STI)
- Starts with painless genetial ulcer (similar to syphilis)
- Presents as tender lymphadenopathy with draining lymph nodes.
Chlamydia Trachomatis
Reiter’s syndrome
The pirates of Calam Island
Reiter’s syndrome Triad
- Cant see (Conjunctivitis)
- Can’t pee (Urethritis)
- Can’t climb a tree (Arthritis)
* Reactive arthritis due to cross reaction of antibodies fighting chlamydia hitting the knee or sacroiliac joint.
Chlamydia Trachomatis, Pneumonia, and Psittaci
treatment
The pirates of Calam Island
Macrolides - Azithromycin
Tetracycline - Doxycycline
* also tx for Co-infection of Chlamydia and Gonorrhea with cephtriaxone
Chlamydia Pneumonia
signs and symptoms
The pirates of Calam Island
Walking (atypical) pneumonia.
More commoin in the elderly.
Chlamydia Psittaci
signs and symptoms
The pirates of Calam Island
Transmitted by birds and bird droppings.
Causes pneumonia!
Schistosoma mansoni, japonicum, haematobium
Trematodes (flukes / flat worms)
source / infection cycle
San Fran-schisto ocean park (Schistosomiasis)
- Free living aquatic organisms → gain entrance through the skin → enter blood stream → carried to liver → mature into adults in the liver! → humans poop and pee into water → snails become intermediate hosts → adult then migrate AGAINST** the **portal flow in the venus system to reach their destination.
- S. mansoni and S. japonicum like to reside in mesenteric veins.
- S. haematobium likes to reside in veins of bladder.
Schistosoma mansoni, japonicum, haematobium
Trematodes (flukes / flat worms)
signs and symptoms
San Fran-schisto ocean park (Schistosomiasis)
- Swimmers itch where larvae penetrate the skin.
S. mansoni and S. japonicum:
- Portal HTN → (chronically) GI distension and abdominal pain.
- Liver cirrhosis and jaundice.
S. haematobium:
- Hematuria in bladder and risk of bladder cancer.
Schistosoma mansoni, japonicum, haematobium
Trematodes (flukes / flat worms)
lab tests / tx
San Fran-schisto ocean park (Schistosomiasis)
Tx for all Trematodes (flukes): Pra_z_iquantal**
On stool O&P you will see:
- S. mansoni: large lateral spine on the side of the body of the egg
- S. japonicum: small spine (or absent) on eggs. Mostly round.
- S. haematobium: Large terminal spine
Enterococcus
lab tests
Protest at the Caucus
gram (+) cocci
catalase (-)
6.5% NaCl Resistant (grows in 6.5% NaCl)
Bile resistant (grows in bile)
NOT encapsulated (ddx from S. Pneumonia)
Enterococcus
signs and symptoms
Protest at the Caucus
UTI’s
Endocarditis
Infection of biliary tree
Enterococcus
Treatment
Protest at the Caucus
Nosocomial infection resisant to almost every antibiotic we have.
Vancomycin resistant
Linezolid
Tigacycline
