All Flashcards
(251 cards)
1
Q
pseudomonas manifestation in ear is called?
A
swimmer’s ear/otitis externa; gross, pus exudates; its just gross;
1
Q
treatment for c. perfringens
A
penicillin works; use w/clindamycin (inhibits toxin synthesis)
2
Q
coxiella
relavent species?
epidemiology?
A
C. burnetii is most relavent species
found in animal reservoirs; commonly seen in farmers, ranchers, vets
2
Q
diagnosis of bordatella
A
culture on bordet-gengou or regan-lowe mediums
PCR, serology
2
Q
where does pseudomonas hang out?
who gets these infecitons?
A
loves wet places/fluids!
its ubiquitious in community and hospital
poeple w/compomised host defenses, disturbed barriers(burns, catheters, etc), and CF pts
3
Q
h. influenzae diseases(encapsulated and unencapsulated)
A
Hib - meningitis, conjuctivitis, cellulitis, epiglottitis, bacteremia, arthritis (ABCCME)
unencapsulated - otitis media, sinusitis, bronchitis, pneumonia (BOPS)
4
Q
describe the microbiological characteristics of acinetobacter
A
GN coccobacillus
non-lactose fermenter; oxidase NEGATIVE
aerobic and non-motile
5
Q
range of symptoms for **C. pneumoniae **infection
treatment?
A
common cold-like symptoms to atypical CA-pneumonia
infection is very common; virtually everyone is infected at one point in lifetime.
treat with doxycycline, erythromycin, quinolones(levofloxacin) at least 10 days
5
Q
diseases caused by m. hominis, m. genitalium & u. urealyticum
A
recovered colonies in 70-80% of SAAs; usually act as normal flora
opportunistic STIs; usually infect w/other pathogens
u. urealyticum can cause NGU
6
Q
Polymyxin B. Colistin clinical use
A
Serious resistant GN infections; inhaled resistant GN pneumonia
6
Q
treatment for actinomyces
A
prolonged penicillin
surgical debridement
can use erythromycin, clindamycin too
7
Q
name the virulence factors of coagulase negative staphylococci
A
slime layer(biofilm)
many same enzymes as s. aureus
NO TOXINS
antimicrobial resistance common
7
Q
bordatella toxins/virulence factors
A
- pertussis toxin (PTX):
- ADP-ribosyl transferase(Gi protein target)
- causes lymphocytosis(systemic disease); bad prognosis
- immunosuppressive when infecting, then causes inflamm later…bad
_ other toxins:_
a) adenylate cyclase toxin – targets and inactivates neutrophils
b) tracheal cytotoxin and **lipopolysaccharide - **combine to destroy cilia on epthelial cells
8
Q
ampicilin. amoxicilin adverse effects
A
in addition to hypersensitivity�.GI distress is common; maculopapular rash if treating mono(100% of pts)
8
Q
treatment for a pneumococcal meningitis
A
ceftriaxone and vancomycin
….macrolide if atypical
8
Q
mycoplasma morphology
A
NO WALL….evolved from GP
TINY(0.3-1u)
pleimorphic–>weird shapes
‘fried egg colony’ - most types
‘mulberry colony’ m. pneumoniae
9
Q
Vancomycin. activity
A
GP ONLY! MRSA activity; enterococci if susceptible; anaerobes
9
Q
newborn pt presents with erythematous skin with desquamation and widespread fluid filled, thin walled blistering. Culture from blister sample is negative for any bacteria. What toxin-related disease is on the differential?
A
scalded skin syndrome via exfoliative toxin from s. aureus
11
Q
amoxicillin. administration
A
PO
12
Q
cephalosporin resistances in general
A
intrinsic: pseudomonas. enterococci; membrane permeability; altered PBPs; B-lactamases
12
Q
Fosfomycin. administration
A
PO/Powder
13
Q
treatment for c. tetani
A
clean wound
metronidazole
passive immunization w/tetanus immunoglob
14
Q
Daptomycin. clinical use
A
complex GP infections(soft tissue; bacteremia/endocardidits)
14
Q
what is a localized SSSS
A
staphylocococcus scalded skin syndrome when localized, it is called bullous impetigo; blisters are filled with bacteria and inflammatory cells; local spread from infected wound
15
types of moraxella infections and treatment
otitis media, sinusitis, conjuctivitis(rarely systemic) treat with amoxicilin/clavulanate use cephalosporins for more serious
15
what disease does ***acinetobacter*** causeusually?
similar to pseudo:
catheter associated UTI(**CAUTI**)
ventilator associated pneumonia(**VAP**)
central line associated blood stream infeciton(**CLABSI**)
16
clinically relevant *legionella* spp.
***L. pneumophilia***
17
microbiological/lab characteristics of pneumococci
GP catalase negative alpha-hemolysis susceptible to optochin soluble in bile salts
18
virulence factors for mycoplasma
1. hemolysins(alpha or beta)
2. polysaccharide capsule
3. **Toxins**
1. m. pneumoniae - CA-resp distress syndrome(CARDS) toxin
2. ADP ribosylating
3. vacuolating toxin
19
**metronidazole** adverse effects
metallic taste;
HA, vertigo, confusion, psychosis,
disulfram-like effect w/alcohol(vomit, flush)
20
rifampin clinical use
prophylaxis for n. meningitidis, s. aureus mycobacterial infections
21
***bordatella*** treatment
1. **azithromycin** or **clarithromycin** to prevent spread(doesnt stop symptoms)
2. **supportive therapy** - hydration, nutrition, oxygen
22
***clostridium perfringens*** unique microbiology
large rectangular rods and "double zone" of hemolysis
rarely makes spores; aerotolerant; grows in culture fast
22
**atypical** pneumia presentation
more low grade flu-symptoms
can have extrapulmonary symptoms
diffuse disease, interstitial
23
cefepime activity
EXTREMELY GN active including pseudomonas; one of broadest spectrum agents available; still has GP activity; resistant to almost all b-lactamases 4th gen
23
stains for **acid fast** bacteria
**carbolfuchsin**
counter stain **methylin blue**
23
diagnostic microbiological charasteristics of *pseudomonas*
**non-lactose fermenting**
**oxidase positive**
**aerobic GN rod**
smells like grapes
24
leading cause of infectious/preventable blindness in world?
treatment?
**trachoma**
treat with erythromycin/macrolides
tetracyclines have chlamydia too but werent mentioned
treatment for trachoma is only effective in childhood....
25
name the tetracyclines, mechanism and activity
doxycycline tetracycline minocycline reversibly bind 30S subunit blocking tRNA access to mRNA broad GN(no pseudo) staph, strep(some CA-MRSA) some anaerobic atyps: chlamydia, mycoplasma 4(tetra) minos by the dox
26
treatment for a pneumococcal otitis
**amoxicillin** if fever is persistant dont need to treat right away
26
sequelae of ***chlamydia pneumoniae***
**_ATHEROSCLEROSIS_**
MS
chronic bronchitis
asthma
COPD exacerbation
reactive arthritis
AAA
stroke
26
**propionibacteria** is responsible for what diseases?
1. acne
2. opportunistic diseases via foreign bodies
* prosthetic heart valves
* prosthetic joints
* vascular catheters
27
causes woody, sulfur granules in its abcesses
has a molar tooth appearance upon culture
***actinomyces israelii***
27
type of ***clostridium tetani*** manifestation
1. **generalized** - masseter cntrcn; opisthotonos(back cntrcn); airway can become compromised from constant thoracic cntrcrn
2. **localized** - limited to site of inoculation; can develop into general
3. **cephalic**: injury to head/neck, in developing coutnries; characterized by cranial nerve involvement
4. **neonatal**: umbilical stump exposed to clay/dung
28
what are viridan streptococci?
alpha(partial) and gamma(none) hemolyzers
29
carbapenem administration
IV
30
isoniazid mechanism, clinical use
inhibits mycolic acid cell-wall syntehsis via O2 dependent pathways used for mycobacterial infections
31
carbapenem activity
VERY BROAD SPECTRUM; GN w/pseudomonas; GP;Anaerobes ertapenem = no pseudo/acinetobacter spp.
32
what disease is **mobiluncus** associated with
what is the treatment for this disease
bacterial vaginosis
metronidazole; however, note that mobiluncus is resistant to metronidazole
33
treatment for h. influenzae
**amoxicillin** for **non-invasive**(unencapsulated); **amoxicillin**-**clavulanate** for resistant strands
3rd gen cephalosporin(**cefotaxamine**) for **invasive Hib**(meningitis)
33
top bacterial causes of **sinusitis**
***strep pneumoniae***
***haemophilus influenzae***
***moraxella catarrhalis***
34
manifestation of ***c. diff***
ranges from anti-biotic diarrhea to life-threatening pseudomembranous colitis
35
phases of bacterial growth curve
lag phase - making machinery
log phase - GROWIN WOOOO
stationary phase - uh oh, running out of shit
decline phase(death phase) - aahgalkjf;lakshhg;lksdf
35
sterilization for things that could be damaged by moist heat(gauzes, dressings, powders)
Hot air sterilization
36
Dicloxacillin. administration
PO
36
***bacteroides fragilis*** cause what infecitons?
characterized by **abcess formation**
intraabdominal
pelvic/endometritis
surgical wound infections
skin/soft tissue infections after surgery/trauma
37
vats dis
mobiluncus
comma shaped, GP non-spore, anaerobic rod
38
who is at higher risk for legionella infections?
elderly/immunocompromised
smoking, chronic lung disease, TLR5(flagellum) polymorphism
39
Polymyxin B. Colistin activity
GN bactilli only
40
cefoxitin clinical use
prophylaxis for intra-abdominal surgery 2nd gen
40
antiseptic
substance used to **prevent multiplication of microroganism** when applied to living systems; **bacteriostatic**
41
what causes methicillin resistance?
acquiring **mecA** --\> **PBP2a** b-lactams cant bind their target enzyme(_transpeptidase_)
41
suppurative vs non-suppurative infections of s.pyogenes
suppurative(pus producing):
* pharyngitis(can be complicated by scarlet fever)
* impetigo, erysipelas, necrotizing fasciitis, strep. TSS
non-suppurative:
* rheumatic fever, rheumatic heart disease
* glomerulonephritis
41
germicide
substance that kills vegetative bacteria and SOME spores
41
***bacteroides fragilis*** is resistant to....
what should you treat with?
penicillins
**metronidazole** and antibiotics to cover other bugs in infection
42
structure of peptidoglycans
**NAG-NAM** sugar backbone
**peptide** cross-bridges and side chains(additional layers)
43
how is staphylococci differentiated from streptococci and enterococci?
microscopic morphology catalase +
44
ceftriaxone, ceftazidime activity
excellent GN activity 3rd gen
44
what are the constitutive ***s. aureus*** toxins?
**hemolysins -** destroy erythrocytes
**leukocidin** - destroys leukocytes and macrophages
**cytolytic peptides** - recruit PMN then kill em(overproduced in CA-MRSA)
45
disinfectant
substance used on non-living objects to render them non-infectious
kills vegetative bacteria, fungi, viruses but **no spores**
46
s. aureus virulence factors
**capsule**(sticky)
**Protein A:** binds IgGs, inhibits phagocytosis
**MSCRAMM**: adhesion proteins
**enzymes**
**toxins**
46
Thermophilic
mesophilic
psychrophilic
**thermo** - optimal temp is 65+-10ºC, min 35-40ºC
**_mesophilic_** - optimal temp is 37!!!(most pathogenic) min is 10-15ºC
**psychrophilic **
* **facultative** - similar to mesophilic but grow down to 0ºC
* **obligate** - opt is 17ºC, killed over 20ºC
46
factors involved in antibiotic resistance in **biofilms**
1. cells **grow slow** in there so they arent affected as much
2. cells in biofilm can get word that antibiotics are present and e**xpress stress responses** to induce resistance
3. antibiotics have **trouble penetrating**
46
top causes of pharyngitis
VIRUSES cause 90%
GAS for the rest
48
ampicillin, amoxicillin activity
widens spectrum to some GN(H. flu. E. coli; NOT pseudomonas)
48
what two resistances prevent vancomycin use?
**VISA**(vanco intermediat s. aureus) --\> **thickened wall**
**VRE**(vanco resistant entero) --\> changes d-ala binding to
48
pyrogenic exotoxins produced by ***s. pyogenes***
SpeA, SpeC - superantigens; responsible for scarlet fever and toxic shock syndrome; HLA dependent; encoded by bacteriophages
SpeB - cleaves IgG
49
treatment for acinetobacter?
complications?
need broad spectrums:
cephalosporin
carbapenem
amp/sulbactam
aminoglycoside
tigecycline
polymyxins
this drug can have lots of resistances
50
what MUST you do if you see a pt with *streptococcus **bovis ***
this is Group __ strep
colonoscopy
*s. bovis* group(including *s.gallolyticus*) is a **Group D** strep that is highly associated with **colon cancer**
51
Vancomycin. administration
IV/PO PO for c.diff; not absorbed
52
cephalexin. administration
PO
53
describe the non-constitutive toxins of s. aureus and their associated syndromes
**exfoliative toxin** --\>scalded skin syndrome
**enterotoxin(_premade_)** --\> food poisoning
**toxic shock syndrome toxin** --\> sepsis
53
streptolysin O, streptolysin S
hemolysins produced by ***s. pyogenes***
55
cephalosporins activity
GN increases w/generations(except 5); most have som GP ; no good against enterococci; only 1 good against MRSA. not much anaerobe activity
56
tigecycline, mechanism, activity, problems
semi-synthetic tetracycline very broad spectrum GN(no pseudo) GP(MRSA and VRE) most anerobes resistance develops rapidly...limits use; also increased mortality w/pneumonia pts....
57
diseases caused by ***legionella***
1. **Legionnaires Disease** - severe pneumonia
* fever, nonproductive cough, chills, HA
* cerebellar involvement often
* 15-20% moretality
* need antibiotics
2. **Pontiac Fever** - flu like symptoms(mild)
* high attack rate, but
* no person-person spread
* no therapy needed
58
common presentations of streptococci pneumoniae
otitis, sinusitis, bronchitis, pneumonia, meningitis, bacteremia
most common bacterial cause of **otitis**, **meningitis**
60
ceftriaxone clinical use
community acquired pneumonia meningitis(penetrates CSF) UTI
61
Nafcillin. Dicloxacillin clinical use
primarily used for methicillin-susceptible S. aureus
62
liquid disinfection
filtration! uses tiny pores that remove microorganisms(cant get rid of viruses)
used for enzymes, vaccines, antibiotics
63
Daptomycin cannot be used where?
inhibited by pulmonary surfactant. DON�T USE FOR PNEUMONIA; bactericidal
65
adverse effects of **TMP-SMX**
**common** - HANV, rash
**less** - hyperkalemia, hepatitis, pancreatits
**rare** - SCAR, anemias, thrombocytopenias, separates drugs from albumin, kernicterus
66
first line agents against MSSA bacteremia
nafcillin, cefazolin(dont need vanco, dapt if not MRSA)
68
unique PK/PD of rifampin
p450 inducer; can decrease concentrations of other drugs in body
69
M protein
virulence factor for ***s. pyogenes***
adhesive - binds many serum proteins including factor H and CD46 on keratinocytes
forms antibodies that react w/cardiac myosin and sarcolemma
**strongly** antiphagocytic
70
osler node vs janeway lesion what are these?
osler node is PAINFUL; erythematous nodule on thumb pad
janeway lesion is not paintful; erythematous nodule on hypothenar emminence
72
name the B-lactamase drug combos
ampicillin-sulbactam amoxicillin-clavanic acid piperacillin-tazobactam
74
Penicillin G. administration
IV
74
adverse effects of **fluoroquinolones**
**Common** - HANV(HA,nausea, vomiting) ab pain, dizzy
**less common** - long QT, tendon rupture, cartilage problems in kids, pregos can cause c.diff
75
describe **empiric** therapy for staphylococcal infections
what are good empiric **outpatient** therapies?
**if pt. is sick**(bacteremia/pneumonia)-
* vancomyicn
* daptomycin
* linezolid
* ceftaroline
**if pt. is not "sick"**(outpatient skin/soft tissue) -
* clindamycin
* TMP/SMX
* doxycycline
* linezolid
76
process of Gram staining
**crystal violet**
iodine to lock in stain to GP
declolorize w/alcohol(GN lose color)
counter stain with **safranin**
GN will be pink(safranin); GP will be purple(crystal violet)
77
ceftazidime. administration
IV
78
Penicillin G. adverse effects
hypersensitivity reactions(rash. hives/anaphylaxis. serum sickness. immune mediated cytopenias. acute interstitial nephritis); seizures at high doses
79
**pour plates**
used to asses # colonizing bacteria present in an original sample;
you dilute it down; count colonies; then back calculate original sample
79
***fusobacterium nucleatum*** causes infections where?
oropharynx
think gingivitis to pharyngitis to jugular venous thrombophlebitis
these infections are dangerous; can move up and down in parapharyngeal spaces(DANGER ZONE)
80
name all the drugs with GP only activity
nafcillin dicloxacillin vancomycin daptomycin bacitracin mupirocin clindamycin linezolid tedezolid
80
#1 bacterial cause of pharyngitis?
***streptococcus pyogenes*** (group a strep)
fever, absence of cough, purulent exudate, cervical lymphadenopathy
80
treatment for group b strep
penicillin
vancomycin or clindamycin if allergic
81
Nafcillin. resistance?
altered PBP encoded by mecA--\>PBP2a(MRSA); cant bind it anymore
82
GN coccobacilli
no capsule
small
causes whooping cough
*bordatella*
***b. pertussis*** specifically
83
mycoplasma species associated with HIV/AIDS
***m. fermentans***, ***m. penetrans*** increase HIV virulence
84
obligate aerobes
obligate anaerobes
facultative anaerobes
microaerophils
**obligate aerobes** - need O2 for respiration
**obligate anaerobes** - killed by O2; use fermentation
**facultative anaerobes** - prefer O2 but dont need it; respiraiton or fermentation
**microaerophils** - can withstand low levels of O2
86
Carbapenems resistance?
any weird acquired metallo-beta-lactamases. KPCs can still be resistant to carbapenems
88
adverse effects of rifampin
orange secretions, hepatitis, GI and heme issues
89
Vancomycin resistance?
alteration of vancomycin binding site (vanA.B.C.D.E),VRE; thickened cell wall(VISA)
90
**Lemierre's Syndrome**
phayngitis is complicated by peritonsillar abscess
spreads through parapharyngeal spaces to the internal jugular vein
causes thrombophlebitis which can embolize and spread to lungs where it forms MORE ABCESSES!
91
**scarlet fever**
manifestation?
uncommon manifestation of acute infection, usually pharyngitis
manifests from **SpeA, SpeC** release
rash starts at trunk
capillary fragility
strawberry tongue and peripheral desquamation in later stages
92
name the relavent anaerobic, GP, non-spore, rods
actinomyces
lactobacillus
mobiluncus
propriobacterium
94
Fosfomycin. clinical use
UTI only
96
fidoxamicin mechanism, use
blocks RNA polymerase by not letting DNA open PO drug approved for c.diff infections does not cross GI; very narrow spectrum(only effects some GP in gut); preserves flora better than others
97
***corynebacterium***
relavent species?
morphology?
disease, toxins?
treatment?
***corynebacterium diphtheriae***
aerobic GP rod
**Diptheria**: acute resp. infection w/pseudomembrane formation in throat
* resp. failure, myocarditis, neuritis, **death**
* uncommon in US
* mediated by **diptheria toxin -** _inhibits protein synthesis_
**Treatment**: **antitoxin serum** plus **erythromycin** or **penicillin**
98
ethambutol use
inhibits arabinogalactan, lipoarabinomannan synthesis used for mycobacterial infections
100
treatment options for this?
**pharyngitis**; GAS(*s. pyogenes*)
**penicillin**
if allergic: **macrolides**, **clindamycin**
101
Asepsis
state of being free of microorganisms
102
fevers, chills, purulent sputum, dyspnea
what ***pseudomonas* syndrome** does this describe
**pneumonia** caused by pseudomonas
104
name all the drugs with pseudomonas activity
piperacillin/pip-tazo ceftazidime cefapime meropenem imipenem fosfomycin - UTI only aminoglycosides(gentamicin, amikacin, tobramycin, streptomycin)
106
name the most common pathological route of infection for:
## Footnote
***s. epidermidis***
***s. saprophyticus***
***s. lugdenensis***
***s. epidermis***(and others) commonly adhere to prosthetic joints, valves, and shunts
***s. saprophyticus*** commonly causes _UTIs_
***s. lugdenensis*** commonly causes native valve _endocarditis_
107
sterilization w/moisture, high pressure and temperature
autoclave
108
where does chromosomal replicaiton occur in bacteria?
@ cell membrane
septum forms between copies
108
**bacterial** pneumonia presentation
sudden onset
sustained fever
pleuritic chest pain
purulent cough
lobar consolidaiton
effusion
109
what is the ***s. milleri*** group?
what disease manifestation are they associated with?
unofficial name for virdans group of bacterial:
**(*s. anginosis, s. constellatus, s. intermedius*)**
can display **beta**, **alpha** or **gamma** hemolysis
unusual propensity to cause **_abcess_** - **liver**, **brain**, **periodontal**
**angi**e **intermed**iately looks at **constellat**ions
110
clinically relevant haemophilus species
***H. influenzae ***(most important)
***H. ducreyi ***(chancroid, genital ulcers)
111
***bacteroides fragilis*** morphology
anaerobic GN rod
LPS w/out endotoxin activity
has an important anti-phagocytosis capsule; stimulates abcess formation
111
diseases caused by ***c. perfringens***
1. **food poisoning:** ab cramps; watery diarrhea; from contaminated meat products; heat-labile enterotoxin
2. **soft tissue infections**: cellulitis, fasciitis, myonecrosis(gas gangrene); DANGEROUS; hemorrhagic bullae, severe pain, edema, pallor, subq emphysema; microscopy helpful!
3. **bacteremia**: most blood isolates are useless
112
required factors for culturing haemophilus?
need **X factor**(hemin) and **V factor**(NAD)
requires **chocolate agar**: heated blood agar which causes the release of these factors
114
36 y/o female pt presents with an acute onset erythematous rash with desquamation. Pt has a fever and hypotension. what s. aureus toxin causes these symptoms??
TSST-1 is most common causes toxic shock syndrome
115
two relevant species of chlamydia pathogenic to humans
two relavent **veterinary** species of chlamydia
* c. trachomatis*
* c. pneumoniae*
* c. psittaci*
* c. abortus*
116
treament for:
1. actinomyces
2. lactobacilli
3. mobiluncus
4. propionibacteria
* *actinomyces** - penicillin; erythromycin, clindamycin
* *lactobacilli** - penicillin, or combo; resistant to vanc
* *mobiluncus** - resistant to metronidazole but still used to treat bacterial vaginosis
* *propionibacteria** - benzoyl peroxide, penicillin, tetracyclines, erythromycin, clindamycin
118
pt presents with acute onset diarrhea, NV, and abdominal pain. pt has no fever. later, a bacterial culture returns with s. aureus bacteria found in stool. what was the cause of this disease?
the CAUSE is the pre-formed enterotoxin created by s. aureus it is both heat stable AND a superantigen, inducing peristalsis and inflammation(NVD)
120
piperacillin. administration
IV
121
pyogenic cutaneous disease caused by ***s. aureus***
impetigo, folliculitis, furuncles, carbuncles, wound infection
121
**lactobacillus** diseases?
type of pt infected?
treatment?
sepsis, and endocarditis(if previous valve problems)
pts are immunocompromised
treat with penicillin/gentamicin
122
clindamycin, mechanism, activity, adverse reaction
binds 50S subunit GP only! "above the diaphragm" classically some CA-MRSA adverse reaction is c. diff infection
122
Daptomycin. activity
GP ONLY! MRSA activity; enterococci(including VRE). anaerobes
123
where is *acinetobacter* found?
where do infections usually occur?
found in water/soil; colonizes skin, respiratory tract, GI tract
primarily a nosocomial pathogen, **particularly ICU**
124
morphology of coxiella
GN, intracellular bacillus
related to legionella
125
treatment for ***fusobacterium nucleatum***
b-lactam+/-b-lactamase inhibitor
## Footnote
**debride abcess!**
127
Polymyxin B and colistin adverse effects
nephrotoxicity. neurotoxicity
128
unique molecules on surface of GP bacteria
teichoic acids, lipotechoic(LTA) polymers
**LTA** is recognized by **TLR2**
130
ceftaroline activity
MRSA activity; broad GP activity. no enterococci; only some gram-neg activity. no pseudomonas�similar activity to that of gen3
132
treatment for ***s. agalactiae*** infection?
penicillin
if allergic: vancomycin or clindamycin
screen pregnant women and treat those that are colonized when at term
134
Penicillin G. clinical use
Grp A and B strep. and Streptococcus pneumoniae; anaerobic infections(dental abscess. human bites); syphilis
135
developmental cycle of chlamydia infection
1. **elementary body**(**EB**) binds host cell and is internalized in a vacuole(inclusion)
2. **EB** differentiates into a **reticulate body(RB)** which is metabolically active and starts to grow
3. **RBs** multiply and at about 20-40hrs after infeciton, differentiate back into **EBs**
4. once 100-1000 **EBs** form, the inclusion is mature and it can lyse to spread to other cells!
136
clinically relevant mycoplasma species
***m. pneumoniae***
***m. hominis***
***m. genitalium***
***m. fermentens***
***ureaplasma urealyticum***
138
name the carbapenems
meropenem imipenem ertapenem doripenem(black boxed)
138
cefazolin, cephalexin(1st gen) clinical use
surgical prophylaxis. soft skin/tissue infections(resistance limiting)
139
***clostridium tetani***
pathogenesis
manifestation
introduced to body via dirty nail, splinter, dirty needle
mediated by **tetanus toxin**(A/B peptides); a-peptide inhibits GABA/glycine which are inhibitory NTs; causes **SPASTIC PARALYSIS**
140
Daptomycin. administration
IV
141
disinfection
process of removing/killing MOST microorganisms on or in a material
141
**peptostreptococcus** is found where?
what diseases does it cause?
mucosal surfaces AND skin
Causes:
1. sinusitits(can travel to brain, lungs)
2. intraabdominal infections
3. endometritis, pelvic abcesses
4. cellulitis, nec fasc
5. osteomyelitis
as an anaerobe, this will create **abcesses**
142
most clinically relavent moraxella species
m. catarrhalis
144
H. influenzae virulence factors
* **polysacchardie capsule**(if encapsulated obviously)
* **adherence factors**
* pili
* HMW adhesins(unencapsulateD)
* **lipooligosaccharide**(LOS)- can be modified by sialic acid terminal addition
* **biofilm** formation(LOS sialylation)
145
most clinically relevant *acinetobacter* spp?
*acinetobacter baumannii*
146
vats dat
clumped GP, nonspore anaerobic rods
**propionibacteria**!
147
how are legionella infections spread?
**aerosolized water sources:**
* showers
* whirlpools
* humidifiers
* tap water/faucets
* cooling towers
148
where do enterococci colonize?
most important virulence factor?
GI tract!
antibiotic resistance is most common virulence factor...comes from antibiotic use affecting microbiome...
149
diseases caused by ***C. trachomatis***
1. **inclusion conjuctivits** - **primary infection**
* opthalmia neonatorum in newborns
2. **follicular conjuctivitis(_trachoma_)** - **chronic infection**
3. **pneumonia** syndrome of newborn
4. **genital STI**
newborns get infection passed to them from mama at birth;
150
cefepime. administration
IV
151
cefoxitin. administration
IV
152
most common Group A strep species?
most common Group B strep species?
what determines grouping?
group A - *s. pyogenes*
group B - *s. agalactiae*
groups are determined by its common **cell wall carbohydrate**
153
types of patients commonly getting enterococcal UTI
males hospitalized, catheterized pts not common in healthy, non-hospitalized females
155
Penicillin V. administration
PO
156
most common species of enterococci how do their treatments differ?
***E. faecalis*** - ampicillin/penicillin are drugs of choice; use ampicillin AND aminoglycoside for endocarditis
***E. faecium*** - vancomycin is drug of choice; resistant to ampicillin; use vancomycin AND aminoglycoside for endocarditis
157
* s. maltophila*
* b. cepacia*
full names?
where are these guys contracted?
* stenotrophomonas maltophila*
* burkhoderia cepacia*
more ICU bugs
treat steno w/TMP-SMX
158
toxins of ***c. diff***
1. **enterotoxin**(toxin A) - attracts PMN and makes them release cytokines
2. **cytotoxin**(toxin B) - destroys cellular cytoskeleton of colon(destroy actin)
160
name the aminoglycosides and their mechanism and activity
gentamicin amikacin tobramycin streptomycin binds 30S ribosome; stops protein synthesis only GN(w/pseudo) activity; cant' penetrate GP wall w/out synergy
161
what are the virulent enzymes in s. aureus related to tissue destruction?
coagulase, hyaluronidase, catalase, fibrinolysin, lipases, nucleases
162
ceftriaxone penetration, half life
high degree of CSF penetration; EXTREMELY long t1/2. can q24h dose for outpatient IV
163
**ecthyma gangrenosum** can result from what manifestation of a *pseudomnas* infection?
ecthyma gangrenosum is a buzzword for pseudomonas
**pseudomonal bacteremia secondary to pneumonia or other infection **can cause this ischemic necrotic ulceration w/raised violaceous margins
164
Colistin(polymyxin E). administration
IV
165
name the macrolides, mechanism, and activity
azithromycin clarithromycin erythromycin binds 50S subunit, blocks translocation broad GN(no pseudo) GP: staph,strep, pneumo(if susc.) atyp: myco, legionella, chlamydia
167
epidemiology of ***bordatella***
* HIGHLY contagious; spread via aerosols
* majority of cases in young children, most deaths
* adults have less severe symptoms but are likely reservoirs
169
**metronidazole**
mechanims, activity
diffuses into bacteria and produces free radicals
activity: **ANAEROBES**"below diaphragm"
includes b. fragilis; protozoa
170
top causes of **acute otitis media**
***strep pneumoniae***
***haemophilus influenzae***
***moraxella catarhallis***
171
treatment of ***c. botulism***
ventilatory support
metronidazole
trivalent botulinum antitoxin
173
Nafcillin, dicloxacillin activity
GP ONLY; narrow specturm; think penicillin G with overcoming certain b-lactamases
174
what diseases are caused by **actinomyces**?
**actinomycoses:**
1. **cerebral**
2. **cervicofacial**(angle of mandible)
3. **thoracic** - can cause aspirate pneumonias; can move through lungs to make draining lesion
4. **abdominal** - appendicitis can perforate, cause bacteremia and allow lesions in liver
5. **pelvic**
176
cefoxitin activity
excellent anaerobic activity 2nd generation
177
Penicillin G. resistance?
B-lacatamases hydrolyze b-lactam ring; PBPs can be modified on transpeptidase; decreased perm.; efflux pumps
179
pyogenic **systemic** disease caused by s. aureus
pneumonia
empyema
osteomyelitis
septic arthritis
endocarditis
bacteremia
180
what infeciton precedes acute rheumatic fever
what is the incubation period
10-30 days following a pharyngitis from a GA-strep infection
181
pathogenesis of **actinomyces israelii**
pt's **mucosal barrier is disrupted**, allowing the actinomycoses to travel
surgery, trauma, **radiation**, **aspiration**, foreign body, diverticulitis, **appendicitis**
182
top causes of bacterial pneumonia
1. *strep pneumoniae*
2. *haemophilus influenzae*
3. *staph aureus*
4. *GAS*
184
ampicillin. amoxicilin clinical use
community acquired HEENT/upper resp infectsion; community acquired UTI
185
treatment for moraxella infections
treat m. catarrhalis with amoxicillin/clavulanate, cephalosporins
just like haemophilus
187
prevnar
pneumovax
both pneumococcal vaccines
**prevnar** - given to all children
**pneumovax** - 65+ y/o
188
pathogenesis for ***L. pneumophilia***
1. attach/entry into _alveolar macrophages_(bind C', type IV pili)
2. **inhibit fusion of phagolysosome**
3. begins **replicating** _in vacuole_
4. secretes virulence factors via **Dot/Icm type IV secretion system**
5. keeps growing till cell lyses then moves to next cell
189
morphology of peptostreptococcus
GP cocci; anaerobe
190
anti-tubercular drugs
isoniazid, rifampin, streptomycin, ethambutol, pyrazinamide
192
diagnostics for ***legionella***
**hard to gram stain**
* use **Giminez**(smears) or **Dieterle**(tissue) stains
* **urine antigen test**(detects LPS serogroup 1)
* direct fluorescent a-body test from sputum
193
piperacillin-tazobactam. activity
adds S.aureus (not MRSA). B-lactamase producing GN and anaerobes; AND PSEUDOMONAS
194
morphology of haemophilus
small, GN, coccobaccilli
195
ampicillin. administration
IV
197
Carbapenems. clinical use
empiric treatment for serious infections and resistant infections
198
ceftriaxone. administration
IV
199
most common bacterial infection of **burn pts**?
pseudomonas!
200
Fosfomycin resistance?
can develop rapidly on the transporter that brings the drug into the bacteria
201
what streptococcal subgroup is ***s. pneumoniae*** a part of?
the **mitis** subgroup
202
treatment of ***c. diff***
discontinue any implicated antibiotics
give oral **metronidazole**, (oral **vanc** if bad)
disinfect room
**STOOL TRANSPLANT**
203
most clinically relevant *pseudomonas* species?
***pseudomonas aeruginosa***
204
name all the cephalosporins in order by generation
1st gen: cefazolin cephalexin(PO) 2nd gen cefoxitin 3rd gen ceftriaxone ceftazidime 4th gen cefepime 5th gen ceftaroline
206
neonate gets fever in first 4-6 weeks of life
doc orders an LP
what is the doc looking for?
group B strep: s. agalactiae
normally colonizes GI/GU(can be picked up in birthing canal)
sepsis and **meningitis** are risks for both early and late onset!
208
what drugs cover *pseudomonas*
pip/tazo
cefepime
ceftazadime
aminoglycosides
imipenem
meropenem
fluoroquinolones(ciprofloxacin)
aztreonam
polymyxins
209
210
relavent ***bordetella*** species
***b. pertussis ***(whoopin cough)
***b. parapertussis ***(milder disease)
211
ceftaroline. administration
IV
213
piperacillin-tazobactam. administration
IV
214
disease caused by mycoplasma pneumoniae
treatment?
**_CA_-pneumonia**(walking) --\>
* leading pneumonia for school age children
* dry cough, malaise, low fever, scratchy sore throat
**treatment**: doxycyclin, erythromycin, azithromycin, levoflaxin, ciproflaxin (**tetracyclines**, **macrolides**, **fluoroquinolones**)
215
sterilization
inactivation or elimination of ALL viable organism and their spores
217
what are the major/minor criteria for rheumatic fever?
major:
* polyarthritis
* carditis
* chorea
* erythema marginatum
* subcutaneous nodules
minor:
* arthralgia
* fever
* elevated CRP or ESR
* 1st degree heart block
need 2 major or 1 major and 2 minor to declare
218
Penicillin G. activity
GN: cocci only; GP: cocci and anaerobes; spirochetes. enterococci
219
carbopenam. adverse effects
hypersensitivity(cross-reaction w/penicillin)
220
stages of ***bordatella*** disease
* *1. catarrhal stage** - cold-like symptoms, highly infectious, 2 weeks
* *2. paroxysmal stage** - severe cough paroxysms, apnea, may cause hypoxia, striking leukocytosis
**3. ** **convalescent stage** - cough may persist for several months, **bacteria absent**
**4. ** **critical pertussis** in infants
- **lymphocytosis**, apnea, can progress to respiratory failure and death
221
cefazolin. administration
IV
223
describe the h. influenzae vaccine
PRP(polyribosyl ribitol phosphate) attached to protein conjugate
224
rifaximin use
traveler's diarrhea enteric drug; does not absorb across gut
225
***clostridium botulinum***
how does it manifest?
what are the 3 forms?
**botulinum toxin**, prtctd in GI, blocks neurotransmission at peripheral cholinergic synapses; **inactivates** proteins that release **ACh**
**FLACCID PARALYSIS**
1. **foodborne - toxin is found in food**
2. **wound -** organism contaminates wound; multiplies; makes toxin
3. **infant -** organism is ingested w/food; multiplies in GI, maks toxin
227
Vancomycin oral
does not cross GI tract given orally; used for c. diff
228
describe these "types" of flagellum
amphitrichous
lophotrichous
peritrichous
monotrichous
amphitrichous - single on each end
lophotricous - multiple flagellum; same spot
peritrichous - multiple in all directions
monotrichous - single
229
Nafcillin. administration
IV
230
hot tub folliculitis
low grade fever, self-limited, benign tender pruritic papules from infected water source
caused by *pseudomonas*
231
top causes of **atypical** pneumonia
1. VIRUSES
2. *mycoplasma pneumoniae*
3. *chlamydia pneumoniae*
4. *legionella pneumophilia*
232
*coxiella*
diseases?
treatment?
**Q fever**(self-limiting flu-like illness) --\> chronic form includes endocarditis
Treat with **doxycycline**
233
***chlamydia*** virulence factors
1. **adherence proteins**
2. **autotransport(T5S)** - moves polymorphic membrane proteins to surface; need for adherence, antigen variation
3. **Type III Secretion(T3S)** - molecular syringe; injects virulence factors across membrane of cell/inclusion
4. **clostridial toxins**
235
unique molecules on surface of **acid-fast bacteria**
classic acid fast bacteria?
mycolic acid
wax d
arabinogalactans
sulfolipids
**mycobacterium** are acid-fast
236
treatment for ***legionella***
**fluoroquinolones**(levofloxacin) for **CA-pneumonia**
* change to **_azithromycin_** if ***legionella*** is diagnosed
237
sanitization
cleaning process which reduces pathogen levels to produce a healthy/clean environment
238
virulence factors for *pseudomonas*?
1. **pili**, **flagella** for adherence/movement
2. **LPS**(endotoxin)
3. **polysaccharide capsule**(slime coat)
4. **Exotoxin A**(ETA): similar to diptheria toxin; causes necrosis
5. **T3S**: exoenzyme S, secreted toxins
6. degradative enzymes
239
Daptomycin. adverse effects
GI distress. HA. elevated CPK(creatine phosphokinase)/rhabdomyolysis(avoid statins)
240
most common forms of botulinum toxin in US
where is ***c. botulinum*** found?
toxins A, B, E
found on soil, surface of fruit/veggies, marine sediment
241
aztreonam activity, clinical use
GN only, used w/b-lactam allergy occasionally; limited immunogenic potential
242
clinical presentation of c. botulinum
**cranial neuropathies** w/symmetric **descending paralysis**
243
ceftazidime clinical use
pseudomonas activity; very broad GN
244
Vancomycin. clinical use
only use instead of b-lactam if: empiric therapy for severe infection. resistant GP infection. allergy to b-lactam; used for C. diff via oral dose
245
Vancomycin. adverse effects
Red Man Syndrome; dose-related ototoxicity; nephrotoxicity(avoid co-administration with other agents)
246
Polymyxin B. administration
IV
247
when you have a patient that works with exotic birds, ducks, poultry farms, etc, and has flu-like/pneumonia symtpoms, what goes on your differential?
chlamydia
***C. pssittaci***
treat with doxy or tetracyclines
248
aztreonam. administration
IV
249
treatment for ***H. influenzae***
**unencapsulated/non-invasive** - amoxicillin; amoxicillin-clavulanate for resistant strands
**Hib(meningitis)** - cefotaxamine(3rd gen cephalo)
250
Bacitracin. activity
GP only, topical
251
recovered colonies in 70-80% of SAAs; usually act as normal flora
opportunistic STIs; usually infect w/other pathogens
*u. urealyticum* can cause **NGU**
diseases caused by m. hominis, m. genitalium & u. urealyticum
