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Nagasaki Flashcard Extravaganza > Bacteria - gram -ve > Flashcards

Bacteria - gram -ve Flashcards

1
Q

Risk factor/transmission for brucellosis?

A

Goat milk unpasteurised
Aerosols

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2
Q

What is the micro of brucellosis?

A

Gram negative coccobaccili - intracellular

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3
Q

What are the hosts for brucella?

A

melitensis - sheep and goats
abortus - cattle
suis - pigs

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4
Q

What is the clinical syndrome of brucellosis?

A

Undulant fevers
Moldy smell
Migratory arthralgia and myalgia
Leukopenia and deranged LFTs
Abdo sx
HSM
10% urogenital
Meningoencephalitis (maybe more common in HIV)
Cardiac manifestations - highest risk of death
Stillbirths
Ddx endocarditis, TB, VL, autoimmune dx, enteric fever, malaria

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5
Q

What is the epidemiology of brucellosis?

A

Mediterranean, Middle East, Central Asia and Central America, Africa

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6
Q

What is Pedro Pons signs?

A

preferential erosion of the anterosuperior corner of lumbar vertebrae in Brucellosis

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7
Q

What is the treatment for brucellosis?

A

The gold standard treatment for adults is daily intramuscular injections of streptomycin 1 g for 14 days and oral doxycycline 100 mg twice daily for 45 days (concurrently).

Another answer suggested gent and doxy

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8
Q

How do you prevent brucellosis?

A

Pasteurise milk
PPE to prevent aerosols
Vaccinate animals
Surveillance

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9
Q

How is brucellosis diagnosed?

A

Biopsy: non caseating granulomas
Bone marrow gold standard
PCR (cannot persist for months)
Multiplex for species
Lots of serology - many non-specific - need two (eg Rose Bengal)
Nb risk to lab staff!

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10
Q

What is PEP for brucellosis

A

Doxy + rif for 3 weeks / or co-trim

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11
Q

What is the transmission of bartonella henslae?

A

Cat scratch!

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12
Q

What is the micro of b.henslae?

A

gram negative facultative

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13
Q

What is the clinical syndrome of b.henslae?

A

Nodes
Fever
Cardiac - endoarditis
CNS
Bone involvement rarely

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14
Q

What is the diagnosis of b.henslae?

A

PCR
Biopsy of warthin-starry

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15
Q

What is the treatment of b.henslae?

A

Azithromycin

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16
Q

What is the micro of leptospirosis?

A

Gram negative aerobic spirochete

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17
Q

What is the epidemiology of leptospirosis?

A

Occurs in rainy seasons

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18
Q

What is the host for leptospirosis?

A

Rats but also livestock, domestic animals, bats, marsupials

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19
Q

What is the clinical syndrome of leptospirosis?

A

Incubation around 7 days
Early phase: fever, myalgia, headache
Late phase: jaundice, renal failure, pulmonary haemorrhage

Uveitis, aseptic meningitis, myocarditis

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20
Q

How is leptospirosis diagnosed?

A

ELISA for IgM
PCR
DFM/MAT

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21
Q

How is lepto treated?

A

For treatment usually use oral doxycycline for mild cases – Doxycycline (100mg PO bid) or
– Amoxicilin (500mg PO tid) or Ampicilin (500mg PO tid)
SEVERE: intravenous penicillin and ceftriaxone for moderate to severe cases but…limited evidence
– Penilicin (1.5m units IV or IM q6h) or
– Ceftriaxon (2g/d IV) or Cefotaxime (1g IV q6h) or
– Doxycycline (loading dose of 200mg IV then 100mg IV q12h)

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22
Q

What is the micro of the plague?

A

Gram negative short pleomorphic cocco-bacillus
Non-sporing, non motile, Capsule
Bipolar staining

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23
Q

What is the vector + host for plague?

A

Parasite of rodents – tolerate chronic bacteraemia

Transmitted by flea bites (Oriental rat flea:
Xenopsylla cheopsis.
(80 flea species implicated)) on skin or ingestion of infected animal material (eating infected guinea pigs in Peru and camels in Asia!).

Sylvatic plague
Outbreaks of plague in susceptible animals
Ground squirrels, gerbils and voles
Bandicoots, marmots, squirrels, chipmunks, prairie dogs and rats Fleas transmit to man
Farmers or trappers

Urban plague
Spread among rats
Black rat Rattus rattus – common around human habitation Less transmission with brown (sewer) rat Rattus norvegicus Epidemic and pandemic

Pneumonic - human to human transmission

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24
Q

What is the clinical syndrome of PNEUMONIC plague?

A

1-3 days incubation period
Rapidly progressive pneumonia
Tachypnoea, dyspnoea, chest pain, cough, haemoptysis
Chest X-ray findings of primary or secondary pneumonia
Initial patchy segmental or lobar pneumonia Rapidly progression within hours or days Bilateral pulmonary consolidation, necrosis and haemorrhage
Contagious to close contacts by respiratory droplet spread Respiratory droplet precautions (universal/mask/eye protection)
[Negative pressure isolation not necessary]
Contact tracing, surveillance and chemoprophylaxis [7 days]

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25
Q

What is the epidemiology of plague?

A

Sporadic outbreaks
Only 6 countries in 2019-22 1722 cases – 175 deaths

MADAGASCAR!!

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26
Q

What is the clinical syndrome of BUBONIC PLAGUE

A

Bubonic (not contagious)
Incubation period of 2-7 days following bite
Sudden onset
Headaches, fever, malaise
Bubo – very painful, tender, erythematous swollen regional lymph nodes
Inguinal (most common), axillary, cervical
Infected skin lesion rarely detected
The majority of infective flea bites occur on lower limbs
May disseminate in blood to lungs and brain
Not contagious Chemoprophylaxis (household)

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27
Q

What is the diagnosis of plague?

A

WBC elevated with neutrophil predominance Platelet levels low
Liver and renal function may be deranged
Gram or Wayson stain of bubo aspirate or sputum Moderately sensitive and specific; Rapid
Culture of bubo aspirate, blood or sputum
Sensitive if patent untreated; specific; takes 2-3 days
Immunofluorescent antibody to aspirate or sputum Moderately sensitive, highly specific, rapid
Dipstick for F1 antigen in bubo aspirate Sensitive, specific and rapid
PCR for F1 gene in bubo aspirate Moderately sensitive, highly specific, rapid

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28
Q

What is the treatment for plague?

A

Streptomycin im 30mg/kg 2 doses daily 10days. (1948)
But: limited availability, side effects-renal, hearing.
Discontinued now except in Madagascar in combination with co-trimoxazole Gentamicin + doxycycline (Boulanger et al. CID 2004:38) (Tanzania, CID 2006:42) Ciprofloxacin (Other fluoroquinolones)
[Chloramphenicol – effective but rarely used - meningitis]
Fluoroquinolones, doxycycline, tetracycline, co-trimoxazole used as prophylaxis to prevent pneumonia
Cephalosporins – not recommended.

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29
Q

What is the prognosis of plague?

A

40-60% bubonic
100% pneumonic or septicaemic

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30
Q

What is IPC for plague?

A

Avoid fleas
Rodent control
PPE
funeral practice
PEP
Vaccine used by military
Surveillance for outbreaks

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31
Q

What is the micro of melioid?

A

Burkholderia pseudomallei
Gram negative bacilli

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32
Q

What is the epidemiology of melioid?

A

Case numbers – 165,000 annually

Deaths – 89,000 annually

Thailand – 3000-5000 cases yearly

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33
Q

What is the transmission of melioid?

A

Acquired through contact with contaminated water or soil through skin abrasions or aerosol (Seasonal)
Rice farmers in Thailand
Indigenous population in Australia
War wounds
Inhalation (helicopter pilots)
Ingestion of water (near-drowning, potable water) Laboratory-acquired
Person-person, animal-person very rare

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34
Q

What is the clinical syndrome of melioid?

A

Incubation: 1-29 d up to 29 y

Fever and rigors; lung and skin involvement; septic shock (20%) Jaundice, diarrhoea, reduced conscious level
Anaemia, neutrophilia, coagulopathy
Metastatic abscesses:
lungs (80% abnormal CXR, multifocal pneumonia, cavitations) liver, spleen, kidneys
skin and soft tissues; muscle and prostate
bones and joints; kidneys; brain
PAROTITIS

Untreated mortality 100%; 10-50% depending on level of care available

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35
Q

What is the diagnosis of melioid?

A
  • Biosafety level 3*
    Isolation
    Blood, urine, throat - sputum, pus,
    Unevenly stained Gram-negative bacilli
    Isolation from non-sterile sites increased by use of selective media (Ashdown’s, selective broth, 420C incubation)

Metallic sheen, sweet earthy smell

Serology - > 1:320 probable

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36
Q

What is the treatment of melioid?

A

Meropenem!
Drain abscesses
Supportive

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37
Q

What is the IPC of melioid?

A

No vaccine
Avoid contact - shoes in rice fields/diabetics

PEP for lab

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38
Q

What is the micro of salmonella typhi/typhoid?

A

Gram negative bacilli

Salmonella Typhi and Salmonella Paratyphi A

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39
Q

What is the epidemiology of typhoid fever?

A

10-20 m
100-200K deaths
++Asia India, Africa, S America

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40
Q

What is the clinical syndrome of typhoid?

A

Prolonged febrile illness with bacteraemia

Week 1 - fever, headache, abdominal pain, vomiting, cough

Week 2 - high grade fever, ++abdo, HSM, rose spots

Week 3 complications - GI bleed, perf, pneumonia

Week 4 - advanced illness, apathetic illness, agitated delirium

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41
Q

What is the diagnosis of typhoid?

A

Blood cultures (poor sens)
Widal test (agglutinating antibodies against O + H antigens) - high false neg rate, can cross react with other febrile illness
RDT

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42
Q

What are the complications of typhoid?

A

Gastrointestinal bleeding Perforation Encephalopathy/shock
Hepatitis Pneumonia Psychiatric
Relapse
Chronic carriage (> 1year)
Carcinoma of gall bladder
Meningitis
Myocarditis
DIC
Cholecystitis
Anaemia
Bone and joint

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43
Q

What is the treatment of typhoid?

A

Ceftriaxone/ cipro/SCA
nb lots of ceft resistance in Pakistan

44
Q

What is the transmission of typhoid?

A

Faecal-oral transmission Water
Food
Hot season or flooding conditions

45
Q

What is the prognosis of typhoid?

A

Relapse
Chronic carriage (> 1year) Carcinoma of gall bladder

90% uncomplicated
10% severe complicated disease
10% + mortality with no treatment
< 1% mortality if adequate treatment

46
Q

How is chronic typhoid diagnosed and managed?

A

3 x faecal cultures
Vi antibodies
1-3 months abx

47
Q

What is the vaccinology of typhoid?

A

Oral attenuated and polysaccharides available
Conjugated Vi much more effective than PS

New Vi WHO approved
No paratyphoid available

48
Q

What are these?

A

Rose spots
Appear in typhoid

49
Q

What is the micro of non-typhoidal salmonella (NTS)?

A

Gram neg bacilli

Typhiumrium
Enteritidis
> 2500 other Salmonella serovars

NOT paratyphoid

50
Q

what is the epidemiology of NTS?

A

NTS 94 million cases (95% CI 62-132) 155,000 deaths (95% CI 39,000-303,000) 80 million cases foodborne

INTS 3.4 million (range 2.1–6.5) million
681,316 (range 415,164–1,301,520) deaths

51
Q

What is the transmission of NTS?

A

Normal habitat of many serotypes is the gut of animals. Found in the food chain.
Ingestion of contaminated food or person to person.
Most infection foodborne
Meat, eggs and processed food (chocolate, peanut butter etc)
Chronic carriage possible (gut not gallbladder)

52
Q

What is the clinical syndrome of NTS?

A

Diarrhoea (gastroenteritis)
Some cause invasive disease with bacteraemia (iNTS)
May lead to focal infection
Bones and joints Endovascular infection Meningitis (very young)
Extremes of life (very young, elderly)
Immunocompromised (malignancy, steroids, immunotherapy agents, DM, Sickle cell disease, HIV - AIDs defining if BSI)

In Africa: Often present as fever without localising signs Overlaps with malaria

53
Q

What is the treatment of NTS?

A

Ceftriaxone
?2nd ppx until CD4 improves?
Start ART

54
Q

What is the IPC of NTS?

A

Food hygiene
Manage HIV!
No vaccine

55
Q

What makes INTS more prevalent in Africa?

A

In HIV -
Gut mucosal defect
Early and profound gut mucosal CD4 depletion (particularly Th17 cells)
More persistance
Impaired serum killing of NTS in HIV infected adults
IgG antibodies compete with bactericidal antibodies

Malaria
Macrophage dysfunction
Dysregulated cytokines

Sickle cell disease Homozygous at risk

Ineffective serum killing of NTS
Deficiency of anti-Salmonella IgG antibodies

56
Q

what is relapsing fever?

A

Relapsing fever is an illness characterized by one or more episodes of fever, headache, and muscle pain that lasts several days and is separated by roughly a week of feeling well. Relapsing fever is caused by several species of Borrelia bacteria, which are distantly related to the bacteria that cause Lyme disease.

e.g. Rickettsia prowazekii and Bartonella quintana, Borrelia recurrentis

57
Q

How is relapsing fever treated?

A

1-2 weeks of a tetracycline

58
Q

What causes Oroya fever?

A

Bartonella bacilliformis, transmitted by sandfly in south america

59
Q

What is the clinical syndrome of Oroya fever?

A

Fever, severe haemolytic anaemia, jaundice, heart failure, effusions 3-8 weeks after bite

60
Q

What is verruca peruana?

A

Bartonella baciliformis - after Oroya fever, developing angioproliferative lesions

61
Q

How is Oroya fever treated?

A

Cipro plus Ceftriaxone if severe

62
Q

What is the clinical syndrome of rickettsial infections

A
  • Incubation period: 5-14 days
  • Systemic endothelial infection resulting in lymphohistiocytic vasculitis
  • Non-specific febrile illness, relative bradycardia
  • Symptoms: fever, rash, eschar, headache, lymphadenopathy, malaise, myalgia, nausea,
    cough
    Severe disease: interstitial pneumonitis, interstitial nephritis, interstitial myocarditis,
    meningoencephalitis
63
Q

What is the microbiology of rickettsia?

A

Obligate intracellular gram negative bacteria

64
Q

Eschar in Asia might mean?

A

Scrub typhus

65
Q

what is the cause of scrub typhus?

A

Orientia tsutsugamushi - million cases per year

66
Q

What is the vector of scrub typhus?

A
  • Leptotrombidium
  • Only larvae (chigger) can transmit the disease
67
Q

What is an eschar?

A
  • A necrotic lesion of the skin at the site of arthropod inoculation
  • No pain, no itchiness
  • An excellent sample for PCR testing
68
Q

What causes Japanese spotted fever?

A
  • Rickettsia japonica
  • Vector: hard ticks (Dermacentor, Haemaphysalis)
69
Q

What causes Rocky Mountain Spotted Fever (bacteria and vector)?

A
  • Rickettsia rickettsii
  • Vector: Dermacenter ticks, Rhipicephalus ticks, Amblyomma ticks
  • ‘Wait for a host in an ambush strategy falling onto a hairy host from a height of 1 m’
  • Frequently bite in the hair and targets children
70
Q

Where does Rocky Mountain Spotted Fever occur?

A

Southern US and S America

71
Q

What causes African tick bite fever (bacteria and vector)?

A
  • Rickettsia africae
  • Vector: Amblyomma ticks
  • Aggressive hunting ticks
  • Frequently attack in groups
  • Non host-specific (humans, cattle, wild ungulates)
    presents with multiple eschars occurs in outbreaks and clusters
72
Q

Which rickettsia has multiple eschars?

A

African Tick Bite Fever

73
Q

What causes Mediterranean Spotted Fever (bacteria and vector)?

A
  • Rickettsia conorii
  • Vector: Rhipicephalus ticks (dog tick)
74
Q

What causes epidemic typhus (bacteria and vector)?

A
  • Rickettsia prowazekii
  • Vector: body louse (Pediculus humanus corporis)
  • Reservoir: human
  • Transmission through close physical contact
75
Q

Who gets epidemic typhus?

A
  • Prison, homeless shelter
76
Q

What is the mortality of epidemic typhus?

A

Variable mortality up to 60%

77
Q

What is Brill-Zinsser disease?

A

Epidemic typhus reactivation years after primary infection

78
Q

What causes epidemic typhus (bacteria and typhus)?

A
  • Rickettsia typhi
  • Vector: rat flea (Xenopsylla cheopsis), cat flea (Ctenocephalides felis)
79
Q

How are rickettsia diagnosed?

A

Clinical

Lab:
- PCR: eschar, skin rash biopsy, whole blood
- LAMP
- Bacterial culture: only available in limited reference laboratories
- Antibody - IFA (indirect immunofluorescent assay) considered gold-standard

80
Q

What is diagnostic of antibody titres in rickettsial illness?

A

Four-fold titre increase in paired samples

81
Q

Name three agglutination tests?

A

Widal test for typhoid fever, MAT for leptospirosis, SAT for brucellosis

82
Q

How are rickettsia treated?

A
  • Doxycycline
  • Inhibition of protein synthesis
  • Excellent penetration to the intracellular space
  • Azithromycin, chloramphenicol * β-lactams are not effective
  • Inhibition of cell wall (peptidoglycan) synthesis
  • Poor penetration to the intracellular space
  • Defervescence within 48 hours
83
Q

What is the IPC of rickettsial infections?

A

Administrative control
* Raise awareness among patients and healthcare workers
* Improve sanitation (epidemic typhus)
* Vaccine development (no vaccine so far…)
Environmental control
* Clean bushes and weeds
* Cut grass close to the ground
* Prevent rat infestation
Personal protection
* Avoid tick/mite bite (repellent, protective clothing)
* Careful inspection for ticks/mites after outdoor activity
* Wash clothes (epidemic typhus)
* DOXY prophylaxis is not routinely recommended

84
Q

What kind of pathogen is rickettsia group?

A

Bacteria
Gram negative
Bacilli
Intracellular

85
Q

What is the clinical syndrome of rickettsial infection?

A

Fever + rash + eschar

Incubation = 5-14 days

86
Q

What do routine bloods demonstrate in rickettsial infection?

A

Low WCC, atypical lymphocytes, eosinophils 0

Low platelets

High CRP, high LFT

87
Q

Scrub typhus causative organism

A

Oriensia tsutsugumashi

88
Q

What are the three groups of rickettsial infection?

A

Scrub
Spotted fever
Typhus

89
Q

Vector of scrub typhus?

A

Mite - larval stage
Trombeculae (“chigger”)

90
Q

Reservoir of scrub typhus?

A

Rat, other rodents

91
Q

Distribution of scrub typhus?

A

Disease of rural area

Asia, Pacific, Northern Australia

92
Q

Clinical syndrome of scrub typhus?

A

Fever + rash + eschar
Incubation: 5-14 days

Rash: maculopapular. Trunk -> extremeties, palmar sparing

Associations: faget’s, pneumonitis, deafness, lymphadenopathy, HSM, myocarditis, delirium

93
Q

Vector + reservoir for spotted fever group rickettsia?

A

Vector = hard ticks

Reservoir = dogs, rats, cattle

94
Q

Japanese spotted fever causative organism and vector?

A

Rickettsia Japonicum
Hard tick (dermacentor, haemaphysalis)

95
Q

Japanese spotted fever clinical syndrome

A

Fever + rash + eschar
Incubation: 2-8 days
Rash: extends to palms and soles

Associated with severe disease

(Shorter incubation and palmar rash distinguishes from scrub typhus)

96
Q

Rocky Mountain spotted fever causative organism and vector

A

Rickettsia rickettsii
Hard tick: dermacentor (ambush type)

97
Q

Rocky Mountain spotted fever clinical syndrome

A

Fever + rash, eschar absent
Incubation 3-12 days
Rash 2 days after fever onset

Severe disease, fatality ~10%, highest in children

98
Q

African tick bite fever causative organism and vector

A

Rickettsia Africae
Ambyloma tick (ambush type)

99
Q

African tick bite fever clinical syndrome

A

Spotted fever group

Fever + multiple eschar (aggressive tick) + regional lymphadenopathy, rash rare

Incubation = 5-10 days

Mild disease

100
Q

Epidemic typhus causative organism and vector

A

Rickettsia Prowazeki
Human body louse

101
Q

Epidemic typhus clinical syndrome

A

Typhus sub group

Fever + maculopapular rash, no eschar (infected faeces –> bite site)

Incubation 10-14 days

Seen in areas of close contact and poor sanitation, eg prisons, shelters

Severe disease –> pneumonia, meningoencephalitis, myocarditis, death

102
Q

What is Brill-Zinner disease?

A

Recrudescence of epidemic typhus in partially treated, occurring years later

103
Q

Endemic (/murine) typhus causative organism and vector

A

Rickettsia typhi
Rat / cat flea

Reservoir = rat, cat (unsurprisingly) + opossum (cute xx)

104
Q

Endemic typhus clinical syndrome

A

Fever + rash + headache + no eschar (infection via infected poo –> itched into bite site)

Incubation 7-14 days

Occuring worldwide, anywhere with rats

Mild disease

105
Q

How are rickettsial infections diagnosed?

A

Usually clinical: fever + rash + eschar

Gold standard = IFA (indirect immunoflourescence assay) - not positive until ~7/7 of illness as antibodies not yet established

PCR of blood / eschar / rash biopsy

Culture of organism difficult

Serology (Weil Felix) for direct / indirect agglutination tests (antibody : antigen)

Lots of x reaction in serological tests between spotted fever groups and also with syphilis

106
Q

How do you treat rickettsial infection?

A

Doxy for all :))
- Duration based on subtype, aim 7-10/7
- IV if severe

Pregnant women, children:
- doxy if severe
- azithro if mild

Defervescence within 48 hours

107
Q

How do you prevent rickettsial infection?

A

ENVIRONMENTAL:
- Clear bush and scrub, keep grass short
- Keep rats away
- Improve sanitation (esp epidemic typhus as lice borne)

PERSONAL:
- Prevent bites (repellent, long clothing)
- Education: keep away from high risk areas eg bush walking, check carefully for bites on return
- Hygiene: wash clothing and bedding well (esp epidemic typhus as lice borne)

No vaccine
Routine doxy prophylaxis not recommended

Nagasaki Flashcard Extravaganza (33 decks)

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