Bacterial Infections II: Atypical

Question 1

Mycoplasma, Legionella, Chlamydia are all ????

Answer 1

atypical causes of pneumonia

Question 2

Small bacteria lacking a cell wall are _____

Answer 2

mycoplasma

Question 3

Where are mycoplasma commonly found?

Answer 3

Commonly found lining mucous membrane of genitourinary tract and respiratory tract

Question 4

_____ most associated with acute infection - pneumonia

Answer 4

M. pneumoniae

Question 5

Filamentous organism
Attaches to epithelial membranes - especially the respiratory tract
Causes epithelial injury and activates immune response

What am I?

Answer 5

mycoplasma

Question 6

Transmitted via respiratory droplets
Incubation period - 2-3 weeks
Most common during fall and summer
Most common in young adults; high school students, college students, military, etc.
Community-acquired rates increasing

What am I?

Answer 6

mycoplasma

Question 7

What kind of infection is characterized by Gradual onset
Milder form of “pneumonia”
Scant sputum production
Often associated with pharyngitis and/or AOM
“Bullous myringitis”
Cough
Extrapulmonary manifestations
Also referred to as “Walking Pneumonia”

Answer 7

mycoplasma

Question 8

How is mycoplasma pneumoniae diagnosed?

Answer 8

Labs - often normal or nonspecific
Typically, a “clinical” diagnosis
Diagnosed by NP swab

Question 9

What does the chest xray look like on a pt with mycoplasma pneumoniae?

Answer 9

Chest X-ray - often nondiagnostic patchy infiltrates (no lobar consolidation)

Question 10

What is the empiric antimicrobial treatment of choice for possible M. pneumoniae community acquired pneumonia?

Answer 10

macrolides

Question 11

Infections of genital/reproductive tract, eye, and respiratory tract in infants are ____

Answer 11

Chlamydia trachomatis

Question 12

Obligate intracellular bacteria
Do not contain a peptidoglycan cell wall

What am I?

Answer 12

Chlamydia

Question 13

_____ is the Second most common cause of “atypical” pneumonia

Answer 13

Chlamydia Pneumoniae

Question 14

Must you distinguish between C. pneumoniae and M. pneumoniae before treatment?

Answer 14

No, they are treated the same

Question 15

What treatment would you prescribe for chlamydia pneumoniae?

Answer 15

macrolides

Question 16

What does Chlamydia Psittaci present as?

Answer 16

“Atypical” pneumonia
Fever, chills, cough, HA

Contact with birds (usually pet birds)

7–15-day incubation period

Question 17

Pneumonia s/s and the have a pet bird at home.

What am I?

Answer 17

Chlamydia Psittaci

Question 18

What is the treatment for Chlamydia Psittaci?

Answer 18

tetracycline
erythromycin

Question 19

What is the most common STD?

Answer 19

Chlamydia Trachomatis

Question 20

What is the incubation period for Chlamydia Trachomatis?

Answer 20

7-14 days, often asymptomatic

Question 21

Female - cervicitis, urethritis, PID
Male - urethritis, epididymitis, prostatitis
Both sexes - conjunctivitis, lymphogranuloma venereum

What am I?

Answer 21

Chlamydia Trachomatis

Question 22

Mucopurulent discharge
Red, inflamed, friable cervix
PID - pelvic pain, dyspareunia, cervical motion tenderness

What am I?

Answer 22

Chlamydia
Trachomatis

Question 23

Mucoid/watery urethral discharge
Dysuria
Epididymitis - testicular pain; palpable, swollen epididymis

What am I?

Answer 23

Chlamydia
Trachomatis

Question 24

What is the diagnostic test for Chlamydia Trachomatis?

Answer 24

culture

gram stain is not helpful

Question 25

What is the Ddx for cervicitis?

Answer 25

Question 26

What is the treatment of choice for urogenital chlamydia?

Answer 26

Z- Max or doxy BID for 7 days

Question 27

What are the complications of Chlamydia Trachomatis

Answer 27

Pregnancy complications - PROM (premature rupture of the membranes) Infertility (from PID) Transmission to newborn Perihepatitis (Fitz Hugh-Curtis syndrome)

Question 28

What is Fitz Hugh-Curtis syndrome?

Answer 28

a rare chronic condition that causes inflammation of the liver capsule and adhesions, leading to pain in the upper right quadrant of the abdomen. It's a complication of pelvic inflammatory disease (PID) that can be caused by infections with Neisseria gonorrhoeae or Chlamydia trachomatis.

Question 29

What are three diseases commonly associated with spirochetes?

Answer 29

Syphilis Lyme Disease Leptospirosis

Question 30

Syphilis is caused by what bacteria?

Answer 30

Treponema pallidum

Question 31

______ transmitted by direct contact with infectious lesion during sexual activity

Answer 31

Syphilis

Question 32

What is the incubation period for syphilis?

Answer 32

21 days before symptoms

Question 33

What are the clinical stages of syphilis?

Answer 33

Primary Syphilis Secondary Syphilis Tertiary Syphilis (Late Syphilis) Neurosyphilis Latent Syphilis

Question 34

Early syphilis occurs ???

Answer 34

Within the first year very infectious

Question 35

What is the symptom free period between early and late syphilis?

Answer 35

Latent syphilis = Infectious w/in 1st year of primary infection

Question 36

Is Tertiary/late syphilis contagious?

Answer 36

NOT contagious

Question 37

When do sx appear in a syphilis pt? Name a definite sign?

Answer 37

Symptoms appear 3-4 weeks after contact chancre: painless ulcer

Question 38

How is syphilis diagnosed?

Answer 38

Culture of ulcer Serologic tests: *Non-treponemal antibody test* If positive then Treponemal antibody test: TPPA and FTA used to confirm diagnosis

Question 39

When will a RPR test be positive on a pt who has syphilis?

Answer 39

Positive 4-6 weeks after infection; 1-2 weeks after presence of chancre

Question 40

What is the treatment for syphilis?

Answer 40

benzathine penicillin G 2.4 million units IM in a single dose (Bicillin L-A) pencillin VK amoxicillian

Question 41

Do you need to report syphilis to the local health department?

Answer 41

YES!!

Question 42

When does secondary syphilis begin? Are you still infectious?

Answer 42

Begins several weeks to 6 months after chancre ***Still Infectious

Question 43

In secondary syphilis, you will see dissemination of ______ throughout body produces systemic symptoms

Answer 43

T. pallidum

Question 44

What is condyloma lata?

Answer 44

genital warts

Question 45

Are all clinical manifestations of ______

Answer 45

secondary syphilis

Question 46

early latent syphilis is ???? after the primary infection. Is it still infectious?

Answer 46

within the first year Yes

Question 47

late latent syphilis is ???? after the primary infection. Is it still infectious?

Answer 47

after the first year NOT infectious

Question 48

What is the presence of gummas indicate?

Answer 48

tertiary syphilis infiltrative tumors Skin, bones, internal organs (liver)

Question 49

Skin & mucous membrane lesions - gumma Bone lesions - marked bone pain Respiratory distress - gumma deposits in lungs Liver disease/cirrhosis Cardiovascular lesions Aneurysms Neurosyphilis What am I?

Answer 49

Tertiary syphilis

Question 50

Neurosyphilis is most common during what stage?

Answer 50

late syphilis

Question 51

What is Asymptomatic neuroinvasion?

Answer 51

T. pallidum infects CSF; no symptoms yet

Question 52

Impairment of proprioception and vibration sense Wide based gait; inability to walk in the dark Muscle hypotonia and hyporeflexia Paresthesia; sharp, recurring pains; pain "crises" Inability to control bladder What am I?

Answer 52

Tabes dorsalis

Question 53

What is tabes dorsalis? What disease is it associated with?

Answer 53

Chronic progressive degeneration of posterior columns of spinal cord neurosyphilis

Question 54

How do you dx neurosyphilis?

Answer 54

same as syphilis plus lumbar puncture

Question 55

What is the treatment for neurosyphilis?

Answer 55

PCN

Question 56

What are some risk factors for neurosyphilis?

Answer 56

HIV Non-HIV Male gender Age 45 years and older

Question 57

What bacteria is associated with Lyme disease?

Answer 57

Borrelia burgdorferi

Question 58

Where is lyme disease more common?

Answer 58

More common in northeastern and north central US

Question 59

Erythema migrans - flat "bulls' eye" lesion with central clearing, HA, myalgias, fatigue. What am I?

Answer 59

Lyme disease

Question 60

When does the bulls eye lesion tend to appear? What % of patients do NOT show this symptom?

Answer 60

occurs 1 week after tick bite 10-20% of patients do not present with lesion

Question 61

What does stage 2 of lyme disease present like?

Answer 61

Bacteremia Secondary skin lesions and rash Worsening of flu-like symptoms Cardiac involvement (4-10% of patients) Neurologic manifestations (10-15% of patients)

Question 62

What does stage 3 lyme disease present like?

Answer 62

Musculoskeletal (60%) Joint pain: arthritis (knee) Neurologic Skin

Question 63

What criteria do you need to establish lyme disease as the cause?

Answer 63

A person exposed to a tick bite who: *Developed erythema migrans or *Had at least one late manifestation and *Laboratory confirmation

Question 64

What lab test do you order to check for lyme disease?

Answer 64

ELISA (Enzyme linked immunosorbent assay) - detects antibodies to B. burgdorferi Confirm with Western Blot

Question 65

What is the treatment of choice for Lyme Disease? Pregnant pt?

Answer 65

doxy amoxicilin

Question 66

How long should you continue treatment for lyme disease?

Answer 66

10-21 days

Question 67

Who do you treat prophalaxis for lyme disease?

Answer 67

Question 68

_____ is transmitted to humans by ingestion of food or drink contaminated by urine of the infected animal (rat)

Answer 68

Leptospirosis

Question 69

_____ manifestations can range from minor to fatal liver and kidney disease

Answer 69

Leptospirosis

Question 70

How is Leptospirosis dx?

Answer 70

serologic testing

Question 71

What is the treatment for Leptospirosis?

Answer 71

doxy

Question 72

_____ is the most serious rickettsial disease

Answer 72

Rocky mountain spotted fever

Question 73

Dermacentor (wood tick, dog tick) is the cause of _____

Answer 73

Rocky Mountain Spotted Fever

Question 74

What states are Rocky Mountain Spotted Fever commonly found in?

Answer 74

N. Carolina, Tennessee, Oklahoma, Arkansas, Missouri

Question 75

How long does it take for Rocky Mountain Spotted fever s/s to appear?

Answer 75

2-14 days after tick bite

Question 76

fever, chills, HA, N/V, myalgias, insomnia, and characteristic rash Rash - faint macules progressing to papules, then to petechiae Rash appears on first on wrists and ankles and spreads centrally Can progress to delirium, lethargy, seizures, and coma What am I?

Answer 76

Rocky Mountain Spotted Fever

Question 77

What is the treatment of choice for RMSF?

Answer 77

Doxy BID

Question 78

Typhus, Ehrlichiosis and Anaplasma all produce symptoms of ____, _____ and ______. What is the treatment?

Answer 78

Fever, rash, myalgia Doxy