Bacteriology Flashcards by Karen Bianca Espinola

Gram (+) cocci in clusters; Catalase (+); Coagulase (-); Novobiocin sensitive

Staphylococcus epidermidis

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Gram (+) cocci in clusters; Catalase (+); Coagulase (+)

Staphylococcus aureus

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Gram (+) cocci in clusters; Catalase (+); Coagulase (-); Novobiocin resistant

Staphylococcus saprophyticus

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Beta hemolytic yellow or golden colonies on blood agar; Salt-tolerant on Mannitol Salt Agar; Normal flora of human nose and skin

Staphylococcus aureus

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Gold color is due to the pigment

Staphyloxanthin

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Alter immune response

Immunomodulators

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Prevents Complement Activation

Protein A

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Builds an insoluble fibrin capsule

Coagulase

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Toxic to hematopoeitic cells

Hemolysins (cytotoxins)

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Specific for white blood cells

PV Leukocidin

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Detoxifies hydrogen peroxide

Catalase

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Inactivates penicillin derivatives

Penicillinase

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Hydrolyzes hyaluronic acid

Hyaluronidase

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Dissolves fibrin clots

Fibrinolysin (Staphylokinase)

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Spread in fat-containing areas of the body

Lipase

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Causes epidermal separation

Exfoliatin

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Superantigens causing food poisoning

Enterotoxins (heat-stable)

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Superantigen leading to Toxic Shock Syndrome

Toxic Shock Syndrome Toxin (TSST-1)

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Causes marked necrosis of the skin and hemolysis

Alpha Toxin

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Skin and Soft Tissue Infections caused by S. aureus

Bullous impetigo
Folliculitis
Furuncles
Carbuncles
Cellulitis
Hidradenitis suppurativa
Mastitis
Surgical site infections

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Most common cause of Acute Endocarditis

Staphylococcus aureus

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Native valve involved in IV drug abusers

Tricuspid valve

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Pneumonia caused by S. aureus

Nosocomial pneumonia
VAP
Necrotizing pneumonia

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Pneumonia by S. aureus: Complicated by

Empyema
Abscess
Pneumatocoele

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From hematogenous spread or local introduction at wound site

Osteomyelitis and Septic Arthritis

Sequestered focus of osteomyelitis arising in the metaphyseal area of a long bone

Brodie abscess

Acute onset (4hrs) of vomiting and diarrhea due to ingestion of preformed heat-stable enterotoxin; Usually from salad made with mayonnaise (potato or tuna); Common cause of food poisoning

Gastroenteritis by S. aureus

Exfoliatin cleaves Desmoglein in desmosomes; Separation of epidermis at Stratum Granulosum; Distinguish from TEN (Lyell Disease) where separation occurs at dermoepidermal junction

Scalded Skin Syndrome (Ritter Disease)

Due to TSST-1; Fever, hypotension, slouging of the filiform papillae; Strawberry tongue, desquamating rash & multi-organ involvement; Usually no site of pyogenic inflammation; Blood CS negative; Usual scenario: Tampon-using menstruating women or in patients with nasal packing for epistaxis

Toxic Shock Syndrome

Treatment: Methicillin-sensitive Staphylococcus aureus (MSSA)

Nafcillin Oxacillin Dicloxacillin

Treatment: Methicillin-resistant Staphylococcus aureus (MRSA)

Drug of Choice: Vancomycin

Treatment: Vancomycin-resistant Staphylococcus aureus

Drug of Choice: Linezolid

Gram (+) cocci in clusters; Catalase (+); Coagulase (-); Novobiocin sensitive; Whitish, non-hemolytic colonies on Blood Agar; Normal flora of skin

Staphylococcus epidermidis

Most common cause of Prosthetic valve Endocarditis; Septic arthritis in prosthetic joints; Ventriculoperitoneal shunt infections

Staphylococcus epidermidis

Drug of choice for Staphylococcus epidermidis

Vancomycin

Gram (+) cocci in clusters; catalase (+); coagulase (-); Novobiocin resistant; Whitish, non-hemolytic colonies on Blood Agar

Staphylococcus saphrophyticus

2nd most common cause of UTIs in sexually active women

Staphylococcus saphrophyticus

Treatment for Staphylococcus saphrophyticus

TMP-SMX, Quinolones (Ciprofloxacin, Gatifloxacin)

Gram (+) cocci in chains; catalase (-); alpha hemolytic; bile optochin sensitive

Streptococcus pneumoniae

Gram (+) cocci in chains; catalase (-); alpha hemolytic; bile optochin resistant

Viridans streptococci

Gram (+) cocci in chains; catalase (-); beta hemolytic; bacitracin sensitive

Streptococcus pyogenes

Gram (+) cocci in chains; catalase (-); beta hemolytic; bacitracin resistant

Streptococcus agalactiae

Gram (+) cocci in chains; catalase (-); gamma hemolytic

Group D Streptococci

Measures hydrolysis of l-pyrrolidonyl-beta- naphthylamide and release of beta-naphthylamine, which in the presence of p-dimethylaminocinnamaldehyde forms a red compound.

PYR test

Gram (+) cocci in chains; Beta hemolytic; Catalase (-); Bacitracin sensitive; Lancefield group A; Positive PYR test; Normal flora of human throat and skin

Streptococcus pyogenes

Spreading factor

Hyaluronidase

Activates plasminogen

Streptokinase (fibrinolysin)

Degrades DNA in exudates or necrotic tissue

DNAse (Streptodornase)

Inactivates complement C5a

C5a peptidase

Produces Scarlet Fever

Erythrogenic toxin

Highly antigenic, causes AB formation; Oxygen-labile; Irreversibly inhibited by cholesterol in skin lipids

Streptolysin O

Oxygen-stable

Streptolysin S

Superantigen similar to TSST

Pyogenic exotoxin A

Protease that rapidly destroys tissue causing Necrotizing fasciitis

Exotoxin B

Titers to document antecedent pharyngitis

Anti-streptolysin O (ASO)

Titers to document antecedent skin infection

Anti-DNAse B

Antibodies decrease efficacy of streptokinase in managing MI

Anti-streptokinase

Perioral blistered lesions with honey-colored crust; Accumulation of neutrophils beneath stratum corneum; Complication: PSGN

Impetigo contagiosa

Superficial infection extending into dermal lymphatics; Painful

Erysipelas

Deeper infection involving subcutaneous or dermal tissues; Facilitated by hyaluronidase (spreading factor)

Cellulitis

Rapidly progressive infection of deep subcutaneous tissues; Facilitated by Exotoxin B

Necrotizing fasciitis

Most common bacterial cause of sore throat; Inflammation, exudate, fever, leukocytosis, and tender CLAD; Pyogenic complications: abscess, otitis, sinusitis, meningitis

Steptococcus pyogenes

Postpharyngitic; Due to erythrogenic toxin, seen in lysogenized strains; Fever, strawberry tongue, centrifugal rash (sandpaper-like), Pastia's lines, desquamation

Scarlet Fever

Susceptibility test for Scarlet Fever

Dick Test

Clinically similar but milder than S. aureus TSS; Due to pyogenic exotoxin A; Recognizable site of pyogenic inflammation; Blood cultures are often positive

Streptococcal Toxic Shock Syndrome

Postpharyngitic; Cross reacting antibodies to M proteins and antigens of joint, heart and brain tissue

Acute Rheumatic Fever

JONES Criteria

``` P-E-C-C-S Polyarthritis Erythema marginatum Chorea (Sydenham's) Carditis (Pancarditis) Subcutaneous nodules ```

Postpharyngitic or post-impetigo; M protein incites immune complex deposition on the glomerular basement membrane

Glomerulonephritis

Drug of choice for Streptococcus pyogenes

Penicillin G

Gram (+) cocci in chains; Beta hemolytic; Catalase (-); Bacitracin resistant; Hydrolyze hippurate; CAMP test positive; Lancefield group B; Grow using LIM broth; Normal flora of Vagina

Streptococcus agalactiae

Causative agent: Urinary Tract Infection in pregnant women

Streptococcus agalactiae

Most common cause of Neonatal pneumonia, sepsis, and meningitis

Streptococcus agalactiae

Most commonly polymicrobial Endometritis; Foul-smelling

Streptococcus agalactiae

Drug of choice for Streptococcus agalactiae

Penicillin G

Drug of choice for more serious S. Agalactiae infection

Penicillin G + Aminoglycoside

All pregnant women should be screened for GBS colonization at

35-37 weeks aog

Gram (+) cocci in chains; Catalase (-); Gamma (nonhemolytic) colonies; Lancefield group D; Bile and Optochin resistant; Hydrolyzes esculin in bile-esculin agar (BEA); positive PYR test; Normal flora of human colon

Group D Streptococci

Endocarditis in patients who underwent GIT surgery due to

Enterococcus faecalis

UTIs due to indwelling urinary catheters and urinary tract instrumentation; Biliary tract infections

Group D Streptococci

Marantic endocarditis in patients with abdominal malignancy due to

Streptococcus bovis

Associated Ca with Marantic Endocarditis

Pancreatic Ca | Colorectal Ca

Treatment for Group D Streptococci

Penicillin plus Gentamicin

For Penicillin-resistance Group D Streptococci

Vancomycin

For Vancomycin-resistant Strains

Linezolid

Gram (+) "lancet-shaped" cocci in pairs (diplococci) or short chains; Alpha hemolytic; Catalase (-); Sensitive to bile and optochin; Prominent polysaccharide capsule; Quellung reaction (+); Normal flora of upper respiratory tract

Streptococcus pneumoniae

Optochin Sensitivity

Optochin Viridans Resistant Pneumonia Sensitive

Quellung Reaction

Capsular swelling

Encapsulated Bacteria

``` Streptococcus pneumoniae Klebsiella pneumoniae Haemophilus influenzae Pseudomonas aeruginosa Neisseria meningitidis Salmonella typhi B group streptococci ```

Antiphagocytic factor

Capsule

For colonization

IgA protease

Reacts with CRP; Acute phase reactant

C-substance

Most common cause of Community Acquired Pneumonia (CAP); Sudden chills, fever, productive cough (rust-colored sputum), pleuritic chest pain; Lobar pattern

Streptococcus pneumoniae

Most common cause of Otitis media, Sinusitis, Bacterial Meningitis; Skull fracture with spinal fluid leakage from nose predisposes to meningitis

Streptococcus pneumoniae

Splenectomy predisposes to sepsis

Septic Shock

Congenital Absence of Spleen; Need to get meningococcal and pneumococcal vaccines

Ivemark Syndrome

Drug of choice for Streptococcus pneumoniae

Penicillin G

Gram (+) cocci in chains; Alpha hemolytic; Catalase (-); Resistant to bile and optochin; Normal flora of Oropharynx

Viridans Streptococci

Enhances adhesion to damaged heart valves

Glycocalyx

Protected from host defenses within

Vegetations

Found in Dental caries

Streptococcus mutans

Found in Subacute Bacterial Endocarditis (SBE); Most common cause of subacute and native valve endocarditis

Streptococcus sanguis

Found in brain abscesses

Streptococcus intermedius

Treatment for Viridans streptococci

Penicillin G with or without Aminoglycoside

Spore-forming, gram (+), rods; aerobic, nonmotile, box car-shaped

Bacillus anthracis

Spore-forming, gram (+), rods; aerobic, motile, reheated fried rice

Bacillus cereus

Spore-forming, gram (+), rods; anaerobic, tennis racket-like

Clostridium tetani

Spore-forming, gram (+), rods; anaerobic, bulging cans

Clostridium botulinum

Spore-forming, gram (+), rods; anaerobic, lecithinase, gas-forming

Clostridium perfringens

Spore-forming, gram (+), rods; anaerobic, pseudomembranes

Clostridium difficile

Non-spore-forming, gram (+), rods; aerobic, nonmotile, curved, chinese characters

Corynebacterium diphtheriae

Non-spore-forming, gram (+), rods; aerobic, curved, tumbling motility

Listeria monocytogenes

Aerobic, gram (+) box car-like rods; nonmotile; spore-forming; Medusa head morphology; Habitat: soil

Bacillus anthracis

Dry "ground glass" surface and irregular edges with projections along lines of inoculation

Medusa Head Morphology

Transmission by contact with infected animals or inhalation of spores from animal hair and wool

Woolsorter's Disease

Calmodulin-dependent adenylate cyclase

Edema factor (EF)

Inhibits a signal transduction in cell division

Lethal factor (LF)

Mediates entry of the other two components into cell

Protective antigen (PA)

EF + PA =

Edema Toxin

LF + PA =

Lethal Toxin

True or False: EF, LF, PA are toxic individually.

False (nontoxic individually but form toxins when combined)

Direct epidermal contact with spores causes formation of malignant pustule with subsequent eschar and central necrosis

Cutaneous Anthrax

Inhaled spores from animals or from weaponized preparations (bioterrorism); Prolonged latent period before rapid deterioration; Massively enlarged mediastinal lymph nodes, pulmonary hemorrhage, meningeal symptoms

Inhalational Anthrax

Ingestion of live spores leads to UGI ulceration, edema, and sepsis (rapidly-progressive course)

Gastrointestinal Anthrax

DOC for Cutaneous Anthrax

Ciprofloxacin

DOC for Inhalational or Gastrointestinal Anthrax

Ciprofloxacin or Doxycycline with one or two additional antibiotics (Rifampicin, Vancomycin, Penicillin, Imipenem, Clindamycin, Clarithromycin)

Aerobic, gram (+), spore-forming rods, motile; Spores germinate when rice is kept warm for many hours

Bacillus cereus

Cholera-like enterotoxin causes ADP-ribosylation with increasing cAMP

Heat-labile Enterotoxin (Secretory Diarrhea)

Staphylococcal-like enterotoxin functions as superantigen

Heat-stable Enterotoxin

Short incubation period (4hrs); Consists primarily of nausea and vomiting, similar to Staphylococcal Food Poisoning

Emetic Form (heat-stable) Food Poisoning

Long incubation period (18hrs); Watery, non bloody diarrhea, resembling Clostridial gastroenteritis

Diarrheal Form (heat-labile) Food Poisoning

Occur after traumatic penetrating eye injuries of the eye with a soil-contaminated object; Complete loss of light perception within 48 hours of the injury

Ophthalmitis

Treatment for Emetic or Diarrheal Food Poisoning

Symptomatic treatment only

Treatment for Ophthalmitis

Vancomycin, Clindamycin, Ciprofloxacin or Gentamicin

Anaerobic, gram (+), spore-forming rods; Spore is at one end (terminal spore); tennis racket-like; Habitat: soil; Entry thru traumatic break in the skin

Clostridium tetani

Protease that cleaves proteins involved in the release of Glycine from Renshaw cells in spinal cord

Tetanus toxin (Tetanospasmin)

Spectrum of Disease: Tetanus

``` Strong muscle spasms Lockjaw (Trismus) Risus sardonicus Opisthotonos Respiratory Failure ```

Treatment and DOC for Tetanus

Debridement of primary wound | DOC: Metronidazole (Pen G - Philippines)

Tetanus vaccination for clean, minor wound

Toxoid (TeANA) for uncertain or 3 doses who had last dose >10 years

Tetanus vaccination for contaminated wound

Toxoid (TeANA) & TIG (ATS) for uncertain or 3 doses who had last dose >5 years

Anaerobic, gram (+), spore-forming rods; Habitat: Soil; Transmitted in improperly preserved food

Clostridium botulinum

Heat-labile neurotoxin that blocks acetylcholine release causing flaccid paralysis (descending pattern)

Botulinum Toxin

Most common Botulinum Toxin in humans

Types A, B and E

Commercial preparation of Exotoxin A

Botox

Triad of Botulism

Symmetric descending flaccid paralysis (with prominent bulbar involvement) Absence of Fever Intact sensorium

When babies ingest spores found in household dust or honey; Due to absence of competitive bowel flora

Infant Botulism (Floppy Baby Syndrome)

Traumatic implantation and germination of spores at the wound site

Wound Botulism

Treatment for Botulism

Adequate ventilatory support Elimination of the organism from GIT Trivalent Botulinum antitoxin (types A, B, E)

Anaerobic, gram (+), spore-forming rods; Nonmotile; Double hemolysis on Blood Agar; Growth on Egg-yolk Agar; Rapidly spreading growth on culture media; Habitat: soil and human colon

Clostridium perfringes

Caused by Alpha toxin which is a lecithinase that cleaves cell membrane; Results from contamination of wound with soil or feces; Gas produced by anaerobic metabolism; Pain, edema & cellulitis with crepitation; Hemolysis and jaundice are common

Gas Gangrene (Myonecrosis)

Production of enterotoxin which acts as superantigen; 8-16 hour incubation period; Characterized by watery diarrhea with cramps and little vomiting; Resolves in 24 hours

C. perfringens Food Poisoning

Treatment for Gas Gangrene

Wound debridement | Penicillin

Treatment for C. perfringens Food Poisoning

Supportive management

Anaerobic, gram (+), spore-forming rods; Exotoxin in stool detected by cytopathic effect (final phase by which viral cells infect cells) on cultured cells or ELISA; Carried in the colon; Transmitted by fecal-oral route

Clostridium difficile

Antibiotics that suppress normal flora in colon, allowing C. difficile to overgrow

Clindamycin 2nd and 3rd Gen Cephalosporins Ampicillin

Inhibit GTPases, leading to apoptosis an death of enterocytes

Exotoxins A and B

Visual result of Exotoxins A and B

Pseudomembranes

This infection can precipitate flare-ups of ______?

Ulcerative colitis

Nonbloody diarrhea associated with pseudomembranes (yellow-white plaques) on the colonic mucosa

Pseudomembranous Colitis

Can occur in Pseudomembranous colitis

Toxic megacolon

What causes Pseudomembranous pharyngitis?

Corynebacterium diphtheriae

What causes Pseudomembranous esophagitis?

Candida albicans

Drug of Choice for Pseudomembranous colitis?

Metronidazole

Aerobic, non-spore-forming, non-motile, gram (+) rods; Club or comma-shaped rods arranged in V or L shape; Look like Chinese characters; Picket fence appearance; Metachromatic granules (Babes-Ernst granules or volutin granules); Black colonies on Tellurite plate; Habitat: Human throat

Corynebacterium diphtheriae

Toxigenicity Test for Corynebacterium diphtheriae

Elek Test

Exotoxin inhibits protein synthesis by adding ADP-ribose to ______

Elongation Factor-2 (EF-2)

Has ADP-ribosylating activity

Subunit A of EF

Binds the toxin to cell surface

Subunit B of EF

Exotoxin is encoded by ______?

Beta-prophage

Result from death of mucosal epithelial cells

Pseudomembranes

Prominent, thick, gray, pseudomembranes over tonsils and throat; Complications: airway obstruction, myocarditis, cranial nerve or muscle paralysis

Pseudomembranous pharyngitis

Treatment for Pseudomembranous pharyngitis?

Antitoxin | Penicillin G

Aerobic, non-spore-forming, gram (+) rods; Arranged in V or L shape; Tumbling motility; Narrow zone of beta hemolysis; Paradoxical growth in cold temp (Cold Enhancement); Habitat: GI and female GUT; Transmitted across placenta or by contact and ingestion of unpasteurized milk products

Listeria monocytogenes

Interacts with E-cadherin on the surface of cells

Internalin

Escape from phagosomes

Listeriolysin

Propels the bacteria thru the membrane of one human cell and into another

Actin Rockets

Transplacental transmission; Characterized by late miscarriage or birth; Complicated by sepsis, multiorgan abscesses and Disseminated granulomas

Early-onset Neonatal Listeriosis (Granulomatosis Infantiseptica)

Transmitted during childbirth and manifests as meningitis or meningoencephalitis

Late-onset Neonatal Listeriosis

Bacteremia, sepsis, or meningitis in pregnant, elderly or immunocompromised individuals

Adult Listeriosis

Treatment for Listeriosis

Ampicillin with or without Gentamicin

Bacteria motility: Tumbling

Listeria monocytogenes

Bacteria motility: Swarming

Proteus mirabilis

Bacteria motility: Shooting-star

Vibrio cholerae

Bacteria motility: Falling leaf

Giardia lambia

Gram (-) diplococci, encapsulated, ferments maltose and glucose

Neisseria meningitidis

Gram (-) diplococci, insignificant capsule, ferments glucose only

Neisseria gonorrhoeae

Gram (-) "kidney-bean" diplococci; Large polysaccharide capsule; Oxidase (+) colonies on Chocolate Agar; Ferments maltose and glucose; Habitat: URT; Humans are the only natural hosts; High carriage rate in close quarters

Neisseria meningitidis

Complement deficiencies in the _____ predispose to illness; Cannot form membrane-attack complexes

Late-acting Complement Components (C5-C9)

Most common cause of Meningitis among aged 2-18 yrs; With headache, fever, stiff neck, and an increased level of PMNs in spinal fluid

Neisseria meningitidis

Dissemination of meningococci into the bloodstream; Multiorgan disease, consumptive coagulopathy, petechial or purpuric rash (purpura fulminans)

Meningococcemia

Most severe form of meningococcemia; High fever, shock, widespread purpura, DIC, thrombocytopenia and adrenal insufficiency; Bilateral hemorrhagic destruction of the adrenal glands

Waterhouse-Friderichsen Syndrome

Drug of Choice for Neisseria meningitidis

Penicillin G

Neisseria meningitidis Vaccine: Contains capsular polysaccharide of _____

Strains A, C, Y, and W-135

Chemoprophylaxis to close contacts

Rifampicin

Gram (-) "kidney-bean" diplococci; Insignificant capsule; oxidase (+) colonies on Thayer-Martin Medium; Ferment glucose only; Habitat: human genital tract; Transmitted by sexual contact

Neisseria gonorrhoeae

Purulent conjunctivitis in newborns

Ophthalmia neonatorum

Urethritis and epididymitis in men; Most common cause of urethritis (in men)

Gonococcal Urethritis

Most common cause of PID; Complications: sterility, ectopic pregnancy, chronic pelvic pain, dyspareunia

Neisseria gonorrhoeae

Perihepatitis with violin-string adhesions

Fitz-Hugh-Curtis Syndrome

Most common cause in sexually active adults; Arthritis, tenosynovitis, or pustules in the skin

Septic Arthritis

DOC for Neisseria gonorrhoeae

Ceftriaxone

DOC for N. Gonorrhoeae with co-infection with Chlamydia trachomatis

Ceftriaxone + Doxycycline

Cause culture-negative subacute bacterial endocarditis in patients with pre-existing heart disease

Eikenella corrodens | Kingella kingae

HACEK Organisms; Minor cause of Endocarditis

``` Haemophilus aphrophilus Actinobacillus actinomycetemcomitans Cardiobacterium hominis Eikenella corrodens Kingella kingae ```

Dog bite Infection

Pasteurella multocida

Human bite Infection

Eikenella corrodens

Gram (-) rods, enriched chocolate agar, polyribitol phosphate capsule

Haemophilus influenzae type B

Gram (-) rods, Regan Lowe agar or Bordet-gengou agar, whooping cough

Bordetella pertussis

Gram (-) rods, poorly gram staining, silver stain, charcoal yeast agar, airconditioning

Legionella pneumophila

Small, gram (-) coccobacillary rods; Requires Factor X (hemin) and V (NAD) for growth (chocolate agar); Satellite phenomenon around S. aureus colonies; Habitat: Upper Respiratory Tract

Haemophilus influenzae

95% of invasive disease of H. influenzae

Type B (Polyribitol phosphate)

Affects children from 6 months to 1 year; Decline in ____________

Maternal IgG and Immature immune system

Most common cause of Epiglottitis; Cherry red epiglottis with Thumb sign

Haemophilus influenzae

Etiology of Laryngotracheobronchitis

Parainfluenza virus

Radiologic sign of laryngotracheobronchitis

Steeple sign

Treatment for H. influenzae

Ceftriaxone

Treatment for Laryngotracheobronchitis

Racimic Epinephrine

Small, gram (-) rods; Culture on Bordet-Gengou agar or Regan-Lowe Charcoal Medium; Habitat: Upper Respiratory Tract

Bordetella pertussis

Mediates attachment

Filamentous hemagglutinin

Causes ADP-ribosylation and lymphocytosis

Pertussis Toxin

Inhibits phagocytic activity

False adenylate cyclase

Damages ciliated cells; Causes whooping

Tracheal cytotoxin

Paroxysmal pattern of hacking coughs, accompanied by production of copious amounts of mucus, that end with an inspiratory "whoop"

Pertussis or Tuspirina

Highest bacterial yield in Pertussis

Catarrhal

DOC for Pertussis

Erythromycin

Poorly gram (-) rods; Visualize with silver stain; Facultative intracellular bacteria; Culture on Charcoal yeast extract agar; Rapid urinary antigen test; Habitat: Environmental water sources

Legionella pneumophila

Facultative Intracellular Bacteria

``` Salmonella Brucella Mycobacterium Listeria Francisella Legionella Yersinia ```

Sole virulence factor of Legionella pneumophila

Endotoxin

3 Most common cause of Atypical Pneumonia

Mycoplasma pneumoniae Legionella pneumophila Chlamydia pneumoniae

Pneumonia accompanied by confusion, nonbloody diarrhea, hyponatremia, proteinuria and hematuria

Atypical Pneumonia caused by Legionella pneumophila

Mild, flu-like illness, "Legion of Silver Pontiac"

Pontiac Fever

Drug of Choice for Legionella pneumophila

Azithromycin or Erythromycin

Gram (-) rods, lactose fermenter, green sheen

Escherichia coli

Gram (-) rods, lactose fermenter, urease (+), Extended spectrum Beta lactamase producer

Klebsiella pneumoniae

Gram (-) rods, comma-shaped, motile, oxidase (+), shooting star motility

Vibrio cholerae

Gram (-) rods, comma-shaped, microaerophilic, Skirrow's agar (Campy's Agar)

Campylobacter jejuni

Gram (-) rods, comma-shaped, urease (+), microaerophilic

Helicobacter pylori

Non-lactose-fermenting, gram (-) rods, motile, oxidase (-), H2S producer

Salmonella spp.

Non-lactose-fermenting, gram (-) rods, nonmotile, oxidase (-), H2S producer

Shigella spp.

Non-lactose-fermenting, gram (-) rods, swarming, oxidase (-), H2S producer, urease

Proteus mirabilis

Non-lactose-fermenting, gram (-) rods, oxidase (+), H2S non-producer, obligate aerobe

Pseudomonas aeruginosa

Facultative gram (-) rods, Lactose fermenting colonies on EMB or MacConkey's Agar; Green sheen on EMB agar; Metallic sheen; TSI aar shows acid slant and acid butt with gas but no H2S; Habitat: Human colon

Escherichia coli

O antigen

Somatic antigen (outer membrane)

H antigen

Flagellar antigen

K antigen

Capsular antigen

Enterotoxins of E. coli that cause watery diarrhea

HST | HLT

Enterotoxins of E. coli that cause bloody diarrhea

Verotoxin (Shiga-like)

Enterobacteriaceae MESSY SPECK

``` Morganella Escherichia Shigella Salmonella Yersinia Serratia Proteus Enterobacter Citrobacter Klebsiella ```

Most common cause of Community-Acquired UTI and hospital-acquired

E. coli

2nd most common cause of neonatal meningitis in the world (#1 in the Philippines)

E. coli

Causes of Neonatal meningitis

B group streptococci (S. agalactiae) Escherichia coli Listeria monocytogenes

ETEC: Watery diarrhea (Traveller's Diarrhea)

Enterotoxigenic E. coli

EPEC: Watery diarrhea of long duration, mostly in infants, often in developing countries

Enteropathogenic E. coli

EHEC: Bloody diarrhea, Hemorrhagic colitis, and Hemolytic Uremic Syndrome; Eating raw hamburger; E. coli O157:H7

Enterohemorrhagic E. coli

EIEC: Bloody diarrhea

Enteroinvasive E. coli

EAEC: Persistent watery diarrhea in children patients infected with HIV

Enteroadherent E. coli

Treatment for E. Coli

Ampicillin or Sulfonamides for UTI | 3rd Gen Cephalosporins for meningitis and sepsis

Facultative gram (-) rods, non-lactose-fermenting; Producing H2S; Cultured in Xylose-Lysine-Deoxycholate (XLD) medium; Habitat: human colon only

Salmonella spp.

Detects antibodies in patient's serum

Widal Test

Invasion of the epithelial and subepithelial tissue of the small and large intestines; Infectious dose is high

Enterocolitis (S. Enteritidis/S. typhimurium)

Due to Vi capsular antigen; Organisms enter, multiply in Peyer's patches and then spread to reticulo-endothelial system; Predilection for invasion of the gallbladder, which can result in establishment of the chronic carrier state

Typhoid Fever (S. typhi)

Bacteremia results in the seeding of many organs, with osteomyelitis, pneumonia, and meningitis as the most common sequelae; Commonly in patients with Sickle Cell Anemia or Cancer

Septicemia (S. choleraesuis)

Drug of Choice for Salmonella spp.

Ceftriaxone (Philippines: Amoxicillin Chloramphenicol, Cotrimoxazole)

DOC for Salmonella in Gallbladder

Ampicillin

Enteric Fever: Week 1 Culture Source

Blood | Bone marrow

Enteric Fever: Week 2 Culture Source

Urine

Enteric Fever: Week 3 Culture Source

Stool

Enteric Fever: Week 4 Culture Source

Bone marrow

Enteric Fever: Post Culture Source

Bile Stool Bone marrow

Non-lactose-fermenting, gram (-) rods; Produce no gas from the fermentation of glucose; Do not produce H2S; Nonmotile; Cultured XLD medium; Habitat: human colon only; Transmission: fecal-oral route

Shigella spp.

Shigella Transmission 4 Fs

Food Fingers Feces Flies

Invade the distal ileum and colon; Low infectious dose (highly infectious); Local inflammation accompanied by ulceration

Shigella

Most common cause of Bacillary Dysentery

Shigella Sonnei-Duval's Bacillus

Most severe form of bacillary dysentery; Most common cause of epidemic dysentery (Bloody Diarrhea)

Shigella dysenteriae type 1 - Shiga Bacillus

Some produce an enterotoxin or verotoxin

Shiga toxin

Group A - Shigella dysenteriae

Shigella dysenteriae type1 - Shiga bacillus | Shigella dysenteriae type2 - Schmitz bacillus

Group B - Shigella flexneri

Flexner's bacillus or Hiss and Russell's bacillus

Group C - Shigella boydii

Newcastle Manchester bacillus

Group D - Shigella sonnei

Duval's bacillus

Treatment for severe cases of Shigella Dysentery

Ciprofloxacin

Comma-shaped, gram (-) rods, motile, oxidase (+), cultured on Thiosulfate citrate bile salts sucrose (TCBS) agar; Shooting star motility; Habitat: human colon only

Vibrio spp.

Enterotoxin (choleragen) acts by

ADP ribosylation

Enhances attachment to the intestinal mucosa

Mucinase

Pandemics caused by

Vibrio cholerae O1 biotype El Tor (cholera El Tor)

Watery diarrhea in large volumes (rice-water stools); Washer women's hand; Complications: cardiac and renal failure, non-gap acidosis, hypokalemia

Cholera (V. cholerae)

Generally self-limited with an explosive onset of watery diarrhea and nausea, vomiting, abdominal cramps, headache and low-grade fever

Gastroenteritis (V. parahemolyticus, V. vulnificus)

Associated with exposure to contaminated water

Wound infections (V. parahaemolyticus, V. vulnificus)

DOC for Cholera

Tetracycline or Azithromycin

Comma-shaped, gram (-) rods, microaerophilic, oxidase (+), catalase (+), grows well at 42C on Skirrows agar or Campy medium (with antibiotics); Habitat: human and animal feces

Campylobacter jejuni

Most common cause of bacterial gastroenteritis (from undercooked chicken); Possibly enterotoxin-mediated diarrhea; Invades mucosa of the colon but does not penetrate; Produces histologic damage to the mucosal surfaces of the jejunum; May mimic ulcerative colitis

Campylobacter jejuni

Antigenic cross-reactivity between oligosaccharides in bacterial capsule and glycosphingolipids on surface of neural tissues

Guillain-Barre Syndrome

Reactive arthritis; Triad of Urethritis, Uveitis and Arthritis

Reiter's Syndrome

Treatment for Campylobacter jejuni for severe disease

Erythromycin

Curved, gram (-) rods, microaerophilic, urease (+); Habitat: human stomach

Helicobacter pylori

Urease (+) Bacteria

Proteus mirabilis Klebsiella pneumoniae Helicobacter pylori Ureaplasma urealyticum

Damages goblet cells of the gastric mucosa; Production of large amounts of ammonia from urea by the organism's urease; Ammonia also neutralizes stomach acid, allowing the organism to survive

Helicobacter pylori

Recurrent pain in the upper abdomen, frequently accompanied by bleeding into the gastrointestinal tract

Peptic Ulcer Disease

Diseases associated to Campylobacter jejuni

Gastric Carcinoma | MALT lymphomas

Treatment for H. pylori infection

Clarithromycin or Metronidazole | Amoxicillin

Facultative gram (-) rods with large polysaccharide capsule (bacterial conjugation); Extended spectrum beta-lactamase (ESBL) activity in drug-resistant strains; Urease (+); Habitat: Upper Respiratory and GIT

Klebsiella pneumoniae

Pneumonia (necrotizing) thick, bloody sputum "currant-jelly sputum", usually nosocomial; Most common cause in alcoholics

Klebsiella pneumoniae

Treatment for Klebsiella pneumoniae

Culture-guided treatment (Cephalosporins alone or with Aminoglycosides)

Facultative, gram (-) rods, non-lactose-fermenting, urease (+), swarming motility

Proteus mirabilis

Urease hydrolyzes the urea in urine to form ammonia; Raises pH producing alkaline urine; Encourage the formation of struvite stones; Composed of magnesium-ammonia-phosphate

Proteus mirabilis

UTI associated with nephrolithiasis; Staghorn calculi form on renal calyces

Complicated Urinary Tract Infection

Treatment for Proteus mirabilis

TMP-SMX or Ampicillin

Gram (-) rods, obligate aerobe, non-lactose-fermenting, oxidase (+), pyocyanin (blue-green pigment), sweet grape-like odor, grow on Cetrimide agar; Habitat: environmental water sources

Pseudomonas aeruginosa

Tissue necrosis and inactivates EF-2

Exotoxin A

Facilitates exotoxin transfer

Type III secretion system

Damages the cilia and mucosal cells

Pyocyanin

From hemoglobin breakdown

Verdoglobin

Cause burn wound infections, hot tub folliculitis, skin graft-loss, green nail syndrome, puncture wound osteomyelitis, pubic osteomyelitis in IV drug abusers

Pseudomonas aeruginosa

Most common cause of Otitis externa, Malignant otitis externa in diabetics, Chronic suppurative otitis media

Pseudomonas aeruginosa

Ventilator-acquired pneumonia; High risk CAP; Typhlitis; Shanghai fever; ecthyma gangrenosum; februle neutropenia

Pseudomonas aeruginosa

3rd most common cause of Nosocomial UTIs

Pseudomonas aeruginosa

Treatment for Pseudomonas aeruginosa

Combination of active antibiotics (antipseudomonal penicillins, 3rd & 4th Gen Cephalosporins, Monobactam, Carbapenems, Fluroquinolones)

Anaerobic, gram (-) rods, predominant anaerobe of human colon, spreads to blood or peritoneum during bowel trauma, perforation or surgery

Bacteriodes fragilis

Infections commonly due to combinations if bacteria in synergistic pathogenicity; LPS with low endotoxic activity; Capsule; Foul smelling discharge; short-chain fatty acid products

Bacteriodes fragilis

DOC for Bacteriodes fragilis

Metronidazole

Small, gram (-) rods, without a capsule; From contaminated dairy or direct contact; Undulating Fever

Brucellosis

DOC for Brucellosis

Doxycycline plus Rifampin

Small, gram (-) rods; Reservoir: rabbits, deer, rodents; Transmission: ticks, aerosols, contact, ingestion; Tularemia

Francisella tularensis

Treatment for Francisella tularensis

Streptomycin or Gentamicin

Most virulent bacteria; small, gram (-) rods, with bipolar (safety pin) staining; Reservoir: wild rodents; Transmission: flea bite or inhalation; PE: buboes, cutaneous hemorrhage

Yersinia pestis

Treatment for Bubonic, Pneumonic, and Septicemic Plague

Streptomycin | Tetracycline

Short, encapsulated, gram (-) rods that exhibits bipolar staining; Buttery colonies with musty odor due to indole production; Reservoir: cats, dogs; Transmission: animal bite

Pasteurella multocida

Treatment for Pasteurella multocida

Penicillin G

Zoonoses

Brucella abortus Francisella tularensis Yersinia pestis Pasteurella multocida

Aerobic, acid-fast rods; High lipid content; Produces catalase and niacin; Slow-growing on Lowenstein-Jensen medium; Habitat: human lungs; Transmission via respiratory droplets

Mycobacterium tuberculosis

Exported repetitive protein that prevents phagosome-lysosomal fusion

Sulfatides

Most important virulence factor that prevents leukocyte migration

Cord Factor

Elicits delayed hypersensitivity

Tuberculin surface protein

Central area of Langhan's giant cells surrounded by a zone of epithelioid cells

Granulomatous Lesions

Granuloma surrounded by fibrous tissue that has undergone central caseation

Tubercle

Usually in middle or lower lobes; Subpleural granuloma

Ghon's Focus in Primary Complex

Subpleural granuloma + associated lymph node =

Ghon's complex

Radiologically detectable calcification

Ranke's complex

Usually in apices; Cicatricial changes, subpleural blebs, cavitation, fibrosis, nodules

Simon's Focus in Reactivation Tuberculosis

Secondary colonization with A. fumigatus (fungus ball)

Aspergilloma

Purified Protein Derivative Skin Test

>5mm - HIV+, AIDS, old TB, immunosuppressed >10mm - high-risk population >15mm - low-risk population (In Phil: 8mm accepted)

TB Lymphadenitis

Scrofula

Spondylitis

Pott's Disease

2 or 3 smear positive

Smear Positive TB

If at least 1 smear positive after another collection

Smear Positive TB

If all smear negative and consistent with active TB chest x-ray

Smear Positive TB

Treatment for Category 1

2 months HRZE and 4 months HR

Treatment for Category 2

2 months HRZES & 1 month HRZE | 5 months HRE

Treatment for Category 3

2 months HRZE | 4 months HR

Can you name other uses of BCG vaccine aside from TB prevention?

For management of Intravesical Bladder Cancer

Cause pulmonary disease in immunocompromised hosts (AIDS patients with CD4<50)

Mycobacterium Avium-Intracellulare Complex

DOC of Mycobacterium Avium-Intracellulare Complex

Azithromycin

Aerobic, Acid-fast rods; Can't be cultured in vitro; Reservoir: humans and armadillos; Transmission: prolonged exposure to nasal secretions of patients with the lepromatous form

Mycobacterium leprae

Tuberculoid Leprosy: Number of lesions

One or few

Tuberculoid Leprosy: Tissue destruction

Little

Tuberculoid Leprosy: Number of acid-fast bacilli

Few

Tuberculoid Leprosy: Likelihood of transmitting leprosy

Low

Tuberculoid Leprosy: Cell mediated response to M. leprae

Present

Tuberculoid Leprosy: Lepromin skin test

Positive

Lepromatous Leprosy: Number of lesions

Many lesions

Lepromatous Leprosy: Tissue destruction

Marked

Lepromatous Leprosy: Number of acid-fast bacilli

Many

Lepromatous Leprosy: Likelihood of transmitting leprosy

High

Lepromatous Leprosy: Cell-mediated response to M. leprae

Reduced or Absent

Lepromatous Leprosy: Lepromin skin test

Negative

Hypopigmented plaques, thickened superficial nerves and significant anesthesia

Tuberculoid Leprosy

Leonine facies; Erythema nodosum leprosum which signals acute flare-ups of disease and are tender red nodules or humps on both shins

Lepromatous Leprosy

Treatment for Tuberculoid Leprosy

Dapsone & Rifampin

Treatment for Lepromatous Leprosy

Dapsone, Rifampin, and Clofazimine

Treatment for Erythema nodosum leprosum

Thalidomide

Associated with congenital malformation: Focomelia (flipper-like limbs)

Thalidomide

Anaerobe (normal oral flora); Setting: local trauma (broken jaw or dental extraction); PE: hard, nontender swelling with sinus tracts draining

Actinomyces israelii

Aerobic, filamentous, gram (+) rods with aerial hyphae; weakly acid-fast (Fite-Faraco Stain); Transmission: inhalation of particles from soil; Manifests as mycetomas and lung and brain abscesses (orange colonies)

Nocardia asteroides

Treatment for Nocardiosis

TMP-SMX + drainage

Smallest free-living organisms; Not seen on gram stain; No cell wall; Only bacteria with cholesterol in cell membrane; Cultured in Eaton's medium; Habitat: human respiratory tract

Mycoplasma pneumoniae

Attachment, inhibition of ciliary motion and necrosis; Toll-like receptor 2 protein

P1 adhesin

Contributes to the damage to the respiratory tract cells

Hydrogen peroxide

Most common type of atypical pneumonia or walking pneumonia

Mycoplasma pneumoniae

Most common infectious cause for Steven-Johnson Syndrome

Mycoplasma pneumoniae

DOC for Mycoplasma pneumoniae

Erythromycin or Azithromycin

Coiled spirochete; Not seen on gram stain because too thin; Cannot be cultured in vitro; Microaerophilic; Habitat: Human Genital Tract

Treponema pallidum

Within hours, enters lymphatics and multiplies; Local, nontender ulcer (chancre) usually forms in 2-10 weeks

Primary Syphilis

Condyloma lata, maculopapular rash, fever, headache, malaise, anorexia, lymphadenopathy; Occurs after 1 to 3 months

Secondary Syphilis

Many years after inoculation; Clinical spectrum: granulomas (gummas), neurosyphilis

Tertiary Syphilis

Neurosyphilis: Prostitute's pupil

Argyll-Robertson Pupil

Snuffles/saddle nose; mulberry molars; Hutchinson triad; saber shins; rhagades; clutton's joints; pulmonary hemorrhage

Congenital Syphilis

Unilateral enlargement of the sternoclavicular portion of the clavicle

Higoumenakis sign

Most important diagnostic test for Primary Syphilis

Dark Field Microscopy

For Screening of Syphilis

Rapid Plasma Reagin | Venereal Disease Research Laboratory (RPR/VDRL)

For confirmatory test for Syphilis

Fluorescent Treponemal Antibody-Absorption (FTA-ABS)

False Positive VDRL Results

Viruses Drugs Rheumatic Fever, Rheumatoid arthritis Lupus, Leprosy

Treatment for Syphilis

Benzathine Penicillin G

Influenza-like symptoms few hours after receiving Penicillin, due to Lysis of Treponemes

Jarisch-Herxheimer Reaction

Weakly staining, gram (-) spirochetes; Largest medically-important bacteria; Stain well with aniline dyes (Giemsa or Wright Stain); Cultured on BSK medium; From bite of deer ticks (Ixodes scapularis)

Borrelia burgdorferi

Stage 1 of Lyme Disease

Erythema Chronicum Migrans

Stage 2 of Lyme Disease

Myocarditis (AV block), meningitis, Bell's palsy

Stage 3 of Lyme Disease

Autoimmune migratory polyartjritis (onion skin lesions), acrodermatitis chronica atrophicans

Lyme Disease

Bell's Palsy Arthritis Cardiac block Erythema chronicum migrans

DOC for Borrelia burgdorferi

Doxycycline

Rapid antigenic changes due to programmed rearrangements of bacterial DNA encoding surface proteins; Transmitted: human body louse (Pediculus humanus)

Relapsing Fever (Borrelia recurrentis)

Thin, coiled spirochetes, hook at one or both pointed ends (Shepherd's Crook); Obligate aerobe, grown on Ellinghausen-McCullough-Johnson-Harris (EMJH) medium or Fletcher's medium; Habitat: wild and domestic animals

Leptospira interrogans

Hallmark lesion of Leptospira interrogans

Vasculitis

Gold Standard Diagnostic For Leptospira interrogans

Leptospire microscopic agglutination test (lepto MAT)

Fever, chills, intense headache, calf tenderness, conjunctival suffusion

Acute Leptospiremic Phase

Aseptic meningitis, pulmonary involvement, hepatic necrosis, glomerulonephritis, snow-flake lesions in chest x-ray, CSF pleocytosis

Immune Leptospiruric Phase

Most severe form of Leptospirosis; Triad: Jaundice, Bleeding, Uremia; Orange cast skin; Most common cause of death is respiratory failure due to massive pulmonary hemorrhage

Weil Syndrome

Treatment for Leptospira interrogans

Penicillin G

Obligate intracellular bacteria; Energy parasites that use host ATP; Cell wall lacks muramic acid; Grown in cycloheximide culture; Cytoplasmic inclusions in Giemsa

Chlamydia trachomatis

Inactive, extracellular; Enters cells by endocytosis

Elemental Body

Metabolically active, intracellular; Seen microscopically

Reticulate Body

Most common STD overall

Chlamydia

Chronic keratoconjunctivitis progressing to scarring and blindness

Trachoma

Most common cause of Infectious Blindness

Chlamydia trachomatis types A-C

Round to oval cytoplasmic inclusion bodies near the nuclei of conjunctival epithelial cells in trachoma

Halberstadter-Prowazek Inclusions

Trachoma A, B, C

Africa Blindness Chronic infection

Striking tachypnea, characteristic paroxysmal cough (Staccato cough), absence of fever, eosinophilia

Chlamydia trachomatis types D-K

Papule or vesicular which ulcerates and leads to suppurative inguinal lymphadenitis (buboes)

Chlamydia trachomatis types L1-L3

Intradermal injection of antigen of C. trachomatis

Positive Frei Test

Initiate lesion development or cause exacerbation of lesions; higher titers of Anti-C. pneumoniae antibodies

Chlamydia pneumoniae (Atypical pneumonia)

Sudden onset pneumonia with malaise, fever, anorexia, sore throat, photophobia, and severe headache

Psittacosis or Bird Fancier's Disease (Chlamydia psittaci)

Treatment of STD (Chlamydia psittaci)

Azithromycin

Treatment of Conjunctivitis (Chlamydia psittaci)

Erythromycin

Treatment of LGV

Doxycycline

Treatment of Psittacosis

Azithromycin

DOC for all Rickettsial infections

Doxycycline

Disease caused by Rickettsia rickettsii

Rocky mountain spotted fever

Disease caused by Rickettsia akari

Rickettsial pox

Disease caused by Rickettsia prowazekii

Epidemic typhus

Disease caused by Rickettsia typhi

Endemic typhus

Disease caused by Orientia tsutsugamushi

Scrub typhus

Disease caused by Coxiella burnetti

Q fever

Disease caused by Ehrlichia chaffeensis

Ehrlichiosis

Vector of Rickettsia rickettsii

Tick

Vector of Rickettsia akari

Mites (chiggers)

Vector of Rickettsia prowazekii

Body louse

Vector of Rickettsia typhi

Rat flea

Vector of Orientia tsutsugamushi

Mites (chiggers)

Vector of Coxiella burnetti

None

Vector of Ehrlichia chaffeensis

Ticks

Incubation period of Rickettsia rickettsii

Incubation period of Rickettsia akari

9-14

Incubation period of Rickettsia prowazekii

Incubation period of Rickettsia typhi

7-14

Incubation period of Orientia tsutsugamushi

10-12

Incubation period of Coxiella burnetti

4-90

Incubation period of Ehrlichia chaffeensis

7-21

Rickettsial infection with eschar

Rickettsial pox

Gram (-) rod, Normal oral flora of cats, "cat-scratch fever", bacillary angiomatosis, transmission: cat bite or scratch

Cat Scratch Disease

Dog reservoir, Transmission: dog tick (Dermacentor) bite, forms morulae in cytoplasm of monocytes

Ehrlichiosis (Ehrlichia chaffeensis)

Facultative gram-variable rod; Clue cells present; Positive whiff test (fishy odor); Malodorous vaginal discharge

Bacterial vaginosis (Gardnerella vaginalis)

Small gram (-) rod, culture on chocolate agar with heme (factor X); painful genital ulcer

Chancroid (Haemophilus ducreyi)

Gram (-) rods, reservoir: domestic animals, transmission: oro-fecal route

Mesenteric Adenitis or Pseudoappendicitis (Yersinia enterocolitica)

Encapsulated, pleomorphic gram (-) bacillus, bipolar densities (Donovan bodies) look like closed safety pins, small painless papule ulcerates to form beefy red ulcer with velvety surface, pseudobuboe formation

Granuloma inguinale (Donovanosis) Klebsiella granulomatis

Treatment for Klebsiella granulomatis or Donovanosis

Azithromycin

Bacteriology Flashcards

(452 cards)