Bacteriology Flashcards
(126 cards)
1
Q
Peptidoglycan
A
Fxn: rigid support, protects against osmotic pressure
Chem: sugar backbone with peptide side chains cross linked by transpeptidase
2
Q
Cell wall
A
Fxn: surface antigen
Chem: peptidoglycan
Gram + lipteichoic acid (induce TNF and IL-1)
Gram - peptidoglycan + outer membrane
Gram + peptidoglycan
3
Q
Outer membrane (ONLY GRAM - )
A
Fxn: Site of endotoxin/LPS
Chem: Lipid A induce TNF and IL-1; O polysaccharide is antigen
4
Q
Plasma membrane
A
Fxn: site of oxidative and transport enzymes
Chem: PL layer
5
Q
Ribosome
A
Fxn: protein synthesis
Chem: 50S and 30s
6
Q
Periplasm (ONLY GRAM - )
A
Fxn: space between cytoplasmic membrane and outer membrane
Chem: contains Beta-lactmases
7
Q
Pilus/fimbria
A
Fxn: mediate adherence of bacteria to cell surface
Chem: glycoprotein
8
Q
Flagellum
A
Fxn: motility
Chem: protein
9
Q
Spore
A
Fxn: resistant to dehydration, heat and chemicals
Chem: keratin-like coat; dipicolinic acid; peptidoglycan
10
Q
Plasmid
A
Fxn: contains genes
Chem: DNA
11
Q
Capsule
A
Fxn: protects against phagocytosis
Chem: organized, discrete PL layer
12
Q
Glycocalyx
A
Fxn: mediates adherences to surfaces, esp. foreign surfaces (indwelling catheters)
Chem: loose network of polysaccharides
13
Q
spherical (coccus) Gram +
2
A
Staphylococcus
Streptococcus
14
Q
spherical (coccus) Gram -
2
A
Moraxella catarrhalis
Neisseria
15
Q
Rod (bacillus) Gram +
8
A
Bacillus Clostridium Corynebacterium Gardnerella Lactobaccilus Listeria Mycobacterium (acid fast) Propionibacterium
16
Q
Rod (bacillus) Gram -
A
Enterics: Bacteroides Campylobacter E.coli Enterobacter Helicobacter Klebsiella proteus Psudomonas Salmonella Serratia Shigella Vibrio Yersinia
Respiratory:
Bordetella
Haemophilus (pleomorphic)
Legionella (silver stain)
Zoonotic: Bartonella Brucella Francisella Pasteurella
17
Q
Branching filamentous Gram +
2
A
Actinomyces
Nocardia (weakly acid fast)
18
Q
Pleomorphic Gram -
2
A
Chlamydia (Giemsia)
Rickettsiae (Giemsia)
19
Q
Spiral Gram -
3
A
Borrelia (Giemsia)
Leptospira
Treponema
20
Q
No cell wall
2
A
Mycoplasma
Ureaplasma
21
Q
Bugs that do not gram stain well
“These Microbes May Lack Real Color”
A
Treponema (too thin - need dark field microscopy and fluorescent Ab staining)
Mycobacteria (high lipid content)
Mycoplasma (no cell wall)
Legionella pneumophila (need silver stain)
Rickettsia (intracellular parasite)
Chlamydia (intracellular paraiste; lacks PG)
22
Q
Giemsa stain
“Certain Bugs Really Try my Patience”
A
Chlamydia Borrelia Rickettsia Trypanosomes Plasomodium
23
Q
PAS stain (periodic acid-Schiff)
A
stains glycogen DIAGNOSE WHIPPLE (tropheryma whipplei)
24
Q
Ziehl-Neelsen (carbol fuchsin)
A
Acid-fast bacteria (Nocardia, Mycobacteria)
protozoa (Cryptosporidium oocysts)
Alternative: auramine-rhodamine stain for screening
25
India ink
Cryptococcus neoformans
26
Silver stain
Pneumocystis (fungi)
Legionella
H. pylori
27
culture: H. influenzae
```
chocolate agar
Factors V (NAD+) and X (hematin)
```
28
culture: N. gonorrhoeae, N. miningitidis
Thayer-Martin agar
```
"Very Typically Cultures Neisseria"
Vancomycin (inhibit Gram +)
Trimothoprim
Colisin (inhibit Gram - except Neisseria)
Nystatin (inhibits fungi)
```
29
culture: B. pertussis
Bordet-Gengou agar
| Regan-Lower medium
30
culture: C. diphteriae
Tellurite agar
| Loffler medium
31
culture: M. tuberculosis
Lowestein-Jensen agar
32
culture: M. pneumoniae
Eaton agar
| requires cholesterol
33
culture: Lactose-fermenting enterics
MacConkey agar
| fermentation produces acid, causing colonies to turn pink
34
culture: E. coli
Eosin-methylene blue (EMB) agar
| colonies with green metallic sheen
35
culture: Legionella
charcoal yeast extract agar buffered with cysteine and iron
36
culture: Fungi
Sabouraud agar
37
Aerobes
| "Nagging Pests Must Breathe"
Nocardia
Pseudomonas aeroginosa
MycoBacterium tuberculosis
38
Anaerobes
| "Frankly Can't Breathe Air"
Fusobacterium
Clostridium
Bacteroides
Actinomyces
lack catalase and/or superoxide dismutase and susceptible to oxidative damage
foul smelling (SCFA), produce gas in tissue (CO2 and H2)
normal flora in GI tract
aminoglycosides INEFFECTIVE because require O2
39
obligate intracellular
| "stay inside when it is Really CHilly and COld"
Rickettisa
Chlamydia
Coxiella
40
facultative intracellular
| "Some Nasty Bugs May Live FacultativeLY"
```
Salmonella
Neissseria
Brucella
Mycobacterium
Listeria
Francisella
Legionella
Yersinia pestis
```
41
Encapsulated bacteria
"SHiNE SKiS"
cleared by the spleen
```
Strep pneumoniae
H. influenzae type B
Neisseria meningitidis
E. coli (K capsule - meningitis)
Salmonella
Klebsiella pneumoniae
GBS
```
asplenics have increased risk: Give vaccines for
1. S. pneumoniae
2. H. influenzae
3. N. meningitidis
42
Encapsulated bacteria vaccines
| conjugated to carrier protein - enhance immunogenicity
Pneumococcal vaccine
H. Influenzae type B
Meningococcal vaccine
43
Urease positive
| "CHuck norris hates PUNKSS"
```
Cryptococcus
H. pylori
Proteus
Ureaplasma
Nocardia
Klebsiella
S. epidermidis
S. saprophyticus
```
44
Catalase positive organisms
| "CATs Need PLACESS to hide"
Catalase
```
Nocardia
Pseudomonas
Listeria
Aspergillus
Candida
E.coli
Staphylococci
Serratia
```
45
Pigment-producing bacteria
Actinomyces israelii - yellow sulfur granules
S. aureus - yellow
Psueodmonas aeruginosa - blue green
Serratia marcescents - red "maraschino cherries"
46
Protein A
S. aureus
prevents opsonization and phagocytosis
binds Fc region of IgG
47
IgA protease
S. pneuomoniae
H. influenzae tpe B
Neisseria
colonize respiratory mucosa
cleaves IgA
48
M protein
GAS
| prevent phagocytosis
49
type III secretion system
| "injectisome"
needle-like protein appendage to delivery toxines from GRAM -
Pseudomonas, Salmonella, Shigella, E.coli
50
EXOTOXIN: corynebacterium diphteriae
Diphteria toxin
Mech: inactivate elongation factor (EF-2)
Manif: pharyngitis with pseudomembranes in throat and severe LAD
51
EXOTOXIN: pseudomonas aeruginosa
Exotoxin A
Mech: inactivate EF-2
Manif: host cell death
52
EXOTOXIN: Shigella spp.
Shiga toxin
Mech: inactivate 60S ribosome by removing adenine from rRNA
Manif: GI mucosal damage (dysentery); also hemolytic uremic syndrome (HUS)
53
EXOTOXIN: Enterohemorrhagic E. coli (EHEC)
Shiga-like toxin
Mech: inactivate 60S ribosome by removing A from rRNA
Manif: HUS (O157:H7); does NOT invade host cells like shiga
54
EXOTOXIN: enterotoxigenic E. coli (ETEC)
Heat-labile toxin (cAMP) - increase Cl secretion
Heat-stable stoxin (cGMP) - decrease NaCl resorption
Manif: watery diarrhea
55
EXOTOXIN: Bacillus antracis
Edema toxin
Mech: mimics AC (increase cAMP)
Manif: edematous borders of black eschar in cutaneous anthrax
56
EXOTOXIN: Vibrio cholerae
Cholera toxin
comma shpaed, oxidase +
grows in alkaline media
endemic in developing countries
Mech: perm activate Gs, increased cAMP, increased Cl secretion
Manif: voluminous RICE-WATER diarrhea
Treatment: prompt oral rehydration
57
EXOTOXIN: Bordetella pertussis
Pertussis toxin
Mech: disable Gi, increased cAMP, impair phagocytosis
Manif: WHOOPING COUGH - child coughs on expiration adn whoops on inspiration; 100-day adult cough
58
EXOTOXIN: Clostridium tetani
Tetanospasmin
Mech: cleave SNARE (required for NT release via vesicular fusion); prevents release of INHIBITORY (GABA and glycine) NT from Renshaw cells in spinal cord
Manif: spasticity, risus sardonicus, "lockjaw,
59
EXOTOXIN: Clostridium botulinum
Botulinum toxin
Mech: cleave SNARE
Manif: flaccid paralysis, FLOPPY BABY (honey jar); prevents release of STIMULATORY (ACh)
60
EXOTOXIN: Clostridium perfringens
Alpha toxin (lecinthinase)
Mech: phospholipase degrades tissue
Manif: myonecrosis ("gas gangrene) and hemolysis ("double zone of hemolysis on blood agar"
61
EXOTOXIN: Streptococcus pyogenes
| 2
1. Streptolysin O
Mech: protein degrades cell membrane; lysis RBC
Manif: Beta hemolysis; host Ab against (ASO) used to diagnose RF
2. Exotoxin A
Mech: binds to MHC II and TCR to cause overwhelming release of IL-1/2, IFN, TNF
Manif: Toxic shock syndrome = fever, rash, shock
62
EXOTOXIN: S. aureus
TSST-1
Mech: binds to MHC II and TCR to cause overwhelming release of IL-1/2, IFN, TNF
Manif:
1. toxic shock syndrome: fever, rash; shock
2. exfoliative toxin: scalded skin syndrome
3. enterotoxin: food poisoning
63
ENDOTOXIN GRAM - LPS
1. Activate macrophages
IL-1 - fever
TNF-alpha - fever and hypotension
Nitric oxide - hypotension
2. Activate complement
C3a - hypotension and edema
C5a - neutrophil chemotaxis
3. Activates tissue factor
coagulation cascade - DIC
64
Bacterial genetics:
| Transformation
ability to take up naked DNA from cell lysis from environment
65
Bacterial genetics:
| Conjugation
F+xF-
F+ plasmid with genes contacts F- bacterium. single stand of plasmid DNA crosses. NO transfer of chrom DNA
HfrxF-
F+ plasmid incorporated into bacterial chrom DNA = Hfr. Replication of incorporated plasmid DNA. Transfer of plasmid and chrom genes
66
Bacterial genetics:
| Transposition
Segment of DNA can jump from on location to another from plasmid to chrom and vice versa
67
Bacterial genetics:
| Transduction
Generalized: "packaging event" - LYTIC phage infects bacterium, cleavaging bacterial DNA. parts of DNA packaged in viral capsid
```
Specialized: "excision event" - LYSOGENIC phage infects bacterium; viral DNA incorporates into bacterial chromosome
Shiga A like toxin
Botulinum toxin
Cholera toxin
Diptheria toxin
Erythrogenic toxin of Strep pyogenes
```
68
alpha-hemolytic bacteria
GREEN RING on blood agar
1. Strep pneumoniae (catalase -/optochin sens)
2. Viridans streptococci (catalase - /optochin res)
69
beta-hemolytic bacteria
CLEAR AREA on blood agar
1. Staph auereus (catalase+/coagulase +)
2. Strep pyogenes - GAS (catalase - /bacitracin sens)
3. Strep agalactiae - GBA (catalase - /bacitracin res)
4. Listeria monocytogenes (tumbling motility, newborn meningitis, unpasteurized milk)
70
Staph aureus
Gram + cocci in CLUSTERS catalase +/coagulase+
Protein A binds Fc-IgG
colonizes in NARES
Inflammatory - skin, organ abscesses, pneumonia, endocarditis, septic arthritis, osteomyelitis
TSST-1, scalded skin syndrome, food poisoning (non-bloody diarrhea and emesis)
MRSA
71
Staph epidermidis
Gram + cocci in CLUSTERS catalase +/coagulase -/novobiocin sens
```
PROSTHETIC DEVICES (hip implant, heart valve) and IV catheters
component of normal skin flora
```
72
Staph saprophyticus
Gram + cocci in CLUSTERS catalase +/coagulase -/novobiocin res
2nd cause of uncomplicated UTI
73
Strep pneumoniae
Gram + diplococci in CHAINS, lancet shaped, encapsulated
catalase - /alpha hemolysis/optochin sens
IgA protease
MC cause of:
1. meningitis
2. otitis media
3. pneumonia
4. sinusitis
Pneumococcus: "rusty sputum", sepsis in sickle cell, splenectomy (GET VACCINE)
74
Viridans group streptococci
Gram + cocci in CHAINS, catalase -/alpha hemolysis/optochin res
normal flora of OROPHARYNX ("not afraid of-the-chin"/optochin)
1. Strep mutans - dental caries
2. S. sanguinis - subacute endocarditis at damaged heart valves
75
Strep pyogenes (GAS)
Gram + cocci in CHAINS, catalase -/beta-hemolysis/bactracin sens/PYR+
1. Rheumatic Fever: Ab to M protein (anti-phago) enhance host defenses against S. pyogenes but GIVE RISE TO RF (ASO titer detects recent infxn)
"JONES"
1. Joints - polyarthritis
2. , circumoral pallor, subsequent desquamation
76
Strep agalactiae (GBS)
Gram + cocci in CHAINS, catalase -/beta-hemolysis/bactracin res/Hippurate test+/produces CAMP that enlarges hemolysis by S. aureus
```
colonizes VAGINA (35 wks screening, IV penicillin ppx)
BABY SEPSIS
```
77
enterococci (GDS)
penicillin G resistant
| UTI, biliary tract infxn, subacute endocarditis (following GI/GU procedures)
78
Strep bovic (GDS)
colonizes GUT
| associated with colon cancer
79
Corynebacterium diptheriae
Gram + RODS
```
ADP-ribosylation
B-prophage
Corynebacterium
Diphtheriae
EF-2/+Elek test
Granules (metachromatic - red and blue)
```
Pseudomembranous pharyngitis (gray pharyngeal exudate)
80
Clostridia tetani
Gram+ spore-forming, obligate anaerobic bacilli
tenatospasmin = exotoxin
Mech: cleave SNARE proteins, block release of INHIBITORY (GABA and glycine)
SPASTIC paralysis
trismus (lockjaw)
risus sardonicus (raised eyebrows and open grin)
prevent with tetanus vaccine
81
Clostridia botulinum
Gram+ spore-forming, obligate anaerobic bacilli
heat-labile
Mech: cleave SNARE, block release of ACTIVATING (ACh)
FLACCID paralysis
floppy baby syndrome - HONEY
82
Clostridia perfringens
Gram+ spore-forming, obligate anaerobic bacilli
alpha-toxin (lecithinase)
GAS GANGRENE
83
Clostridia difficile
Gram+ spore-forming, obligate anaerobic bacilli
1. Toxin A - binds to brush border of gut
2. Toxin B - cytotoxin - cytoskeletal disruption via actin depolymerization
pseudomembranous colitis on endoscopy -- diarrhea
secondary to Ab use: clindamycin or ampicillin
Diagnosis: stool PCR
Treatment: MTZ or oral vanc
84
Bacillus antracis
Gram+ spore forming rod
Anthrax toxin - only one with polypeptide capsule (D-glu)
1. cutaneous - painless, NECROTIC papule surrounded by vesicles - ulcer with black eschar
2. pulmonary - flu like that progresses to fever, pulm hemorrhage, mediastinitis and shock
85
Bacillus cereus
REHEATED RICE SYNDROME
1. emetic type
2. diarrheal type - watery, nonbloody
86
Listeria monocytogenes
only Gram+ ENDOTOXIN
unpasteurized dairy, cold deli
transplacental, vaginal
ROCKET TAILS - tumbling motility
spontaneous abortion
meningitis (ampicillin in infants)
gastroenteritis (self-limiting)
87
Branching filaments
| Actinomyces vs. Nocardia
```
Actinomyces Nocardia
Gram+ anaerobe Gram+ aerobe
not acid fast acid fast (weak)
normal oral flora soil
penicillin sulfonamides
```
Actinomyces: oral/facial abscesses that drain through sinus tracts, yellow “sulfur” granules
Nocardia: pulmonary infxn in IC, cutaneous after trauma
88
Mycobacterium Tuberculosis
Primary: BASES (Ghon focus)
Secondary: APICES (cavitary lesion)
Extrapulmonary: CNS, vertebral (Potts), Lymph, Renal, GI, Adrenals
Caseating granulomas
PPD+ current infxn or past exposure (BCG false pos)
PPD- no infection or anergic
interferon gamma release assay (IGRA) fewer FP for BCG
89
Mycobacteria
ACID-FAST
PINK RODS
1. Tuberculosis: fever, night sweats, weight loss, cough (nonprod or prod), hemoptysis
2. M. avium-intracellulare: disseminated in AIDS, azithromycin ppx CD4 <50
3. M. scrofulaceum: cervical lymphadenitis in children
4. M. marinum: hand infxn in aquarium handlers
90
Leprosy (Hansen disease)
| Mycobcaterium leprae
ACID FAST BACILLUS
likes cool temp - glove and stocking
US reservoir: armadillos
1. Lepromatous - lion=like facies, communicable, low cell mediated immunity with Th2 response, lethal
Treatment: dapsone + rifampin + clofazimine
2. Tuberculoid: few hairless skin plaques, high-cell mediated with Th1 immunse response
Treatment: dapsone + rifampin
91
Neisseria
GRAM- DIPLOCOCCI
IgA proteases
Gonococci Meningococci
Polysaccharide capsule
Glucose ferment Maltose + Glucose ferment
vaccine
sexually/perinatal resp/oral
condoms, erythro
CTX + (azithro/doxy chla) CTX or penicillin G
Gonococci: gonorrhea, septic arthritis, neonatal conjunctivitis, PID, Fitz-Hugh-Curtis syndrome (liver strings)
Meningococci: meningococcemia, meningitis, waterhouse-Fridrichsen syndrome (1. adrenal gland destruction 2. DIC 3. Shock)
92
Haemophilus influenzae
GRAM- ROD
IgA protease
chocolate agar
```
Aerosol transmission
1. epiglottis/thumbprint sign (amoxicillin)
2. meningitis (CTX)
3. otitis media
4. pneumonia
(but S. pneumoniae MC for 2-4)
```
Vaccine type b given b/w 2 and 18 months
93
Legionella pneumophila
GRAM- ROD
SILVER STAIN
CHARCOAL yeast extract culture with Fe and Cys
Aerosol transmission from environmental water source
Legionnaire's disease = severe pneumonia (unilateral and lobar), fever, GI, CNS
"French legionnaire with SILVER helmet, sitting around a CHARCOAL campfire, with his IRON ROD - he is no CYSsy
Pontaic fever
94
Pseudomonas aeruginosa
GRAM- ROD
aerobic/nonlactose fermenting/oxidase+
BLUE GREEN (pyocyanin)
GRAPE-LIKE ODOR
found in water - hot tub folliculitis
produces endotoxin (fever, shock) and exotoxin A (inactivates EF-2)
THINK BURN VICTIMS
CHRONIC PNEUMONIA IN CYSTIC FIBROSIS
1. pneumonia
2. sepsis
3. otitis externa
4. UTI
5. drug use
6. diabetes
7. osteomyelitis
ecthyma grangrenosum - rapidly progressive necrotic cutaneous lesion, IC patients
95
E.coli EIEC
intestinal mucosa - necrosis and inflammation
| similar to Shigella
96
E.coli ETEC
heat-labile and heat-stabile
| Traveler's diarrhea (watery)
97
E.coli EPEC
no toxin
flattens villi and prevents absoprtion
PEDIATRIC diarrhea
98
E.coli EHEC
Shiga-like toxin
O157:H7
```
hemolytic uremic syndrome (HUS):
1. anemia
2. thrombocytopenia
3. ARF
shistocytes on peripheral blood smear, PLT consumption, decreased renal blood flow
```
does not ferment sorbitol (distinguished from other E. coli_
99
Klebsiella
1. Aspiration pneumonia - "red currant jelly sputum"
2. Abscesses in lungs and liver
3. Alcoholics
4. di-A-betics
100
Campylobacter jejuni
BLOODY diarrhea
comma or S-shaped, oxidase+, grows at 42 C
antecedent to Guillain Barre syndrome and reactive arthritis
101
Salmonella typhi
Gram- bacilli
non-lactose/oxidase-
typhoid fever
1. rose spots on abdomen
2. constipation
3. abdominal pain
4. fever
Treat: CTX or FQ
102
Salmonella spp.
Gram- bacilli
non-lactose/oxidase-
BLOODY diarrhea
poultry, eggs, pets, turtles
103
Shigella
BLOODY diarrhea
mucosal invasion
Antigen-sampling M cells
Fingers, Flies, Food, Feces
104
Yersinia enterocolitica
transmitted from pet feces, contaminated milk, pork
acute diarrhea
pseudoappendicitis
105
Helicobacter pylori
curved Gram- rod
catalase, oxidase, urease+
Diagnosis: urea breath test or fecal Ag test
Manif:
gastritis
peptic ulcers (duodenal)
RF for gastric adenocarcinoma and MALT lymphoma
Treat: Triple therapy
1. PPI
2. Clarithromycin
3. Amoxicillin (or MTZ if penicillin allergy)
106
Leptospira interrogans
spirochete
found in water containing animal urine (SURFERS)
leptospirosis: flu-like, myalgias (calves), jaundice, photophobia with conjunctival suffusion (erythema without exudate)
Weil disease: severe form with jaundice and azotemia from liver and kidney dysfxn, fever, hemorrhage, anemia
107
Lyme disease
| Borrelia burgdoferi
spirochete
Borrelia burgdorferi (transmitted by Ixodes deer tick)
visualized using aniline dyes (Wrighte or Giemsa stain) in light microscopy
mouse = natural reservoir
common in NE US (Connecticut, NY...)
```
Key Lyme pie to FACE
Facial nerve palsy (bilateral)
Arthritis - migratory
Cardiac AV block
Erythema chronicum migrans (bulls-eye)
```
Treat: doxycycline, CTX
108
PRIMARY Syphilis
| Treponema pallidum
spirochete
PRIMARY
Painless chancre
Diagnosis: dark-field microscopy
Treat: penicillin
109
SECONDARY Syphilis
| Treponema pallidum
```
maculopapular rash (palms and soles)
condylomata lata (smooth, moist, painless, wart like white lesions on genitals)
```
Diagnosis: VDRL/RPR, confirm with FTA-ABS
Treat: penicillin
110
TERTIARY Syphilis
| Treponema pallidum
```
gummas (chronic granulomas)
aortitis
neurosyphilis (tabes dorsales)
Argyll Robertson's pupil (prostitutes pupil - accomodates but does not react)
broad-based ataxia
+Romberg
Charcot joint
stroke without htn
```
Diagnosis: spinal fluid for VDRL and PCR
Treat: penicillin
111
CONGENTIAL Syphilis
| Treponema pallidum
```
CONGENITAL
rhagages (linear scares at angle of mouth)
snuffles (nasal discharge)
saddles nose
Hutchinson teeth
mulberry molars
saber shins
CN VIII deafness
```
Treat mom early within 1st trimester
Treat: penicillin
112
False positive for VDRL
Viral infection (mono, hepatitis)
Drugs
Rheumatic fever
Lupus and leprosy
113
Jarisch-Herxheimer reaction
Flu-like syndrome after Ab started for syphilis
| due to killed bacteria (spirochetes) releasing endotoxins
114
Anaplasmosis
Anaplasma spp.
Trans: Ixodes ticks
granulocytes with morulae in cytoplasm
Treat: doxycycline
115
Cat scratch disease
| bacillary angiomatosis
Bartonella spp.
Trans: cat scratch
116
Relapsing fever
Borrelia recurrentis
Trans: Louse
117
Brucellosis/undulant fever
Brucella spp.
Trans: unpasteurized dairy
118
Psittacosis
Chlamydophila psittaci
Trans: parrots
119
Q fever
Coxiella burnetii
Trans: aerosols of cattle/sheep amniotic fluid
presents as pneumonia
culture neg. endocarditis
Treat: doxycycline
120
Erlichiosis
Erlichia chaffeensis
Trans: Ambylomma (Lone star tick)
monocytes with berry-like inclusions in cytoplasm
Treat: doxycycline
121
Tularemia
Francisella tularensis
Trans: ticks, rabbits, deer fly
122
Typhus
Epidemic: Rickettsia prowazekii
Trans: louse
Endemic: Rickettsia typhi
Trans: fleas
Rash starts CENTRALLY and spreads out
SPARES palms and soles
Treat: doxycycline
123
Rocky Mountain spotted fever
Rickettsia rickettsii
North Carolina
Trans: dermacentor (dog tick)
Classic triad:
1. headache
2. fever
3. rash (vasculitis) - starts and wrists and ankles and spreads to TRUNK, PALMS AND SOLES
Treat: doxycycline
124
Bacterial vaginosis
Gardnerella vaginalis
gram-variable rod
gray vaginal discharge
FISHY smell
KOH whiff test
CLUE CELLS (epithelial cells covered with bacteria - "stippled appearance")
treatment: MTZ (or clindamycin)
125
Chlamydia
obligate intracellular organisms
mucosal infections
2 forms:
1. elementary body - endocytosis
2. reticulate body - replicates via fission, reorganizes into elementary bodies
C. trachomatis:
reactive arthritis (Reiter syndrome)
Type A, B,C: follicular conjunctivitis in Africa causes blindness
Types D-K: nongonococcal urethritis, PID, neonatal pneumonia, neonatal conjunctivitis
Types L1, L2, L3: Lymphogranuloma venereum: small painless ulcers on genitals with swollen painful inguinal lymph nodes that ulcerate
Diagnosis: cytoplasmic inclusions on Giemsa or fluorescent Ab stained smear
Treat: AZITHRO OR DOXY
126
Mycoplasma pneumoniae
ATYPICAL 'WALKING' PNEUMONIA
common in military recruits and prisons (<30 yo)
insidious onset, headache, nonproductive cough
patchy or diffuse intersitial infiltrate
high titer of IgM
Eaton agar
Treat: macrolides, doxycycline, FQ
