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1
Q

Corynebacterium diphtheriae
Toxin and mechanism
Manifestation

A 
Diphtheria toxin (exo) - inactivates EF2
Pharyngitis with pseudomembranes in throat and severe lymphadenopathy (bull neck)
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2
Q

Pseudomonas aeruginosa
Toxin and mechanism
Manifestation

A

Exotoxin A - inactivates EF2

Host cell death

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3
Q

Shigella
Toxin and mechanism
Manifestation

A 
Shiga toxin (exo) - inactivate 60S ribosome by removing adenine from rRNA 
GI mucosal damage causing dysentery, enhances cytokine release causing HUS
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4
Q

EHEC
Toxin and mechanism
Manifestation

A

Shiga-like toxin (exo) - inactivate 60S ribosome by removing adenine from rRNA
SLT enhances cytokine release, causing HUS but doesnt invade cells

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5
Q

ETEC
Toxins and mechanism
Manifestation

A

Heat-labile toxin (exo) - overactivates adenylate cyclase (increase cAMP) –> increase Cl- secretion in gut and H20 efflux
Heat-stable toxin (exo) - overactivates guanylate cyclase (cGMP) –> decrease resorption of NaCL and H2O in gut
Watery diarrhea: labile in the Air (adenylate) and stable on the Ground (guanylate)

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6
Q

Bacillus anthracis
Toxin and mechanism
Manifestation

A 
Edema factor (exo) - mimics the adenylate cyclase enzyme (increase cAMP)
Reponsible for characteristic edematous borders of black eschar in cutaneous anthrax)
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7
Q

Vibrio cholerae
Toxin and mechanism
Manifestation

A 
Cholera toxin (exo) - overactivates adenylate cyclase (increase cAMP) by permanetly activating Gs --> increase Cl- secretion in gut and H2O efflux
Voluminous "rice-water" diarrhea
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8
Q

Bordetella pertussis
Toxin and mechanism
Manifestation

A 
Pertussis toxin (exo) - overactivates adenylate cyclase (increase cAMP) by disabling Gi, impairing phagocytosis to permit survival of microbe 
Whooping cough: coughs on expiration and "whoops" on inspiration
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9
Q

Clostridium tetani
Toxin and mechanism
Manifestation

A

Tetanospasmin (exo) - cleave SNARE protein required for neurotransmitter release
Muscle rigidity and “lock jaw” - prevents release of inhibitory (GABA and glycine) NT in spinal cord

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10
Q

Clostridium botulinum
Toxin and mechanism
Manifestation

A 
Botulinum toxin (exo) - cleave SNARE protein required for NT release
Flaccid paralysis, floppy baby - toxin prevents release of stimulatory (ACh) signals at NMJ
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11
Q

Clostridium perfringes
Toxin and mechanism
Manifestation

A 
Alpha toxin (exo) - phopholipase that degrades tissue and cell membranes 
Degradation of phospholipid C - myonecrosis (gas gangrene) and hemolysis
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12
Q

Streptococcus pyogenes
Toxin and mechanism
Manifestation

A 
Streptolysin O (exo) - Protein that degrades cell membrane 
Lyses RBC, contributes to B-hemolysis - host antibodies against toxin (ASO) used to diagnose rheumatic fever
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13
Q

Staphylococcus aureus
Toxin and mechanism
Manifestation

A

Toxic shock syndrome toxin (TSST-1), exo - bring MHC II and TCR in proximity to outside of antigen binding site to cause overwhelming release of IFN-gamma and IL2 –> Shock
TSS: fever, rash, shock; other toxins - scalded skin and food poisoning

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14
Q

Streptococcus pyogenes
Toxin and mechanism
Manifestation

A

Exotoxin A - bring MHC II and TCR in proximity to outside of antigen binding site to cause overwhelming release of IFN-gamma and IL2 –> Shock
Toxin shock syndrome: fever, rash, shock

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15
Q

What are the effects on Endotoxin?

A 
Edema
Nitric Oxide --> hypoTN
DIC/Death --> from coagulation cascade
Outer membrane
TNF-a --> fever, hypoTN
O-antigen
eXtremely heat stable
IL-1 --> fever
Neutrophil chemotaxis

Activates complement (C3a –> hypoTN, edema and C5a –> PMN chemotaxis)

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16
Q

Four phases of bacterial growth

A

Lag: metabolic activity w/o division
Exponential/log: rapid cell division
Stationary: nutrient depletion slows growth/spore formation in some
Death: prolonged nutrient depletion and buildup of waste products lead to death

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17
Q

Where does penicillins and cephalosporins act in growth phase?

A

Exponential/lag phase - peptidoglycan is made here

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18
Q 
Staphylococcus aureus 
Morph:
Virulence: 
Dz:
Toxin:
A

Staphylococcus aureus
Morph: gram + cocci in clusters, catalase/coagulase +
Virulence: protein A binds Fc-IgG to inhibit complement fixing and phagocytosis
Dz: (1) inflamm dz: skin infxn, organ abscess, pneumonia (2) toxin mediated: TSS, scalded skin, food poisoning (3) MRSA resistant to B lactams (4) bacterial endocarditis, osteomyelitis
Toxin: TSST-1 binds MHC-II and Tcell receptor for Tcell activation; food poisoning due to preformed enterotoxins;

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19
Q

Staphylococcus epidermidis
Commonly infects?
Where is it found?
Problem with taking blood?

A

Staphylococcus epidermidis: prosthetic devices and intravenous catheters by producing adherent biofilms.
Component of normal skin flora Contaminates blood cultures

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20
Q 
Streptococcus pneumoniae
Morph: 
Virulence: 
Dz:
Clinical presentation:
A

Streptococcus pneumoniae
Morph: lancet shaped, gram + diplococci, optochin sensitive
Virulence: capsule, IgA protease
Dz: MCC meningitis, otitis media, pneumonia, sinusitis
Clinical presentation: rusty sputum, sepsis in sickle cell anemia and splenectomy

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21
Q 
Viridans group streptococci
Morph: 
Normally found:
Dz:
Clinical presentation:
A

Viridans group streptococci
Morph: a-hemolytic, optochin resistant
Normally found: oropharynx
Dz: dental caries (mutans), subacute bacterial endocarditis (s. sanguis - sticks to damaged valves by making glycocalyx)
Not afraid of-the-chin (in mouth, optochin resistant)

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22
Q

Streptococcus pyogenes (group A)
Morph:
Dz:
Clinical presentation:

A

Streptococcus pyogenes (group A)
Morph: bacitracin sensitive
Dz: (1) pyogenic: pharyngitis, cellulitis, impetigo (2) toxigenic: scarlet fever, toxic shock like syndrome, necrotizing fasciitis (3) immunologic: rheumatic fever, acute glomerulonephritis
Clinical presentation: antibodies to M protein enhance defense but also give rise to rheumatic fever; Scarlet fever: rash sparing face, strawberry tongue, scarlet throat

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23
Q

Rheumatic Fever
Bug
Criteria
Cause

A 
Streptococcus pyogenes - group A
J - Joints polyarthritis
O - carditis
N - Nodules (subcutaneous)
E - Erythema marginatum
S - Sydenham's chorea 
Pharyngitis --> rheumatic fever from antibodies to M protein
Impetigo --> glomerulonephritis
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24
Q 
Streptococcus agalactiae (group B)
Morph: 
Normally found:
Dz:
Clinical presentation:
A 
Streptococcus agalactiae (group B)
Morph: bacitracin resistant, b-hemolytic
Normally found: vagina, BABIES
Dz: pneumonia, meningitis, sepsis
Clinical presentation: screen pregnant women at 35-7 weeks, hippurate test positive, produces CAMP factor
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25
``` Enterococci (group D streptococci) Morph: Normally found: Dz: Clinical presentation: ```
Enterococci (group D streptococci) Morph: penicillin G resistant, grow in 6.5% NaCl and bile Normally found: colonic flora Dz: UTI, biliary tract infxn, subacute endocarditis Clinical presentation: vancomycin resistant are important cause of nosocomial infections
26
Streptococcus bovis Normally found: Dz: Clinical presentation:
Streptococcus bovis Normally found: the gut Dz: bacteremia and subacute endocarditis Clinical presentation: colon cancer patients
27
``` Corynebacterium diphtheriae Morph: Toxin: Normally found: Dz: Clinical presentation: ```
Corynebacterium diphtheriae Morph: gram + rods, metachromatic granules, Elek's test, black colonies on cystine-tellurite agar Toxin: exotoxin by beta-prophage inhibits EF-2 Dz: diphtheria Clinical presentation: pseudomembranous pharyngitis, lymphadenopathy, myocarditis, arrhythmias ABCDEFG: ADP-ribosylation, Beta-prophage, Corynebacterium, Diphtheria, EF2, Granules
28
``` Spores Formed when? Properties? How to kill? Kinds of bacteria? ```
Form at end of stationary phase when nutrients are limited Resistant to heat/chemicals, dipicolinic acid in core, no metabolic activity Have to autoclave at 121 C for 15 min Bacillus anthracis, Clostridium perfringens, C. tetani, B. cereus, C. botulinum, Coxiella burnetii
29
``` Clostridium tetani Morph: Toxin: Dz: Clinical presentation: ```
Clostridium tetani Morph: Gram +, spore forming, obligate anaerobe, bacilli Toxin: tetanus toxin (exo) - proteases cleave releasing proteins for NT Dz: tetanic paralysis (blocks glycine and GABA release from Renshaw cells in spinal cord) Clinical presentation: spastic paralysis, trismus (lockjaw), risus sardonicus
30
``` Clostridium botulinum Morph: Toxin: Dz: Clinical presentation: ```
Clostridium botulinum Morph: gram +, spore forming, obligate anaerobic bacilli Toxin: preformed, heat-labile toxin inhibits ACh release at NMJ Dz: Botulism Clinical presentation: flaccid paralysis - ingestion of preformed toxin in adults and ingestion of spores in honey in babies (floppy baby)
31
``` Clostridium perfringens Morph: Toxin: Dz: Clinical presentation: ```
Clostridium perfringens Morph: gram +, spore forming, obligate anaerobic bacilli Toxin: alpha toxin (lecithinase - phospholiapse) Dz: myonecrosis and hemolysis Clinical presentation: gas gangrene
32
``` Clostridium difficile Morph: Toxin: Dz: Clinical presentation: ```
Clostridium difficile Morph: gram +, spore forming, obligate anaerobic bacilli Toxin: toxin A - enterotoxin binds brush border of the gut; toxin B - cytotoxin destroys cytoskeletal structure of enterocytes Dz: pseudomembranous colitis (toxin B) Clinical presentation: secondary to antibiotic use (clindamycin or ampicillin), diarrhea, tx with metronidazole or oral vanc
33
``` Anthrax - cutaneous Morph: Toxin: Dz: Clinical presentation: ```
Anthrax - cutaneous (contact) Morph: bacillus anthracis - gram +, spore forming, polypeptide capsule Toxin: anthrax toxin Dz: black eschar caused by lethal factor and edema factor Clinical presentation: black painless skin lesions (necrosis surrounded by edematous ring) --> bacteremia and death
34
``` Anthrax - pulmonary Morph: Toxin: Dz: Clinical presentation: ```
Anthrax - pulmonary (inhalation) Morph: bacillus anthracis - gram +, spore forming, polypeptide capsule Toxin: anthrax toxin Dz: Woolsorters' disease Clinical presentation: flu-like symptoms --> fever, pulmonary hemorrhage, mediastinitis, shock
35
``` Bacillus cereus Morph: Toxin: Dz: Clinical presentation: ```
``` Bacillus cereus Morph: spore forming Toxin: cereulide a preformed toxin Dz: reheated rice syndrome Clinical presentation: food poisoning, N/V 1-5 hours and diarrheal type (watery, nonbloody)/GI pain (8-18 hrs) ```
36
Listeria monocytogenes Morph: Dz: Clinical presentation:
Listeria monocytogenes Morph: facultative intracellular microbe; tumbling motility (actin rockets) Dz: amnionitis, septicemia, spontaneous abortion; granulomatosis infantiseptica; neonatal meningitis; meningitis in IC, gastroenteritis in healthy Clinical presentation: ingesting unpasteurized milk/cheese/deli meats or vaginal transmission; ampicillin for infants, IC, eldery
37
``` Actinomyces Morph: Normally found: Dz: Clinical presentation: ```
Actinomyces Morph: long branching filaments, gram + anaerobe Normally found: oral flora Dz: oral/facial abscess Clinical presentation: drain through sinus tracts to form sulfur granules, treat with penicillin
38
``` Nocardia Morph: Normally found: Dz: Clinical presentation: ```
Nocardia Morph: long branching filaments, gram + aerobe, acid fast Normally found: soil Dz: pulmonary infections in IC and cutaneous infections after trauma in healthy Clinical presentation: treat with sulfonamides
39
Mycobacterium tuberculosis Clinical: Virulence:
Mycobacterium tuberculosis Clinical: fever, night sweats, weight loss, hemoptysis Resistant to multiple drugs Virulence: cord factor in virulent strains inhibit macrophage maturation and induces release of TNFa. Sulfatides (surface glycolipids) inhibits phagolysosomal fusion.
40
Mycobacterium kansaii | Clinical:
Mycobacterium kansaii | Clinical: pulmonary TB like symptoms
41
Mycobacterium avium-intracellulare | Clinical:
Mycobacterium avium-intracellulare | Clinical: disseminated non-TB disease in AIDS, resistant to multiple drugs, treat prophylactically with azithro
42
PPD + when...
current infection, past exposure, BCG vaccinated
43
PPD - when...
No infection or anergic (steroids, malnutrition, immunocompromised) and sarcoidosis
44
Primary tuberculosis progression - 4 outcomes
Infection with Mycobacterium tuberculosis to nonimmune host --> hilar nodes and Ghon focus (Ghon complex) --> (1) heal by fibrosis - immunity/hypersensitivity/TB + (2) progressive lung disease - HIV/malnutrition/ --> death (3) severe bacteremia - miliary tuberculosis --> death (4) Preallergic lymphatic or hematogenous dissemination --> dormant tubercle bacillin in several organs --> reactivation later
45
Secondary tuberculosis progression
Mycobacterium tuberuclosis infection to partially immune hypersensitized host --> reinfection --> secondary TB of fibrocaseous cavitary lesion in upper lobes
46
Reactivation of tuberculosis outcomes - 2
(1) Secondary tuberculosis (2) Extrapulmonary tuberculosis CNS (parenchymal tuberculoma or meningitis) Vertebral body (Pott's disease) Lymphadenitis Renal GI
47
Leprosy Morph: Dx: 2 types Clinical:
Leprosy Morph: mycobacterium leprae, acid-fast bacillus that like cool temp Dx: (1) Lepromatous: diffusely over skin and is communicable (low cell mediated immunity with humoral Th2 reponse) (2) Tuberculoid: few hypoesthetic, hairless skin plaques (high cell mediated immunity with largely Th1 type immune response) Clinical: infects skin and superficial nerves, glove and stocking loss of sensation; multidrug therapy of dapsone and rifampin for 6 mo for tuberculoid and dapsone, rifampin, clofazimine for 2-5 years for lepromatous
48
``` Neisseria gonorrhoeae Morph: Virulence: Transmission: Dz: Clinical: ```
Neisseria gonorrhoeae Morph: Gram - diplococci, ferment glucose, no polysaccharide capsule or maltose fermentation Virulence: IgA proteases Transmission: sexually Dz: gonorrhea, septic arthritis, neonatal conjunctivitis, PID, Fitz-Hugh Curtis syndrome Clinical: no vaccine, tx with ceftriaxone + azithromycin for possible chlamydia
49
``` Neisseria meningiditis Morph: Virulence: Transmission: Dz: Clinical: ```
Neisseria meningiditis Morph: Gram - diplococci, ferment glucose, polysaccharide capsule and maltose fermenter Virulence: IgA protease Transmission: respiratory/oral Dz: meningococcemia and meningitis, Waterhouse-Friederichsen syndrome Clinical: tx ceftriaxone or penicillin G
50
``` Haemophilus infulenzae Morph: Virulence: Transmission: Dz: Clinical: ```
Haemophilus infulenzae Morph: Gram - rod, culture on chocolate agar and requires V (NAD+) and X (hematin) Virulence: capsule type B (vaccine), IgA protease Transmission: aerosol Dz: epiglottitis (cherry red), meningitis, otitis media, pneumonia Clinical: tx with ceftriaxone, rifampin for close contact prophylaxis, vaccine b/t 2-18 months
51
``` Legionella pneumophila Morph: Virulence: Transmission: Dz: Clinical: ```
Legionella pneumophila Morph: Gram - rod, silver stain, charcoal yeast extract with iron and cysteine Virulence: Transmission: aerosol from water source Dz: (1) Legionnaires' disease - severe pneumonia, fever, GI, CNS (2) Pontiac fever - mild flu like syndrome Clinical: look for Ag in urine, macrolide or quinolone, hyponatremia
52
``` Pseudomonas aeruginosa Morph: Virulence: Transmission: Dz: Clinical: ```
Pseudomonas aeruginosa Morph: aerobic gram - rod, non-lactose, oxidase +, pyocyanin pigment, grape-like odor Virulence: endotoxin (fever, shock) and extoxin A (inactivates EF2) Transmission: water source Dz: Pneumonia, Sepsis (black lesion), external otitis (swimmer's ear), UTI, drug use, diabetic osteomyelitis, hot tub folliculitis, malignant otitis externa (DM) Clinical: wound and burn infxn, cystic fibrosis; tx with aminoglycoside plus extended spectrum penicillin
53
``` EIEC Morph: Virulence: Transmission: Dz: Clinical: ```
EIEC Morph: gram - rod Virulence: fimbriae (cystitis, pyelonephritis), K capsule (pneumonia, neonatal meningitis), LPS endotoxin (shock) Transmission: invasive to intestinal mucosa Dz: necrosis and inflammation Clinical: dysentery
54
``` ETEC Morph: Virulence: Dz: Clinical: ```
``` ETEC Morph: gram - rod Virulence: fimbriae (cystitis, pyelonephritis), K capsule (pneumonia, neonatal meningitis), LPS endotoxin (shock), labile/stable toxin Dz: no inflammation or invasion Clinical: Traveler's diarrhea (watery) ```
55
``` EPEC Morph: Virulence: Dz: Clinical: ```
EPEC Morph: gram - rod Virulence: fimbriae (cystitis, pyelonephritis), K capsule (pneumonia, neonatal meningitis), LPS endotoxin (shock) Dz: adheres to apical surface, flattens villi, prevents absorption Clinical: diarrhea in children
56
``` EHEC Morph: Virulence: Dz: Clinical: ```
EHEC Morph: gram - rod, O157:H7, doesnt ferment sorbitol Virulence: fimbriae (cystitis, pyelonephritis), K capsule (pneumonia, neonatal meningitis), LPS endotoxin (shock), Shiga-like toxin Dz: HUS, endothelium swells and narrows lumen leading to mechanical hemolysis and decrease renal BF Clinical: anemia, thrombocytopenia, acute renal failure; dysentery (toxin)
57
``` Klebsiella Morph: Virulence: Dz: Clinical: ```
Klebsiella Morph: gram -, lactose fermenter Virulence: abundant polysaccharide capsule Dz: lobar pneumonia in alcoholics/diabetics when aspirated, nosocomial UTI Clinical: red currant jelly sputum, aspiration pneumonia, abscess in lungs/liver, alcoholics, diabetics
58
``` Salmonella Morph: Transmission: Dz: Clinical: ```
Salmonella Morph: flagella, hydrogen sulfide, doesnt ferment lactose Transmission: hematogenous, animal reservoirs Dz: invades intestinal mucosa and cause monocytic response, blood diarrhea Clinical: antibiotics may prolong symptoms
59
``` Shigella Morph: Transmission: Dz: Clinical: ```
Shigella Morph: does not ferment lactose Transmission: cell to cell, human reservoir Dz: invade intestinal mucosa and cause PMN infiltration, blood diarrhea Clinical: antibiotics prolong excretion or organisms in feces
60
``` Campylobacter jejuni Morph: Transmission: Dz: Clinical: ```
Campylobacter jejuni Morph: comma or S-shaped, oxidase positive, 42 C Transmission: fecal-oral transmission through foods (poultry, meat, unpasteurized milk) Dz: bloody diarrhea in children Clinical: antecedent to GBS and active arthritis
61
``` Vibrio cholerae Morph: Virulence: Dz: Clinical: ```
Vibrio cholerae Morph: comma-shaped, oxidase positive, alkaline media Virulence: toxin permanently activates Gs --> increase cAMP Dz: rice-water diarrhea Clinical: rehydration necessary
62
Yersinia enterocolitica Transmission: Dz: Clinical:
Yersinia enterocolitica Transmission: pet feces, contaminated milk or pork Dz: mesenteric adenitis Clinical: mimics Crohn's appendicitis
63
Helicobacter pylori Morph: Dz: Clinical:
Helicobacter pylori Morph: curved gram - rod, urease + Dz: gastritis in duodenal ulcers (creates alkaline environment) Clinical: RF for peptic ulcer, gastric adenocarcinoma, lymphoma; tx with PPI, clarithromycin, amoxicillin, metronidazole
64
Spirochetes | Morph:
Spirochetes Morph: spiral shaped bacteria with axial filaments Forelia, Leptospira, Treponema (BLT) Clinical:
65
``` Leptospira interrogans Morph: Transmission: Dz: Clinical: ```
Leptospira interrogans Morph: spirochete Transmission: water contaminated with animal urine Dz: leptospirosis (flu like symptoms, jaundice, photophobia with conjunctivitis), Weil's disease (severe form with jaundice and azotemia from liver/kidney dysfunction; fever, hemorrhage, anemia) Clinical: surfers in tropics
66
``` Borrelia burgdorferi Stages: Transmission: Dz: Clinical: ```
Borrelia burgdorferi Stages: (1) erythema chronicum migrans (bulls eye rash), flu like symptoms (2) neurologic and cardiac (facial palsy, AV block) (3) MSK (migratory polyarthritis), neuro (encephalopathy, polyneuropathy), cutaneous manifestations Transmission: Ixodes tick, mouse reservoir, NE USA Dz: facial palsy, arthritis, cardiac block, erythema migrans Clinical: tx with doxycycilne, ceftriaxone
67
``` Syphilis Morph: Screen: Dz: Clinical: ```
Syphilis Morph: Treponema pallidum Screen: VDRL screen and confirm FTA-ABS Dz: Primary - painless chancre; Secondary - maculopapular rash (palms, soles), condylomata lata; Tertiary - gummas, aortitis (vasa vasorum), neurosyphilis (tabes dorsalis), Argyll Robertson pupil, broad based ataxia, + Romberg, Charcot joint, stroke w/o HTN; Congenital: saber shins, saddle nose, CN VIII deafness, Hutchinson's teeth, mulberry molars Clinical: treat with pen G, placental transmission typically occurs at first trimester
68
Salmonella typhi | Clinical presentation
Salmonella typhi Clinical presentation: typhoid fever, found only in humans, rose spots on the abdomen, fever, headache, diarrhea, can remain in gallbladder as carrier state
69
Argyll Robertson pupil
constricts with accommodation but is not reactive to light (tertiary syphilis) Prostitute's pupil - accommodate but doesnt react
70
VDRL false positive
VDRL detects Ab that reacts with beef cardiolipin; false positive for viral infection (mono, hepatitis), some drugs, rheumatic fever, SLE, leprosy
71
Jarisch-Herxheimer reaction
Flu-like syndrome immediately after antibiotics are started - due to killed bacteria releasing pyrogens
72
Bartonella spp
Cat scratch disease from cat scratch
73
Borrelia burgdorferi
Lyme disease from Ixodes ticks (deer and mice)
74
Borrelia recurrentis
Recurrent fever from louse (variable surface antigens)
75
Brucella spp
Brucellosis/undulant fever from unpasteruized dairy
76
Campylobacter
Bloody diarrhea from puppies/livestock (fecal-oral, ingestion of undercooked meat)
77
Chlamydophila psittaci
Psittacosis from parrots and other birds
78
Coxiella burnetii
Q fever from aerosols of cattle/sheep amniotic fluid
79
Ehrlichia chaffeensis
Ehrlichiosis from Lone Star tick
80
Francisella tularensis
Tularemia from ticks/rabbits/deer fly
81
Leptospira spp
Leptospirosis from animal urine
82
Mycobacterium leprae
Leprosy from armadillos and humans with lepromatous leprosy
83
Pasteurella multocida
Cellulitis, osteomyelitis from animal bites, cats, and dogs
84
Rickettsia prowazekii
Epidemic typhus from louse
85
Rickettsia rickettsii
Rocky Mountain spotted fever from Dermacentor tick bite
86
Rickettsia typhi
Endemic typhus from fleas
87
Yersinia pestis
Plague from fleas (rats and prairie dogs are reservoirs)
88
``` Gardnerella vaginalis Morph: Transmission: Dz: Clinical: ```
Gardnerella vaginalis Morph: pleomorphic, gram variable rod Transmission: sexual activity but not STD Dz: vaginosis with Clue cells or vaginal epithelial cells covered with bacteria Clinical: gray vaginal discharge with fishy smell, non-painful; metronidazole
89
Rocky Mountain spotted fever Morph: Clinical:
Rocky Mountain spotted fever Morph: Rickettsia rickettsii, obligate intracellular organisms need CoA and NAD+ Location: distributed in US Clinical: rash at wrists and ankles spreads to trunk, palms, soles
90
Typhus Morph: Clinical:
Typhus Morph: R. typhi and R. prowazekii Clinical: endemic fleas = R. typhi; epidemic human body louse = R. prowazekii --> rash starts centrally and spreads out sparing palms and soles Palm and sole rash also in Coxsackievirus A, Rocky Mountain spotted, secondary Syphilis
91
Ehrlichiosis
Tick - Ehrlichia | Monocytes with morula (berry-like inclusions) in cytoplasm
92
Anaplasmosis
Tick - anaplasma | Granulocytes with morula in cytoplasm
93
Q Fever
Tick feces and cattle placenta release spores that are inhaled as aerosols from Coxiella burnetii Pneumonia
94
``` Chlamydiae Morph: Transmission: Dz: Clinical: ```
Chlamydiae Morph: Chlamydia trachomatis, obligate intracellular organism; lacks muramic acid in cell wall Transmission: Elementary body enters cell via endocytosis and reticulate body replicates in cell by fission (form seen on tissue culture) Dz: reactive arthritis, conjunctivitis, nongonococcal urethritis, PID --> trachomatis; atypical pneumonia --> pneumoniae/psittaci; Clinical: treat with azithromycin or doxycycline; cytoplasmic inclusions on Giemsa or fluorescent antibody stained smear
95
what type of chlamydiae trachomatis causes chronic infection, blindness due to follicular conjunctivits in Africa?
A, B, C
96
what type of Chlamydia trachomatis causes urethritis/PID, ectopic pregnancy, neonatal pneumonia (staccato cough), neonatal conjunctivitis?
D-K
97
What type of chlamydia trachomatis causes lymphogranuloma venereum?
L1, L2, L3
98
Mycoplasma pneumoniae Morph: Dz: Clinical:
Mycoplasma pneumoniae Morph: no cell wall (sterols instead), Eaton's agar Dz: walking pneumonia in <30 yoa Clinical: insidious onset, headache, nonproductive cough, diffuse interstitial infiltrate; high titer of cold agglutinins (IgM); tx with macrolide or fluoroquinolone; military recruits and prisons
99
Histoplasmosis Morph: Location: Dz:
Histoplasmosis Morph: dimorphic fungi, Macrophage filled with Histoplasma Location: Mississippi and Ohio River valleys Dz: pneumonia from bird or bat droppings, treat with fluconazole or itraconazole for local and amphotericin B or systemic infections
100
Blastomycosis Morph: Location: Dz:
Blastomycosis Morph: dimorphic fungi, broad-base budding Location: states E of Mississippi River and Central America Dz: inflammatory lung disease and can disseminate to skin and bone, granulomatous nodules, treat with fluconazole or itraconazole for local and amphotericin B or systemic infections
101
Coccidioidomycosis Morph: Location: Dz:
Coccidioidomycosis Morph: dimorphic fungi, spherule filled with endospores Location: SW US, California - increased after earthquake; San Joaquin Valley or desert "valley fever" Dz: pneumonia, meningitis can disseminate to bone and skin, treat with fluconazole or itraconazole for local and amphotericin B or systemic infections
102
Paracoccidioidomycosis Morph: Location: Dz:
Paracoccidioidomycosis Morph: dimorphic fungi, budding yeats with captain's wheel formation Location: Latin America Dz: pneumonia, treat with fluconazole or itraconazole for local and amphotericin B or systemic infections
103
Tinea versicolor Morph: Location: Dz:
Tinea versicolor Morph: Malassezia furfur, spaghetti&meatball on KOH prep Location: hot, humid weather Dz: degradation of lipids produces acids that damage melanocytes and cause hypopigmented/hyperpigmented patches; topical miconazole, selenium sulfide (Selsum)
104
Tinea pedis, cruris, corporis, capitis, unguium Morph: Location: Dz:
Tinea pedis, cruris, corporis, capitis, unguium Morph: dermatophytes Location: Dz: pruritic lesion with central clearing resembling a ring caused by dermatophytes
105
Candida albicans Morph: Dz: Clinical:
Candida albicans - systemic or superficial fungal infection Morph: dimorphic yeast, pseudohyphae and budding yeast Dz: oral and esophageal thrush in IC, vulvovaginitis, diaper rash, endocarditis in IVDA, disseminated candidiasis, chronic mucocutaneous candidiasis Clinical: tx topical azole for vaginal, fluconazole or caspofungin for oral/esophageal, fluconazole or amphotericin B or caspofungin for systemic
106
Aspergillus fumigatus Morph: Dz:
Aspergillus fumigatus Morph: septate hyphae that branch at 45 angle Dz: invasive aspergillosis in IC and chronic granulomatous dz; allergic bronchopulmonary aspergillosis in asthma; aspergillomas in lung cavities especially after TB infection, produce aflatoxins assocaited with HCC
107
Cryptococcus neoformans Morph: Dz: Clinical:
Cryptococcus neoformans Morph: yeasts with wide capsular halos and unequal budding in India ink, encapsulated Dz: meningitis, cryptococcosis Clinical: soil and pigeon droppings through inhalation w/ hematogenous dissemination to meninges; Sabouraud's agar, stains with India ink, latex agglutination test detects polysaccharide capsular antigen; Soap bubble lesions
108
Mucor and Rhizopus Morph: Dz: Clinical:
Mucor and Rhizopus Morph: irregular, borad, nonseptate hyphae branching at wide angles Dz: mucormycosis, rhinocerebral and frontal lobe abscesses Clinical: ketoacidotic diabetic and leukemic patients - proliferate in blood vessel walls when excess ketone and glucose --> penetrate cribriform plate and enter brain; presents with HA, facial pain, black necrotic eschar on face, cranial nerve involvement
109
Pneumocystis jirovecii Morph: Dz: Clinical:
Pneumocystis jirovecii Morph: disc shaped yeast on methenamine silver stain, diffuse bilateral CXR appearance Dz: pneumocystis pneumonia (PCP) - diffuse interstitial pneumonia Clinical: inhaled, most are asymptomatic but IC predisposes to disease. Lung biopsy or lavage and tx with TMP-SMX, pentamidine ,dapsone
110
Sporothrix schenckii Morph: Dz: Clinical:
Sporothrix schenckii Morph: dimorphic, cigar shaped budding yeast leives on vegetation, spores Dz: sporotrichosis Clinical: traumaticaly introduced into the skin (thorn), causes local pustule or ulcer with nodules draining along lymphatics; tx with itraconazole or potassium iodide
111
``` Giardia lambli Morph: Transmission: Dz: Clinical: ```
Giardia lambli Morph: protozoa; trophozoites or cysts in stool Transmission: cysts in water Dz: Giardiasis Clinical: bloating, flatulence, foul-smelling, fatty diarrhea; tx with metronidazole
112
``` Entamoeba histolytica Morph: Transmission: Dz: Clinical: ```
Entamoeba histolytica Morph: protozoa, flask shaped ulcers, trophozoites with RBC in cytoplasm or cysts in stool Transmission: cysts in water Dz: amebiasis Clinical: bloody diarrhea, liver abscess (anchovy paste exudate), RUQ pain (flask shaped ulcer); tx with metronidazole, iodoquinol for asymptomatic cyst passers
113
``` Cryptosporidium Morph: Transmission: Dz: Clinical: ```
``` Cryptosporidium Morph: cysts on acid-fast stain Transmission: cysts in water Dz: diarrhea Clinical: severe diarrhea in AIDS or mild in healthy; prevention by filtering water; nitazoxanide in healthy hosts ```
114
``` Toxoplasma gondii Morph: Transmission: Dz: Clinical: ```
Toxoplasma gondii Morph: protozoa, ring enhancing lesion Transmission: cysts in meat or cat feces, crosses placenta Dz: brain abscess in HIV Clinical: congenital - chorioretinitis, hydrocephalus, intracranial calcifications; dx by biopsy/serology; tx with sulfadiazine and pyrimethamine
115
``` Naegleria fowleri Morph: Transmission: Dz: Clinical: ```
Naegleria fowleri Morph: amoebas Transmission: swimming in freshwater lakes enters through cribriform plate Dz: rapidly fatal meningoencephalitis Clinical: seen in spinal fluid, amphotericin has been effective for few survivors
116
``` Trypanosoma brucei/gambiense/rhodesiense Morph: Transmission: Dz: Clinical: ```
``` Trypanosoma brucei/gambiense/rhodesiense Morph: Transmission: Tsetse fly - painful bite Dz: African sleeping sickness Clinical: enlarged lymph nodes, recurring fever, somnolence, coma; detect in blood smear; tx with Suramin for blood borne disease or melarsoprol for CNS penetration ```
117
``` Plasmodium 4 types and characteristics Transmission: Dz: Clinical: ```
Plasmodium (1) vivax - 48 hr w/ fever 1&3 days, dormant in liver (2) ovale - same as vivax (3) falciparum - sever, irregular, parasitized RBC occlude capillaries in brain/kidney/lungs (4) malariae - 72 hr cycle Transmission: anopheles mosquito Dz: malaria Clinical: fever, headache, anemia, splenomegaly; dx w/ blood smear - trophozoite ring, RBC schizont with merozoites; tx with chloroquine - blocks heme polymerase or mefloquine, life threatening --> IV quinidine, vivax/ovale --> primaquine for hypnozoite
118
``` Babesia Morph: Transmission: Dz: Clinical: ```
``` Babesia Morph: protozoa Transmission: NE USA, Ixodes tick Dz: Babesiosis Clinical: fever, hemolytic anemia; asplenia increase risk of severe illness; blood smear - ring form with maltese cross; tx with atovaquone + azithromycin ```
119
``` Trypansoma cruzi Morph: Transmission: Dz: Clinical: ```
Trypansoma cruzi Morph: protozan Transmission: S. America, Reduviid bug (kissing bug w/ painless bite) Dz: Chagas disease Clinical: dilated cardiomyopathy, megacolon, megaesophagus; blood smear for dx; tx with nifurtimox
120
``` Leishmania donovani Morph: Transmission: Dz: Clinical: ```
``` Leishmania donovani Morph: Transmission: sandfly Dz: visceral leishmaniasis (kala-azar) Clinical: spiking fevers, hepatosplenomegaly, pancytopenia; dx macrophages containing amastigotes; tx with sodium stibogluconate ```
121
``` Trichomonas vaginalis Morph: Transmission: Dz: Clinical: ```
``` Trichomonas vaginalis Morph: trophozoites on wet mount Transmission: STD Dz: vaginitis Clinical: foul-smelling, greenish discharge; itching and burning; tx with metronidazole for patient and partner ```
122
Enterobius vermicularis Transmission: Dz: Treat:
Enterobius vermicularis (pinworm) Transmission: food contaminated w/ eggs Dz: intestinal infection causing anal pruritius (scotch tape test) Treat: Bendazole or pyrantel pamoate
123
Ascaris lumbricoides Transmission: Dz: Treat:
Ascaris lumbricoides Transmission: fecal-oral, eggs visible in feces Dz: intestinal infection Treat: Bendazoles
124
Strongyloides stercoralis Transmission: Dz: Treat:
Strongyloides stercoralis Transmission: larvae in soil penetrate skin Dz: intestinal infection causing vomiting, diarrhea, anemia Treat: Ivermectin or albendazole
125
``` Ancylostoma duodenale Necator americanus Transmission: Dz: Treat: ```
``` Ancylostoma duodenale Necator americanus Transmission: larvae penetrate skin Dz: intestinal infection causing anemia by sucking blood from intestinal walls Treat: Bendazoles or pyrantel pamoate ```
126
Dracunculus medinensis Transmission: Dz: Treat:
Dracunculus medinensis Transmission: drinking water Dz: skin inflammation and ulceration Treat: slow extraction of worm
127
Onchocerca volvulus Transmission: Dz: Treat:
Onchocerca volvulus Transmission: female blackfly bite Dz: hyperpigmented skin and river blindness; allergic reaction to microfilaria Treat: ivermectin
128
Loa loa Transmission: Dz: Treat:
Loa loa Transmission: deer fly, horse fly, mango fly Dz: swelling in skin, worm in conjunctiva Treat: diethylcarbamazine
129
Wuchereria bancrofti Transmission: Dz: Treat:
Wuchereria bancrofti Transmission: female mosquito Dz: blocks lymphatic vessels, elephantiasis (9 mos to 1 yr to become symptomatic) Treat: diethylcarbamazine
130
Toxocara canis Transmission: Dz: Treat:
Toxocara canis Transmission: food contaminated with eggs Dz: visceral larva migrans Treat: albendazole or mebendazole
131
Taenia solium Transmission: Dz: Treat:
Taenia solium Transmission: ingestion of larvae encysted in undercooked pork OR ingestion of eggs Dz: intestinal infection OR cysticercosis, neurocysticercosis Treat: Praziquantel or that plus bendazoles for neurocysticercosis
132
Diphyllobothrium latum Transmission: Dz: Treat:
Diphyllobothrium latum Transmission: ingestion of larvae from raw freshwater fish Dz: Vitamin B12 deficiency --> anemia Treat: Praziquantel
133
Echinococcus granulosus Transmission: Dz: Treat:
Echinococcus granulosus Transmission: ingestion of eggs from dog feces Dz: cysts in liver, causing anaphylasix if antigens released Treat: -bendazoles
134
Schistosoma Transmission: Dz: Treat:
Schistosoma Transmission: snails host, cercariae penetrate skin of humans Dz: liver and spleen granulomas, fibrosis, inflammation; chronic infection with S. haematobium can lead to SCC of bladder Treat: Praziquantel
135
Clonorchis sinensis Transmission: Dz: Treat:
Clonorchis sinensis Transmission: undercooked fish Dz: biliary tract inflammation --> pigmented gallstones and associated with cholangiocarcinoma Treat: praziquantel
136
Paragonimus westermani Transmission: Dz: Treat:
Paragonimus westermani Transmission: undercooked crab meat Dz: lung inflammation and secondary bacterial infection, hemoptysis Treat: praziquantel
137
Parasite - brain cysts, seizure
Taenia solium (cysticercosis)
138
Parasite - liver cysts
Echinococcus granulosus
139
Parasite - Vitamin B12 deficiency
Diphyllobothrium latum
140
Parasite - Biliary tract disease, cholangiocarcinoma
Clonorchis sinensis
141
Parasite - hemoptysis
Paragonimus westermani
142
Parasite - portal HTN
Schistosoma mansoni
143
Parasite - hematuria, bladder cancer
Schistosoma haematobium
144
Parasite - microcytic anemia
Ancylostoma, Necator
145
Parasite - perianal pruritus
Enterobius

Microbiology (7 decks)

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