Cardiac Infections- IL- Mary (3)* Flashcards Preview

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Flashcards in Cardiac Infections- IL- Mary (3)* Deck (43):
1

Bartonella:
Gram stain
Description
Motility

Growth Requirements

Gram (-)
curved, small, pleomorphic bacillus
Nonmotile

aerobic: fastidious growth requirements in prolonged humid atmosphere (6wks)

2

Bartonella Species
3 common +3 uncommon

Common:
B. bacilliformis, B. henselae, B. quintana

Uncommon:
B. elisabethae, B. clarridgeiae, B. grahmaii

3

Oroya Fever/Carrion's disease:
Cause
Description of Disease
Incubation period
Severity of disease?

B. bacilliformis
Acute Febrile illness w/ severe anemia-->chronic cutaneous form
2-6wk incubation
High mortality rate w/o therapy

4

Oroya Fever insect vector
Locations (3)

Lutzonmyia sandfly
Peru/Ecuador/Columbia (ANDES MOUNTAINS)

5

Oroya Development of Acute Disease

Bite-->bacteria into RBC--> acute anemia

6

Symp of Mild Oroya Fever (5 systems)
What happens when these infections resolve?

1. Myalgias/arthalgias
2. Lymphadenopathy
3. CNS: HA, mental change, seizures
4. GI: anorexia, abd pain
5. Heart: Angina
ends w/ Humoral Immunity

7

Chronic Oroya Fever (mos-yrs)

Benign bloody nodules (1-2cm)
Heal on their own

Asymp bacteremia in 15% survivors (reservoir)

8

Trench Fever:
bacterial species
Insect Vector

B. quintana
Pediculus humanus (body louse)

9

Geographic Location of B. quintana
Populations infected(2)

Worldwide
1. homeless (poor sanitation)
2. AIDS

10

Trench Fever Signs/Symp (3)

1. recurring FEVERS lasting 5 days (quintana=5)
2. HA, myalgia
3. Conjunctivitis

11

Cat Scratch Disease:
bacterial species

B. henselae

12

#1 clinical human infection of Bartonella

Cat Scratch Disease
22,000 cases in USA (no higher incidence in vets)

13

Cat Scratch Disease:
Cat Factoids (3)

stray cats > indoor cats; kittens > cats; cats are asymptomatic

14

Cat Scratch disease:
Transmission

cats--> fleas-->cats-->human (bite/scratch/flea)

flea-->human (not common)

15

Cat Scratch Disease :
Symptoms and timeline (4)

-papule/pustule (3-10d) lasting 1-3wk

-Regional ipsi LN enlargement (1-7wk)
+ F/Rash/malaise

-Chronic regional draining adenopathy (lasts 2-4mos)

-spontaneous resolution

16

Atypical Cat Scratch Disease (5)

1. Parinaud's oculoglandular syndrome
2. Granulomatous hepatitis
3. Pneumonitis
4. Neuro: Encephalopathy/ neuroretinitis
5. Fever of unknown origin (FUO)

17

Bartonella Endocarditis:
Culture (+) or (-)
Species (2)
symp (3)

Culture (-)
B. quintana, B. hensalae
subacute presentation
1. Fever
2. embolic phenomena
3. valvular heart disease

"so symptoms are pretty much the same w/ all Infective endocarditis"

18

Bacillary Angiomatosis:
Species (2)
patient population (3)

B. quintana, B. hensalae
HIV/organ transplant/immunocompromised

19

Bacillary Angiomatosis:
What do the lesions look like?
Where are the lesions typically found?
Symptoms (3)?

1. Raised red/purple lesions (can bleed)-->like hemangioma
or Hyperpigmented, hyperkeratotic plaques
2. Lesions: oral/nasal/genital mucosa
3. Bone Pain: Forearms/legs
4. GI: Abd pain, N/V, Jaundice, GI bleed, anorexia
5. Other: F/C, Malaise, Night Sweats

20

Bartonellosis Diagnosis:
1. Stains + organism that can be dx'ed this way?
2. Is culture a good method for all manifestations of bartonellosis?
3. What is the #1 way to dx b. henslae + b. quintana?

1. Oroya Fever (bacilliformis): Giemsa stain

2. Culture: Not for Cat Scratch Disease; ok for other manifestations of henslae/ quintana infection

3. Serology: #1 method (IgG/IgM immunoassays)
IgM >1:16 = recent infection
IgG >1:256 = current/past infection
Repeat 1-2wks later

21

Treatment:
1. Oroya Fever (B. bacilliformis)
2. Cat Scratch Disease (B. henselae)
3. Bacillary angiomatosis

1. Oroya: Chloramphenicol (S. Am)
Ciproflox, Doxy, Bactrim

2. CSD lymphadenitis: Azithromycin

3. Erythromycin/azithromycin or Doxy (8-10wk in HIV or endocarditis)

22

Whats HACEK stand for?

Haemophilus aprophilus
Actinobacillus actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella kingae

*H. aprophilus + Actinobacillus are group into Aggregatibacter

23

HACEK growth pattern

slow growing, fastidious (CO2 atmosphere)
Deep infections

24

Non-Cardio H + A manifestations (5)

1. Meningitis/Brain Abscess
2. Soft Tissue Infection, Parotitis
3. Septic Arthritis, Osteomyelitis
4. UTI
5. Pneumonia

25

Cardio H + A manifestations (3)

H, A are endogenously found where?

1. Empyema + Chest Wall Infection
2. Pericarditis
3. Endocarditis

*Flora of Mouth -->periodontitis

26

H + A:
Diagnosis/Culture
Treatment

Dx: blood/chocolate agar

Tx:
- #1 = 3rd gen Ceph
- Bactrim, Fluoroquinolones, Tetracyclines, Aminoglyc.

27

Cardiobacter:
Gram stain
Description
Motile?
Aerobic/Anaerobic
Growth

Gram (-)
small pleomorphic rod
non-motile
facultative anaerobic
fermentative, indole, and oxidase (+)
1-2wk in broth -or- enhanced CO2/humidity on agar

28

Where can Cardiobacter be found in healthy humans?

Predisposing factors to C. hominid infection (2)?

respiratory tract (low virulence)

1. heart disease
2. dental procedures/oral disease
(bacteria enters blood through oropharynx)

29

Symptoms of C. hominis endocarditis

slow onset w/ Fever + Malaise

30

Treatment of C. hominis

Penicillins (Ceftriaxone, ampicillin w/ gentamicin)

31

Eikenella Corrodens:
Transmission (2)

"corrodes" agar
1. Human Bite Wounds
2. Fist-Fight Injury

32

Eikenella manifestations (4)

Treatment

1. brain abscesses
2. sinusitis
3. pneumonia/ lung abscess
4. endocarditis

Tx: Penicillin (extendend cephalosporins, tetracyclines)

symptoms: "Brad Sucker Punched Egleton" -->b/c Eikenella is transmitted by fighting

33

Kingella Kingae:
Gram Stain
Description
Endogenously found where on humans?

Gram (-)
small coccobacilli
human oropharynx

34

Kingella in children

Treatment

"sterile"/aseptic arthritis (but actually septic) w/ Pain, F
Tx: children generally recover, abx similar to Eikenella (Penicillin)

35

Strep species causing:
abscess in brain, oropharynx, peritoneal cavity

S. anginosus
S. constellatus
S. intermedius

"ANGIe is CONSTantly INTERrupting about abscess in the brain, oropharynx and peritoneal cavity. Idiot"

36

Strep species causing:
Subacute bacterial endocarditis, neutropenic sepsis, penumonia, meningitis

S. mitis
S. pneumoniae
S. oralis

37

Strep Species causing:
Dental caries, endocarditis

S. mutans
S. sobrinus

"Mutans mutates your teeth into cavities"

38

Strep Species Causing:
bacteremia, endocarditis

S. Salivarius

"Sail BAC to my heart (ENDOCARDITIS)"

39

Strep species causing:
colon cancer, meningitis

Strep Bovis (S. gallolyticus, S. pasteurianus)

"if Strep bovis, be sure to look at their bowels"

40

Strep species causing:
Meningitis, bacteremia, strep toxic shock syndrome

S. suis

"I'm SUper SHOCKed MEN eat BACon"

41

Nutrient variable Strep species causing:
endocarditis, pancreatic abscess, otitis media, postpartum + postabortal sepsis

Abiotrophia

42

hemolysis of Strep viridans
treatment

alpha (partial) hemolytic
Tx: penicillin (bacteriostatic) +/- aminoglycoside

43

Strep species that cause endocarditis (6)

#1 strep viridans (alpha hemolytic)
2. Mitis
3. Mutans (also dental caries)
4. Salivarius
5. Abiotropia
6. Bovis (also colon cancer)