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8th > Chapter 154 - Gram Negative Coccal and Bacillary Infections > Flashcards

Chapter 154 - Gram Negative Coccal and Bacillary Infections Flashcards

1
Q

Mortality rates for meningococcal infection in the United States

A

10% to 15%

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2
Q

Gold standard for diagnosis of meningococcal infection

A

Culture isolation of N. Meningitidis from blood, CSF, other bodily fluids, or skin biopsy tissues

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3
Q

In the US, vaccination with a capsular polysaccharide conjugate vaccine against serogroups __ is recommended for all patients at ___ with a booster at ___

A

A, C, W135, Y
11 or 12 years old
16 years old

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4
Q

N. Meningitidis is almost always encapsulated hence allowing differentiation into serogroups based on ___

A

Capsular polysaccharides

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5
Q

Capsules decrease the visibility of N. Meningitidis via molecular mimicry, best illustrated by serogroup ___

A

B

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6
Q

Poor prognostic marker for meningococcal infection

A

High serum lipooligosaccharide (LOS)

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7
Q

Facilitates adherence to endothelial cells, mediate vascular damage, and facilitate breach of blood brain barrier

A

Type IV pili

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8
Q

Nasopharyngeal carrier rates for

Infants and young children, adolescents, and in young adults.

A

0.5 to 1%
5%
20 to 40%

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9
Q

In meningitidis, __ have higher risk of infection; while ___ have higher mortality

A

Males

Females

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10
Q

Matching type

  1. Meningitis and meningococcemia in infants younger than 6 mos old
  2. 25% of meningococcal pneumonia in older adults
  3. Most devastating outbreaks in subSaharan Africa
  4. Infections with high mortality in subSaharan Africa
  5. Most recent serogroup to emerge as cause of disease in subSaharan Africa
  6. 30-40% in US, 80% in Europe
  7. 30% in US and Europe
A 
Y
Y
A
W135
X
B 
C
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11
Q

Hallmark of acute meningococcemia

A

Acute petechial rash (60%) in extremities

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12
Q

Petechia were more common in infants than in children or adults.
True or False

A

False, children 1 to 18 years old (74%) than infants (48%) or adults (45%)

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13
Q

Presence of petechia predicts risk of mortality, but rapid increase in number and size does not correlate with fulminant disease progression.
True or False

A

False, do not predict risk of mortality but predicts risk of fulminant disease progression

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14
Q

Life threatening condition characterized by adrenal hemorrhage, ensuing adrenal crisis, often accompanied by purpura fulminans.

A

Waterhouse-Friderichsen syndrome

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15
Q

Most common sequela of meningitis

A

Sensorineural hearing loss or deafness

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16
Q

Triggers production of proinflammatory cytokines of the innate immune system including IL6, IL8, TNF alpha which contributed to endothelial damage

A

Lipooligosaccharide (LOS)

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17
Q

Single greatest risk factor for disseminated meningococcal disease

A

Lack of bactericidal antibodies

  1. Anatomical or functional asplenia
  2. HIV infection
  3. Defects in terminal or alternative complement pathway
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18
Q

CSF findings in meningococcal meningococcal meningitis

A

CSF leukocytes exceed 100 x 106/L
Elevated protein
Decreased glucose

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19
Q

Direct cause of death from acute meningococcal infection (2)

A

Shock, multiple organ failure

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20
Q

Single most important factor in treatment of acute meningococcal infection

A

Early initiation of antibiotics

No more than 30 mins from initiation of antibiotics

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21
Q

Presumptive treatment for meningococcal meningitis

A

3rd gen cephalosporin

Ceftriaxone or cefotaxime for 7 days

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22
Q

Not beneficial in meningococal meningitis although useful in pneumococcal diseases

A

Dexamethasone

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23
Q

Droplet precaution should be maintained from presumptive diagnosis until at least __ hours after initiation of effective antibiotic regimen

A

24

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24
Q

Close contacts are defined as those who have prolonged contact (> ___ hours) within close proximity (< ___ feet) of infected patient or those who had direct exposure to oral secretions from ___ days before the onset of symptoms until ___ hours ff initiation of effective antibiotics

A

8 hours
3 feet
7 days
24 hours

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25
Q

Single most impt factor in treatment of acute meningococcal infection is

A

Early initiation of antibiotics

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26
Q

N. Meningitidis can be diff from N. Gonorrhoeae by its maltose fermenting abilities.
True or False

A

True

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27
Q

On blood agar, N. Meningitis is light gray round, glistening and ___

A

Nonhemolytic

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28
Q

Nonpathogenic N. Meningitis is almost always nonencapsulated.
True or False

A

True

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29
Q

Vital for survival as it inhibits antibody and complement mediated killing and phagocytosis of N. Meningitidis

A

Capsule

30
Q

Down regulator of alternative complement pathway

A

Factor H binding protein

31
Q

Exclusive natural hosts for N. Meningitidis

A

Humans

32
Q

Characterized by retiform purpura and necrosis of skin which may extend to subQ and occasionally muscle and bone

A

Purpura fulminans

33
Q

In some cases, chronic meningococcemia can evolve into (3)

A

Acute meningococcemia
Meningitis
Carditis

34
Q

MOT of N. Meningitidis

A

Droplet or direct contact (arises wirhin 2 weeks)

35
Q

In acute meningococcemia, blood cultures may be positive in 40-80% but declines rapidly with initiation of antibiotics.
True or False

A

True

36
Q

In contrast to blood and CSF, meningococci can still be cultured from skin lesions up to ___ hours after antibiotic administration

A

13

37
Q

Highest sensitivity for culture

A

Blood specimen

38
Q

Highest sensitivity for culture and Gram staining

A

CSF

39
Q

PCR is most useful in

A

Negative cultures
And
Cheonic meningococcemia

40
Q

Latex agglutination test kit is not routinely performed as it cannot detect serogroup

A

B

41
Q

Chemoprophylaxis administered more than __ days is not recommended

A

14 days

42
Q

Chemoprophylaxis for meningococcemia

A

Rifampin 4 doses in 2 days (children &adults)
Ciprofloxacin (adults)
Ceftriaxone single dose IM
(Pregnant)

43
Q

Polysaccharide conjucate vaccine with DIphtheria toxoid against ACW135Y

A

Menactra

Menveo

44
Q

Recombinant vaccines against serogroup B

A

Bexsero

Trumenba

45
Q

Pseudomonas aeruginosa blue green nonfluorescent color specific is conferred by ___

A

Pyocyanin

46
Q

Malignant otitis externa is invasive with a mortaity rate of

A

20%

47
Q

Mortality for ecthyma gangrenosum is ___

A

30-70%

48
Q

In MacConkey agar, P. Aeruginosa appear ___ due to ____

A

White, non lactose fermenter

49
Q

P. Aeruginosa is obligately aerobic and grows best at

A

42 C

50
Q

Green yellow pigment of P. Aeruginosa that fluoresces under a Wood lamp

A

Pyoverdin

51
Q

Matching type

  1. TNF alpha production
  2. Binds adenosine diphosphate-ribosyltransferase
  3. Binds adenylate cyclase
  4. Damages cell membranes

A. Exo S
B. Exo T
C. Exo U
D. Exo Y

A

A
B
D
C

52
Q

Higher levels of serum exotoxin A antibodies results in more severe P. Aeruginosa septicemia.
True or False

A

False, less severe

53
Q

TLR 4 agonist and septic shocj mediator common to Gram (-) bacteria

A

Lipopolysaccharide

54
Q

Confers resistance to antibiotics

A

Biofilm formation

55
Q

P. Aeruginosa is number ___ for patients with cystic fibrosis; ___ for nosocomal pneumonia; ___ for catheterized patients who had UTI

A

1st
2nd
3rd

56
Q

Accumulation of ___ results to chloronychia

A

Pyocyanin

57
Q

Triad of Green nail syndrome

A

Dyspigmentation
Onycholysis
Paronychia

58
Q

External otitis is common in children ages

A

5-14 years old

59
Q

Classic finding of malignant otitis externa

A

Presence of granulation tissue in floor of external auditory canal

60
Q

Ecthyma gangrenosum is commonly seen in

A

Anogenita region (57%)&raquo_space; extremities (30%)

61
Q

Most frequent serotype isolated from P. Aeruginosa is

A

O11

62
Q

Bacteremia with P. Aeruginosa is common in patients with CD4 count less than

A

50 cells/ul

63
Q

Used to monitor disease activity in external otitis

A

ESR and CRP

64
Q

Treatment for green nail syndrome

A 
Topical antimicrobials
2% NaOCl
Tobramycin
Gentamicin
Bacitracin
Polymyxin B
Ciprofloxacin
\+ avoidance of water submersion
65
Q

Treatment for external otitis

A

Oral ciprofloxacin for 7-10 days

66
Q

Malignant otitis externa warrants Tx with

A

Ciprofloxacin for 6-8 weeks
Alt: anti pseudomonas penicillin for 6-10 weeks
+ mastoidectomy

67
Q

In those with neutropenia, burn wounds, ecthyma gangrenosum, or signs of spesis, management is

A

Antipseudomonal B lactam + aminoglycoside

68
Q

Alternative drug for multidrug resistant strains but with very high rates of nephrotoxicity

A

Colistin

69
Q

Alternative options for multidrug resistant infection

A

Ceftazidime-Avibactam
Ceftolozane-Tazobactam
Colistin

70
Q

Homemade ear drops comprised of

A

1:15 acetic acid + isopropyl alcohol

8th (28 decks)

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