Chapter 156 - Miscellaneous Bacterial Infections With Cutaneous Manifestations

Question 1

Most common form of anthrax associated with lowest morbidity

Answer 1

Cutaneous anthrax

Question 2

Natural pathogens of anthrax (3)

Answer 2

Sheep
Goats
Cattle

Question 3

Anthrax is CDC Category __

Answer 3

A

Question 4

There is no potential for human to human transmission of inhalational anthrax.
True or False

Answer 4

True

Question 5

MC route of transmission of anthrax

Answer 5

Percutaneous inoculation of spores

Question 6

Injectional anthrax is more __ than cutaneous anthrax with ___ mortality rate.

Answer 6

Insidious without eschar

Higher

Question 7

Major virulence factors of anthrax (2)

Answer 7

1. Poly-D-glutamic acid capsule
2. Tripartite anthrax toxin
   (Protective antigen, lethal factor, edema factor)

Question 8

Best target for vaccines or immunotherapy of anthrax

Answer 8

Protective antigen

Question 9

True pustules are pathognomonic for anthrax.

True or False

Answer 9

False, rare

‘Malignant pustule’

Question 10

Important feature for differentiating anthrax from brown recluse spider bite

Answer 10

Painless necrotic ulcer

Question 11

Naturally occurring anthrax is treated with

Answer 11

Penicillin

Doxycycline

Question 12

Weaponized anthrax or bioterrorism associated anthrax is treated with

Answer 12

Fluroquinolones, even in pregnant or on children

Question 13

FDA -license humanized monoclonal antibody approved for cases of inhalational anthrax

Answer 13

Raxibacumab

Question 14

Smears and cultures from vesicles or from the necrotic tissue beneath the eschar became negative within __ hours of initiation of penicillin therapy for anthrax

Answer 14

6

Question 15

Mortality rate of untreated cutaneous anthrax is roughly

Answer 15

5-20%

Question 16

Most common form of tularemia in the United States

Answer 16

Ulceroglandular disease

Question 17

Most common tick vectors of tularemia (3)

Answer 17

Dermacentor variabilis
Amblyomma americanun
Ixodes

Question 18

Mosquitoes may serve as mechanical vectors of waterborne variant of tularemia (F. Tularensis holarctica)
True or False

Answer 18

True

Question 19

Type of Francisella that infect patients with inherited defects in phagocytosis such as chronic granulomatous disease

Answer 19

Francisella philomiragia

Question 20

Painful red ulcer evolving into a necrotic chancriform ulcer covered by a black eschar with regional lymphadenopathy

Answer 20

Tularemia

Question 21

Culture of F. Tularensis

Answer 21

Cysteine-supplemented blood agar

Question 22

Treatment for tularemia (3)

Answer 22

Aminoglycoside (Gentamicin) 10 days
Fluroquinolone 10 days
Doxycycline 15 days

Question 23

Prophylaxis for tularemia

Answer 23

Ciprofloxacin

Question 24

Types of tularemia (5)

Answer 24

Ulceroglandular: 5% mortality rate
Oculoglandular 
Oropharyngeal
Typhoidal: 30% mortality rate
Pulmonary: 30% moratlity rate

Question 25

Most common form of plague; Form of plague with highest mortality

Answer 25

Bubonic plague | Pneumonic plague

Question 26

Flea vector associated with epidemic plague in the Old World

Answer 26

Xenopsylla cheopis

Question 27

Plague is considered a CDC category __ biologic weapon

Answer 27

A

Question 28

Hallmark of bubonic plague

Answer 28

Tender regional LN with extensive subcutaneous edema

Question 29

In anthrax, most common site of buboes in adults; in children

Answer 29

Inguinal buboes | Cervical and axillary buboes

Question 30

Diagnosis of plague is suggested with a convalescent passive hemagglutinin titer greater than ___

Answer 30

1:16

Question 31

Preferred treatment but not FDA approved for plague

Answer 31

Gentamicin x 10 days

Question 32

Use as postexposure prophylaxis for plague

Answer 32

Doxycyline x 10 days | Cotrimoxazole

Question 33

All forms of plague are nearly always fatal. | True or False

Answer 33

False, pneumonic and septicemic

Question 34

Most important way to prevent plague

Answer 34

Rodent control prevention

Question 35

Brucellosis involve 4 organ systems

Answer 35

Joints Reproductive organs Liver CNS

Question 36

Reservoirs for Brucella

Answer 36

Domesticated animals

Question 37

2 species that commonly infect human

Answer 37

Brucella melitensis | Brucella abortus

Question 38

Most common source for human infection

Answer 38

Contaminated unpasteurized milk or cheese

Question 39

Cause of mortality of most brucellosis patients

Answer 39

Endocarditis

Question 40

Culture of Brucella sp | Specimen for culture

Answer 40

8 to 10% CO2 | BM biopsy

Question 41

Cross reactions with ___ are known and recent ___ baccination may stimulate false positive Brucella agglutination

Answer 41

F. Tularensis | Cholera

Question 42

Treatment for brucellosis

Answer 42

Doxycyline and Rifampin for 6 weeks

Question 43

Brucella is categorized as Category ___ bioweapon

Answer 43

B

Question 44

Brucella is an intracellular pathogen hence AIDS patients have a more frequent or more severe disease. True or False

Answer 44

False, do not

Question 45

Matching type 1. Fatal endocarditis 2. Abortion in cattle 3. Caseation necrosis A. Abortus B. Melitensis C. Canis D. Suis

Answer 45

B A D

Question 46

Skin lesions occur in <5% of patients as violaceous papulonodular eruption on trunk and lower extremities. True or False

Answer 46

True

Question 47

For cultures, ___ have the highest yield

Answer 47

Bone marrow specimens

Question 48

Causative agent of glanders

Answer 48

Burkholderia mallei

Question 49

Characteristic eruption of glanders is crops of pustules, papules, bulla with prominent involvement of ____

Answer 49

Nasal mucosa

Question 50

Common manifestation of glanders

Answer 50

Mucopurulent bloody nasal discharge

Question 51

Counterpart of glanders in animals

Answer 51

Farcy

Question 52

Agglutination titer of ___ for brucellosis is sufficient to begin treatment

Answer 52

1:160

Question 53

Treatment for glanders

Answer 53

Sulfadiazine + Ceftazidime, Gentamicin, Doxycycline, Imipenem, Ciprofloxacin

Question 54

Subcutaneous and viscera abscesses of glanders should be treated for ___

Answer 54

1 year

Question 55

Treatment for pasteurella multicida

Answer 55

Co-amoxiclav

Question 56

Cat teeth are longer and sharper and may cause (2)

Answer 56

Septic arthritis | Osteomyelitis

Question 57

Characteristic for pasteurella multocida

Answer 57

Necrotizing cellulitis

Question 58

2 etiologic agent of rat bite fever

Answer 58

Streptobacillus moniliformis | Spirillum minus

Question 59

Classic triad of rat bite fever

Answer 59

Fever Polyarthralgia Acral rash

Question 60

Confirmatory diagnosis of rat bite fever

Answer 60

Blood cultures

Question 61

Matching type 1. Less than 10 days incubation period 2. Bite occurs concurrently with systemic symptoms 3. 60% arthritis 4. Rash most prominent on palms, soles, and around joints A. Streptobacillus moniliformis B. Spirillum minus

Answer 61

A B A A

Question 62

MOT of rat bite fever

Answer 62

Rat bite Or Contact with rat contaminated food or drink

Question 63

Culture of rat bite fever sp

Answer 63

Trypticase soy broth | Supplemented thioglycolate