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1
Q

Gram + - subgroups

A
  1. cocci
  2. Robs (bacilli)
  3. branching filaments
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2
Q

gram + branching filaments - bugs (and characteristics)

A
  1. Actinomyces - anaerobe, not acid fast

2. Nocardia - aerobe, acid fast

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3
Q

gram + robs - bugs (and characteristics)

A
  1. Clostiridium - spore forming, anaerobe
  2. Bacillus - spore forming, aerobe
  3. Listeria - no spore forming, tumbling motile, aerobe
  4. corynobacterium - no spore forming, non-motile,
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4
Q

gram + cocci are divided to (and characteristics)

A
  1. staphylococcus (cat+, clusters)

2. streptococcus (cat-, chains)

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5
Q

staphylococcus - bugs

A

ALL CAT+, CLUSTERS

  1. S. aureus
  2. S. epidermidis
  3. S. saprophyticus
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6
Q

streptococci are divided into subgroups according to (and the meaning)

A

hemolysis

  1. partially hemolysis (α)
  2. complete hemolysis (clear) (β)
  3. no hemolysis (γ)
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7
Q

β hemolytic streptococci - bugs and groups

A
  1. S pyogens (group A)

2. S. agalactiae (group B)

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8
Q

γ hemolytic streptococci - bugs and groups

A
  1. enterococcus (E. faecalis, E. feacium) - Group D,

2. Nonenterococcus (Streptococcus bovis)

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9
Q

α hemolytic streptococci - bugs (and characteristics)

A
  1. S. pneumoniae

2. Viridaans streptococci (eg. S. mutans, S. sanguinis, S. mitis)

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10
Q

S. pneumoniae - clinical manifestation

A

A. MCC OF: 1. Meningitis 2. Otitis media (in children)
3. Pneumonia 4. Sinusitis
B. Sepsis in sickle cell and splenectomy

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11
Q

Enterococci can cause

A

I. UTI
2. biliary tract infection
3. sabacute endocarditis
(following GI/GU procedures)

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12
Q

actinomyces vs Nocardia according to clinical manifestations

A

Acinomyces –> oral/facial abscess that drain through sinus tracts, PID with intrauterine device
Nocardia –> pulmonary infections in immunocompromised and cutaneous infection after trauma in immunocompoment

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13
Q

actinomyces vs Nocardia according to treatment

A

MNEMONIC: SNAP –> Sulfa - Nocardia / Actinom - Penicillin
Acinomyces –> penicillin
Nocardia –> sulfonamides

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14
Q

Gram (-) - subgroups

A
  1. diplococci
  2. coccoid robs (cocciobacilly)
  3. robs
  4. oxidase (+) comma shaped robs
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15
Q

Gram (-) - subgroups - diplococci - bugs

A
  1. Neisseria meningitis
  2. Neisseria gonorrhoeae
  3. Moraxella catarrhalis
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16
Q

Gram (-) - subgroups - coccoid robs - bugs?

A
  1. haemophilus infleunzae
  2. Pasteurella
  3. Brucella
  4. Bordetella pertusis
  5. Francicella tularencis
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17
Q

Gram (-) - subgroups - oxidase +, comma shape

A
  1. Campylobacter jejuni (grows in 42c, oxidase +, comma shape)
  2. Vibrio cholera (grows in alkaline media, oxidase +, comma shape)
  3. Helicobacter pylori (produces urease, oxidase +, comma shape, catalase +)
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18
Q

Gram (-) stain robs are divided to (only the groups)

A
  1. Lactose fermeter

2. Lactose nonfermenter

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19
Q

Gram (-) stain robs Lactose nonfermenter bugs

A
  1. Salmonela
  2. Proteus
  3. Yersinia
  4. Shigella
  5. pseudomonas
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20
Q

Gram (-) stain robs - lactose fermenter bugs

A
  1. klebsiella
  2. E. coil
  3. Enterobacter
  4. citrobacter
  5. others
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21
Q

neisseria gonococci vs neisseria meningitis - prevention

A

neisseria gonococci –> condoms (for STD), erythromycin ointment (neonatal transmision)
neisseria meningitis –> Rifampin, ciprofloxacin or ceftriaxone prophylaxis in close contacts

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22
Q

neisseria gonococci vs neisseria meningitis - treatment

A

neisseria gonococci –> ceftriaxone + (azithromycin or doxycycline) for possible chlamydial coinfection
neisseria meningitis –> ceftraxone or penicillin G

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23
Q

ciprofloxacini used for

A

cystitis and pyelonephritis

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24
Q

Fluoroquinolones - diverticulitis and GI infections

A
  1. moxifloxacin alone (it cover anaerobes)

2. ciprofloxacin, gemifloxacin and levofloxacin must be combined with metronidazole because they dont covers anaerobles

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25
Fluoroquinolone that covers anaerobes
moxifloxacin
26
Anaerobes - drugs
oral (above the diaphragm): 1. penicillin G or VK, ampicillin or amoxicillin 2. clindamycin Abdominal / GI 1. metronidazole 2. beta lactam/lactamase combination PIPERACILLIN, CARBAPENE,S AND 2ND GENERATION CEPH ALSO COVER ANAEROBES
27
Gram (-) bacilli are covered by
1. quinolones 2. aminoglycosides 3. carbepens 4. peperacillin, ticarcillin 5. aztreonam 6. cephalosporins
28
common cause of meningitis in newborn (0-6months) (in order)
1. Group B streptococci 2. E. coli 3. Listeria
29
common cause of meningitis in children (6months-6yr) (in order)
1. S. pneumoniae 2. N. meningitis 3. H. influenzae type B 4. Enteroviruses
30
common cause of meningitis in 6-60 years (in order)
1. S. pneumoniae 2. N. meningitis (1st in teens) 3. Enteroviruses 4. HSV
31
common cause of meningitis in 60+ (in order)
1. S. pneumoniae 2. Gram - robs 3. Listeria
32
common cause of pneumonia in neonates (less than 4 weeks)
1. S. agalactiae | 2. E. coli
33
common cause of pneumonia in children (4wks - 18yr) (in order)
1. viruses (RSV) 2. mycoplasma 3. C. trachomatis (infants - 3 years) 4. C. pneumoniae (school-aged children) S. pneumoniae
34
common cause of pneumonia in adults (18-40yr) (in order)
1. mycoplasma 2. C. pneumoniae 3. S. pneumoniae 4. viruses (eg. influenza)
35
common cause of pneumonia in adults (40-65yr) (in order)
1. S. pneumoniae 2. H. infuenzae 3. Anaerobes 4. viruses 5, Mycoplasma
36
common cause of pneumonia in elderly (in order)
1. S. pneumoniae 2. Influenza virus 3. Anaerobes 4. H Influenzae 5. Gram (-) robs
37
CATALASE + organism - examples
PLACESS (+ nocardia, H. pylori, B. cepacia 1. Staphylococci 2. E-coli 3. Candida 4. Serratia 5. Listeria 6. Aspergillus 7. Pseudomonas 8. Nocardia
38
staphylococcus aureus can cause .... (categories and manifestations
A. inflammatory disea: 1. skin infection 2. organ abscesses 3. pneumonia 4. endocarditis 5. osteomyelitis B. Toxin mediated disease: 1. TSST-1 --> Toxic shock syndrome 2. Exfoliative --> scalded skin syndrome 3. enterotoxin --> rapid onset food poisoning C. MRSA infection: serious nosocomial and community-acquired infections
39
Toxic shock syndrome - is associated with (situations)
1. S. aureus --> vaginal tampons, nasal packing | 2. S. pyogenes --> painful skin infection
40
diptheria - symptoms
1. pseudomembranous pharyngitis (grayish-white membrane) 2. Lymphadenopathy (bull neck) 3. myocaridits 4. arrhythmia 5. demyelination/paralysis of peripheral nerves
41
spore forming bacteria - bugs and diseases
1. Bacillus antrhacis --> antrax 2. Bacillus cereus --> Food poisoning 3. Clostiridium botulinum --> botulism 4. Clostiridium difficile --> Antibiotic associated colitis 5. Clostiridium perfingess --> gas gangrene, food poisoning 6. Clostiridium tetani --> tetanus 6. Coxiella burnetii --> Q fever
42
Clostiridia - toxins
1. Clostiridium tetani --> tetanospasmin 2. Clostiridium botulinum --> Botulinum toxin 3. Clostiridium perfringens --> Alpha toxin, head labile enterotoxin 4. Clostiridium difficile --> Toxin A (eneterotoxin), Toxin B (cytotoxin)
43
cutaneous antrhax?
painless, papule surrounded by vesicle --> ulcer with black eschar, (painless, pencrotic) --> uncommonly progress to bactremia and death
44
pulmonary antrhax? / aka?
inhalation of spores --> flu like symptoms that rapidly progress to fever, pulmonary hemorrhage, mediastinitis and shock. aka: woolsorter's disease
45
Listeria monocytogenes can cause
1. in pregnant --> amnionitis, septicemia, spontaneous abortion 2. newborns --> granulomatosis infantiseptica, neonatal meningitis 3. immunocompromised patients --> meningitis 4. healthy individuals --> mild gastroenteritis
46
Nontypeable of H. infl stains are the MCC of
A. mucosal infection: 1. otitis media 2. conjunctivitis 3. bronhitis
47
en-capsuled type B H. influenza causes
invasive infection: 1. meningitis 2. acute epiglottitis (children) 3. septic arthritis 4. sepsis
48
risk factors for Legionnaires's disease
1. Cigarette smoking 2. alcoholics 3. chronic lung disease 4. immunosuppressed states
49
pseudomonas aeroginosa - manifestations (and associated conditions)
1. Pneumonia (Cystic fibrosis, mechanical ventilation) 2. otitis externa - swimmer's ear (diabetes) 3. UTI (hospital patients) 4. ecthyma gangrenosum (immunocompromised patients) 5. sepsis 6. osteomyelitis (eg. puncture wounds, drug use) 7. wound infection (burn victim) 8. hot tub folliculitis (water) 9 nosocomial infections (catheter equipment)
50
Pseudomonas aeroginosa - mechanism of action
produce 1. endotoxin --> fever + shock 2. exotoxin A --> inactivates EF-2 3. pyocacin --> generates ROS
51
E. coli - presentation
1. EIEC --> dysentery with white blood cells, fever 2. ETEC --> traveler's diarrhea (watery) 3. EPEC --> watery diarrhea, usually in children 4. EHEC --> dysentery, hemolytic uremic syndrome
52
Klebsiella - clinical manifestation (and situations)
1. lobar pneumonia (and bronchopneumonia) (in alcoholics, diabetes) 2. UTI (nosocomial) 3. Abscess in Lung and liver
53
Campylobacter jejuni - clinical manifestations
1. Major cause of bloody diarrhea (especially in children) 2. Guillain-Barre syndrome 3. reactive arthritis
54
Salmonella typhi vs other salmonella vs shigella - GI manifestation
Salmonella typhi --> constipation, followed by diarrhea other salmonella -->bloody diarrhea shigella --> bloody diarrhea (bacillary dysentery)
55
Penicillin G vs V
Penicillin G --> IV and IM form | Penicillin V --> Oral
56
Penicillin G and V - clinical use
gram + cocci and robs, gram (-) cocci, spirochetes: 1. gram (+) organisms (S. pneumoniae, S.pygoenes, Actinomyces) 2. gram (-) cocci (mainly N. meningitidis) 3. spirochetes (mainly T. pallidum)
57
aminopenicillins (amoxicillin, ampicillin) - clinical use
``` extended spectrum penicillin: 1. H. infl 2. H. pylori 3. E. coli 4. Listeria 5. Proteus 6. Salmonella 7. Shigella 8. Entetococci MNEMONIC : HHELPSS + enterococci ```
58
Penicillinase-resistant penicillins - drugs and clinical use
1. Dicloxacillin2. Nafcillin 3. Oxacillin 4. Methcillin | S. aureus (except MRSA)
59
Antipseudomonals - drugs / clinical use
Piperacillin, Ticarcillin 1. psudomonas spp and gram-negative robs 2. gram (-) robs
60
β-lactamase inhibitors - use
often added to penicillin antibiotics to protect the antibiotic from destruction by β-lactamase (penicillinase)
61
Cephalosporins - drugs
1st generation --> cefazolin, cephalexin 2nd generation --> cefoxitin, cefaclor, cefuroxamine 3rd generation --> ceftriaxone, cefotaxime, ceftazidime 4th generation --> cefepime 5th generation --> ceftraroline
62
organisms typically not covered by Cephalosporins?
mnemonic: LAME Listeria, Atypicals (Chlamydia, Mycoplasma) MRSA, Entrococci exception. Ceftaroline (5th) covers MRSA
63
1st generation cephalosporins - drugs and clinical use
``` cefazolin, cephalexin 1. gram + cocci 2. Proteus 3. E. coli 4. Klebsiella cefazolin used prior to surgery to prevent S. aureus wound infection ```
64
2nd generation - drugs and clinical use
cefoxitin, cefaclor, cefuroxamine 1. like 1st generation (gram + cocci, proteus, E.coli, Klebsiella) 2. H. infuenzae 3. Enterobacter aerogenes 4. Neisseria spp 5. Serratia marcescens
65
3rd generation - drugs and clinical use
ceftriaxone, cefotaxime, ceftazidime serious gram (-) infections resistant to other β-lactams - ceftriaxone --> meningitis, gonnorrhea, disseminated Lyme disease - Ceftazimide --> Pseudomonas
66
4th generation - drugs and clinical use
cefepime gram (-) organism, with high activity against Pseudomonas 2. gram (+)
67
5th generation - drugs and clinical use
``` ceftaroline 1. broad gram (+) 2. borad gram (-) INCLUDING MRSA DOES NTO COVER PSEUDOMONAS ```
68
Cephalosporins - toxicity
1. hypersensitivity reactions 2. autoimmune hemolytic anemia 3. disulfiram-like reaction 4. vitamin K deficiency 5. exhibit cross-reactivity with penicillins 6. Increases aminoglycosides mediated nephrotoxicity
69
Carbapenems - drugs
1. Imipenem 2. Meropenem 3. Doripenem (newer) 4. Ertapenem (newer)
70
Carbapenems - clinical use
1. Gram (+) cocci 2. Gram (-) robs 3. anaerobes WIDE spectrum but significant side effects limit use of life threatening infection or after other drugs have failed Ertapenem has limited pseudomonas coverage
71
Carbapenems - toxicity
1. GI distress 2. skin rash 3. CNS toxicity (seizurs) at high plasma levels (less risk with meropenem)
72
Monobactams (Aztreonam) - clinical use
1. Gram (-) robs ONLY (no anaerobesm no gram (+)) | For penicillin allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides
73
Monobactams (Aztreonam) - side effects
usually nontoxin --> occasional GI upset
74
Vancomycin - clinical use
``` gram (+) bugs only: serious Multidrug resistance organisms, including: - MRSA - S. epidermidis - Clostiridium difficle (oral) - Enterococcus species ```
75
Vancomycin - toxicity
well tolerated 1. nephrotoxicity 2. ototoxicity 3. thrombophlebitis 4. red man syndrom (diffuse flushing)
76
red man syndrom - appearance, caused by, solution
- diffuse flushing - it is caused by vancomycin - pretreatment with antihistamines and slow infusion rate
77
Fluroroquinolones - drug that i not -floxacin
enoxacin
78
Fluororoquinolones - clinical use
1. gram (-) robs of urinary and GI tracts (including Pseudomonas) 2. Neisseria 3. some gram (+)
79
Fluororoquinolones - toxicity
1. GI upset 2. superinfections 3. skin rash 4 .headache/dizziness 5. leg cramps and myalgias (less commonly) 6. Prolonged QT 7. tendonitis or tendon rupture (if >60 or prednisone) 8. contraindicated in pregnancy, nursing mothers, children under eighteen --> possible damage to cartilage
80
metronidazole - clinical use
1. Giardia 2. Entamoeba 3. Trichomonas vaginalis 4. Garndenella vaginalis 5. Anaerobes (Bacteroides, C. difficile) 6. H. pylori
81
metronidazole - adverse effects
1. Disulfiram-like reaction (severe flushing, tachycardia, hypertension) with alcohol 2. headache 3. metallic taste
82
Daptomycin - clinical use
1. S. aureus SKIN infection (esp MRSA) 2. bacteremia 3. endocarditis 4. VRE
83
Daptomycin - toxicity
1. Myopathy | 2. rhabdomyolysis
84
Antimicrobial therapy - protein synthesis - divisions and drugs
50S --> 1. Chloramphenicol 2. Clindamycin 3. Linezolid 4. Macrolides 5. Streptogramins 30S --> 1. aminoglycosides 2. Tetracyclines
85
50S --> 1. Chloramphenicol 2. Clindamycin 3. Linezolid 4. Macrolides 5. Streptogramins 30S --> 1. aminoglycosides 2. Tetracyclines
1. Gentamycin 2. Neomycin 3. Amikacin 4. Tobramycin 5. Streptomycin
86
Aminoglycosides - clinical use
1. severe gram (-) rob infection 2. Synergistic with β-lactam antibiotics 3. Neomycin for bowel surgery
87
Aminoglycosides - side effects
1. nephrotoxicity (worse with cephalosporins) 2. Neuromascular blockage 3. Ototoxicity (esp with loop diuretics) 4. Teratogen
88
Tetracyclines - clinical use
1. Borrelia bugdorferi 2. M. pneumoniae 3. Rickettsia 4. Chlamydia 5. acne 6. Ehrichiosis/Anaplasmosis 7. Q fever
89
Tetracyclines - toxicity
1. GI distress 2. discoloration of teeth and inhibition of bone growth in children 3. photosensitivity 4. Contraindicated in pregnancy
90
chloramphenicol - clinical use
1. meningitis (H. infl, N. meningitis, S. pneumoniae) 2. Rocky Montain spoted fever (R. ricketsi) Limited use owing to toxicities but often still used in developing countries (low cost)
91
chloramphenicol - toxicity
1. anemia (dose dependent) 2. aplastic anemia (dose independent) 3. gray baby syndrome
92
Clindamycin - clinical use
1. anaerobic infections in aspiration pneumonia, lung abscess, oral infection 2. invasive A streptococcal infection 3. Gardenella vaginalis
93
Clindamycin - toxicity
1. pseudomembranous colitis 2. fever 3. diarrhea
94
Linezolid - clinical use
gram (+) species MRSA and VRE
95
Linezolid - toxicity
1. bone marrow suppression (esp thrmbocytopenia) 2. peripheral neuropathy 3. seretonin syndrome
96
Macrolides - drugs
1. Azythromycin 2. Clarithromycin 3. Erythromycin
97
Macrolides - clinical use
1. Atypical pneumonias (Mycoplasma, chlamydia, legionalla 2. STI (chlamydia) 3. Gram (+) cocci (streptococcal infections in patients allergic to penicillin) 4. B. pertusis
98
Macrolides - side effects
1. GI uspet 2 2. Arrhytmia (long QT) 3. Acute cholestatic hepatitis 4. Rash 5. eosinophilia 6. increased serum levels of theophyllines, oral anticoagulants 7. inhibit P-450 (clarithromycin and erythrmicycin) 8. contraindicated in pregnancy (embryotoxic)
99
Antimicrobial therapy - Folic acid synthesis - drugs
1. Sulfonamides: a. sulfadiazine b. sulfamethoxazole (SMX) c. sulfisoxazole 2. Trimethoprim (or pyrimethamine) 3. dapsone
100
Sulfonamides - toxicity
1. hypersensitivity 2. G6PD hemolysis 3. nephrotoxicity (tumbulointestinal nephritis) 4. photosensitivity 5. kernicterus (infants) 6. displace other drug from albumin (eg. warfarin)
101
Treatment of highly resistant bacteria
MRSA: vancomycin, daptomycin (esp skin), linezolid, tigecycline, ceftaroline VRE: linezolid and streptogramins (quinupristin, dalfopristin) Multidrug-resistant P. aeruginosa: polymixins B and E (Colistin) Multidrug-resistant Acinetobacter baumannii: polymixins B and E (Colistin)

Infectious diseases (13 decks)

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