Haemophilus, Bordetella,

Question 1

Two main classes of H. I.

Answer 1

Encapsulated (type able)

Non-encapsulated (non-type able) refers to serotype testing

Question 2

Ecapsulated H.i.

Answer 2

Respiratory tract infections
Bacterial meningitis, mainly in children and elderly

Before vaccine Hib was leading cause of bacterial meningitis
High death and complication rate

Question 3

Unencapsulated H.i.

Answer 3

Respiratory infections
Ear aches
Disseminated disease in comprimised indv

Question 4

H.i Capsule

Answer 4

Made from carbohydrates

Type B most important,

Contributes to VIRULENCE (allows to get to meninges)

• antiphagocytic
• prevents complement binding

Question 5

H.i. Epidemiology

Answer 5

Reservoir in nasopharynx of human only

75% indv carry H.i.

Opportunistic

Question 6

Hib Disease Course

Answer 6

Acquired through aerosol
Nasopharyngitis and otitis media

• > baceteremia -> meningitis
• > epiglottitis
• > joint infection
• > cellulitis

Question 7

Hib Pathogenisis

Answer 7

No known exotoxins, (maybe IgA protease)

Adhesins

Endotoxins (LPS)

• initially covered by capsule, camouflage
• bacteria takes host choline and puts on LPS, more camouflage

Question 8

Hib immunity

Answer 8

Passive immunity in very young
-maternally acquired

Active immunity in the absence of vaccine

• at about 3-4 years
• usually induced by asymptomatic infections

Question 9

Hib vaccine

Answer 9

Conjugate capsular vaccine

carbohydrates linked to increase effectivity

Recent inc in non Hib Hi infections, vaccinated indv may have reduced protection against other strains?

Question 10

Hib treatment

Answer 10

Different antibiotics dependent on specific disease

Low mortality if caught early

Steroid use reduces damage to inflammation

Question 11

Unencapsulated Hi (NTHi) targets

Answer 11

Restricted to resp tract and ear

• nasopharynx
• otitis

Question 12

NTHi in adults

Answer 12

Usually occurs in pts with underlying respiratory problem

Needs predisposing factors

Question 13

NTHi virulence

Answer 13

Adhesins

Both intra and extracellular
-keep in mind for treatment

Question 14

NTHi immunity

Answer 14

No vaccine

Question 15

Treatment of NTHi

Answer 15

Antibiotics (mainly amoxicillin)

Hard to fight biofilms

Question 16

H.i diagnosis (growth and metabolism)

Answer 16

Facultative anaerobe

No fermentation pattern

Fragile, easily killed?

Not grow on blood agar

Fastidious, needs lots of growth factors (x and v)

Question 17

Bordetella Pertussis

Answer 17

Small Gram-negative coccobacillus

Obligate aero be

Question 18

BP disease course

Answer 18

Transmission aerosol droplets

Stage 1 mild respiratory symptoms

Stage 2 narrowed glottis and cough attacks
-infants have small airways and died of hypoxia

Question 19

BP Infection Steps

Answer 19

1.  Introduction via water droplets
2. Interactions with ciliated epithelial cells in the trachea and nasopharynx
3. Adherence
4. Local multiplication (no dissemination)
5. Toxin production
6. Evasion of host defenses (stops beating cilia)
7. Transmission

Question 20

BP virulence

Answer 20

1. Pertussis toxin
2. Adenylate cyclase toxin
3. Dermonecrotic toxin
4. Tracheal cytotoxin
5. LPS

Question 21

Pertussis Toxin

Answer 21

Leads to increased level of cAMP

-> inc insulin, sensitization of histamine,

Question 22

Dermonectrotic toxin

Answer 22

causes local necrosis and inflammation

Through actin polymerization

Question 23

Tracheal cytotoxin (TCT)

Answer 23

Peptidoglycan fragment
Kills tracheal epithelial cell
Ciliostasis (reduces clearance)

Question 24

BP virulence summary

Answer 24

Ciliary stasis

Adhesins

Toxins

Question 25

BP vaccine

Answer 25

Subunit/component vaccine More effective than old whole cell vaccine (and less side effects)

Question 26

DP diagnosis

Answer 26

``` Classic cough –  Isolation of the organism –  Lymphocytosis (increased lymphocytes in blood) –  History of contacts ```

Question 27

Detection

Answer 27

PCR (only for b pertussis)

Question 28

Treatment of BP

Answer 28

Therapeutic (like oxygen) Antibiotics

Question 29

Corynebacterium

Answer 29

Pleomorphic Gram positive rods (non spore forming) Aerobes

Question 30

Corynebacterium diptheriae

Answer 30

Human only host 2-5 day incubation Local inflammatory response skin or sore throat and fever Pseudo membrane and bull neck (swollen Lymph nodes)

Question 31

Diptheria toxin (general)

Answer 31

Cells localized but toxin becomes systemic Lethal to eukaryotic cells -Heart, kidney, nervous system most susceptible Blocks protein synthesis

Question 32

Diagnosis and treatment of CD

Answer 32

Need special media (forms metachromatic granules) Detect toxin: PCR (or Elek test) Antitoxin available from CDC Antibiotic therapy

Question 33

Dip immunization

Answer 33

Depends on immunity (ab) to TOXIN Led to vaccine that uses toxin

Question 34

Legionella pneumophila

Answer 34

Gram negative rod | Pleomorphic

Question 35

Leg epidemiology

Answer 35

Grows wherever water found (can live in amoebae) -can forms biofilms, difficult to remove Air ventilation system, water towers, etc

Question 36

Legi symptoms

Answer 36

Atypical pneumonia | -diffuse localization in lung

Question 37

Legi Disease

Answer 37

Disseminated, systemic disease

Question 38

Legi pathogenicity

Answer 38

Airborne transmission (not person to person) Usually presents as "cold" Summer and early fall (more air conditioning)

Question 39

Legi targets

Answer 39

Macrophages and alveolar cells Induces apoptosis

Question 40

Legi diagnosis

Answer 40

(Fastidious, grown on charcoal yeast) Direct fluorescent ab test in sputum usual method Antigens in urine

Question 41

Legi prevention

Answer 41

Proper water handling High temp, chlorine, cleanings

Question 42

Mycoplasma (general)

Answer 42

Infects upper respiratory tract Smallest bacterium and smallest genome NO PEPTIDOGLYCAN CELL WALL ->Pleomorphic

Question 43

Mycoplasma survival strategy

Answer 43

Variable lipoproteins and lipid anchors stabilize Increases cell membrane rigidity (by incorporating cholesterol)

Question 44

Mycoplasma epidemiology

Answer 44

"Walking pneumonia" Possibly up to 50% of summer pneumonias -frequency varies by year Outbreaks in close contact groups Hits adolescents and college kids

Question 45

Mycoplasma symptoms

Answer 45

Atypical pneumonia - diffuse throughout lung - doesn't respond to Penicilin Weakness, fever, cough

Question 46

Mycoplasma Diagnosis

Answer 46

Clinical picture PCR detection Cold agglutination test (present in half pts)

Question 47

Haemophilus influenzae general characteristics

Answer 47

Small, gram-negative, pleomorphic, non-motile