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PHAR152 > Infectious Disease Intro > Flashcards

Infectious Disease Intro Flashcards

1
Q

What are some characteristics of the immune system?

A

can be specific
has memory
mobile and fast acting
flexible

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2
Q

What are non-specific lines of defense?

A

physical barriers (such as skin)
chemical barriers (such as stomach acid)
mucus and cilia protect the resp tract
urine flushes bacteria out of the urinary tract
enzymes in tears and saliva

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3
Q

Which cells of the innate immune system can act as macrophages?

A

macrophages
neutrophils
monocytes
natural killer cells
eosinophils

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4
Q

Which cells of the innate immune system will phagocytize and release inflammatory mediators?

A

mast cells
basophils

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5
Q

List off some specifics of the cells of the innate immune system.

A

macrophages and monocytes: APCs and surveillance
neutrophils: defense against bacteria and fungus
eosinophils: defense against parasites and respond to allergies
basophils: respond to allergies

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6
Q

Which cells make up the adaptive immune system?

A

B and T lymphocytes

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7
Q

How is the adaptive immune system divided?

A

humoral mediated: within the serum
cellular mediated: within the cells

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8
Q

How are T cells activated? What happens when T cells are activated?

A

activated by antigen presenting cells
activated T cells secrete IL-2 which activates more T cells

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9
Q

What are the three forms that an activated T cell can take?

A

CD4 (helper cells): secretes ILs and interferon, stimulates CD8,
production of antibodies
CD8 (cytotoxic cells): kills cells recognized as foreign
regulating cell: regulates T cell response

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10
Q

How are B cells activated?

A

after they recognize antigens

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11
Q

What forms can B cells take?

A

plasma cells: secrete antibodies
memory cells: important in future attacks

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12
Q

What are cytokines?

A

soluble factors secreted by cells
can activate cells, call for back up, etc
ex: ILs, TNF, IFN

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13
Q

What are inflammatory mediators?

A

any soluble factor that causes inflammation
secreted by various cells
ex: histamine, PGs, etc

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14
Q

What happens when antibodies bind to antigens?

A

trap the antigen or clump them together
increase attack of immune cells

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15
Q

What is an infection?

A

gets a response of host immune system and person gets ill

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16
Q

What is a sub-clinical infection?

A

specific response in the body is evoked (antibody production) but the person is not ill

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17
Q

What is colonization?

A

presence of organism at a body site without production of disease

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18
Q

What is the normal microbiota of the skin?

A

diphtheroids (corynebacterium)
propionibacteria (p.acnes)
staphylococci (especially coagulase -)
streptococci

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19
Q

What is the normal microbiota of the GI tract?

A

bacteroides
clostridium
diptheroids
enterobacteriaceae
fusobacterium
streptococci (anaerobic)

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20
Q

What is the normal microbiota of the upper respiratory tract?

A

bacteroides
haemophilus
neisseria
streptococci

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21
Q

What is the normal microbiota of the genital tract?

A

corynebacterium
enterobacteriaceae
lactobacillus
mycoplasma
staphylococci
streptococci

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22
Q

What is the most important aspect of curing infection?

A

the host defense which is composed of the innate and adaptive systems

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23
Q

True or false: antibiotics always cure an infection

A

false

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24
Q

What might be required if antibiotics do not cure an infection?

A

drainage of abscess
removal of dead tissue
removal of foreign bodies or prosthetic device
decrease in immune suppression

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25
What are the factors that affect host defenses?
malnutrition age immunoglobulin deficiencies deficiencies in cellular immunity alcoholism diabetes immunosuppressive therapy invasive procedures
26
What are the non-specific symptoms of infection?
malaise listlessness loss of appetite headache myalgia arthalgia
27
True or false: fever is due to an infection unless proven otherwise
true
28
Aside from infection, what else can induce a fever?
autoimmune diseases malignancy
29
What is a fever for 6am, 4pm, rectally, and armpit?
6am: 37.2 4pm: 37.7 rectally: 38.2 armpit: 37.2
30
What is the normal range of white blood cells?
5-10 x10 to the 9/L -anything greater may be infection
31
Aside from infection, what are other situations where WBC count can be elevated?
leukemia rheumatoid arthritis taking lithium or corticosteroids
32
What are the normal percentages of WBCs?
total neutrophils: 50-70% segmented neutrophils: 50-70% bands: 3-5% lymphocytes: 20-40% monocytes: 0-7% eosinophils: 0-5% basophils: 0-1%
33
What is the difference between a segmented neutrophil and a band?
segmented neutrophils are mature neutrophils bands are immature neutrophils
34
What might be present with chronic infection?
anemia
35
What are the symptoms of septic shock?
decreased BP, then decreased CO decrease in renal function hepatic dysfunction (increased bilirubin) decreased oxygenation disseminated intravascular coagulation
36
How can history help with the diagnosis of infection?
severity of signs and symptoms source of infection (contact, trauma, etc) try and determine which organism is causative
37
How can physical examination help with the diagnosis of infection?
localize the infection ex: characteristic rash of measles, neck stiffness of meningitis
38
What can be done in the lab to help with the diagnosis of infection?
WBC and differential ESR and CRP renal and hepatic function electrolytes microbiology
39
What are the microbiology techniques used to determine invading pathogens?
gram stain culture sensitivity testing
40
What kind of information can you determine from a gram stain?
gram + or - cocci vs bacillus presence of WBC is it actually bacteria
41
True or false: all organisms stain great under a gram stain
false ex: tuberculosis, viruses
42
What is the best method for revealing an organism?
culture -organism is grown and the biochemical profile is determined -not all organisms grow well -possible contamination issues
43
What is MALDI-TOF MS?
matrix-assisted laser desorption/ionization time of flight mass spectrometry -gets a fingerprint via ionization to identify microorganism
44
What is sensitivity testing?
determines which antibiotics the organism is susceptible to based on minimal inhibitory concentration
45
How does disk diffusion help in assessing susceptibility?
you can measure the zones of inhibition as zone size correlates with sensitivity of the organism -larger the zone=more sensitive to the antibiotic
46
When is immunologic testing (serology) useful?
when organism cannot be cultured or treatment has already begun
47
What is antibody testing?
detects presence of antibodies directed against the pathogen
48
What is antigen testing?
detects presence of antigen in the urine, serum, CSF, etc
49
What is PCR?
polymerase chain reaction detects very low amounts of specific DNA in clinical specimens
50
What is prophylaxis and why are antibiotics used for it?
prophylaxis is the process of trying to prevent infection antibiotics are used in certain cases like Rheumatic fever but its not always a great idea (drives resistance)
51
What is the difference between empiric therapy and direct/specific therapy?
empiric therapy is essentially making an educated guess on what the organism is and then logically choosing an antibiotic direct therapy you know the organism, specificity, etc
52
If a probable infection is presented, what are some things to keep in mind when considering if an antibiotic is indicated?
age, other illnesses, travel history, etc examine chance that symptoms could be due to other things consider likelihood of viral infection consider urgency of the situaiton
53
What are the eight steps in the logical stepwise approach to the selection of a specific antibiotic?
1. is an antibiotic indicated? 2. have appropriate lab specimens been obtained? 3. what organisms are most likely? 4. which drug is best? 5. is combination therapy appropriate? 6. what are the important host factors? 7. best route of administration? 8. what is the right dose and duration?
54
Why do lab specimens need to be obtained before antibiotics are given?
antibiotics can sterilize blood and tissues quickly follow-up cultures are less reliable
55
What is a tool that can help you take into account regional data when trying to determine which organism is the most likely cause of infection?
antibiogram -reports susceptibility -gives you some direction -more number tested=more faith
56
What are some things to keep in mind when trying to determine which organism is most likely the cause of infection?
regional data setting (hospital acquired vs community acquired vs nursing home acquired) site of infection and circumstances age of patient immunosuppressed patients may present irregular bacteria
57
What should be kept in mind when determining which drug is the best for an infection?
is there a drug of choice and can it be used? patient allergies (real or not?) penetration issues location of infection side effects bactericidal or bacteriostatic cost dosage regimen narrow or broad-spectrum
58
What are situations where bactericidal antibiotics would be preferred?
severe or life-threatening infection immunosuppressed patients
59
What should you ask yourself when trying to decide if combination therapy is appropriate?
are multiple organisms likely?
60
Why is combination therapy used for infection?
to limit resistance for synergism (one antibiotic enhances activity of another)
61
What are the risks of combination therapy?
increased risk of toxicities increased risk of colonization with resistant organisms higher costs false sense of security
62
What are important host factors?
pregnancy renal or hepatic function (affects choice of antibiotic and dose) immunosuppressed (may need bactericidal antibiotics) prosthetic devices age drug-drug interactions drug-disease interactions patient preference adherence
63
Which drugs are safe, cautioned, and to be avoided in pregnancy?
safe: penicillins, cephalosporins, erythromycin base caution: AMG, vancomycin, clindamycin, trimethoprim, nitrofurantoin avoid: tetracycline, FQ, TMP-SMX, erythromycin estolate, sulfonamides
64
What are some things to keep in mind when trying to determine best route of administration?
more of a question in hospital setting in the outpatient setting almost always oral serious infections require parenteral use
65
What are some things to keep in mind when determining the right dose and duration?
the infection in question individualized depending on patient factors
66
What are some reasons for antibiotic failure?
noncompliance under dosing inaccessible site prosthetic material resistance superinfection
67
What is superinfection?
antibiotics drives secondary infection some consider a resistant organism to be superinfection
68
What are the five clinical manifestations of infection?
non-specific symptoms fever white blood cell count other non-specific symptoms (anemia, increased ESR and CRP) septic shock
69
What is the process of diagnosing infection?
1. history (signs/symptoms, source) 2. physical examination (localize) 3. lab (gram stain, C & S)

PHAR152 (21 decks)

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