which component of LPS induces TNF/IL1? which is the antigen?
Lipid A induces TNF and IL1
O polysaccharide is antigenic
lipoteichoic acid is only in what kind of bacteria?
gram pos
what organisms should be giemsa stained? (5)
chlamydia, borrelia, rickettsiae, trypanosomes, plasmodium
PAS stain is used to dx which infectious dz?
Whipple’s dz (tropheryma whipplei)
india ink used for
cryptococcus neoformans
Ziehl-Neelsen stain good for
acid fast organisms (nocardia, mycobacteria)
silver stain used for
fungi, legionella, h pylori
tuberculosis agar
lowenstein jensen agar
obligate aerobes
Nagging Pests Must Breathe
nocardia, pseudomonas, m tb, bacillus
obligate anaerobes
Can’t Breathe Air
clostridium, bacteroides, actinomyces
2 obligate intracellular bugs
chlamydia, rickettsia
pts w/ CGD are vulnerable for what category of bugs?
catalase pos
catalase pos bugs
pseudomonas, listeria, aspergillus, candida, e coli, staph aureus, serratia
urease pos bugs
crytpo, h pylori, proteus, ureaplasma, nocardia, klebsiella, s epidermidis, s saprophyticus
sulfur granules
actinomyces israelii
protein A
binds Fc region of Ig to evade immune system. made by staph aureus
IgA protease expressed by which bugs?
strep pneumo, h flu, neisseria
M protein
helps prevent phagocytosis, expressed by strep pyogenes
bacteria that make toxins that inhibit protein synth (4)
corynebacterium diphtheriae
pseudomonas
shigella
EHEC O157:H7
bacteria that make toxins that inc fluid secretion (3)
ETEC (heat stabile and labile toxins)
bacillus anthracis
vibrio cholerae
rice water diarrhea
cholera
bacteria that make toxins that inhibit phagocytic activity (1)
bordetella pertussis
bacteria that make toxins that inhibit NT release (2)
clostridium tetani
clostridium botulinum
bacteria that make toxins that lyse cell membranes (2)
c perfringens (alpha toxin) strep pyogenes (streptolysin O)
bacteria that make toxins that are superantigens and cause shock (2)
staph aureus (toxic shock syndrome toxin) strep pyogenes (exotoxin A)
bacteria: transformation vs conjugation vs transduction
transformation - uptake of naked DNA from env
conjugation - bacteria sex
transduction - injecting DNA via virus
phage encoded bacterial toxins (5)
ABCDE: shigA-like toxin Botulinum Cholera Diphtheria Erythrogenic toxin of strep pyogenes
alpha, beta, gamma hemolysis
alpha - partial, green. Strep pneumo and viridans
beta - complete, clear. Staph aureus, strep pyogenes, strep agalactiae, listeria
staph epidermidis - what does it cause
infections of prosthetic devices / catheters. also common blood culture contaminant
dental caries caused by
viridans strep (mutans)
subacute bacterial endocarditis (abnormal valve)
viridans strep (sanguis)
Jones criteria for rheumatic fever
Joints Heart Nodules Erythema marginatum Sydenham's chorea
main concern w/ enterococcus
combining / transferring abx resistances (penicillin resistance, VREs)
pseudomembranous pharyngitis
diphtheria
2 groups of bacteria that form spores
bacillus
clostridium
bacteria that blocks function of Renshaw neurons
c tetani
tx of c diff
metronidazole or oral vanc
reheated rice syndrome
bacillus cereus
nocardia causes
pulm infxn in immunocompromised and cutaneous infxns after trauma in immunocompetent
med condition that can make PPD negative
sarcoidosis
Pott’s disease
extrapulm TB in vertebral bodies
prophylactic tx for MAC
azithromycin
reservoir for leprosy in US
armadillos
lepromatous vs tuberculoid leprosy
lepromatous - diffusely over skin, leonine facies, due to low cell mediated immunity and a mostly humoral Th2 response
tuberculoid - hypoesthetic hairless skin plaques. high cell mediated immunity Th1 response
lactose fermenting gram negs
Citrobacter, Klebsiella, E coli, Enterobacter, Serratia
n. gonorrhoeae found inside what cells?
PMNs
how do you tell meningococcus vs gonococcus
meningococcus ferments maltose
which neisseria has a capsule
meningococcus
Fitz Hugh Curtis syndrome is a complication of
gonorrhea / PID
Waterhouse Friderichsen syndrome
complication of n. meningitidis infxn, causes bleeding of adrenals
epiglottitis caused by
h flu type b
hallmark lab finding in legionella infxn
hyponatremia
legionnaires dz
severe pna, fever, GI and CNS sx
pontiac fever
mild flu like syndrome caused by legionella
common cause of diabetic osteomyelitis
pseudomonas
two common manifestations of pseudomonas infxn in normal host
external otitis (swimmer’s ear), hot tub folliculitis
tx of pseudomonas
aminoglycoside + extended spectrum pcn (ex piperacillin, ticarcillin)
MCC traveler’s diarrhea
ETEC
EPEC manifestation
diarrhea in kids
triad of HUS
anemia, thrombocytopenia, renal failure
red currant jelly sputum
klebsiella
what organ does salmonella typhi hang out in in carriers?
gallbladder
rose spots on abdomen
typhoid fever (s typhi)
2 fairly common sequelae of campy
Guillian barre
reactive arthritis
bacteria that can mimic Crohn’s or appendicitis
yersinia enterocolitica
3 spirochetes
borrelia, leptospira, treponema
leptospirosis sx
flu like sx, jaundice, photophobia w/ conjunctivitis
Weil’s disease
severe for of leptospirosis w/ jaundice and azotemia from liver and kidney dysfunction, fever, hemorrhage, anemia
reservoir and vector for borrelia burgdorferi
mouse > ixodes tick
3 stages of lyme disease
stage 1 - erythema chronicum migrans, flu like sx
stage 2 - facial nerve palsy and AV nodal block
stage 3 - musculoskeletal (arthritis), encephalopathy and polyneuropathy, cutaneous manifestations
bull’s eye erythema w/ central clearing
erythema migrans of lyme disease
screening and confirmation tests for syphilis
screening - VDRL
confirmation - FTA-ABS / MHA - TP
Argyll Robertson pupil
assoc w/ tertiary syphilis
pupil accomodates but does not react to light
which congenital disease? saber shins, saddle nose, CNVIII deafness, Hutchinson’s teeth, mulberry molars
syphilis
VDRL tests ab for ____. Who gets false pos?
cardiolipin
viral infxn, drugs, rheumatic fever, SLE, leprosy
Jarisch Herxheimer reaction
flu like syndrome immediately after starting abx (seen in syphilis)
gardnerella vaginalis
bacteria causing vaginosis (not STD, but assoc w/ sexual activity). causes gray vaginal d/c w/ fish odor, painless.
classic triad of rickettsial diseases
HA, fever, rash
cause of typhus (endemic vs epidemic)
endemic - rickettsia typhi
epidemic - rickesttsia prowazekii
monocytes w/ morula (berry like inclusion) in cytoplasm
AND
granulocytes w/ same inclusion
ehrlichia in monocytes
anaplasma in granulocytes
Chlamydia trachomatis serotypes A,B,C
Africa
Blindness
Chronic infection
other serotypes cause everything else
atypical PNA w/ inc cold agglutinins (IgM)
mycoplasma pneumoniae
histoplasma likes to hang out in (inside body)
macrophages
broad based budding fungus
blastomycosis
“captain’s wheel” formation
paracoccidiomycosis
what causes all the tinea pedis / cruris / corporis / capitis?
Microsporum, Trichophyton, Epidermophyton
Tinea versicolor
caused by Malassezia furfur
common in hot/humid weather
causes hypo/hyperpigmented patches
specific disease that predsiposes to disseminated aspergillosis (not AIDS)
chronic granulomatous disease
fungus that branches at acute angles
aspergillus
“soap bubble” lesions in brain
cryptococcal meningitis
who gets mucormycosis (2)
DKA pts
leukemic pts
rose garderner’s disease
sporothrix schenckii
parasite that causes severe diarrhea in AIDS but mild dz in normal pts
cryptosporidium
classic triad of congenital toxo
chorioretinitis, hydrocephalus, intracranial calcifications
causative organisms of african sleeping sickness
trypanosoma brucei, gambiense, rhodesiense
sx of malaria
fever, HA, anemia, splenomegaly
most severe causative agent of malaria
plasmodium falciparum
babesiosis
fever and hemolytic anemia, predominantly in NE US (ixodes tick like lyme disease)
causative agent of Chaga’s dz
trypanosoma cruzi
sx of visceral leishmaniasis
spiking fevers, hepatosplenomegaly, pancytopenia
sx of trichomonas vaginalis
foul smelling greenish d/c, itching and burning
enterobius vermicularis infxn
pinworm, anal pruritis, dx w/ scotch tape test
cause of visceral larva migrans
toxocara canis
cause of cysticercosis
ingesting EGGS of taenia solium
diphyllobothrium latum
tapeworm that causes vit b12 def > anemia
echinococcus granulosus
tapeworm that causes cysts in liver > anaphylaxis if they burst
schistosoma
from snails
liver and spleen granulomas
s. haematobium causes hemorrhagic cystitis and inc risk of SCC of bladder
clonorchis sinensis
from undercooked fish
biliary tract inflammation > pigmented stones, inc risk of cholangioCA
paragonimus westermani
from undercooked crab
lung inflammation, hemoptysis
viral recombination vs reassortment
recombination = genetic drift reassortment = shift
live attenuated vaccines (6)
smallpox chicken pox yellow fever Sabin's polio virus MMR influenza (intranasal)
killed virus vaccines (4)
rabies
influenza (injection)
Salk polio
HAV
only dsDNA virus
parvoviridae
circular DNA viruses (3)
papilloma
polyoma
hepadna
only dsRNA virus
reoviridae
pos sense RNA viruses (7)
retro toga flavi corona hepe calici picorna
which types of viruses (nucleic acid categories) are infectious as naked viral genomes?
most dsDNA (except pox and HBV) pos sense ssRNA
only diploid virus family
retroviruses
nonenveloped viruses (8)
PAPP: papilloma, adeno, parvo, polyoma
CPR: calici, picorna, reo
hepeviridae
DNA viruses
HHAPPPP
hepadna, herpes, adeno, pox, parvo, papilloma, polyoma
HHV6 causes
roseola (exanthem subitum)
HHV7 causes
less common cause of roseola
hepadnavirus example
HBV
adenoviruses can cause
febrile pharyngitis
hemorrhagic cystitis
PNA
conjunctivitis
2 most important types of papillomavirus that cause cancer
16, 18
2 polyomaviruses and what they cause
JC - PML in HIV
BK - in transplant pts, commonly targets kidney
MCC sporadic encephalitis
HSV1
what type of cells do EBV and CMV stay latent in, respectively?
EBV - B cells
CMV - monocytes
Tzanck test
detects herpes from vesicular fluid
2 reoviruses
coltivirus, rotavirus
coltivirus causes
colorado tick fever
MCC fatal diarrhea in children
rotavirus
5 picornaviruses
polio, echo, rhino, coxsackie, HAV
PERCH
a calicivirus
norovirus
5 things caused by flaviviruses
HCV yellow fever dengue st louis encephalitis west nile
2 things caused by togaviruses
rubella
W/E equine encephalitis
influenza is part of what family
orthomyxoviridae
4 viruses in paramyxoviridae
parainfluenza
RSV
measles virus
mumps virus
filoviruses cause
hemorrhagic fever - ebola/Marburg
arenaviruses cause (2)
LCMV (lymphocytic choriomeningitis virus)
Lassa fever encephalitis
most notable bunyavirus
hantavirus (hemorrhagic fever, PNA)
4 segmented viruses
bunya, orthomyxo, arena, reo
viral infection causing black vomit
yellow fever
fns of hemagglutinin and neuraminidase
hemagglutinin - helps w/ entry
neuraminidase - helps w/ new virus exiting cell
palivizumab
monoclonal ab against F protein on paramyxoviruses - given to prevent PNA in premies
Koplik spots
seen in measles
red spots w/ blue/white center on buccal mucosa
3 c’s of measles
cough
coryza
conjunctivitis
3 sx of mumps
parotitis, orchitis, aseptic meningitis
negri bodies
rabies
Hep E affects
pregnant women (high mortality)
which hep B antibody indicated immunity?
anti-Hb surface
Hep B E antigen
indicates acute viral replication > high transmissibility
CD4 count for AIDS
<200
presentation of histo in AIDs pt
low fever, cough, hepatosplenomegaly, tongue ulcer
aids pt w/ superficial vascular proliferation, on biopsy shows neutrophilic inflammation
Bartonella henselae
cotton wool spots on fundoscopic exam
CMV retinitis
aids pt w/ superficial vascular proliferation, on biopsy shows lymphocytic inflammation
HHV8 (kaposi)
cause of interstitial PNA in AIDs pt
CMV
3 normal vaginal flora
lactobacillus
e coli
group b strep
3 MCC meningitis in newborns
group B strep
E coli
listeria
MCC of meningitis in non-newborns
strep pneumo
in sickle cell pt w/ osteomyelitis, what is likely cause?
salmonella
2nd MCC UTI in young sexually active women
staph saprophyticus
“swarming” colonies
proteus
classic presentation of congenital rubella
PDA (or pulm art hypoplasia), cataracts, deafness, +/- blueberry muffin rash
which congenital infection (ToRCHeS) most often causes stillbirth?
syphilis
rash of childhood that presents following high fevers (can cause febrile seizures)
roseola (HHV6)
cause of chancroid
haemophilus ducreyi
cause of condyloma acuminata
(genital warts) HPV 6 and 11
MC bacterial STD in US
chlamydia
Fitz Hugh Curtis syndrome
infxn of liver capsule and “violin string” adhesions of parietal peritoneum to liver
what step of cell wall synth do beta lactams block?
peptidoglycan cross linking
2 abx that block peptidoglycan synth
bacitracin, vanc
mech of rifampin
block mRNA synth
mech of metronidazole
damage DNA
abx that block protein synth at 50S subunit
chloramphenicol, macrolides, clindamycin, streptogramins, linezolid
abx that block protein synth at 30S subunit
aminoglycosides, tetracyclines
PCN - bactericidal/static? for what types of bugs?
cidal for gram pos cocci and rods, gram neg coci, spirochetes
oxacillin, nafcillin, dicloxacillin - mainly used for? important side effect?
staph aureus (non-MRSA) interstitial nephritis
2 wider spectrum penicilllins
ampicillin, amoxicillin
beta lactamase inhibitors (3)
clavulanic acid, sulbactam, tazobactam
what extra bugs do amoxicillin/ampicillin cover?
HELPSS - h flu, e coli, listeria, proteus, salmonella, shigella
ticarcillin and piperacillin
penicillins active against pseudomonas
which cephalosporin covers MRSA?
cephtaroline
organisms typically not covered by cephalosporins
LAME - listeria, atypicals, MRSA, enterococci
generations of cephalosporins - what do they cover
1st - gram pos cocci, proteus, e coli, klebsiella
2nd - 1st+ H flu, enterobacter, neisserias, serratia
3rd- serious gram neg infxns (meningitis, gonorrhea, pseudomonas)
4th- inc activity against pseudomonas and gram pos
aztreonam
monobactam, works on gram neg rods only, good for pts w/ PCN allergy or renal insufficiency that can’t handle aminoglycosides
what is imipenem always given w/ and why?
cilastatin - dec inactivation of drug in renal tubules
when are -penems used?
life threatening infections or ones that have failed other options - must be worth risk of serious side effects
main side effect to worry about for -penems
seizures
vanc binds to
d-ala-d-ala portion of cell wall precursor
vanc spectrum
gram pos only, but gets even the really resistant ones like MRSA, enterococci and C diff
side effects of vanc
nephrotox, ototox, thrombophelbitis, diffuse flushing = red man syndrome
can mostly be prevented by giving antihistamines first and slow infusion rate
generally well tolerated
batericidal/static for the protein synth inhibitors
aminoglycosides are cidal
rest are static
which drugs are aminoglycosides
GNATS - gentamicin, neomycin, amikacin, tobramycin, streptomycin
spectrum/uses of aminoglycosides
severe gram neg rod infxns
aminoglycosides are synergistic w/
beta lactams
side effects of aminoglycosides
nephrotoxicity, neuromuscular blockade, ototox, teratogen
resistance to aminoglycosides
transferase enzymes inactivate drug
demeclocycline non-abx use
used as diuretic in SIADH
which tetracycline to use in pts w/ renal failure?
doxy
why are tetracyclines avoided in kids?
inhibit bone growth
resistance to tetracyclines
dec uptake or inc efflux from cells
3 macrolides
azithromycin, clarithromycin, erythromycin
what are macrolides good for
atypical PNA, STDs (chlamydia), gram pos cocci
side effects of macrolides
MACRO - motility issues, arrhythmias (prolong QT), cholestatic hepatitis, rash, eOsinophilia
resistance to macrolides
methylation of 23S rRNA binding site
serious side effect of chloramphenicol
aplastic anemia (dose independent)
clindamycin uses
anaerobic infxns above the diaphragm
spectrum of SMX
gram pos, gram neg, nocardia, chlamydia - good for simple UTIs
2 important side effects of SMX
hemolysis in G6PD def, nephrotox (tubulointerstitial nephritis)
resistance to SMX
altered enzyme, dec uptake, or inc PABA synth
enzyme blocked by TMP
dihydrofolate reductase
what is TMP/SMX used for?
UTIs, shigella, salmonella, PCP
side effects of TMP
megaloblastic anemia, leukopenia, granulocytosis
which type of abx cant be taken w/ antacids?
fluoroquinolones
spectrum of quinolones
gram neg rods of urinary and GI tracts, pseudomonas, neisseria, some gram pos
unique side effect of quinolones
tendon rupture
resistance to quinolones
altered DNA gyrase or efflux pumps
what is metronidazole used for
giardia, entamoeba, trichomonas, gardnerella vaginalis, anaerobes, part of triple therapy for h pylori
2 sorta weird side effects of metronidazole
disulfiram like reaction to alcohol
metallic taste
4 drugs used for active TB, 1 used for prophylaxis
rifampin, isoniazid, pyrazinamide, ethambutol
prophylaxis - isoniazid
4 abx given for MAC
azithromycin, rifampin, ethambutol, streptomycin
tx of m. leprae
dapsone + rifampin, add clofazimine for lepromatous form
rifampin is used as prophylaxis for
contacts of children w/ h flu type B
main side effect concern w/ rifampin
many drug interactions cuz inc P450 activity
side effect of ethambutol
optic neuropathy causing red green colorblindness
prophylaxis for endocarditis in surgical/dental procedures
penicillins
prevention of gonococcal or chlamydial conjunctivitis in newborn
erythromycin ointment
AIDS infxns prophylaxis schedule
CD4 <50 - add azithromycin for MAC
what do you use for VREs?
linezolid and streptogramins (-pristin)
-azoles mechanism
block ergosterol synth
ampho B mechanism
binds ergosterol and forms leaky holes in fungal membrane
side effects of ampho B
fever/chills “shake and bake”, hypotension, nephrotox (better w/ hydration), arrhythmias, anemia, IV phlebitis
nystatin is
topical ampho B
when to use the azoles - fluconazole? itraconazole? clotrimazole/miconazole?
flucon - chronic suppression of cyrptococcal meningitis, any candidal infection
itracon - blasto, cocci, histo (regional mycoses)
clotrim/micon - topical infxns
side effects of azoles
gynecomastia (testosterone synth inhib), liver dysfunction
when is 5FU used for fungal infxns?
systemic infxns alongside ampho B
-fungins mech and use
mech - inhib cell wall synth by inhibiting synth of beta glucan
used for invasive aspergillosis and candida
use of terbinafine
dermatophytoses
griseofulvin used for
oral tx of superficial infxns (deposits in keratin rich tissues) - dermatophytes but has lots of side effects
toxo tx
pyrimethamine
trypansoma brucei tx
suramin and melarsoprol
t. cruzi tx
nifurtimox
leishmaniasis tx
sodium stibogluconate
chloroquine used for
non-falciparum malaria (too much resistance in falciparum)
drugs that tx plasmodium falciparum
artemether/lumifantrine, atovaquone/proguanil, quinidine for life threatening or artisunate
drug for flukes
praziquantel
zanamavir and oseltamivir - mech and use
inhib influenza neuraminidase > dec release of new virus
tx and prevention of influenza A and B
ribavirin - mech, use, tox
mech - inhib IMP dehydrogenase to inhib synth of guanine nucleotides
use - RSV, chronic hep C
tox - hemolytic anemia, teratogen
acyclovir and valacyclovir- mech, use, tox
guanosine analog - chain terminator
HSV and VZV (mucocutaneous and genital lesions, encephalitis)
no significant tox
famciclovir used for
herpes zoster
ganciclovir - mech, use, tox
guanosine analog - inhibits viral DNA polymerase
CMV
leukopenia, neutropenia, thrombocytopenia, renal tox
foscarnet and cidofovir - mech, use, tox
viral DNA polymerase inhib (doesnt need to be activated)
CMV retinitis, acyclovir resistant HSV
nephrotox
3 conditions for starting HAART
AIDS defining illness, CD4<500, or high viral load
HAART regimen
2 NRTIs + (1 NNRTI OR 1 protease inhib OR 1 integrase inhib)
suffix for protease inhibitors
-navir
“booster” for protease inhibitors
ritonavir - inhibits cyt P450 to inc drug concentrations
toxicity of protease inhibitors
hyperglycemia, GI intolerance, lipodystrophy
nephropathy and hematuria for just indinavir
list NRTIs (4 drugs and 1 suffix)
DATE- didanosine abacavir tenofovir emtricitabine
-vudine
which HIV drug is used during pregnancy to prevent vertical transmission?
ZDV - zidovudine
tox of NRTIs and NNRTIs (same)
bone marrow suppression (fix w/ GCSF and EPO) peripheral neuropathy lactic acidosis rash anemia (ZDV)
list NNRTIs (3)
NED -
nevirapine
efavirenz
delavirdine
name integrase inhibitor
raltegravir
tox of integrase inhibitors
hypercholesterolemia
how do interferons work as antivirals?
block replication of both RNA and DNA viruses
tox of IFNs
neutropenia, myopathy
uses of IFN alpha, beta, and gamma respectively
alpha - chronic hep B/C, Kaposi’s sarcoma
beta - MS
gamma - NADPH oxidase def
abx/virals/fungals/etc to avoid in pregnancy (8) and what they cause
SAFe Children Take Really Good Care
sulfonamides - kernicterus aminoglycosides - ototox fluoroquinolones - cartilage dmg clarithromycin - embryotoxic tetracyclines - discolored teeth, inhib bone growth ribavirin - teratogenic griseofulvin - teratogenic chloramphenicol - "gray baby"