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Flashcards in Micro Key Associations Deck (211):
1

Staphylococci

gram positive round clusters

2

Preferentially colonizes the vagina

Streptococcus agalactiae

3

Anaerobic

Gram positive spore forming rod

endospores introduced through wounds

Clostridium tetani

Tetanus

4

Best prevention for staph

WASH YOUR HANDS

5

Think bunnies, Rabbits, and hares oh my.... or Peter Rabbit in a Tulle Skirt

Francisella tularensis

Tuleremia

6

Gastroenteritis - fever, diarrhea, cramps 24-48h

Listeria

spp. (L. monocytogenes)

Ampicillin & PCN or Bactrim

7

gram-negative bacilli, aerobic growh requires X factor (hemin) and V factor (NAD)

humans are only natural host, secretions or airborne droplets

Haemophilis influenzae

8

Strep Throat-Presence of erythema, uvulitis, and tonsillar exudates

Streptococcus pyogenes

9

most common cause of UTIs and Gram-negative sepsis, most frequent cause of Traveller's diarrhea, important cause of neonatal meningitis

Escherichia coli

1. cephalosporins, 2. aminoglycosides, 3. TMP/SMX (bactrim) 4. fluoroquinones

10

index organism for fecal contamination of water

Escherichia coli

11

Multi-system disease following a "cytokine storm" induced by a toxin, TSST-1 (a superantigen)

Staphylococcus aureus-toxic shock syndrome

12

UTI, bacteremia; systemic infections introduced via invasive intervention

Staphylococus Coagulase negative (S. saprophyitcus)

penicillin; for invasive infections: vancomycin

13

Classic Triad: fever, headache, rash, hx of bite in <50%, early: HA, intense myalgia, anorexia, fever. Rash: begins on ankles/wrist and spreads centrally. maculopapular, evolves into petechial rash, palms/soles 40-80%, severe case: hemorrhage, necorsis, gangrene of digits, usually no eschar

higher risk: G6PD deficiency, elderly, alcoholism

Rickettsia rickettsii

Rocky Mountain Spotted Fever (RMSF)

tropism for vascular endothelial cells

14

PCR, ELISA for toxin A and B, NOT Culture, Cdiff antigen, cytotoxicity assay, fecal leukocytes in 50%, pseudomembranes on endoscopy in 30-50%

Clostridium difficileC.diff, C,diff infection (CDI)

15

(G+) Clustered cocci, facultative anaerobes
 

Staphylococus

 

16

Placenta - in utero infection → immediate abortion/neonatal death → infection at parturition (meningitis 2wk post-birth or immediate sepsis after delivery)

Listeria

spp. (L. monocytogenes)

Ampicillin & PCN or Bactrim

17

No cell walls- don't stain. Pleimorphic.

Mycoplasmataceae

Mycoplasma spp. Ureaplasma spp.

18

Inducible clindamycin resistance

beta-hymolytic streptococci

19

mouth pain, drooling, dysphagia, respiratory distress "hot potato voice", edema of the floor of mouth with swelling and displacement of tongue superiorly and posteriorly. woody, tender SWelling of suprahyoid region of neck

^^not to be confused with diphtheria, which can cause bull neck

predisposing factors: odontogenic infection (70-85%), trauma, mandibular fracture, foreign bodies, neoplasm

(NOT A SPECIFIC BUG) Ludwig's Angina

mixed oral aerobes, anaerobes, occasionally S. aureus

infection of submandibular space: sublingual, submlyohyoid spaces

Antibiotics should be initiated as soon as possible, should initially be broad-spectrum and cover gram-positive, gram-negative, and anaerobic organisms. Combinations of penicillin, clindamycin, and metronidazole are typically used. Respiratoy distress - intubation

20

endocarditis, dental caries

Streptococcus viridans

For all Strep: beta‐lactam; cephalosporin; macrolide;
respiratory fluorquinolone

21

"Bull Neck" appearance is Airway Obstruction

^^not to be confused with Ludwig's Angina (hot potato voice, woody, tender swelling of suprahyoid. from mixed aerobes and anaerobes)

Corynebacteria diptheriae

22

veneral syphilis, yaws, endemic syphilis, pinta

Treponema pallidum

syphilis

23

1. gram stain: reveals gram+ cocci in clusters.

2. Culture: beta-hemolytic, produces a golden yellow pigment,

3. metabolic - catalase positive, coagulase positive,

4. PCR of rRNA

Staphylococus aureus

24

Infections of valves, catheters, shunts, prothetic devices, etc...

Coagulase negative Staphylococcus infection

25

louse-borne relapsing fever

Borrelia recurrentis

26

Food-borne botulism - cranial nerve palsies, muscle weakness, respiratory paralysis, (also infant botulism and wound botulism)

Clostridium botulinum-Botulism

Remove toxin - gastric lavage, wound debridement; respiratory support, polyvalent equine antitoxin

27

3 laboratory diagnostic techniques for Staphylococcus infections

  1. Gram stain
  2. PCR
  3. Culture

28

localized with systemic toxin-effect (scalded-skin syndrome, toxic-shock syndrome)

clindamycin, cephalosporins, erythromycin

For MRSA – vancomycin, TMP/SMX,
doxycycline, linazolid

Staphylococus aureus

29

RABIES:1. incubation can be from 2wks to year. 2. prodrome: fever, HA, sorethroat, parasthesias at inoculation site (50%) GI, behavioral and emotional symptoms, priapism, agitation, depression 3. Acute encephalitis: Furious (80%) painful contraction of pharyngeal muscles with swallowing liquids --> hydrophobia and foaming at mouth, hyperactivity and agitation leading to confusion and seizures, Paralytic (20%) Brain stem encephalitis: cranial nerve dysfunction, 4: coma and death: due to respiratory center dysfunction

Lyssavirus

Rabies

negative sense, enveloped ssRNA

one of the only disease where you can get vaccinated after exposure

30

after 4-6 weeks, 90% with IgG elevation, after Abx, titers fall slowly, PCR for serum, CSF, and synovial fluid. C6 antibody (ELISA)

Borrelia burgdorferi

Lyme disease

spirochetes

oral Abx unless patient has neurologic or cardiac symptoms, oral doxycycline, amoxiciliin, IV ceftriaxone, 15% develop Jarsich-Herxheimer reaction

31

oxacillin resistance

MRSA

32

pre-existing anti-dengue Ab: previous infections, maternal Ab, higher risk in secondary infections, higher risk in locations with >= 2 serotypes circulating Primary: develop Ab that can neutralize virus of homologous serotype. subsequent infections: pre-existing heterologous Ab forms complex with new infecting serotype - DO NOT neutralise new virus, can get greater proportion of monoctes increasing viral replication. infected monocytes release vasoactive mediators - increased vascular permeability and hemorrhagic manifestations

Dengue

Arbovirus, 4 serotypes

humans are main reservoir hosts, urban settings: Aedes aegypti and albopictus, slyvatic: non-human primates and tree-dwelling Aedes stegomyia

33

major shifts in HA and NA

antigenic shift:

34

culture - greenish metallic colonies on blood agar. can have fruity (grape) smell

Pseudomonas aeurginosa

Whirlpool folliculitis

multi-drug reistant; highest mortality rate of all noscomial pathogens. It's the HOST not the bug.

35

1. Gram stain, 2. Culture, 3. serology, 4. PCR of nasal swab, widening mediastinum on CXR

Bacillus Anthracis

36

Dental caries

Viridans Streptococci

37

infection occurs when bacteria enters peritoneal cavity

abcesses in GI tract, pelvis and lungs

Bacteroides fragilis-bacteroides

38

sore throat, fever, lymphadenopathy, tonsillar enlargement with exudate; paltal petechiae (25-60%), cervical lymphadenopathy (80-90%), splenomegaly (50%), hepatomegaly (10-15%); can be asymptomatic

Epstein-Barr Virus (EBV)

mononucleiosis

gamma-herpesvirus

distinguish from strep using monospot

39

"Honey crusted rash"

Impetigo (Streptococcus pyogenes)

Impetigo (Stayphylococcus aureus)

40

endocarditis, sepsis, UTI, opportunistic pathogen

Streptococcus enterococcus

Nitrofurantoin, may be PCN
sensitive (amoxicillin); For deep infections vancomycin; linezolid if
resistent

41

  • Food-borne
  • Rare, occurs in source-specific outbreaks
  • At risk: really young and really old, immunosuppressed individuals (pregnancy, steroids, transplant Pts, HIV)

Listeria

spp. (L. monocytogenes)

42

selective media for Staphylococcus aureus

mannitol salt agar

43

Latex particle agglutination for...

Streptococcus pneumoniae

44

incubation 2-21 days: starts with fever, severe HA, muscle pain, weakness, fatigue, GI distress - vomiting, diarrhea, abd pain. unexplaiend hemorrhage

Ebola virus

Filovirus

(-)ssRNA, enveloped, helical, nonsegmented, zoonotic

45

septic arthritis

Stayphylococcus aureus

46

gram-negative coccobacilli

through skin abrasions, unpasteurized dairy products, livestock (zoonosis)

Brucella Brucellosis

47

ulcers with black base at site of bite, high fever, lymphadenopathy, pneumonia (if bacteria was inhaled)

Francisella tularensis

Tuleremia

1. gentamycin or streptomycin, 2. doxycycline, 2. attenuated vax (only for high risk)

48

1. gram stain - gram + rods,

2. culture- can grow on temps as low as 0 deg C, use cold enrichment to isolate from mixed flora

Listeria

spp. (L. monocytogenes)

49

gram-negative enterobacteriaceae, mucoid

Klebsiella pneumoniae

50

fried rice sickies

Food-poisoning (enterotoxin), traumatic ocular infection

Bacillus cereus

no treatment for food poisoning

51

UTI, staghorn calculi (kidney stones that take shape of tubules), sepsis

Proteus mirabilis; Proteus vulgaris

ampicillin

52

chancroids - begins as tender papule on genital or perianal area; lesion can ulcerate, with suppurative lymphadenopathy

Haemophilis ducreyi

Chancroid

1. azithromycin, 2. ceftriaxone (IM) 3. ciprofloxacin

53

Invasive (endocarditis, pneumonia, osteomyelitis)

Staphylococus aureus

clindamycin, cephalosporins, erythromycin

For MRSA – vancomycin, TMP/SMX,
doxycycline, linazolid

54

Pneumococcal vaccine

  1. PCV13 (conjugate): all infants, young children, and adults >65
  2. PCV13 followed by PPSV23 (polysaccharide) at 6-12 mo
  3. Also high risk individuals: sickle cell, HIV, other immune dysfunction

55

1. ciprofloxacin, 2. doxycycline, 3. raxibacumab (monoclonal Ab for inhalation anthrax) 4. vaccine for high-risk individuals

Bacillus Anthracis

56

infects human embryonic cortical neural progenitor cells (hNPCs) which produce infectious progeny virus, increase cell death of hNPCs

birth defects: microcephaly

Zika virus

57

gram stain and culture on blood or chocolate agar

Moraxella catarrhalis

All strains produce beta-lactamases, macrolides, fluoroquinolones, amoxicillin-clavulanate

colonization is dependent on age, COPD adults have higher rate, resistant to penicillin

58

food poisoning from enterotoxin, skin and soft tissue infection -gas gangrene or clostridial myonecrosis

Clostridium perfringens

gaseous gangrene

radical surgery (may require amputation) 2. penicillin, 3. hyperbaric O2

59

Non-selective media for Streptococcus

Sheep blood agar, chocolate agar

60

gram-negative rodbody lice feces

Bartonella quintana

Trench Fever

61

Acid fast stain, fluorescent stain, MTB rapid diagnostics, Gambian pouch rat expert,

.1ml PPD 5TU injected intracutaneously and induration measured 48-72 hrs. + is 5,10,15 determined by sensitivity, specificity ,and prevalence for diff groups. --> indicated presences of viable mycobacteria

Mycobacterium tuberculosis

62

gram-negtative non-sporulating bacillus, obligate aerobe except with nitrate, oxidase positive

typically nosocomial, colonizes damage tissues, ubiquitious

Pseudomonas aeurginosa

Whirlpool folliculitis

63

1. if bitten by a possible rabid animal: A. capture the animal and observe for 10 days. 3. destroy animal and examine for Negri bodies, C. treat immediately if you cannot capture the animal or it has rabies

Lyssavirus

Rabies

negative sense, enveloped ssRNA

one of the only disease where you can get vaccinated after exposure

64

Sporiform, facultative anaerobes

Bacillus Anthracis

65

Kaposi's sarcoma: vascular tumor associated with HIV, Castleman's disease: focal or multicentric lymphoma (not associated w/ HIV)

HHV8

Kaposi's sarcoma-associated herpes virus, castleman's disease

Gamma- herpesvirus ds linear DNA, enveloped, icosahedral

66

1. flea bite, 2. contact with infected animal tissue. 3. inhaled aerosolized organisms - human to human during epidemics

 

1. wild rodents, city rats, squirrels and prairie dogs in southwest US

Yersinia pestis

bubonic plague

67

Asymptomatic: 20-50% Dengue fever (DNF): 2-7 days of high ever "break bone fever" 1. painful fever with HA, muscle aches, joint aches, backache. retro-orbital pain, diffuse erythematous maculopapular rash, no plasma leak or severe hemorrhage. N/V abdominal pain may occur. 2. critical (plasma leak): last 24-36hr, usually alert and lucid. 3. convalescent phase: stabilization of vital signs, HCR, increase urine output, rash: confluent pruritic rash with small island of unaffected skin, fluid overload if don't decrease fluid resuscitation.

___

2. dengue hemorrhagic fever: positive tourniquet test, skin hemorrhage: petechiae, purpura, ecchymoses, thrombocytopenia (=< 100.000/mm3), plasma leakage: hemoconcentration, pleural effusion, ascites, hypoproteinemia 3.Dengue shock syndrome: DHF + circulatory failure, narrow pulse pressure, hypotension + cold/clammy skin. >20% mortality w/o prompt tx. <1% if early intensive support therapy

 

Dengue

Arbovirus, 4 serotypes

humans are main reservoir hosts, urban settings: Aedes aegypti and albopictus, slyvatic: non-human primates and tree-dwelling Aedes stegomyia

68

sandfly

Bartonella bacilliformis

Oroya Fever (Carrion's Disease)

69

penicillin; for invasive infections: vancomycin

Staphylococus Coagulase negative (S. saprophyitcus)

70

Bacillus

Gram positive rods

71

recombination of genomic material in cell co-infected with 2 diff viruses

reassortment

72

Catheter related sepsis-- gram positive

enterococcus spp

73

Nitrofurantoin, may be PCN
sensitive (amoxicillin); For deep infections vancomycin; linezolid if
resistent

Streptococcus enterococcus

74

if given ampicillin (because you think it's strep), will present with rash

Epstein-Barr Virus (EBV)

75

pneumonia with significant lung necrosis and bloody sputum common in alcoholics or those with underlying lung disease, hospital acquired UTI and sepsis

Klebsiella pneumoniae

1. 3rd gen cephalosporin, 2. cipro

76

pertussis toxin, part of the TDaP vax.

Bordatella pertussis

whooping cough

77

1. gram stain, 2. culture (urine, CSF, sputum, blood) 3. pathogenic strains from stool. 4. EMB agar

Escherichia coli

78

non-sporiforming, small cocci/diplo, motile

Listeria

spp. (L. monocytogenes)

79

no treatment for food poisoning

self-limiting, no treatment

Bacillus cereus

80

meningitis - bacteremic spread and may be associated with trauma, neurosurgery CSF leak or paranasal sinusitis, epiglottitis- emergency with celluitis and swelling pharyngitis fever drooling difficulty swallowing breahing and thumbprint sign, otitis media & sinusitis (URTI), pneumonia (LRTI), septic arthritis, sepsis

 

Risk: HIV/AIDS
• Sickle cell disease
• Splenectomy
• Chronic lung disease
• Also smoking, malignancy, pregnancy and alcoholism

Haemophilis influenzae

1. 2nd or 3rd gen cephalosporins, Hib vax, passive immunization from mother

81

1. acute: fever, HA, back pain, mylagia, intense arthralgia, rash in 50%: maculopapular, diffuse hyperemia, edema of face and extremities

__

2. chronic: debilitating polyarthraglias. can last months to >1 year. less common in children, peripheral joints, spinal pain, associated with tenosynovitis and Raynaud's syndrom

Chikungunya

82

15% develop Jarsich-Herxheimer reaction

Borrelia burgdorferi

Lyme disease

spirochetes

oral Abx unless patient has neurologic or cardiac symptoms, oral doxycycline, amoxiciliin, IV ceftriaxone, 15% develop Jarsich-Herxheimer reaction

83

radical surgery (may require amputation) 2. penicillin, 3. hyperbaric O2

Clostridium perfringens

gaseous gangrene

radical surgery (may require amputation) 2. penicillin, 3. hyperbaric O2

84

alpha-hemolytic strep

Streptococcus pneumoniae

Streptococcus viridans

85

Streptococcus

gram positive dipolococci

86

Group B, beta-hemolytic

Streptococcus agalactiae

87

one of the causes of "atypical" pneumonia: mostly mild or asymptomatic infections. upper (bronchitis, pharyngitis) lower (pneumonia)

Chlamydia pnuemoniae

88

gram-negative diplococci

transmitted by sexual contact, major reservoir in women carriers

Neisseria gonorrhea

89

Shingles: usually unilateral and contained in 1-3 dermatomes latency in dorsal root ganglia, prodromal pain 50% thoracic

__

postherpetic neuralgia - persistent pain >1 month, incidience increases with advancing age. Herpes zoster ophthalmicus - vesicles on one side of forehead and on tip of nose may be associated with severe corneal involvement, can lead to blindness

herpes zoster

shingles

90

Antitioxin (Europe only), Antibiotics (PCN, erythromycin, rifampin, tetracycline), respiratory isolation, supportive therapy

Corynebacteria diptheriae

91

regional lymphadenitis, enlarged and tender lymph nodes, fever, headache, rash, splenomegaly, culture-negative endocarditis, bacillary angiomatosis. Granuloma with central necrosis + giant cells.

Bartonella henselae

Cat scratch disease

1. azithromycin, 2. doxycycline

92

1. gram stain: reveals gram+ cocci in clusters.

2. Culture: gamma-hemolytict,

3. metabolic - catalase positive, coagulase positive

Staphylococus Coagulase negative (S. saprophyitcus)

93

gram stain, anaerobic culture (produces a black pigment when grown on blood agar)

 

Bacteroides melaninogenicus-bacteroides

94

Localized infections with toxin mediated effects (scalded skin syndrome/toxic shock syndrome/food poisoning)

Stayphylococcus aureus

95

inducible clindamycin resistance

Staphylococcus resistance

96

CNS - brain & brainstem & CSF - Top 5 causes of meningitis, 20% mortality

Listeria

spp. (L. monocytogenes)

Ampicillin & PCN or Bactrim

97

pyomyocysitis

Stayphylococcus aureus

98

Anaerobic

Gram positive spore forming bacilli

1. soil 2. canned food 3. smoked fish 4. honey (infant botulism) 5. IV drug use

Clostridium botulinum-Botulism

99

1. culture (easily transmited so careful 2. skin test. 3. measure rise in IgG

Francisella tularensis

Tuleremia

1. gentamycin or streptomycin, 2. doxycycline, 2. attenuated vax (only for high risk)

100

Detect of unique DNA sequences that are able to distinguish MRSA and MSSA

Staphylococcus aureus PCR

101

gram-negative enterobacteriaceae

Yersinia pestis

bubonic plague

102

1. neonates are susceptible from 6-24 mnths with IgG is low. 2. Army recruits, college dorms

Neisseria meningitidis

bacterial meningitis

103

immunosuppression - CF, prolonged hospitalization, burn wound patients

OTITIS EXTERNA, WHIRLPOOL FOLLICULITS. Cutaneous infections: paronychia, toe web infections, cellulitis, pyoderma (skin infection w/ pus); GI infections: typhilitis, Shanghai fever, diarrhea; bacteremia, bone + joint infections

Pseudomonas aeurginosa

Whirlpool folliculitis

multi-drug reistant; highest mortality rate of all noscomial pathogens. It's the HOST not the bug.

104

Men: genital infection restricted to urethra, complications: epididymitis, prostatitis, anorectal GC

Women: vaginal discharge, dysuria, abdominal pain, 10-20% ascending genital infection with tubo-ovarian abscess, PID - increased risk of infertility or ectopic/tubal preganancy, bartholinitis. Neonates: ophthalamia neonatorum

Neisseria gonorrhea

ceftriaxone plus azithromycin, penicillin resistance common

105

human to human, respiratory route, may be 3-5 days before rash

varicella zoster virus (VSV)

alpha-herpesvirus, latency in neurons, has nucleocapsid, enveloped

106

TETANUS - muscle spasms, persistent back spasm (opisthotonos), lowjaw (trismus), respiratory muscle paralysis, neonatal tetanus (umbilical stump -90% mortality)

Clostridium tetani

Tetanus

wound debridement, antibiotics, passive immunization: tetanus immune globulin, active immunization: tetanus toxoid

107

Respiratory: tracheobronchitis, atypical or walking pneumonia

Genital: PID, pyelonephritis, Urethritis

Mycoplasmataceae

Mycoplasma spp. Ureaplasma spp.

108

skin infection; localized (cellulitis, impetigo, folliculitis, furnuncles, carbuncles)

Staphylococus aureus

clindamycin, cephalosporins, erythromycin

For MRSA – vancomycin, TMP/SMX,
doxycycline, linazolid

109

responsible for blindness, infertility

Chlamydia trachomatis

110

Detection of _____ streptolysin O and DNAase B antibodies

Streptococcus pyogenes

111

Whooping Cough: 1. catarrhal phase: patient is highly contagious (1-2wk) - low grade fever, rhinorrhea, mild cough, abx effective 2. paroxysmal phase: (2-10wk) whooping (burse of non-productive coughs), increase # of lymphocytes in blood smear, Abx ineffective 3. convalescent phase

Bordatella pertussis

whooping cough

erythromycin, vaccine, treat household contacts with erythromycin

112

1. culture of blood, bone marrow. liver, lymph nodes 2. serologic test. 3 skin test (indicates exposure only)

Brucella Brucellosis

6 weeks of antibiotics; pasteurization of milk

113

ss RNA viruses, orthomyxovirus, enveloped, types A, B, C

 

Influenza

114

ELISA, PCR, Bordet-Gengou media, fluorescein-labeled Abs

Bordatella pertussis

whooping cough

erythromycin, vaccine, treat household contacts with erythromycin

115

biphasic: acute bacteremic phase = flu-like symptoms (fever, myalgia, arthalgia, headache, Oroya fever); chronic phase = cutaneous nodules develop 1-2 months after and persist for years

Bartonella bacilliformis

Oroya Fever (Carrion's Disease)

116

Worrisome AB-Resistance: Vancomyocin, Oxacillin, Clindamycin

Staphylococus aureus

117

gram-negative, enterobacteriaceae, facultative anaerobe

Escherichia coli

118

Gram stain, PCR, Rapid Strep

Streptococcus pyogenes

119

Sporiform, aerobic

Bacillus cereus

120

1. cephalosporins, 2. aminoglycosides, 3. TMP/SMX (bactrim) 4. fluoroquinones

Escherichia coli

121

Gram stain and culture of ulcer exudate and pus from lymph nodes

cultures are ineffective, often have no growth

Haemophilis ducreyi

Chancroid

122

gram-negative diplococci 

normal flora in vagina and orophaynx

Moraxella catarrhalis

123

culture specimen from suspected food source

Bacillus cereus

124

first infection = usu. more severe symptoms; recurrent infections = usu. less severe

primary genital infection: fever, anorexia, malaise, headache, regional lymphadenopathy, genital lesions

primary oral infection: gingivostomatitis (vesicles with ulceration), cervical lymphadenopathy

____

keratitis, herpetic whitlow (vesicular infection + inflammation of the nail bed); IN IMMUNOCOMPROMISED HOSTS: chronic skin lesions (primary manifestation), esophagitis, pneumonia (rare), dissemination (rare)

aseptic meningitis (from inflammation of sacral nerve roots)

HSV (HSV-1, HSV-2)

alpha-herpesvirus, latency in neurons, has nucleocapsid, enveloped

125

Anaerobes

Gram positive spore forming bacilli

soil, water, sewage, part of normal flora

Clostridium perfringens

gaseous gangrene

126

fever, rash, superficial fluied-filled vesicles, pustules, crusts/scabs

Complications: Hepatitis, pneumonitis, encephalitis; infection of cutaneous lesions; Reye's syndrome (encephalopathy, liver disease) is assoc. w/ aspirin consumption; Guillain-Barre syndrome

varicella zoster virus (VSV)

alpha-herpesvirus, latency in neurons, has nucleocapsid, enveloped

127

non-sporiform, aerobic, club-shaped

Corynebacteria diptheriae

128

gram-negative rod

cat bite or scratch

Bartonella henselae

Cat scratch disease

129

gram-negative diplococci (Serogroup B)

humans = only reservoir

Neisseria meningitidis

bacterial meningitis

130

obligate aerobe, requires cysteine

rabbits, rodents, tics, fleas

Francisella tularensis

Tuleremia

131

Antibiotic associated colitis (diarrhea), dehydration, electrolyte disturbances, shock, toxic megacolon, reactive arthritis

Clostridium difficile

C.diff, C,diff infection (CDI)

discontinue causative Abx, initiate Abx effective against Cdiff: metronidazole, oral vancomyocin, fidaxomicin, toxin-binding resins

132

lepromatous: high bacillary lode, diffuse, extensive skin involvement, plaques, nodules, deformity of facial structures, anergy, tuberculoid: few bacilli present, <5 skin lesions, anasethesia present, react to M.leprae skin test, nerve involvement common, mixed

Mycobacterium leprae

Leprosy (Hansen's disease)

133

5 lab diagnostic techniques for streptococcal infections

  1. Gram stain
  2. antigen detection
  3. molecular diagnostics
  4. aerobic and anaerboci culture
  5. antibody detection

134

Flu like sxs, leukopenia + thrombocytopenia + elevated transaminases, Complications: spetic shock, ARDS, neuro (peripheral , facial palsy, demyelinating polyneuropathy, brachial plexopathy); morulae in granulocytes

Anaplasma phagocytophilium

Anaplasmosis

tropism for neutrophils, intracellular bacteria

135

Endocarditis

Viridans Streptococci

Enterococcus spp

136

Gram negative rods, non spore forming, polysaccharide capsulepart of the normal flora of intestine

Anaerobes

Bacteroides fragilis-bacteroides

Bacteroides melaninogenicus-bacteroides

137

roseola infantum in 20-30% of cases, usually self-limited, mild, febrile seizures 3-13%, rare encephalitis

___

acute onset high fever with well-appearance subocciptal adenopathy, red throat, abrupt disappearance of fever with onset of macular rash, drop in WBC prior to rash, may have atypical lymphocytes, 6 days duration, mono like illness in adults

HHV6

spring/fall, spread by saliva, 6th disease,

beta- herpesvirus ds linear DNA, enveloped, icosahedral

138

Fluoroquinolone resistance

Streptococcus pneumoniae

139

Neonatal sepsis/megingitis

Postpartum sepsis

Streptococcus agalactiae

140

gram -, obligate intracellular bacteria

Chlamydia trachomatis

Chlamydia psittaci

Chlamydia pnuemoniae

141

70 antigenic variations, resistant to beta lactamses and carbapenemase

Klebsiella pneumoniae

142

West Nile fever (WNF) 20-30% or West nile neuroinvasive disease (WNND) <1%: meningitis, encephalitis or myelitis, that produces flaccid paralysis

_____

1. West nile meningitis: symptoms of WN fever + meningitis. 20% have cranial nerve palsies, CSF: ~200 WBC/mm3( often neutrophils, elevated protein, normal glucose), usually recover without permanent neurological sequelae, 2. WN Encephalitis: more common in older and immunocompromised individuals, fatality rate 20% - cardiac arrythmia or respiratory failure. chronic neurologic sequelae: tremors, parkinsonism, ataxia, can last months.years, high rate of institutionalization. 3.flaccid paralysis: typically asymmetric in >1 limb, ~50% with encephalitis, rarely occurs w/o fever or other symptoms. permanent weakness and prolonged recovery

West Nile Virus

enveloped flavivirus

143

Penicillin/cephalosporin resistance

  1. Streptococcus pneumoniae
  2. viridans streptococci

144

Resp. Tract --> Exudate in Pharynx/trachea --> Airway Obstruction. Tonsillitis/pharyngitis; Neck Adenopathy. Other Presentations: MYOCARDITIS and Cranial neuropathies

Corynebacteria diptheriae

Antitioxin (Europe only), Antibiotics (PCN, erythromycin, rifampin, tetracycline), respiratory isolation, supportive therapy

145

Sputum gram stain with gram positive diplococci

Streptococcus pneumoniae

146

Meningitis*, Pneumonia*, bacteremia, otitis media, sinusitis

Streptococcus pneumoniae

For all Strep: beta‐lactam; cephalosporin; macrolide;
respiratory fluorquinolone

147

Gram positive opportunitistic infection, such as a UTI

enteroccocus spp

148

1. clinical : tourniquet test (positive: >20 petechiae/in2) 2. acute: virus detection, blood CSF, tissue, RT-PCR, antigent detection (NS1 protein), 0-5 days post-onset of symptoms. 3. Serology: IgM >5 days post onset. IgG: paired acute.convalescent - 4-fold rise in titers

Dengue

Arbovirus, 4 serotypes

humans are main reservoir hosts, urban settings: Aedes aegypti and albopictus, slyvatic: non-human primates and tree-dwelling Aedes stegomyia

149

Immunochromatography for....

  1. Streptococcus pyogenes
  2. Streptococcus agalactiae

150

subcutaneous hemorrhage results in blackish skin discoloration giving name "Black Death"

Yersinia pestis

bubonic plague

1. streptomycin or gentamycin 2. doxycycline

151

A woman is pregnant and expecting, with regard to Streptococcus infections, what should you test her for?

GBS

 

152

spirochetes, corkscrew shaped

Treponema pallidum

syphilis

153

Gram Stain, immunochromatography, latex, molecular diagnosis, aerobic and anaerobic, antibody detection

Streptococcus pneumoniae

154

Intracellular pathogenesis - binds epithelial cells, escapes intracellular killing via filopods (bacteria push against membrane and through to adjacent cells, escaping immunosurveillance), cell to cell spread

Listeria

spp. (L. monocytogenes)

155

Trench fever: fever, headache. back pain, lasts for 5 days and occurs at 5 day intervals. 2. bacteremia, endocarditis, bacillary angiomatosis

Bartonella quintana

Trench Fever

1. doxycycline 2. chloramphenicol 3. azithromycin

156

transmission secondary to contact with infected body fluids: contaminated medical instrumetns and close contact with sick or dead patients and their bodies. likely mechanism is skin or mucous membrane contact with virus infected fluids - blood, semen, diarrhea, vomit

Ebola virus

Filovirus

(-)ssRNA, enveloped, helical, nonsegmented, zoonotic

157

vancomycin resistance

VRSA

158

10-15% of otitis media, 3rd most common for bacterial sinusitis, lower RTI especially in COPD and bronchitis patients, pneumonia in elderly

Moraxella catarrhalis

All strains produce beta-lactamases, macrolides, fluoroquinolones, amoxicillin-clavulanate

colonization is dependent on age, COPD adults have higher rate, resistant to penicillin

159

osteomyelitis

Stayphylococcus aureus

160

For all : beta‐lactam; cephalosporin; macrolide;
respiratory fluorquinolone

Streptococcus

161

minor shift in HA or NA with only minor changes in antigenicity. 

antigenic drift

162

Types: 1) Bubonic, 2) Septicemia, 3) Pneumonic. Presentation: Fever, headache, chills, fatigue, leucocytosis, sepsis, pneumonic plague (epidemics).

Yersinia pestis

bubonic plague

1. streptomycin or gentamycin 2. doxycycline

163

Scalded skin syndrome: exfoliatin-mediated detachment of the granulosum and spinosum layers within the epidermis

Staphylococcus aureus

164

Yellow Fever: 3-6 day incubation conjunctival suffusion1. hepatitis with jaundice, 2. fever. 3. backache

Yellow Fever

165

meningococcal meningitis with petechial rash, meningococcemia w/o meningitis, meningitis w/o meningococcemia, mild transient bacteremia, pneumonia

Neisseria meningitidis

bacterial meningitis

3rd gen cephalosporins (ceftriaxone, cefepime); chloramphenicol - used in developing countries

Chemoprophlyaxis should be given to close contacts only after exposure to invasive disease. Meningitis Belt = Sub-Saharan Africa

166

Gram stain, blood culture for possible disseminated GC, chocolate agar, commercial antigen probes, urine NAAT

Neisseria gonorrhea

167

Vancomycin resistance

enterococci

168

mixed oral aerobes, anaerobes, occasionally S. aureus

infection of submandibular space: sublingual, submlyohyoid spaces

(NOT A SPECIFIC BUG) Ludwig's Angina

Antibiotics should be initiated as soon as possible, should initially be broad-spectrum and cover gram-positive, gram-negative, and anaerobic organisms. Combinations of penicillin, clindamycin, and metronidazole are typically used. Respiratoy distress - intubation

169

non selective media for Staphylococcus

  • sheep blood agar
  • chocolate agar

170

gram-negative enterobacteriaceae, motile

Proteus mirabilis; Proteus vulgaris

171

neonatal and postpartum sepsis, meningitis

Streptococcus agalactiae

For all Strep: beta‐lactam; cephalosporin; macrolide;
respiratory fluorquinolone

172

Wide zone beta-hemolysis: Strep

streptococcus pyogenes

173

eschars, necrosis in RT, oropharyngeal and abd infection

1. cutaneous (95%): painless black vesicles, can be fatal if untreated. 2. pulmonary (woolsorter's disease). 3. abd pain, vomiting, bloody diarrhea

Bacillus Anthracis

1. ciprofloxacin, 2. doxycycline, 3. raxibacumab (monoclonal Ab for inhalation anthrax) 4. vaccine for high-risk individuals

174

Lateral neck radiograph; Look for THUMBPRINT sign

Haemophilis influenzae

1. 2nd or 3rd gen cephalosporins, Hib vax, passive immunization from mother

175

Group D 

Streptococcus enterococcus

176

aerobic, non-spore forming, nonmotile bacillus

Mycobacterium

tuberculosis

avium and intracellulare

leprae

177

CNS (Meningitis) and placenta, bacteremia in immunocompromised

Listeria

spp. (L. monocytogenes)

Ampicillin & PCN or Bactrim

178

Endemic: Latin America, Sub-saharan Africa, East Asia

Bacillus Anthracis

179

1. gram stain for gram- rods, 2. blood cultures. culture of bubo aspirate 4. serology. 5. rapid diagnostic - antibody against F1

Yersinia pestis

bubonic plague

1. streptomycin or gentamycin 2. doxycycline

180

high fever, sweats malaise, anorexia, abdominal pain, diarrhea, back pain, lymphadenopathy (10%), hepatosplenomegaly (40%); granulomas. Can progress into undulant/Malta fever; COMPLICATIONS: arthritis, osteomyelitis, meningitis

Brucella Brucellosis

6 weeks of antibiotics; pasteurization of milk

181

1. culture, 2. examination of urine with high pH

Proteus mirabilis; Proteus vulgaris

182

Gram stain and culture of CSF, CSF on chocolate agar, blood cultures

Neisseria meningitidis

bacterial meningitis

3rd gen cephalosporins (ceftriaxone, cefepime); chloramphenicol - used in developing countries

Chemoprophlyaxis should be given to close contacts only after exposure to invasive disease. Meningitis Belt = Sub-Saharan Africa

183

down-regulates cytotoxic CD8 response Immunocompetent: asymptomatic, mono, congenital CMV, immunocompromised: retinitis (50% bilateral), pneumonitis, GI- colitis, esophagitis, CNS-encephalitis, myelitis

cytomegalovirus (CMV)

Also mono

Beta-herpesvirus DNA virus, icosahedral, lipid envelope

negative monospot

184

Alpha hemolysis: strep

streptococcus pneumoniae

185

diagnosis is made clinically - NEVER a microbiologic diagnosis, feel impending doom, usually with antecedent trauma

Clostridium perfringens

gaseous gangrene

radical surgery (may require amputation) 2. penicillin, 3. hyperbaric O2

186

ampicillin resistance

E. faecium

187

high risk: infants <1 year old, adults (as immunity wears off)

Bordatella pertussis

whooping cough

erythromycin, vaccine, treat household contacts with erythromycin

188

Respiratory Tract [URI, pharyngitis, Scarlet fever, suppurative sequelae (tonsillar or retropharyngeal abscess), nonsuppurative sequelae (rheumatic fever, glomerularnephritis)],

Skin [Impetigo, ecthyma (punched out ulcers into dermis, green-yellow crust), cellulitis (acute skin infection, SubQ), erysipelas (superficial cellulitis), necrotizing fasciitis (incl. deep fascia), toxic shock (systemic infection, fever, hypotension, tachycardia/pnea, desquamation)]

Streptococcus pyogenes

For all Strep: beta‐lactam; cephalosporin; macrolide;
respiratory fluorquinolone

189

toxin-mediated (food poisoning)

Staphylococus aureus

clindamycin, cephalosporins, erythromycin

For MRSA – vancomycin, TMP/SMX,
doxycycline, linazolid

190

flu like sxs + maculopapular rash, leukopenia + thrombocytopenia + elevated transaminases, Complications: spetic shock, ARDS, coagulaopathies, neuro (meningoencephalitis, seizures, coma, peripheral, primary cranial neuritis) - more complications and fatalities; morulae in MONOCYTES

Ehrlichiaspp. Ehrlichiosis

191

cutaneous manifestations: erythema chronicum migrans -occurs at tick bite site, 3-30 days post bite, usually red outer with central clearing, fatigue, F/C, adenopathy, meningeal signs, hepatitis, splenomegaly

MSK manifestations: 80% untreated patients affected, occur within 2wks-2years. from joint pain to intermittent arthritis to chronic erosive synovitis. Early disease: migratory pain in joints, tendonitis, bursae potenitally affected, frank arhtritis with marked swelling can occur in large joints with remission inbetween attacks, small % with chronic arthritis

Cardiac: occurs within several weeks, 5% untreated patients, usual presentation: AV block (1st degree, Wenkebach, complete heart block) may present with EKG changes, myopericarditis, LV dysfunction, brief: 3days to 6 weeks

Neuro manifestations: early- symptoms of meningeal irritation concomitant with ECM, not associated with CSF pleoctyosis or neuro defecits, late: 15% cases affected, several weeks to months after onset of diseasae, includes meningitis, encephalitis, chorea, cranial neuritis, motor/sensor radiculitis, myelitis. usual pattern: fluctuating meningitis with superimposed cranial nerve palsy or peripheral neuropathy

Borrelia burgdorferi

Lyme disease

spirochetes

oral Abx unless patient has neurologic or cardiac symptoms, oral doxycycline, amoxiciliin, IV ceftriaxone, 15% develop Jarsich-Herxheimer reaction

192

pulmonary disease in elderly men with COPD, elderly non-smoking women, CF, hypersensitivity pneumonitis (hot tub lung), disseminated disease in AIDS patients, lymphadenitis in children

Mycobacterium avium and intracellulare

M. avium complex (MAC)

surgey may be required despite "modern therapy"

Lady Windermere's Syndrome

193

fever, rigors, myalgia, headache; sore throat, dry cough, nasal obstruction, viral pneumonia

CAN BE FOLLOWED BY: bacterial pneumonia, infection Guillain-Barre syndrome

Influenza

194

0.5-3% develop disseminated infection: fever, migratory arthalgias, suppurative arthritis, pustular rash on extremities, purulent conjunctivitis in newborns (ophthalmia neonatorum); pharyngitis

Neisseria gonorrhea

ceftriaxone plus azithromycin, penicillin resistance common

195

birdsbird owners, veternarians, zoo/per shop workers, poultry industry

Parrot fever, ornithosis

 

Chlamydia psittaci

 

196

HPS: F/C, HA, myalgia, GI distress, dizziness, x4-10days. leads to cough, severe SOB, mortality 38%

Hantavirus

bunyavirus

rodents via urine or feces

197

1. neonatal conjunctivitis, 2. infant pneumonitis, 3. genital infections in adults 4. trachoma

Chlamydia trachomatis

 

 

198

Anaerobic

Gram positive spore forming bacilli

spores may be in environment for monts, asymptomatically in colonic flora up to 5% of normal population

Clostridium difficile

C.diff, C,diff infection (CDI)

199

Scarlet Fever- scarlatiniform sandpaper rash, strawberry tongue

Streptococcus pyogenes

200

1. encapsulated, beta-lactamase. filamentous hemagglutininhuman - highly contagious, transmitted via respiratory route

Bordatella pertussis

whooping cough

201

Real-time PCR for detection of _____ amplified DNA

Streptococcus agalactiae

202

slowly replicatng mycobacteria, incubation is 5-20 yearsvia droplets from close and frequent contact to nose and mouth, armadillos in southern US

Mycobacterium leprae

Leprosy (Hansen's disease)

203

Direct detection of ______ ribosomal RNA

Streptococcus pyogenes

204

1. serology 2. PCR

Bartonella henselae

Cat scratch disease

1. azithromycin, 2. doxycycline

 

Bartonella quintanaTrench Fever

1. doxycycline 2. chloramphenicol 3. azithromycin

205

if it's a nasty, leaky skin infection, it's probably ____. Honeycomb appearance think impetigo from _____

Staphylococus aureus

206

Vaccines: PCV13 (conjugate) + PPSV23 (polysaccharide)

Streptococcus pneumoniae

207

Otitis media

streptococcus pneumoniae

208

1. necrotizing anaerobic pneumonia (LUNG ABSCESSES), brain abscesses. peridontal disease

 

Bacteroides melaninogenicus-bacteroides

1. Metronidazole 2. Clindamycin

209

GRAM POSITIVE UTI

Enterococcus spp

210

(G+) Group A , cocci in chains, beta-hemolytic

Streptococcus pyogenes

211

Primary TB: hematogenous dissemination including apical posterior arias of lung, development of delayed type hypersensitivity and skin test conversion or IGRA (quantiferon) Granuloma - containment of TB

Latent TB

Mycobacterium tuberculosis