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Micro review Flashcards

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1
Q

Bordetella purtusis

A

aka whooping cough
highly contagious
gram neg aerobic coccobacillys capsulate
humans only known reservoir

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2
Q

Bordetella purtusis phases

A

catarrhal
paroxysmal
convalescent

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3
Q

catarrhal phase

A

rhinorrhea
lacrimation
conjunctival injection
low grade fever for days

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4
Q

paroxysmal phase

A

uncontrollable expirations, followed by gasping inhalation (whoop)
post cough cyanosis, gagging, vomiting
last up to 4 weeks

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5
Q

convalescent phase

A

reduction in frequency and severity of cough, can last from weeks to months

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6
Q

Bordetella purtusis Tx

A

supportive
azithromyocin
chemoprophylaxis to control outbreaks

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7
Q

klebsiella pneumonia

A

gram negative, non-motile, capsulate rods

facultative anaerobe

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8
Q

klebsiella infections

A 
UTI
soft tissue
endocarditis
CNS
severe bronchopneumnia
CAP and HAP (cavitary lung lesions)
currant jelly sputum
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9
Q

M. cartarrhalis

A 
gram neg bacteria
chocolate agar
diplococci
catalase +
oxidase +
penumonia, especially in elderly
otitis media
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10
Q

N. meningitidis

A 
aerobic gram neg kidney shaped diplococci, capsule
oxidase +
ferments maltose and glucose
thayer martin and chocolate agar
commensal of URT
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11
Q

clinical manifestation of N. meningitidis

A 
meningitis
septicemia
pneumonia 
septic arthritis, pericarditis, chronic bacteremia
conjunctivitis
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12
Q

N. meningitidis Tx

A

penicillin

3rd generation cephalosporins

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13
Q

Pseudomonas

A

aerobic gram neg rod
pyocyanin
primarily nosocomial
in hospital can colonize moist surfaces

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14
Q

Pseudomonas infections

A 
HAP, VAP
community aquired infections associated w/hot tubs, whirpools, swimming pools, extended contact lenses
otitis externa
puncture wounds thru shoes
endopthalmitis
endocarditis
UT
skin infections, burns, ecthyma gangreosum
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15
Q

pseudo bacterial factors

A 
exo and endotoxins
type III secreted toxins
pili
flagella
proteases
phospholipids
iron binding proteins
exopolysaccharides
biofilms
pyocyanin
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16
Q

pseudo Tx

A

extended spectrum penicllin and aminoglycoside combination

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17
Q

Chlamydophilla psittaci

A

gram neg obligate intracellylar bacteria

macrophages principal host cell

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18
Q

Chlamydophilla psittaci diseases

A

psittacosis
atypical pneumonia
febrile illness

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19
Q

Chlamydophilla psittaci transmission

A

aerosolized bird secretions, dust

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20
Q

Chlamydophilla psittaci Tx

A

tetracyclines
macrolides
FQs

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21
Q

Chlamydophilla pneumoniae

A

80% of adults seropositive
common in kids <5
atypical penumonia

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22
Q

Chlamydophilla pneumoniae atypical pneumonia

A

incubation several wks
non productive cough
preceded by nasal congestion, sore throat, and hoarseness
HA

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23
Q

Chlamydophilla pneumoniae labs

A

normal white count

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24
Q

Chlamydophilla pneumoniae Tx

A

tetracyclines
macrolides
FQs

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25
Coxiella burnetti
gram neg that infects hosts monocytes incompletely eliminated after acute infection will continue to multiply in immunocompromised and endocarditis patients despite high Abs infects mammals, birds, ticks
26
Coxiella burnetti spread
animal feces, urine, milk, birth products survives in environment and can be spread by wind major outbreaks associated w/sheep and goats during lambing season
27
Q-fever
``` Coxiella burnetti 60% seroconvert w/o disease 38% self limited 2% require diagnostic evaluation prolonged fever pneumonia hepatitis rash meningitis, encephalitis, menigioencephalitis, peripheral neuropathy pericarditis, myocarditis ```
28
Coxiella burnetti prego
uterine infections and spontaneous abortions
29
Q fever endocarditis
intermittent fever vegetations frequently absent cerebral emboli, renal insufficiency, splenomegaly, hepatomegaly
30
Coxiella burnetti Tx
Doxy | Doxy + hydroxychloroquine for 18-36 months for endocarditis
31
Francisella tularensis
infectious zoonosis small aerobic pleomorphic gram neg bacillius rabbits, squirrels, muskrats direct contact, ingestion of water or meat, bite of infected tick or fly, aerosol, NOT human -> human
32
Francisella tularensis clinical
``` ulceroglandular glandular oculoglandular typhoidal oropharyngela pneumonic ```
33
Francisella tularensis ulcerolglandular
``` fever and constitutional symptoms swollen lymph nodes that drain an inoculation ulcer formation sore throat patchy infiltrates on CXR ```
34
Francisella tularensis glandular
fever constitutional symptoms lymphadenopathy
35
Francisella tularensis typhoidal
fever of unknown cause
36
Francisella tularensis oropharyngeal disease
uncommon in US mucous membranes of mouth and pharynx are portal of entry contaminated water or food painful exudative pharyngitis and tonsillitis pharyngeal ulcers swollen retropharyngeal and cervical lymph nodes
37
Francisella tularensis pneumonic disease
inhalation exposure fever, malaise, dry cough, substernal discomfort, pleural effusion, dyspnea, sore throat, CXR- peribronchial infiltrates to bronchopenumomia w/effusion hilar adenopathy
38
Francisella tularensis Tx
gentamicin or streptomycin doxy cipro
39
bacillus anthracis
``` spore forming gram pos non motle rod aerobic or facultatively anaerobic catalase + hemolysis neg sheep agar zoonotic (goats, sheep, cattle, antelope, kudu, pigs, horses, zebu) soil contaminated w/spores ```
40
bacillus anthracis inhalation:
mediastinal adenopathy and widening, pleural effusions, rapidly fatal if not treated w/multiple abx and pleural drainage
41
bacillus anthracis cutaneous
most common
42
bacillus anthracis GI
oropharyngeal | intestinal
43
bacillus anthracis menigeal
nearly always fatal, can occur as complication of inhalation, cutaneous, or GI
44
bacillus anthracis Tx
multi-drug regimen | pleural drainage
45
Yersinia pestis
gram neg coccobacillus, microaerophilic, nonmotile, and non-spore forming rodents and fleas as vectors prairie dogs
46
clinical manifestation of plauge
bubonic septicemic pneumonic
47
bubonic plague
swollen tender lymph nodes (boboes) closest to site of initial infection fever, chills, myalgia, arthralgia, HA, malaise, prostration untreated- tachycardic, agitation, confusion, delirium, convulsions
48
septicemic plague
nausea, vomiting, diarrhea, ab pain DIC hypotension, renal failure, obtundation ARDS
49
pneumonic plague
fever, cough, chest discomfort, tachycardia, dyspnea, bacteria laden sputum, chills, HA, myalgias, weakness, dizziness respiratory distress, hemoptysis, cardiopulmonary insufficiency, circulatory collapse death w/in 24hours
50
Yersinia pestis Tx
streptomycin for penumonic tetracyclines for bubonic chloramphenicol for meningitis
51
leptospirosis
spirochete w/terminal hook dark field microscopy or silver stain obligate aerobe weils disease, pulmonary hemorrhage syndrome
52
leptospirosis resevoir
persistent renal carriage from rodents, dogs, pigs, cattle, and sheep colonize renal tubules, excreted in urine, and survives for wks to months in enviroment
53
leptospirosis transmission
penetrates skin or mucous membranes during contact w/contaminated water, soil, vegetations
54
leptospirosis early phase
``` 3-7 days fever, myalgia, ab pain, diarrhea, cough, photophobia mm tenderness rash conjunctival suffusion ```
55
leptospirosis late phase
``` aka weils disease jaundice acute hemorrhage renal failure severe thrombocytopenia GI bleeding pulmonary hemorrhage myocarditis aseptic menigitis ```
56
lepto diagnosis
agglutination test
57
leptospirosis Tx
doxy | penicillin
58
H. influenza
``` encapsulated gram neg pleomorphic rod aerobic or facultative aanaerobe chocolate agar nasopharyx of adults and kids type B was most common cause of meningitis before vaccines ```
59
H. influenza menigitis
children <5f and adults w/skull trauma or CSF leaks Type B diagnosis by detecting PRP capsular Ags in CSF
60
H. influenza epiglottis
life threatening infection in kids thumb print
61
H. influenza Pneumonia
fever, cough, lobar consolidation parapneumonic effusion and empyema smoking risk factor
62
other presentations of H. influenza
bronchitis (COPD) acute sinusitis otitis media
63
H. influenza Tx
3rd generation cephalosporin
64
C. diptheriae
gram + bacillus, club shaped non-spore forming aerobic reservoir- throat and pharynx
65
respiratory diptheriae
incubation of 1-7 days sore throat, malaise, fever pharyngeal erythema followed by tonsillar exudate -> grayish membrane tightly adhered and bleeds on attempted removal
66
C. diptheriae clinical presentation
cervical adenopathy- bull neck stridor extension of membrane - airway obstruction myocarditis, recurrent laryngeal n palsy, and peripheral neuritis
67
C. diptheriae Tx
erythromycin | antitoxin
68
legionellas
weakly gram - pelomorphic rod facultative intracellular requires cysteine and iron (charcoal yeast extract) water organism, amebae, air-conditioners
69
legionellas risk factors
smokers 55+ high alcohol intake immunosupression
70
legionaires disease
-fevers, malaise, cough, chills, dyspnea, -myalgias, HA, chest pain, diarrhea distinguish from other penumonias mental confusion
71
pontiac fever
fever sore throat mylagia, HA, extreme fatigue short duration, lasting on average 3 days legionellas
72
Tx of legionella
FQ azithromycin erythromycin +rifampin in immunocompromised dug must penetrate human cells
73
M. pneumonia
``` smallest free-living bacteria no cell wall (therefore beta lactams have no effect) sterol containing membrane requires cholesterol for culture military, dorms highest incidence 5-20 ```
74
M. pneumonia respiratory infection
``` 2-3 wks incubation fevers, malaise, HA, and cough 5-10% progress to pneumonia cough usually non-productive 'walking pneumonia' can also cause Bullous myringitis ```
75
M. pneumonia Dx
primary clinical | positive cold agglutinins in 65%
76
M. pneumonia Tx
macrolides | tetracyclines
77
S. pneumonia
``` gram + diplococcus lancet shaped blood agar alpha hemolytic optochin sensitive lysed by bile polysaccharide capsule ```
78
S. pneumonia risk factors
``` influenzae infection COPD CHF alcoholics asplenia ```
79
S. pneumonia typical pneumonia
most common causative agent | shaking chills, high fever, rigors, lobar consolidation, rusty (blood tinged) sputum
80
other manifestations of S. pneumonia
Adult meningitis most common causative agent | otitis media and sinusitis most common causative agent in kids
81
S. pneumonia pneumonia Tx
beta lactams macrolides FQs
82
Tx of S. pneumonia T meningitis
3rd generation cephalosporin | vancomicin if penicillin reisistant
83
SARS
coronavirus (second most common cause of common cold) reservoir- birds and small mammals virus also found in urine, sweat, and feces
84
clincial manifestation of SARS
``` fever >100.4 flu-like illness dry cough dypsnea progressive hypoxia ```
85
SARS Dx
clinical Hx and travel Hx (far east or Toronto)
86
SARS Tx
supportive | 50% mortality in elderly
87
Varicella-Zoster virus
infects epi cells and lymphocytes in oropharynx and URT infected lymphocytes disseminate virus enters skin thru endo cells in blood vessels and spreads to epi -> rash virus remains dormant in CN ganglia and DRGs reactivation -> herpes Zoster
88
Varicella-Zoster virus Tx
shingles- acyclovir PO immunocompromised w/shingles- IV acyclovir aspirin CI due to Ryes syndrome
89
Varicella-Zoster virus vaccine
CI in: hematologic malignant neoplasms AIDS/HIV w/CD4 < 200 people receiving high dose immunosupressive therapy or anti-tumor necrosis factor
90
S. aureus
``` gram + cocci in clusters catalase + coagulase + beta hemolytic small yellow colonies on blood agar ferments mannitol ```
91
S. aureus transmission
hands, sneezing, surgical wounds | foods: custards, potato salad, canned meats
92
S. aureus pathogenesis
adhesions, toxins, enzymes, surface binding proteins, capsule tissue invasion and toxin mediation
93
S. aureus toxin mediated disease
food poising toxic shock syndrome scalded skin syndrome
94
staph aureus clinical manifestations
``` skin bacteremia endocarditis pericarditis osteromyelitis septic arthritis, infected prothetic joints penumonia ```
95
S. aureus skin maifestations
``` impetigo folliculitis furuncle abscess erysipelas cellulits mastitis necrotizing fasciitis wound infections ```
96
S. aureus endocarditis
roth spts oslers nodes (ICs) janeway lesions (septic emboli) petichiae
97
S. aureus pneumonia
nosocomial pneumonia | salmon colored sputum
98
Staphylococcal food poisoning
S. aureus enterotoxins A-E 2-6 hours after eating nausea, vomiting, diarrhea, ab pain self limited
99
Toxic shock syndrom
S. aureus TSST-1 (super Ag) fever, erythoderma, hypotension, 3+organ systems, deequamation of palms and soles
100
scalded skin syndrome
S. aureus | exfoliative toxin A or B
101
S. aureus Tx
gastroenteritis is self limiting Nafcillin/oxacillin MRSA-vancomicin
102
Pneumocystis jirovecii
fungus obligate extracellular parasite silver stain opportunistic infection in HIV patients w/CD4 count less then 200
103
PCP
fever nonproductive cough shortness of breath CXR- patchy infiltrate, ground glass, lower lobe and periphery may be sparred
104
PCP Dx
silver staining cysts in bronchial alveolar lavage fluids or biopsy
105
PCP Tx
sulfamethaxazole/trimethoprim | or dapsone
106
PCP prophylaxis
when CD4 count <200
107
Histo
dimorphic fungus facultative intracellular parasite soil, caves, abandoned buildings w/bats or birds
108
Histo transmission
disruption of soil, cleaning attics, bridges, barns, tearing down old structures, spelunking endemic to Mississippi and Ohio river valleys
109
Histo acute
most asymptomatic | several weeks after exposure fever, chills, fatigue, non-productive cough, anterior chest discomfort, myalgias
110
Histo chronic
progressive often fatal | elderly immunocompromised and COPD patients at risk
111
Histo x-ray acute
patchy lobar or multilobar infiltrate
112
Histo x-ray chronic
upper lobe infiltrates. multiple cavities, fibrosis of lower lobes (mimics TB)
113
Histo Tx
``` itraconazole Amphotericin B (IV) ```
114
Blasto
thermally dimorphic fungus broad based budding yeast associated w/soil and decaying vegetation, especially near rivers and lakes
115
blasto endemic
north central, south central, great lakes, and SE sea board
116
blasto acute
asymptomatic or thought to have community acquired pneumonia fever, malaise, non-productive cough skin lesions
117
Blasto acute CXR
lobar, multilobar, or nodular
118
Blasto chronic
``` fever night sweats fatigue weight loss cough hemoptysis dyspnea ```
119
Blasto chronic CXR
cavitary, nodular, fibrosis, mass like
120
Blasto Tx
all patients should be treated Itraconazole if mild amphotericin B if severe
121
Coccidiodes
dimorphic fungi inhaled anthroconidia -> spherules -> internal septation -> endospores endemic to SW desserts
122
coccidiodes clinical
``` most asymptomatic 5-11 days post exposure fever, weight loss, fatigue, dry cough, peluritic chest pain arthralgias erythema nodosum ```
123
coccidiodes CXR
pulmonary infiltrates hilar adenopahty peripneumonic effusion pulmonar nodule-> cavitary
124
coccidiodes disseminated
immunocompromised 3rd trimester of pregnancy, skin, joints, bones
125
coccidiodes Tx
itraconazole | amphortericin B
126
Paramyxoviruses traits
enveloped helical neuclocapsid negative sense ssRNA
127
paramyxoviruses
parainfluenza measles mumps RSV
128
parainfluenza
person-person contact | most children exposed by elementary school
129
parainfluenza clinical
Coryza, rhinorrhea, pharyngitis w/o lymphadenopathy and low grade fever symptoms for 3-5 days CROUP
130
Croup
raspy barking cough w/indpiratory stridor, dyspnea, and respiratory distress symptoms result from subglottic inflammation and edema
131
parainfluenza bronchiolitis or pneumonia
cough, rales, wheezing, hypoxia
132
cold
reinfection of adults w/parainfluenza typically caused cold symptoms in normal adults and kids
133
measles
``` rubeola highly contagious 3 Cs- cough, coryza, conjunctivits generalized maculopapular rash fever ```
134
measles contagious
4days before and after onset of rash
135
measles clincial
incubation 8-12 days prodrome of fever, Cs, koplik spots malaise, myalgia, HA rash 2-6 days after catarrhal symptoms head-> trunk-> extremities
136
measles complications
diarrhea, otitis media, pneumonia post infectious encephalomyelitis subacute sclerosing panencephalitis
137
subacute sclerosing panencephalitis
degenerative demylinatng disease due to chronic infection | occurs years after acute measles infection and is universally fatal
138
measles Tx
supportive | prevention w/vaccine
139
Mumps clinical
parotitis aseptic meningitis- common and usually mild encephalitis rare and severe orchitis
140
mumps Tx
supportive and prevention w/vaccine
141
RSV
epidemics late fall in souther states peaking in feb-march in colder climates
142
RSV clinical
infants conjunctival injection, mucopurulent discharge, cough, low grade fever otitis media less common- wheezing, tachypnea, cyanosis expiratory wheezing and rales
143
RSV CXR
hyperinflation and diffuse interstitial pneumonitis
144
RSV Tx
ribavarin | no vaccine
145
strongyloides stercoralis
endemic in warm climates contact w/larvae in soil enter circulation -> rupture in alveolar spaces-> coughed -> swallowed
146
stongyloides pulmonary
can be sever in immunocompromised | resembles ARDS w/acute onset of dyspnea, productive cough, and hemoptysis accompanied by fever, tachypnea, hypoxemia
147
stongyloides Tx
ivermectin
148
aspergillosis
ubiquitous organisms in foil, decaying matter, air spore like conidia-> reach tissue forming invasice hyphae basements, crawl spaces, bedding, humidifiers, ventilation ducts, potted plants, dust, condiments, marijuana
149
invasive aspergillosis
``` immunocompromised fever pulmonary inflitrates nodules wedge-shaped densities resembling infarcts sinusitis ```
150
aspergillosis extrapulmonary
CNS absesses, endophthalmitis, MI, GI, renal, osteomyelitis, endocarditis
151
aspergillosis Dx
BAL, needle aspiration, thoracoscopic biopsy, open lung biopsy
152
Tx aspergillosis
Antifungal- voriconazole or liposomal amphotericin B reversal of immunosupression surgical resection of infected lesions
153
aspergilloma
ball in cavity debris in preformed cavity from TB, histo, or fibrocystic sarcoidosis Tx- intraconazole or voriconazole
154
allergic bronchopulmonary aspergillosis (ABPA)
history of chronic asthma, or cystic fibrosis airway obstruction, fever, eosinophillia, postive sputum cultures, mucous plugs containing Hyphae, brown flecks in sputum, upper lobe contraction, elevated IgE
155
ABPA Tx
corticosteroids and itraconazole
156
Cryptococcosis
immunosupressed- HIV meningitis is most common in clinical manifestation pulmonary and other organ involvement can occur
157
cryptococcus neoformans
yeasts environment and tissues polysaccharide capsule is major virulence factor
158
cryptococcus CNS
``` meningioencephalitis HAs over several weeks nuchal rigidity lethargy personality changes confusion visual abnormalities nausea and vomiting ```
159
cryptococcus pulmonary
risk factors: COPD, corticosteroid use, solid organ transplant fever, cough, dyspnea treated w/antifungals
160
other organs affected by cryptococcus
``` skin prostate osteoarticular surfaces breast eye larynx ```
161
cryptococcus Dx
yeast grown in culture from CSF, blood, sputum, skin lesions, other body fluids india ink stain latex agglutination
162
cryptococcus CNS Tx non-aids
amphotericin B and flucytosine for 6 weeks
163
cryptococcus CNS Tx aids
amphortericin B and flucytososine for 2 wks followed by fluconazole
164
HACEK organisms
``` Heamophilus spp actinobacillus actinomycetemcomitans cardiobacterium hominis Eikenella corrodens Kingella ```
165
HACEK
5% of endocarditis normal flora common cause of endocarditis in IV drug users difficult to diagnosis
166
CMV
``` member of herpes family double stranded DNA genome latent infections most clinical disease due to reactivation of latent infection in immunocompromised owl eye ```
167
CMV vertical spread
in utero during vaginal delivery | breast milk
168
CMV horizontal spread
saliva genital urine
169
CMV congenital and neonatal
microcephaly, intracerebral calcification, hepatosplenomegaly, and rash mental retardation and hearing loss mother w/primary infection during pregnancy
170
CMV immunocompetent
most asymptomatic | few w/mono like illness
171
CMV transplant recipients
fever, neutropenia, atypical lymphocytes, and hepatosplenomegaly hepatits- transplanted liver penumonia colitis- diarrhea
172
CMV AIDS
CD4 <50 retinitis colitis
173
CMV Tx
antivirals

Resp II (15 decks)

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