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Microbio Flashcards

1
Q

Gram nonreactive bacteria

A

Chlamydia
Legionella

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2
Q

Acid fast bacteria

A

Mycobacteria
Nocardia
Indicates mycolic acid in cell wall

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3
Q

Gram stain and shock

A

LPS on Gram negative most likely to cause shock
But gram + can also cause through various virulence factors

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4
Q

Protein A

A

Expressed on S aureus
Binds i gg to subvert immune response

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5
Q

Diphtheria toxin

A

Interferes with protein elongation at EF 2

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6
Q

Shiga toxin

A

Inhibit proteinsynthesis by damaging ribosomes

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7
Q

LPS

A

Complementactivation via tlr4 cd14 MD2 → cytokine release and widespread immune response

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8
Q

DIC

A

LPS → clotting factors and platelet migration

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9
Q

Waterhouse friderichsen syndrome

A

Adrenal failure in setting of septicemia often +DIC

Usually neisseria meningitis
Also pseudomonas, ‘s pneum, s aureus, H flu

Organ failure
Adrenocorticalinsufficieny
Severe hypotension
Coma

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10
Q

Toxic shock

A

Associated with superantigens that cause cytokine storm
SEB, TSST1, SEC2, strep exotoxin a and c
Skin desquamation

Usually s_pyogenes or Saureus

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11
Q

Toxic component LPs

A

Lipid A

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12
Q

C perfringens

A

Gas gangrene

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13
Q

S aureus lab tests

A

Positive:
Gram
Catalase
* CoagulaSe
* DNase
* Mannitol ferment

Other:
* B-hemolytic
Novobiocin sensitive
Bile salt resistant

  • unique from other staph species
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14
Q

Test differentiating S epi from S. Sapro

A

Novobiocin
Epi - sensitive
Sap - resistant

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15
Q

S epidermis

A

Norm(al skin ‘
Endogenous infections in ic., venous line, foley,
→ cellulitis osteomyelitis endocarditis UTIs -
Medical devicecontamination.

Mainly subacute endocarditiswhen history of value replacement acute more likely aureus

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16
Q

S saprophyticus

A

Vaginal flora
Gu infections in sexually active young women

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17
Q

Strep tests

A

Glram POS
* catalase Ng
* Pairs or chains
Non motile
No spores ‘

Hemolysis differentiates spectes

  • differentiates staph
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18
Q

S. Agalactiae tests

A

Group B strep
B hemolytic
Bacitracin resistant

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19
Q

S.pyogenes tests

A

Group A strep
B-hemolytic
Bacitracin serisitive

Pyr rapid test
Anti-streptolysin o (aso) titers
Anti-dnase B, anti hyaluronidase,anti streptokinase,anti-m

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20
Q

S. Pneumonia e tests

A

Alpha hemolytic
Optochin sensitive
Encapsulated

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21
Q

Viridans strep tests

A

’ Opportunistic
No cap:sule
Alpha hemolytic
Optochin resistant

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22
Q

Group B strep infections

A

Normal vagina
Infection in Newborns after vag delivery
Septicemia, meningitis, pneumonia,osteomyelitis

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23
Q

S. Pneum infection s

A

Normal upper respiratory
Meningitis, otitis media, pneumonia, sepsis

Especially severe in kids, old, ic, asplenic

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24
Q

Group A strep infections

A

Aka pyogenes - fever

N normal skin and throat
Strep throat
Skin infections
Necrotizing fasciitis
Autoimmune sequelae due to m protein

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25
M protein
- Group a strep (pyogenes) Blocks complement *Rheumatic fever Post infectious glomerulonephritis
26
Spe-b
Superantigen Protease precursor S pyo → necrotizing fasciitis
27
Rheumatic fever
Type 2 hypersens M protein 2-3 weeksafter strep throat. Not group A strep skin infections for some reason 2 major or 1 major 2 minor: M: polyarthritis, carditis,nodules, erythema, chorea m: fever, arthralgia w/o polyarthritis, high CRP or ESR, prolonged PR interval on EKG
28
Post strepglomerulonephritis
Type 3 Hs Skin or pharyngeal GAS Dx w/ elevated ASO or anti-dnase B
29
Viridian'S strep infections
Dental caries Subacute endcaarditis on previously damaged valves Opportunistic Biofilms
30
CAP tx outpatient
Presumptive for S. Pneumoniae unless other risk factors Generally a macrolide (-thromycin) Can be fluoroquinolone (-floxacin), doxy
31
Pneumococcal pneumonia tx inpatient
IV 3rd gen cep + macrolide (-thromycin) Eg. Ceftriaxone+ azithromycin + Vanco if complicated eg. HAP VAP
32
Pneumococcal meningitis tx
Vanco + cef-3
33
Outpatient tx uncomplicated strep
Amoxicillin Erythromycin if allergy
34
B cereus
Bacillus Gram POS Spore forming i Contaminated food Reheated fried rice prototypical
35
B cereus tx
Supportive Most cases dt toxins and most bacteria are abx-resistant, so ab x not generally given
36
Inhalation anthrax
Hemorrhagic mediastinitis - widening of mediastinum on X-ray Necrotizing pneumoni a Bacteremia Meningitis Fatal
37
B anthracis tx
- Combination clindamycin and linezolid for inhalation Ciprofloxacin or doxy for localized cutaneous
38
Gas gangrene
C. Perfringens Alpha toxin - perforates cells
39
Listeria monocytogenes
Vulnerable-neonates, pregnant, ic, old Contaminated food e.g. Unpasteurized dairy raw veg processed meat Vertical trans.. In healthy adults visuallyself-limited gastroenteritis
40
Listeria pregnancy and neonates
Early pregnant: sa, stilbirth,prematurity After birth meningitis, septicemia
41
Listeria Ab x
Resistan t to most Most notablyfluoroquindones Ampicillin preferred Growing resistance Bact rim usually works
42
Cold enrichment
Largely unique to listeria Accelerated growth at cooler temps
43
Common feature in all nocardia i infections
Abcess
44
Nocardia pneumonia
Ic. or preexisting lung disease Necrosis, cavitations, abscess Secondarydissemination causing abscesses in brain, skin Can also cause primary abscesses elsewhere
45
Nocardiaappearance
Gram positive rods in chains or filaments Similar toactinomyces but weakly acid-fast
46
Nocardia eco niche
Soil Obligate O 2
47
Nocardia tx
Slow growing '' Prolonged ab x course No resistance yet Poor px when disseminated Bactrim is tx of choice
48
HUS
Shige-like toxin in ehec Microthrombi shear red cellsand platelets Anemia-thrombocytopenia - acute kidney failure following bloodydiarrhea
49
Shiga-like to mins
Inhibit 28 S on 60 s ribosome subunit Also independently necrosis and inflammation Ehec
50
Neonatal meningitis
Most commonly E coli Also listeria
51
Pil i
- Biofilms,epithelialedherenu
52
Kleibsellapreumonia
. Vulnerable pts Diabetes, etoh Pulmonaryhemmorahgic necrosis Red currant jelly sputum Aspiration prenmonia
53
Macconkey agar
Lactose fermentation turns media pink Eg. Ecoli lactase POS → pink
54
Pseudomonas aeruginosa
Ic, vulnerable - cf, burns, leukemia, age s neutropenia Hap/ VAP Non-respiratory e.g. Hot tub folliculitis, otitis external, osteomyelitis following penetrating injury, UTIs from catheters, necrotizingenterocolitis in leukemia
55
Pseudomonas tx
4th gen ceph + amino glycoside (-mycin) Pip/tazo mosaggrssive
56
Salmonella tests
Motile facultative ' anaerobe ferments glucose Reduces sulfer- black t si medium
57
Shigella infectious dose
Very low Resistant togastric acid
58
Shigella tx
Ceftriaxoneand fluoroquin clones
59
Salmonella tx
Supportive Ab x prolonginfectious duration
60
Y ersinia enterocolitica
.galstroenteritis / food poisoning from pork products, puppies Iron overloadpredisposes Pain can mimic appendicitis
61
Y-entero tx
Supportive if uncomplicated Otherwise aminoglycosydes (my cin) and bact rim Tend to be fluoroquinoloneresistant
62
Campylobacter jejune appearance
Motile curved or corkscrew gram neg rod
63
Campy virulence
Direct invasion of intestinalepthelium Corkscrew shape and flagellum → bloody diarrhea Can result in reactivearthritis
64
Campy transmission
Under cooked chicken most common
65
Campy complications
Reactive arthritis Guillan barre
66
Urease
Involved in H pylori, y enter o, some other enter bacterium NeutralizesStomach acid via ammonia production to promote survival
67
Whooping cough toxin
Pertussis exotoxin binds ' G, protein receptor increasing secretions Pili paralyze mucocilary escalator
68
Pertussis complications
Respiratoryexhaustion Pertussis encephalopathy
69
Pertussis tx
Macrolides (-thromycin) Prophylaxis with erythromy in for contacts Tdap prevention
70
Legionella path
Enter and replicate in alveolarmacrophages Type 4 secretion system effector proteins
71
Legionnaire's sx
Neuro-headache, confusion Diarrhea Lobar or atypical pneumonia Often hyponatremia Generally all together
72
Legionella tx
Azithromycin or levofloxacin
73
Neisseriameningitidis manifestations
Meningitis Purpuri c rash Possible URI Complications: Di c Waterhous-friderichsen syndrome
74
Neisseria tx
Ceftriaxone
75
H flu manifestations
Meningitis Epiglottitis Pneumonic Otitis media Esp in 6-18 mo between breastfeadingand vaccination
76
Acinetobacter
VAP
77
Lyme disease st
Stage 1: Erythema migran s / bull's eye Stage 2: Facial nerve palsy Arthritis Cardiac block Stage 3: If untreated Meningitis
78
Rocky mountair spotted fever
Dog tick Southeastern us Headache -fever- rash on palms and solesof feet Leukopenia Hyponatremja Hepatic transaminase Thrombocytopenia
79
RMSF tx
Doxycydine
80
Yersinia pestis
Rat fleas Bacteria invade mq Tender, swollen lymph nodes Lesion at bite site Progression to septicemic plague - DIC + necrosis
81
Yersiniapestis tx
Streptomycin
82
Q fever
Coxiella burnetii Farm animals Flu-like Pneumonia Endocarditis with'negative cultures (C. Burn doesn't culture well) Hepatitis
83
Ssdna virus
Parvoviridae is only currently clinically relevant All other DNA viruses are ds
84
Ds DNA viruses
Adenovirus Papillomavivus Polyomavirus Hepadnavirus - hep B Herpesvirus Poxvirus
85
Parvovirus b 19
Naked icosahedral ss DNA Infects immature erythrocytes Kids: fifth disease - slapped cheek rash Sickle cell: aplastic crisis In u tero: hydropsfetalis Adults: arthritis
86
Adenorinus
Naked icosahedral ds DNA linear Conjunctivitis,pharyngitis, ge, myocarditis, acute hemorrhagic cystitis
87
HPV
Naked icosahedral ds DNA circular genome 1 and 2: warts 6 and 11 - genital warts 16 and 18-cervical cancer
88
CMV
Herpesvirus Enveloped icosahedral ds DNA R eactivation infection in ic - pneumonia, esophagitis, retinitis, colitis Mono (2nd most common to ebv) Congenital: retinitis, microcepholy, hearing loss, seizures, blueberry muffin rash
89
Roseola
HHV 6 and 7 High fever x few days → macular rash
90
Kaposi sarcoma
Opportunistic Triggered by hhv8 in ic
91
Circular DNA genomes
Hepraviridae- hep B Pappllomaviridae Polyomaviridae
92
Blueberry muffin rash
Congenital CMV - congenital rubella Indicates extramedullary hematopoesis
93
CMV in HIV
AIDS if outside liver spleen or lymph nodes Prolonged, progressive Retinitis → hemorrhage → blindness Colonic ulceration Pneumo nitis Encephalitis
94
CMV in transplant
Primary from organ or secondary from reactivation Higher rejection risk Fever Pneumonia Hepatitis Pancreatitis Colitis
95
CMV blood smear
Owl eye inclusion body Reactive lymphocytes
96
CMV tests
CMV lg M or G High WBC High lfts Negative eb V monospot
97
CMV tx
Gangliocivir prophylaxis in HIV W CD 4 <50, organ transplant, hsct Potentially Gangliocivir, valganciclovir, foscarnet, cidoforvir in severe infection Es pecially newborns
98
Mono
Most commonly eb v in young otherwise healthy Posterior cervical and submandibular lymphadenopathy Fever Hepatosplenomegaly Exudative pharyngitis Fatigue If hepatosplenomegaly avoid contactsports for 12 monthsdue torisk of rupture St usuallyresolve2-3 wk Fatigue longer
99
Starry skylymiph node
Burkitt lymphoma Eb v associated Myc gene
100
Owl eye cells
Hodgkin lymphoma - aka Reed sternberg - eb v associated CMV infection
101
Oral hairy leukoplakia
White patches on tongue in ic Eb v associated
102
Eb v test s
Monospot Eb v early antigen ig G for 6 mo Anti- eb Na after that High WBC High lfts
103
EBV tx w amoxicillin
→ diffusemacropapular rash Can develop to erythema multiform e (target)
104
Chickenpox tx
Acyclovir first 24 hours or if complicated Symptomatic eg r. Antihistamines VSV antibodies, IV acyclovir can be used if very complicated e.g. In pregnant women orhiv
105
Post herpetic neuralgia tx
Capsaicin, gabapentin, TCAs, steroids
106
Postherpetic neuralgia
A complication after shingles rash has cleared Dt sensory Herve damage
107
Ds RNA viruses
Reoviridal is only clinically relevant genus i Includes rotavirus and Colorado tick virus
108
Orthomyoxviridae
(-)ssRNA Along withretroviruses the onlythat replicates in nucleus Includes flu
109
F protein
Membrane fusion protein in RSV
110
Influenza complications
Primary pneumonia Secondarybacterial pneumonia Cns- encephalitis, meningitis,guillan barre Other- myositis, rhabdo. Myocarditis,pericarditis
111
Neuraminidase
Cleaves sialic acid residues to allow for viralspread/release from host cell Flu
112
Measlescomplications
Diarrhea Giant cell pneumonia Encephalitis Subacute sclerosing panencephalitis 7-10 years post infection → death
113
Mumps complications
Pancreatitis,orchids (testes), meningitis, encephalitis, myocarditis, nephritis
114
Rubella presentation
Rash start face down body spare palms soles Generalizedeymphadenopathy ( unlike measles) Low grade fever vs high grade in measles
115
Rubellacomplicatins
Arthritis Encephalitis, Guillanbarre Idiopathicthrombocytopenic purpor a Myocarditis Congenitalrubella - torch infection,life threatening- blueberry muffin rash
116
Congenital rubella
IUGR - small size Blueberry muffin rash Bi lateral cataracts Sensorineuralheaving loss Machine heart murmur- patent da, VSD Intellectual disability
117
Opportunistic pneumonia in HIV
Pjiroveci - PCP Cocci Tb
118
Dimorphic fungi
Mold in cold Yeast in heats
119
C. Albicans dimorphism
Exception Yeast in cold Mold in heat
120
Amphoterrible side fx
Fever, and chills HypOkalemia Dt perforation of renal tubular ducts
121
Cytokine gran uloma
TNF a
122
Folic acid synthesis inhibitors
Trimethopri M Sulfa drugs
123
Metronidazole
Targets DNA integrity Bacterial andprotazoal
124
Rifampin
Targets mRNA synthesis
125
Fluoroquinotones
_Floxacin Gyrase inhibitors
126
50 S inhibitors
Macrolide s- thromycin Cindamycin Linezolid Chloramphenicol
127
30 s inhibitors
Aminoglycosides. - mycin/ micin except -thromycin; amikacin Tetracyclines -cycline
128
Peptidoglycan synthesis inhibitors
Vancomycin Bacitracin
129
Antipsendomonals
Piperacillin Ticarcillin Cefepime Monobactams-azetronam Carbapenems Polymyxin if resistant
130
Daptomyan
Cell membranedisruption Lipopeptide
131
Penicillins coverage
Gram POS Especially syphilis and group B strep
132
Staph first line
Methicillin, nafcillin, oxacilion, aminopenicillins with beta lactamase inhibitors
133
Aminopenicillins coverage
Listeria Strep pneumonia e Staph Enterococcus
134
Piperacillin coverage
E coli Bacteroides H flu Staph aureus Pseudomonas
135
Ceftaroline coverage
Fifth gen cef MRSA Gram POS and many neg
136
Aztreonam
Monobactam Pseudomonas E coli Kleibsella
137
Carbapenems coverage
Pseudomonas MRSA Enterococci
138
Daptomycin coverage
MRSA Enterococci
139
Fluoroquinolone'S coverage
E coli Legionella Salmonella typhi Anthrax
140
Aminoglycosides coverage
- mycin _ micin - amikacin Gram negative aerobes
141
Tetracyclines coverage
Chlamydia Rickettsia Lyme
142
Tigecycline coverage
Broad E coli Kleibsella MRSA
143
Amphenicols
' 50 S inhibitors Cholera S aureus St pneumonia e Rickettsia E coli
144
Macrolide'S
- thromycin ' Strep Staph Legionella Chlamydia
145
Linezolid
50 S inhibitor Oxazolidinore MRSA Vancomycin-resistant enterococci (VRE)
146
Penicillin resistance gene
MecA
147
MRSA tx
Vancomycin Daptomycin Linezolid Tigecycline Ceftaroline Doxycycline Tmp-smx
148
Multi- drug resistant tx
Polymyxins Carbapenems
149
Polymyxin
Binds phospholipids on cell surface. A last resort
150
Penicillin resistance strep pneumonia
Changes in structure of target pbps Unlike most other organisms which is beta lactamase production
151
Jarisch herxheimer rxn
Penicillin G reaction Fever and chills Low bp Skinlesions
152
Beta lactams cause _ _ dependent killing while aminoglycosides are __ dependent.
- Beta lactams - time Aminoglycosides-concentration
153
Gonorrhea tx
Ceftriaxone
154
Cephalosporins adverse effects
Less likely to cause Hs than penicillin but still avoid in penicillin allergy Autoimmune hemolytic anemia When w/aminoglycosides nephrotoxicity When w/ alcohol disulfiram like reaction - flusing, hypotension, tachycardia, n+v
155
Vancomycin infusion reaction prophylaxis
Antihistamines and slow infusion
156
Mechanism vancomycin
InhibitNAG-NAM unit from being added to peptidogyan chain in cell wall
157
Cipro levo moxi differences
Cipro= systemic Levo and moxi= respiratory, above diaphragm
158
Fluoroquinolones Mx
DNA gyrase/topoisom erase inhibitors
159
Fluoroquinolone resistance
Target sitealteration Efflux pumps
160
Cipro uses.
Gram neg. rods: - E coli, H flu, moraxella, kleibsella, legionella, *pseudomonas, salmonella, 's typhi anthrax Some gram POS cocci Tb No: Gonorrhea - resistance Strep pneumonia Systems: Gi, gu, bone, joint, CNS
161
Levofloxacin uses
Similar coverage to cipro but - better lung distribution - S pneumonia coverage - better MRSA - better legionella - worse atpseudomonas Basically hap, cap and skin
162
Moxifloxacin uses
Similar tocipro but: - not for UTIs - better at mycoplasma including CNS Tb - better gram POS bacilli - worse pseudomonas Mostly hap,CNS tb, complex abdominal Also fine renal impairment - vs adjust dose
163
Donot take fq with
Cations eg.calcium, iron Adjust dose of p450 Adjust dose cipro and levo renal disease C/i qt interval prolongation/ tor Sades de points. C/i. Myasthenia graves dt peripheral nm j
164
Fluroquinolone side effects
Renal Torsades de pointes /QT elongation CNS, PNS Allergy - relatively rare Rash - photosensitivity Sjs-rare Avoid in kids - joints and cartilage
165
Sulfonamides target
Dihydropteroate synthase dhps
166
TMP target
Dihydrofolate reductase DHFR
167
Tmp-smx resistance
More PABA precursor Enzyme alteration Efflux pumps
168
Tmp.smx coverage
Aerobic POS and neg Nocardia Fungi- p. Jiroveci Protazoa-plasmodium No: Anaerobic Intracellular Mycoplasma Mycobacteria Spirochetes
169
Aminoglycoside adverse fx
Nephrotoxicity - acute tubular necrosis Ototoxicity. Vestibulotoxicity C/i. Myastenia gravis-NMB Monitor every 3 days
170
Macrolide AES
Gi - diarrhea at motil in recepto Q t prolongation Hepatotoxicity
171
Linezolid AES
Bone marrow suppression Peripheralneuropathy Serotoninsyndrome_ Mao cross reactivity
172
Second line Tb
Streptomycin Amikacin Cipro Cycloserine- MDR Paraaminosalizylic acid- MDR Ethionamide
173
Component of mycobacterium cell wall
My colic acids Acid fast stain Synthesis targeted by isoniazid
174
Isoniazid vita min deficiency
B6
175
Acyclovir
Guanosine analog Activated by herpes viral kinases Specific to herpes viruses Hsv- 1,2 VZV
176
Ganciclovir
Similar to acyclovir CMV Acyclovir -resistant HSV
177
Cidofovir
Viral DNApolymerase inhibitors CMV retinitis in AIDS Acyclovir resistant HSV
178
Foscarnet
Nonspecific viral polymerase inhibitor RNA, DNA, rt Herpesvirus, HIV
179
Ribavarin
A/G mimic Induces mutation in RNA replication Also vs:. DNA viruses Hep C, severe RSV
180
Oseltamivir Zanamivir
Flu neuraminidase Release budding virus from cell Within 48h of sx
181
HBV tx
Adefovir - adenosine analog rna-dept DNA poly inhibitor Entecavir - DNA poly inhib Lamivudine- cytosine analog, chain term, DNA poly and HIV rt Telbivudine- thymidine analog, DNA poly and its rt activity Tenofovir- DNA poly,HIV rt Ifn.2a
182
Ns 5a inhibitors
HCV MOA unclear Daclatasvir Ledipasvir Ombitasvir
183
Ns 5b inhibitors
HCVreplication - buvir
184
Ns 3/4 a protease inhibitors
HCV translation - Previr and ritonavir
185
Eb v tx
Symptomati- acetaminophen and NSAIDs Antivirals not helpful
186
Foscarnet Æ
Renal impairment Electrolytes- low k, CA, mg
187
RSV t x
Supportive Ribavarin if complex Broad spectrum nucleoside antiviral Purine mimic Chain terminator Viral RNA poly Palivizumab for prevention
188
Ribararin AES
Anemia Hemolytic anemia Neutropenia Anemia → MI in preexisting cv Teratogen
189
-navir
HIV protease inhibitors
190
-gravir i
HIV integrase inhibitors
191
Maraviroc
HIV attachment inhibitor ccr5
192
Enfuvirtide
HIV penetration/entry inhibitor gp41
193
First line malaria
Chloroquine Resistance common
194
Severe/complicated malaria tx
Iv quinine and doxy or clindamycin Transition to Po quinidine Mx: - reduce 02 uptake -Reduce carb metabolism - intercalates into DNA
195
Malaria prophylaxis
Atovaquone- proguanil Doxy Mefloquine
196
Toxoplasmosis tx
Sulfadiazine Pyrimethamine
197
Trypanosomiasis tx
Chagas- Latin America - cv Beznidazole Nifurtimox Sleeping sickness - Africa- cns Melarsoprol - cns Pentamidine isethinonate _ blood
198
Roundworm and pinworm tx
Ivermectin
199
Tapeworm and hookworm t
Benzimidazoles -Bendazole
200
Shistosomasis tx
Praziquantel
201
Fungal membrane target
Ergosterol
202
Fungal cell wall target
Beta glucan
203
Flucytosine
Nucleotide analog precursor Antifungal - fungistatic Thymidylate synthetase inhibitor

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