Microbiology Flashcards
(324 cards)
1
Q
Which part of the bacterial structure contains Beta-lactamases?
A
Periplasm = space between cytoplasmic membrane and peptidoglycan wall in gram (-) bacteria
*note: Beta-lactamases = hydrolytic enzymes, resistant to antibiotics
2
Q
Which bacteria contain sterols, but have no cell wall?
A
Mycoplasma
3
Q
Which bacteria has a cell wall/membrane with mycolic acid and a high lipid content?
A
Mycobacteria
4
Q
Bugs that don’t gram stain well?
A
“These Rascals May Microscopically Lack Color”
- Treponema (too thin)
- Rickettsia (intracellular)
- Mycobacteria (high lipid content in cell wall; need acid-fast stain)
- Mycoplasma (no cell wall)
- Legionella (mostly intracellular)
- Chlamydia (intracellular; and lacks muramic acid in cell wall)
5
Q
Giemsa stain, stains:
A
- Borrelia
- Trypanosomes
- Chlamydia
- Plasmodium
6
Q
PAS (periodic acid-Schiff): what structures does it stain? what’s it used to dx?
A
“PAS the sugar” –> it stains glycogen and mucopolysaccharides!
–dx Whipple’s disease (Tropheryma whippeli)
7
Q
Ziehl-Neelson stain = carbol fushsin
A
stains acid-fast organisms (mycobacteria)
8
Q
India ink–> what organism does it stain?
A
stains cryptococcus neoformas
9
Q
silver stain:
A
- Fungi (ie pneumocystis)
- Legionella
10
Q
chocolate agar with factors V (NAD+) and X (hematin)
A
H. influenza
11
Q
Thayer-Martin/VPN media (Vancomycin, Polymyxin, Nystatin)
A
N. gonorrhea
- vancomycin –> inhibits gram +
- polymyxin –> inhibits gram -
- nystatin –> inhibits fungi
12
Q
Bordet-Gengou agar (potato agar)
A
Bordetella pertussis
13
Q
Lowenstein-Jensen agar
A
M. tuberculosis
–> takes 3-4 weeks to grow though! (can do acid-fast stain in mean time to help rule out…)
14
Q
Eaton’s agar
A
Mycoplasma pneumonia
15
Q
pink colonies on MacConkey’s agar
A
lactose-fermenters
- MacConkey’s agar:
- biosalts and crystal violet–> inhibit gram +
- lactose–> only carb in agar
- neutral red stain–> lactose fermenters take up lactose and neutral red; form pink colonies
**non-pink growth on MacConkey’s = gram (-), but not lactose fermenter
16
Q
Tellurite plate, Loeffler’s media
A
C. diphtheriae
17
Q
Sabouraud’s agar
A
Fungi
18
Q
Obligate aerobes:
A
“Nagging Pests Must Breathe”
- Nocardia
- Pseudomonas
- Mycobacterium tuberculosis
- Bacillus
19
Q
Obligate anaerobes:
A
“Can’t Breathe Air”
- Clostridium
- Bacteroides
- Actinomyces
- **Anaerobes lack catalase and/or superoxide dismutase, so susceptible to oxidative damage
- **Aminoglycosides = ineffective against anaerobes!
- **Treat anaerobes with:
- Metronidazole
- Clindamycin
20
Q
Obligate intracellular bugs:
A
“stay inside (cells) when it’s Really Cold”
- Rickettsia
- Chlamydia
21
Q
Facultative intracellular bugs
A
“Some Nasty Bugs May Live FacultativeLY”
- Salmonella
- Neisseria
- Brucella
- Mycobacterium
- Listeria
- Francisella
- Legionella
- Yersinia
22
Q
bugs with a positive quellung rxn?
-who’s at increased risk of infection with these organisms?
A
encapsulated bacteria:
- SHiN SKiS:
- S. pneumonia
- H. influenza
- Neisseria meningitidis
- Salmonella
- Klebsiella pneumonia
- group B strep
*asplenic pts –> increased risk of infection with encapsulated organisms
23
Q
Catalase-positive organisms:
-which pts have recurrent infections with these organisms?
A
- S. aureus
- Serratia
- Pseudomonas
- Candida
- E. coli
*pts with chronic granulomatous disease (NADPH oxidase deficiency) have recurrent infections with these organisms
24
Q
Urease-positive bugs
A
“K-PUNCH”
- Klebsiella
- Proteus
- Ureaplasma
- Nocardia
- Cryptococcus
- H. pylori
*Urease splits urea into ammonium, which binds Mg and P –> forms stones –> stones deposited in renal calyces
25
Protein A
S. aureus virulence factor; binds Fc region of Ig; prevents opsonization and phagocytosis
26
IgA protease
virulence factor of SHiN: S. pneumonia, H. influenza, Neisseria
--> enzyme that cleaves IgA in order to colonize respiratory mucosa
27
M protein
virulence factor of Group A Strep: helps prevent phagocytosis
*Note: antibodies to M protein enhance host defenses against GAS, but can give rise to Rheumatic fever...
28
Which 2 bacteria produce a toxin that inhibits protein synthesis by inactivating elongation factor, EF-2?
C. diphtheriae --> Diphtehria toxin
| Pseudomonas aeruginosa --> Exotoxin A
29
Which 2 bacteria produce a toxin that inhibits protein synthesis by inactivating the 60S ribosome by cleaving rRNA?
Shigella --> Shiga toxin
| EHEC (including O157:H7) --> Shiga-like toxin
30
List 5 bacteria that produce an ADP-ribosylating A-B toxin:
1) Corynebacterium diphtheriae
2) Pseduomonas aeruginosa
3) ETEC
4) Vibrio cholerae
5) Bordetella pertussis
***Mechanism: B-binding component binds host cell surface receptor, enabling endocytosis; A-active component attaches ADP-ribosyl to disrupt host cell proteins
31
Which 2 bacteria produce a heat stable toxin? What's the mechanism?
ETEC and Yersinia enterocolitica
*mechanism: increased cGMP --> decreased reabsorption of NaCl and H20 in gut --> increased fluid secretion
* note:
- ETEC --> watery diarrhea
- Yersinia --> bloody diarrhea
32
Which E. coli has a toxin that functions by the same mechanism as the cholera toxin? What's the mechanism?
ETEC - heat labile toxin
*mechanism: increased cAMP by permanently activating Gs --> increased Cl secretion in gut and H20 follows it --> so increased fluid secretion
33
Which bacteria has a toxin that mimics adenylate cyclase (toxin acts like the enzyme!)?
Bacillus anthracis: toxin= edema factor --> mimics adenylate cyclase --> increased cAMP --> increased fluid secretion
34
2 toxins produced by ETEC (enterotoxigenic E. coli) and their mechanisms?
- heat labile toxin: increases adenylate cylcase--> increased cAMP-->iincreased Cl secretion in gut --> increased H20 secretion
- heat stabile toxin: increases guanylate cyclase --> increased cGMP --> decreased reabsorption of NaCl and H20 in gut
35
Which 2 bacteria produce a toxin that cleaves SNARE protein required for neurotransmitter release (and thereby inhibit release of neurotransmitter)?
Clostridium tetani and Clostridium botulinum
36
Which bacterial toxin acts through this mechanism?
--> overactivates adenylate cyclase by inhibiting Gi--> increased cAMP --> thereby, impairs phagocytosis, permitting survival of microbe
Pertussis toxin (Bordatella pertussis)
37
Tetanospasmin toxin: which neurotransmitters does it affect and how? what are the manifestations?
-tetanospasmin prevents release of inhibitory neurotransmitters (GABA and glycine) --> get muscle rigidity and "lock jaw"
38
Botulinum toxin: which neurotransmitters does it affect and how? what are the manifestations?
botulinum toxin prevents the release of stimulatory (Ach) signals at neuromuscular junctions --> get flaccid paralysis, "floppy baby"
39
Which bacteria produces Alpha toxin/Lecithinase (degrades phophospolipids)
Clostridium perfringens
| -degradation of phospholipids--> myonecrosis (gas gangrene) and hemolysis (double zone of hemolysis on blood agar)
40
Streptolysin O toxin: mechanism?
- Streptococcus pyogenes (Group A strep)
- toxin lyses RBCs, contributes to Beta-hemolysis
- ASO antibodies can be used to dx rheumatic fever
41
Which 2 organisms have superantigens? what are the toxins? superantigen mechanism?
- Group A strep (Strep pyogenes) --> Exotoxin A
- Staph aureus --> TSST-1 (toxic shock syndrome toxin)
*superantigens bind MCH II and TCR simultaneously to stimulate a huge release of IL-2 and IFN-gamma --> results in shock; both can cause toxic shock syndrome (fever, rash, shock)
42
bacterial "competence"
| -which bacteria are "competent?
competence = ability to take up DNA from environment = transformation (in bacterial genetics)
-many bacteria can undergo transformation, but especially common in SHiN (S. pneum, H. infl, Neisseria)
43
Conjugation: (F+ X F-) vs (Hfr X F-)?
(F+ X F-): only plasmid DNA can be transferred this way
(Hfr X F-): Transfer of plasmid AND chromosomal genes (because F+ plasmid can become incorporated into bacterial chromosomal DNA --> "Hfr cell"
44
Transduction:
bacterial genetic term --> spread of bacterial DNA via lytic ("generalized transduction") or lysogenic ("specialized transduction") bacteriophage (virus that infects bacteria)
45
What makes MRSA resistant to Beta-lactams?
Altered penicillin-binding protein
46
rusty sputum
pneumococcus! (strep pneumonia)
47
Strep pneumonia = most common cause of:
- Meningitis
- Otitis media (in kids)
- Pneumonia
- Sinusitis
48
Bacteria that causes acute bacterial endocarditis?
Staph aureus
49
Bacteria that causes subactue bacterial endocarditis at damaged valves?
-Strep sanguis (viridans group strep)
| think of the sanguinistas in true blood :)
50
strawberry tongue
Scarlet fever --> toxigenic effect of group A strep
51
about 15% of colon cancer pts are colonized by which strep?
strep bovis (group D strep)
52
ABCDEFG of Corynebacterium diphtheriae
```
ADP ribosylation
Beta-prophage (encodes exotoxin)
Corynebacterium
Diphtheria
Elongation
Factor 2
Granules (dx by gram + rods with metachromatic -blue and red- granules)
```
*exotoxin encoded by a beta-prophage--> exotoxin inhibits protein synthesis via ADP ribosylation of EF2
53
Spore-forming bacteria:
certain gram + rods:
* main ones:
- Bacillus anthracis
- Clostridium perfringens
- Clostridium tetani
* also:
- Bacillus cereus
- Clostrium botulinum
- Coxiella burnetti
54
Prevents glycine and GABA and glycine release from Renshaw cells in spinal cord?
Tetanospasmin (Clostridium tetani toxin) --> blocks inhibitory neurotransmitters, so causes spastic paralysis, trismus (lockjaw) and risus sardonicus
55
Treatment of C. difficile?
metronidazole or oral vancomycin (only case in which vancomycin is given orally!)
56
2 toxins produced by C. difficile, and how do they act?
Toxin A = enterotoxin: binds brush border of gut
Toxin B = cytotoxin: destroys cytoskeletal structure of enterocytes, causing necrosis of colon epithelium = pseudomembranous colitis
57
Only bacterium with a polypeptide capsule (that contains D-glutamate)?
Bacillus anthracis
58
move from cell to cell via "actin rockets"; bacteria is acquired by ingestion of unpasteurized milk/cheese and deli meats, or by vaginal transmission during birth
Listeria monocytogenes
59
treatment of actinomyces vs nocardia?
"ooooh SNAP!"
- Sulfa for Nocardia
- Actinomyces - use Penicillin
60
Langhans giant cells --> see multiple peripheral nuclei organized in the shape of a horseshoe
characteristic of TB caseating granulomas
61
Extrapulmonary tuberculosis:
- CNS--> tuberculoma or meningitis
- Pott's disease in vertebral bodies
- lymphadenitis
- renal
- GI
62
Ghon complex =
-TB granulomas
= Ghon focus (calcified scar, usually in lower lobes) + lobar and perhilar lymph node involvement; reflects primary infection or exposure
63
Mycobacterium kansasii
pulmonary TB-like symptoms; more common in pts with COPD (chronic bronchitis or emphesyma)
64
Prophylactic treatment for Mycobacterium avium-intracellulare?
- Azithromycin
| - ->MAI is often resistant to many drugs; causes disseminated disease in AIDS pts.
65
Reservoir in US is armadillos?
Mycobacterium leprae (Leprosy = Hansen's disease)
66
Treatment for leprosy?
- long term oral Dapsone (but, toxicity = hemolysis and methemoglobinemia)
- alternatively: rifampin, or combination of clofazimine and dapsone
67
Lactose-fermenting bacteria (grow pink on MacConkey's agar)...
macConKEES or CEEKS:
- Citrobacter
- Klebsiella
- E. coli
- Enterobacter
- Serratia
*note: E. coli produces Beta-galactosidase--> breaks lactose into glucose and galactose!
68
Which class of bacteria are resistant to Penicillin G (or rather, which class can Penicillin G be used to treat)?
Gram (-) bacilli are resistant to Penicillin G (but, may be susceptible to penicillin derivatives)
Penicllin G and V are mostly used to treat gram (+) organsims, and syphilis!
69
Fitz-Hugh-Curtis syndrome
caused by N gonorrhea
| -->stars in lower genital tract, ascends through upper genital tract, ultimately infects liver capsule
70
Treatment for N. gonorrhea?
ceftriaxone
71
Waterhouse-Friderichsen syndrome
caused by N. meningitidis
| -->adrenal hemorrhage --> adrenal insufficiency --> hypotension + DIC + electrolyte abnormalities
72
Prophylaxis and treatment for N. meningitidis?
- Vaccine available (not for type B)
- Rifampin prophylaxis in close contacts
- Treatment: ceftriaxone or penicillin G
73
Why can H. influenza be grown with Staph aureus?
H. infl requires Factors V (NAD+) and X (hematin) for growth; S. aureus provides factor V!
74
Prophylaxis for H. influenza?
| Treatment for meningitis caused by H. infl?
- Vaccine: type B capsular polysaccharide conjugated to diphtheria toxoid or other protein
- Prophylaxis in close contacts: Rifampin
- Treatment for meningitis: Ceftriaxone
75
Legionnaires disease vs Pontiac fever?
Both caused by Legionella pneumophila
- Legionnaires' disease = severe pneumonia and fever
- Pontiac fever - mild flu-like syndrome
***suspect Legionella in pts with recent exposure to contaminated water (ie cruise ship, hotel, etc...)
76
pt with Cystic Fibrosis + Pneumonia?
Pseudomonas
77
PSEUDOM of pseudomonas (presentations):
- Pneumonia (especially in cystic fibrosis pts)
- Sepsis (black lesions on skin--> ecthyma gangrenosum = cutaneous necrotic disease, common in imm-compromised pts)
- External otitis (swimmer's ear)
- UTI
- Drug use endocarditis and Diabetic Osteomyelitis
- Malignant otitis externa in diabetics
- ->also: hot tub folliculits
- assoc with wound and burn infections
- water source
- produces pyocyanin = blue-green pigment
- grapelike odor
78
Treatment for Pseudomonas?
Aminoglycoside + extended-spectrum penicillin (ie piperacillin or ticarcillin)
79
E. coli virulence factors: What do they cause?
- Fimbriae?
- K capsule?
- LPS?
Fimbriae -->cystitis and pyelonephritis
K capsule --> pneumonia, neonatal meningitis
LPS --> septic shock
80
Anemia + Thrombocytopenia + Acute Renal Failure?
HUS = hemolytic uremic syndrome (EHEC O157:H7)
81
Which E. coli strain is the only one that does not ferment sorbitol?
EHEC
82
Which E. coli strains cause bloody diarrhea?
EIEC and EHEC
83
Which E. coli strain normally causes diarrhea in children?
EPEC (P for pediatrics :))--> doesn't produce toxin; adheres to apical surface, flattens villi, prevents absorption
84
Which E. coli strains produce a toxin (and what toxin is it?) Which do not produce toxin?
EIEC --> no toxin
ETEC --> heat labile and heat staible toxins
EPEC --> no toxin
EHEC --> shiga-like toxin
85
Which antibiotic should be used to treat Salmonella?
TRICK QUESTION! Do not treat Salmonella with antibiotics; antibiotics may prolong symptoms!
86
Osteomyelitis in a sickle cell patient?
Think Salmonella!
87
spots on abdomen + fever + headache + diarrhea?
Salmonella typhi (rose spots on abdomen)
88
Which is more virulent: Shigella or Salmonella?
Shigella is more virulent --> only takes
| 10^1 organisms for infection, vs Salmonella --> takes 10^5 organisms!
89
Which bacterial infection is associated with Reiter's syndrome/Reactive arthritis?
- Shigella flexneri
| - Chlamydia
90
Causes mesenteric adenitis (which may mimc Crohn's or appendicitis)?
Yersinia enterocolitica! (transmitted from pet fecies, contaminated milk, pork; outbreaks of diarrhea in daycare centers...)
91
Triple therapy for H. pylori treatment:
1) PPI
2) Clarithromycin (macrolide)
3) Amoxicillin or Metronidazole
* **Quadruple Therapy:
- Bismuth salicylate
- Metronidazole
- PPI
- Tetracylcine
92
flulike symptoms, jaundice, and photophobia with conjunctivitis, in person who was in contact with animal urine?
Leptospirosis (Leptospira interrogans)
--> severe form = Weil's disease
93
Weil's disease
=Icterohemorrhagic Leptospirosis
--> severe form of Leptospirosis (Leptospira interrogans): jaundice and azotemia (from liver and kidney dysfxn); fever, hemorrhage, anemia
94
water contaminated with animal urine? Think:
- Leptospira
| - Hantavirus
95
Ixodes tick
vector for:
- Lyme disease (Borrelia burgdorferi)
- Babesia
96
3 stages of lyme disease:
"BAKE a key Lyme pie!" (Bell's palsy, Arthritis, Kardiac block, Erythema migrans)
Stage 1: erythema chronicum migrans (bull's eye rash), flu-like symptoms
Stage 2: Neurologic (bilateral or unilateral Bell's palsy) and Cardiac (AV nodal block) manifestations
Stage 3: chronic monarthritis and migratory polyarthritis
97
Treatment for Lyme disease: at early stages (1 and 2)? Later disease?
Doxycycline --> for early stages
| Ceftriaxone --> later disease
98
Treatment of choice for Syphilis?
Penicillin G!
99
primary syphilis:
painless chancre (localized)
100
secondary syphylis:
(secondary = systemic) disseminated disease with constitutional symptoms
- maculopapular rash (palms and soles)
- condyloma lata
- visualize treponemes from chancres and condyloma lata by darkfield microscopy
101
tertiary syphilis
- gummas (chronic granulomas)
- aortitis (VASO VASORUM DESTRUCTION!)
- neurosyphilis = tabes dorsalis
- Argyll Robertson pupil
- Signs: ataxia, + Romberg, Charcot joint, stroke but no HTN
102
FTA-ABS
test used to confirm syphilis (screening test = VDRL)
103
CN VIII deafness in a neonate?
Congenital syphilis (other signs = saber shins (ant bowing of tibia), saddle nose (flat nasal bridge), Hutchinson's teetch (notching of upper incisors), mulberry molars)
104
What may cause a false positive VDRL (screening test for syphilis)?
Viruses (mono, hepatitis)
Drugs
Rheumatic fever
Lupus and Leprosy
* note: VDRL detects a nonspecific antibody that reacts with beef cardiolipin
* can confirm dx of syphilis with FTA-ABS
105
Transmitted by lice/louses?
Borrelia recurrentis and Rickettsia rickettsii
106
Transmitted by spores from tick feces and cattle placenta?
Coxiella burnetti --> causes Q fever
107
transmitted by animal/cat/dog bites? symptoms?
Pasteurella multocida --> cellulitis, osteomyelitis
108
Transmitted by fleas?
Rickettsia typhi, Yersinia pestis (Yersinia is also transmitted by rodents, prairie dogs...)
109
Treatment for all Rickettsial diseases?
Doxycycline
110
Headache + Fever + Rash that starts on palms and soles?
Rickettsia rickettsii = Rocky Mountain spotted fever (transmitted by tick)
111
Headache + Fever + Rash that starts centrally and spreads outward without involving palms or soles?
Rickettsia typhi = Rickettsia prowazekii (transmitted by louse) --> "Typhus on Trunk"
112
Q fever
- presents as pneumonia
- caused by Coxiella burnetti (part of Rickettsia)
* "Queer" b/c:
- no rash
- no vector (transmitted by inhaling aerosoles from ticks feces or cattle placenta)
- negative Weil-Felix
- no "Rickettsia" in genus name
113
Weil-Felix Reaction
DX Rickettsia (not Coxiella though)--> mix pt's serum (with anti-Rickettsial antibodies) with Proteus antigens --> antirickettsial antibodies cross-react to Proteus O antigens and agglutinate
114
Cytoplasmic inclusions seen on Giemsa or Fluorescent antibody-stained smear
Lab dx for Chlamydia
115
Treatment for Chlamydia?
- 1st line = Azithromycin
| - Or: Doxycyline
116
Chlamydia: What is associated with each types:
- A, B, C:
- D-K:
- L1, L2, L3
- A, B, C: blindness in Africa, chronic infection
- D-K: urethritis, PID, ectopic pregnancy, neonatal pneumonia, neonatal conjuctivitis
- L1, L2, L3: lymphogranuloma venereum (acute lymphadenitis)
117
3 main organisms that cause interstitial/atypical/walking pneumonia?
* Chlamydia pneumonia
* Mycoplasma pneumonia (most common)
* Legionella pneumophila
118
RBC agglutination or lysis in cold temperatures?
Mycoplasma pneumonia --> cold agglutinins (IgM)
--> this happens b/c Mycoplasma pneumonia shares antigens with human RBCs, so when body mounts a response against antigens, it also lyses RBCs, leading to anemia; antibodies that cause this RBC destruction = cold agglutinins
119
only bacterial membrane that contains cholesterol?
Mycoplasma pneumonia
120
Treatment for Mycoplasma pneumonia?
tetracycline or erythromycin
121
5 Infections associated with birds:
1) Histoplasmosis --> pneumonia
2) Cryptococcus --> meningitis in AIDS pts
3) Chlamydia psittaci --> atypical pneumonia
4) Avian influenza
5) West Nile Virus
122
Exotoxin A
2 organisms have an exotoxin A:
- Pseudomonas (similar to diphtheria toxin, inactivates EF2)
- Group A Strep (similar to TSST1of Staph aureus --> superantigen, causes shock)
*note: there's also an alpha toxin (lecithinase) that Clostridium perfringens has...
123
Pneumonia, after pt was in:
1) Mississippi or Ohio river valleys
2) States east of Mississippi River and Central America
3) Southwestern US, California
4) Latin America
1) Histoplasmosis
2) Blastomycosis
3) Coccicidomycosis
4) Paracoccidioidomycosis
124
Dimorphic fungi: List them. What do they all cause? What makes them dimorphic?
- all cause pneumonia and can disseminate
- dimorphic: mold in cold (20 degrees); yeast in heat (37 degrees); exception = coccidiomycoides = spherule (not yeast) in tissue
- Includes:
1) Histoplasmosis
2) Blastomycosis
3) Coccidioidomycosis
4) Paracoccidioidomycosis
125
pneumonia-causing fungi that forms spherules filled with endospores in tissues (much larger than RBCs)
Coccidioidomycosis
126
meningitis, pneumonia, and dissemination to bone and skin following an earthquake?
Coccidioidomycosis
127
Budding yeast with "captain's wheel" appearance?
Paracoccidioidomycosis
128
spaghetti and meatball appearance on KOH prep
Tinear versicolor (caused by Malassezia furfur); degrades lipids and produces acids that damage melanocytes --> so get hypopigmented and/or hyperpigmented patches
129
Dimorphic yeast: pseduohyphae and budding yeasts at 20 C; germ tubes at 37 C
Candida albicans
130
Branching septate hyphae that branch at acute angles, not dimorphic. Get a "fungus ball"
Aspergillus fumigatus (especially in immunocompromised pts or pts with Chronic granulomatous disease)
131
Heavily encapsulated yeast (budding yeast form only); have wide capsular halos and unequal budding
Cryptococcus
132
Meningitis in AIDS pt?
Cryptococcus
133
"soap bubble" lesions in brain?
Cryptococcus
134
How do you culture Cryptococcus? Stain?
Culture on Sabourad's agar
| Stain with India ink
135
nonseptate hyphae that branch at wide angles?
Mucor and Rhizopus species (Mucormycosis)
136
Fungus that causes a black necrotic eschar on face?
Mucor and Rhizopus
137
Fungus that penetrates cribriform plate and enter brain --> get frontal lobe abscesses, headache, facial pain, maybe cranial nerve involvement?
Mucor and Rhizopus
138
disk-shaped yeast on methenamine silver stain?
Pneumocystis jiroveci
139
When do you start PCP prophylaxis in HIV pt?
when CD4 < 200 cells/mm3
140
Dimophic, cigar-shaped budding yeast that causes ascending lymphangitis
Sporothrix schenckii = rose gardner's disease
141
Severe diarrhea in AIDS pt?
Cryptosporidium
142
infant born with triad of: chorioretinitis, hydrocephalus, intracranial calcifications?
congenital toxoplasmosis
143
transmission by Tsetse fly; painful bite
-Trypanosoma brucei (gambiense, rhodesiense); causing African sleeping sickness (enlarged lymph nodes, recurring fever, somnolence, coma)
144
Transmitted by Anopheles mosquito
Plasmodium (malaria)
145
When do you give Primaquine and why?
Give to pts with Plasmodium vivax/ovale --> because there's a dormant form that lives in liver (hypnozoite) that chloroquine/mefloquine can't get.
146
"maltese cross" on blood smear?
Babesiosis (transmitted by Ixodes tick, same as Lyme disease)
147
transmitted by Reduviid bug (painless bite)
Trypanosoma cruzi = Chaga's disease
148
Achalasia (dilated esophagus and absent peristalsis in esophagus), and dilated cardiomyopathy
Chagas disease (also may have megacolon)
149
spiking fevers, hepatosplenomegaly, pancytopenia; and "amastigotes" within macrophages?
visceral Leishmaniasis = "kala-azar
150
transmitted by sandfly?
Leishmaniosis
151
most common nematode infection in US?
Enterobius vermicularis = pinworm! test with scotch tape test (best!!)
152
1/3rd of world's popl is infected with this worm?
Ascaris lumbricoides = giant roundworm
153
Nematodes that can cause anemia?
Ancylostoma, Necator (hookworms)
154
Treatment for Intestinal nematode infections?
- bendazoles
| - pyrantel pamoate
155
transmitted by female blackflies?
-Onchocerca volvulus
156
causes hyperpigmented skin and river blindness?
Onchocerca volvulus (blackflies, black skin, black visions)
157
Treatment for Onchocerca volvulus?
Ivermectin (for river blindness!)
158
can see worm crawling in conjunctiva?
Loa Loa
159
Elephantiasis (appears about 1 year post bite by mosquito)
Wuchereria bancrofti
160
Transmitted by eating larvae in pork: get cysticercosis and neurocysticercosis, mass lesions in brain (with swiss cheese appearanc) --> seizures, altered mental status, coma...
Taenia solium
161
Ingest larvae in raw freshwater fish; causes B12 deficiency
Diphyloobothrium latum
162
causes anaphylaxis if organism's antigens are released from cysts (so must kill daughter cysts before attempting to remove surgically)
Echinococcus granulosus
163
snails are the host
Schistosoma
164
inflammation of spleen and liver; can lead to squamous cell carcinoma of bladder
Schistosoma
165
Nematodes routes of infection:
- ingested?
- cutaneous?
Ingested: "EAT" these:
- Enterobius
- Ascaris
- Trichinella
Cutaneous: get into your feet through the "SANd"
- Strongyloides
- Ancylost`oma
- Necator
166
Parasite hint: brain cysts, seizures
Taenia solium (cysticercosis)
167
Parasite hint: liver cysts
Echinococcus granulosus
168
Parasite hint: B12 deficiency
Diphyllobothrium latum
169
Parasite hint: Biliary tract disease, cholangiocarcinoma
Clonorchis sinensis
170
Parasite hint: portal hypertension
schisto
171
Parasite hint: hematuria, bladder cancer
schisto
172
Parasite hint: perianal pruritus
Enterobius
173
Live-attenuated vaccines:
"Live! see Small Yellow Chickens get vaccinated with Sabin's and MMR!"
- smallpox
- yellow fever
- chickenpox (VZV)
- Sabin's (polio)
- MMR
* also: intranasal influenza vaccine
174
Killed vaccines:
"RIP Always":
- Rabies
- Influenza (intramuscular)
- Polio -- salk (SalK = Killed)
- HAV
175
Recombinant vaccines
HBV (recombinant HBsAg angtigen)
| HPV (types 6, 11, 16, 18)
176
What HPV strains are in the vaccine?
6, 11, 16, 18
177
Only DNA virus that is ssDNA (the rest are dsDNA)
Parvovirus (part-of-a-virus)
178
Only RNA virus that is dsRNA (the rest are ssRNA!)
Reovirus ("repeat-o-virus")
179
All viruses are haploid (1 copy of DNA or RNA) except?
Retroviruses: have 2 identical ssRNAs
180
Where do DNA viruses replicate? exception?
Nucleus (except poxvirus replicates in cytoplasm)
181
Where do RNA viruses replicate? Exception?
Cytoplasm (except influenza virus and retroviruses --> in nucleus)
182
Naked/Non-enveloped viruses:
"Naked CPR and PAPP smears!" (PAPP=DNA; CPR = RNA)
- Calcivirus
- Picornavirus
- Reovirus
- Parvovirus
- Adenovirus
- Papilloma
- Polyoma
183
List the DNA viruses
DNA viruses are "HHAPPPPy!"
- Hepadnavirus
- Herpesvirus
- Adenovirus
- Parvovirus
- Poxvirus
- Polyomavirus
- Papillomavirus
184
General rules about DNA viruses (and exceptions):
All DNA viruses are:
- dsDNA (except Parvovirus)
- liner (except Polyoma, Papilloma, and Hepadna)
- icosahedral (except Pox)
- replicate in nucleus (except Pox)
185
Acute hemorrhagic cystitis (hematuria + dysuria), febrile pharyngitis
Adenovirus
186
Aplastic crisis in sickle cell pt?
Parvovirus B19
187
Progressive multifocal leukoencephalopathy (PML) in HIV pts?
JC virus (Polyomavirus)
188
flesh-colored dome lesions with central lesion; resolves on own (usually)
molluscum contagiosum (poxvirus)
189
Where are these herpesviruses latent?:
- HSV1
- HSV2
- VZV
- EBV
- CMV
* HSV1--> trigeminal ganglia
* HSV2 --> sacral ganglia (S2 and S3)
* VZV --> trigeminal or dorsal root ganglia
* EBV--> B cells
* CMV --> mononuclear cells
190
Cancers associated with EBV?
- Burkitt's lymphoma, Hodgkin's lymphoma
| - Nasopharyngeal carcinoma
191
Roseola
HHV-6 "sixth disease"
| --> high fevers for several days, followed by diffuse macular rash
192
What are the atypical lymphocytes in EBV?
NOT infected B cells! They're activated CD8+ cytotoxic T-cells--> "Downy cells" with foamy cytoplasm
193
Which HPV strains are associated with warts? CIN, cervical cancer?
Warts: 1, 2, 6, 11
| CIN/Cervical cancer: 16, 18
194
#1 cause of fatal diarrhea in kids? (fatal by dehydration)
Rotavirus (a Reovirus)
195
List the Picornaviruses:
```
"PERCH"
Poliovirus
Echovirus
Rhinovirus
Coxsackievirus
Hep A virus
```
196
Norwalk virus
A calcivirus
| --> viral gastroenteritis
197
List the Flaviviruses:
```
HCV
Yellow Fever
Dengue
St. Louis encephalitis
West Nile virus
(all are arboviruses, except for HCV)
```
198
List the Togaviruses:
Rubella (German measles)
Eastern equine encephalitis
Western equine encephalitis
199
What does Coronavirus cause?
- Common Cold
| - SARS
200
Influenza virus is part of what viral family?
Orthomyoxvirus
201
Paramyxoviruses
Parainfluenza = croup
RSV--> bronchiolitis in babies
Rubeola = Measles
Mumps
202
Negative-stranded viruses:
have to transcripe (-) strand to (+); so, bring their own RNA-dep-RNA-pol. Includes: "Always Bring Polymerase Or Fail Replication"
- Arenaviruses
- Bunyaviruses
- Paramyxoviruses
- Orthomyxoviruses
- Filoviruses
- Rhabdoviruses
203
Segmented viruses:
"BOAR"
- Bunyaviruses
- Orthomyxoviruses (influenza!)
- Arenaviruses
- Reoviruses
204
Most common cause of viral aseptic meningitis?
Enteroviruses (the Picornaviruses, minus Rhinovirus; specifically: Echovirus and Coxsackievirus)
205
Which part of spinal cord does poliovirus affect?
Affects MOTOR neurons of the ANTERIOR horn; causes paralysis
206
Transmitted by the Aedes mosquito?
Yellow Fever virus (a Flavivirus)
207
High fever + black vomitus (coffee-ground emesis) + Jaundice + red tongue with white center
```
Yellow Fever (Flavivirus, transmitted by Aedes mosquito)
--> black vomitus is from GI bleeding
```
208
How does Rotavirus lead to diarrhea?
Villous destruction with atrophy, leads to decreased absorption of Na+ and H2O
--> it's fatal by dehydration
209
Hemagglutinin and Neuraminidase
Influenza antigens:
- HA--> promotes viral entry
- NA--> promotes progeny virion release
210
F (fusion) protein
Surface protein of Paramyxoviruses --> causes respiratory epithelial cells to fuse and form multinucleated giant cells
--> Palivizumab = monoclonal antibody against F protein; prevents pneumonia in premature infants
211
Low-pitched cough vs High-pitched cough
Low-pitched --> Seal-like barking cough = Croup = Paraifluenza
High-pitched --> RSV
212
Palivizumab
monoclonal antibody against the F protein of Paramyxoviruses; given to premature infants to prevent pneumonia from RSV
213
Cough + Coryza (nasal, cold symptoms) + Conjunctivitis
Measles
214
Mumps causes:
"POM"
- Parotitis
- Orchitis
- aseptic Meningitis
--> may lead to infertility after puberty
215
cytoplasmic inclusions in Purkinje cells of cerebellum
Negri bodies of Rabies (commonly found in Purkinje cells of cerebellum)
216
virus travels to CNS by migrating in a retrograde fashion up nerve axons
Rabies virus
217
What kind of Polymerase does HBV carry?
DNA-dep-DNA-pol
218
HBsAg
Hepatitis B infection
219
anti-HBsAg
immunity to Hep B (vaccine or recovered from disease)
220
HBeAg
active viral replication; high transmissibility
221
anti-HBeAg
low transmissibility
222
HBcAg
can't see this in serum; but, indicates new disease
223
anti-HBcAg: IgM? IgG?
IgM --> acute/recent infection
IgG --> chronic disease
*Positive during window period
*not present if vaccinated; only if have/had disease
224
ALT:AST in viral hepatitis? alcholic hepatitis?
alcoholic hepatitis: AST>ALT
| viral hepatitis: ALT>AST
225
HIV envelope proteins:
gp120 and gp41: acquired from budding through host cell plasma membrane:
gp120--> attachment to host cell; "docking glycoprotein"
gp41--> fusion and entry; transmembrane glycoprotein
226
HIV capsid protein
gag (p24)
227
HIV pol protein:
Reverse transcriptase (synthesizes dsDNA from RNA)
228
What does HIV bind on T-cells? on macrophages?
T-cells: HIV binds CXCR4 or CCR5 co-receptor and CD4
| Macrophages: CCR5 and CD4
229
Why do ELISA/Western blot tests often give false-positives in babies born to HIV-infected mothers?
Because anti-gp120 can cross the placenta
230
HIV diagnosis: Which test is initially used? Then which test is used to confirm positive results?
1) ELISA --> high false positive rate (high sensitivity, low specificity; "Rule out" test)
2) Western blot assay (high false negative rate; high specificity, low sensitivity; "rule in" test)
231
3 ways to dx AIDS:
1) CD4 < or = 200
2) AIDS indicator condition in HIV + pt: ie PCP
3) CD4/CD8 ratio < 1.5
232
chronic watery diarrhea in AIDS pt
Cryptosporidium (see acid-fast cysts in stool, esp when CD4<200)
233
Encephalopathy in AIDS pt
JC virus reactivation (get demyelination)
234
Neuro Abscesses in AIDS pt
Toxoplasmosis (ring-enhancing lesions; CD4<100)
235
Meningitis in AIDS pt
Cryptococcus (may also cause encephalitis; india ink stain --> see yeast with narrow-based budding and large capsule; CD4<50)
236
Retinitis in AIDS pt
CMV (cotton-wool spots on funduscopic exam; may also have esophagitis; CD4<50)
237
Dementia in AIDS pt
Directly associated with HIV; but, rule out other causes
238
AIDS pt with superficial vascular proliferation: Biopsy shows neutrophilic inflammation? lymphocytic inflammation?
* Neutrophilic inflammation --> "Bacillary angiomatosis" --> Bartonella henselae
* Lymphocytic inflammation --> HHV-8 = Kaposi's sarcoma
239
low fevers, cough, hepatosplenomegaly, tongue ulcer (basically, systemic disease) in AIDS pt?
Histoplasmosis (see oval yeast cells within macrophages)
240
Hairy leukoplakia (white stuff on lateral part of tongue) in AIDS pt
EBV
241
Primary CNS lymphoma in AIDS pt
EBV
242
Interstitial pneumonia (with intranuclear inclusion bodies on biopsy) or regular pneumonia (esp with CD4<200) in AIDS pts?
* Interstitial pneumonia with owl's eye inclusion bodies --> CMV
* Pneumonia with CD4 PCP
243
Pleuritic pain, Hemoptysis, infiltrates on imaging in AIDS pt
Invasive Aspergillosis
244
TB-like disease in AIDS pts (esp CD4<50)
Mycobacterium Avium - Intracellulare
245
3 bugs that can cause mesenteric adenitis (so may mimic appendicitis):
- Yersinia enterocolitica
- Campylobacter
- non-typhoidal Salmonella
246
Bloody Diarrhea...
is SEEECSY!
- Salmonella
- EHEC
- EIEC
- Entamoeba
- Campylobacter
- Shigella
- Yersinia
247
Causes of watery diarrhea?
- ETEC
- C. diff
- C. perfringens
- Cholera
- Protozoa: Giardia and Cryptosporidium (in imm-compromised)
- Viruses: Rotavirus, Adenovirus, Norwalk virus
248
3 main causes of atypical pneumonia:
- Mycoplasma
- Legionella
- Chlamydia
249
Cause of osteomyelitis in most pts?
S. aureus
250
Cause of vertebral osteomyelitis?
M. tb (Pott's disease)
251
Cause of osteomyelitis in Sickle cell pt?
Salmonella
252
Elderly pt with delirium?
UTI or anti-cholinergic drugs side effects
253
Positive nitrite test
Specific for gram (-) bacterial UTI
254
Positive leukocyte esterase test
non-specific for bacterial UTI
255
UTI -causing bug; motile, so "swarms" on agar; produces urease, and associated with struvite stones
Proteus
256
Hydrops fetalis in utero cause?
Parvovirus B19
257
neonate with chorioretinitis + hydrocephalus + intracranial calcifications?
congenital Toxoplasma
258
Neonate with PDA (or pulmonary artery hypoplasia) + cataracts + deafness +/- "blueberry muffin" rash (purpura d/t thrombocytopenia)
congenital Rubella
259
Neonate with unliateral hearing loss + seizures + petechial rash + "blueberry muffin" rash
congenital CMV
260
Neonate with temporal encephalitis and vesicular lesions
congenital HSV-2
261
often results in stillbirth, hydrops fetalis; if infant is born: facial abnormalities, CN VIII deafness, teeth issues... etc...
congenital Syphilis
262
Rubella, Rubeola, Roseola
* Rubella = "German measles" --> rash begins at head and moves down; have a truncal rash; post-auricular lymphadenopathy
* Rubeola = Measles --> first: cough, coryz, conjunctivitis, Koplik spots on tongue; then: rash starts at head and moves down
* Roseola = HHV-6: macular rash over body after several days of high fever; usually in infants
263
Erythematous, sandpaper-like rash with fever and sore throat
Scarlet Fever (GAS)
264
vesicular rash on palms and soles; ulcers in mouth
Hand-Foot-Mouth disease (Coxsackie A virus)
265
strawberry-colored cervical mucosa, corkscrew motility on wet prep, vaginitis
Trichomoniasis
266
Koilocytes
look like fried eggs! (squamous cells with perinuclear cytoplasmic clearing)
--> HPV 6 and 11
267
Most common bacterial STD in US?
Chlamydia trachomatosis
268
Antibiotics/anti-microbials that should NOT be taken during pregnancy:
"Countless SAFe Moms Take Really Good Care"
- Clarithromycin
- Sulfonamides --> kernicterus
- Aminoglycosides --> ototoxicity
- Fluoroquinolones --> cartilage damage
- Metronidazole --> mutagenesis
- Tetracyclines --> discolored teeth, inhibition of bone growth
- Ribavirin (antiviral) --> teratogenic
- Griseofulvin (anti-fungal) --> teratogenic
- Chloramphenicol --> "gray baby"
269
Side effects: Hyperglycemia, Lipodystrophy (deposition of fat on back and abdomen), Nausea, Diarrhea
HIV: Protease inhibitors (all end in "-navir"
270
HIV drug that can cause nephrotoxicity and nephrolithiasis
Indinavir (protease inhibitor)
271
HIV drug that can cause pancreatitis
Ritonavir (protease inhibitor)
272
HIV drugs that lead to bone marrow suppression
NRTIs (nucleoside reverse transcriptase inhibitors) --> especially Zidovudine (ZDV), but all of them...
273
HIV drug that can cause megaloblastic anemia
ZDV (Zidovudine), a NRTI
274
Protease inhibitors mechanism:
Inhibit HIV-1-protease (pol gene) from cleaving the polypeptide products of HIV mRNA into functional parts, so can't assemble virions --> prevent maturation of new viruses
275
NRTIs vs NNRTIs
- NRTIs--> COMPETITIVELY inhibit nucleotide binding to reverse transcriptase; must be phosphorylated by thymidine kinase to be active
- NNRTIs --> NON-COMPETITIVELY bind to reverse transcriptase (site diff from NRTI's); don't need to be phosphorylate to be active.
276
Antimicrobial drugs that act on 50S ribosomal subunit to block protein synthesis:
- Chloramphenicol
- Macrolides
- Streptogramins
- Clindamycin
- Linezolid
277
Antimicrobials that block protein synthesis AT 30S ribosomal subunit?
- Aminoglycosides
| - Tetracyclines
278
Vancomycin and Bacitracin mechanism?
-block peptidoglycan synthesis
279
Fluoroquinolone mechanism?
blocks DNA topoisomerase
280
Penicillin mechanism of action:
- block cell wall synthesis by inhibiting peptidoglycan cross-linking
- bind PBPs (penicillin-binding proteins)
- activate autoclytic enzymes
281
Penicillinase-Resistant Penicillins:
- list them
- why are they resistant to penicillinase (Beta-lactamase)?
- clinical use?
- Methicillin, Nafcillin, Dicloxacillin
- have a bulkier R group, so are resistant to penicillinase
- used to treat S. aureus (but, not MRSA, b/c altered penicillin-binding protein target site)
282
Clinical use for Aminopenicillins (Ampicillin and Amoxicillin):
"HELPSS kill Enterococci"
- H. influenza
- E. coli
- Listeria
- Proteus
- Salmonella
- Shigella
- Enterococci
283
Tibarcillin, Carbenicillin, Piperacillin
=Carboxypenicillins = anti-Pseudomonals
"Take Care of Pseudomonas"
-used to treat Pseudomonas!
284
Beta-lactamase inhibitors: CAST
- Clavulonic Acid
- Sulbactam
- Tazobactam
*can add to penicillinase-sensitive antibiotics to prevent destruction by Beta-lactamases (ie to aminopenicillins)
285
Beta-lactamase inhibitors: CAST
- Clavulonic Acid
- Sulbactam
- Tazobactam
*can add to penicillinase-sensitive antibiotics to prevent destruction by Beta-lactamases (ie to aminopenicillins)
286
Antimicrobials that block cell wall synthesis by inhibiting peptidoglycan cross-linking:
- Penicillin
- Methicillin
- Ampicillin
- Piperacillin
- Cephalosporins
- Aztreonam
- Imipenem
286
Antimicrobials that block cell wall synthesis by inhibiting peptidoglycan cross-linking:
- Penicillin
- Methicillin
- Ampicillin
- Piperacillin
- Cephalosporins
- Aztreonam
- Imipenem
287
Antimicrobials that block peptidoglycan synthesis
- Vancomyci
| - Bacitracin
287
Antimicrobials that block peptidoglycan synthesis
- Vancomyci
| - Bacitracin
288
Antimicrobial that blocks nucleotide synthesis
- sulfonamides
- trimethoprim
***given together at TMP-SMX
288
Antimicrobial that blocks nucleotide synthesis
- sulfonamides
- trimethoprim
***given together at TMP-SMX
289
Antimicrobial that blocks DNA topoisomerases
Fluoroquinolones
* contraindicated in pregnant women and kids, b/c may damage cartilage
* only exception = can give fluoroquinolones to kids with CF
289
Antimicrobial that blocks DNA topoisomerases
Fluoroquinolones
* contraindicated in pregnant women and kids, b/c may damage cartilage
* only exception = can give fluoroquinolones to kids with CF
290
Antimicrobial that blocks mRNA synthesis?
Rifampin
290
Antimicrobial that blocks mRNA synthesis?
Rifampin
291
Antimicrobial that damages DNA?
Metronidazole
291
Antimicrobial that damages DNA?
Metronidazole
292
Antimicrobials that block protein synthesis at the 50S ribosomal subunit? 30S subunit?
"but AT 30, CCEL at 50"
* 30S subunit:
- Aminoglycosides
- Tetracyclines
* 50S subunit:
- Chloramphenicol
- Clindamycin
- Erythromycin (macrolides)
- Linezolid
292
Antimicrobials that block protein synthesis at the 50S ribosomal subunit? 30S subunit?
"but AT 30, CCEL at 50"
* 30S subunit:
- Aminoglycosides
- Tetracyclines
* 50S subunit:
- Chloramphenicol
- Clindamycin
- Erythromycin (macrolides)
- Linezolid
293
Are cephalosporins bacteriostatic or bactericidal?
Bactericidal
294
Mechanism of Cephalosporins?
They're Beta-lactam drugs that inhibit bacterial cell wall synthesis (like Penicillin, by inhibiting peptidoglycan cross-linking), but less susceptible to penicillinases
-->Bactericidal
295
'Which organisms are NOT covered by cephalosporins?
"LAME" organisms:
- Listeria
- Atypicals (ie Mycoplasma, Chlamydia)
- MRSA
- Enterococci
296
Chlamydia treatment:
Azithromycin or Doxycycline
297
N. meningitis treatment?
Ceftriaxone or Penicillin G
298
Treatment for Pseudomonas:
- Aminoglycoside + extended spectrum penicillin (ie an anti-pseudomonal: Ticarcillin, Carbenicillin, Piperacillin)
- -> can also treat with a 3rd gen cephalosporin (Ceftazidime) or 4th gen cephalosporin (Cefepime)
299
First generation cephalosporins coverage:
* gram (+) cocci
* "PEcK"
- Proteus
- E coli
- Klebsiella
300
Second generations cephalosporins coverage:
* gram (+) cocci
* "HEN PEcKS"
- H. influenza
- Enterobacter
- Neisseria
- Proteus
- E. coli
- Klebsiella
- Serratia
301
3rd generation cephalosporins coverage:
- serious gram (-) infections that are resistant to other Beta-lactams
* ceftriaxone: gonorrhea, meningitis, and late stage lyme disease (earlier, use doxycycline)
* ceftazidime: pseudomonas
302
4th generation cephalosporins coverage:
*increased activity against Pseudomonas and gram (+) organisms
303
Cefepime
4th generation cephalosporin; good for both gram (+) and gram (-) coverage
-->can be used to treat Pseudomonas
304
Ceftriaxone
3rd gen cephalosporin
| -treats gonorrhea, meningitis, and late stage lyme disease
305
Ceftazidime
3rd gen cephalosporin
| -can be used to treat Pseudomonas
306
Cefuroxime
2nd gen cephalosporin
307
Cefazolin
1st gen cephalosporin
308
cephalexin
1st gen cephalosporin
309
cefoxitin
2nd gen cephalosporin
310
cefaclor
2nd gen cephalosporin
311
cefotaxime
3rd gen cephaolosporin
312
3 Cephalosporin toxicities:
- may cross react with penicillins
- increased nephrotoxicity when given with Aminoglycosides
- Disulfiram-like reaction when take with ethanol
313
Mechanism and Clinical uses of Aztreonam:
*mechanism: inhibits cell wall synthesis by binding to PBP and inhibiting peptidoglycan cross-linking
* Clinical uses:
- ONLY gram (-) rods
- ->give to pts who are allergic to penicillins or pts who can't tolerate aminoglycosides (b/c renal insuficiency; b/c side effect of aminoglycosides = nephrotoxicy, and aminoglycosides also treat gram (-) rods)
314
Imipinem:
broad-spectrum antibiotic
***Always given with Cilistatin (to prevent inactivation of Imipinem in renal tubules)
***only used for severe life-threatening conditions or after failure of other drugs, b/c has bad side effects (GI, CNS toxicities--> seizures)
315
Drugs that binds D-ala D-ala on bacterial cell wall precursors?
Vancomycin
316
Clinical use of vancomycin?
Gram (+) ONLY!
| -->including: MRSA, C. diff (oral dose), enterococci
317
Toxicites of Vancomycin:
"NOT the Red Man!"
- Nephrotoxicity
- Ototoxicity
- Thrombophlebitis
- Red man syndrome = diffuse flushing
