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Flashcards in Pathogens with Respiratory Transmission Deck (73)
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1

Three primary bacteria discussed in this packet

Mycobacterium
Mycoplasma
Corynebacterium

2

Staining used for mycobacterium?

Acid-Fast

3

Describe the growth of mycobacteria?

Very Slow (18hours)
Growth from one pole

4

Significance of mycobacteria growth time?

Culturing is too slow for diagnosis

5

mycobacterial structure associated with virulence?

Serpentine Cord Formation

6

Describe the mycobacterial cell wall

Made with mycolic acids (very hydrophobic
Waxy part of outer layer

7

Significance of mycolic acids in mycobacterium? (2)

Acid-Fastness
Prevents lysozyme or complement attack

8

What is Freund's Adjuvant?

The waxy part of the outer layer of mycobacteriua
Antigenic

9

What is LAM? Why do we care?

Lipoarabinomannan
Stimulates cytokine production by mammalian host

10

TB promotes what other disease?

HIV

11

Symptoms of mycobacterium tuberculosis?

Fatigue, Fever, Night Sweats, Weight Loss, Hemoptysis

12

Primary presentation of mycobacterium tuberculosis?

Exudative lesion (edema, inflammation)
Usually Unnoticed

13

Three potential responses to exudative lesions?

Healing
Necrotizes lung
Productive Lesion

14

A productive lesion will cause a _____ to occur. This can cause these two responses.

Granuloma
Encasing or Spreading (via lymph, bronchi, or blood)

15

Encases granulomas run the risk of

Reactivation
Leads to multiple granulomas, fibrination of lung

16

Mycobacterium tuberculosis spread in the blood can lead to ...

Miliary TB

17

What is caseum?

Necrotic tissue damaged by inflammatory response and lack of vascularization

18

Why are caseum especially bad in mycobacterial infection?

The hollowed areas they leave behind may allow encapsulated TB to escape

19

Prevalence of TB?

2B people in the world infected (30%)

20

TB at risk populations in the US? (5)

Minorities and Immigrants
Co-Existing Infection (esp. HIV)
Homeless
Very Young or Old
Travelers in High Risk Areas

21

How is TB spread?

Person-to-Person via respiratory droplets

22

What does TB do when in the body?

Attach to alveolar macrophages and invade
Prevent Phagolysosome fusion
Cytotoxicity from cord factor
Cytokine-mediated inflammation

23

T or F. TB always presents with primary symptoms of the lungs.

False. Rarely primary extrapulmonary symptoms will occur.

24

Two sites where long term TB retention may occur.

Granulomas and Bone Marrow.

25

Two tests used to detect TB?

Mantoux (PPD) Test
QuantiFERON-Gold assay (IGRA)

26

How does a Mantoux (PPD) Test work?

Intradermal Protein Injection
Sensitivity within 72 hours indicates that Tmem cells were present

27

How does a QuantiFERON-Gold assay work?

Tests for releave of IFN-g from peripheral lymphocytes when exposed to TB antigen

28

Best method of diagnosing TB?

PCR

29

Two ineffective means of diagnosing TB?

Culture (too slow)
Acid-fast sputum stain (requires massive inf. to detect)

30

What does a IGRA+ or PPD+ patient with no symptoms and normal X ray indicate? What should you do?

Latent TB
Latent TB MUST be treated

31

Drug therapy commonly used to treat tuberculosis patients?

INH, Rifampin, Pyrazinamide, Ethambutol daily for 6-9 months

32

Drug therapy commonly used for latent TB?

Just INH

33

What non-chemical treatment method is important in some patients?

Directly Observed Therapy

34

Why might someone except to see TB+ patients very commonly in other countries?

Other parts of the world vaccinate for TB

35

How do you treat XDR-T patients? (3)

Meropenem + Clavulanate
Linezolid is effective, but almost always causes adverse events
Bedaquiline

36

Two manifestations of mycobacterium leprae?

Tuberculoid Leprosy
Lepromatous Leprosy

37

Describe tuberculoid leprosy (paucibacillary).

Macular Lesions
Nerves on One Side (occasional bilateral) Involved

38

Describe lepromatous leprosy (multibacillary)

Progressive Nodular Lesions
Bilateral Nerve Death --> Bone Resorption/Extremity Loss

39

Which form of leprosy is rare in the modern era

Lepromatous

40

Describe the skin markings seen on patients with mycobacterium leprae

Whitened, anaesthetized skin area with red ring around it

41

Most mycobacterium leprae cases come from what parts of the world? How is it transmitted?

Asia and Africa
Long-term contact

42

What organisms can have mycobacterium leprae infections?

Humans and Armadillos

43

Describe the pathogenesis of mycobacterium leprae.

Inflammatory disease (like TB)
Inflammation damages Nerve Endings
Hyposensitivity can cause soft tissue damage and bone loss

44

How do you treat mycobacterium leprae?

Dapsone (sulfone) + Rifampin

45

Significance of M. avium-intracellulare?

Most common hospital-acquired bacterial infection of AIDS patients

46

Treatment for M. avium-intracellulare?

Clarithromycin + Ethambutol for life

47

How does M. kansasii present?

TB-like symptoms in IC patients

48

Describe the physical structure of mycoplasm bacteria

Probably the smallest possible free-living entity
No Cell Wall, Membrane Only with Sterols

49

How do mycoplasm generate sterols?

They don't. They take them from the host.

50

Describe what you would see in attempting to culture mycoplasm pneumoniae.

Grows Slowly
Tiny Colonies with Depressed centers (Fried Egg Appearance)

51

Describe the clinical presentation of mycoplasma pneumoniae

Mild atypical (wheeze+crackle) pneumonia
tracheobronchitis
Insidious Onset
Mild Fever + Dry Cough

52

How is mycoplasma pneumoniae transmitted?

Transmitted via respiratory droplets

53

Circumstances in which mycoplasma pneumoniae is more common.

Schoolchildren
Winter

54

Describe the pathogenesis of mycoplasma pneumoniae.

Proline-rich adhesion protein forms elongated tip, binds epithelial cells.
Protein M blocks the Ab Fab region
Cyotoxic Effects

55

List cytotoxic effects of mycoplasma pneumonia

Production of H2O2, O2-
Competition for nutrients

56

How is mycoplasma pneumonia

Typically don't treat if mind
Tetracycline, Erythromycin

57

What drug are you a doof if you give to treat mycoplasma.

Penicilin
Mycoplasma don't have a cell wall

58

Mycoplasma genetalium manifest in what three ways?

Normal Flora
Urethral Infections
Genital Infections

59

Manifestations of mycoplasma hominis?

10% of salphingitis
Post-partum fever

60

Unique metabolic activity of ureaplasma urealyticum?

Requires 10% urea to grow

61

Long term effect of ureaplasma urealyticum metabolism?

Generates an alkalinized environment
Causes bladder stones
Bladder stones --> Non-gonococcal urethritis in males

62

Describe the physical structure of Corynebacterium diphtheriae

G+ with mycolic acids in outer mem
Club Shaped
Pleomorphic

63

Important diagnostic test for Corynebacterium diphtheriae.

Plate on tellurite blood agar, will reduce potassium tellurite to tellurium (turn it black)

64

Clinical presentation of Corynebacterium diphtheriae?

Throat Infection -- sore throat, fever
"Bull-Neck" -- Swollen Lymph Nodes
Pseudomembrane -- forms at back of throat and may obstruct airway
Toxin

65

Effects of Corynebacterium diphtheriae toxin?

Absorbed in blood -- affects heart, liver, kidneys

66

How are toxigenic strains of Corynebacterium diphtheriae identified?

Elek immunodiffusion test
Filter paper with antitoxin placed perpendicular to stain streaks
Toxin and Anti-Toxin form precipitate

67

How is Corynebacterium diphtheriae spread?

Aerosolized droplets

68

When is Corynebacterium diphtheriae typically acquired?

Usually a childhood disease, most adults immune from subclinical exposure (except not really)

69

Mortality rate of Corynebacterium diphtheriae

10-25%

70

Describe the pathogenesis of Corynebacterium diphtheriae.

- AB toxin from beta-phage conversion.
- B binds EGF-like receptor and it internalized. Low pH in vesicle allows hydrolysis, frees the A
- A binds NAD and ADP, ribosylates EF-2
- NO PROTEIN SYNTHESIS

71

How does Corynebacterium diphtheriae work its tox genes.

High Fe turns off toxAB operon
Free Fe is kept at low levels in the body
Corynebacterium diphtheriae only releases the toxin in the body

72

How is Corynebacterium diphtheriae prevented?

DTaP or DPT
Booster before school and every 10 years

73

How is Corynebacterium diphtheriae treated?

Quarantine
Equine anti-toxin in large dose
Penicillin/Erythromycin to keep bacteria low