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Systemic Flashcards

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1
Q

How does Staphylococci stain?

A

G+

catalase+

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2
Q

How do you differentiate Staph bugs?

A

S. aureus: alpha hemolysis, coagulase +

S. epidermidis and saprophyticus: coagulase -

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3
Q

Clinical presentations of Staph aureus due to growth of bacteria?

A

skin lesion: furuncle walled off by coagulase

folliculitis: localized to hair follicles after shaving or fomite
(complication from acne, primary cause is propionibacterium acnes)

non-bullous impetigo: superficial epidermis infection, causes crusted blisters (staph aureus is #1 cause, strep group A is #2)

Bacteremia and wound infections: surgical wounds often present as cellulitis; endocarditis

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4
Q

Clinical presentations of Staph aureus due to exotoxin release?

A

bullous exfoliation: “staphylococcal scalded skin syndrome”

bullous impetigo: painful fluid-filled blisters; almost always in infants

toxic shock syndrome: abrupt fever, rash, hypotension, multisystem involvement, DIC
menstrual and non-menstrual types, immune rxn. to TSST toxin

food poisoning: violent nausea, vomiting, occ. diarrhea, no fever, very quick onset and recovery
(vomiting > diarrhea, think B. cereus, S. aureus, norovirus)

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5
Q

Clinical presentation of Staph. epidermidis?

A

nosocomial infections associated with surgery and biofilms on implanted devices

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6
Q

Clinical presentation of Staph. saprophyticus?

A

UTI in women (but 90% of UTIs are UPEC E. coli)

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7
Q

What is the epidemiology of Staphylococci?

A

nosocomial and opportunistic

contact and fomites

normal flora in 100%, so can’t eradicate

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8
Q

Treatment of Staph?

A

nafcillin, oxacillin, cefazolin

tetracycline for furuncles

MRSA: SxT, clindamycin, doxycycline, linezolid (vancomycin if severe)

quinolones, SxT, amoxy/clav for S. saprophyticus

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9
Q

What do Streptococci and Enterococci look like?

A

G+ cocci

often in chains or pairs

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10
Q

How are Streptococci and Enterococci classified?

A

hemolysis: alpha (doesn’t steal Fe), beta (steals Fe), or gamma (none)

Lancefield serotyping: IDs by cell wall antigens

Biochemistry: Abx resistance, NaCl tolerance, bile-esculin

Colonization pattern: enterococci, lactococci, pneumococci

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11
Q

What is the only group A Strep and what type of hemolysis?

A

S. pyogenes

beta-hemolytic

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12
Q

Clinical presentation of invasive infections of S. pyogenes (group A Strep)?

A

human erysipelas (dermis and subQ infection)

puerperal fever: infection of uterus after delivery

surgical sepsis

scarlet fever: strep bacteremia (upper body rash, fever, strawberry tongue)

Streptococcal toxic shock-like syndrome

necrotizing fasciitis: deep cellulitis that spread through subQ into and through deep fascia (50% fatality)

pneumonia

bacteremia (fatality rate 35%)

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13
Q

How can you differentiate scarlet fever from measles by the rash?

A

measles starts on head, scarlet fever starts on torso

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14
Q

What are the local infections of Strep. pyogenes?

A

pharyngitis (strep throat): fever, anterior cervical lymphadenopathy, tonsil exudate, NO COUGH, can spread to middle ear, sinuses, and meninges

impetigo: crusty blisters, esp on face

acute rheumatic fever: heart valve damage after Strep throat (autoimmune)

acute glomerulonephritis: blood and protein in urine, may lead to chronic glomerulonephritis

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15
Q

What is the epidemiology of Strep. pyogens?

A

only reservoir is humans

strep throat: nasal droplets and contact, common in winter in kids age 6-13

impetigo: common in summer, contact and fomite spread

rheumatic fever: autoimmune 1-4wks after disseminated strep, occurs in .5-3% of untreated strep throat

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16
Q

What is the treatment of Group A Strep?

A

All Group A sensitive to PenG

rheumatic fever and acute glomerulonephritis: anti-inflammatory drugs and rest; PenG prophylaxis to prevent recurrent infections

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17
Q

What broad spectrum drug regimen covers Staph and Strep?

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A

vancomycin for staph

clindomycin for strep

18
Q

What Strep is Group B, and what type of hemolysis?

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A

Strep. agalactiae

beta hemolytic

19
Q

Clinical presentation of Strep. agalactiae (Group B)

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A

acute diseases in infants, immunocompromised, and elderly

neonatal sepsis and pneumonia

neonatal meningitis

respiratory distress syndrome, bacteremia, soft tissue infections in elderly

20
Q

Epidemiology of Strep. agalactiae (Group B)?

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A

infected mother to baby during delivery

25-30% of mothers are carriers, 50% chance of vertical transmission

21
Q

Control of Group B Strep?

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A

screen for Group B strep at 36 weeks; if + give ceph III or amp + streptomycin intrapartum (give to baby prophylactically if premature baby or test was not done)

22
Q

What organisms are in Group D Strep?

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A

S. bovis

Enterococci (faecalis, faecium, bovis)

23
Q

What type of hemolysis does Group D Strep. have?

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A

non-hemolytic (gamma), sometimes alpha

24
Q

Clinical presentations and epidemiology of Group D Strep?

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A

common nosocomial infections: bacteremia, endocarditis, UTI (from catheter)

transmitted on hands of hospital workers (often GI tract and bacteremia from colon lesions)

25
Control and treatment of Group D Strep?
MDR is very common (Enterococci resistant to beta-lactams) treat with penicillin + aminoglycoside pen or ceftriaxone for S. bovis vancomycin for Enterococcus, but high resistance in US
26
Type of hemolysis of Strep. viridans (oral)?
alpha hemolytic
27
Clinical presentation of Strep. viridans?
sub-acute bacterial endocarditis after tooth extraction or dental surgery (normal URT flora)
28
Treatment of Strep. viridans?
sub-acute bacterial endocarditis is 100% fatal if untreated long term high dose bactericidal antibiotics (pen, vanco) prophylactic antibiotic before oral surgery
29
How is Strep. pneumoniae (pneumococci) identified in culture?
alpha hemolytic diplococci with large PS capsule quelling reaction: antiserum against capsule is added, capsule will swell and have negative stain with methylene blue if S. pneumoniae is present
30
Clinical presentation of Strep pneumoniae?
sudden onset lobar pneumonia with fever, chills, sharp pain, mental confusion, and high leukocytes #2 cause of acute otitis media meningitis
31
Epidemiology of S. pneumoniae?
community, hospital, or ventilator acquired aspiration of vomit
32
Risk factors and treatment of S. pneumoniae?
mucus accumulation (i.e. from allergies), alcohol/drug use, general debility (flu, anemia, COPD, age) vaccine to prevent invasive pneumococcal disease fluoroquinolones or ceph III
33
What does Listeria monocytogenes look like in culture?
thin G+ rods motile at 20C, nonmotile at 37C intracellular parasite
34
Clinical presentation of Listeria monocytogenes?
diarrhea, dysentery, possible meningitis or bacteremia can cross placenta: early onset = stillbirth with granulomas; late onset= infant bacterial meningitis
35
How is Listeria monocytogenes transmitted?
contaminated food (milk, cheese, meat), sometimes after long refrigerator storage
36
Treatment of Listeria monocytogenes?
ampicillin + aminoglycoside | erythromycin
37
What does Pseudomonas aeruginosa look like in culture?
G- rod obligate anerobe (can use NO3-) fruity aroma blue-green fluorescent pigments
38
Where is Pseudomonas aeruginosa found, and how does it infect humans?
abundant in soil and water opportunistic nosocomial infections (usually biofilms)
39
Clinical presentations of Pseudomonas aeruginosa?
skin biofilms in burn patients and diabetics lung biofilms in cystic fibrosis (90% of CF deaths) otitis externa (swimmers ear) eye infections after trauma or surgery (esp Lasik) UTI from catheters bacteremia and sepsis in leukemia, burn patients, and diabetics ecthyma gangrenosum (non-pus producing ulcers) in diabetics folliculitis from contaminated water (hot tubs)
40
Treatment for Pseudomonas?
sterile precautions for burn patients topical antimicrobials cipro + aztreonam gentamycin + ticarcillin (or carbencillin if severe) meropenem + levofloxacin assess resistance profile don't use quinolone (quorum sensing signal)
41
Clinical presentation of Pseudomonads Acinetobacter baumanii?
nosocomial infections: ventilator-associated pneumonia, septicemia
42
Clinical presentation of Burkholderia cepacia?
opportunistic in CF patients | catheter associated UTI

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