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Unit 2 Flashcards

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1
Q

What are the components of the innate immune system?

A 
Natural killer cells
Mast cells
Eosinophils
Basophils
Phagocytic cells: macrophages, neutrophils, and dendritic cells
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2
Q

What are the functions of the innate immune system?

A

(1) Recruit immune cells (cytokines) = inflammation
(2) Activate complement cascade
(3) Phagocytosis by macrophages/neutrophils
(4) Antigen presentation
(5) Physical barrier (skin, mucus, gut flora)

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3
Q

What are the Gram-positive bacteria?

A

Staphylococcus
Entercoccus
Streptococcus

Bacillus
Clostridium

Corynebacterium
Listeria

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4
Q

What is the Gram stain appearance of Staphylococcus aureus?

A

Gram-pos cocci in clusters

catalase-positive

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5
Q

What is the typical disease association of Staph. aureus?

A 
Cutaneous infections (boils, folliculitis, wounds)
Toxinogenic infections (TSS, food poisoning)
Pneumonia (particularly w/ impaired immune system) 
Foreign body (sutures, etc.)
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6
Q

What are the virulence traits of Staph. aureus?

A

Fibronectin binding protein (adherence)
α-toxin (pore-forming)
Coagulase, fibronectin-binding protein
Protein A

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7
Q

Scalded Skin Syndrome

A

Systemic circulation of epidermolytic toxins
(localized in adults, widespread in infants)

Serine proteases highly specific for a protein binding together epidermal & dermal layers

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8
Q

Toxic Shock Syndrome

A

Local infection and toxin production (superantigen)

Toxin expression requires oxygen, neutral pH, and high protein levels

Leads to high fever, shock, vomiting, muscle pain, and organ failures (hepatic, renal)

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9
Q

Staphylococcus epidermidis

A

Normal skin flora

Primary virulence factor: slime! ==> biofilm formation
Adheres to foreign bodies (catheters, shunts, artificial/damaged heart valves)

Difficult to treat - often requires removal of the device. Highly resistant to antibiotics! (including methicillin)

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10
Q

What is endocarditis?

A

Bacteria growing on heart valves

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11
Q

What is the Gram stain appearance of Streptococcus?

A

Gram-positive cocci often in chains or pairs

catalase-negative

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12
Q

Streptococcus pyogenes (Group A Strep) - description? What does it cause?

A

β-hemolytic

Cause strep throat, scarlet fever, rheumatic fever, & post-strep glomerulonephritis

Normal flora!

Skin & wound infections - spreading

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13
Q

What is the virulence factor in Group A Strep (Strep. pyogenes)?

A

M-protein (80+ types –> adherence, antigenic, antiphagocytic!!)

M-protein binds Factor H to surface of bacterial cells, which reduces C3b on surface –> anti-phagocytic mechanism

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14
Q

What is one of the possible consequences of streptococcal pharyngitis?

A

Rheumatic fever
Some M-proteins of Group A Strep are rheumatogenic
Some M-types share antigenic similarities with protein components in heart & valve tissues ==> antibody-mediated damage to heart valves

==> heart damage :(

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15
Q

What diseases can be caused by Streptococcus pneumoniae?

A

Pneumonia, sinusitis, otitis media, bronchitis (non-invasive)
Meningitis, bacteremia/septicemia (invasive)

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16
Q

How do Strep. pneumoniae evade host defenses?

A

Antiphagocytic polysaccharide capsule (90+ different types)

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17
Q

Describe the pneumonia vaccine for adults

A

Pneumovax; 23-valence
Approved for 65+
Protects against invasive pneuococci (meningitis, septicemia, etc.) but not against pneumonia = misnomer

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18
Q

Describe the pneumonia vaccine for kids

A

Prevnar
Conjugate vaccine (w/ diphtheria)
==> Herd immunity (may also be protective in adults against pneumonia)

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19
Q

Enterococcus (faecalis & faecium) - common sites of infection?

A

Common sites of infection = urinary tract, surgical sites, biliary tract

Frequent cause of nosocomial infections

Often causes MIXED INFECTIONS

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20
Q

What is scary about enterococcus + antibiotics?

A

Becoming resistant to most of them! Including vancomycin!!!!!! ==> VRE :((((

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21
Q

What does nosocomial mean?

A

Originating in a hospital

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22
Q

Clostridium - characteristics?

A

Gram-pos rods

STRICT ANAEROBES & SPORE FORMERS

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23
Q

Clostridium difficile

A

Relatively resistant to most antibiotics

Associated with, or follows, antibiotic use. Normal GI flora is suppressed, C. dif proliferates

Common cause of nosocomial diarrhea and, in more severe cases, pseudomembranous colitis

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24
Q

Clostridium tetani

A

Present in soil & animals (spores!)

Toxin is transported to CNS ==> blocks inhibitory interneurons ==> spastic paralysis, lockjaw

Vaccine targets TOXIN, not bacteria

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25
Clostridium botulinum
Soil & animals (spores!) Preformed toxin in food ==> circulation Toxin blocks acetylcholine at neuromuscular junctions ==> flaccid paralysis Especially common in home-canned foods (cluster cases)
26
Clostridium perfringens
``` Wound infections (cellulitis, fasciitis, myonecrosis [gas gangrene]) ^^Alpha-toxin!!! Kills phagocytic cells as well as muscle! ``` ``` Food poisoning (enterotoxin) ==> contaminated food, toxin produced in vivo, site of action = small intestine ```
27
E. coli - what is their shape? What diseases do they cause?
Gram-neg rod Normal flora in large intestine ETEC - typical traveler's diarrhea from contaminated food/water Self-limiting; managed by fluid replacement UTIs - typically endogenous from GI tract getting into the "wrong" place Abdominal infections - release of contents of colon to peritoneal cavity
28
Pseudomonas aeruginosa
Gram-neg rod Infections of traumatic injuries, surgical wounds, and especially BURNS Chronic lung infections of pts with CF
29
What are the causes of lung infections in pts with CF per age?
IN CHILDREN - Staph aureus - usually controlled with antimicrobials IN YA - Pseudomonas aeruginosa pathogen of paramount importance
30
Neisseria gonorrhoeae
Gram-neg (diplo)cocci Causative agent of gonorrhea and conjunctivitis leading to blindness in infants born to infected mothers Key to infectivity is PILI --> adherence, interferes with neutrophil killing
31
Anaerobes (other than clostridia) - locations? Diseases?
Normal flora in colon, mouth, female genital tract, skin Usually cause disease as a mixed infection (aspiration --> lung abscess, leakage from colon --> abdominal abscess, etc.)
32
Bacteroides fragilis
Common colon flora; rather aerotolerant Occurs in anaerobic abscesses below the diaphragm Virulence factors: tissue-destructive enzymes, capsule, superoxide dismutase (enzyme that degrades superoxide = toxic byproduct of oxygen)
33
What is one example of a bacteria that is an obligate intracellular?
Chlamydia trachomatis
34
What is a bacteria without a cell wall?
Mycoplasma pneumoniae
35
What are some of the diseases of Chlamydia trachomatis?
Trachoma = chronic infection of conjunctiva, leading to scarring and blindness. Endemic in Asia, Africa Genital infections = STD, neonatal conjunctivitis, neonatal pneumonia ==> the most common bacterial STD in humans ==> the leading cause of infectious blindness worldwide
36
What disease does mycoplasma pneumoniae cause?
Atypical pneumonia (common; 10%). "Walking pneumonia" Predilection for younger persons (5-20 yo) Occurs in any season Bacteria adheres to respiratory epithelial cells --> growth remains extracellular --> produces hydrogen peroxide and superoxide radicals, which damage tissue
37
What is the difference in the pneumonia caused by Mycoplasma pneumoniae vs. Streptococcus pneumoniae?
Strep. pneumoniae = bacteria grow within alveoli (air sacs themselves), fill them with phagocytic cells & fluid Mycoplasma pneumoniae = inflammation & thickening of interstitium, the tissue around the air sacs. Alveoli are clear.
38
What is metronidazole good against?
Anaerobes! (like C. dif & Bacteroides) | Protozoa (trich, giardia, etc.)
39
What is an adverse reaction of metronidazole?
Antabuse-like reaction (GI upset, vomiting, headache) if alcohol consumed within 3 days of drug
40
What is nitrofurantoin good for?
Treating UTIs, b/c of rapid excretion via kidneys Treats E. coli (and TEM-1)
41
What is the mechanism of aminoglycosides?
Protein synthesis inhibition (30s) | BACTERICIDAL (bind irreversibly)
42
What are the adverse effects of aminoglycosides?
Ototoxicity, nephrotoxicity
43
What is the spectrum of aminoglycosides?
NARROW SPECTRUM: only gram(-) aerobes E. coli, Klebsiella, Pseudomonas
44
Which drugs are IV only & require routine monitoring of Cp levels?
Vancomycin & aminoglycosides
45
Which drugs are renally excreted?
Pencillins, cephalosporins, vancomycin, carbapenems, aminoglycosides, nitrofurantoin, fluoroquinolones
46
Are aminoglycosides effective against entercocci?
No, not on their own. They must be given together with penicillin or vanco.
47
What are the different fluoroquinolones good against?
EXTENDED SPECTRUM Cipro: pseudomonas, chlamydia, mycoplasma Levo: S. pneumoniae, pseudomonas, chlamydia, mycoplasma Moxi: S. pneumoniae, chlamydia, mycoplasma
48
Which antibiotics are bacteriostatic?
TMC = tetracyclines, macrolides, and clindamycin
49
What are the DDIs with fluoroquinolones?
theophylline + caffeine (↓ metabolism) antacids (↓ FQ absorp)
50
What is penicillin good against?
Pen G: Gram + (Staph/Strep) ENTEROCOCCUS! Pen V: Gram - (N. gonorrhoeae)
51
What is Dicloxacillin good against?
MSSA | this is a penicillinase-resistant drug
52
What are amoxi/ampicillin good against?
Enterococcus, E. coli
53
What is the name of the β-lactamase inhibitor?
Amoxicillin-clavulanate "Mocks the cleave"
54
What are Pip/Tazo good against?
``` MSSA E. coli Klebsiella Pseudomonas Bacteroides fragilis ``` MEKPB
55
What are all of the cephalosporins good against?
MSSA
56
What is (only) ceftriaxone good against (among the cephs)?
N. gonorrhoeae
57
What are ceftazidime (3rd) and cefepime (4th) good against?
Pseudomonas
58
What are the generations of cephalosporins?
``` 1st = cephalexin, cefazolin 2nd = cefaclor, cefuroxime 3rd = ceftriaxone, ceftazidime 4th = cefepime ```
59
What are carbapenems generally good for?
They are wide spectrum - reserved for MDR organisms
60
What is Ertapenem (a carbapenem) good against? What are Imip, Dora, & Mero good against?
Ertapenem: MSSA Bacteroides Imip/Dora/Mero: MSSA Bacteroides AND Pseudomonas
61
What is vancomycin good against?
MSSA, MRSA, Enterococcus | C. diff (oral only)
62
What are the macrolides good against? What are their names?
Erythro/azithro/clarithromycin S. pneumoniae & pyogenes N. gonorrhoeae & Chlamydia Mycoplasma
63
Where do the macrolides concentrate?
The lungs
64
What are the DD interactions of macrolides?
Clar/ery inhibit CYP450 ***NOT AZI*** ==> "A-okay"
65
What are the tetracyclines good against?
S. pneumoniae, N. gonorrhoeae (+/-), chlamydia, and mycoplasma Basically everything from the macrolides except S. pyogenes
66
What are some of the adverse reactions of tetracyclines?
Affects bone/tooth development - not for pregnant women or kids <8 yo DD interactions with metal cations (antacids, diary, iron) in stomach
67
What does clindamycin do well, that other drugs don't?
Penetrates into bone
68
What is clindamycin good against?
NARROW SPECTRUM Gram + cocci (Staph, Strep) Bacteroides *Choice in CA-MRSA*
69
What are some of the adverse reactions of clindamycin?
Severe diarrhea | Pseudomembranous colitis

Disease & Defense (3 decks)

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