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CRRAB 1 > Week 1: Intro to cardiovascular infectious disease > Flashcards

Week 1: Intro to cardiovascular infectious disease Flashcards

1
Q

What are the natural host defenses found in the CV system?

A

complement, WBCs, Abs, mechanical flow

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2
Q

What causes acute endocarditis?

A

overwhelming bloodstream challenge with bacteria

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3
Q

What causes subacute endocarditis?

A

Bacterial infection in a damaged heart valve

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4
Q

What is temporal evolution of acute endocarditis?

A

Extremely febrile, rapidly damages cardiac structures (Abnormal EKG), seeds infection in distal sites through sepsis, death within weeks

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5
Q

What kind of hypersensitivity is Roth spots?

A

Type 3 hypersensitivity

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6
Q

What is temporal evolution of subacute endocarditis?

A

Indolent course of infection, causes structure cardiac damage slowly, rarely seeds infection at distal sites, gradually progressive

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7
Q

What are symptoms of endocarditis?

A

fever, anemia, abnormal heartbeat. Abdominal or side pain sometimes. Patient looks very ill. Petechiae, septic emboli, Roth’s spots, splinter hemorrhages. Enlarged spleen in some subacute cases.

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8
Q

What organisms typically cause acute endocarditis?

A

Staph aureus, sometimes Strep pyogenes

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9
Q

What organisms typically cause subacute endocarditis?

A

Streptococcal species (viridans), Enterococcal species

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10
Q

Where are typical portals of entry for endocarditis?

A

Oral cavity, skin, Upper respiratory tract

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11
Q

Where are local infections found in the heart?

A

Mitral and tricuspid valves, prosthetic valves

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12
Q

What are the requirements of the Duke Criteria for a positive result?

A

2 major criteria, 1 major, 3 minor, or all 5 minor met.

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13
Q

What can trump a diagnosis of endocarditis if the Duke Criteria is positive?

A

alternative diagnosis is established, symptoms resulve and do not recur with less than 5 days of Abx therapy, or lack of histological evidence of endocarditis

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14
Q

What are the Duke Major criteria?

A

1) Positive blood culture with viridans streptococci, S. bovis, or HACEK group, S. Aureus, or enterococci. 2 + cultures 12 hours aprt, all 3 or majority of 4 seperate cultures drawn within an hour. Coxiella brunetii detected once in blood culture with positive IgG antibody titer.
2) New mass on valves upon echocardiogram

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15
Q

What are minor Duke criteria?

A

Predisposition (heart condition, injection drug use), Fever >38C, Vascular phenomena (arterial emboli, Janeway lesions), Immunological phenomena (Osler’s nodes, Roth’s spots, rheumatoid factor, glomerulonephritis), Microbe evidence (positive blood culture not meeting major criterion)

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16
Q

What are the Hacek organisms?

A

Haemophilus, Aggregatibacter (Actinobacillus), Cardiobacterium, Eikenella, Kingella. Fastidious, less common cause of infective endocarditis, normal part of human microbiome in oral-pharyngeal region

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17
Q

What is empiric treatment for acute endocarditis?

A

Nafcillin or oxacillin +/- gentamicin or tobramycin (this combo isn’t for staph) OR Vanco + gentamycin

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18
Q

What is empiric treatment for SUBACUTE endocarditis?

A

Ampicillin/sublactam + gentamicin or tobramycin OR vancomycin + ceftriaxone or gentamicin/tobramycin

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19
Q

What should you give patients with a penicillin allergy?

A

Cephalosporins (3rd to 5th gen) or carbapenems OR Vancomycin

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20
Q

What is the most common cause of endocarditis?

A

S. aureus

21
Q

Is S. aureus gram+ or -?

A

Gram+, falcultative anaerobe

22
Q

What are virulence factors of S. aureus?

A

biofilm formation, capsule, adhesins, secreted enzymes and hemolysins, pathogenicity islands which contain info for methicillin resistance

23
Q

What is the tree for S. aureus?

A

Gram+, Cocci, Catalase+, Coagulase+

24
Q

What are the virulence factors for deep tissue invasion of S. aureus?

A

hyaluronidase, staphylokinase, lipase

25
Q

What is the 2nd most common overall cause of endocarditis? What is it usually associated with?

A

Streptococcal species (viridans- alpha-hemolytic); previous mitral valve damage

26
Q

What is the 3rd most common cause of endocarditis? What is it usually associated with?

A

Enterococcus species; genitourniary procedures in older men, obstetric procedures in younger women

27
Q

What are virulence factors of enterococcus?

A

pili, surface proteins, extracellular enzymes (proteases, hyaluronidases); resistance to penicillin and carbepenems.

28
Q

What is the tree for S. pyogenes?

A

Gram+, cocci, catalase-, Beta-hemolytic, bacitracin sensitive

29
Q

What are important virulence factors of S. pyogenes?

A

Streptokinase (plasminogen–> plasmin), M protein (phagocytosis), Hyaluronidase (breaks down connective tissue), DNase, Streptolysin O (destroys RBCs), Streptolysis S (destroys WBCs)

30
Q

Describe Rheumatic heart disease?

A

Follows S pyogenes pharyngitis in genetically prediscoposed individuals, leading to antibodies made against M protein that cross react with meromyosin on heart (type 2 hypersensitivity)

31
Q

Who is at risk for rheumatic heart disease?

A

Strep throat infection (prolonged/untreated), prior case of rheumatic fever, age 5-15 years old

32
Q

What are symptoms of rheumatic heart disease?

A

2-4 weeks after strep infection, pain swelling in large joints, fever, weakness, muscle aches, shortness of breath, chest pain, nausea and vomiting, hacking cough, circular rash, lumps under skin

33
Q

What usually causes myocarditis?

A

viral infection (coxsackie virus B and adenovirus in children)

34
Q

What is the tree for coxsackie a and B virus?

A

ssRNA (+), Group IV, nonsegmented, icosahedral nucleocapsid, nonenveloped, picornaviridae, enterovirus

35
Q

What usually causes pericarditis?

A

Coxsackieviruses A and B, echovirus, influenza virus; usually occurs during summer months

36
Q

What organism causes Rocky Mountain spotted fever?

A

Ricketsia ricketsii

37
Q

What is classic triad of RMSF?

A

fever, headache, rash

38
Q

What is first line treatment of RMSF?

A

Doxycycline

39
Q

What are the 2 obligate intracellular parasites that need host ATP?

A

Chlamydiae and Rickettsiae

40
Q

What organisms are the most common to cause palm and sole rash?

A

RMSF, syphillus, coxsackievirus

41
Q

What are the virulence factors of strep viridans species?

A

Dextran production

Attachment: FimA, GspB

42
Q

What are the virulence factors of streptococcus pneumoniae?

A

Capsule (prevents phagocytosis)

43
Q

What are the virulence factors of strep pyogenes?

A

Capsule, M protein (molecular mimicry), Beta hemolytic, ASO, DNAse

44
Q

What are the virulence factors of Neisseria meningitidis

A

capsule (prevents phagocytosis)

45
Q

What are the virulence factors of Enterococcus species?

A

Biofilm formation (various proteins)

46
Q

What are the virulence factors of Staph aureus?

A

Capsule, biofilm formation (various proteins), Binding proteins (Elastin, collagen, FnbpA), Coagulase, Leukocidin

47
Q

What are the virulence factors of Stap epidermidis?

A

SD-repeat containing protein-G (help to bind to fibrin), biofilm formation (various proteins)

48
Q

What are the virulence factors of Coxsackie A and B and adenoviruses?

A

Coxsackie-Adenovirus cellular receptor (CAR) binding proteins

49
Q

What are the virulence factors of Ricketsia rickettsii

A

OmpA and OmpB (attachment), Type 4 secretion system (T4SS) for host cell entry

CRRAB 1 (5 decks)

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