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214 Cards in this Set
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- Back
How is Bordatella pertussis spread? |
Respiratory droplets |
|
How does Bordatella pertussis spread attach to the respiratory epithelium? |
Filamentoushemagglutinin (pili) |
|
Describe the Filamentoushemagglutinin (pili) of Bordatella pertussis |
1.
allowsattachment to respiratory epithelium 2. Antibodies against it prevent infection |
|
What causes the symptoms in a Bordatella pertussis infection?
|
Toxins because it doesn't invade |
|
What are the three toxins in Bordatella pertussis? |
1. Pertussis toxin
2. Adenylate cyclase toxin 3. Tracheal toxin |
|
Pertussistoxin of Bordatella pertussis (function/mechanism) (2) |
1. causes ADP ribosylation of Gi => inhibits (disabled) Gi=> increases cAMP => edema
2. ribosylationalso causes => disables chemokine receptors of lymphocytes => lymphocytesunable to enter blood stream => lymphocytosis |
|
Adenylatecyclase toxin of Bordatella pertussis (function/mechanism) |
(actslike Anthracis EF toxin aka acts like adenylate cyclase) => increases cAMP=> edema |
|
Trachealtoxin of Bordatella pertussis (function/mechanism) |
part of the peptidoglycan wall that damages ciliated cellsin respiratory epithelium |
|
Three phases of Bordatella pertussis infection |
1. Catarrhal phase
2. Paraoxysmal phase 3. Convolescent phase |
|
Catarrhalphase of Bordatella pertussis 1. Length 2. Symptoms (3) |
1. Lasts 1-2 weeks
2. Most contagious stage 3. nonspecificsymptoms 4. conjunctival injection 5. lacrimation |
|
What is the most contagious phase of whooping cough? |
Catarrhal phase |
|
Paroxysmal phase of Bordatella pertussis 1. Length 2. Feature |
1. Lasts 2wks - 2 months
2. characteristiccough aka whooping cough, usually in childrenD |
|
Convolescent phase of Bordatella pertussis |
1. Lasts up to 3 months
2. Gradual improvement of symptoms |
|
Disease that Bordatella pertussis causes |
Whooping cough |
|
Another name for whooping cough |
100 day cough |
|
How do you treat whooping cough |
Macrolides, but symptoms won't improve till toxin goes away |
|
What type of vaccine is Bordatella pertussis and what is it in? |
1. Acellular vaccine (purified antigen of the bacteria)
2. DTaP |
|
Is Haemophilus influenza gram negative, positive, or other? |
Gram negative |
|
What is the shape of Haemophilus influenza? |
Coccobaccilliary shape |
|
What media do you use to grow Haemophilus influenza? |
Grown on Chocolate agar with Factor V which is NAD(nicotinamide) and Factor X which is hematin |
|
What factors are required to grow Haemophilus influenza? |
1. Factor V which is NAD (nicotinamide)
2. Factor X which is hematin |
|
How is Haemophilus influenza transmitted |
Aerosol transmission |
|
What are the clinical presentations of Haemophilus influenza? (4) |
1. Pneumonia
2. Epiglottitis 3. Otitis Media 4. Meningitis |
|
What is the most likely cause of bacterial epiglottis? |
Haemophilus influenza |
|
Haemophilus influenza epiglottis (4) |
1. inflamedepiglottis
2. inspiratory stridor 3. drooling 4. cherry red epiglottis |
|
What is the most dangerous complication of inflamed Haemophilus influenza? |
Meningitis |
|
What strain of Haemophilus influenza causes Meningitis? |
Type B capsule strain |
|
What patient population is particularly vulnerable to Haemophilus influenza and can present with what additional symptoms? |
1.
sicklecell or asplenia patients 2. Sepsis 3. Septic arthritis |
|
Describe the vaccine for Haemophilus influenza 1. What strains covered 2. Consists of? 3. Administer when? |
1. Covers Type B capsule only (prevents meningitis)
2. consistsof polysaccharide of Haemophilus capsule conjugated to diphtheria toxoid thatincreases immunigencity of capsule so body produces strong IgG response 3. Administer 2-18 months |
|
How do you treat Haemophilus influenza? |
Generally treat with beta-lactam |
|
How do you treat a systemic infection or meningitis caused by Haemophilus influenza? |
Ceftriaxone |
|
If you have a case of meningitis caused by Haemophilus influenza, in addition to treating the patient with ceftriaxone, what additional thing do you need to do? |
Treat with rifampin for prophylaxis of meningitis in closecontacts |
|
Is Legionella gram negative, positive, or other |
1. Gram negative, but doesn’t take up gram stain very well
2. Need silver stain to visualize |
|
How do you visualize Legionella |
Silver stain |
|
How do you grow Legionella? |
Grows on buffered charcoal yeast agar extract in presencecysteine and iron |
|
What two diseases does Legionella cause and which is more severe? |
1. Pontiac Fever (self-limited)
2. Legionnaire's Disease (severe) |
|
Pontiac fever 1. Cause 2. Symptoms 3. Treatment |
1.
Caused by Legionella 2. Fever 3. Malaise 4. Self limited |
|
Legionnaire's Disease 1. More common in? 2. Features (4.5) 3. Treatment |
1. More common in smokers
2. Features: Atypical pneumonia 3. xray shows patchy infiltrate with consolidationof one lobe 4. pneumonia may presentwith hyponatremia / neurologic symptoms such as headache and confusion /diarrhea 5. high fever > 40 degrees C 6. Treat with fluoroquinolones or macrolides |
|
Is Legionella oxidase positive? |
Yes |
|
How do you treat Legionnaire's disease? |
Fluoroquinolones OR Macrolides |
|
What specific presentation would point to Legionnaire's disease |
pneumonia may presentwith hyponatremia and/or neurologic symptoms such as headache and confusion and/or diarrhea |
|
How do you diagnose Legionnaire's Disease quickly? |
Rapid urine antigen test |
|
Is Bartonella henslae gram negative, positive, or other? |
Gram negative, but requires a Warthin-Starry stain, a typeof silver stain to be visualized |
|
What type of stain do you need to visualize Bartonella henslae? |
Warthin-Starry stain, a type of silver stain to be visualized |
|
What disease is caused by Bartonella henslae in immunocompetent people? |
Cat Scratch fever |
|
What disease is caused by Bartonella henslae in immunocompromised people? |
Bacillary angiomatosis |
|
Cat Scratch Fever 1. Cause 2. Transmitted by 3. Symptom 4. Occurs in what patient population 5. Treatment |
1. Caused by Bartonella henselae
2. Transmitted by cat scratches 3. Symptom: Painful enlarged lymph nodes (axillary lymphadenitis) 4. Occurs in immunocompetent people 5. Usually self-limiting, but if severe can use Macrolides (Azithromycin) |
|
How do you treat Cat Scratch Fever? |
Usually self-limiting, but if severe can use Macrolides (Azithromycin) |
|
Bacillary angiomatosis 1. Cause 2. Transmitted by? 3. Occurs in what patient population? 4. Symptoms (3) 5. Treatment (2) |
1. Caused by Bartonella henselae
2. transmitted by cat scratches 3. Occurs inimmunocompromised people, especially HIVFevers 4. Symptoms: Chills 5. Headaches 6. Raisedred vascular lesions (Similar presentation to Kaposi Sarcoma) 7. Treatwith Doxycycline or Macrolides |
|
How is Bacillary angiomatosis transmitted? |
Cat scratch |
|
How do you treat Bacillary angiomatosis? |
Treatwith Doxycycline or Macrolides |
|
Is Brucella gram negative, positive or other? |
Gram negative |
|
What is the reservoir or Brucella? |
farmanimals including cows, goats, sheep, pigs |
|
How is Brucella transmitted? |
1. Person with direct contact with animals such as vet,butcher, or rancher
2. Person with indirect contact: ingestion of unpasteurizeddairy products such as cheese or milk |
|
Is Brucella facultative intracellular? |
Yes: Facultative intracellular organism in macrophages – preventphagolysosome fusion |
|
Brucellosis 1. Symptoms (5) |
1. Undulant Fever (fever rises and falls)
2. Chills 3. Anorexia 4. Spreads to the reticuloendothelial organs causingenlargement of the spleen, liver, lymph nodes then can spread systemically 5. Osteomyelitis in chronic brucellosis infections |
|
Where does Brucella spread to after infection? |
Spreads to the reticuloendothelial organs causing enlargement of the spleen, liver, lymph nodes then can spread systemically |
|
What type of fever is caused by Brucellosis |
Undulant fever |
|
What can you get after chronic Brucellosis? |
Osteomyelitis |
|
How do you treat Brucellosis? |
Doxycycline AND Rifampin used for adjunctive therapy |
|
Is Francisellatularensis gram negative, positive or other?
|
Gram negative |
|
What is the main reservoir for Francisella tularensis? |
Rabbits |
|
How do you get Francisella tularensis? (3) |
1. Direct contact with rabbits or eating rabbit
2. Indirect transmission through dermacentor tick 3. Can be aerosolized, potential bioterrorist weapon, mustreport to CDC |
|
What type of tick transmits Francisella tularensis? |
Dermacentor tick |
|
Is Francisella tularensis facultative intracellular? |
Yes facultative intracellular in macrophages |
|
Pathogenesis of Francisella tularensis |
Painful ulcer at site of infection (often tick bite) =>macrophages => lymph systems (regional lymphadenapthy => reticuloendothelial organs =>Granulomas with caseating necrosis in reticuloendothelial organs (ie lymphnodes, spleen, liver) |
|
Where does Francisella tularensis spread to in the body and what does it cause at these sites? |
1. Reticuloendothelial organs
2. Granulomas with caseating necrosis in reticuloendothelial organs (ie lymph nodes, spleen, liver) |
|
How do you treat Francisella tularensis? |
Streptomycin or other aminoglycosides |
|
Where is Pasteurella multocida found naturally? |
Respiratory tract of small mammals like cats and dogs (pets) |
|
How is Pasteurella multocida transmitted? |
Cat and dog bites |
|
What is the initial presentation of Pasteurella multocida? |
Cellulitis within 24 hours of infection |
|
Where can a Pasteurella multocida infection spread to? |
Bones => Osteomyelitis |
|
Is Pasteurella multocida catalase positive? |
Yes |
|
Is Pasteurella multocida oxidase positive? |
Yes |
|
What is the most important virulence factor in Pasteurella multocida? |
Capsule |
|
How do you grow Pasteurella multocida? |
5% Sheep's blood agar |
|
What does Pasteurella multocida look like on staining? |
Bipolar staining (safety pin staining) |
|
How do you treat Pasteurella multocida? |
Empiric treatment is Penicillin with possible addition ofB-lactamase inhibitor |
|
What type of stain is an acid fast stain and what does it stain? |
1. Carbol fuschin stain
2. High concentrations of mycolic acid (two waxy side chains) |
|
What type of stain do you use to look at Mycobacterum tuberculosis? |
Acid fast (Carbol fuschin stain) |
|
How long does Mycobacterum tuberculosis take to culture? |
2 to 6 weeks (slow) |
|
What type of media do you use to grow Mycobacterum tuberculosis? |
Lowenstein-Jensen media |
|
Is Mycobacterum tuberculosis an obligate aerobe? |
Yes |
|
How is Mycobacterum tuberculosis transmitted? |
Respiratory droplets |
|
Where does Mycobacterum tuberculosis reside/proliferate? |
Inside macrophages |
|
What is an essential virulence factor for Mycobacterum tuberculosis? |
Cord factor |
|
Cord factor of Mycobacterum tuberculosis function (2) |
1. Glycolipids in the cell wall involved with clumpingof bacteria into serpentine like formation
2. Protects bacteria from being destroyed byeliciting granuloma formation by increasing TNF-alpha + cytokines =>activating other macrophages => allows it to be walled off in granuloma by macrophages |
|
Sulfatides of Mycobacterium tuberculosis function |
allowsTB to survive inside macrophages by preventing phagolysosome fusion |
|
What are the three paths of progression after primary TB infection? |
1. Healed latent infection
2. Systemic infection (miliary TB) 3. Reactivation TB |
|
Primary TB infection pathogenesis |
affectslower or middle lobes of lungs => heals => fibrotic lesion => lesioncalcification + hilar lymph node calcification => Ghon complex (visiblecalcifications seen on chest xray of lung parenchyma and hilar lymph nodes) =hilar lymphadenopathy + peripheral granulomatous lesion in middle or lower lunglobe |
|
What part of the lungs does a primary TB infection target? |
Hilar region (lower/middle lobes) |
|
What stage of a TB infection do you see Ghon complexes? |
Primary infection |
|
Ghon complex 1. When do you see this 2. Features (2) 3. Imaging |
1. Primary TB infection
2. Hilar lymphadenopathy 3. Peripheral granulomatous lesion in middle or lower lung lobe 4. Visible calcifications of lung parenchyma and hilar lymph nodes see on xray |
|
Describe the tubercles seen in TB |
Ceaseating type of granulomas – Langerhan giant cells(activated macrophages) attempt to wall off infection with central area ofcaseating necrosis surrounded by fibrosis and scarring |
|
Primary TB infection symptoms and progression |
Prolonged fever, most commonly inchildren with most cases resolving, healing by fibrosis and calcification andbecoming latent => positive PPD shown as a wheel on the skin do to type IVhypersensitivity |
|
BCG vaccine |
1. BCG vaccine from attenuated Mycobacterium bovis can causepositive PPD even if patient never exposed to TB
2. 0-80% effective against TB |
|
What do you call systemic TB? |
Miliary TB |
|
Miliary TB |
1. Bacteremia (systemic) => multiorgan failure
2. Potentially lethal |
|
Reactivation of latent TB 1. Associated with? 2. Affects which lung lobes 3. Symptoms (5.5) |
1. Associated with immunosuppression through down regulation ofTNF-alpha release => uncontained infection
2. Affects upper lobes of lungs 3. Symptoms: Cough 4. night sweats 5. hemoptysis 6. Cachexia and weight loss often seen due to TNF-alphasecreted by cord factor |
|
Before starting TNF-alpha inhibitors such as Infliximab, what should you do first and why? |
Screen for TB or else at risk for reactivation |
|
Which lung lobes are affected in reactivated TB? |
upper lung lobes |
|
Pott's disease |
TBinfected spinal column on multiple vertebra => demineralization of the bonewith soft tissue swelling => pain, spinal deformities, spine weakness |
|
What is TB of the spine called? |
Pott's disease |
|
Why is Cachexia and weightloss often seen in TB? |
Due to TNF-alpha secreted by cord factor |
|
Describe CNS TB infection |
Meningitiswith possible formation of cavitary lesion or Tuberculoma |
|
How do you treat active TB infection? |
1. Treat with combination of RIPE:
2. Rifampin 3. Isoniazid 4. Pyrazinamide 5. Ethambutol |
|
How do you treat latent TB prophylaxis? |
Rifampin or Isoniazid for 9 months |
|
What type of environment does Mycobacterium leprae thrive in? |
Cold temperatures, giving it predilection for extremities of the body |
|
What part of the body does Mycobacterium leprae like to go? |
extremities |
|
What type of stain do you use to visualize Mycobacterium leprae? |
Acid fast (Carbol fuschin stain) |
|
What is the US reservoir for Mycobacterium leprae? |
Armadillo |
|
What is another name for Leprosy |
Hansen's disease |
|
What are the two forms of Mycobacterium leprae infection and which is more severe? |
1. Tuberculoid leprosy
2. Lepromatous leprosy (more severe) |
|
What type of immune response leads to Tuberculoid leprosy? |
TH1 cell response with cell mediated immunity |
|
What type of immune response to Lepromatous leprosy? |
TH2 cell response with humoral immunity |
|
Tuberculoid leprosy 1. Immune response 2. Containment? 3. Lepromin test result? 4. Symptoms 5. Treatment |
1. TH1 cell response with cell mediated immunity
2. Body can contain bacteria within macrophages 3. Positive Lepromin test 4. Minimal symptoms except Well-demarcated hairlesshypoesthetic skin plaque such as bald scalp but can occur anywhere on body 5. Treatment: Multidrug Treatment with Dapsone and Rifampin for 6 month |
|
Lepromin skin test 1. Define2. Positive result indicates? |
1. intradermal injection of antigens similar to TB PPD test with positive Lepromin skin test demonstrating good cell mediated response
2. Positive => TH1 cell dominant response => Tuberculoid Leprosy |
|
What does a biopsy of Tuberculoid leprosy show? |
small amount of bacteria |
|
Lepromatous leprosy 1. Immune response 2. Containment 3. Lepromin skin test result 4. Transmission 5. Symptoms (3+) 6. Treatment (3) + how long |
1. TH2 mediated response with humoral responseL
2. imited containment of infection – are not able to becontained in macrophages 3. Lepromin skin test negative 4. Human to human transmission 5. Symptoms: Symmetric glove and stocking neuropathy (extremities) 6. Poorly demarcated raised lesions most notably on extensorsurfaces (face away from body = cooler) 7. Facial deformity including thickening of skin, loss ofeyebrows and eyelashes, collapse of nose, formation of nodular ear lobes =>leonine facies (lion face) 8. Treatment: Multidrug Treatment with Dapsone, Rifampin, and Clofaziminefor 2 to 5 years with deformities that may not be reversible even withtreatment |
|
What would biopsy of Lepromatous leprosy show? |
lots of bacteria |
|
Where are the lesions located in Lepromatous leprosy? |
Extensor surfaces |
|
Where is the neuropathy located in Lepromatous leprosy? |
Extremities (Symmetric glove and stocking) |
|
What shape are spirochetes? |
Spiral shaped |
|
Do spirochetes gram stain well? |
No because of thin walls, except Borrelia with a special stain |
|
What class of bacteria is Borrelia burgdorferi? |
Spirochete |
|
Where do you find Borrelia burgdorferi? |
Northeast US |
|
Typical history of Borrelia burgdorferi? |
Hiking/camping in forest |
|
What tick transmits Borrelia burgdorferi? |
Ixodes Scapularis |
|
Describe Ixodes Scapularis life cycle and its relation to Borrelia (reservoir, hosts, vector, etc) |
1. Larvae in white-footed mouse (main reservoir)
2. Adults in white-tailed deer (obligatory host) 3. Vector: Tick 4. Incidental/dead end host: humans |
|
How do you visualize Borrelia burgdorferi? (2) |
1.
Wright's Stain 2. Giemsa stain |
|
What disease does Borrelia burgdorferi cause? |
Lyme diseae |
|
Lyme disease 1. Cause 2. Vector 3. Stages (3) |
1. Borrelia burgdorferi
2. Spread via Ixodes Scapularis tick 3. Stage 1: erythema chronicum migrans- bull's eye rash - not painful, not pruritic, fever/chills, occurs within a month of bite 4. Stage 2: heart block caused by myocarditis + bilateral facial nerve palsies (Bell's palsies) 5. Stage 3: Arthritis of large joints, such as knee, migratory polyarthritis, CNS effects - subtle encephalopathy 6. Treatment: Doxycycline if early, ceftriaxone if severe or late |
|
Stage 1 of Lyme disease 1. Main symptom (description (2)) 2. Other symptoms (1.5) 3. When does it occur? |
Bull's eye rash: erythema chronicum migrans 1. Not painful2. Not pruritic 3. Fever/chills 4. Occurs within a month of bite |
|
Stage 2 of Lyme disease - symptoms (2) |
1. Heart block caused by myocarditis
2. bilateral facial nerve palsies (Bell's palsies) |
|
Stage 3 of Lyme disease -symptoms (3) |
1. Arthritis of large joints, such as knee
2. migratory polyarthritis 3. CNS effects - subtle encephalopathy |
|
How do you treat Lyme disease? (2) |
Treatment: Doxycycline if early, ceftriaxone if severe or late |
|
What class of bacteria is Leptospira interrogans |
Spirochete |
|
Can you visualize Leptospira interrogans under microscope? |
No |
|
Where do you find Leptospira interrogans regionally? |
Endemic in tropical regions such as Hawaii |
|
How would you describe how Leptospira interrogans looks? |
Small thin, spiral, question mark/hooked shape |
|
Where do you find Leptospira interrogans in nature? |
Rodent and dog excreted urine |
|
How is Leptospira interrogans transmitted to humans? |
Transmitted to humans when they swim in contaminated water |
|
What is associated with Leptospira interrogans infections? |
Water sports |
|
Early Leptospria interrogans infection symptoms (4) |
1. Flu like symptoms
2. Fever 3. intenseheadaches 4. Conjunctival suffusion – diffuse reddening of the eyes withoutinflammatory exudate (no pus) |
|
What is the most severe form of Leptospirosis called? |
Weil's disease |
|
Weil's disease 1. Define 2. How does it spread in body and to where? 3. Symptoms (2) |
1.
Severe Leptospirosis infection 2. Travels through bloodstream => multiple organs, particularly kidneys and liver 3. Kidney dysfunction 4. Liver dysfunction and jaundice |
|
What disease does Treponema pallidum cause? |
Syphillus |
|
What type of bacteria is Treponema pallidum? |
Spirochete |
|
How is Treponema pallidum spread? |
STD |
|
How do you visualize Treponema pallidum? |
Dark field microscopy needed for direct visualization |
|
What are two screening tests for Treponema pallidum? |
1. VDRL screening test (not specific)
2. RPR screening test |
|
What molecule does the VDRL screening test specificially look for? What disease does it screen for, thought not specific? |
1. Antibodies to Cardiolipin cholesterol lecithin
2. Treponema pallidum |
|
What could potentially create false positive on VDRL or RPR screening test for syphilis? |
1. Mono
2. RF 3. SLE 4. LEP 5. DRG (IV drug user) |
|
How do you confirm Treponema pallidum? |
FTA antibody test |
|
Describe the primary stage of Syphilis 1. Symptoms 2. Timeline |
1. Painless genital chancre that appears a fewweeks after innoculation (invades small blood vessels => ischemia, necrosis,nerve damage aka painless)
2. heals in 3-6 weeks, but if left untreatedprogresses to next stage |
|
Describe the secondary stage of Syphilis (4) (Symptoms and timeline) |
1. Systemicdisease
2. maculopapular rash occurs on palms and soles weeks to months afterinfection (occurs generally entire body but including palms and soles) 3. condyloma latum on mucous membranes – lot a bumps (flat topped, less wart like) 4. can visualize spirochetes within condyloma latum via darkfield microscope |
|
Describe the symptoms and pathogenesis/mechanism of each symptom of Tertiary Syphilis (3) |
1. Formationof gummas – soft growths with firm necrotic center that can occur anywhere inany tissue
2. aortitis of the ascending thoracic aorta => ascending thoracicaneurysm that looks like tree-barking (looks thick and wrinkled) via destroythe vaso vasorum (small vessels that supply blood to aorta) 3. Tabes dorsalis –demyelination of the dorsal column of the spinal cord => loss of vibration,proprioception, and discriminating touch, and odd gait, lancinating pain 4. Argyll Robertson pupils - react to accomodatioin but no reaction to light aka "Prostitutes's pupil" |
|
What are Argyll Robertson pupils and when do you see these? |
1. react to accomodatioin but no reaction to light aka "Prostitutes's pupil"
2. Tertiary Syphilis |
|
Condyloma lata 1. Disease 2. Stage |
Secondary Syphilis (indicates systemic infection) |
|
gummas 1. Describe 2. Disease/Stage |
1. soft growths with firm necrotic center that can occur anywhere in any tissue
2. Tertiary Syphilis |
|
Congenital Syphilis Symptoms (5)
|
1. Saber shins - anterior bowing of the tibia
2. Saddle nose (stubby nose with indented bridge) 3. Hutchinson's teeth - notched incisors 4. Mulberry molars - molars with severe enamel outgrowths 5. Deafness |
|
How do you treat Syphilis? |
Penicillin for everyone in all stages |
|
Jarisch-Herxheimer reaction |
1. mayoccur hours after treatment – dying spirochetes release LPS that leads tocytokines release => fevers, chills, headache
2. Sign of working Syphilis treatment |
|
Is Pseudomonas aeruginosa, gram positive, negative or other? |
Gram negative |
|
What is the shape of Pseudomonas aeruginosa? |
Rod |
|
What environment does Pseudomonas aeruginosa thrive in? |
Aquatic environments |
|
Is Pseudomonas aeruginosa oxidase positive or negative? |
Oxidase positive |
|
Is Pseudomonas aeruginosa catalase positive? |
Yes |
|
What happens when Pseudomonas aeruginosa is plated? |
Produces blue-green pigment, sometimes will even turn wounds blue |
|
What bacteria turns wounds blue through a pigment? |
Pseudomonas aeruginosa |
|
What pigments does Pseudomonas aeruginosa |
Pyocyanin/pyoverdin pigments |
|
What infection produces a fruity grape-like odor? |
Pseudomonas aeruginosa |
|
Is Pseudomonas aeruginosa an obligate aerobe, obligate anaerobe or facultative? |
obligate aerobe |
|
What is the #1 cause of gram negative nosocomial pneumonia? |
Pseudomonas aeruginosa |
|
What patient population is particularly vulnerable to Pseudomonas aeruginosa pulmonary infections |
CF |
|
What is the #1 cause of respiratory failure in CF patients? |
Pseudomonas aeruginosa |
|
What are IV drug users most likely to develop with Pseudomonas aeruginosa? |
Osteomyelitis |
|
What are diabetics with Pseudomonas aeruginosa likely to develop? |
Osteomyelitis |
|
What two patient populations are likely to develop Osteomyelitis with Pseudomonas aeruginosa? |
1.
IV drug users 2. Diabetics |
|
Is Pseudomonas aeruginosa encapsulated? |
Yes |
|
A burn patient is likely to get what infection? |
Pseudomonas aeruginosa |
|
Pseudomonas aeruginosa infections (main symptoms/presentations) (5) |
1.
Nosocomial Pneumonia 2. Nosocomial UTI 3. Hot tub faculitis 4. Ecthyma gangrenosum - sepsis which causes black cutaneous necrosis 5. Swimmer's ear - otitis externa |
|
Hot tub faculitis |
1. Caused by Pseudomonas aeruginosa
2. Pruritic papular /pustular fascilulitis associated with under chlorinated hot tubs |
|
Pseudomonas aeruginosa Exotoxin A |
Ribosylates EF2 causing inhibition of protein synthesis and cell death |
|
How do we treat Pseudomonas aeruginosa? |
1.
Piperacillin + Tazobactam 2. Aminoglycosides 3. Fluoroquinolones |
|
Is Proteus mirabilis gram negative, positive or other? |
Gram negative |
|
Is Proteus mirabilis obligate aerobe, obligate anaerobe, facultative aerobe, or facultative anaerobe? |
Facultative anaerobe |
|
What does Proteus mirabilis show when plated? |
Swimming motility |
|
What does Proteus mirabilis smell like? |
Fishy odor |
|
How do you treat Proteus mirabilis? |
Sulfonamides |
|
Describe the kidney stones formed by Proteus mirabilis |
Staghorn caliculi |
|
How does Proteus mirabilis promote struvite stone formation? |
Urease positive => NH3 + CO2 => alkaline environment |
|
Two clinical presentations of Proteus mirabilis? |
1. Kidney stones
2. UTI |
|
What group of bacteria is Coxiella burnetti closely related to? |
Rickettsia |
|
What is a major difference between Coxiella burnetti and Rickettsia |
Coxiella burnetti does not cause rash |
|
Is Coxiella burnetti gram negative, positive, or other? |
Gram Negative |
|
What disease does Coxiella burnetti cause? |
Q fever |
|
Is Coxiella burnetti facultative intracellular, obligate intracellular or neighter? |
Obligate intracellular |
|
How is Coxiella burnetti transmitted? |
Spore like structure can survive digestive tract and appear in feces of animals => dirt => aerosol transmission of fecal matter in dirt => inhaled |
|
What is the major reservoir for Coxiella burnetti? |
Farm animals |
|
People likely to get Coxiella burnetti and how? |
1.
Famers from farm animals 2. Vet delivering baby farm animals gets exposed to Placental Excretion |
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Symptoms of Coxiella burnetti (4) |
1. Pneumonina
2. Headache 3. Fever 4. Hepatitis |
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How do you treat Coxiella burnetti? (2) |
1. Self-limiting infection within 2 weeks
2. Rarely can progress to cause endocarditis in chronic infection in immunocompromised or in previous valvular damage |
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How do you prevent Coxiella burnetti infection? |
1. Pasteurize milk
2. Vets can have an acellular vaccine |
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What type of pneumonia does Mycoplasma pneumoniae cause? (2) |
1. Atypical pneumonia - can't readily culture or isolate microbe
2. Walking pneumonia- Xray shows severe pneumonia but patient still doesn't appear super clinically sick and can walk about |
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Does Mycoplasma pneumoniae gram stain? |
No cell wall, therefore doesn't appear on gram stain |
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What is special about Mycoplasma pneumoniae's cell membrane? |
Has Cholesterol |
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What is the only bacteria with cholesterol in its cell membrane? |
Mycoplasma pneumoniae |
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How is Mycoplasma pneumoniae infection described on xray? |
Reticulonodular or patchy infiltrate |
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Who is particularly at risk for Mycoplasma pneumoniae? (2) |
1. Young adults in close contact
2. Military recruits |
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How do you culture Mycoplasma pneumoniae? |
Eaton's agar (takes a long time) |
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What is a test for Mycoplasma pneumoniae? |
1-2 weeks into infection develop IgM molecules thatagglutinate erythrocytes in cold temperatures (cold aggultinins) => possiblyleading to RBC lysis |
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Which bacterial infection causes cold aggultinins? |
Mycoplasma pneumoniae |
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How do you treat Mycoplasma pneumoniae? |
Macrolides (can't use anything that works on cell walls) |