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204 Cards in this Set
- Front
- Back
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First organism to affect immunosuppressed PT's.
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Yeast
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Normal flora on...
Skin Nose Oropharynx Gingival Vaginal vault |
Skin = S. epidermidis (MC)
Nose = S. aureus (MRSA) Oral = Strep viridans Gum = actinomyces, fusiobacterium (anaerobe) Vagina = bactobacilli, group B streps |
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Staining:
Gram POS cocci |
Staph or strep
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Staining:
Gram NEG cocci |
Nisseria, Moraxella
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Staining:
Gram POS rod |
Bacillus, clostridium, Listeria, Corrybacterium
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Staining:
Gram POS branching rod |
Norcardia, actinomyces
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Staining:
All else |
gram Neg rod
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Endotoxin toxic portion?
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Gram NEG
LPS (lipid A = toxic) Inc macrophages Inc cytokines |
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Exotoxin toxic portion?
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Gram NEG or POS
A-B component A = active toxin B = binding Exfoliation (Nikolsky sign) |
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What is the only gram + to form an endotoxin?
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lysteria monocytogenes
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What are the 5 virulence factors?
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Gram NEG: Pili/fimbrae (ie. Gonorrhea)
Gram POS: Teichoic acid IgA proteases Capsules (Nisseria = largest) Antiphagocytic surface |
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What are the 3 antiphagocytic surfaces?
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Antiphagocytic surface
- Strep pyogene: M protein - Nisseria: pili - Staph aureus: protein A |
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What is the only organism that give off Neurotoxin?
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Clostridium
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Differentiate between C. Tetani and C. Botulinum.
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TETANI: painful spasm
BOTULISM: flaccid paralysis |
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Which 2 organism that can evade killing?
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Mycobacterium TB - cord factor
- macrophages will recruit T-cells, forming granulomas Listeria - jumping cell to cell |
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Agar:
Ferment lactose |
MacConkey's
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Agar:
Fecal stool (E. coli) |
EMB (eosin methylene blue)
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Agar:
Legionella |
Buffered Charcoal Yeast Agar
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Agar:
Nisseria, Hemophilus |
Chocolate agar (%)
- X factor: heme - V factor: NAD |
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Agar:
Vibrio cholera |
TCBS
Ferment sucrose (turns orange) |
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Organisms that could only survive in aerobic environment.
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Gram POS
-Nocardia -Pseudomonas Aeruginosa -Mycobacterium TB (Apex for high O2) -Bacillus |
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Organisms that could only survive in anerobic environment.
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Gram NEG
-Clostridium -Bacteroides -Actinomyces |
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Organisms that could only survive in both environment.
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Facultative Anaerobes
-Salmonella -Neisseria -Brucella -Mycobacterium -Listeria -Francisella -LEGIONELLA |
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Top 5 SKIN flora
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STAPHS!!
S. epidermidis #1 S. aureus S. pyogenes S. saprophyticus Propionobacterium Acne |
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What kind of bug (staining) is staph?
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gram (+)
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What does staph look like?
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cluster
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Which staph is coagulase +?
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S. aureus
- the rest are coagulase NEG (epidermidis, saprophyticus) |
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What is the MCC of acute endocarditis?
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S. aureus
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What is the mcc of death in burn patients in the 1st week?
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S. aureus
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What is the mcc of death in burn patients in the 2nd week?
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Pseudomonas aurugenosa
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What pigment does S. aureus make?
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Which organism produces gold pigment (yellow colonies)?
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What enzyme does S. aureus secrete to fight against antibiotics?
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Beta-lactamase
(attacks "garage doors") |
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What are the 8 STAPH aureus enzymes?
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1. Catalase: break down H2O2
2. B-lactamase: break down betalactam AB 3. Coagulase & staphylokinase: eats through clots 4. Lipase (panniculitis, folliculitis, mastitis) 5. Elastase (bullous emphysema) 6. Collagenase (skin & bone) 7. Lecithinase (skin infection) 8. Enterotoxin (food poisoning) |
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What is the function of Enterotoxin?
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causes food poisoning
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What is the function of Lecithinase?
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causes skin infection (subcutanous fat)
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What is the function of Collagenase?
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destroys skin & bone
- MCC of osteomyolitis (2nd = salmonella) |
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What is the function of Elastase?
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causes bullous emphysema
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What is the function of Lipase?
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causes panniculitis, folliculitis, mastitis
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What is the function of Coagulase & staphylokinase?
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Coagulase & staphylokinase: eats through clots
- MCC of acute BE - MCC of death in burn PT's in first week - 2nd week = pseudomonas |
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What is the function of Catalase?
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break down H2O2
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What is an acinus?
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A group of alveoli (grapes like)
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What are the 3 types of lung damages?
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Panacinar > panlobular (AGING)
Centriacinar > centrilobular (SMOKING) Distal/paraseptal (BULLOUS) |
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Which substance in your body fight against elastase in your lungs?
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Alpha-1-anti-trypsin (A1AT) produced in the Liver.
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What is oxidative burst?
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NADPH becomes bleach to kill organism
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What is the function of B-lactamase?
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break down betalactam AB (garage door)
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What are the property of S. aureus?
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Gold pigment
Beta-lactamase Coagulase + Ferment mannitol MCC osteomyolitis |
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What pigment does staph epidermitis make?
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white
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What is staph epidermitis associated with?
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shunts and central lines
** Arnold Swarchenegger has aortic valve replacement = has prosthetic valve, need to be on warfarin for life, need to stop making movies. |
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What is used to treat a staph epidermitis infection?
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1st = vancomycin
2nd = Linezolid- for Vancomycin resistance |
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What pigment does staph saprophyticus make?
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none
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Which organism has age bimodal distribution?
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S. saprophyticus
** UTI in newly active adolescent female |
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What type of bug is propionobacterium acne?
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gram POS anaerobe
- hides in hair follicles |
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What are two S. aureus toxins?
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Staph Scalded Skin Syndrome
Toxic Shock Syndrome Erythrodermic Toxin (STREP) |
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Physical finding of Staph Scalded Skin Syndrome
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- Exfoliating (Nikolski sign)
- Red rash all over the body - Palms and Soles |
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Physical finding of Toxic Shock Syndrome
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**Retained tampon**
Triad - high fever - hypotension (shock) - rash (P & S) |
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Physical finding of Erythrodermic Toxin (STREP)?
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- carlet fever [Strep]
- Sand paper rash, palms and soles, strawberry tongue |
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Most skin infections are caused by STAPH, except 5 which are caused by STREPS pyogenes. Which are they?
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LINES
- Lymphangitis - Impetigo - Necrotizing fascitis - Erysipelas - Scarlet fever ** all other skin infection = Staph!! |
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red line going up arm
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Lymphangitis
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honey crusted lesion
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Impetigo
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flesh eating bacteria, compartment syndrome
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Necrotizing fascitis strep
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red lesion with raised edges, doesn't blanch
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Erysipelas
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sandpaper rash, strawberry tongue, palm & sole
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Scarlet fever
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SKIN INFECTION:
3 characteristic of cellulitis? |
Flat
Red Blanches - Strep pyogenes doesn't! |
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cellulitis around the breast
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Mastitis
- have mom breastfeed continuously to clear duct |
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infection at the head of the penis
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Balanitis
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cellulitis around abdomen
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panniculitis
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infants, trauma, staph aureus, around eye
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periorbital cellulitis
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proptosis, older patient, s. pneumo
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orbital cellulitis
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nodular induration with infection & pus
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carbuncle
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hair follicle in middle of carbuncle, no pus
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furuncle
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deep skin infection, s. aureus
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carbunculosis
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infection of many hair shafts
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furunculosis
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Inflammation of the fascia
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fasciitis
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What is fasciitis and what are the 2 sub-types?
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- Plantar (heel spur, osteophytes)
- Necrotizing (strep pyogenes) |
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infection of hair shaft
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folliculitis
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infection of eye lid
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blepharitis
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What are the 8 normal oral organism?
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STREPS!!
Strep pyogenes Strep pneumoniae H. influenzae Nisseria catarrhalis - N. gonorrhea - N. meningitis Peptococcus Peptostreptococcus Fusobacterium Actinomyces Strep viridans - Strep mutans - Strep sanguis - Strep salivarius |
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What are the two group A streptococcus bugs?
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s. pyogenes and s. pneumonia
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What is s. pneumonia described as looking like?
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diplococci- like 2 kidney beans (only gram + diplococci)
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In order, what are the most common causes of meningitis from 2m to 10y?
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strep pneumonia, nisseria meningitis
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In order, what are the most common causes of meningitis from 10-21y?
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nisseria meningitis, strep pneumonia
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What is the most common cause of meningitis >21y?
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strep pneumonia
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What is the #1 cause of sinusitis, otitis media, bronchitis and pneumonia?
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s. pneumonia
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What is the #2 cause of sinusitis, otitis media, bronchitis and pneumonia?
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hemophilus influenza
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What are the top 3 IgA proteases organism?
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Strep pneumo
H. influenza Nisseria catarrhalis N. gonorrhea N. meningitidis ** MCC of sinusitis in order! |
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Which organism causes Vincent's angina (painful ulcer at back of throat) and trench mouth (pus from gum)?
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Fusobacterium
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Which organism has draining fistula (leaking to skin) and produce sulfur granules
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Actinomyces
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Streptococcus is what kind of bug?
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gram POS
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What does streptococcus look like?
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cocci in chains
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How does streptokinase work?
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breaks up clots by converting plasminogen to plasmin and binds fibrinogen
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What is the antidote for streptokinase, urokinase or tPA?
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aminocaproic acid
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What is the group B strepotcoccus bug?
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s. agalactiae
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What are the group D strepotcoccus bugs?
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viridans, mutans, sanguis, sulivarius, enterococcus
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What does s. agalactiae cause?
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meningitis from 0-2 months
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In order, what are the most common causes of meningitis from 0-2m?
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group b strep, e.coli, listeria
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What strep is the most common cause of subacute bacterial endocarditis?
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viridans
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What strep causes cavities?
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mutans
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If a UTI is nitride negative, what bug is suspected?
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s. enterococcus
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What do you treat s. enterococcus with?
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vancomycin
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What is #1 for epiglotitis?
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hemophilus influenze type B
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What is the normal stomach flora?
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H. pylori
- Dx = CHLOE test - Follow = Urease breath test |
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What does H. pylori look like?
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gram - comma shaped
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What positive enzyme is h. pylori?
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urease +
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What is the treatment for h. pylori?
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amoxicillin, bismuth, H-2 blocker or a PPI
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What are the urease + bugs?
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P = Proteus
P = pseudomonas U = ureoplasma N = norcardia C = cryptococcus H = H. pylori S = Staph saprophyticus |
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What is the #1 for UTI's and gastroenteritis?
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E. coli
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What is the #2 for UTI's?
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proteus
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What is the #3 for UTI's?
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klebisella pneumonia
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What is e. coli infection associated with?
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hamburger
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Enterotoxigenic e. coli (ETEC) is associated with what?
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rice-water diarrhea
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Enteroinvasive e. coli EICC is associated with what?
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travelers diarrhea
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endemic HUS
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Enterohemorragic e. coli (EHEC) is associated with what?
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epidemic HUS
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What is 0157:H7 e. coli associated with?
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What is the treatment for e. coli?
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amphicillin, erythromycin, etc...
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What is a clue for a proteus UTI?
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urease +, high pH
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What is proteus associated with?
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struvite stones
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Who is klebsiella associated with?
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alcoholics, any mention of fissures with pneumonia
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What does the sputum look like with klebsiella?
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currant jelly sputum
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What are the top 4 curved rods (comma shaped)?
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Vibrio
Campylobacter Listeria H. pylori |
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What is the only gram + to form an endotoxin?
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listeria monocytogenes
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What do adults get with a lysteria monocytogenes infection?
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gastroenteritis
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What do babies get with a lysteria monocytogenes infection?
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meningitis
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What is a lysteria monocytogenes infection associated with?
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cabbage and migrant workers
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What shape is lysteria monocytogenes?
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comma shaped
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What is the movement of lysteria monocytogenes described as?
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tumbling motility
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How do you treat lysteria monocytogenes?
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ampicillin, macrolides, vancomycin
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What kind of bug is vibrio cholera?
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gram - comma shaped
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What kind of diarrhea do you get with vibrio cholera?
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rice water
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What is vibrio parahaemolyticus associated with?
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diarrhea associated with raw fish
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What is vibrio vulnificus associated with?
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gastroenteritis associated with raw oysters
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What type of gram - is hemophilis?
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pleomorphic rod
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What protease does hemophilus have?
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IgA protease
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What is the main virulence factor of hemophilus?
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capsule
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What is the invasive type of hemophilus?
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hemophilus B
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What does the invasive hemophilus cause?
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meningitis, sepsis, epiglotitis
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What does the non-invasive hemophilus cause?
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sinusitis, otitis, bronchitis and pneumonia
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What are the normal Small Intestine flora?
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95% E. coli
- makes vitamin K - factor 1.9.7.2 - folate - B5 (panthotenic acid) |
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What are the 5 Small GI infections?
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1. Cholecystitis
2. Ascending cholangitis 3. Appendicitis 4. Bacterial peritonitis 5. Abdominal abscess - Perforation: anaerobe (tx = exposure) |
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What is the test for vitamin-B12 deficiency?
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Schilling's test - determine whether the patient has pernicious anemia. (radioactive B12 after B12 IM)
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What are the normal flora of Distal Ileum and Colonic flora?
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E. coli (MCC of UTI)
Proteus (2nd) Klebsiella (3rd, currant jelly sputum) Serratia marscencens (GI, UTI) Acenetobacter Citrobacter |
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Which organism causes cerebal abscesses in newborn infants?
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Citrobacter
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Which organism prefer immunosuppressed PT's on ventilators in hospital?
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Actinobacter
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What are the 4 BIG MAMA anaerobes?
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Bacteroides fragilis (obligative anaerobe of GI)
Strep bovis Clostridium melanogosepticus Clostridium difficile |
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What 2 anaerobes are associated with colon cancer?
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clostridium melanosepticus, and strep. bovis
- in PT's with extended AB |
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What is c. difficile associated with?
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pseudomembranous colitis (gastroenteritis) associated with broad spectrum antibiotics
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What is the treatment for c. difficile?
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vancomycin or metronidazole
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What are the 3 rectal normal flora?
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Group B streps
E. coli Lysteria monocytogenes (affects really young and old) ** BABY B.E.L. = MCC of meningitis |
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Strep group with partial hemolysis
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ALPHA-hemolysis
green zone |
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Strep group with complete hemolysis
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BETA-hemolysis
clear zone |
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Strep group with no hemolysis
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GAMMA-hemolysis
red zone (heme still there) |
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What kind of hemolysis is streptokinase have?
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Beta-hemolysis (complete)
- convert plasminogen to plasmin - bind fibrinogen - will not clot again |
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What is the contraindication for streptokinase?
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when PT has previous recent history of strep infection (sore throat) because of immunity.
** Use tPA instead! |
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TX for clot in PT with open fistula and grafts.
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Urokinase
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TX for clot in acute MI.
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Streptokinase
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TX for clot in acute MI/stroke <3hrs
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tPA
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What kind of hemolysis pattern does Strep pneumo exhibit?
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ALPHA-hemolysis (partial)
80 strains Pneumovax = 23 strains, 98% |
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Who should be on Pneumovax?
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elderly >65yo
SCA >2yo (no spleen) End organ failure PSGN (strain 12) |
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What kind of hemolysis pattern does Group-A Strep pyogenes exhibit?
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BETA-hemolysis (complete)
70 strains |
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What is the MCC of throat infection?
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Strep pyogenes
Rheumatic fever Mitral > Aortic valve 2nd MCC of skin infection |
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What kind of hemolysis pattern does Group-B Strep agalactaciae exhibit?
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BETA-hemolysis (complete)
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What is the MCC of neonatal sepsis?
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Strep agalactaciae
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What kind of hemolysis pattern does Group-D Strep viridans exhibit?
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ALPHA-hemolysis (partial)
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What is the MCC of subacute BE?
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Strep viridans
Valve must be previous damaged! (TX = amox) Only Staph aureus affects healthy valve. |
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What kind of hemolysis pattern does enterococci exhibit?
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GAMMA-hemolytic (none)
anaerobic Likes immunocompromised PT's NITRITE NEGATIVE uti TX = vancomycin |
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What is the MOA of Vancomycin?
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Cell wall inhibitor
- inhibit phospholipid bilayer - TX FOR ALL GRAM POS!! |
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What are the 4 sign of toxicity of vancomycin?
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- Red man syndrome (overdose)
- Intense histamine release - Ototoxic - Nephrotoxic |
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Review:
Which part of kidney is affected due to drugs? |
Tubules & interstitium
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Which 3 popular organism we can use vancomycin to treat?
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MRSA
Staph epidermidis (bimodal) Enterococcus |
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If organism is MSSA (methacillin sensitive), what is the DOC?
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Nafacillin
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What does cornybacterium diptheria look like?
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chinese letter
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What is the toxin produced by cornybacterium diptheria?
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toxin that ADP-ribosylates EF-2
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What can cornybacterium diptheria form in the back of the pharynx?
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pseudomembrane- never scrape off because it will hemorrhage
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What kind of bug is cornybacterium diptheria?
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gram POS
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How is cornybacterium diptheria treated?
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antitoxin first, then antibiotic
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ADP-ribosylator:
Gs |
Vibrio cholera, ETEC
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ADP-ribosylator:
Gi |
B. pertussis
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ADP-ribosylator:
EF2 |
C. diptheria, pseudomonas
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What 5 things can cause heart block?
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lyme disease
legionella thyphoid fever diptheria chaga's disease |
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What are the 2 spore formers
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Bacillus
Clostridium |
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What is spore made of?
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Ca-diplocholinate (dormant)
** release TOXIN when exposed to heat |
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What kind of bug is bacillus?
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gram + spore former
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What is the shell of bacillus made of?
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poly D-glutamic acid
** we have L-glutamic acid |
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wool sorter's disease
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Pulmonary anthrax
- heat activated toxins - mediastinal hemorrhagic lymphadenitis |
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What are 3 toxins of B. anthrax?
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Lethal factor = deadly
Edema factor Protective factor = mediates entry |
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Which sub-type of anthrax doesn't kill you?
|
Cutaneous anthrax
- malignant pustules - skin necrosis |
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Fried/reheated rice
|
Bacillus cereus
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What are the two toxins of B. cereus?
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Emetic (1-6 hrs)
Diarrheal (18 hrs) - increase cAMP, watery diarrhea |
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What is c. difficile associated with?
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pseudomembranous colitis (gastroenteritis) associated with broad spectrum antibiotics
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What is the treatment for c. difficile?
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1st line = Metronidazole
2nd line = vancomycin |
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What are SE's of metronidazole?
|
Disulfiram-like effect
Dysguizia |
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What is c. perfringens associated with?
|
gastroenteritis associated with holiday ham
- enterotoxin - instantaneous diarrhea |
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Is c. perfringens an aerobe or anaerobe?
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strict anaerobe
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What kind of gangrene does c. perfringens cause?
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gas gangrene (attack extremities in DM)
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What are 2 sub-types of gas gangrene?
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DRY - necrotic tissue
WET - blood going to area (worse because gas emboli) |
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What is the TX for gas gangrene?
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Amputation
Hyperbaric chamber |
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What is c. melanogosepticus associated with?
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colon CA
- along with strep bovis - produce black pigment |
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What is c. tetani associated with?
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dirty wound- rusty nail, etc
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How does c. tetani work?
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inhibits the release of glycine from the spinal cord- contracted muscles and die from respiratory failure
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What is an analog to c. tetani?
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stryck 9
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What is the treatment for c. tetani?
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vaccinate- give toxoid
for infection- antitoxin first, then antibiotics |
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How does c. botulinum work?
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causes flaccid paralysis by blocking the release of presynaptic AcH - floppy baby - die of respiratory failure.
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What is c. botulinum associated with?
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honey and malaises in babies
canned food in adults |
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In what kind of wound/PT do you not give tetani TX to?
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minor/clean wound, or immunized PT
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What kind of wound/PT do you have to give tetani TX to?
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clean wound without immunization, or dirty wound with immunization <3 or >10 years.
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