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133 Cards in this Set

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Bacillus anthracis?
toxin-producing, encapsulated, facultative anaerobe.
Anthrax Means of Infection?
a)Through the skin (contact with anmals or animal hides)
b)Ingestion of contaminated meat with break in GI mucosa
c)Inhaling spores,
Anthrax What kind of toxins?
1)Edema toxin (massive local edema)
2)Lethal toxin (massive release of cytokines from macrophages, sudden death common in anthrax infections)
Anthrax Sx?
-Piainless, cutaneous balck eschar on exposed areas of skin with marked surrouding edema and vesicles
-NOn specific flu like Sx, rapidly porgress to dyspnea and shock
Anthrax Dx?
cultures and Gram stains from clinically identified sites, including cutaneous lesions, pleural fluid, CSF, or stool, Chest x-ray (or CT) PCR , ELISA
acute pharyngeal or cutaneous infection by Corynebacterium diphtheriae, some strains: exotoxin.
Diphteria Sx?
-Tenacious gray membrane at portal of entry and pahrynx, can detahc and cause airway obstruction
-sore throat, nasal discharge, hoarseness, malaise, fever.
-bullneck edema
-Mycarditis, neuropathy
-skin ulcers is EXOtoxin present
Diphteria Dx?
-clinical presentation
Diphteria Mode of transmition?
-respiratory droplets from humans
-respiratory secretions
-skin lesions,
- rarely by fomites
Listeria monocytogenes?
Facultative, motile G+ rod, capale of invading several cell types and causes intracellular infx
Listeria mode of trnasmission?
-ingestion of contaminated dairy products, raw vegetables, or meats and
-grows at refrigerator temperatures.
Listeria Disease Sypmtoms?
*Primarily Listeremia is RARE with HIGH FEVER & NON-LOCAL SXS.
bacteremia, meningitis, cerebritis, dermatitis, an oculoglandular syndrome, intrauterine and neonatal infections, or rarely endocarditis
Listeria Dx?
By laboratory isolation
Streptococcus pneumoniae?
gram-positive, aerobic, encapsulated diplococcus
Pneumococcal Dz?
-otitis media,
Pnumococcal Sx?
-Productive cough, fever, rigors, dyspnea , early pluritic chest pain
-Consolidated lobar pneumonia (X ray
Staphylococcal infxs and species??
gram-positive, aerobic organisms.
-Staphylococcus aureus: virulent and antibiotic resistant.
-S. epidermidis hospital-acquired infections,
-S. saprophyticus causes urinary infections.
S aureus Sx?
-Localized erythema wiht induration
-possible abscess
-gastroenteritis, food poisoning
-scalded skin syndrome (toxin)
-toxic shock syndrome (TSS)
S aureus Dx?
Gram stain and culture,X-ray
Staph mode of transmission?
Direct invasion thorugh skin
-vesicular pustules and crusting (impetigo) or
- cellulitis
- focal and nodular (furuncles and carbuncles).
Streptococcal and Enterococcal Infections ?
S. pyogenes: group A β-hemolytic, gram-positive aerobic organisms
Streptococcal and Enterococcal Dz?
pharyngitis, pneumonia, wound and skin infections, sepsis, and endocarditis.
Sequelae :rheumatic fever and glomerulonephritis
-Scarlet fever
-strawberry tongue (diff from TSS)
Streptococcal and Enterococcal Sx?
-Abrupt onset of sore throat
fever, malaise, nausea, headache
-Thoat red and Edematous, w/ or w/o exudate
-cervical nodes tender
Streptococcal and Enterococcal Dx?
-Throat culture
S. pyogenes Dz?
-Erysipelas is a particular form of streptococcal cellulitis.
-Necrotizing fasciitis due to S. pyogenes is a severe dermal (or rarely muscular) infection that spreads along fascial plane
-pneumonia and ampyema
Enterococcal Infx?
-Enterococcus faecalis
and E. faecium
cause: endocarditis, UTI, intra-abdominal infection, cellulitis
-wound infection
-concurrent bacteremia.
Toxic Shock Syndrome (TSS)causing organisms ?
staphylococcal or streptococcal exotoxins.
high fever, hypotension, diffuse erythematous rash, and multiple organ involvement, shock
clinically and by isolating the organism.
Campylobacter and Related Infections?
Gram-negative bacilli
Campyobacter Sx?
diarrhea (loose, watery or bloody)relapsing fever
bacteremia, with: endocarditis, osteomyelitis,

or septic arthritis.
Vibrio cholerae
acute infection of the small bowel , toxin that produces copious watery diarrhea, leading to dehydration, oliguria, and collapse.
Cholera Dx?
by stool culture or serology.
Cholera mode of Transmission
Traval to endemic area (crowded, war, famine) or contact with infeced person
Escherichia coli Infections ?
inhabitants of the large intestine. strains produce toxins that cause diarrhea, and all strains produce infection when they invade sterile tissues.
Sometimes fever,
abdominal cramps
Different kinds of E.coli?
(name 3)
ETEC: travellers diarrhea (_T_C = Travelling Countries)
EIEC: bloody diarrhea,
dysentery (_I_C = Intensive Care Unit for bleeding)
EHEC (O157:H7): aSx carrier, non-bloody diarrhea,(CMTD) (or bloody in her notes) hemorragic colitis, hemolytic uremic Syndrome, TPP (_H_C = Helen Carney, my little sister always bugged me)
Haemophilus Infx?
numerous mild and serious infections, including bacteremia, meningitis, pneumonia, otitis media, cellulitis, sinusites, bronchitis, arthritis, endocarditis and epiglottitis
H influenzae is teh most common
-Colonize the Upper respiratory tract in COPD patients
HAmophilus Dx?
culture and serotyping.
Klebsiella, Enterobacter, and Serratia Infections (Hospital acquired)
-closely related normal intestinal flora
-infections in the respiratory or urinary tract that present as pneumonia, cystitis, or pyelitis and may progress to lung abscess, empyema, and septicemia
-Red Jally sputum (klebsiella)
Legionella Infections ?
pneumonia, with extrapulmonary features
-immunocompromised, smokers or lung Dz
-scant sputum production, pleuritic chest pain, toxic appearance.
Legionella INfx?
requires specific growth media, serologic testing, or PCR analysis
X-ray: consolidation, patchy infiltrates
-Assoc with contaminated water sources.
Bordetella pertussis?
Pertussis (Whooping Cough)
(a small, nonmotile, gram-negative coccobacillus)
Pertussis Dx?
nasopharyngeal culture (leukocytosis), PCR, and serologic assays.
Pertussis Sx?
Infant before 2
Prodromal 2 week catarral stage, malaise , cough coryza , anorexia
URI followed by paroxysmal or spasmodic coughing that
ends in a prolonged,high-pitched, crowing inspiration (the whoop).
PErtussis transmission?
Reservoir adolescents and adults: REspiratory droplets
Yersinia Infections(Bubonic Plague; Pestis; Black Death)
short bacillus bipolar staining G- rod
Yersinia Sx?
Sudden onset of high fever, malaise, muscular pains, prostration, axyllary or inguinal lymphadenitis. pneumonia, bacteremia or maningitis
Yersinia Dx?
Positive smear and blood culture of bubo
Mode of transmission?
Esposire to rodent in endemic areas or fleas. repiratory droplets via pneumonia
Pseudomonas and Related Infections?
aeruginosa and other members of this group of gram-negative bacilli are opportunistic pathogens
Pseudomonas DX?
by culture (hospital aquired mostly)
P aeruginosa?:
G- bacilli , opportunistic infx (HIV, ICUs)
Dx by culture,
resistance is common,
Many anatomic sites like heart valves, 1st Sign is G-SEPSIS
Salmonella infx?
a lot of serotypes A, (S typhi) B and C, also infect animals, TYPHOID FEVER Dx clinical, culture
Tx Cipro,
Salmonella S&S
incubation 8-14 d
Onset: gradual (fever, headache, arthalgia, pharyngitis)
Temp rises (40C) stays high for 10 day, lowers 3 weeks,
prostration, CNS Sx, 10% pt w/pink blanching lesions (rose)
Intestinal perforation may occur, 2ndary pneumonia
Salmonella Dx:
Similar diseases: rickesttsias, leptos, TB, malaria, Yersinia,
etc, influenza, Lymphoma and other infxns DO CULTURES
even bone marrow
intestinal infection, bloody diarrhea, nausea
Dx clinical/stool culture,
Abx + rehydration
Shigella mech of disease?
penetrate mucosa of large intestine, toxin,
1-4 days incubation, watery diarrhea (may confuse with protozoal infxs),
electrolyte loss, dehydration circulatory collapse, death
Febrile disease by Francisella Tularensis, Sx: local ulcerative lesion, lymphadenopathy, systemic Sx. Dx: EPIdemilogic and clinic, Tx Abx
Tularemia, Who and more Sx?
Hunters, butchers, farmers, and fur handlers winter. Contact wth animals, rabbits, NO human to human
Bioterrorisim 1-10 days, h/a, Nausea, vominting 40 C fever, weakness
sweats, inflamed papules. regional lymph nodes enlarge, delirium
Pathogenic Protozoans:
Entamoeba histolytica, Cryptosporidium sp, Giardia lamblia, Isospora belli, Cyclospora cayetanensis, and members of the phylum Microsporidia
Non-intestinal Protozoan ifx
malaria, babesiosis, eishmaniasis, toxoplasmosis, trypanosomiasis. Extraintestinal Protozoa: nematodes in Nematodes (Roundworms), flukes in Trematodes (Flukes), and tapeworms in Cestodes (Tapeworms).
Intestinal Protozoa transmission?
fecal oral route, poor hygiene, sexually. Dx: STOOL specimen (G, lamlia, Cryptosp and E histo)
Entamoeba Dz?
asymptomatic, but sometimes mild diarrhea, severe dysentery, liver abscesses
Dx: stool, serologic
Tx: metronidazole or tinidazole
Entamoeba species and forms?
E. histolytica is pathogenic,but E. dispar harmless
trophozoite in liquid stools
and cyst in formed stools (resistant to the external environment)
Eh trophozoites?
adhere and kill colonic epithelial cells and PMNs,
degrade the extracellular matrix, invade intestine wall
spread necrotic liver other organs
Eh Sx?
ASk Barbara: asymptomatic, chronically pass cysts, diarrhea and constipation, flatulence, cramping, liver tenderness referred to the right shoulder
Sx similar to appendicitis (no SURGERY!!) or IBS
skin and lungs
Eh ddx
misdiagnosis IBS, UC, salmonellosis, shigellosis (but Eh low WBC),
diff from other hepatic dz
EXAMINE STOOL b4 doing anything else
proctoscopy, Biopsy
C. parvum and C. hominis
watery diarrhea, GI distress, persistent and severe in those with AIDS
coccidian protozoa
ingestion by another vertebrate, the oocyst releases sporozoites that transform into trophozoites in epithelial cells,
incubation period is about 1 wk,
excretion/shedding of oocysts,
immunocompromised big fluid loss
Crypt Dx, Tx?
Acid fast in stools, antigen essays, self-limited. Nitazoxanide (children and immunocomp),
Stools slightly infectious, follow BIOSAFETY
Giardia trophozoites or cysts, fecal-oral route,
Giardia cysts remain viable in surface water and are resistant to chlorination, lots of boiling
Giardiasis signs Sx?
Ask Alexis to describe: 1 to 2 wk after infection, watery malodorous diarrhea, abdominal cramps and distention, flatulence, eructation, intermittent nausea, epigastric discomfort
Giardiasis Dx?
trophozoites or cysts in stool, enzyme assays
Tx Meronidazole, Flagyl
obligate intracellular spore-forming protozoan parasites,
many ways to acquire, inoculate host cell with infective sporoplasm, inflammation when spores liberate.
Microsp Sx, Signs
AIDS related diarrhea, disseminated infection, and corneal disease.
DX fluorecense, PCR etc.
African Trypanosomiasis? (African Sleeping Sickness)
protozoa T. brucei transmitted by the bite of a tsetse fly, Mechanism to escape immune defense by changing surface proteins,
Trypanosomiasis Sx:
skin lesions, intermittent fever, headache, rigors, transient edema, generalized lymphadenopathy, meningoencephalitis
Trypanosomiasis Dx?
identifying the organism in blood,CSF, lymph
serologic, clinically: Chancre sore, papule becomes dusty red nodule
Trypanosomiasis Tx?
pentamidine, melarsoprol, or eflornithine
Avoid endemic areas, clothing DEET
Babesiosis ?
Babesia microti from rodents and deer ticks invad RBCs
Babesiosis S&S?
Ask Shawn C
asymptomatic, malaria-like illness with fever,hemolytic anemia.
immunocompromised, may hepatoslenomegaly
Babesiosis Dx?
peripheral blood smear, serology, or PCR
Babesiosis Tx?
azithromycin plus atovaquone or with quinine plus clindamycin.
no if asymptomatic
Chagas' Disease (American Trypanosomiasis)?
Trypanosoma cruzi, transmitted by kissing bug,
bugs deposit feces containing metacyclic trypomastigotes
Chagas' Disease S&S?
Cells of the reticuloendothelial system, myocardium, muscles, and nervous system, skin lesion, unilateral periorbital edema, fever, malaise, generalized lymphadenopathy, and hepatosplenomegaly, chronic cardiomyopathy, megaesophagus, or megacolon. May be asymptomatic
Chagas' Disease Dx?
trypanosomes in peripheral blood, PCR, serologic tests,
Chronic disease develops in 20 to 40%, after a latent phase that may last years or decades.
Chagas' Disease Tx
nifurtimox or benznidazole
in chronic, Tx is symptomtomatic
Vector flies Phlebotomus sp are infected by biting humans or animals, survive in the vertebrate host as intracellular amastigotes
Visceral leishmaniasis Sx
irregular fever, hepatosplenomegaly, pancytopenia, and polyclonal hypergammaglobulinemia, high mortality if untx
Cutaneous leishmaniasis Sx
painless nodular skin lesions that enlarge, ulcerate centrally, and persist for months to years but eventually heal. Dx smears or cultures of splenic or bone marrow aspirates
Mucocutaneous disease Sx
following cutaneus nasopharyngeal tissues and can cause gross mutilation of the nose and palate.
Leishmaniasis Tx ?
pentavalent antimony compounds, liposomal amphotericin B, amphotericin B deoxycholate, or miltefosine,
4 species of Plasmodium. (falciparum, vivax,
ovale, malariae), Transmited by: Anopheles mosquito, Life cycle: gametocytes, sporozoites, schizonts, marozoites
Malaria Sx
jaundice, hepatomegaly, Fever (periodic), chills, sweating, hemolytic anemia, and splenomegaly.
P. falciparum causes microvascular obstruction (he is the bad one to have)
Malaria Dx.Tx
Plasmodium in peripheral blood smear; Tx: chloroquine, quinine, check for hypoglycemia and hydration.
Toxoplasma gondii, Sx from none, to benign lymphadenopathy, a mononucleosis-like illness (rash hepatosplenomegaly, retinochoroiditis, confusion) or life-threatening CNS ,disease in immunocompromised people. (CNS mass lesion)
Toxop tranmsision
Human exposure to toxoplasmosis is common wherever cats are found, oocysts from cat feces, crosses the placenta
Toxop infection:
usually asymptomatic but may cause mild, self-resolving cervical or axillary lymphadenopathy
Acute toxoplasmosis may mimic infectious mononucleosis with lymphadenopathy
Types of toxoplasmoisis
Severe disseminated toxoplasmosis is rare in immunocompetent people,
CNS toxoplasmosis can cause focal neurologic deficits,
Congenital toxoplasmosis (pregnancy), Prognosis is poor (if the fetus survives until birth)
serologically (Ig G antibodies)
If CNS involvement head CT , brain biopsy
Anaerobic Bacteria?
Infections suppurative, abscess formation tissue necrosis
in gas formation in tissue
clostridial diseases
rare but can be fatal, Abdominal disorders, such as cholecystitis, peritonitis, ruptured appendix, and bowel perforation
Clostridial other symptoms?
Sudden onset of pian and edema in wound, prostration and systemic toxicity, brown to blood tinged watery exudates with skin discoloration, gas and tissue
Clostridia Dx:
Gram positive rods in culture
Leprosy (Hansen's Disease)
chronic infection by the acid-fast bacillus Mycobacterium leprae
Leprosy Sx
have pale anesthetic macular nodular or erythematuous skin lesion, superficial nerve thickening with associated anesthesia, Rash is non pruritic
Leprosy Dx
Clinical and lab biopsy
M leprae reservoirs
Armadillos and humans
Leprosy trnasmission
nasal droplets and secretions
Tuberculoid leprosy
mildest form, intact cellular immunity, more benign, asymmetric nerve involvement.
Lepromatous leprosy
Defective cellular immunity , progressive malignant nodular skin lesions, slow symmeric nerve involvement
Borderline leprosy
most common , numerous lesion that resemble turbeuloid leprosy
peripheral neurites, distal hypoestesia and weakness
Other Mycobacteria?
Present in soil and water, less virulent than TB, except elderly get M. avium
What is MAC?
Mycobacterium avium complex
MAC pulmonary dz affects whom?
mid to older pts with preveious lung problems, AIDS pts
MAC sx?
cough, expectoration, slowly progressive, fever, weight loss
MAC cutaneous dz from what organisms?
M. marinum (pools), M. ulcerans, M. kansasii
MAC cutaneous dz sx?
lesions, reddish bumps in upper extremities or knees
MAC disseminated dz affects whom?
AIDS, immunocompromised
MAC disseminated dz sx?
fever, anemia, thrombocytopenia, diarrhea, abd pain (like Whipples)
MAC disseminated dx:
culture of blood, bone marrow, SI
Mycobacterium tuberculosis sx?
fatigue, weight loss, fever, night sweats, productive cough, dyspnea, chest pain, hemoptysis with cavitary TB
TB dx?
sputum culture/smear, pulmonary infiltrates on chest radiograph, blood test of gamma IFN
TB organism is?
acid fast bacilli
TB transmission?
inhale droplets
Who is at risk for TB?
elderly, HIV, homelessness
TB positive PPD?
> 10mm induration
TB tx?
isoniazid, rifampin, pyrazinamide, ethambutol together for initial tx; second line: aminoglycosides (streptomycin) and fluoroquinolones used for MDR-TB
TB vaccine?
BCG vaccine - 50% effective
Extrapulmonary TB is from?
hematogenous dissemination
Miliary TB sx?
lungs and bone marrow most often affected, children, imunocompromised, elderly
Miliary TB sx?
fever, chills, weakness, malaise, progressive dypspnea, anemia, thrombocytopenia, leukemoid reaction
Extrapulmonary TB can give you what other conditions?
pyelonephritis, meningitis, peritonitis, pericarditis, lymphadenitis, liver infx, bone/joint problems