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164 Cards in this Set
- Front
- Back
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ophthalmia neonatorum
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MCC of b/l conjunctivity in newborns, vertical; erythromycin drops prevent chlamydia and gonorrheae infection
assoc w/ pneumonia afebrile staccato cough, wheezing eosinophila |
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trachoma
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MCC of global blindness
b. Transmission • Hand to eye c. Chronic suppurative eye disease characterized as a follicular (inclusion) keratoconjunctivitis d. Contracted in people living in dry and sandy regions in Africa and Asia MCC of global blindness chlamidia ABC african blind chronic infection |
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chlamydia psittaci
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Gram negative obligate intracellular parasites, reticulate body replicates-->elementary body is infective (E)nters cell; binary fission
Cause of ornithosis (psittacosis), a type of zoonosis b. Inhalation of dried bird droppings from parrots, parakeets, pigeons, chickens, ducks c. Causes bronchitis or pneumonia |
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chlamydia trachomatis
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Gram negative obligate intracellular parasites, reticulate body replicates-->elementary body is infective (E)nters cell; binary fission
--STD, urethritis (acute urethral syndrome in women, cervicitis, PID, bartholin gland abscess; CAN VISUALIZE RETICULATE BODY; Men (nonsp urethritis (sterole pyruia), epididymiti prostatis, proctitis Reiter's synrome HLA B27 (joints ureal, urethra); DNA probe azithromycin or doxycyline |
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chlaymydia pneumoniae
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Gram negative obligate intracellular parasites, reticulate body replicates-->elementary body is infective (E)nters cell; binary fission
Second MCC of atypical pneumonia b. Transmission • Respiratory aerosol c. Seroepidemiologic association with coronary artery disease d. Rx • Doxycycline |
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MCC of b/l conjunctivity
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ophthalmia neonatorum Chlamydia
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MCC of global blindness
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trachoma (chamydia) ABC
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LGV
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Tiny papules in the genital region
• No ulcers b. Inguinal lymphadenitis with granulomatous microabscesses and multiple draining sinuses c. Fibrous stricture formation produces localized lymphedema of scrotum/vulva, RECTAL STRICTURES IN WOMEN d. Rx• Doxycycline 100 mg bid x 21 days a form of chlamydia |
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2nd MCC of atypical pneumonia
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chlamydia
no pus or productive cough |
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richettsial characteristics
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gram negative oligate intraceullar parasites; vector-->endothelial cells; escape phagosomes-->lymphocytic vasclitis
eschar binary fission endogenous phopholipase A-->inflammation adn thrombosis-->sitm arachodonic acid metabolism majority of the rashes are petechia |
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RMSF
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R. rickettsii is the bacteria, the tick is dermacentor variabilis
tick, dogs, rodents, tick to tick resevoir; extremity to trunk a. MC rickettsial disease in the United States ; b. Highest incidence in North Carolina • Bite of the wood tick, Dermacentor variabilis (American dog tick) 2. Clinical findings a. Incubation, • Median 7 days , b. Three classic diagnostic features -(1) Rash (95%) • Spreads from hands to trunk (2) Fever, (3) History of tick exposure (4) All 3 are present in < 20% of cases c. Gastrointestina- N/V, diarrhea, abdominal pain, hepatitis d. CNS-• Headache, lethargy, delirium, coma e. DIC f. Laboratory findings (1) Absolute neutrophilic leukocytosis with a left shift or normal to decreased count with increased band neutrophils (2) Hyponatremia (50%) • ? Syndrome of inappropriate ADH ; (3) Hypoalbuminemia (30%) (4) CSF findings-• Increased mononuclear cells and neutrophils, slight protein elevation, slight decrease in glucose (5) Mainstay for diagnosis is serological testing-• Indirect immunofluorescence technique and ELISA g. Rx-• Doxycycline; chloramphenicol alternative h. Case mortality 8% gram negative oligate intraceullar parasites; vector-->endothelial cells; escape phagosomes-->lymphocytic vasclitis eschar binary fission endogenous phopholipase A-->inflammation adn thrombosis-->sitm arachodonic acid metabolism majority of the rashes are petechia |
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typus grousp of richettsia
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R. powazekii louse, reservoir in humans, trunk to extreity; R typhi fleas-->rodent; trunk to extremitiy
R. tsutugamushi--mite-->rodent; trunk-->extremity, eschar |
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erlichiosis
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Human monocyte ehrlichiosis (HME) (Slide B8)
1. Obligate intraleukocytic (MONOCYTES usually, granulocyte in a less common disease) organism a. Produces a mulberry-like inclusion called a MORULA in the cytoplasm b. Primarily infects wild and domestic animals c. Anaplasma infects granulocytes (Ixodes deer tick) 2. Transmission a. Bite of a tick, Amblyomma (lone star tick) b. ****Reservoir white-tailed deer 3. Clinical findings • Fever, headache, myalgia, rash (~30%) 4. Rx: doxycycline 5. Case mortality 3% |
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Ureaplasma urealyticum, Mycoplasma hominis
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Transmission
• Sexual contact 2. Non-specific urethritis (NSU), endometritis, PID types of mycoplasma |
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mycoplasma pneumoniae
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MCC of atypical pneumonia
2. Clinical findings a. Transmission, (1) Droplet infection, (2) Common in crowded conditions (military personnel, college students) b. Interstitial pneumonia • Low grade fever, insidious onset, non-productive cough, no signs of consolidation c. Cold agglutinins*** • Anti-I IgM antibodies may cause hemolytic anemia d. Associations: ***• Erythema multiforme, bullous myringitis, Guillain-Barré syndrome 3. Rx • Azithromycin, erythromycin, clarithromycin tiniest free living organisms; fried egg appearance in culture; membrane has cholesterol |
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name 2 obligate intraceullar parasites
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chlamydia and richettsia
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what bug can lieave a phagosome?
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rickettsia
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MCC of atypical pneumonia
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mycoplasma #2 chlamydia
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how to create a gram stain
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Crystal violet iodine complex
• Stains both gram positive and negative cell walls; 2. Iodine • Mordant that fixes crystal violet 3. Alcohol a. Removes lipid from gram (-) organisms, thereby losing the dye in the decolorization process b. Gram (+) organisms retain crystal violet; 4. Safranin • Counterstain that stains gram (-) organisms red endotoxic--LPS lipid in cell wall of gram neg |
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gram + coci in clummps or clusters
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a. Gram (+) cocci in clumps or clusters
staph |
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gram + lancet shaped in diplos or chains
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b. Gram (+) organisms that are lancet shaped, in diplos or chains
strep pneumoniae and enterococcus gram stain |
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tiny gram + cocci
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c. Tiny gram (+) cocci
• Peptococcus, Peptostreptococcus (both are anaerobes) |
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gram - diplococci
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d. Gram (-) diplococci
• Neisseria ("coffee bean" shaped), Moraxella |
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gram - fat rods
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e. Gram (-) fat rods
• E. coli, Klebsiella |
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gram - thin rods
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f. Gram (-) thin rods
• Pseudomonas, Bacteroides (anaerobe), Hemophilus, Fusobacterium (anaerobe) |
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large gram + rods
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g. Large gram (+) rods
• Bacillus species, Clostridia, Corynebacteria ("Chinese letters") |
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small gram + rods
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h. Small gram (+) rods
• Listeria, Propionibacterium (anaerobe), Lactobacillus (anaerobe in the vagina) |
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filamentous and branching gram + organisms
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i. Filamentous and branching gram (+) organisms
(1) Nocardia (aerobic and partially acid fast) (2) Actinomyces (anaerobe with sulfur granules) |
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normal flora in mouth
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Mouth
a. Anaerobic bacteria • Peptostreptococcus, Fusobacterium (trench mouth), Prevotella, Actinomyces b. Streptococcus viridans c. Candida albicans |
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normal flora in skin
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Skin
a. Staphylococcus epidermidis (coagulase negative): MC b. Staphylococcus aureus c. Propionibacterium: important in acne d. Candida |
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normal flora in nose
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neisseria
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normal flora in colon
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Colon
a. Bacteroides fragilis: MC b. Candida albicans c. E. coli d. Enterococcus faecalis e. Clostridium species: difficile, perfringens mostly yeasts |
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normal flora in vagina
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Vagina
a. Lactobacillus: MC b. Candida albicans: yeast form c. E. coli d. Staphylococcus epidermidis |
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what is B lactamase?
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b-Lactamase
a. b-lactamase is an extracellular enzyme elaborated by certain organisms • Example N. gonorrhoeae/meningitidis, H. in¬fluenza, S. aureus b. Function • Hydrolyzes and renders ineffective the b-lactam ring of penicillin and cephalosporin antibiotics c. Constitutive pathogens • Continually synthesize -lactamase d. Inducible pathogens • Generate the enzyme only in the presence of the antibiotic |
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microdilution techniques
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Microdilution techniques
a. Determine the minimal inhibitory concentration (MIC) values for test organisms against multiple antibiotic agents b. MIC is defined as the lowest concentration of an antibiotic which inhibits the in vitro growth of an infectious organism |
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modified kirby bauer disk agar diffusion test
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**more area around means it has good killing power; bug has low resistance
Filter paper disks are impregnated with various antimicrobial agents of specific concentrations onto an agar plate, which has been previously inoculated with a suspension of the isolated bacteria b. Measurement of the zones of growth inhibition correlate with the susceptibility or resistance of the organism c. S (susceptible), I (intermediate), and R (resistant) (1) S means that the standard oral dose of the antibiotic is 2 to 4 times the minimal inhibitory concentration of the drug that is necessary to kill the organism • S also implies that the minimum dose of a parenteral agent will suffice to kill the organism (2) I means that oral medications is not effective in killing the organism, but the maximum dose of a parenteral agent is effective (3) R means that the antibiotic will not kill the organism |
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staphylococcus
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gram + coci in clumps, catalase positive; coagulase positive (aureus); S. epidermidis and sparophyticus are coag negative
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staph aureus
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hand transmission, mostly in ant nares; golden pigment, coagulase (act fibrin which walls off abscess), hemolysins (B hemolytic), protien A (MOST IMPT VIRULENCE FACTOR), binds heavy chain of IgG and prevents activaiton of complement; teichoic acid-adherance to cells, leukocidins--toxic to luekocytes; B lactamase strains, epidermolytic, enterotoxins (GI, food poisoning), peptidoglycans (endotoxic like for septic arthrits)
TSS-if in vagina MCC of furuncles (boils), styes, IMPETIGO (2nd is strep pyogenes), scalded skin syndrome, TSST (IL1, 2, TNF in tampons), acute osteomyelitis in children, postop wound, penumatocyst (tension pneumothorax in CF), IV catheter, acute bacterial endocartitis IVDA adn non IV DA*** CC in food poisoning due to enterotoxin vomit>diarrhea, culture food, acute conjunctivitis, 3rd degree burns, pneumonia in CF, nosocomial pneumonia, otitis media, pseudomembranous colitis |
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staph epidermidis
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coagulase negative; gram + cocci in clumps
Coagulase negative, catalase positive, b-lactamase producer b. Normal flora on the skin and mucous membranes c. Glycocalyx producing strains adhere to prosthetic implants and catheters d. MCC of infections involving- (1) Prosthetic devices • Heart valves, hip, vascular grafts (2) CSF and peritoneal shunts e. Rx • Vancomycin +/- rifampin |
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staph saprophyticus
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gram + cocci in clumbs; catalase -
Coagulase negative, catalase positive b. Accounts for 10 to 20% of acute urinary tract infections in young, sexually active females • Second to E. coli in causing UTIs c. Rx • Oral cephalosporin or amoxicillin clavulanate |
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MCC food poisoning
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staph aureus, enterotoxin vomiting>diarrhea, culture food
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MC bacterial endocarditis
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staph
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MCC impetigo
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staph
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MCC of nosocomia pneumonia and septicemia in hospital
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staph
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MCC of otitis media
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staph
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MCC of pseudomembranous colitis
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staph
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MCC of UTI
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E coli #2 staph saprophyticus
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2nd MCC of UTI
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staph saprophyticus; #1 is e coli
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peptostreptococci
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gram + cocci in chains, coag/cat negative; M proteins MI virulence factor
MC anaerobic streptococci producing infection b. Common organism isolated in brain, lung, pelvic, and abdominal abscesses |
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a. Streptococcus (Enterococcus) faecalis
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gram + cocci in chains, coag/cat negative; M proteins MI virulence factor
group D strep Normal flora in colon (2) Infective endocarditis and genitourinary infections |
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b. Streptococcus bovis
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gram + cocci in chains, coag/cat negative; M proteins MI virulence factor
Normal flora in colon group D strep (2) MCC of endocarditis in patient's with colorectal cancer, Crohn's disease, or ulcerative colitis |
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strepococcus mutans
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group B strep; gram + cocci in chains, coag/cat negative; M proteins MI virulence factor
MCC of dental caries (Slide B27) b. Acts on sucrose to produce dextran, which enhances plaque formation c. Produces acid from fermentation of sucrose which erodes enamel |
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strep viridians
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group B strep Produces a-hemolysis
b. Normal flora in the oropharynx c. MCC of infective endocarditis (1) Enters blood stream with dental procedures (2) Valves must be damaged d. Prevent endocarditis by giving amoxicillin before dental and urinary tract procedures e. Rx • Penicillin G |
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strep agalactiae
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group B strep
(1) Produces CAMP factor • b-hemolysis on blood agar in the presence of Staphylococcus aureus (2) Colonizes vaginal flora of 15-25% of pregnant women (3) Transmission • During birth b. Most common cause of the following infections- (1) Neonatal meningitis, pneumonia, sepsis, chorioamnionitis (2) Premature rupture of membranes > 18 hrs before delivery or premature delivery are major risk factors • Mother should receive ampicillin to prevent infection in neonate c. Common cause of the following infections- (1) Urinary tract infections (2) Postpartum endometritis d. Rx • Penicillin G, ampicillin |
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strep pneumoniae
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gram + lancet shaped chain diplococus, optochin sensitive; positive quellung reaction, capsul MI virulence factor; capsular polysaccharid inhibits phagocytose!!!!!!
risk: splenetomy, alcohol, sickle cell disease MCC community aquiared pneumonia (consolidation, virtration fremitis), MCC meningitis in addults >18, sinusitis in children, otitis media, spontaneous peritonitis in children w/ ascitis, septicemia in splenectomized pts-->death in children w/ sickle cell pneumococcal vaccines against polysaccarize |
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strep pyogenes
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group A strep, resp droplets, rhematic fever (infective endocarditis T2HS/T4HS), not a septicemia; post strep GN is T3 HS; erysipelas
exudative tonsillitis due to a bacteria; culture or ELISA ludwig's angia--MC neck space infection scarlet fever-desquamating, sandpaperlike rash, strawberry tonue, T3HS, celluitis w/ lyphangitis red streak; peritonsillar abscess (uvula dev to opp side problem w/ swallowing), necrotizing fasciitis, strep gangrene exotoxin B CC: impetigo, pneumonia, menigitis, septicemia, postpartum endometritis, TSS, ednocarditis |
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strep gen characteristics
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gram + cocci chains, coag and cat neg
a hemoylsis--incompelte and green due to biliverdin pigment; b hemolysis--clear zone; gama hemolysis no hemolysis B hemolytic--M portein MI group A has hyaluronidase, streptokinase (breaks down fibirn cltos and DNAase B erythrogenic toxic desquamates; streptolysin O O2 labile; S O2 stable; pyrogenic exotoxin A TSST; B--necrotizing fasciitis |
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meningtis top 3
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strep pneumo, n menigitis, moraxilla catarralis
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MI virulence factor in strep
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M protein
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MI virulence factor in strep pneumo
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capsular polysaccharide inhibits phagocytosis
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MCC community acquired pneumonia
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strep pneumo
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MCC sinusitis in children
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strep pneumo
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MCC of otitis media
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strep pneumo
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MCC of neonatal menigitis
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strep agalactiae group b strep
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mcc of pneumonia in neonates
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group b strep agalactieae
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MCC of infective endocarditis
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strep viridians
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MCC of dental caries
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strep mutans
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MCC of endocarditis in pts w/ colorectal cancer, chron's disease, UC
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strep bovis
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neisseria gonorrhoeae
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PILI PREVENT PHAGOCYTOSIS; IGA PROTEIASE; VAGINTIS, URETHRITS, CERVICITS, ENDOMETRITIS MCC PID,FHC SYNDROME
• Sexual contact, during birth b. Main host defenses against gonococci (1) Secretory IgA, IgG, complement, neutrophils (2) Estrogen in vaginal mucosa prevents adherence c. Virulence factors (1) Pili that mediates adherence to mucosal surfaces and also prevents phagocytosis • Piliated bacteria are virulent and those lacking pili are non-virulent (2) IgA proteases for adherence (3) Lipooligosaccharide a modified form of endotoxin that is not as likely to produce septic shock as lipopolysaccharide in N. meningitidis d. Primarily infect mucosal surfaces in urethra and vagina e. Certain strains disseminate (1) Resist killing by antibodies and complement (2) Porin in cell wall inactivates C3b f. Patient's deficient in C6-C9 more likely to disseminate infection during menses and pregnancy g. Symptoms occur 2-7 days after sexual exposure (first week) h. Women (1) Urethritis (2) Vaginitis (children; lack estrogen) (3) Cervicitis (4) Endometritis (5) PID (MCC) • In 45% of cases, both N. gonorrhoeae and C. trachomatis coexist (6) Fitz-Hughes-Curtis syndrome • Perihepatic scars with RUQ pain, complication of PID (7) Bartholin gland abscess i. Men • Urethritis, epididymitis/prostatitis j. Neonate (1) Ophthalmia neonatorum (usually first week, bilateral) (2) Erythromycin eye drops are routinely given to newborns to prevent Chlamydia and Neisseria gonorrhoeae infections k. Disseminated gonococcemia (1) Mainly women (2) Septic arthritis (knee) (3) Tenosynovitis (hands, feet) (4) Dermatitis (pustules hands, feet) (5) C6-C9 deficiency predisposes to dissemination l. Diagnosis (1) Gram stain of exudate showing phagocytosed organisms in neutrophils (only definitive for men; women may have false positive from other non-pathogenic organisms) (2) DNA probes are most often used for confirmation. m. Rx (1) Urethritis, cervicitis, PID • Ceftriaxone (for GC) + doxycycline (for Chlamydia) (2) Disseminated • Ceftriaxone (3) Ophthalmia neonatorum • Ceftriaxone |
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neisseria specias characteristics
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gram - diplococci coffee bean appearance best on CO2 chocolate agar thayer martin; oxidase and ctalase positive
meningitdes-maltose and glucose; gorrhoease only glucose; fimbriae impt VF for adherence LSP endotoxin; IgA protein; b lactamase |
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neisseria menigitis
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Transmission
• Airborne droplets that colonize the nasopharynx b. Site of proliferation (1) Posterior nasopharynx (2) About 5% of people are carriers (3) Carrier rate increases to 35% in people living in close quarters (e.g., military recruits) c. Virulence factors (1) Polysaccharide capsule to resist phagocytosis by neutrophils (2) Endotoxin (lipopolysaccharide) that can produce septic shock and DIC (3) IgA protease that helps bacteria attach to respiratory epithelium by cleaving secretory IgA d. Meningococcemia (1) Predisposes to Waterhouse-Friderichsen syndrome • Petechia expanding into ecchymoses, septic shock, DIC, bilateral adrenal hemorrhage (hemorrhagic infarction) (2) Hematogenous spread to meninges producing meningitis • MCC of meningitis from 1 mth to 18 yrs old (3) Rx • Penicillin G (4) Rx close contacts (carriers) with rifampin (or ciprofloxacin) (5) Polysaccharide capsule vaccine |
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MCC meningitis 1mo -18 y/o
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N. meningitidis
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moraxella catarrhalis
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Coccobacillary gram negative rod that resembles cocci of Neisseria species
2. Children • Otitis media and sinusitis 3. Adults • Chronic bronchitis (second most common cause, H. influenzae most common) and pneumonia in patients with COPD 4. Rx • Amoxicillin/clavulanate, oral cephalosporin, or TMP/SMX |
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q fever
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coxiella burnetii
Gram negative coccobacillary bacteria 2. Transmission a. Aerosol (MC) of urine, feces, amniotic fluid, placental tissue b. Birthing process c. Contact with manure of sheep, cattle, goats; abattoir (slaughter house) employees d. Tick bite 3. Atypical interstitial pneumonia 4. Granulomatous hepatitis with ring forms; endocarditis 5. Rx • Doxycycline |
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bacillis anthracis
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aerobic large gram + rods, heat resistant spores not in tissue
Capsule composed of amino acids rather than polysaccharides • Inhibits phagocytosis b. Habitat • Soil c. Exotoxin has three proteins (virulence factors) (1) Edema factor • Activates adenylate cyclase (2) Lethal factor • Inhibits a signal transduction protein involved in cell division (3) Protective antigen • Assist entry of above proteins into cells d. Capsule composed of D-glutamate (not polysaccharide), which is antiphagocytic • Capsule and above toxins are required to be pathogenic (virulent) e. Transmission (1) Direct contact with animal skins or products (most commonly sheep and cattle) and entry of the organisms through abrasions or cuts (2) Inhalation • Use in germ warfare f. Cutaneous anthrax (90 to 95% of cases) (1) Occurs through direct contact with infected or contaminated animal products (2) Resemble insect bites (a) Eventually swell to form a black scab, or eschar, with a central area of necrosis (b) Called a "malignant pustule" (3) If untreated, death occurs in 20% of patients g. Pulmonary anthrax (1) Inhalation of spores present in contaminated hides or germ warfare • Example wool (called Woolsorter's disease) (2) Necrotizing pneumonia, meningitis, pronounced splenomegaly, and dissemination throughout the rest of the body • "First sign of the disease is death" (3) Soil contamination • Prevented by sterilizing dead animals and animal products h. Vaccine available for high risk patients • Examples veterinarians, soldiers entering developing countries i. Rx • Ciprofloxacin |
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bacillis cereus
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Enterotoxins are virulence factors
(1) Preformed enterotoxin similar to cholera in that it adds adenosine diphosphate-ribose (ADP-ribosylation) to a G protein which stimulate adenylate cyclase; increases cAMP in enterocytes causing secretory type of diarrhea (2) Enterotoxin resembling staphylococcal enterotoxin by acting as a superantigen b. Transmission • Reheated fried rice or tacos with rice c. Two syndromes (1) Nausea and vomiting within 4 hrs of eating (2) Watery diarrhea after 18 hours d. Gram positive rods in stool e. No Rx Characteristics a. Aerobic Bacillus species are large gram (+) rods with square ends b. Produce heat resistant spores • Spores do not form in tissue c. Source of polymyxin and bacitracin |
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clostridia perfringens
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VF a toxin lecithinase; anaerobic gram + bacilli
gas gangrene wet and foot poisoning in reheated meat; enterotoxin superantigen sim to stah is VF |
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clostridia tetani
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TEnnis racket appearance, motile on blood augar
anaerobic gram + bacilli; poor staining --closed wounds, IVDA skin popping, ubilical card; VF tetanospasim inhibits release of inhibitors NT--GABA and glycine sustained contraction --lock jaw, risus sardonicus, opithotonus active and passive immunization, debride wound, O2 administer Td if non-immunized in 10years, clean wound passive immune + Td |
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C botulinum
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heat resistnat spores; heat labile exotoxin
anaerobic Gram + bacilli, diff to stain heat labile toxin is VF, irrev blocks acetylcholine release 1st diplopia--.descending paralysis and mydriais adults-can's; infants==honey; ingest spore wound botulism-MCC in ww |
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clostridium dificile
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pseudomembranous colitis, secrtory diarrhea, Ab cuse
toxins A and B VF in colon cytotoin assay of stool |
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corneybacteria diptheriae
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club shaped gram + rods, chinese letter apppeanse
ADP-ribose to EF2; impaired B ox of FA w/ tappy cat heart MMCD mycarditis schick est pseudmomembrane in throat dysphonia bullneck appearnce pierpheral N and CN demyelination to paralysis horse antitoxin neurtralizes toxxin |
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propionbacterium acnes
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aneorobe like cornebact ; inc T in females; andrgens on sebaceous glands -->FA in hair follicle produces lipases
inflame |
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listeria monocytogenes
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motile, tumbling motility
soft cheeses and unpast milk, hot dogs actin rockets gram positive rod listeriolysin O degrades cell membrane actin rockets propel organism cel to cell in pregancy--abortion neonatal meningitis-abscesses and immunocompromised hosts #3 MC in infants meningitis tx: ampicillin |
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erysipelothrix rhusiopathiae
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erysipeloid, or fish-handler's disease)
1. Contracted by veterinarians, butchers, or those who work with fish, pigs 2. Painful, sharply demarcated purplish skin rash at the site of inoculation (usually hands) • Border extends outward |
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actinomyces isralii
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anaerobe, normal flora in mouth, dental extractions and MCC endometriitis w/ IUDs
sulfur granules in pus MC in jaw filamentous bacteria |
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nocardia asteroides
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aerobic, weakly acid fast; gram + filamentous bact, resp droplets
pulm disease in immunocompromised pts-->dissem abscesses to CNS and kidney |
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IUD endometrititis from?
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actinomyces isralii
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enterobacteriacae in general
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gram - non spre forming rods w/ endotoxin in cell walls VF
lactose fermentation in ecoli (+) not in shigella or salmonella reduce nitrates to nitrites-->UTIs K antigens-capsule interferes w/ phagocytosis, falgellar H, somatic O LIMULUS TEST-MEASURE OF ENDOTOXIN PRODUCTION |
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common pathogens of enterobacteriacae
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Enterobacter
• Sepsis, pneumonia (2) Escherichia • Meningitis, sepsis, pneumonia, diarrhea, urinary tract infections, peritonitis (3) Shigella • Diarrhea (4) Klebsiella • Pneumonia, urinary tract infections (5) Proteus • Urinary tract infections (6) Salmonella • Sepsis, osteomyelitis, diarrhea, food poisoning (7) Yersinia • Diarrhea, mesenteric adenitis (8) Serratia • Infections in immunocompromised hosts, phagocytic disorders |
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Esherichia coli
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enterotoxins heat stable toxin cGMP (ST), heat labile toxin (LT) cAMP, vertoxin shiga like 0157:H7 strain
fcal pollution indicator organism MENINGITIS, SEPSIS, PNEUMONIA, DIARRHEA uti, PERITONITIS MCC of UTI in LUT (acute pyelonephritis VUR ascending infection MCC of nosocomial septicemia leading to septic shock MCC w/ indwelling urinary catheter MCC spontaneous peritonitis in cirrhotics w/ ascites MCC traveler's diarrhea secretory diarrhea MCC of HUS-entrohemorrhagic strain hamburger meat, TP, RF, schistocytes Shiga toxin, colitis dysentery no fever acute cholesytitis, acute appendicitis, acute diverticulitis DUE TO LUMINAL OSTRUCTION fecolith or stone #2 neonatal meningitis, pneumonia, otitis media |
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MCC of LUTI
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e coli acute pyelonephritis VUR asceding infection
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MCC of traveler's diarrhea
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E coli secretory diarrhea, heat stabile and labile
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MCC of HUS
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enterhemorrhagic strain, hamburger meat, TP, RF microangiopathic hemolytic anemai w/ schistocytes due to shiga toxin and hemorrhagic colitis w/ cramps watery diarrhea-->dysentery no fever
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MCC acute cholecystitis
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e coli stone in cystic ductposs CBD
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MCC acute appendicitis
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fecolith in adults RLQ
e coli |
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MCC acute diverticulitis
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fecolith L side appendicits mimics except on left leukocytes
E coli |
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shigella
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DIARRHEA no animal reservoirs
S sonnei MC 4Fs fingers flies food feces children in day care centers (sim to HAV) invades mucosa blood diarrhea, psedumembranes, + fecal smear for luekocytes no carrier assoc w/ HLA B27 |
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salmonella enteritidis
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SEPSIS OSTEOMYELITIS DIARRHEA FOOD POISONING
animal reservoirs poultry, turtles iguanas domesttic livestokc f/o death in chidren if animaltramitted not if human tramsmitted entercolitis MCC of entercolitis and food posioning, not a septicemic phase invasive-sm/lg intesting postive fecal smear for leukocytes |
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salmonella typhi
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septicemia
SEPSIS OSTEOMYELITIS DIARRHEA FOOD POISONING animal reservoirs poultry, turtles iguanas domesttic livestokc f/o death in chidren if animaltramitted not if human tramsmitted typhoid fever--f/o, contact w/ asymp carrier (typhoid mary) 1st enter macs in peyer's pathces-->1st week high fever, 2nd week rash +vasculitis, diarrhea + stool; HSM, sinus brady, absolute neutropenia endotxins act Neutrophil adhesion meolecutres blood culture + before sotll 3rd week potential for bowel perforation 4th- chronic and resolution chronic carrier state-cholestystecomy |
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salmonella paratyphi
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SEPSIS OSTEOMYELITIS DIARRHEA FOOD POISONING
animal reservoirs poultry, turtles iguanas domesttic livestokc f/o death in chidren if animaltramitted not if human tramsmitted commonly assoc w/ sepicemia osteomyelitis in sickle cell septicemia and chornic carrier state gallbladder MC site, human reservoir; enteric fever sim typhoid fever sal |
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MCC of entercolitis and food poisoning
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salmonella enteritidis
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klebsiella pneumonia
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fat non mitle gram - rod + capsule MCC of pneumonia in nursing homes thick blood sputum
lobar pneumonia in alcholics cavitary, mocid capsule #2 lobar pneumona (MCC strep); UTI |
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MCC of pneumonia in nursing homes
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klebsiella
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serratia marcescens
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water loving, RED, immunocompromised host
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3 water loving bacteria
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legionella, serratia, pseudomonas
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porteus
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swarm, staghorm, smell of ammonia
kidney magnesioum, ammonium phosphate |
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name 2 urease producers
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proteus and H pylori
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yersinia entercolitica
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pseudotuberculosis
gram - coccobacilli, biolar graumuloatous non caseating mesenteric lymphadentis simulate acute appendicitis assoc w/ HLA-B27 MCC contaminant of stored blood iron lover |
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MCC contaminant of stored blood
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yersinia entercolitica
pseudotuberuculosis iron lover |
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vibrio colerae
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cholera, f/o, eating marine shellfish (shrim and oysters esp in louisiana)
gram - comma chaped bact ADP-ribosylations, cAMP secretory diarrhea no inflammation die of volume depletion recewater stools oral solutions w/ glucose |
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vibrioparahaemolyticus
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motile comma shaped gram -, raw seafood, sim to cholerae, severe watery diarrhea
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vibio vulnificus
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handling or eating sheefish, skin infections fatal septicemia
gram - comma shaped rods |
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campylobacter jejuni
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flaggated surved s shaped
cattle, chicken, puppies f/o, poutry unpasteurized milk sim to v cholerae invasive entercolitis, MC food-borne illness and invasive entercolitis in US crypt abscess resemble UC, bloody dairrhea w/ leukocytes organism in stool GBS, HLA-B27 |
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MC food-borne illness and invaseive enteroclitis in US
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campylobacter jejuni
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Helicobacter pylori
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gram - curved rod, pylorus an dantrum, mucus later not invasive
urea destruction of mucus-->PUD, gastritis metaplasia-->adenocarcinoma duodenal ulcer NEVER MALIGNANT NO BIOPSY; gastric ulcer poss malig biopsy assoc w/ pernicious anemia cancer-gastric adneocarcionma, low GRADE B CELL MALIGNANT LYMPHOMA CLO-test breath test is the BEST stool antigen test is cheapest detects ACTIVE DISEASE AND STAGE AND SUCCESS |
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pseudomonas
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gram - rod, green, waterloving
repirators (MC ICU nosocomia pneumonia); COD in CF w/ pneumonia, COD in burn infections, MC hot tub folliculitis need chlorine, MCC malignant external otiitis in diabetes, MCC osteochornitis/myeltiis in puncture wound rubber CC: conjunctivitis in lens wears, UTI |
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MCC of nosocomia pneumonia in ICu
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pseudomonas respirators
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MCOD in burn infections
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pseudomonas
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MCC of ho tub follicuitis
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pseudomonas
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MCOD in CF
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pseudomonas pneumonia
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MCC of malignant external otitis in diabetes
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pseudomonas
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hemophilis ducrei
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chancroid, sexual, painful ulcer, suppurativ engual nodes
shool of fish appearnce gram - rod IgA protease |
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haemophilis influenz
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MCC of acute epiglottitis in children, insp stridor thumbprint sign on XR of lat neck (edema)
MCC of acute bronchtis +chronic bronchitis in smokers 2nd MCC of otitis media -sinutsits, bact menignitis, orbital cellutiis and septicemia, septic arthritis, conjucntivitis in children gram - rod, lactamse, IgA portease is VF, X factor hematin, V factor NAD risk: young, spleectomy, alcohoism, COPD |
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hemophilis aegytius
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pink eye conjuctnivits in children
gram - rod |
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MCC of acute epiglottis in children
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H. influenzae
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MCC of acute bornchitis + COPD
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H. influenzae
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bordetella pertussis
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gram - rod, pili in URT-->necrosis of ep
ADP-ribse + Gi -->cAMP lymphoctes an'tender nodes inc WbCs LEUKIMOID RXN no protection in children <1 2-4 weeks coughing + whoop convalescence decline 3-4 weeks --poss hemorrhage, otitis media, meningoencephalitis, rectal prolaspa, pneumonia MCCOD <3 children BORDET GENGOU MEDIUM whooping cout-catarrha. |
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MCCOD in children <3 y/o
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bordetella pertussis
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legionella pneumophilia
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facultative intracellular invades mononuclear cells, needs IRON AND CYSTEIN
water coolers, mists BEST SEEN ON SILVER STAIN AND IF STAINS risk: smoker, alcholic, immunosupp (CMI) penumonia atypical, T4RTA chronic intrerstitial nephritis destroy JG, normal AG MA |
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brucella
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Gram negative rods: Brucella species FEVER AND OSTEOMYELITIS
1. Characteristics a. Pathogenesis is unclear; endotoxins are involved b. Infect animals (1) B. melitensis • Goats and sheep (2) B. abortus • Cattle MC source of infection in the United States (3) B. suis • Pigs c. Transmission • Unpasteurized milk/cheese, direct contact d. Granulomatous reaction primarily in the reticuloendothelial system • Bone marrow, spleen (splenomegaly), liver (hepatomegaly), lymph nodes (lymphadenopathy) 2. Brucellosis a. Brucellosis secondary to B. abortus usually mild and self-limited b. B. melitensis produces severe disease called undulant fever (1) Transmission • Eating unpasteurized goat's milk cheese is the MC source (2) Disseminated disease • Osteomyelitis MC complication (3) Doxycycline + gentamicin or streptomycin |
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francisella tularesnsis
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tularemia gram - rod; hunter and fur trapper; rodents, deer, RABBITSa
dermacentor ticks, skin contact or aerosol ulceroglandular-MC papular lesion-->LAD that drain, sepsis and dissemination |
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pasteurella multocida
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gram - rods bipolar staining mouth of cats and dogs (bite of CAT)
MC infection due to animal bite celluitis MC tentintis, arthritis osteomylitis veterinarians |
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2 bact w/ bipolar staining
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yersinia and pasturella multocida
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MC infection due to animal bite
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pasturella mulocida
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yersinia pestis
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prarie dogs, rat flea-->ground squirrels SW area
capsular fraction 1 prevents phagocytosis by neutorphils, endotoxin, V and W --fleas-->rodent (reservoir) BUBONIC MC pneumonic (aerosol), septicemia bubonic--LN in groin enlarge, mat together,drain to the surface |
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bartonella henselae
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pleomorphic gram - rod; oral flora of cat
cat scratch disease--immunocompetent people <18, painful regional LAD, axilla cervical non-caseating graulomatous; ILVER STAIN bacillary angiomatosis-IMMUNOCOMPROMISED aids, mimics kaposi's; silver stain |
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calymmatobacterium granulomatosis
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donovan's bacillus granuloma inguinale
gram - rods DONAVAN'S BODIES, sexual, genital ulcerations w/ destrucito of soft tissue and bone NO LAD!!!! |
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gardnerella vaginalis
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bacterial vaginosis gram - rods
MC vaginitis ph >5.5 due to less lactobacilli clue cells-squamous cells w/ bacteria adherent to cm |
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MC vaginitis
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gardnerella vaginalis
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eikenella corrodens
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gram - rods
coomon in human bites in fighting soft tissue infections immunocomp head and neck in IVDA...lick needles prior to using |
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treponema pallidum
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syphilis; SPIROCHETE, gram neg rod, can't be cultured!, sexual and vertical
small vessel vasculitis endartitis obliterans (knocks out nerves w/ plasma cell INFILTRATE!) 1/3 PRIMAR/SECONDAYR spont resolves; 1/3 latent syphilis; 1/3 tertiary syphilis primar-chancer; secondary-rash palms/soeles, condyloma; tertiary-neruo--demyletionatoin post root, post column, absent DTrs argyll robertion aortic arch aneruysm gummas congenital--peg teeth ect saddle nose |
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primary syphilis
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solitary painless vascuilit damages nerves + chancre 2-10 weeks
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secondary syphilis
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1-3 mo, maculopapular rash on palms and soles!!, condyloma lata, alopecia, inc alp; membranous glomeruolpathy, gen LAD
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latent syphilis
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no lsions 1-2 years after secondyary can reappear; late latent not infective
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tertiary syphilis
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neurosyphilic MC; meingovascular-->strokes, gen paresis dementia
tabes dorsalis--demyelination post root and post column; atxai, loss of vitration, abbsent DTRs, argyll robertson puil (accomodate but do not react ot light) CAF inc protien, postive FTA-ABS positive CV-aortic arch aneurysm gummas |
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congenital syphilis
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3rd mo tirmester
saber shins, addle nose, rhagades (fissure in mouth) late: peg teeth, mulberry molars, deaf, keratitis of eye-->blind |
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labs of syphilis
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dark field primary and secondary
RPR and VDRL (beef cardiolipid FP in SLE) FTA-ABS confirm does not diappear after Rx |
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jarish herxheimer rxn
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in syphilis, do to treatment of penicillin; sendoary syphilis
fever rash flu due to release of endotoxin from trepenemes |
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borrelia recurrentis
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replasing fever, tick, louse
high fever, hemorrhage rash HSM spirochete |
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borrelia burgdorferi
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lyme disease
resevior-white footed mouth/deer obligatory host of tick ioxids dammini tick stage 1 erythema chronicum migrans, flu 2: myocarditis 1st degree block, menigitis, bell's paslsy peirpheral neuropathy 3. diabling arthritis, CNS SPIROCHETE |
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leptospira itnerrogans
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SPIROHETE weil's disease
shephard's staff, darkfield rats, dogs (MC in US) excreted in URINE swimming in pons on farms biphasic--septicemic and immune fever jaudice, hemorrhagic diathesis RF, conjuctivits photophobia mengitis Ab...end phase imune in URINE |
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mycobaterium tuberculosis
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obligate aerobe, acid fast mycolic acid; CORD FACTOR vf
PPD resides in MACROPHAGES prevents fusion of lysosomes w/ phagosomes grauloma CD4 T + mac mac release IL1, 12 stim memory CD4 CD4 reelase gamma-interferon which act macs to kill and release cytokine to keep macs localised macs fuse to form multinucleated giant cells; caseous grmaulomas...lipid primary TB-periphery of lung upper part lower lobe lower part uppe rlobe...ghone focus in periphery, ghon complex in hilar LN, erythema nodosum reactivation in upper lobes--cavitary leasions, kidney MC extrapulm site miliary spread in lungs enter artery white spots system in pulm vein spread to vetebra POTT'S DISEASE NATIVE AMERICANS PPD delated HST4 >15 no risk; >10 high risk; >5 immuocomp AIDS postive test does not diff active disease |
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mycobacterium bovis
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MCC of intestinal TB in countries w/o pasteruization WW
swallowed form lung infection-->peyer's patches in terminal ileum; chronic inflammation strictures -->obstruction |
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MCC of interstinal TB in US
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myco tuberculosis
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MCC of intestinal TB WW
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mycobacterium bovis
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M scrofulaceum
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atypical mycobacteria; afebrile gralumoatous cervical adenitis; in children
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M avium intracellulare complex
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atypical mycobacteria MC 2 species
mostly in AIDS <100 whipple's like foamy macs |
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tuberculoid leprosy
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can't be cultivated in culture, mice and armadillos; in endothelial cells and schwaan
intact CMI, granuloma; positive lepromin skin test sim to PPD; few organsimsacid fast stain is -; not contagious; hypopig macular skin lesions seonsroy loss!!! autoamputation of digits |
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lepromatous leprosy
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can't be cultivated in culture, mice and armadillos; in endothelial cells and schwaan
lack CMI oraganisms in foamy macs NOT granulomas negative lpromin skin test numrous organisms leionine facies somewhat contagious nerve put pathch sensory loss grnz zone below has foamy macs erythema nodosum leprosum after Rx |
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petococcus and peptostretococcus
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gram _ cocci anarobic
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lactobacillis, bacteriodes prevotella,
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anaerobic gram - rods normal flora, foul odor, abscesses
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bacteriodis fragilis
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human colon normal flora
vessel thrombosis, MC anaerobic isolate |
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P melangenicus
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oral cavity normal flora
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fusobacterium
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tapered gram - anaerobes mix w/ prevotella in oral and pleuropum abscess
dental hygiene poor TRENCH MOUTH acute ulcerative gingivitis vincent's disease-gingitive periodonitis |
