Block 6 - Micro - Hacek

Front 1

Curved, small, gram-negative, aerobic, nonmotile, pleomorphic bacillus

Fastidious growing requirements

Require prolonged incubation in a humid atmosphere, up to six weeks

Back 1

Bartonella

Front 2

-Oroya fever, Carrion’s disease
-Incubation 2-6 weeks
-Acute febrile illness with severe anemia
-High mortality without therapy (around 10% with therapy)

Back 2

B. Bacilliformis

Front 3

What spreads B. Bacilliformis?

Back 3

Lutzomyia (sandfly)

Front 4

Where is lutzomyia?

Back 4

Andes

Front 5

What happen when RBCs are infected by B. Bacilliformis?

Back 5

become fragile

Front 6

Benign 1-2 cm nodules can persist for months to years

Heal on their own

Asymptomatic persistent bacteremia can be found in 15% of survivors,
which can serve as the
organism’s reservoir

Back 6

Verruga Peruana

chronic B. Bacilliformis infection

Front 7

Found worldwide

Responsible for febrile outbreaks-Trench fever (5 day fever)

Common in homeless population, associated with poor sanitation

Increasingly being seen among AIDS patients

Spread by body
louse, Pediculus humanus

Self limiting (i.e. low mortality) febrile recurring illness, with fevers lasting ? days

Also, headaches, conjunctivitis, myalgia

Back 7

B. Quintana

Front 8

vascular proliferative form of infection due to Bartonella organisms (quintana and henselae)

First described in 1983 in a patient with HIV

Can be seen in patients who have had organ transplant or who are immuno-competant

Back 8

Bacillary Angiomatosis

Front 9

Raised red or purple lesions in the skin that bleed when traumatized

Lesions in the oral mucosa, tongue, oropharynx, nose, penis, or anus

Bone pain, frequently in the forearms or legs

Fever, chills, malaise, night sweats, anorexia, and weight loss

Abdominal pain, nausea, vomiting (peliosis hepatis)

Jaundice

Gastrointestinal bleeding

Back 9

Bacillary Angiomatosis

Front 10

Lesions can be from 1 -1000

Resemble hemangiomas

Can also be hyperpigmented hyperkeratotic plaques, often overlying osseous defects

Back 10

Bacillary Angiomatosis

Front 11

most common clinical human infection with Bartonella

Back 11

B. Henselae - CSD

Front 12

Is flea - to- human spread of B. Henselae very common?

Back 12

NO

Front 13

A papule/pustule develops 3-10 days after contact; can last 1-3 weeks

Regional ipsilateral lymph node enlargement develops 1-7 weeks later

Chronic regional adenopathy of lymph nodes draining site of contact is the “typical presentation” (80-90% of cases)

Fever, malaise, rash

Back 13

Clinical Sx of CSD

Front 14

Lymph node enlargement can last 2-4 months

Spontaneous resolution

Back 14

CSD course

Front 15

Parinaud’s oculoglandular syndrome -
Granulomatous conjunctivitis with lymphadenitis

Granulomatous hepatitis

Pneumonitis

Neurologic involvement

Encephalopathy (2-4%!), neuroretinitis
FUO

Back 15

Atypical presentations of CSD

Front 16

Not recommended for routine cases of patients with cat scratch disease lymphadenopathy

May be useful in patients who have other manifestations of either B henselae or B quintana infection, including fever of unknown origin, neuroretinitis, encephalitis, culture-negative endocarditis, and peliosis or bacillary angiomatosis

Back 16

Cultures

Front 17

This is the best (easiest) way to diagnose B. hensalae and quintana

70-90% sensitivity
Enzyme immunoassay and immunofluorescence assay for IgG and IgM

Back 17

Serologic Testing

Front 18

IgM titer of >1:16

Back 18

Evidence of recent bartonella infection

Front 19

IgG titer of >1:256

Back 19

Evidence of current or past Bartonella infection

Front 20

Do all patients mount an immune response to Bartonella?

Back 20

NO

Front 21

For how long can serology be positive after exposure?

Back 21

months

Front 22

Standard therapy is chloramphenicol in South America

Others: ciprofloxacin, doxycycline, trimethoprim-sulfa

Back 22

Treatment of B. Bacilliformis

Front 23

If treated, what is used for typical CSD?

Back 23

Azithromycin

Front 24

Erythromycin/azithromycin or doxycycline

Treat for 8-12 weeks in HIV patients or if evidence of endocarditis

Back 24

Treatment of Bacillary Angiomatosis

Front 25

sometimes pleomorphic

obligate parasite: mucous membranes (usually humans, rarely animals)

Back 25

Haemophilus

Front 26

Empyema and chest wall infection

Pericarditis

Endogenous flora of mouth
-20% teenagers and adults
-50% of refractory periodontitis in adults
-90% localized juvenile periodontitis

Endocarditis (HACEK organism)

Back 26

Haemophilus/Actinobacillus actinomycetemcomitans

Front 27

What must be used to grow Haemophilus/Actinobacillus actinomycetemcomitans?

Back 27

Blood or chocolate agar

Front 28

Third generation cephalosporins

Tmp/smx
Fluoroquinolones
Tetracyclines
Aminoglycosides

Back 28

Treatment of Haemophilus/Actinobacillus actinomycetemcomitans?

Front 29

Named because of predilection to cause endocarditis

Non motile facultative anaerobic small pleomorphic
GNR

Fermentative, indole and oxidase positive

Can be found in respiratory tract of healthy humans

Back 29

Cardiobacterium Hominis

Front 30

Primary clinical syndrome: endocarditis

Low virulence, with slow onset fevers and malaise after bacteria enters blood through oropharyngx

Predisposing factors: heart disease, dental procedures/oral disease

Requires 1-2 weeks for detection in broth, with enhanced CO2 and humidity to grow on agar media

Back 30

Cardiobacterium Hominis

Front 31

Ceftriaxone 2 g iv daily (or ampicillin with gentamicin) for 4 weeks

Back 31

Treatment of Cardiobacterium Hominis

Front 32

Which Antibiotic is effective for all HACEK organisms?

Back 32

Penicillin

Front 33

Eats away (“corrodes”) the agar of a Petri dish

Associated with human bite wounds

Fist-fight injury

Endocarditis, sinusitis, pneumonia, brain abscesses, lung abscesses

How the head of a dead man killed his killer

Pencillin, extended-spectrum cephalosporins, tetracyclines, etc.

Back 33

Eikenella Corrodens

Front 34

Small, gram-negative coccobacilli

Human oropharynx

Associated with “sterile”/aseptic arthritis in children (it is really septic)

Pain and fever

Children generally recover

Back 34

Kingella Kingae

Front 35

Abscesses in brain, oropharynx, peritoneal cavity

S. Viridans

Back 35

Anginosus

Front 36

Subacute bacterial endocariditis, neutropenic sepsis, pneumonia, meningitis

S. Viridans

Back 36

Mitis

Front 37

Dental caries, endocarditis

S. Viridans

Back 37

Mutans

Front 38

Colon cancer (gallolyticus); meningitis (pasteurianus)

S. Viridans

Back 38

Bovis

Front 39

MIC <0.1 mcg/ml:

Back 39

Penicillin Sensitive S. Viridans

Front 40

MIC 0.2 to 2 mcg/ml:

Back 40

Moderately Resistant S. Viridans

Should add an Aminoglycoside

Front 41

MIC > 2 mcg/ml:

Back 41

Very resistant S. Viridans

Need Aminoglycoside for a longer period of time