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223 Cards in this Set
- Front
- Back
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3 Main Brain Infections
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Meningitis
Encephalitis Abcess |
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Diabetic Extremity Infection
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DM caused by endocrine problem
Infection caused by neuropathy, vascular compromise, and immunologic impairment |
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Phenetic System
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groups organsims based on phenotypic characteristics
genus and species |
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Phylogenetic system
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groups organisms based on nucleic acid (more reliable)
RNA "typing" (genotyping) strains |
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Eukaryotes
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Animalia
Plantae Protoctista Fungi Protozoa |
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Eukaryotes
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unicellular or multicellular
no cell wall (petidoglycan) cytoplasmic membrane: cytoskeleton (microfilaments, microtubules) and sterols present for support/protection, also use for communication endocytosis and exocytosis 80s Ribosomes (60s+40s) membrane bound nucleus with multiple chromosomes extrachromasomal DNA within organelles transcription (nucleus) translation (cytoplasm) genetic exchange: meiosis, zygote fusion |
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Prokaryotes (Bacteria)
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unicellular
cell membrane: transport, motility, oxidative phosphorylation, DNA replication, communication cell wall (peptidoglycan); Mycoplasma have no cell wall! 70s Ribosomes (50s+30s) No nuclear membrane with a single chromosome extrachromasomal DNA in plasmids transcription/translation (cytoplasm) genetic exchange: transformation, transduction, conjugation |
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Prokaryotes (Viruses)
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Classified by Structure:
spikes (protein projections) capsid: envelop (membrane) or naked RNA or DNA without a nuclear membrane or proteins (no cell walls, organelles or ribosomes) Shape: icosohedral and helical Core: RNA or DNA virus, Single-stranded or DS genetic material; positive or negative/circular or linear structure |
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Prions
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don't know what class to put in
just a protein |
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Cocci (spherical)
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Staphylococcus aureus (clusters)
Streptococcus pyogenes (chains) Streptococcus pneumonia (pairs) |
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Bacilli (rods)
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Bacillus subtilis (clusters or pairs)
GNB |
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Coccobacilli (between cocci and bacilli)
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Haemophilis influenzae
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Pleiomorphic (polymorphic; comma-shaped bacilli)
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Campylobacter jejuni
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Spirochetes (spiral shaped)
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Treponema palladium (Syphilis)
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Gram positive organisms
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thick peptidogylcan cell wall
no outer membrane hold iodine/violet stain when decolorized with alcohol-acetone solution cocci and bacilli |
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Gram negative organisms
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thin peptidoglycan cell wall
outer membrane with porins becomes clear when decolorized with alcohol-acetone solution cocci and bacilli |
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Acid fast organisms
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similar to Gram positive
have waxes and lipids in their cell wall (difficult to retain stain) need different staining procedure to identify MYCOBACTRIUM - virulence factors are mycolic acid, Wax D, sulfolipids, cord factor, and arabinogalactans) |
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Wall-less organisms
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have no cell wall
does not stain MYCOPLASMA |
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Gram positive cell structure
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thick peptidoglycan cell wall (40+ layers of chain link mesh fence) - prevents complement lysis but still opsonized
teichoic and lipoteichoic acids |
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Gram negative cell structure
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outer membrane with LPS containing:
Lipid A - endotoxin Core oligosaccharide O antigen periplasmic space (cytoplasma) b/n inner and outer membrane single layer of peptidoglycan |
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Staphylococcus aureus (CPS; Gram positive)
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catalase +/coagulase +
facultative anaerobes found primarily in the nares and on some people’s skin causes impetigo, follicilitis, soft tissue infections, endocarditis, osteomyelitis, septic arthritis, pneumonia, wound and catheter associated infections, TOXIC SHOCK SYNDROME; can produce a localized or secondary infection; produce EXOTOXIN that are proteases to digest nerve proteins and form pores in membranes as a virulence factor MRSA – methicillin resistant strain acquired in community and nosocomially; resistant to beta-lactams due to production of beta-lactamases (penicillinases ) |
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Staphylococcus epidermidis (CNS; Gram positive)
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catalase +/coagulase –
facultative anaerobes main microbe found on the skin; cause of many catheter-associated infections due to formation of biofilm; methicillin resistance exists nosocomially have SLIME (increased adherence to plastic and metal surfaces) as a virulence factor resistant to beta-lactams due to production of beta-lactamases (penicillinases ) |
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Staphylococcus saprophyticus (CNS; Gram positive)
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catalase +/coagulase –
facultative anaerobes found in vagina; cause of UTIs |
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Streptococcus pyogenes (Gram positive)
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catalase -/beta hemolysis
microaerophilic; found in oropharynx +/- cause of pharyngitis, otitis, tonsillitis, impetigo, and cellulitis; produces exotoxin; have PILLI (increased adherence to target tissue) as a virulence factor bacitracin susceptible; NOT resistant to beta-lactams |
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Streptococcus agalactiae (Gram positive)
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catalase -/beta hemolysis
found in gut and sometimes vagina +/- cause of neonatal sepsis/meningitis; diabetic extremity infections ACQUIRED IN BIRTH CANAL bacitracin resistant |
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Streptococcus pneumoniae (Gram positive)
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catalase -/alpha hemolysis; lysed by bile
microaerophilic; found in nasopharynx; cause of pneumonia (community acquired), otitis, and meningitis has a CAPSULE to avoid phagocytosis as a virulence factor (vaccine can be made) obtains resistance determinants by transformation – including beta-lactam resistance in community and nosocomially; resistant to beta-lactams due to altered PBPs VACCINE AVAILABLE!!!! |
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Streptococcus viridans (Gram positive)
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catalase -/alpha hemolysis; not lysed by bile
microaerophilic; found in oropharynx and gut; cause of periodontal disease and endocarditis |
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Streptococcus bovis (Gram positive/ Lancefield group D)
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catalase -/gamma hemolytic
microaerophilic; cause of endocarditis and intraabdominal infections |
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Enterococcus faecalis/faecium (Gram positive)
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catalase -/gamma hemolysis
facultative anaerobes; found in gut; cause of UTIs, intra-abdominal infections, and endocarditis strain of vancomycin-resistant bacteria exists nosocomially (also resistant to ampicillin ) |
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Peptostreptococcus/Peptococcus (Gram positive)
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obligately anaerobic cocci
found in the oropharynx and gut; causes pleuropulmonary aspiration pneumonia and abscesses in the lung |
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Neisseria meningitidis (Gram negative cocci; nonmotile; diploccoci)
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oxidase +/aerobe; grows on NYC media
found in nasopharynx +/-; cause of meningitis, has fimbriae which attach to host cells has a CAPSULE to avoid phagocytosis as a virulence factor (vaccine can be made) have PILLI (increased adherence to target tissue) as a virulence factor INTRACELLULAR GROWTH in human/non-phagocytic cells to evade immune response as a virulence factor have ENDOTOXIN/LPS that is released when lysed - resp. for ENDOTOXIN SHOCK (only occurs in Gram neg. bacteria) VACCINE AVAILABLE!!! (young adults) |
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Neisseria gonorrhoeae (Gram negative cocci; nonmotile; diplococci)
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oxidase +/aerobe; grows on NYC media
STD – not part of microflora; cause of gonorrhea, pelvic inflammatory disease and septic arthritis; can show up as a subclinical infection; has fimbriae which attach to host cells have PILLI (increased adherence to target tissue) as a virulence factor obtains resistance determinants by transformation –including cephalosporin and fluoroquinolones in community; produces broad-spectrum beta-lactamases |
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Moraxella catarrhalis (Gram negative cocci; Neisseria family; nonmotile; diplococci)
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oxidase +/aerobe; no growth on NYC media
found in nasopharynx (especially children) cause of otitis, conjunctivitis, and meningitis produces broad-spectrum beta-lactamases |
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Acinetobacter (Gram negative cocci; Neisseria family; nonmotile; diplococci)
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oxidase -/catalase +; aerobe
found in oropharynx and skin cause of opportunistic infections of any organ resistance to most broad-spectrum drugs exists nosocomially |
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Eikenella corrodens (Gram negative cocci; Neisseria family; nonmotile; diplococci)
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aerobe
found in oropharynx (dental plaque) of 40-70% of people cause of soft tissue ("clench fist") and human bite wound infections |
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Gemella (Gram negative cocci; nonmotile; diplococci)
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oxidase -/catalase -; aerobe
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Mycobacterium tuberculosis (Gram positive aerobic or facultative bacilli)
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acid-fast positive rods; weakly gram positive
human is reservoir but not part of microflora; cause of tuberculosis; can produce a chronic or dormant infection; highly infectious organism but not very virulent survives/replicates within phagocytes as virulence factor Treatment: aminoglycosides, carbapenems, fluoroquinolones, and isoniazid resistance to multiple drugs; exist in community |
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Nontypical Mycobacteria/NTM (Gram positive aerobic or facultative bacilli)
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acid-fast positive; weakly gram positive
cause of opportunistic infections (tuberculosis-like disease in AIDS and other immunocompromised), soft tissue infections, and leprosy treated using aminoglycosides, carbapenems, fluoroquinolones, and isoniazid |
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Nicardia asteroides (Gram positive aerobic or facultative bacilli)
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acid fast rods; weakly gram positive
found in soil causes opportunistic pulmonary infections |
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Bacillus anthracis/subilis/cereus (Gram positive aerobic or facultiative bacilli)
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spore forming; facultative or aerobic
found in soil and contaminated food cause wound infections and food poisoning; anthrax produce EXOTOXIN that are proteases to digest nerve proteins as a virulence factor VACCINE AVAILABLE!!! |
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Corynebacterium diptheriae (Gram positive aerobic or facultative bacilli)
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catalase +; grow on tellurite agar and H2S Tinsdale agar; small, pleomorphic
found in the nasopharyngeal "carriers" in third-world countries cause opportunistic infections; diphtheria produces EXOTOXIN as virulence factor to inactivate G proteins |
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Corynebacaterium jekium (Gram positive aerobic or facultative bacilli)
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catalase +; grow on tellurite agar and H2S Tinsdale agar; small, pleomorphic
non-sporeforming; microaerophilic/facultative found in gut, skin, and vagina cause of opportunistic infections |
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Listeria monocytogenes (Gram positive aerobic or facultative bacilli)
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non-spore forming obligate aerobes
zoonosis cause of opportunistic infections in pregnant women and neonates and elderly; can cause meningitis survives/replicates within phagocytes as virulence factor |
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Clostridium botulinum (Gram positive anaerobic bacilli)
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spore forming obligate anaerobes
found in contaminated food cause of botulism and wound infections produce EXOTOXIN that are proteases to digest nerve proteins as a virulence factor |
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Clostridium difficile (Gram positive anaerobic bacilli)
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spore forming obligate anaerobes
not part of normal microflora but can reside in the gut (primarily in hospitalized patients) cause of CDAD (an adverse reaction to antibiotic treatment – kills normal microflora so CD takes over ) - diarrhea is main symptom and it’s due to EXOTOXIN |
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Clostridum perfringens (Gram positive anaerobic bacilli)
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spore forming obligate anaerobes
produce EXOTOXIN that are proteases to digest nerve proteins as a virulence factor found in gut; cause of gas gangrene and intra-abdominal infections |
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Clostridium tetani (Gram positive anaerobic bacilli)
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spore forming obligate anaerobes
found in soil; cause of tetanus produce EXOTOXIN that are proteases to digest nerve proteins as a virulence factor VACCINE AVAILABLE!!! |
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Propionibacterium acnes (Gram positive anaerobic bacilli)
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non-spore forming
found on skin; cause of acne and folliculitis |
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Escherichia coli (Gram negative aerobic or facultative bacilli)
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5 major strains that present differently due to pilli (attach at different sites) and LPS
Non-fermenter(MacConkey) - rapid agar growth; facultative anaerobes found primarily in the gut (also colonize in the URT in hospitalized individuals) but also can be zoonotic causes UTIs, gastroenteritis, diabetic extremity infections, and abdominal infections; has fimbriae which attach to host cells produce SIDEROPHORES to scavenge iron for metabolism as a virulence factor have PILLI (increased adherence to target tissue) as a virulence factor produces EXOTOXIN as virulence factor to inactivate G proteins INTRACELLULAR GROWTH in human/non-phagocytic cells to evade immune response as a virulence factor ESBL producer |
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Klebsiella pneumoniae (Gram negative aerobic or facultative bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobes
found in the gut cause of UTIs, abdominal infections, folliculitis, and pneumonia (especially in alcoholics ); has a CAPSULE to avoid phagocytosis as a virulence factor (vaccine can be made) resistance to 3rd generation cephalosporins exists nosocomially; produces broad spectrum beta-lactamases (ESBL producer ) |
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Enterobacter cloacae (Gram negative aerobic or facultative bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobes
found in the gut cause of UTIs, abdominal infections, and diabetic extremity infections resistance to 3rd generation cephalosporins exists nosocomially; has inducible (AmpC) cephalosporinases; one bug that seems to be able to develop resistance during therapy |
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Citrobacter freundii (Gram negative aerobic or facultative bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobes
found in the gut cause of UTIs, abdominal infections, and diabetic extremity infections has inducible (AmpC)cephalosporinases |
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Morganella morganii (Gram negative aerobic or facultaive bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobes
found in the gut cause of UTIs, abdominal infections, and diabetic extremity infections |
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Proteus mirabilis/vulgari (Gram negative aerobic or facultative bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobes
found in the gut cause of UTIs, abdominal infections, folliculitis, and diabetic extremity infections |
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Providencia stuartii (Gram negative aerobic or facultative bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobes
found in the gut cause of UTIs, abdominal infections, and diabetic extremity infections |
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Serratia marcescens (gram negative aerobic or facultative bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobes
found in the gut cause of UTIs, abdominal infections, and diabetic extremity infections has inducible (AmpC) cephalosporinases |
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Salmonella enterica (Gram negative aerobic or facultative bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobes
zoonosis and contaminated food are sources; fecal/oral contact cause of typhoid fever, gastroenteritis, and septicemia; has fimbriae which attach to host cells produce SIDEROPHORES to scavenge iron for metabolism as a virulence factor has a CAPSULE to avoid phagocytosis as a virulence factor (vaccine can be made) have PILLI (increased adherence to target tissue) as a virulence factor INTRACELLULAR GROWTH in human/non-phagocytic cells to evade immune response as a virulence factor VACCINE AVAILABLE!!! |
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Shigella flexneri (Gram negative aerobic or facultative bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobes
found in contaminated food cause of dysentery and gastroenteritis INTRACELLULAR GROWTH in human/non-phagocytic cells to evade immune response as a virulence factor inherently ACID-RESISTANT in stomach |
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Yesinia enterocolitica (Gram negative aerobic or facultative bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobes
zoonosis; freshwater streams cause of gastroenteritis |
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Yesinia pestis (Gram negative aerobic or facultative bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobes
zoonosis cause of "plague" |
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Pseudomonas aeruginosa (Gram negative aerobic or facultative bacilli)
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Non-fermenter (MacConkey) - rapid agar growth; obligate aerobes (oxidze glucose); polar lagella
found in water, soil, and food (colonize in gut and URT in hospitalized) cause of nosocomial pneumonia, UTIs, respiratory infections in cystic fibrosis patients, and wound infections in burn patients resistance exists to many drugs nosocomially; exhibits beta-lactam resistance by reducing outer membrane permeability; has inducible (AmpC) cephalosporinases; treated using a beta-lactam drug along with an aminoglycoside |
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Burkholderia cepacia (Gram negative aerobic or facultative bacilli; Pseudomonas family)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobe
found in plants, soil, and water cause respiratory infections in cystic fibrosis patients |
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Stenotrophomas maltophilia (Gram negative aerobic or facultative bacilli; Pseudomonas family)
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Non-fermenter (MacConkey) - rapid agar growth; facultative anaerobe
found in hospital enviroment opportunistic patohogen; causes UTI, wound infections, catheter-associated infections carbapenem resistance exists nosocomially; produces carbapenemases |
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Alcaligenes xyloxidans (Gram negative aerobic or facultative bacilli)
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fastidious (need special culture technique - more time to grow; longer time to diagnose) falcultative anaerobe found in soil and water opportunistic pathogen; causes RTI |
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Campylobacter jejuni (Gram negative aerobic or facultative bacilli)
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fastidious (need special culture technique - more time to grow; longer time to diagnose) falcultative anaerobe
microaerophilic; spiral/curved morphology zoonosis causes gastroenteritis |
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Helicobacter pylori (Gram negative aerobic or facultative bacilli)
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fastidious (need special culture technique - more time to grow; longer time to diagnose) falcultative anaerobe
microaerophilic; spiral/curved morphology human reservoir cause of peptic ulcer disease |
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Gardnerella vaginalis (Gram negative aerobic or facultative bacilli)
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found in vagina
causes bacterial vaginosis |
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Haemophilus influenzae (Gram negative aerobic or facultative bacilli)
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fastidious (need special culture technique - more time to grow; longer time to diagnose) falcultative anaerobe
found in nasopharynx causes otitis, epiglottis, meningitis in children, bronchitis, pneumonia in adults (especially smokers) has a CAPSULE to avoid phagocytosis as a virulence factor (vaccine can be made) obtains resistance determinants by transformation produces broad-spectrum beta-lactamases VACCINE AVAILABLE!!! |
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Haemophilus ducreyi (Gram negative aerobic or facultative bacilli)
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fastidious (need special culture technique - more time to grow; longer time to diagnose) falcultative anaerobe
STD - human reservoir causes chancroid |
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Brucella melitensis (Gram negative aerobic or facultative bacilli)
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zoonosis
causes brucellosis |
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Bordetella pertussis (Gram negative aerobic or facultative bacilli)
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human is reservoir
causes whooping cough in infants; older individuals has less severe disease INTRACELLULAR GROWTH in human/non-phagocytic cells to evade immune response as a virulence factor produces EXOTOXIN as virulence factor to inactivate G-proteins VACCINE AVAILABLE!!! |
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Francisella tularensis (Gram negative aerobic or facultative bacilli)
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zoonosis: found in rabbits and rodents
causes tularemia (BIOTERRORISM) |
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Pasteurella multocida (Gram negative aerobic or facultative bacilli)
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found in dogs: animal oropharynx
causes bite wound infections readily treatible |
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Legionella pneumophilia (Gram negative aerobic or facultative bacilli)
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found in contaminated water (air conditioner collecting pans)
causes Legionnaire's disease survives/replicates within phagocytes as virulence factor |
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Vibrio cholerae/parahemolyticus (Gram negative aerobic or facultative bacilli)
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Fermenter (rapid agar growth)
produces EXOTOXIN as virulence factor to inactivate G proteins found in sewage-contaminated water, shellfish (raw) causes Cholera, gastroenteritis VACCINE AVAILABLE!!! |
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Bacteroides fragillis (Gram negative obligate anaerobe bacilli)
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difficult to treat
found in gut: main organism in ileum and colon causes abdominal infections and absesses only bacteria susceptible to metronidazole; produces broad-spectrum beta-lactamases |
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Prevotella bivia/distens(Gram negative obligate anaerobe bacilli)
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found in vagina
causes PID |
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Prevotella melaninogenica/denticola/
distens/intermedia/oralis/oris (Gram negative obligate anaerobe bacilli) |
found in oropharynx
causes pluropulmonary aspiration pneumonia and absesses |
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Fusobacterium nucleatum (Gram negative obligate anaerobe bacilli)
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found in the oropharynx and gut
causes gingivitis and sepsis |
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Actinomyces israelii (other bacteria)
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found in oropharynx
causes periodontal disease and actinomycosis |
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Chlamydia pneumoniae (other bacteria)
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found in the oropharynx?
causes pneumonia in elderly OBLIGATE INTRACELLULAR GROWTH in human/non-phagocytic cells to evade immune response as a virulence factor treated using tetracyclines, macrolides, and fluoroquinolones |
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Chlamydia trachomatis (other bacteria)
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STD - greatest cause of blindness worldwide (not US)
causes nongonococcal urethrits and PID; also trachoma treated using tetracyclines, macrolides, and fluoroquinolones |
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Mycoplasma pneumoniae (other bacteria)
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lack cell wall; highly pleiomorphic
found in oropharynx and gut causes pneumonia and RTIs treated using tetracyclines, macrolides, and fluoroquinolones |
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Ureaplasma urealyticum (other bacteria)
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lack cell wall; highly pleiomorphic
found in vagina causes UTI |
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Rickettsia rickettsii (other bacteria)
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OBLIGATE INTRACELLULAR GROWTH in human/non-phagocytic cells to evade immune response as a virulence factor
transferred by TICKS (arthropod normal flora)!!! causes Rocky Mountain Spotted Fever treated using tetracyclines, macrolides, and fluoroquinolones |
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Bartonella henselae (other bacteria)
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obligate intracellular parasite in eukaryotic cells; fastidious
zoonosis (trauma) causes Cat Scratch Fever, bacillary angiomatosis in immunocompromised |
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Coxiella burnetti (other bacteria)
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obligate intracellular parasite in eukaryotic cells
zoonosis (inhalation) causes Q fever |
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Ehrlichia chaffeensis (other bacteria)
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obligate intracellular parasite in eukaryotic cells
transferred by TICKS!!! causes Ehrlichosis |
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Borrelia burgdorferi (other bacteria)
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spirochete (coiled morphology) with motility via axial filament
transferred by TICKS!!! causes Lyme disease |
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Treponema palladum (other bacteria)
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spirochete (coiled morphology) with motility via axial filament
STD - human reservoir causes syphilis CROSS PLACENTAL BARRIER |
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RNA Viral Replication
(determines therapy - easy to treat) |
Steps:
1. Attach receptors 2. Enter cell (endocytosis) 3. Uncoat (loses envelope/capsule) 4. Replicates (RNA-->mRNA-->Protein) 5. Assemble 6. Egress (leave and kill cell) |
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Retro-RNA Viral Replication
(determines therapy - never eradicate) |
Steps:
1. Attach receptors 2. Enter cell (endocytosis) 3. Uncoat (loses envelope/capsule) 4. Replicates (RNA-->mRNA-->Protein) and incorporates genome inside human cell forever! 5. Assemble 6. Egress (leave and kill cell) |
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General Overview of Viral Replication
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DNA Virus:
unwind/copied-->+mRNA-->protein ssRNA Virus: -RNA-->+mRNA-->protein dsRNA Virus: unwind-->+mRNA-->protein Retro-RNA Virus: copied/inserted into DNA-->-RNA-->+mRNA -->protein **polarity exists in ssRNA viruses (+ strands can directly synthesize proteins while (-) strands must first have their complimentary strand made ); all genomes are linear |
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Enterovirus (+ssRNA Virus)
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cause poliovirus
VACCINE AVAILABLE!!! |
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Rhinovirus (+ssRNA virus)
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causes common cold
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Hepatovirus (RNA virus)
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causes Hepatitis A virus
VACCINE AVAILABLE!!! |
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Astrovirus (+ssRNA Virus)
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cause gastroenteritis and diarrhea
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Calcivirus (+ssRNA virus)
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causes Norwalk virus; gastroenteritis
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Flaviviridae (+ssRNA virus)
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causes Dengue and Yellow fever virus
located in liver VACCINE AVAILABLE!!! |
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Hepatitis C virus (+ssRNA virus)
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causes Chronic Hepatitis C
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Alphavirus (+ssRNA virus)
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causes Eastern Equine Encephalitis virus
VACCINE AVAILABLE!!! |
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Rubivirus (+ssRNA virus)
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causes Rubella virus
affects on skin and mucous membranes CROSS PLACENTAL BARRIER VACCINE AVAILABLE!!! |
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HTLV Retroviruses (Retro-RNA virus)
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causes Human T-lymphocyte viruses
affects brain, lymphoid |
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Lentivirinae (Retro-RNA virus)
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causes HIV-1 and HIV-2 (AIDS)
affects brain, lymphoid CROSS PLACENTAL BARRIER |
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Rotavirus (dsRNA virus)
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causes Rotavirus
affects GI; diarrhea VACCINE AVAILABLE!!! |
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Hantavirus (-ssRNA virus)
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causes Hantaan virus
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Influenzavirus A,B (-ssRNA virus)
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causes Influenza
affects upper/lower respiratory tract VACCINE AVAILABLE!!! |
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Arenavirus (-ssRNA virus)
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causes Lymphocytic Choriomeningitis virus and Lassa Fever virus
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Filovirus (-ssRNA virus)
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causes Ebola virus and Marburg virus
affects systemically (fever, diarrhea, muscle aches, etc.) |
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Vesiculovirus (RNA virus)
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causes Vesicular Stomatitis virus (VSV)
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Lyssavirus (-ssRNA virus)
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causes Rabies virus
affects brain VACCINE AVAILABLE!!! Works Post-Infection |
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Paramyxovirus (-ssRNA virus)
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causes Newcastle disease virus
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Morbillivirus (-ssRNA virus)
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causes Measle virus
VACCINE AVAILABLE!!! |
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Rubulavirus (-ssRNA virus)
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causes Mumps virus
VACCINE AVAILABLE!!! |
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Pneumovirus/Respiratory syncytial virus/RSV (-ssRNA virus)
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causes respiratory illness in infants
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Orthohepadnavirus (Retro? DNA virus)
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causes Chronic Hepatitis B
VACCINE AVAILABLE!!! |
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Papillomavirus (dsDNA virus)
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causes Human Papillomavirus and Condyloma acuminatum (genital warts)
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Mastadenovirus (dsDNA virus)
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causes Adenovirus
affects GIT, nose |
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Alphaherpesvirinae Herpes Simplex viruses types 1 and 2 (HSV-1 and HSV-2) - (dsDNA) - Herpes family
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causes genital/mucocutaneous herpes in normal host and can spread systemically: encephalitis, mucoutaneous disease in the immunocompromised host, neonatal systemic infections and keratoconjuctivitis
CROSS PLACENTAL BARRIER |
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Betaherpesvirinae/Cytomegalovirus (dsDNA) - Herpes family
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causes CMV retinitis in transplanted ocular tissue patients and HIV patients, esophagitis in immunocompromised
affects liver, lymphoid CROSS PLACENTAL BARRIER |
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Gammaherpesvirinae (dsDNA) - Herpes family
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causes Epstein-Barr virus (EBV)/mononucleosis
affects throat, liver, lymphoid |
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Roseolovirus (dsDNA) - Herpes family
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causes Human herpes virus 6 (HHV-6)
affects skin and mucous membranes |
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Varicellovirus/Varicella-zoster virus/VSV (dsDNA) - Herpes family
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causes Varicella (chickenpox) and Herpes zoster in normal or immunocompromised
VACCINE AVAILABLE!!! |
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Orthopoxvirus (dsDNA)
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causes Variola (smallpox)
VACCINE AVAILABLE!!! |
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Trichophyton tonsurans,
Microsporum canis (Dermatologic fungal infection) |
causes Tinea captitis (scalp ringworm)
found in animals and humans |
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Microsporum gypseum/canis,
Trichophyton rubrum (Dermatologic fungal infection) |
causes Tinea corporis (scalp ringworm)
found in soil and humans |
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Epidermiphyton floccosum, Trichophyton rubrum (Dermatologic fungal infection)
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causes Tinea cruris (jock itch)
found in humans |
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Trichophyton mentagrophytes, T. rubrum (Dermatologic fungal infection)
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causes Tinea pedis (athlete's foot)
found in humans |
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Trichophyton rubrum (Dermatologic fungal infection)
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causes Onychomycosis (nail infection)
found in humans most difficult to treat b/c under nailbed |
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Blastomyces dermatidies (Systemic yeast infection)
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causes Blastomycosis (lung fungal infection)
found in decaying plant material |
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Coccidoides immitis (Systemic yeast infection)
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causes Coccidiodidomycosis (lung fungal infection)
found in soil |
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Histoplasma capsulatum (Systemic yeast infection)
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causes Histoplasmosis (Ohio and Mississippi River valleys)
found in soil and bird poop |
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Aspergillus flavus, A. fumigatus (Systemic mold infection)
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only occurs in immunocompromised (leading cause of death in cancer patients is fungal)
Lung fungal infection found in decaying plant material and soil |
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Candida albicans (Systemic yeast infection)
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only occurs in immunocompromised (leading cause of death in cancer patients is fungal)
Mouth fungal infection found in human gut and oral cavity |
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Cryptococcus neoformans (Systemic yeast infection)
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only occurs in immunocompromised (leading cause of death in cancer patients is fungal)
Brain fungal infection found in fruit, pigeon droppings, and plants |
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Cryptosporidium parvum (Apicomplexa Protozoa- apical microtubule complex; reproductive cycle may incude sexual stage)
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causes diarrhea in immunocompromised
found in domestic and wild animals all stages develop in epithelial cells of stomach or intestine Treatment: TMP/SMX (anti-folates) |
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Isospora bella (Apicomplexa Protozoa- apical microtubule complex)
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causes diarrhea in immunocompromised
found in contaminated food or water with ooCYSTS complex reproductive cycle with obligatory intracellular asexual reproduction in epithelium of small intestine and sexual stage Treatment: TMP/SMX (anti-folates) |
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Plasmodium flaciparum/ovale/malriae/vivax (Apicomplexa Protozoa- apical microtubule complex)
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causes Malaria
transmitted by arthropods develops in hepatocytes in humans from erythrocytes; gametocytes taken up by mosquitoes during feeding with sexual stage in mosquitoes DDT used in US but still found at Airports Treatment: Quinolone Antimalarials |
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Toxoplasma gondii (Apicomplexa Protozoa- apical microtubule complex)
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causes Toxoplasmosis (CNS infection) in immunocompromised (AIDS) and pregnant women - CROSS PLACENTAL BARRIER
transmission may be congenital, contaminative or via food chain oocytes produced by felines and passed through feces beef, pork, mutton contain CYSTS!!! can infect pets, pests, and food Direct Infection: eat pigs, beef Indirect Infection: cat litter box disease from CYSTS) survives/replicates within phagocytes as virulence factor Treatment: Pyrimethamine with either Sulfonamides or Clindamycine (anti-folates) |
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Giardia intestinalis(Sarcomastigophora Protozoa - flagella, asexual)
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causes diarrhea
found in extracellular lumen of small intestine transmission by CYSTS!!! Treatment: Metronidazole |
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Leishmania (Sarcomastigophora Protozoa - flagella, asexual)
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causes cutaneous and visceral infection
intracellular (develops in macrophages) transmission by arthropods lacks flagella in vertebrate hosts |
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Trichomonas vaginalis (Sarcomastigophora Protozoa - flagella, asexual)
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causes vaginitis
transmitted venereally extracellular in vagina and urethra of both sexes no cyst stage Treatment: Metronidazole |
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Trypanosoma (Sacomastigophora Protozoa - flagella, asexual)
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causes sleeping sickness
extracellular or intracellular |
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Entamoeba (Sarcomastigophora/Sarcodina Protozoa - pseudopods; asexual)
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causes diarrhea (amebiasis) and liver abscess
extracellular and invasive originally located in large intestine by may move into liver through portal system trasmission via CYSTS Treatment: Metronidazole |
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Babesia (Sarcomastiophora/Sarcodina - pseudopods; asexual)
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causes Babesia
transmitted through TICKS and blood transfusions |
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Pneumocystis (unclassified Protozoa)
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causes Pneumonia (PCP) in AIDS patients
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TORCHS
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Bugs that can cross placental barrier:
Toxoplasma Rubella Cytomegalovirus (CMV) HSV HIV Syphilis |
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What is the only bug that can be acquired in the birth canal?
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Streptococci
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Rank Infectious Diseases by most mortalities in 2002
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Lower respiratory infections
HIV/AIDS Diarrhea Tuberculosis Malaria Measles Pertussis Tetanus Mengitis Syphilis Hepatitis B Tropical Disease Pertussus |
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normal microbial flora
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microorganisms (mostly bacteria) commonly found on or in the bodies of healthy individuals.
Some are present extended periods of time and others are only briefly. Most are commensal - bacteria benefit from symbiotic rlnship. |
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colonization
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the growth of microorganism on/in body WITHOUT deleterious effects to the host due to the organism or immune response.
transcient colonization: organism eliminated rapidly stable conlonization: organism remain long-term colonization resistance: keeps human alive through protection (keeping pathogens away) and constant immune stimulation (low level). **There are many more non-human cells in the body than human cells. (exterior-skin; interior-mucous membrane, GI, RT, and vaginal) |
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infection
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invasion of cells, tissues or organs by pathogenic microorganisms which cause the body injury followed by an immune response that leads to further damage
it is usually accompanied by disease (signs and symptoms) |
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Which microbes make up our normal flora on our skin?
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Skin:
Staph. epidermidis Staph. aureus Propionibacterium acnes Corynebacterium |
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Which microbes make up our normal flora on our face?
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Mouth and Tongue:
Strep. Vieridans Lacotobacilli Neisseria Candida albicans (transcient) Gums and Tonsils: (obligate gram neg. anaerobes) Fusobacterium Veillonella Prevotella Nose: Staph. auerus Strep. pneumoniae Strep. pyogenes Haemophalus influenzae Neisseria meningitidis |
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Which microbes make up our normal flora in our GIT?
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Ileum:
Bacteroidis fragilis E. coli Enterococcus faecalis Enterococcus faecium Colon: Bacteroides fragilis (anaerobic gram neg.) Prevotella (anaerobic gram neg.) Fusobacterium (anaerobic gram neg.) Clostrisdium (anaerobic gram pos.) Peptostreptococcus (gram pos. anaerobe) E. coli (gram neg. facultative) Klebsiella (gram neg. facultative) Proteus (gram neg. facultative) Enterobacter (gram neg. facult.) Streptococci viridans (gram pos.) Lactobacilli (gram pos.) Entercocci (gram pos.) |
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Which microbes are located in the vagina?
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Doderlein's bacilli
Lactobacilli (gram pos) Peptostreptococcus (gram pos anaerobe) Clostridium (anaerobic gram pos) Corynebacterium (gram pos) Prevotella (gram neg. facultative) Gardnerella vaginalis (gram neg. aerobe) Streptococcus agalactia (gram pos. aerobe) |
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What purpose does skin serve as a non-immune defense?
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physical barrier
normal microflora dryness sloughing of cells to remove bacteria acidic environment from secretions that inhibit microbe growth |
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What purpose does mucous membranes in the GI, RT, and UT serve as a non-immune defense?
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barrier
goblet cells cilia GALT and MALT produce IgA |
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What purpose does respiratory tract serve as a non-immune defense?
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trapping system from air turbulence and nose with ciliated cells
saliva has lysozymes, lactoerrin and IgA macrophages in alveolar cells |
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What purpose does GIT serve as a non-immune defense?
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gastric acid kill bacteria but not spores (Clostridia have spores and H.pylori and Shigella are acid resistant)
pancreatic enzymes cell turnover (shedding) and peristalsis microflora **Note: PPIs cause increased aspirations of microbes and lead to more infections. |
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What purpose does genitourinary tract serve as a non-immune defense?
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flushing
acidity and solutes in urine (ammonia) kidney hypertonicity prevents upward spread of bacteria males have 4x's longer urethra so lower UTI incidences |
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What are factors that govern the initiation of an infection?
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size of microbe (more bugs, increase infection)
virulence immune competence presence of underlying disease (DM) compromised blood low anatomical obstruction indwelling foreign body (devices) age/immunosenescence |
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What are the stages of infection?
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1. Encounter: food, water, air body fluids (sex, blood, etc.), insects, animals, fomites, etc.
2. Entry (skin, mucous memb., inoculation -injection, trauma, bite, surgery) 3. Local infection (primary lesion): colonization/virulence; adhere (fimbrae) 4. Multiplicaton 5. Contiguous spread: cellular invasion (macrophages and PMN by phagocytosis and endocytosis) and tissue invasion (between cells) 6. Evasion of host defenses 7. Systemic spread (blood and lymph) 8. Distal lesions (secondary) 9. Damage: altered host cell functon, endo/extoxins, immune response 10. Outcome: trasmission to a new host; recovery or not **Immune system attacks at steps 3,4,5,6. |
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What are the types of infections?
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acute infection: rapid onset (hour-days) and brief duration (days-weeks)
chronic infection: organism persits for months-years dormant infecton: cyclical periods of infection carrier state: host sheds bacteria or spores to others (never fully recovered from infection) secondary infection: microbial infectiom followng a different infection (ex. otitis media following viral infection) mixed (polymicrobial) infection: two or more bacteria infecting the same tissue |
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What are opportunistic infections?
What are the risk factors? |
caused by opportunistic pathogens incapableof infecting individuals with normal host defenses
Risk factors: -neutropenia (chemotherapy) -impaired cell-mediated immunity (chemotherapy, immunosupp. therapy) -impaired humoral immunity (chemotherapy, steroids) -loss of skin (catheter, devices) -loss of mucous membranes (chemotherapy, prior infection) -surgery (organ transplant) -alteration of normal microbial flora (chemotherapy, hospital environment) -blood products, donor organs (bone marrow, solid organ transplant) |
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Which microbes cause skin-soft tissue infections (SSTIs)?
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Impetigo, Lymphangitis, Cellulitis:
Staph. aureus, Strep. pyogenes (crusty) Folliculitis: Staph. aureus, Kliebsella pneumonia, Enterobactor, Pseudomonas, Propionbacterim acnes, and Corynebacterium Human bite wounds: Eikenella, Staph. aureus, Strep Animal bite wounds: Pasteurella, Staph aureus, Strep Necrosis: Corynebacterium, Bacteriodes, Strep. pyogenes Treatment: drug that covers Staph, Strep, simple gram neg., Pseudomonas, and anaerobes |
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Which microbes cause onychomycosis (nail fungus)?
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Trichophyton, Epidermophyton, and Microsporum
**Diagnose with KOH test |
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What microbes cause bone and joint infections?
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Post trauma osteomyelitis:
Staph. aureus, Strep, gram neg. bacilli Osteomyelitis: Staph. aureus, gram neg. bacilli Implanted devices: Staph. epidermidis, Staph aureus, Strep, Enterococci, Enterobacter, Pseudomonas Bite wounds: Eikenella (human), Pateurella (animal) IV drugs: Pseudomonas, Staph Osteomyelitis Tuberculosis: Mycobacterium Osteomyelitis in Immuno.: Aspergillosis, Candida Osteomyelitis in Sickle Cell: Salmonella Sepsis Arthritis: Neisseria gonorrhoeae, Staph. aureas, Strep., gram neg. anaerobes |
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What microbes cause URTIs?
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Otitis media (Risk factors): Viral, Strep. pneumonia, Haemophilis influenzae, Moraxella catarhalis, Strep. pyogenes, Staph. aureus, E.coli, Pseudomonas, Mycoplasma
Pharyngitis (Complications): Viral, Strep. pyogense, Haemop. influenzae, Chlamydia pneumoniae, Mycoplasma pneumoniae, Corny diphtheriae (EMERGENCY) Laryngitis (Croup): Parainfluenzae, RSV Epiglottis (EMERGENCY): Haemop. influenzae Sinusitis: Strep. pneumoniae, Haemop. influenze, Moraxella catarrhalis, Viruses, Strep. pyognes, Staph. aureus, Anaerobes |
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What microbes cause LRTIs?
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Acute bronchitis: Mycoplasma, Chlamydia
Chronic Bronchitis: H. influnzae, Strep. pneum. Moraxella catarrhalis, Neisseria, Kleibella pneumonia, Psuedomonas, Serratia marcescens Bronchiolitis (infants): RSV (55%), Parainfluenza CA-Pneumonia: Strep, Haemophilis, Moraxella, Mycoplasma, Chlamydia, MSSA/MRSA, Anaerobes, Legionellla, Enterobact. Psuedomonas HA-Pneumonia: Enterobact, Pseudomonas, Staph, Legionella, Anaerobes, Acinetobacter Aspriation Pneumonia: Anaerobes and gram pos. Fungal Pneumonia/Immuno.: Fungi - Aspergillus, Cryptococcus, Candida, and parasites Tuberculosis: Mycobacterium tuberculosis |
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What microbes cause meningitis and CNS infections?
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Meningitis (bacteria, virus, fungi): Strep. pneumoniae, Staph (MS/MRSA), Neisseria, Haemop. influenze, Listeria monocytogenes (opportunisitic), Enterobacteriaceae, Pseudomonas, and Viral (low mortality)
Encephalitis (usually caused by viruses): Herpes, Fungi, Listeria - high mortality Brain Absess (usually bacterial): Staph (MS/MRSA), Strep, Haemo. influenzae, Enterobacteriaceae, Psuedomonas, Bacteroides fragillis, Anaerobes Shunt Infections: Staph or Strep Venous Sinus Thrombosis: Staph or Strep |
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What is bacteremia?
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invasion of blood by pathogenic bacteria
Primary bacteremia: nosocomial infection from catheter or inoculation Secondary: invasion of microbes from another site of infection into the blood Infective endocardistis (IE): infection of the endocardial surface of heart, usually valves Acute bacterial endocarditis (ABE): infection caused by Staph. aureus and is characterized by high fevers and has a rel. short toxic course of few days-weeks. Subacute bactrial endocarditis (SBE): less severe infection caused by less virulent bacteria characterized by lower fevers, anorexia, weight loss, and night sweats lasting for several weeks |
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What microbes cause endocarditis?
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Native Valve (Streptococcal): Strep. viridans and Strep. bovis
Staphylococcal IV drug user: MSSA/MRSA Staphylococcal Prostetic Valves: MRSE, MSSA/MRSA, GNB Enterocococcal: Enterococcus faecalis HACEK (rare): oral bugs (slow) Haemop., Actinobacillus, Cardiobacteria, Eikenella, Kiegella GNB (rare): Enterobacteria, Psuedomonas Fungal: Candida, Aspergillus |
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What microbes cause Diarrhea?
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Enterotoxigenic Diarrhea (Cholera), Enterohemorrhagic Diarrhea (E. coli), Traveler's Diarrhea (Shigella), Salmonella, Campylobacteriosis, Cryptosporidiosis, Staph, Clostridium/CDAD, Yersiniosis, Invasive Entamoeba (Dysentery), Giardia, Viral Gastroenteritis
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What microbes cause GI infections?
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Peritonitis (alcholism, chronic liver disease) - mostly gram neg. enterics and anaerobes: E. coli, K. pneumonia, Strep.
Biliary Tract/Cholangitis - mostly gram neg. enterics, anaerobes: E. coli, B. fragilis, Psuedomonas...some gram pos.: Strep. viridans/aureus post surgery Fungal Peritonitis (CAPD): Candida Cholecytitis (gall bladder): E. coli, Entrics, Enterococcus, Anaerobes (rare) Peptic Ulcer Disease: Helicobacter pylori |
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What microbes cause UTIs?
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Acute Cystitis: E. coli (90%), Staph. saprophyticus
CA-Pyelonephritis: E. coli, Protus HA-Pyelonephritis: GNB: E. coli, Pseudomonas, Enterococcus Catheter-Associated UTI: MRS, MSSA/MRSA, Enterococcus **Vancomycin covers all Acute Prostatitis (STD): Neisseria gonorrhea, Chlamydia, Enterobacteriaciae Chronic Prostatitis: Enterobacteraciae, Pseudomonas, enterococcus Urethritis: Neisseria gonorrhoeae, Chlamydia, Tichomonas, Ureaplasma, Mycoplasma |
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What microbes cause STDs?
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Urethritis/Cervicitis/Prostatitis: Neisseria gonorrhaeae, Chlamydia
PID: Neisseria gonorrhea, Chlamydia trachomatus, Entric gram neg, Ureaplasma, Bactroides Genital Herpes: HSV-1/2 Chancroid: Haemophilus ducreyi Lymphogranulopa venerum: Chlamydia Syphilis: Treponema palladum **Very sensitive to penicillin (spirochete) Ghonorrhea: Neisseria gonorrhea Epididymitis: Neisseria gonorrhea, Chlamydia, E. coli Vaginosis: Gardnerella vaginalis. Bacterpodes. {e[tpccis Vaginalis: Trichomonas vaginalis *Metronidazole Genital Warts: Human Papillovirus |
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What microbes do you need to cover for with surgery?
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Clean Surgeries
-Cardiothoracic, Orthopedic, Neurosurgery, Ophthalmic, Vascular/Graft Surgery, Breast: Treat for Staph -Ophthalmic, Head/neck Surgery: Treat for Staph and Strep Dirty Surgeries Gastroduodenal, Biliary tract/Laparoscope/Cholecystectomy, Genitourinary, Obstetric/Gynecoloic, Colorectal, Appendectomy: Treat for Staph, Strep, GNB or anaerobes |
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What are some of the terminology used in antimicrobial therapy?
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antibacterial agents: drugs directed against bacteria
antifungal agents: drugs directed against fungi antiprotozoal agents: drugs directed against protozoa antihelminthic agents: drugs directed against nematods antiviral agents: drugs directed against viruses antiseptics: compounds used topically to limit microbial growth; too toxic to unse internally disinfectants: compounds used on inanimate objects (counter tops) to destroy microbes; too toxic for internal or external use Germicides: disinfectants that can kill microbes rapidly "cidal": kills (ex. RTI drugs) "static": limits growth of population (uses immune system) |
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What are the natural antibiotics?
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These have resistance to them.
PCNs (Pen-G) Cephalosporins (Cephalosporin C) Carbapenems (thienamycin) Monobactams (aztreonam) Glycoptides (vancomycin) Lipopeptides (daptomycin) Aminoglycosids (streptomycin) Macrolides, Azalides, Ketolides (erythromycin) Lincomycins (lincomycin) Streptogramins ("synercid") Tetracyclines (chlortetracycline) |
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What are the synthetic antibiotics?
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Fluroquinolones (ciprofloxacin)
Oxazolidinones (linezolid) Nitroimidazols (metronidazole) Trimethoprim Sulfonamides (sulfamethoxazole) **Synthetic drugs don't get deactivated...that's why they are so popular!!! |
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What's the spectrum of activity for drugs?
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Fluoroquinolones: BROADEST spectrum!
-treats Mycobacteria, Gram negative bacteria, Gram positive bacteria, Chlamydias, Rickettsias, and Mycoplasmas Tetracycline:Gram negative bacteria, Gram positive bacteria, Chlamydias, Rickettsias, and Mycoplasmas Erythromycin: Gram positive bacteria, Chlamydias, Rickettsias, and Mycoplasmas Aminoglycosides: Mycobacteria, Gram negative bacteria, Gram positive bacteria Cephalosporins, Penicillins, Sulfonamides: Gram negative and Gram positive bacteria Isoniazid: Mycobacteria Aztreonam: Gram negative bacteria Vancomycin: Gram positive bacteria |
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What is the MOA of PENs, Cephalosporins, Carbapenems, and Monobactams?
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These inhibit cell wall synthesis by binding to PBP enzymes
**Note: Microbes alter or make a new PBP site to block beta-lactams from binding ex. MRSA and PRSP (Penicillin Resistant Strep. pneumoniae). This is an example of altering the target site to develop resistance. Microbes can also produce Beta-lactamases to develp resistance. This inactivates the drug. Gram negative microbes can also alter the antibiotic accumulation by altering their porins in the outer membrane. |
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What is the MOA of Glycopeptides (vancomycin), Bacitracin, Isoniazid?
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These inhibit cell wall synthesis
**Note: Microbes can alter their target site to block Vancomycin from binding ex. VRE (Vacomycin-Resistant Enterococci). This is an example of altering the target site to develop resistance |
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What is the MOA of Aminoglycosides, Tetracyclines, Macrolides, Azalides, Ketolides, Lincosamides, Chloramphenicol, Streptogramins, and Oxazolidinones?
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These inhibit protein synthesis inside the cell by binding to ribosomes in the cytoplasm
**Note: Microbes can alter their ribosomal protein to block the actions of Aminoglycosides and methylate the RNA on their ribosome to block the actions of Macrolides, Clindamycin and Tetracycline. This is an example of altering the target site to develop resistance. Microbes can also produce acetyltransferases, nucleotidyltransferases, and phophotransferases which are enzymes that change the drug structure of Aminoglycosides, Clindamycin, and Chloramphenicol to inactivate them. Gram negative microbes can also alter the accumulation of Chloramphenicol by altering their porins in the outer membrane (ex. Pseudomonas). Microbes can also have P-gp pumps in their inner membrane that actively efflux drug as a new or redirected transport system in order to alter Macrolides and Tetracycline accumulation (ex. Pseudomonas). |
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What is the MOA of Fluoroquinolones, Nitroimidazoles, and Rifampin?
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These inhibit nucleic acid synthesis inside the cell by binding to enzymes (DNA gyrase, RNA polymerase)
**Note: Microbes can alter their DNA gyrase to block actions of FQ and alter RNA polymerase to block actions of Rifampin. This is an example of altering the target site to develop resistance. Gram negative microbes can also alter the FQ accumulation by altering their porins in the outer membrane (ex. Pseudomonas) Microbes can also have P-gp pumps in their inner membrane that actively efflux drug as a new or redirected transport system in order to alter FQ accumulation (ex. Pseudomonas). |
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What is the MOA of Trimethoprim and Sulfonamides?
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These target the folate pathway by inhibiting enzymes (RNA polymerase, dihydrofolate reductase) so all purine synthesis is blocked and dUMP can't be converted to dTMP
**Note: Microbes can become insensitive to dihydrofolate reductase or increase production of the normal enzyme. This is an example of altering the target site to develop resistance. Gram negative microbes can also alter the Trimethoprim accumulation by altering their porins in the outer membrane (ex. Pseudomonas) |
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What is the MOA of Polymyxins and Lipopeptides?
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These disrupt the cytoplasmic membrane function/integrity outside the cell
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What is the MOA of Polyenes: Amphoteracin B, Nystatin and what are they used to treat?
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Antifungals: These are large, extremely polar and you can't take orally so have to be injected. They are EXTREMELY TOXIC!
These bind to ergosteral and cause fungal memberane disruption. These cause NEPRHOTOXICITY and INFUSION RXNS!! Amphoteracin B: effective against every fungus (Dermatophytosis/TEM, Blastomycosis, Coccidiomycosis, Histoplasmosis, Aspergillosis, Candiasis, and Cryto/Coccosis) but very TOXIC!! This can be injected but causes HYPERSENSITIVITY RXNS AND NEPHROTOXICITY IN 50% OF PATIENTS (REVERSIBLE)!! ONLY USED FOR IMMUNOCOMPROMISED PATIENTS!! Nystatin: effective against every fungus (Dermatophytosis/TEM, Blastomycosis, Coccidiomycosis, Histoplasmosis, Aspergillosis, Candiasis, and Cryto/Coccosis) but it is the too TOXIC! YOU CAN'T INJECT NYSTATIN!! ONLY USED TO TREAT CANDIDIASIS! |
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What is the MOA of Imidazoles: Clotrimazole, Ketoconazole, Miconazole?
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Antifungals: These were made first. They were made to retain the efficacy of Amphotericin B but are not as toxic. These block ergosterol biosynthesis by inhibiting CYPs. These attack ergosterols in a different way. They are large and lipophillic so they require acidity to solubilize. DO NOT TAKE WITH PPI'S!!! They have good oral activity.
They are powerful CYP INHIBITORS!!! ALL IMIDAZOLES CAN TREAT ALL FUNGI BUT LESS POTENT THAN TRIAZOLES!!! KETOCONAZOLE CAUSES GYNECOMASTIA BECAUSE IT INHIBITS HUMAN STEROID BIOSYNTHESIS!!! |
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What is the MOA of Triazoles: Fluconazole, Itraconazole, Voriconazole, Posaconazoles and what are they used to treat?
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Antifungals: These block ergosterol biosynthesis by inhibiting CYPs. These attack ergosterols in a different way. They are large and lipophillic so they require acidity to solubilize. DO NOT TAKE WITH PPI'S!!! They have good oral activity.
They are powerful CYP INHIBITORS!!! ALL TRIAZOLES CAN TREAT ALL FUNGI!!! |
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What is the MOA of Allylamines: Terbinafine and what are they used to treat?
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Antifungals: These block ergosterol biosynthesis by inhibiting CYPs. These attack ergosterols in a different way. They are large and lipophillic so they require acidity to solubilize. DO NOT TAKE WITH PPI'S!!! They have good oral activity.
They are powerful CYP INHIBITORS!!! ALLYLAMINES ARE THE MOST EFFECTIVE AGAINST DERMATOPHYTOSIS (TEM)!!! |
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What is the MOA of Echinocandins: Caspofungin and what are they used to treat?
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Antifungals: These inhibit fungal cell wall (beta-1,3-glucan). They have a narrow spectrum and have less ADRs than Polyenes.
NO CYP DIs!!! ECHINOCANDINS ARE ONLY EFFECTIVE AGAINST YEAST INFECTIONS (APERGILLOSIS, CANDIDIASIS)!!! |
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What is the MOA for antimetabolites: 5-Fluorocytosine and what are they used to treat?
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Antifungals: It behaves like a MECHANISM BASED INHIBITOR where it inhibits DNA and protein synthesis by blocking biosynthisis of dTMP. The side effect is that they suppress bone marow and GI. THESE HAVE RAPID RESISTANCE SO YOU HAVE TO USE WITH AMPHOTERICIN B.
ANTIMETABOLITES ARE ONLY EFFECTIVE AGAINST YEAST INFECTIONS (CANDIDIASIS AND CRYTO/COCCOSIS) WITH COMBINATION THERAPY!!! |
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What is the MOA of metronidazole and what is it used to treat?
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Antiprotozoal: Used to treat Entamoeba histolytica, Giardia intestinalis, and Trichomonas vaginalis
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What is the MOA of Quinolines: chloroquine, hydroxychloroquine, mefloroquine, and priquine and what are they used to treat?
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Antiprotozoal agents: They work as ANTIMALARIALS and are used to treat Plasmodium
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What is the MOA of Pyrimethamine in combination with Sulfonamides or Clindamycin?
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Antiprotozoal agents: They block the folate pathway and prevent the production of dTMP. They are used to treat Toxoplasma
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What is the MOA of Trimethoprim-Sulfamethoxazole and what are they used to treat?
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Antiprotozoal agents: They block the folate pathway and prevent the production of dTMP. They are used to treat Cryptosporidium parvum, Isospora belli, Pneumocystis carinni (a fungus)
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Which RNA viruses have vaccines?
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Poliovirus
Hepatitis A Dengue fever and yellow fever virus Eastern equine encephalitis Rubella virus Rotavirus Influenza Rabies Measles Mumps |
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Which DNA viruses have vaccines?
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Chronic Hepatitis B
Condyloma acuminatum (genital warts) Varicella (chicken pox) Variola (small pox) |
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Which DNA viruses have drugs for treatment? "ovir"
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Herpes
CMV EBV HHV-6 Varicella |
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Which bacteria have vaccines?
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Tetanus
Diphtheria Pertussis Strep. pneumoniae Neisseria meningitidis Haemophilus influenza Salmonella typhi Bacillus anthracis Vibrio cholerae Yersinia pestis |
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What is microbial resistance?
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the natural or acquired capacity of a pathogenic microorganism to survive the deleterious effects of an antimicrobial agent
It is a function of: *the pathogen *the antibacterial agent *the concentration of the antibacterial agent |
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What are MDROs?
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Multidrug-Resistant Organisms
1. Methicillin-Resistant Staph. aureus (MRSA): also includes HA-MRSA and CA-MRSA 2. Multi-Drug Resistant Strep. pneumoniae (MDRSP) 3. Vancomycin-Resistant Enterococci (VRE) 4. Gram-Negative Bacilli (GNB) *Escherichia coli (ESBLs) - produce beta-lactamases *Klebsiella pneumoniae (ESBLs) - produce beta-lactamases *Acinetobacter baumannii (multiple mechanisms) *Pseudomonads: (Multi-Drug Resistant) ***Pseudomonas aeruginosa (Amp C resistance) ***Stenotrophomonas maltophilia (CPases) ***Burkholderia cepacia |
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What contributes to resistance?
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Over-prescribing of antibiotics
Inappropriate use of antibiotics Out-patient care and transmission (MRSA) Implanted medical devices Increases in patients with immunologic diseases Increased travel, trans-continental exposure Agriculture use of antimicrobials as "growth promoters" (99% of antibitics go here) Biocide use: "Home Hygiene Products" Animals Resistance transmission from environment and microflora |
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How do microbes acquire resistance?
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1. Innately/Inherently
a. Viruses, Fungi and Protozoa are resistant to beta-lactams b. Gram negative pathogens are resistant to Vancomycin because they have pores and Vancomycin is big 2. Aquired a. Mutation: ex. Staph. areus ad Psuedomonas altered their DNA gyrase so FQ can't bind b. Acquisition **Transformation: uptake of "naked" DNA from outside of the cell that gets incorporated into bacterial chromosome (e. Strep. pneumoniae, Neisseria gonnorrheae, and Haemophilus influenzae. **Transduction: infecton of the cell by a virus (bacteriophage) vector that carries new DNA. This is the least important in resistance. (ex. Staph. aureus) |
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How do microbes acquire resistance?
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b. Acquisition (cont.)
**Conjugation: a direct, unidirectional transfer of DNA from once cell to another via physical contact between sex pilli. It is mediated by plamsids (small, independently replicated, circular DNA molecules which carry nonchromosomal genes that allows for environmental adaptation). Plasmids are used for fertility (transfer of genetic info), antibacterial resistance, production of virulence factors such as exotoxins and adhesions, and utilization of nutritional sources. **Transposon/Integrons (Jumping Genes): this is when genetic elements are moved from on part of the chromosome to another. Also genetic information can be shared beween plasmids and chromosomes within the same cell. This now is a permanent part of the chromosome. MUTATION AND CONJUGATION ARE THE 2 MAIN WAYS THAT BACTERIA ACQUIRE RESISTANCE!!! |
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What is horizontal transmission vs. vertical transmission?
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Vertical transmission is replication species (1 cell --> 2 cells --> 4 cells, etc.).
Horizontal transmission is conjugation between 2 different species (they share genetic info between plasmids). They only have to be in the same environment to do this. |
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What are the major bacterial resistance determinants for Staph aureus?
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MRSA (modified PBP target and produces Penicillinases)
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What are the major bacterial resistance determinants for Streptococcus pneumoniae?
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altered PBP target (PCNs)
decreased binding (Tetracycline) methylated ribosome (Erythromycin) |
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What are the major bacterial resistance determinants for Neisseria gonorrheae?
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beta-lactamases (PCNs)
alterned DNA gyrases (Quinolones, Cephalosporins) |
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What are the major bacterial resistance determinants for Mycobacterium tuberculosis?
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resistant to antituberculosis drugs (several mechanisms)
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What are the major bacterial resistance determinants for Enterococcus faecium/faecalis?
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beta-lactamases (PCNs)
altred binding site (Vancomycin/VRE) |
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What are the major bacterial resistance determinants for Staph. epidermidis?
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altered PBP target (MRSE)
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What are the major bacterial resistance determinants for Acinetobacter baumanii?
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All 3 mechanisms: altered binding site, beta-lactamase enzyme production, and efflux
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What are the major bacterial resistance determinants for Enterobacter cloacae?
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produce beta-lactamases against AmpC and Cephalosporins
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What are the major bacterial resistance determinants for Klebsiella pneumonia?
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produce beta-lactamases against AmpC and Cephalosporins
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What are the major bacterial resistance determinants for Pseudomonas?
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All 3 mechanisms: altered binding site, beta-lactamase enzyme production, and efflux
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What are the major bacterial resistance determinants for Stenotrophomonas maltophilia?
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produce carbapenemases which chop up all PCNs and beta-lactams
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What is breakpoint?
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Antibacterial drug breakpoints represent the highest MIC (90)for which the unbound plasma concentrations of the antimicrobial drug (following standard doses) are sufficient to achieve the PK/PD target against a defined organism and for which adequate clinical data support their use.
It is calculated by multiplying the Avg Cpx (peak concentration of drug) by Pbf (extent of protein binding of drug) and then dividing that value by the half-life factor of the drug multipled by (MIC 90 x 4). The half-life ranges between 0.5 and 2. 4 is a shift factor. |
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How do you use breakpoint?
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Those with a "low" breakpoint would fall in the "susceptible" range. Here, the infecting organism should respond to therapy with the antibiotic in question. (ex. PSSP - Penicillin Susceptible Strep. pneumoniae)
Those with between "low" and "high" breakpoint fall within the intermediate range. Here the MIC of the infecting organism either falls into a range inwhich it apporaches or exceeds the concentreation of the antibiotic which can ordinarily be achieved. In this case, increase the dose. (ex. ISSP - Intermediate Susceptible Strep. pneumoniae) Those who are esistant have an infecting organism which would not respond to herapy no matter how much drug is given. In this case, find another drug to treat with. (ex. PRSP - Penicillin Resistant Strep. pneumoniae) |
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What is TI?
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Therapeutic Index = Toxic dose for humans / Toxic dose for "bugs"
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What determines the activity of antibiotics?
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MICs and Breakpoints
Aminoglycosides/Fluroquinolones have high Cmax/MIC FQ/B-lactams/Vanco. have to have AUC>MIC Vanco/Beta-lactam have Time>MIC |
