Cardiovascular/lymphatic System Bacteriology

Front 1

What are medical conditions that involve the blood?

Back 1

1. septicemia: bacteria grow in the bloodstream...immune response can be septic shock

2. bacteremia: presence of bacteria in blood...viremia and fungemia

Front 2

What is the normal biota of the cardiovascular and lymphatic system?

Back 2

closed system with no normal biota

Front 3

What is rheumatic fever?

Back 3

1. strep pyogenes is the etiologic agent and sequelae of S. pyogenes pharyngitis

2. Pathogenesis: autoimmune rxn to M protein (bacterial component of cell envelope that acts as anti-phagocytic factor and adhesin)

3. parts of mitral valve resemble M protein....damage here when immune response

Front 4

What are the signs and symptoms of rheumatic fever?

Back 4

acute fever, polyarthritis, carditis and erythema marginatum.....eventually can lead to colonization of opportunistic bacteria and fatality due to extensive damage of valve

**highest incidence= school age children....no skin infection after pharyngitis

Front 5

What is endocarditis?

Back 5

inflammathon of endocardium...fever malaise, back and CP, anemia, abnormal heart beat....can seem like an MI..

**petechiae on upper half of body and under fingernails

**can lead to spleen enlargement

Front 6

What are the predisposing factors for endocarditis?

Back 6

1. IV- drug use

2. heart disease

3. valve insufficiency

4. indwelling catheter, pacemaker, prosthetic heart valves, CHF, prior endocardtisi

Front 7

What is the diagnosis for endocarditis?

Back 7

DUKE CLINICAL CRITERIA!....either 2 major and 3 minor or 1 major and 5 minor.

1. Major (micro)= typical organisms x 2 blood cultures, persistent bacteremia more than 12 hours, 3/3 or 3/4 blood cultures

2. major (valve)= echo with vegetation, new valve regurgitation

3. minor: predisposing cardiac conditions or IDU, fever greater than 38C, vascular phenomenon (bleed, clot, aneurysm, Janeway lesions), immune phenomenon (glomerular nephritis, osler nodes, roth spots), positive blood culture, abnormal echo but not diagnostic

Front 8

What are the causative agents for acute endocarditis?

Back 8

"AVE CHL"

1. staph aureus (30%)

2. viridans strep (18%)

3. enterococcus (11%)

4. coag-negative staph (11%)

5. HACEK bacteria: periodontal films

6. Lancefield strep (group D, pyogenies, pneumonia, Neisseriae gonorrhea)

Front 9

What is the transmission and epidemiology of acute endocarditis?

Back 9

parenteral route (direct entry) is most comon

**IV drug use, traumatic injuries, surgical procedures

Front 10

How do your prevent and treat acute endocarditis?

Back 10

avoid introduction into the blood stream.....culture, ID, antibiogram, approtpriate abx, high continuous levels of abs due to biofilms on vegetation.

Front 11

What is subacute endocarditis?

Back 11

primary risk factor: damage to heart valves or by congenital defect....irregularities in the valves promotes attachment by bacteria, formation of biofilms and shedding of bacteria into the blood stream

Front 12

What are the etiologic agents for subacute endocarditis?

Back 12

1. viridans streptococci (strep. sanguis, S. oralis, S. mutans)....these are alpha hemolytic strep, dont possess Lancefield antigens...normal flora of oral cavity and upper respiratory, genital, GI.....

**Most common cause of subacute bacterial endocarditis

Front 13

What plays an important role in tooth decay?

Back 13

S. mutans

Front 14

What is the transmission and epidemiology of subacute endocarditis?

Back 14

minor breaks in skin/mucus membranes (crazy toothbrushing, dental stuff)....can go into bloodstream and into heart valve

**no person to person transmission nor environment

**mid 20s- 50s

**prevention: prophylactic abs before surgery

Front 15

What is septicemia and what are the signs and symptoms?

Back 15

organisms multiplying in the blood.....fever, hypotension due to loss of fluid from vasculature

Front 16

What are the causative agents for septicemia?

Back 16

90% bacteria; 10% fungi

Front 17

What is the pathogenesis, virulence factors of septicemia?

Back 17

endotoxic shock and fever for gram negative bacteria.....

teichoic and lipoteichoic acid for gram positive bacteria causing shock and fever

Front 18

What is the transmission, culture/diagnosis, and treatment?

Back 18

1. transmission : parenteral introduction via IV lines or surgery

2. culture/diagnois: blood cultures

3. treatment: broad spectrum abx

Front 19

What is Yersenia app?

Back 19

1. genus is a member of Enterobactericeae....related to E. coli and Salmonella

2. gram negative rods

3. safety pin appearance = Y. pestis.....the reason for the bubonic and pneumonic

plague.....bioterrorism

4. Y. enterocolitica: severe GI infection

Front 20

What is the pathogenesis of Yersenia pestis?

Back 20

1. primary infection via flea bite site

2. septicemic plague

3. bubonic plague

4. pneumonic plague

Front 21

What is the bubonic plague?

Back 21

sudden onset low fever, prostration, slurred speech, abd pain...LN infected and inflamed= bubo (firm and movable).........septicemia to hemoconcentration to circulatory failure and death

Front 22

What is the pneumonic plague?

Back 22

rapid spread and near 100% mortality....contracted by pneumonic complications ...get generalized headache, nausea, respiratory difficulty, fever, cough with blood tinged sputum.....cyanosis and death from suffication

Front 23

What is the epidemiology of the sylvatic plague due to Yersenia

Back 23

wild rats and rodents...transmitted to humans via FLEAS.....epizootics in rats, squirrels, prairie dogs and cause sporadic human cases..

can also happen via ingestion of contaminated animals or handling contaminated tissues

Front 24

What is the epidemiology of the pneumonic plague?

Back 24

clinical form with the greatest potential for rapid transmission....direct person to person spread

Front 25

How do you diagnose Yersenia pestis?

Back 25

collect blood, sputum, LN biopsy... DFA and pig inoculation

**specimens are hazardous

Front 26

How do you treat and control Yersenia pestis?

Back 26

1. abx therapy initiated 12-15 hours after appearance of fever to be of value

2. abx prophylaxis for close contact (bioterrorism)

3. vaccine available

Front 27

What is Yersenia enterocolitica?

Back 27

agent of enterocolitis in cold N. America ...increased metabolic activity at 22-25 degrees (water, milk, wild and domestic animals)

**treat with broad spectrum

Front 28

What is Francisella tularensis?

Back 28

etiologic agent of tularemia.....aka Rabbit fever, tic fever, deer fly fever and glandular fever

**bioterrorism

**gram-negative coccobacillus

Front 29

What are the clinical manifestations of Francisella tularensis?

Back 29

1. sx after 3-5 day incubation period (fever, chills, malaise, fatigue)

2. clinical classification on basis of site of infection + presence of skin ulcers and lymphadenopathy:

1. ulceroglandular

2. oculoglandular

Front 30

What is ulceroglandular form of Francisella tularensis?

Back 30

most common.....painful papule develops in the area of the insect bite....ulcerates and develops necrotic center and raised borders....localized lymphadenopathy

Front 31

What is oculoglandular form of Francisella tularensis?

Back 31

less common....direct contamination of eye leads to conjunctivitis and regional lymphadenopathy.....systemic illness with multiorgan sepsis...GI from ingestion of contaminated meat and pneumonic from inhalation of infected aerosols

Front 32

What is the epidemiology of Francisella tularensis?

Back 32

1. most common reservoirs: rabbits and ticks

2. transmission to humans: tick bite, contact with infected rabbits, consumption of contaminated meat

3. infectious dose low....highest in OK, ARK, MISSOURI

Front 33

How do you diagnose for Francisella tularensis?

Back 33

hazardous collection, lab acquired infections are common....

Front 34

How do you prevent Francisella tularensis?

Back 34

live, attenuated vaccine for high-risk peeps

Front 35

What is Borrelia spp.?

Back 35

1. gram negative spirochete

2. major: B. burgdorferi (Lyme disease) and B. recrurrentis (relapsing fever)

3. antigenically related to Treponema palladium (syphillis)

Front 36

What is the pathogenesis of B. burgdoferi (Lyme dz)?

Back 36

occurs in stages...

1. early: stage 1....erythema migrans (bull's eye), fever, minor constitutional symptoms

2. early infection: stage 2....disseminated infection, sever fatigue, annular lesions and joint/muscle pain. less common symptoms like rash, meningitis, cranial nerve palsy, Bells palsy, conjunctivitis, hepatitis, respiratory distress

3. late infection: stage 3....persistent infection, long episodes of arthritis, skin lesions appear blue- red and swollen + chronic encephalomyelitis and keratitis

Front 37

How does the CDC define Lyme disease?

Back 37

erythema migrans greater than 5 cm in diameter and at least one late manifestation + lab confirmation of infection

Front 38

What is relapsing fever (borreliosis)?

Back 38

tick fever/recurrent fever....generalized infection with abrupt onset....chills, fever, headache, musculojoit pain, spleen and liver enlargement

**epidemic borreliosis: louse-borne....single relapse and most severe form

**endemic borreliosis: tick-borne.....multiple relapses and less severe

Front 39

what is the epidemiology of Lyme disease?

Back 39

1. CDC says its the most common insect vector borne infection

2. most foci in the Northeast, upper midwest and Pacific West

3. lifecycle: ticks and mice....preferred host: white-tailed deer.....most transmitted by nymph state ticks and paralyze mammals and birds.

Front 40

What is the epidemiology of epidemic borreliosis?

Back 40

transmitted by human louse....louse picks up bacterium when feeding on bacteremic patient .....transmission when louse in carried by host

Front 41

What is the epidemiology of endemic borreliosis?

Back 41

geographic location depends on distribution of tick vectors and animal reservoirs....infection during the tick feeding process....endemic in W/SW US

Front 42

What is the diagnosis for Lyme disease?

Back 42

microscopic examination of blood/tissues not recommended.....

need ones of the following:

1. diagnostic levels of IgM or IgG via ELISA antibodies to spirochetes

2. significant increase in antibody titer between acute and convalescent serum samples (IgM appears 2-4 week after onset of erythema migrants and peak after 6-8 weeks of illness....IgGs appear later (peak 406 months)

3. western blot to confirm positive ELISA

Front 43

What is the diagnosis for relapsing fever?

Back 43

clinical is not diagnostic...need to see bacteria in blood....no accurate serologic tests bc of antigenic shifts

Front 44

Treatment for lyme disease and relapsing fever?

Back 44

antibiotics

Front 45

How do you prevent/control Lyme dz?

Back 45

avoid the vector...use appropriate light clothing...long pants and sleeves w closed toe shoes...

**vaccine taken off market bc of side effects

Front 46

What is Brucella?

Back 46

1. AKA undulant fever, Bang's disease (cattle), Malta fever

2. wide host range including domestic animals....B. abortus= cattle, B. suis= pigs

3. bioterrorism

Front 47

What is the morphology for Brucella?

Back 47

small, gram negative coccobacilli

Front 48

What is the pathogenesis of Brucella?

Back 48

survive and multiply in PMN's and macrophages...local lymphadenopathy before bacteremia...lesions of small granulomas

**incubation period is days to months (~3 weeks)....onset abrupt with fatigue (most common cc).....diurnal fever, anorexia, muscle aches, headaches, back aches....RELAPSES= hallmark!

**can last for 20 years

Front 49

What is the epidemiology of Brucella?

Back 49

1. zoonotic disease...major reservoirs for humans = cattle and hogs

2. ingestion, contact inhalation = most common means of transmission (dairy products and unpasteurized milk in the US)

3. California and Texas - highest # of cases

4. vaccination for animals reduce human casea

Front 50

How do you diagnose Brucella?

Back 50

1. classified among "fevers of unknown origin"...non specific symptoms

2. isolation from blood, bone marrow, liver!....intracellular position may cause negative blood culture

3. serologic tests indicate active dz

Front 51

What is the control of Brucella?

Back 51

effective vaccine for animals is available leading to elimination of animal reservoir for human infection

Front 52

What is Coxiella burnetti?

Back 52

obligate intracellular bacteria....etiologic agent of Q fever!

**bioterrorism

Front 53

What is the morphology for Coxiella burnetti?

Back 53

small, gram negative pleomorph

Front 54

What is the clinical manifestations for Coxiella burnetti?

Back 54

1. incubation for months-years...presentation insidious (subclinical to pneumonia with prolonged fever and hepatitis)...

2. most common presentation: subacute endocarditis (occurs on a prosthetic or damaged heart valve

Front 55

What is the epidemiology for Coxiella burnetti?

Back 55

woldwide associated with LIVESTOCK!.....transmission via arthropod-vertebrae-arthropod cycle (not humans)

**reservoirs: cattle, sheep, goats

Front 56

What is the most common way for infection in humans for Coxiella burnetti?

Back 56

inhalation of dust particles/aerosols contaminated with organisms from birth tissue or excreta of infected animals

**Texas and California.....farm workers, meat cutters, vets, lab techniques, consumers of raw milk at most risk!

Front 57

How do you diagnose Coxiella burnetti?

Back 57

serology via IFA.....PCR (blood and heart valve)....tissue culture

Front 58

What is Bartonella?

Back 58

1. gram negative bacilli

2. variety of animal reservoirs

1. B. bailliformis

2. B. quintana

3. B. henselae

Front 59

What is B. Bacilliformis?

Back 59

cause of Oraya fever...endemic to Peru, Ecuador, Colombia

**sandfly vector

Front 60

What is B. quintana?

Back 60

cause of trench fever, subacute endocarditis and bacillary angiomatosis

**angiomatosis= proliferation of blood clots from knots of capillaries to subcutaneous nodules.....its a vascular proliferative dz seen in immunocompromised peeps

Front 61

What is B. henselae?

Back 61

cause of bacillary angiomatosis but primarily involves skin and lymph nodes in contrast to subQ tissues and bones.....causes subacute endocarditis and Cat scratch disease (CSD),

Front 62

What is Ehrlichia and Anaplasma?

Back 62

1. E. chaffensis is agent for HME (human monocytic ehrlichiosis)

2. Anaplasma phagocytium: agent for HGA (human granulocytic anaplasmosis)

**both gram negative obligate intracellular bacteria

Front 63

What is the clinical manifestation for Ehrlichia and Anaplasma?

Back 63

1. E. chaffensis: HME agent and resembles RMSF (about 12 days after tick bite, high fever, malaise, myalgia develop).....leukopenia+thrombocytopenia

Front 64

What is the epidemiology of Ehrlichia and Anaplasma??

Back 64

E. chaggensis = SE, Mid atlantic, south central US (TX,AR, OK, MO, GA, S. Carolina)

**major insect vector= Lone Star Tick

**major reservoirs: white tailed deer, dog

Front 65

How do you diagnose Ehrlichia and Anaplasma?

Back 65

microscopy but not highly sensitive....

1. IFA

2. DNA amplification/probe

Front 66

What is the morphology and physiology for Rickettsia?

Back 66

very small, gram negative coccobacilli

**obligate intracellular parasite

Front 67

What is the notable species in Rickettsia?

Back 67

1. Rocky Mountain spotted fever = R. ricketsii

2. Rickettsialpox= R. akaru

3. Epidemic typhus= R. prowazekii

4. Murine thyphus= R. typhi

**all associated with arthropod vectors

Front 68

What is the pathogenesis for Ricketrsia?

Back 68

1. able to induce phagocytosis

2. enter endothelial cells...escape phagosome and replicate in nucleus or cytoplasm..replicate until cell bursts and releases stuff.....

Front 69

What is Rickettsia ricketsii?

Back 69

etiologic agent of Rocky Mountain Spotted Fever

**pathogenesis: incubation period 3-12 days.....sudden onset with HA, fever, malaise, and myalgia..

**2-4 days after, rash appears on soles of palms and soles....then generalized and hemorrhagic..can lead to widespread endothelial damage with occlusion in small vessels and electrolyte changes

Front 70

What is the epidemiology for Rickettsia rickettsii/

Back 70

1. transmission by various tick species....wood tick (Dermacenter anderson) is common in Rocky mountain and dog tick (D. variables) and Amblyinna americanum common in SE/central states....ACT AS RESERVOIRS AND VECTORS (acquire from infected animal hosts)

Front 71

What is the most severe and common rickettsiosis in the US?

Back 71

RMSF....OK, MO, NC, TN (children and young adults in warmer months)

Front 72

What is the diagnosis for Ricketsia rickettsii?

Back 72

1. no isolation bc its difficult and requires trained personnel

2. microscopy with DFA or skin lesion biopsy allows confirmation within hours

3. detect Abs by end of 2nd week with microimmunofluorescence

4. do Weil-Felix for cross reacting abs to Proteus

5. PCR!

Front 73

What is Anthrax?

Back 73

1. Bacillus anthracis (gram positive endospore forming rod)

2. signs/sx: skin, legs, GI CNS

3. pathogenesis/virulence factor: lethal factor

5. transmission/epidemiology: animal reservoir, endospore former, BIOTERRORISM