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252 Cards in this Set

  • Front
  • Back
Group of microorgs that cause disease when host defenses are impaired
Secondary
Group of microorgs that can successfully infect the healthy respiratory tract by unique properties which allow them to evade host defenses
Professional
Name 3 common systemic bugs
Parainfluenza, H. influenzae and influenza virus
Microbial adhesion of Influenza A and measels virus
Hemogglutinin
Microbial adhesion of rhinovirus
Capsid protein
Microbial adhesion of Cox A
Capsid protein
Microbial adhesion of of Parainfluenza Type 1 and RSV
Envelope protein
Microbial adhesion of mycoplasma pneumoniae
Mycoplasmal molecule or "foot"
Microbial adhesion of H. influenzae, Strep. pneumonia, Klebsiella pneumoniae
Surface molecule
Name 2 bugs that synthesize a glycan that forms a matrix between cells to develop dental plaques
Strep mutans and Lactobacillus
What produces dental caries?
Plaque bateria secrete lactic acid. (Strep mutans and lactobacillus)
Name 2 anerobic bugs that contribute to peridontal disease
Actinomyces and Bacteroides
Why do rhinoviruses usually only affect the URT?
They like to grow at 33 degrees C, not 37. Thus, they flourishin the URT, not the LRT where it is warmer
Bug that causes Herpangina
Cox A
Vesicular enathem of the tonsis and soft palate affecting children 6 months-10 years in summer and fall
Herpangina (Cox A)
Bug of Hand, foot and mouth disease
Cox A
Demographics of Hand, foot and mouth
Enathem in the spring and summer in kids < 5
Vesicular lesions and ulcerations, tender cervical lymphadenopathy, high fever, irritability and swollen gingiva
HS Gingivostomatitis
Bugs of a cold
Rhinoviruses and secondarily Coronaviruses
Attachment Mech: Penton fiber binds to cell receptor
Adenovirus
Attachment Mech: G protein on virus binds to glycoside on cell
RSV
Most common causes of pharyngitis
Strep Pyogenes and Unknown
Causes disease in summer and fall, multiply in tonsils and can spread to other parts of the body including the meninges resulting in a meningitis (2 bugs)
Cox and ECHO
VP4 mediates binding to host cell and determines trophism
Cox and ECHO
A toxin activity associated with their pentons
Adenovirus
Fever, sore throat, very enlarged cervical lymph nodes and may produce pharygealconjuctival fever. If you have a sore throat and eye involvement, think what bug?
Adenovirus
Creamy exudate on the tonsils, widespread lympahdenoapathy, systemic disease. What bug?
EBV
Linked to late effect cancers Burkitt's Lymphoma and Nasopharyngeal Carcinoma
EBV
Usually generate Heterophile Ab that will produce a + Monospot
EBV (Cytolomegalovirus will be Monospot -)
In what demographic do most severe middle RTI occur?
infants or very young children (epiflottitis, laryngitis, croup and bronchitis/tracheobronchitis are all middle RTIs)
Characteristics of Strep mutans (and note hemolysis type)
Gram + cocci that grow in chains; of the group Strep Viridans; alpha hemolytic
Tx for Strep mutans?
Penicillin G
Attributes of Pathogenesis of Strep mutans?
Cell associated carb capsule
How do you differentiate between pharyngeal thrush and Candida lesions?
Candida lesions will be painless
Fungi causing Stomatitis
Candida
Viruses causing Stomatitis
HSV and COX A
Dimporphic fungus: yeast form on mucosal surface as normal flora, but hyphae and pseudohypae in tissues
Candida albicans (Opportunistic)
Yeast form produces proteases and phosholipase that assist tissue invasion
Candida albicans
Characteristics of HSV
Enveloped viron w/ linear dsDNA
Cowdry type A acidophilic nuclear inclusion bodies
HSV
Initial infection and replication in mucoepithelial cells and establish latent infections of sensory neurons
HSV
Gingivostomatitis in kids
HSV Type 1
Gingivostomatitis in young adults
HSV Type 2
Causes herpes labialis (cold sores)
HSV Type 1
Dx by cytopathogenic effects in Tzanck test
HSV
Tx of HSV? Resistant bugs?
Acyclovir, famiciclovir and valacyclovir. For resistant bugs, Foscarnet and Cidofovir.
Dendritic ulcers in keratoconjuctiitis
HSV
Characteristics of COX
Naked, icosahedral viron with ss + sense RNA
Tx of COX?
Supportive
Common cold virus most common in adults
Rhinovirus
Common cold viruses predominant in kids
Coronavirus and Parainfluenza virus
Characteristics of Rhinovirus
Naked icosahedral viron with ss + sense RNA
Secretor IgA and interferon important for controlling the spread of this infection
Rhinovirus
Treatment with Pleconaril is possible, but usually not done for this virus
Rhinovirus
Characteristics of Coronavirus
Enveloped virus with helical nucleocapsid containing ss + sense RNA
Causes the common cold in kids and perviously SARS
Coronavirus
Characteristics of HPIV?
Enveloped virus with helical nucleocapsid containing ss - sense RNA
Tx of HPIV?
Supportive, no vaccine
May cause croup (barking cough with inspiratory stridor), Bronchiolitis (fever and expiratory wheezing) and Pneumonia
HPIV
Clinical presentation often consists ofexudates, palatal petechiae, follicles, scarlet fever-like rash and tender cervical adenitis
Strep Pyogenes (Group A)
Which virus will give you an exudate? (Most viruses lack exudates)
EBV
Characteristics of Strep Pyogenes (Group A); Catalase?
gram + cocci that grow in chains; Catalase -
Cell associated M protein and hyaluronic capsule; extracellular products
Strep Pyogenes
Hemolysis of Strep Pyogenes (Group A)
Beta hemolysis
Tx of strep pyogenes
Penicillin G
Honey crusted lesions on face and trunk
Impetigo; Strep Pyogenes
Characteristics of C. diphtheria
Gramp + club-shaped rod
Extracellular A-B type exotoxin that inhibits protein synthesis by inactivation of elongation factor
C. Diphtheria
Black colonies on tellurite agar (Loeffler medium) is Dx
C. Diphtheria
Virulence factor that inhibits the activation of complement and protects the org from phagocytosis
M protein of Strep Pyogenes
May produce pyrogenic exotoxins that stimulate T cells to pour out inflammatory cytokines (superantigen) and induce TSS
Strep Pyogenes (So can staph auerus)
Colonizes in the pharynx forming a pseudomembrane composed of fibrin, leukocytes, necrotic epithelial cells
C. Diphtheriae
Multinucleated giant syncytial cells with intranuclear inclusion bodies
HSV
Has at least 17 adhesion moelcules including fibronectin and collagen binding proteins
Strep. Pyogenes
What proteins create antibodies that crossreact with cardiac myosin and sacrolemmal membrane to cause rheymatic fever? What bug?
M protein in Strep Pyogenes
Toxins and antibodies of this bug can lead to GN and streptococcal TSS
Strep Pyogenes
Name 2 things Strep Pyogenes has to inhibit host defenses
M proteins and polysaccharide capsule
"Bull-neck" appearance due to swelling of lymph nodes
C. Diptheria
A/B toxin coded for by lysogenic beta phage is the major pathogenic factor
C. Diptheria
What sort of vaccine is the Diptheria vaccine?
Formalin inactivated toxoid
What does the B fragment of the Ditheria toxin do?
B = Binds
Causes an acute epiglottis due to swelling of supraglottic tissue; usually in kids 2-4
H. influenzae
What protects H. influenzae from phagocytosis?
Antiphagocytic capsule
Prevention of H. influenzae?
Hib vaccine: consists of type b capsular material conjugated to diptheria toxoid
What age group is H. influenzae most prevalent in?
Kids 2-4
The usual cause of laryngitis
Parainfluenza Virus
Causes croup (a laryngotracheobronchitis) that affects kids in the fall and winter
Parainfluenza Virus
Parainfluenza Virus binds to epithelial cells of tracheobronchal tree via what?
Hemagglutin/neuraminidase protein
Causes Whooping cough
Bordetella pertussis
How do Bordetella pertussis attach to epithelial cells?
Hemagglutinin and fimbria
This bug can survive in phagocytic cells and secrete pertussis toxin, adenylate cyclase toxin, tracheal cytotoxin and an endotoxin
Bordetella pertussis
Tx of Whooping cough via Bordetella pertussis
Erythromycin
Prevention of Bordetella pertussis?
Acellular pertussis vaccine
Causes 75% of bronchiolitis infections
RSV
Demo of RSV
children 2 or less in the late winter or early spring
Dangerous pediatric nosocomial infection
RSV
Type of influenza most frequently involved in yearly epidemics
A
What part of influenza is responsible for the molecular biology of antigenic drift and shift in yearly epidemics?
Hemeagglutinin and neuraminidase
Forms an ion channel in endosome which permits the influx of ions and that releases the core that travels to the nucleus for replication of the s.s. virion RNA
M2 matrix protein of influenza
(Without M2, influenza cannot replicate)
What determines the binding that can occur in influenza?
Hemagglutinin
Protein sequence of HA changes. (Point mutations in that segment that codes of HA of the influenza virus).
Antigenic drift (Yearly)
Take two different influenza viruses with different types of HA and NA and combine them... Exchange of RNA segments between two viruses.
Antigenic shift causing major pandemics
Antiviral drugs which inhibit viral neuraminidase
Zanamivir and Oseltamivir
What mediates lobar pneumonia?
Bacteria
What mediates interstitial pneumonia?
Virus
How are acute pneumonias classified?
Community-acquired (CAP) and Hospital-acquired (HAP)
What general group of bugs cause children's pneumonias?
Viruses (Only cause 10-20% of adult pneumonias)
Major bacterial causes of CAP
Strep pneumonia, H. influenza and Moraxella catarrhalis
Characteristics of Bordetella pertussis?
Gram - coccobacilli with fastidious growth requirements
Bordetella pertussis, Oxidase + or -?
Oxidase +
Name 2 bugs with an A-B type exotoxin
Bordetella pertussis and C. Diphtheriae
Growth on Bordet-Gengou or blood charcoal agar
Bordetella pertussis
Tx of Bordetella pertussis?
Whole cell inactivated vaccine part of DPT and two acellular pertussis vaccines as part of D TaP, Or Erythromycin if neccessary
Human Metapneumovirus (HMPV) may cause what?
Bronchitis/Bronchiolitis
Wheezing on expiration can be correlated with what according to the bug table?
RSV in bronchiolitis
Characteristics of RSV
Enveloped virus with helical nucleocapsid containing ss negative sense RNA
Tx of RSV
Supportive or Ribavirin in severe peds cases
May use palivizumab as a preventative measure for this virus
RSV
Why do viruses with HA glycoproteins cause heme-agglutination when mixed with RBCs?
HA attaches to host sialic acid receptors which are present on the surface of erythrocytes (also present on the cells of the URT)
What allows the influenza virus to attach to the URT cell membranes?
HA attaches to host cell sialic acid receptors (present in URT and RBC)
What is the function of Nueraminidase (NA) in the influenza virus?
Breaks down Neruaminic acid in the mucin and exposes sialic acid receptors for HA to bind
What is the mechanism of Zanamivir and oseltamivir?
Inhibit NA in influenza
Name two viruses with Fusion (F) protein that causes the infected host cells to fuse together into multinucleated giant cells
PIV and RSV
Can cause Reyes syndrome in kids
Influenza
Characteristics of Influenza virus
enveloped with 8 helical nucleocapsids each containing a different ss negative sense RNA
What types of influenza can undergo antigenic DRIFT?
A and B
What type of influenza can undergo antigenic SHIFT?
A
What is the mechanism of Amantadine and Rimantadine in the tx of influenza?
inactivate M2 proton channel necessary for replication of the virus
Define acute and chronic Pneumonias
Acute = sx 1-3 days following infection

Chronic = sx progress over three weeks or longer
When bacteria is leaked into the pleural space during a pneumonia
Empyema
A causual fungi of a typical CAP in an immunosuppressed individual
Pneumocystis jiroveci
A pneumonia in an AIDS pt is probably caused by what?
Pneumocystis jiroveci
A pneumonia in a pt with cystic fibrosis is probably caused by what?
P. aeruginosa
Name the common pathogens of a CAP in pts < 50
Strep pneumonia, mycoplasma pneumonia and chlamydophila pneumonia and resp viruses
Name the common pathogens of a CAP in pts > 50
Strep pneumonia, H. influenza, Moraxella catarrhalis, Legionella and other resp viruses
neonatal pneumonia is frequently observed in infants born to infected mothers with what?
Chlamydophilia trachomatis
Atypical pneumonias are NOT caused by what?
Strep pneumonia or H. influenza
Characteristics of Strep pneumonia
Gram + cocci that are seen in PAIRS rather than chains like other Strep
How do you differentiate between Strep viridans and Strep pneumonia since they are both alpha hemolytic?
Strep pneumonia is Optichin sensitive (will stop growing) while Strep viridans is Optichin resistant
Extracellular products IgA protease and pneumolysin
Strep pneumonia
Hemolysis of Strep pneumonia?
alpha hemolytic
+ Quelling Rxn
Strep pneumonia and H. influenza
Tx of Strep pneumonia
Polysaccharide capsular vaccine; Penicillin G; Cephalosporin and Vanco for Pen resistant strains
Characteristics of H. influenza
Gram - faculative coccobacilli with fastidious growth requirements (Like Bordetella pertussis)
H. influenza, Catalase what?
Catalase -
Requires factor X (hemin) and factor V (NAD) for growth
H. influenza
Growth on chocolage agar supplemented with growth factors X and V
H. influenza
Prevention of H. influenza
Hib conjugate vaccine containing type b capsule
Which polysaccharide capsule of H. influenza usually causes disease in kids and is bad?
b (b=bad)
What specific type of H. influenza will cause ottitis media in kids?
nonencapsulated strains as they lack the virulent invasiveness of the capsulated ones and can thus only cause localized infection
What pathogenesis does H. influenza cause?
Epiglottis and meningitis in kids and pneumonia in the elderly
What is the significance of Filamentous hemagglutinin (FHA)?
Allows Bordetella pertussis to bind to ciliated epithelial cells. (Note: remember Bordetella pertussis does NOT actually invade they body. It releases exotoxins from the surface of the ciliated epithelial cell it binds to)
The AB subunits of Pertussis toxin activate what?
G protein --> adenylate cylase --> > cAMP --> protein kinase
Exotoxin of Bordetella pertussis that impair the generation of H2O2 and superoxide
Extra cytoplasmic adenylate cyclase
Exotoxin of Bordetella pertussis that destroys ciliated epithelial cells resulting in impaired clearance of mucus
Tracheal cytotoxin
This type of CAP develops more slowly and have less severe, more systemic complaints (besides a non-productive cough)
Atypical pneumonia
What are the major bacterial causes of Atypical pneumonia?
Legionella and Mycoplasma pneumonia
What are the Chlamydia causes of an Atypical Pneumonia
Chlamydophila pneumonia and psittaci
A possible viral cause of an atypical pneumonia in a kid
RSV (Although
Unique bacteria that lack a peptidoglycan cell wall
Mycoplasma
Atypical pneumonias will show up as what on a CXR
Interstitial pattern (Which is usually associated with viruses, but bacteria such as mycoplasma pneumonia can also produce this pattern)
Require sterols for growth
Mycoplasma pneumonia (All mycoplasma require sterols due to lack of cell wall)
Adhesion virulence factor of Mycoplasma pneumonia
protein P1
May cause a Walking Pneumonia
Mycoplasma pneumonia
Tx for Mycoplasma pneumonia
Erythromycin and Tetracycline
IgM "cold agglutinins" are Dx
Mycoplasma pneumonia
2nd most common nosocomial infection
Nosocomial pneumonia (UTIs are the first)
Endotracheal intubation increases the risk for this infection
Nosocomial Pneumonia
How do you determine if a pt acquired a nosocomial pneumonia or if it was just incubating?
If they develop the disease after being hospitalized for > 5 days = Nosocomial
Name 3 opportunistic orgs
CMV, Aspergillis fumigatis, and Pneumocystis jiroveci
Name the most common orgs to cause a nosocomial pneumonia
Gram negative rods (E. coli, Klebsiella pneumonia, P. aeruginosa) and Staph aureus
Many pts with this show evidence of peridontal disease and 3/4 of the cases occur in pts > 65
Aspiration pneumonia
Most common cause of Aspiration pneumonia
Anerobic strep (Peptostreptoccocus species)
unique cell wall components prevent destruction in the lysosomes
Mycobacteria TB
Bacteria causes of Chronic CAP
Mycobacterium TB and avium, and Nocardia
Fungi causes of Chronic CAP
Histoplasma capsulatum, Coccidiodes immitis, Blastomyces dermatitidis, Cryptococcus neoformans, and Sporothrix scheneckii)
Fungal causes of Chronic Opportunistic Pulmonary Mycosis
Aspergillus fumigatus and flavia
Prevalent fungi around the Mississippi river areas
Histoplasma and Blastomyces
Fungi prevalent in the southwest that causes systemic infections
Coccidioides immitis
Name the 3 dimorphic fungi that can cause systemic infections
Histoplasma capsulatum, Coccidoides immitis, Blastomyces dermatitidis
NONencapsulated (despite name) and found in bat and bird poop
Histoplasma capsulatum
Fungi are isolated form soil and rotten wood and environmental form is mold
Blastomyces dermatitis
Tx of Histoplasma capsulatum infection
Non-disseminated: Intraconazole
Disseminated: Amphotericin B
Mold form lives in desert sand
Coccidiodes immitis
Tx of Coccidiodes infection
Non-disseminated: Fluconazole
Disseminated: Amphotericin B
Tx of Blastomyces dermatitidis
Non-disseminated: Azoles
Disseminated: Amphotericin B
Encapsulated yeast cells often found in pigeon droppings
Cryptococcus Neoformans
Tx of Cryptococcus Neoformans
Fluconazole
India Ink stain shows yeast cells with surrounding halo
Cryptococcus neoformans (Common infection in AIDS pts)
Filamentous fungus ubiquitous in the environment
Aspergillus
Fungus that causes a Type I HS (Elevated IgE)
Aspergillus
Tx of Aspergillus
Surgical removal of aspergilloma or Amphotericin B
Pathology associated with periodontal disease, chest pain, anemai and putrid breath
Lung Abcess
Bacteria cause of Lung Abcess
Anaerobic bacteria
Bacteria that cause Otitis Media & Acute Sinusitis
Strep pnumonia, H. influenza and Moraxella catharralis
Causes chronic sinusitis, particularly in AIDS pts
P. aeruginosa
produce only lactic acid from sugars
Lactobacillus
Characteristics of lactobacillus
Gram-positive facultative anaerobic or microaerophilic rod-shaped bacteria
Causal org of epiglottitis in kids? In adults?
H. influenza in kids, Strep pyogenes in adults
Viruses that can cause a pharyngotonsillitis
Adenovirus, Cox A, EBV and Enterovirus
Tx of adenovirus
supportive
Characteristics of Adenovirus
Naked viron with linear ds DNA
Infects human B cells and is associated with Burkitt's Lymphoma
EBV
Heterophile Ab resulting in a + Monospot
EBV
Characteristics of EBV
Enveloped viron with linear ds DNA
Tx of EBV
supportive
Downey cells in blood smear
EBV
organisms are engulfed by alveolar macrophages and replicate within them since the unique cell wall components prevent destruction in the lysosomes
Mycobacterium tuberculosis
healed primary lesions of Primary TB that have become calcifies are called
Ghon complexes
Prevention of Primary TB
a live attenuated vaccine is available
TB that occurs at other sites including the CNS and GU tract and results from the hemeatogenous spread of the bacteria
Miliary (extrapulmonary) TB
hospital-acquired lung abcesses are the result of which usual hospital-acquired infections?
K. pneumonia, P. aeruginosa
IV drug users are prone to lung abcesses from which bug?
S. aureus
inhaled from deer mouse feces invade pulmonary capillary endothelium resuling in large increases in fluid in the lungs and hyptension and cardiogenic shock
Sin Nombre hantavirus
Name some parasites that can cause lung infections
Ascaris and hookworms and Schistosome larvae, Echinococcus granulosus larvae and Paragonimus westermanii
Characteristics of Mycobacteria TB
Acid fast aerobic rod
Unique cell wall containing mycolic acids and cord factor
Mycobacteria TB
Unique cell wall prevents killing by macrophage lysosomes; intracellular parasites
Mycobacteria TB
Prophylactic tx for Mycobacteria TB
Isoniazid
Faculative intracellular growth: can survive and multiply in macrophages
Mycobacteria TB
Nonmotile, no capsule, no attachment pili and No exotoxins or endotoxins. DOES ahve lipolysaccharide
Mycobacteria TB
Polysaccharide capsule yeast
Cryptococus neoformans
Branching (45 degree angles) septated hyphae
Aspergillus
Wheezing pt and CXR with fleeting infiltrates
Aspergillus
Pneumonia lesions can calcify, looking similar to TB on a CXR ("Coin lesion")
Histoplasma capsulatum
Yeast forms present in macs
Histoplasma Capsulatum
Cysts and trophozoites present; cysts attach to type I pneumocytes
Pneumocystis jiroveci
Diffuse "flying saucer" cysts
Pneumocystis jiroveci
Hyphae with distinctive tuberculate macroconidia
Histoplasma capsulatum
Big, broad, budding yeasts
Blastomyces dermatitidis
Athroconidia found in the desert sand
Coccidiodomycosis
Lancet shaped diplococcus
Strep pneumoniae
Colonizes with help of protein adhesins and an IgA protease; produces hydrogen peroxide
Strep pneumoniae
What does Strep pneumoniae have that reduces the efectiveness of complement and Ab, < phagocytic uptake
polysaccharide capsule
Hyaluronic acid capsule inhibits phagocytic uptake
Strep Pyogenes
Has a toxin that is a potent ADP ribosyl transferase
C. diphtheriae
Adheres through filamentous HA, pertactin and pili
B. pertussis
Tozin that has an ADp ribosyl transferase that > cAMP
B. pertussis
Tracheal cytoxin that kills ciliated resp cells
B. pertussis
Often causes resp disease in adolescents and young adults
Mycoplasma pneumoniae (Walking pneumoniae)
attaches to UR and bronchial epithelial cells via P1 protein
Mycoplasma pneumoniae
Fried egg appearing colonies on culture
Mycoplasma pneumoniae
Pneumonia associated with ventilators and postinfluenza infections
S. auerus
Gram negative rod, lactose-fermenter with capsule
Klebsiella pneumoniae
Pneumonia associated with ventilator, alcoholism (although pneumoccocus is still more common) and aspiration
Klebsiella pneumoniae
Current jelly sputum
Klebsiella pneumoniae (nonmotile)
Gram -, nonfermenting rod, motile
P. aeruginosa
Burn, CF, severly neutropenic patients, respirator associated pneumonia
P. aeruginosa
production of copious extracellular slime
P. aeruginosa
gram - NONstaining, pleomorphic rod with no peptidoglycan
Chlamydia pneumoniae (Atypical Pneumonia)
Poorly gram - staining rod which is a faculative intracellular pathogen of human macs
Legionella pneumophila
Found in contaminated water, air-conditioners, etc.
Legionella pneumophila (NOT contagious from person to person)