Enterobacteriaceae

Front 1

Enterobacteriaceae: morphology
1) gram stain
2) sporulation
3) motility

Back 1

(1) gram-neg
(2) no sporulation
(3) most have flagella

Front 2

Enterobacteriaceae: biochem
1) metabolism
2) oxidase
3) nitrate reduction

Back 2

(1) facultative anaerobes
(2) oxidase-neg
(3) reduces nitrate --> nitrite

Front 3

Enterobacteriaceae: lactose fermentation
1) lac-pos: MacConkey color, examples
2) lac-neg: MacConkey color

Back 3

(1) lac-pos: pink (E coli, Klebsiella, Enterobacter)
(2) lac-neg: tan/gray

Front 4

Enterobacteriaceae:
major surface antigens (5)

Back 4

(1) flagella (H antigen)
(2) fimbriae (pili)
(3) capsule (K antigen)
(4) somatic (O antigen)
(5) LPS

Front 5

What does LPS consist of (3)?

Back 5

(1) lipid A -> outer memb
(2) core oligosacs -> KDO sugar
(3) O polysacs -> antigenic

Front 6

REST STOP:
LPS Inflammatory Response

Back 6

(1) release blebs of outer memb
(2) antibiotics cause further LPS release
(3) LPS binds LBP in serum
(4) taken up by macrophage via CD14
(5) CD14 passes LPS to TLR4 (transmemb)
(6) macrophages -> TNF-a and IL-1
(7) septic shock

Front 7

Enterobacteriaceae:
virulence factors (5)

Back 7

(1) adhesins (fimbriae)
(2) toxins (hemolysin)
(3) iron acquisition (siderophores)
(4) capsule (LPS)
(5) plasmids (R plasmid)

Front 8

Enterobacteriaceae:
common infections (5)

Back 8

(1) enteric
(2) UTI
(3) abd/pelvic
(4) pneumonia
(5) bacteremia
***Misc: neonatal meningitis, surgical wounds, decubitus ulcers, brain abscesses

Front 9

E. coli:
common infections (3)

Back 9

(1) UTI - 90% cases
(2) pneumonia - nosocomial
(3) bacteremia - can lead to sepsis, shock

Front 10

Klebsiella (pneumoniae, oxytoca):
common infections

Back 10

(1) catheter-assoc UTI
(2) Freelander's pneumonia: classic lobar, immunocomp'd pts --> pulmonary necrosis, pleural effusion, empyema

Front 11

Klebsiella (pneumoniae, oxytoca):
(1) unique feature of capsule
(2) resistance

Back 11

(1) mucoid -> inhibit phagocytosis
(2) ampicillin-resistant

Front 12

Proteus (mirabilis):
(1) usu pts?
(2) enzyme production
(3) appearance on blood agar

Back 12

(1) urinary catheters
(2) urease -> crystals -> pyelonephritis, bacteremia
(3) swarms (b/c motile)

Front 13

Morganella (morganii):
(1) related to what?
(2) usu pts?

Back 13

(1) Proteus, Providencia
(2) catheterized urinary tracts

Front 14

Providencia:
(1) related to what?
(2) usu pts?

Back 14

(1) Proteus, Morganella
(2) catheterized urinary tracts

Front 15

Enterobacter (cloacae, aerogenes)
(1) usu pts?
(2) source?
(3) resistance

Back 15

(1) ICU, comorbidity, antibiotics
(2) source: GI flora
(3) highly resistant

Front 16

Serratia (marcescens):
(1) usu setting?
(2) favors what kind of environ?
(3) endocarditis in which pts?
(4) characteristic color?

Back 16

(1) nosocomial
(2) moist, wet
(3) IV drug users
(4) red pigment

Front 17

Citrobacter (freundii, koseri):
(1) usu assoc infection
(2) two infections in neonates

Back 17

(1) catheter-assoc UTI
(2) meningitis, brain abscess

Front 18

Enterotoxigenic E. coli (ETEC):
(1) leading cause of...?
(2) pathogenesis
(3) enterotoxins (2)
(4) pos sx?
(5) neg sx (usu)?

Back 18

(1) childhood diarrhea, traveler's diarrhea
(2) fimbriae adhere to GI epithelium
(3) heat-stable (ST), heat-labile (LT)
(4) watery diarrhea, nausea, cramps
(5) no fever, no vomit, no bloody/mucoid stools

Front 19

Enterohemorrhagic (EHEC) +
Shiga Toxin-producing E. coli (STEC):
(1) major cause of...?
(2) sources of outbreak
(3) disease in <5 + elderly?
(4) most common serotype
(5) shiga-like enterotoxins
(6) pos sx?
(7) neg sx?

Back 19

(1) bloody diarrhea
(2) beef, H2O, petting zoos
(3) HUS
(4) O157
(5) SLT-1, SLT-2 -> attach + efface
(6) bloody diarrhea, abd cramps
(7) usu no fever

Front 20

Enteropathogenic E. coli (EPEC):
(1) leading cause of...?
(2) effect on intestinal epithelia?
(3) what can protect infants?

Back 20

(1) acute diarrhea in infants
(2) attach + efface -> lose microvilli
(3) breastfeeding

Front 21

HUS
(1) stands for...?
(2) triad of...?
(3) usu pts?

Back 21

(1) hemolytic uremic syndrome
(2) thrombocytopenia, hemolytic anemia, nephropathy
(3) children <5 + elderly

Front 22

Enteroaggregative E. coli (EAEC):
(1) pattern of adherence
(2) causes what disease?

Back 22

(1) stacked bricks
(2) travelers' diarrhea

Front 23

Enteroinvasive E. coli (EIEC):
(1) why similar to shigellosis?
(2) seen in what pts?

Back 23

(1) invade GI epith cells -> take over host actin-filament assembly
(2) travelers

Front 24

Diffuse Adhering E. coli (DAEC):
(1) similar to what kind of E. coli?

Back 24

(1) EAEC (traveler's diarrhea)

Front 25

Enterobacteriaceae:
Which E. coli strain is indigenous to U.S.?

Back 25

EHEC
(bloody diarrhea, HUS, O157, Shiga-like toxins)

Front 26

Shigella (sonnei, flexneri, dysenteriae, boydii):
(1) common settings
(2) pos sx
(3) pathogenesis
(4) toxins
(5) diagnosis
(6) treatment

Back 26

(1) overcrowded: military camps, daycare
(2) watery -> dysentery, abd pain, fever
(3) invasive -> ulcer (~pseudomemb)
(4) Shiga-toxin (AB)
(5) stool culture, fecal WBCs
(6) avoid antibiotics b/c could be EHEC/STEC

Front 27

Salmonella (enterica, typhi):
(1) pathogenesis
(2) characteristic infections
(3) high-susceptible host factors

Back 27

(1) invade enterocytes, M cells -> enter Peyer's -> multiply within macrophages -> infected macros disseminate
(2) gasteroenteritis, typhoid fever, bacteremia
(3) AIDS, sickle cell, hypo-HCl

Front 28

Gastroenteritis (Salmonella):
(1) sources
(2) role of enterotoxin
(3) pos sx?
(4) neg sx?
(5) diagnosis
(6) treatment

Back 28

(1) poultry, eggs
(2) hypersecretion of H2O
(3) nausea, vomit, diarrhea, fever, chills, cramps, myalgias
(4) no bloody diarrhea
(5) agar color change
(6) self-limiting, NO antibiotics

Front 29

Typhoid fever (Salmonella):
(1) common strains
(2) pos sx
(3) neg sx
(4) lab findings
(5) diagnosis
(6) source of chronic asymptomatic?
(7) treatment

Back 29

(1) S. typhi, S. paratyphi
(2) fever, abd pain, hepatosplenomegaly, headache, delirium, chills, ROSE SPOTS
(3) usually no diarrhea
(4) leucopenia, anemia, elevated liver enzymes
(5) blood/bone marrow culture
(6) infected gall bladder
(7) fluoroquinolones, 3* cephalosporins

Front 30

Bacteremia (Salmonella):
(1) %risk from gastro?
(2) %risk endovasc infection in elderly?
(3) persistent bacteremia suggests?

Back 30

(1) 1-4%
(2) 10-25%
(3) endovasc (aortitis)

Front 31

Yersinia enterocolitica:
(1) enterotoxin + role
(2) reservoirs?
(3) inhib by refrigeration?
(4) pos sx?
(5) possible sequelae?
(6) N Europe: causes what?
(7) US: winter peak w/...?
(8) where are mucosal ulcers?
(9) what increases risk?

Back 31

(1) ST -> watery diarrhea
(2) domestic animals, springs/streams
(3) no, grows at 4 C
(4) fever, diarrhea, abd pain, nausea, vomit
(5) reactive polyarthritis, erythema nodosum
(6) diarrhea
(7) chitterlings
(8) terminal ileum (incl appendix)
(9) iron overload

Front 32

Yersinia pestis:
(1) two diseases + transmission
(2) grows best at what temp?
(3) US: which states?
(4) bubonic sx
(5) pneumonic sx
(6) treatment + success

Back 32

(1) rodent fleas (bubonic), inhalation (pneumonic)
(2) 28 C
(3) southwest
(4) fever, chills, weakness, painful bubo -> shock
(5) resp failure, bloody sputum -> DIC
(6) streptomycin, gentamicin (fatality 15-50%)