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202 Cards in this Set

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neutrophils defend against which organisms?
extracellular bacteria (*staph aureus**pseudomonas*, GAS, flu, e. coli, fungi
macrophages defent against which organism?
intracellular bacteria, fungi
complement defends against which organism?
capsulated- neiserria meningitis, strep pneumo
what host defense is against fungi?
neutrophils and macrophages
cancer chemo causes what lapses in host defense?
neutropenia, mucositis (physical barriers)
solid organ transplantation causes lapses in what host defense?
cell mediated immunity against intracellular bacteria (physical barriers in 1st month)
bone marrow transplant causes lapses in what host defiencse?
neutropenia, mucositis, cell mediated and humoral immunity
Cell mediated immunity against which pathogens?
intracellular
empiric antibiotics for neutropenic fever/cancer?
antiseudomonal betalactams w/ gram negative coverage- cefepime or carbapenems
which transplant type has greatest risk?
lung (or heart lung combo)
which protozoan is common in 1-6 month of solid organ transplant due to immunosupression?
toxoplasmosis
which fungi are common in 1-6 month of solid organ transplant due to immunosupression?
endemic mycosis +aspergillus
describe pre, early-post, and late-post immune system defects?
neutropenia, graft vs. host t-cells and b cells, chronic t cell/b cell problems
endemic mycoses are seen more in solid organ transplant or bone marrow transplant?
solid organ
Common culture negative organisms for Endocarditis
HACEK (hard to grow)- Haemophilus aphrophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)+ Bartonella, Coxiella
azithromycin is used against?
gram negatives only
how long to treat complicated catheter infection
4-6 weeks
name worst to least catheters for infection?
non-tunnel> tunnel> picc> port
after femoral, worst site for catheter infection?
internal jugular>subclavian
alternatives for vancomycin w/ MRSA?
daptomycin, linezolid
most common organisms in native valve endocarditis?
Strep viridans, staph aureus (acute)
most common organisms in early prosthetic endocarditis?
Coag neg staph
late prosthetic endocarditis?
coag neg staph, strep viridans, staph aureus
nosocomial endocarditis organisms?
staph aureus, gram negative, candida
IVDU endocarditis organisms?
staph aureus, polymicrobial (enterococci/pseudomonas)
Causes of culture negative endocarditis?
HACEK, Bartionella, Coxiella
what are oslar nodes?
tender nodules in digits seen in endocarditis
what are janeway lesions?
non-tdner pustular lesions on palms and soles seen in endocarditis
What are roth spots?
retinal lesions seen in endocarditis
major criteria of Endocarditis (dukes); how many needed?
2/2 or persistently positive blood cultures OR Endocardial environment; need 2
minor criteria for endocarditis (dukes); how many needed
predispositon, fever, peripheral phenomena, less convincing microbiology; need 5 or 1 major + 3 minor
tx of endocarditis: MSSSA, strep, culture negative
cetriaxone
tx of endocarditis: MRSA, Coag Neg Staph
Vancomycin
Tx of endocarditis: strep and enterococci
gentimicin/penacillin; substitute vanc if gentamicin resistant
t/f use endocarditis prophylaxis for Mitral valve prolapse? For prosthetic valve?- in procedures
No; Yes
which normal skin flora is anerobic?
propionibacterium
organisms that cause impetigo?
Group A strep, staph aureus
organisms that cuase folliculitis?
staph aureus, pseudomonas
what organisms causes a skin infection via swimming pools and hot tubs?
pseudomonas
what organisms cause furnucles/carbuncles?
just staph aureus
what is inflammation of the dermis called?
ersipelas
what causes erlyipsea?
Group A strep, other group streps
how to differentiate erlypsia from cellulitis?
it is well demarcated! Also raised
risk factors for erlypsia?
venous stasis, alcohol abuse, lymphatic obstruction
where is cellulitis?
in dermal and superficial fascia layers- deeper than erysipelas
common organisms in cellulitis?
gram positives; In DM/diabetes ulcer- gram negatives and anerobes
tx of cellulitis?
vancomycin
which post-op cellulitis has a high risk of necrotizing fasciatis? When does it occur?
Group A strep; w/ in 2 days
what is fourneir's gangrene?
necrotizing fascitis in the scrotum
pathogenesis of necrotizing fascitis?
Strep pyogenesis exotoxins/superatigens A-C over produce cytokines
cause of pyomyositis?>
staph aureus
necrotizing fasciaties is in what part of skin?
subcutaneous fatt and tissue
inmates/football teams/postpartum women all get what?
CA-MRSA
tx for CA-MRSA?
Clinda, vanc, bactrim, doxy
presentation and organism from ingesting raw shell fish?
hemorrhagic bullae; vibrio vulnificus
tx for hemorrhagic bullae of vibriovulnificus
doxycycline
presentation and organism for people who handle saltwater fish, shellfish, poutry, and meat?
indollent cellulitis/seal finger= erysipelothrix rhusiopathie
Tx for erysipelothrix rhusipathiae for handling saltwater fish and meat?
vancomycin
tx of anthranx
doxycycline or ciprofloxacin
cat bites cause what dz w/ which organism?
acute lymphangitis; pasturella
getting in fresh or salt water w/ minor trauma causes what? Organism?
chronic granulomatous lymphangitis; mycobacterium marinum
tx of mycobacterium marinum chronic granulomatous lypmhangitis?
clarithro, doxy, or bactrum; or rifampin
2 organisms that can cause TSS
staph aureus (super antigen); Group A strep (exotoxins)
differences between how GAS and staph aureus TSS look?
GAS- necrotizing facitis; Staph- desquamization
what organism causes scalded skin syndrome? Tx?
staph aureus superantigen; vanc
describe SRIS? Temp, HR, RR, WBC
Temp:36 or 38, HR>90, RR>20 or PaCO2<32, WBC> 12k or < 4 k or 10% immature
sepsis?severe sepsis?
SIRS + infection + 1 organ failed
septic shock?
SIRS + infection + hypotension
sepsis rate increasing or descreasing? Mortality rate?
increasing; declining but still high (absolute numbers continue to rise)
who gets sepsis?
6th decade, non-white males, w/ alcohol dependence or genetics
pathogens that cuase the most sepsis?
gram positives; increasing candida but still rare
pathogenesis of spesis?
cytokines influence hypothalamus, endothelial cells, and vessel wall causing fever, depletion of IV volume and vasodilation leading to lactic acidosis and death
in sepsis, which organism causes ecthyma gangrenosum?
pseudomonas- burn/open wound patients
component responsible for shock in gram negative sepsis? Host cell components?
LPS (lipid A + O antigen); Host cell-TLR4, CD14, and cytokines
component responsible for gram positive staph?
lipoteichoic acid activated by TLR2, peptidoglycan activates cytokines, superantigens/exotoxins
empiric abx for sepsis?
carbapenem, 3/4 cephalsopron, piperacillin +/- vanc
when to use hrAPC? Risk?
sepsis w/ acute organ dysfunction; risk= bleeding
when to use steroids in sepsis? Insulin?
when hypotensive after a week; when glc above 150
name some characteristics of atypical pneumonia
more mild, insterstitial cxr, no response to pcn
organisms of atypical pneumonia?
mycoplasma, chlamydophila, legionella (coxsiella, franciella, pcp, endemic fungi, respirtaory viruses)
what viruses cause atypical pneumonia?
influenza A, rsv, metapneumovirus, rhinovirus, coronavirus
how to differentiate viral from bacterial pneumonia?
URI manifestations, normal WBC, winter/kids/nursing home
most common cause of atypical pneumonia?
mycoplasma
pathophysiology of mycoplasma pneumonia
attach w/ P1, damage cilia and elaborate gas-H202/superoxides
complications of mycoplasma pneumoia?
bullous myrigintis, steven johnson target syndrome, hemolytic anemia (agglutins), meningoenchephalitis, myopericarditis, arthritis
which atypical pneumonia organism is an obligate intracellular bacteria>
chlamydiae pneumoniae
pathogenesis of chlayminia pneumonia
elementary bodies phagocytosed, into vesicules, become reticulate bodies, back to elementary bodies that are released
biological characteristics of legionalla pneumophilia?
aerobic, gram positive, non-spore forming
where is legionella pneumophila found and how is it infective?
bulding water supplies, it is inhaled into lower respiratory tract and then consumed by macrophages
which atypical pneumonia cannot go from person to person
legionella
clinical manifestions of legionella pneumonia?
sudden pontiac fever (flu like) or Legionairre's dz (non-productive cough ans systemic signs)
differences and similarities of tx of atypical pneumonias?
All- macrolides, floroquinolones Mycoplasma and chlamydia- Tetracyclines
What Ig is in the upper airways and antibacterial?
IgA
symptoms and signs of CA- pneumonia?
fever, cough, chest pain, rales, lobar infiltrate
history of LOC puts one at risk for what?
aspiration pneumonia w/ polymicrobial anerobes
what causes pneumonia in birth to 3 weeks?
GBS, e. coli, Listeria
what causes pneumonia in 3 weeks to 3 months
strep pneumo, chlamydia, bordatella, s. aureus
What cuases pneumonia in 3 months up to 5 years?
strep pneumo, h. flu, mycoplasma
what causes pneumonia in young adults?
strep pneumo, atypicals
what causes pneumonia in adults?
Strep pneumo, H. flu, moraxella, s. aureus
which pneumonia will not last a long time?
strep pneumo
tx of strep pneumo pneumonia?
ceftriaxone or quinolones
morphology of h. flu?
gram negative bacillus
tx of h. influenza pneumonia?
ceftriaxone
morphology of moraxella?
gram negative diploccocus
t/f moraxella colonizes?
true- nasopharyngeal mucosa mostly of infants
tx of moraxella pneumonia
ceftriaxone
which organism causes necrotizing pneumonia, pleural effusion, and empyema?
staph aureus
tx of staph aureus pneumonia
vancomycin
what determines when a pneumonia patients should be hospitalized?
CURB-65 of 2/3: confsion, uremia, respiratory rate, blood pressure low, 65 or older
empiric tx for healthy outpatient pneumonia>
macrolides or doxy
empiric tx for outpatient w/ comorbid illness or use of abx
macrolide + betalactam or enhanced floroquinolone
empiric tx for hospitalized pneumonia patient
macrolide + betalactam or enhanced floroquinolone
empiric tx for ICU pneumonia
beta lactam + macrolide or enhanced floroquinolone; suspect MRSA add vanc
how does host commensal flora change when in hospital?
goes from gram positive to gram negative
Hospital acquired pneumonia organisms?
Enterobacteria, pseudomonas, staph aureus, actinobacter (PASE)
what medicine can predispose to hospital acquired pneumonia?
PPI
which cancer is most likely to give fever?
non-hodkins lymphoma
with IV acess what nosocomial cause of FUO do you consider?
phlebitis
with intubation, ng what nosocomail cause of FUO do you consider?
nosocomial sinusitis
treatment of toxoplasmosis?
pyrimethamine/sufadiazine
which gastroenteritis are caused by cytotoxins, destroying cells?
shiga toxin, c. diff toxins
how do gram negatives and viruses cause gastroenteritis?
invasion
which gastroenteritis are caused by neurotoxin? What do you see?
staph, b. cereus= vomiting
how does norovirus present?
vomiting w/ little diarrhea
which parts of epithelial cell are affected by cholera toxin?
GM1 ganglioside bound to, ADP-ribolyasylated
antibiotics for cholrea?
doxycycline, flouroquinolone
antibiotiscs for ETEC?
rifaximin
what type of ecoli produces shiga toxin?
enteroinvasive e. coli
which e. coli causes chronic diarrhea?
enteroaggreative
where do you get E.colia O157: H7
water, meat, veggies, anything not staerillized/pasturierzed
virulence factors of E. coli O157: H7?
shiga-like toxin
how to grow e. coli o157.h7?
sorbitol maccokeny agar
which parasite diarrhea is most common in US?source?
giardia; water
tx of giardia?
metronidazole
how to diagnose parasite diarrhea?
microscopy; can do ag test for giardia and cryptosporidia
presentation of entamoeba histolygica?
chronic bloody diarhea
tx of parasite diarrhea?
metronidazole; nitrazoxanide for cryptosporidium parvum
presentation of cryptosporidium parvum?
nonbloody chronic diarrhea
how to test for C. diff?
test for toxins w/ ag- cannot culture
which agenst of gastroenteritis are nonfermenters of lactose?
salmonella and shigella
for which gastroenteritis are abx contraindicated?
EHEC, salmonella
tx of salmonella?
cirpfloxaxin or ceftriaxone
rose spots on abdomen seen in what disease?
salmonella typhi
what gastroenteritis do you get from pork or milk?
yersina entercolitia
most common cause of bacterial diarrhea in US?
campylobacter jejuni
which bacteria gives you Guillian barre? What other symptoms?
campylobacter jejuni; bloody diarrhea
tx of camplyobacter jejuni?
macrolides or doxy
subacute bacterial endocarditis on native valve?
strep viridans
subacute bacterial endocarditis on prosthetic valve?
coag negative staph
acute native valve endocarditis?
staph aureus
IVDU endocarditis organisms?
staph aureus
drug for coccidio?
intraconazole
what disease do filipinos get?
coccidio
how to diagnoses HSV encephalitis?
CSF pcr
which encephaltisis is accompanined by problems to heart, eye, muscle, and hand foot and mouth dz?
enterovirus
transmission of enterovirus? Who gets it?
fecal-oral; kids in daycare
what gives you a polio-like ilnness w/ encephalitis?
WNV
how to diagnose WNV?
Ab in CSF and serum
who gets nocardia?
transplant or steroid immunosuppressed, rarely seen in HIV infected
which lung disease has intracellular very small organisms?
histo
what disease is likely to cause fever and seizures in advanced HIV?
toxoplasmosis
name organisms likely to cause fever in advanced HIV
cryptococal, disseminated MAC or histo, reactivation CMV, lymphoma, toxo
how to daignose mycobacteria?
blood cultures
how to diagnose cryptococal?
serum/csf ag
how to diagnose histo
urine histo
how to daiganose cmv?
serum cmv pcr
gram positive branching fillamentous organisms that are weakly acid fast
nocardia
tx of nocardia
bactrim
gram positive branching fillamentous organisms that are not acid fast
actinomyces
treatment for MAC?
clarithromycin, rifampin, ethambutol
how to differentiate MAC from mTb?
amplification
where do you get leishmaniasis? How is it transmitted?
tropics; sandfly
what causes cutaneous larvae migrans?
ancysolostoma BRAZILense (dog and cat hook work)
what causes skin lesion and infiltrate on CXR?
endemic mycoses- blasto, histo
t/f or false you colonize blasto?
FALSE
where do endemic mycoses go most?
lung> skin> bone
nocardia goes where?
lung, brain, skin
tender painful axillary nodes makes you think of what dz? w/ necrotizing granulomas
cat scrat dz
in summer in mo, very sick, thromboctyopenia, elevated liver enzymes?
erhlichiosis
tx for erhlichia?
doxycycline
granulocytoc vs. monocytic eehrlichiosis?
anaplasmosis= granulocytic; chaffenis= monolocytic
morphology of ehrlichia?
gram negative, onligate intracellular
vecttor for granulomcytic ehrlichiosis? Monocytic?
granulocytic= ixodes tick; monocytic= lone star tick
hospitalized UTI organisms?
klebsiella, other enterobecter, staph saprophytics, enterococci
what to use for UTI when pregnant?
beta lactam antibiotics
tx pyelonephritis or high resistance UTI?
fluroquinolones
what to use in hospitalized pyelonephritis?
ceftriaxone
bacteria that cover the gut?
carbanemens, pip/tip, metronidazole + 3rd/4th cephalosporin
virulence factors of bacteriodes fragilis?
beta-lactam production; capsule
pneumonia + erythema nodosum?
blasto
which abx is a weak MAOI inhibitor and causes thrombocytopenia and optic neuropathy?
linezolid
which atbx rapidly depolarizes membranes?
daptomycin, linezolid
when can daptomycin not be used?
pneumonia
which abx you have to measure trough levels?
vancomycin
which anx is active agaist b fragilis?
ticarcillin, pieracillin
which cephalosporins cover pseudomonas?
cefepime, ceftazidime
1st generation cephalopsorin?
cefazoli
side efects of carbapenems?
seizures, less w/ meropenem
monobactams/atrezonam work against what?
gram negatives and pseudomonas
mechanism fo action of vanc?
inhibits cell wall synthesis by binding to d alanine
adverse effects vancomycin?
red man, ototoxicity, hematologic