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186 Cards in this Set
- Front
- Back
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Why is S aureus resistant to B-lactams?
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Altered penicillin-binding protein
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S aureus food poisoning - food types
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ham, mayo cream pastries
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Agar - S aureus
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Mannitol salt agar (salt tolerant organism)
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Staph aureus - virulence factor
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Protein A - binds Fc-IgG and inhibits opsonization
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Strep pneumo - most common cause of what 4 things
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MOPS
- Meningitis - Otitis media (in children) - Penumonia - Sinusitis |
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Strep pneumo - virulence factor
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IgA protease - allows strep pneumo to attach to mucosa
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Staph saprophyticus causes
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UTIs
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Staph epidermidis causes
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Subacute endocarditis & Infects catheters
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Strep mutans causes
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Dental caries
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Strep sanguis causes
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subacute endocarditis (glycocalyx)
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If patient has a heart problem, what do you give prophylactically before dental procedure?
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Penicillin (amoxocillin or cephalexin)
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What causes rheumatic fever?
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Abs to M protein enhance host defenses against S pyrogens but can give rise to rheumatic fever.
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Jones Criteria
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Joints - polyarthirtis
O - pancarditis Nodules - subcutaneous Erythema marginatum Sydenham's chorea |
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What usually procedes glomeruloneprhitis caused by S pyrogenes?
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impetigo
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Rash everywhere but face, Strawberry tongue, Red throat
- What is it? - Cause? |
scarlet fever
S. pyrogenes |
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What test is used for Group b strep?
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CAMP
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What do you give Group B positive pregnant lady during labor?
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Intrapartum penicillin prophylaxis
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Strep agalctiae - Tx
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Aminoglycoside or Cephalosporine
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Enterococcus faecalis causes
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UTI, Biliary tract infections, subacute endocarditis
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What encodes Corynebacerium diphtheriae exotoxin?
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B-prophage
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Blue and Red granules (Metachromatic)
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Corynebacteirum diphterhiae
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Corynebacerium diphtheriae - Test
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Elek's test
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Black colonies on cystine-tellurite agar
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Corynebacerium diphtheriae
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What is in the core of spores?
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Dipicolinic acid
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Which cells does C. tetani act at?
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Renshaw cells in spinal cord
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C perfringens causes
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myonecrosis, gas gangrene, hemolysis
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C difficile toxins
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Toxin A (binds brush border) & Toxin B (destroys enterocytes) --> pseudomembranous colitis
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Which 2 antibiotics commonly cause pseudomembranous colitis
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Clindamycin or Ampicillin
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C difficile - Tx
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Metronidazole - tx of choice
or Oral Vancomycin |
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What is in Bacillus anthracis polypeptide capsule?
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D-glutamate
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Gram + rod; mediastinal widening on CXR
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Bacillus anthracis
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Boxcar Gram +ive rod
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Bacillus anthracis
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Reheated rice sx
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Bacillus cereus
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Preformed toxin in Bacillus cereus
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Cereulide
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"Actin rockets"
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Listeria monocytogenes
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Gram +ive rod; intracellular
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Listeria monocytogenes
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Listeria causes
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- Amnionitis
- Speiticemia - Spontaneous abortion - Granulomatosis infantiseptica - Neonatal meningitis - meningitis in immunocompromised |
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Listeria Tx in infants
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Ampicillin
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Actinomyces causes
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Oral/facial abscesses that drain through sinus tract --> sulfur granules
aka Lumpy Jaw |
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Nocardia causes
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Pulmonary infecitons in immunocompromised and cutaneous infecitons after trauma in immunocompentent
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Actinomyces tx
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Penicillin
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Nocardia Tx
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Sulfonamide
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Gram +ive aerobe; acid fast
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Nocardia
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"Lumpy Jaw"
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Actinomyces
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Positive auramine-rhodamine stain of sputum
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Tuberculosis
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Tuberculosis - envelope
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Mycolic acids
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Primary Tb - presentation
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- Ghon focus (small area of granulomatous calcificaiton); mid zone in lung
- Fever, chest pain, cough - Hilar LNs |
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Ghon Complex
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Ghon focus + Hilar LAD
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Secondary Tb - Presentation
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- Cavitary lesion, upper lobe, caseous necrosis
- Fever, hemoptysis, wt loss, night sweats, cough |
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Tuberculosis - Hematogenous spread
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Miliary Tb - caseating granulomas in virtually any organ (seedlike white-gray lesions, 1-3mm)
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Culture - Mycobacteria
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Lowenstein-Jensin agar
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Mycobacterium kansaii - presentation
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pulm Tb-like sxs in COPD patients
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Mycobacterium scrofulaceum - presentation
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Cervical LAD in children
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Mycobacterium marinum - presentation
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Hand infection in aquarium handlers
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M avium - presentation
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- Disseminated dx in AIDS patients
- Resistant to multiple drugs - Prophylaxis - azithromycin |
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Causes of Negative PPD
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- Immunocompromised (HIV)
- Chronic steroids - Sarcoidosis - Malnourished - No infection |
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Mycobacteirum leprae - reservoir
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Armadillos
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Mycobacteirum leprae - Tx
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Dapsone + Rifampin (for 6mo) - tuberculoid form
Dapsone + Rifampin + Clofazimine (2-5 yrs) - lepromatous form |
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Mycobacteirum leprae - Lepromatous form
- Presentation - immune Response |
- Diffuse, skin, comunicable
- Low cell-mediated w/ humoral Th2 response |
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Mycobacteirum leprae - Tuberculoid form
- Presentation - immune Response |
- few hypoesthetic hairless skin plaques
- High cell mediated w/ Th1 response |
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Bacteria - "glove and stocking" loss of sensation
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Mycobacteirum leprae
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Why is there no N gonorrhoae vaccine but there is an N meningitidis vaccine?
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N gonorrhoeae has rapid antigenic varaition of pilus proteins
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N Gonorrhoeae - causes
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- Gonorrhea
- Septic arthritis - Neonatal conjunctivitis (3-5 days after birth) - PID - Fitz-Hugh-Curtis Sx (complication of PID, infects liver capsule) |
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N Gonorrhoeae - Most important pathogenic feature
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Pili
- promotes adherence to mucosa - Protects against phagocytosis - Undergoes antigenic varaition |
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N Meningitidis - Causes
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- Meningococcemia & Meningitis
- waterhouse-Friderichsen Sx |
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N Gonorrhoae - Tx
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Ceftriaxone + (azithromycin or doxy for possible chlamydia)
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N meningitidis - Tx
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Ceftiraxone or pen G
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N Meningitidis - culture
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Thayer Martin Media
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N gonorrhoae - culture
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Thayer Martin Media
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N Gonorrhoeae - how do you prevent neonatal conjunctivitis
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Erythromycin eye drops at birth
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H Influenza - Causes
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- Epiglottis
- meningitis - Otitis Media - Pneumonia |
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IgA protease producers
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SHiN
- S pneumonia - H influenza type B - Neisseria |
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H Influenza - culture
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chocolate agar (requires factor V (NAD) and X (hematin)
or agar w/ S aureus |
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Thumb sign on X-ray
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Epiglottis - H flu
- Make child comfortable, don't upset b/c could lose airway |
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Painful solitary ulcer
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Haemophilus ducreyi
- Tx: ceftriaxone |
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Legionella pneumophila - Causes
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- Legionnaires' disease - pneumonia, fever, GI, CNS
- Pontiac fever - mild flu-like sx |
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Legionella pneumophila - stain
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Silver
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Legionella pneumophila - culture
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Charcoal yeast (iron and cystein)
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Legionella pneumophila - How do you detect clinically?
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Ag in urine
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Legionella pneumophila - Tx
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Macrolide or quinolone
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Legionella pneumophila - weird lab result
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hyponatremia
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Pseudomonas aeruginosa - causes
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- Wound and burn infections
- Pneumonia (esp CF) - Sepsis - black lesions on skin - External otitis (swimmer's ear) - UTI - Drug use and Diabetic Osteomyelitis - Hot tub folliculitis - Malignant otitis externa in diabetics |
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"Blue-green pigment"
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Pseudomonas
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"Grape like odor"
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Pseudomonas
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Pseudomonas aeruginosa - virulence factors
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Endotoxin (fever, shock)
Exotoxin A - inactivates EF-2 |
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Pseudomonas aeruginosa - most important pathogenic feature
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Polysaccharide capsule
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Pneumonia in CF patient
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Pseudomonas
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Pseudomonas aeruginosa - Tx
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Aminoglycoside plus extended sepctrum penicillin (pipercillin, ticarcillin)
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How does pseudomonase acquire resistance to antibiotics?
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Porin protein - restricts flow of many antbiotics
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E coli - virulence factors
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Fimbriae - cystitis and pylonephritis
K capsule - pneumonia, neonatal meningitis LPS endotoxin - spetic shock |
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E coli - EIEC - Presentation
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- Bloody diarrhea & fever (invades intestinal mucosa)
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E coli - ETEC - Presentation
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- Labile and Stable Toxin
- No invasion - Watery (traveler's) diarrhea |
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E coli - EPEC - Presentation
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- Watery diarrhea - pediatrics
- No toxin, flattens villi (prevents absorption) |
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E coli - EHEC - Presentation
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- Bloody diarrhea
- 0157:H7 - Shiga-like toxin (inhibit 60S subunit) & - HUS (Anemia, thormbocytopenia, and acute renal failure) |
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E coli - EHEC - Transmission
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Undercooked hamburgers (meat)
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E coli - ETEC - Tx
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TMP-SMX or fluoroquinolones
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Most common cause of gram negative sepsis?
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1. E coli
2. Klebsiella |
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Klebsiella - Virulence factor
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Polysaccharide capsule --> red currant jelly
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Klebsiella - causes
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- Lobar pneumonia (diabetics, alcoholics)
- Nosocomial UTIs |
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Salmonella - Causes
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- Bloody diarrhea
- Salmonella typhi - typhoid fever - rose spots on abdomen, fever, HA, diarrhea. Can remain in gallbaldder --> carrier state |
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Salmonella typhi - where does it stay to be a carrier
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gallbaldder
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Typhoid fever - presentation
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rose spots on abdomen, fever, HA, diarrhea
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Salmonella - virulence factor
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- flagella
- disseminate hematogenously - produce hydrogen sulfide |
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Salmonella - spread
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hematogenously
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Shigella - spread
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cell to cell; no hematogenous
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Shigella - causes
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bloody diarrhea
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"ate egg salad or chicken salad"
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Salmonella
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"patient w/ pet turtle or works in pet store"
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Salmonella
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Salmonella - tx
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Don't give antibiotics; prolongs sxs
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Osteomyelitis - sickle cell
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Salmonella
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Bloody, non-motile; associated w/ Reiter's (reactive arthritis)
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Shigella
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Gram negative rod, associated w/ Guillam barre
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Camplybacter
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Gram negative rod; raw oysters
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Vibrio cholera
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Gram negative rod, pet feces
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Yersinia enterocolitica
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Camplyobacter jejuni - causes
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bloody diarrhea
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Camplyobacter jejuni - contracted from
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poultry, meat, unpasteurized milk
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Most common gastroenteritis cause in U.S.
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Campylobacter jejuni
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Gram negative rod, rice water diarrhea
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Vibrio choelra
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Yersinia Enterocolitica - transmission
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pet feces
contaminated milk pork |
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Gram negative rod, mimic's Crohn's or appendicitis
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Yersinia enterocolitica
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H pylori - Tx
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PPI + Clarithromycin + Amoxicillin
(if pen allergy --> Metronidazole) |
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Leptospira - transmitted from
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Water contaminated w/ animal urine
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Leptospira - presentation
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flu-like sxs, jaundice, photophobia
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Leptospira - endemic
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surfers and in torpics (Hawaii)
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Weil's Disease
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- Leptospira
- Sever form; jaundice, azotemia, fever, hemorrhage, anemia |
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Ixodes tick
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- Transmits Lyme & Babesia
- Reservoir - mouse |
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Lyme Dx - tx
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Doxycycline or Ceftriaxone
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Lyme Dx - Stages
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- 1 - Erythema chronicum migrans (bull's eye)
- 2 - Neuroglogic (facial N palsy, bilateral) and cardiac (AV node block) - 3- MM (chronic monoarthritis and migratory polyarthritis), neuro (encephalopathy) and cutaneous |
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Name 3 Spirochetes
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Borellia, Treponema, Leptospira
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Painless chancre
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Syphilis
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Syphilis screening test and confirmatory test
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VDRL & FTA-ABS
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Gram -ive, rash on palms and soles
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syphilis
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Dark field microscopy
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Syphilis
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Treponema - primary syphilis presentation
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Painless chancre
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Treponema - secondary syphilis presentation
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Rash on palms and soles, condyloma lata
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Treponema - tertiary syphilis presentation
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- Gummas (granuloma), aortitis (tree bark, vasa vasorum destruction), tabes dorsalis (dorsal columns and roots), A-r pupil
- Broad-based ataxia, positive Romberg - Charcot joint (can't feel joints) - Stroke w/out HTN |
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Treponema - congenital syphilis presentation
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- Saber shins, saddle nose, CN VIII deafness, Hutchinson's teeth, mulberry molars
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Charcot joint
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Syphilis, can't feel joints so damage them
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Gram -ive bacteria; broad-based ataxia, +ive Romberg
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Tabes dorsalis - syphilis
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TORCH --> baby has "snuffles" (blood tinged nasal secretion)
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Syphilis
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Argyll Robertson Pupil
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Constricts w/ accomodation but not reactive to light
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VDRL false positives
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VDRLS - Detects Ab that reacts w beef carddiolipin
- Viral infection (mono, hepatittis) - Drugs - Rheumatic fever - Leprosy - SLE |
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Jarisch-Herxheimer rxn
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Flu-like sx after antibiotics started due to killed bacteria releaseing pyrogens
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Yaws
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- Treponema pertenue
- Skin and joint infection - keloids --> limb deformity - facial disfigurement (nasal bone and cartilage) - positive VDRL |
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Bartonella - Presentation
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Cat scratch: LAD, pustule at scratch, fever,
- stellate granuloma w/ central necrosis |
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Borrelia recurrentis
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- Recurrent fever
- Louse |
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Brucella spp - Presentation / Cause
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- Brucellosis - undulant fever
- unpasteurized dairy |
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Gram negative, parrots
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Chlamydophila psittaci
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Q fever
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Coxiella burnetti - intracellular rickettsial organism
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Coxiella burnetti - transmitted from
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Cattle/sheep amniotic fluid
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Lone star tick
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Ehrlichia chaeffeensis
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Francisella tularensis - transmitted by
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Ticks, rabbits, deer fly
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Francilla tularensis - presentation
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Tularemia - ulceroglandular dx, atypical pneumonia or GI dx
"fever, chills, myalgias , arthralgias, ulcer w/ black base, LAD" |
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Fracisella Tularensis - geography
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Missouri, Arkansas
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Animal bite
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Pasteurella multocida
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Ricketsia prowazekkii- causes
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Epidemic typhus
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Ricketsia prowazekkii - transmitted by
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Louse
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Rickettsia rickettsii - causes
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Rocky Mountain spotted fever
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Rickettsia rickettsii - transmitted by
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Dermacentor tick
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Rickettsia typhi - causes
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endemic typhus
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Rickettsia typhi - transmitted by
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Fleas
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Rats and Prarie dog reservoir
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Yersinia pestis
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Buboes
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Black necrotic LNs
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Gray vaginal discharge w/ fishy smell
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Garnderella vaginallis
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Clue cells
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Garnderella vaginallis
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Garnderella vaginallis - tx
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Metronidazole
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Dermacentor tick
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- Rocky Mountain Spotted fever
- Francisella tularensis - Colorado tick fever virus |
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Rash starts at wrists and ankles --> trunk
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Rocky Mountain Spotted Fever
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Obligate intracellular - need CoA and NAD
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Rickettsiae
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Gram negative, central rash that spreads out
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Ricketsia prowazekii
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Ricketssiae classic triad
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HA, fever, rash
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3 bugs: rash on palm and sole
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- Coxsackievirus A - hand foot and mouth
- Ricketsiae - Rocky Mountain spotted fever - Treponema - Secondary syphilis |
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Monocytes w/ morula (berry-like inclusions) in cytoplasms
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ehrlichiosis
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Granulocytes w/ morula in cytoplasm
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Anaplasmosis
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Weil-Felix Test
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- heterophile Ab test used to dx richketsiall dxs (not Coxiella)
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Most common walking pneumonia
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Mycoplasma pneumonia
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Cold aggutins + pneumonia
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Mycoplasma pneumonia
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Eaton's agar
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Mycoplasma pneumonia
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Mycoplasma pneumonia - Tx
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Macrolide (Azithromycin) or Fluoroquinolones
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Chlamydiae - Most important immune response
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TH1 cells - b/c intracellular
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Chlamydiae - infectious vs replicating form
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Elementary body - infectious
Reticulate body - replicating |
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Chlamydiae - Tx
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Azithromycin (or doxycycline)
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Chlamydiae - stain
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Geimsa or Fluroescent Ab stained smear
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Chlamydiae - why obligate?
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can't make own ATP
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Gram negative + neonatal penumonia (Staccato cough) or neonatal conjunctivitis
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Chlamydia
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Gram -ive + Ulcerative dx + LAD
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Lymphogranuloma venereum - chlamydia
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