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128 Cards in this Set
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Contrast aminoglycosides vs penicillins in their time vs. concentration killing effects.
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AG = concentration dependent killing where the concentration of the drug determines the rate of bacterial killing while PEN = time dependent killing where the amount of time above the MIC determines the bacteriocidal effects.
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Your patient has a severe type I allergy to penicillin. Do you give them a macrolide or a cephalosporin?
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cephalosporins are great if there is only a mild allergy but if the allergy is severe give a macrolide (azithro, erythro or clarithromycin) as there will be a similar spectrum of coverage with less likelihood of causing allergy.
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The following drugs all act on bacterial ribosomes. Contrast these two groups:
aminoglycosides and tetracyclines vs. macrolides, chloramphenicol, clindamycin. |
aminoglycosides and tetracyclines act on the 30 S subunit.
macrolides, chloramphenicol and clindamycin act on the 50 S subunit. |
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Classify the following as alpha/beta/gama hemolytic: pyogenes, agalactiae, pneumoniae, viridans, enterococci (groupD)
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alpha (green)= pneumoniae, viridans
beta (complete)= pyogenes, agalactiae gamma (none)= enterococci, group D strep |
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What is the Lancefield classification of streptococci based upon?
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cell wall carbohydrates:
Group A: S. pyogenes Group B: S. agalactiae Group D: S. bovis, enterococcus Non assigned: pneumoniae, viridans |
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What is the main virulence factor that Group B strep has that Group A does not?
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Group B's capsule is its virulence factor
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How do you differentiate enterococci and group D streptococci?
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enterococci are penicillin resistant and can grow in 6.5% NaCl.
S. bovis and equinus aren't penicillin resistant and can't grow in NaCl. Both hydrolyze esculin. |
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What two common infections are due to viridans streptococci?
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S. mutans= dental carries
S. sanguis = endocarditis |
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What is the only strep thats bacitracin sensitive?
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S. pyogenes is bacitracin sensitive
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How does the catalase test differentiate between strep and staph?
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strep is catalase negative.
staph is catalase positive and will bubble when H2O2 is added |
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What bug is catalase + cocci that form clusters?
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staphlococci are gram + cocci that form clusters and are catalase + while strep is catalase -
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What are the 3 main exotoxins associated with Staph and what are their associated disease states?
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exfoliatin- scalded skin syndrome
enterotoxins - food poisioning TSST- toxic shock syndrome superantigen |
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What diseases are caused by direct invasion by staph aureus?
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pneumonia, meningitis, osteomyelitis, endocarditis, septic arthritis, skin infections ie cellulitis and impetigo, catheter infections... in addition to toxin mediated : scalded skin syndrome, TSS, and food poisioning.
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How do you differentiate between S. aureus and S. epidermidis?
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Both staph aureus and staph epidermidis are catalase + cocci but S. aureus is coagullase + while epidermidis is coagulase negative.
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What is the second leading cause behind E coli of female UTIs?
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Staph saprophyticus (gram +, catalase +, coagulase -)
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What two diseases do you see recurrent staph infections due to a decreased ability of PMNs?
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Job's disease- inefective macrophage activation, thus inefficient IL 8 secretion and decreased chemotaxis
Chronic granulomatous disease- no oxidative burst. |
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What are some staph aureus virluence factors?
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capsule inhibits phagocytosis and enhances attachment
lipoteichoic acid attaches to fibronectin residues on host cells. protein A inactivates complement clumping factor causes aggregation of bacteria teichoic acids mediate attachment protein A makes Ig ineffective by binding their constant region. |
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What is the most common causitive agent of bacterial otitis media?
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strep pneumoniae in its unencapsulated form is the most common cause of otitis (bacterial)
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what is the bug: small gram negative, requires Heme and NAD (factors X and V) to grow?
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H. influenzae
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serotype b is now less common due to vaccination schedules and serotype a is not predominating
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What is the bug? Gram negative diplococcus, "bean" shaped, serotype A is most often causal of epidemics.
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N meningitidis
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What is the bug? Gram positive diplococcus, lancet shaped, alpha hemolytic, not resistant to optochin, >90 serotypes.
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S. pneumoniae
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differentiate viridans from pneumoniae as pneumoniae is not resistant to optochin.
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What encapsulated bug is most commonly associated with meningitis from age 6 mo to the grave?
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S. pneumoniae affects older individuals.... N. meningitidis affects 6 mo to 6 years and influenzae affects under 7 years.
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What is the difference in immunogenicity of the capsule of H. influenzae type B?
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H. influenzae type B has teichoic acid in its capsule as do gram positive bugs.
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Why is a conjugated vaccine more effective in younger patients?
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The very young are unable to make a good immune response by polysaccharide based B cell stimulation alone. Conjugated vaccines tie the polysaccharide antigen to a protein based antigen to get T cells involved to start stimulating the B cells.
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What is the only pathogenic gram negative coccus?
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Neisseria meningitidis
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can also cause petechiae and bilateral adrenal hemorrhage
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What is the most common cause of meningitis in newborns?
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1.Group B strep (agalactiae)
2. E coli 3. Listeria |
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Most common cause of meningitis in kids 6 mo-6 yrs?
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1. S. pneumoniae
2. N. meningitidis 3. H influenzae |
all 3 are encapsulated
enteroviruses are also causal |
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What do the following have in common: chlamydia, mycobacterium leprae and Rickettsia?
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Chlamydia, mycobacterium leprae and Rickettsia are all obligate intracellular bacteria as they depend on the host cell for citrate synthase, lactate dehydrogenase.
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What do the following have in common: Listeria, Legionella, TB, salmonella and shigella?
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They are all facultative intracellular bacteria so they can reproduce inside or outside other cells.
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How does listeria monocytogenes get out of the cell and infect the adjacent cells?
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listeria can lyse open other cells with listeriolysin O or excape by polymerizing the host's actin forming a "rocket" that shoots it into neighboring cells
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Name an antibiotic that is particularly good at diffusing through the cell membrane and killing obligate intracellular bacteria.
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Tetracycline concentrates well in the cytosol and kills most obligate intracellular bacteria. Rifampin also does this to some degree as well.
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Non fusogenic pathogens prevent fusion of the phagosome to the lysosome. Give an example.
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Mycobacterium, chlamydia and legionella are all non-fusogenic, thus prevent the fusion of the lysosome and the phagosome while Coxiella burnettis is fusogenic and permits this fusion as it doesn't kill that specific organism..
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contrast the zipper with the trigger mechanism of bacterial entry into host cells.
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zipper = binding ligands to receptors that contact the membrane and cause the bug to be slowly tugged in.
trigger = injection of bacteria directly into target cells cytoplasm ie macropinocytosis |
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What is the bug? Affects immunocompromised, commonly infants under 6 mo, can cause miscarriage, pathogenicity is due to "internalin" which facilitates zipper mechanism of entry. Treat with SMX/TMP and ampicillin.
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Listeria monocytogenes.
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Sulfamethoxazole MOA?
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Sulfamethoxazole acts as a PABA analog that inhibits dihydropteroate synthase. Broad spect. Causes kernicterus in neonates.
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Including chlymidia
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Trimethoprim MOA?
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Trimethoprim acts downstream of sulfonamides, instead acting on dihydrofolate reductase to inhibit folic acid synthesis. Bacteriostatic unless given as bactrim (with SMX) in which case it becomes bacteriocidal.
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What is the route of administration of SMX / TMP? Do these drugs cross the BBB?
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SMX/TMP can be given orally. They cross to the BBB. However, they do have a delayed onset of action.
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A side effect of SMX/RMP is renal stones as they become less soluble when metabolized via N-acetylation. How do you treat this?
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Alkalinize the urine to allow for greater excretion
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What is the role of DNA gyrase (type II topoisomerase)? What drugs target this enzyme?
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DNA gyrase relaxes the supercoils in DNA. Quinolones act on bacterial DNA gyrase to impair replication.
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bacteriocidal and broad spectrum
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What is a dangerous side affect associated with quinolones?
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tendon rupture!!
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MOA of quinolones?
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quinolones act on bacterial DNA gyrase, they are bacteriocidal, extended spectrum. Don't give with milk/ antacids or to children. consider tendon rupture.
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Name a 2nd, 3rd and 4th generation fluroquinolone. What changes about their efficacy as you approach 4th generation.
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2nd Gen = ciprofloxacin
excellent G-, good G+, good antipseudomonal 3rd Gen = levofloxacin excellent G- and G+, no antipseudomonal, some anaerobic 4th Gen = moxifloxacin Most broad, good antipseudomonal, good anaerobic and G-/+ |
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What drug is an alternative to vancomycin resistant gram positives?
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Daptomycin is bacteriocidal and effective new antibiotic against vanco resistant bugs, don't use if you need to penetrate the lung, only given IV.
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What is the drug? It's an UTI antiseptic which damages bacterial DNA.
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Nitroimidazoles: ie nitrofurantoin
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What is the drug? Used for anaerobes and protozoa, MOA is by damaging bacterial DNA, used in membranous collitis to kill c. diff along with vancomycin. Has a disulfiram effect if taken with alcohol.
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Metronidazole (nitroimidazoles) aka Flagyl
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What is the drug? Inhibits DNA dependent RNA polymerase, 1st line for anti TB and leprosy. Induces CYP450 enzymes.
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Rifampin!
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Strep pyogenes
Lancefield group? Hemolysis Antigens Cell wall virulence and extracellular virulence factors diseases |
Strep pyogenes is lancefield group A, it is beta (completely) hemolytic, it is inhibited by bacitracin, Antigens include C carbohydrate, T/R antigens and M proteins, cell wall virluence is M proeteins and hyaluronic acid capsule and streptolysin O, S, and pyrogenic exotoxins. Diseases are pharyngitis, APSGN, scarlet fever.
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Strep agalactiae
Lancefield group? Hemolysis Antigens Cell wall virulence and extracellular virulence factors diseases |
S. agalactae is group B, it is beta hemolytic and has C carbohydrate antigens. It has a polysaccharide capsule and virulence factors include hyaluronidase, proteases and neuraminidase. Infections are bovine mastitis and baby meningitis (Group B = Bad for Babbies)
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E. faecalis/ E faecium
Lancefield group? Hemolysis Antigens Cell wall virulence and extracellular virulence factors diseases |
Grow in 6.5% NaCl, and in 10% bile, resistant to penicillins, Mostly gamma, Group D lipotechoic acid. Normal flora, cause UTIs abscesses, endocarditis, IV cath infections.
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S. bovis, S equinus
Lancefield group? Hemolysis Antigens Cell wall virulence and extracellular virulence factors diseases |
Group D strep, grow in bile but not NaCl like enterococci, usually gamma hemolysis, sensitive to penicillin, hydrolyze esculin,Normal flora/ UTIs.
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S. pneumoniae
Lancefield group? Hemolysis Antigens Cell wall virulence and extracellular virulence factors diseases |
No Lancefield group. Gram positive diplococcus, lancet shaped. Grows on blood agar, alpha hemolytic, optochin positive while viridans is not, Antigens include IgA protease, pneumolysin, Causes meningitis (most common cause in adult) bacteremia, pneumonia, OM,
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Viridans streptococci( salvarius, pyogenes sanguis, mutans)
Lancefield group? Hemolysis Antigens Cell wall virulence and extracellular virulence factors diseases |
No Lancefield. Species differentiated by sugar fermentation. Alpha hemolytic. Dental carries from mutnas and endocarditis
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S. aureus
Lancefield group? Hemolysis Antigens Cell wall virulence and extracellular virulence factors diseases |
Gram positive cocci in clumps
Catalase positive, beta hemolytic (golden), encapsulated, clumping factor, protein A binder, exfolatin and hemolysin antigens, TSST. Causes skin infections, SSS, bullous impetigo, scarlet fever, osteomyelitis, bacteremia, TSS, food poisoning. |
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H. influenzae
Lancefield group? Hemolysis Antigens Cell wall virulence and extracellular virulence factors diseases |
gram negative bacillus (needs NAD and Heme X/V factors), polysaccharide capsule and endotoxin produced, IgA protease, causes pneumonia, bacterema, cellulitis, epiglottis (no longer HiB meningitis due to vaccine), DIC, septic shock. Tx with triaxone and chloramphenicol.
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Neisseria meningitidis
Hemolysis Antigens Cell wall virulence and extracellular virulence factors diseases |
gram negative diplococcus beans, grows on blood agar, polysaccharide capsule, endotoxin, IgA protease. Meningitis, causes DIC, SS due to LPS. Use broad spect cephalosporins ceftriaxone, cefipime.
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Listeria monocytogenes
Hemolysis Antigens Cell wall virulence and extracellular virulence factors diseases |
gram positive bacillus, facultative intracellular, zipper mechanism using internalin, lyses, actin tail. Causes bacteremia, CNS infections, spontaneous abortion.
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What bug causes scarlet fever?
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Strep pyogenes
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Protein A binding Fc-IgA is due to what bacteria?
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Staph aureus has protein A as a virulence factor.
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Name 3 encapsulated bacteria
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H influenzae, Strep pneumoniae, Neisseria menengitidis are all encapsulated
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Which are hardier, group D strep or enterococci? explain.
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Group D strep die in NaCl and bile while enterococci grow well in 6.5% NaCl and are penicillin G resistant.
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What antibiotic commonly causes c. diff infections and how do you treat them?
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clindamycin causes c. diff membranous colitis and it is treated with metronidazole or vancomycin.
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When a child has the flue mom goes to the five (V) and dime (X) to buy some chocolate. This bug causes what 4 EMOP diseases and how do you treat?
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haEMOPhilus causes Epiglottis, Meningitis, Otitis media and Pneumonia. Culture it on chocolate agar with heme and NAD cofactors and treat meningitis with triaxone and give rifampin for prophylaxis.
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Compare and contrast Shigella vs Salmonella.
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Both are non lactose fermenters, both are oxidase negative gram - rods, both cause bloody diarrhea. Salmonella have flagella and disseminate hematogenously, symptoms are prolonged with antibiotic. Shigella is more virulent. Recall that salmonella typhi causes typhoid fever, diarrhea, HA
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Name 3 bugs that cause bloody diarrhea
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Campylobacter, Salmonella, Shigella, EHEC, EIEC
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What do ETEC and vibrio cholerae have in common with rotavirus and adenovirus?
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All cause watery diarrhea. Recall that c. diff can cause both watery/bloody diarrhea
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How do you treat Rickettsial infections and what is the triad of symptoms?
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Rickettsiae presents with HA, fever and a vasculitis rash. Treat with tetracycline
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What strains of chlamydia cause urethritis, PID, ectopics, neonatal pneumonia/conjunctivitis?
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Type D-K of chylamydia cause these symptoms while A-C think of Africa/Blindness and Chronic infection
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What causes syphilis?
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the spirochete treponema pallidum.
Treat with penicillin G |
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Which test would you use for the primary screen of syphilis VDRL or FTA?
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FDRL is more sensitive but less specific so use it first later to follow with a more specific immunoflourescence. Non treponemal cross reacts with cardiolipid.
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What virus most commonly causes mononucleosis
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EBV and it also causes Burkitt's lymphoma.
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This virus infects B cells, is characterized by fever, hepatosplenomegaly, pharyngitis and lymphadenopathy. Peaks around 15-20 yo and has a positive heterophil antibody test (agglutination of sheep RBC). What two serious diseases are associated with this virus?
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This is EBV, it is associated with Hodgkin's and Burkitt's lymphomas.
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What is the highly infectious lesion of secondary syphilis?
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condylomata lata
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What are the clinical features of chlamydia trachomatis (D-K)
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urethritis, cervicitis, conjuctivitis, Reiter's syndrome, PIC
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recall that Reiters is urethritis, red eyes and joint pain (can't see, can't pee and it hurts in the knees)
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What is the most common STD in the US?
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chlamydia.
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Name 3 antipseudomonals
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piperacillin, ticarcillin, carbenicillin TCP: Takes care of pseudomonas
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This drug of choice for enterobacter kills gram positive cocci and gram negative rods. It is broad spectrum.
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imipenem/cilastatin
PEN = broad long lasting = ciLASTin |
Wide spectrum use for ceph resistant bugs, only give IV
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Buy AT 30 CCELL at 50.
MOAs |
30 S: Aminoglycosides and Tetracyclines
50S: Chloramphenicol, clindamycin E: Erythromycin (static) L= Lincomycin (static) L = Linezolid |
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This drug damages bacterial DNA and targets protozoa, giardia, entamoeba, trichomonad, garderella vaginalis and anarobes.
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Metronidazole.... don't drink disulfram like reaction.
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This class of antibiotics are catonic and work like a detergent lysing cell membranes.
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polymixins MIX up membranes.
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This drug inhibits DNA dependent RNA polymerase. it has drug interactions by increasing P450, turns body fluids red, and is used for H influenzae meningococcal prophylaxis and TB.
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Rifampin
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Treatment for HSV, VZV and EBV but not CMV. Inhibits DNA polymerase by chain termination.
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Acyclovir
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Treatment for CMV, can cause renal toxicity and neutropenia. Imnhibits DNA polymerase.
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Ganciclovir.
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5 MOA of drugs for HAART
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1. entry inhibitors
2. nucleoside analogue RTI 3. Non nucoside RTI 4. Protease inhibitors - prevents viral maturation 5. Integrase inhibitors |
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Drugs to avoid in pregnancy: SAFE Moms Take Really Good Care
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S-sulfnamides = kernicterus
A-aminoglycosides = ototoxicity F- fluroquinolones -cartilage E- erythromycin Metronidazole - mutagenesis Tetracyclines- teeth, bone Ribavarin (antiviral)- teratogenic Griseofulvin (antifungal) Chloramphenicol - gray baby |
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Hepatic Elimination
CRIMES |
Clindamycin
Rifampin Isoniazid Metronidazole Erythromycins Sulfonamides/Streptogramins |
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This drug is a urinary antisceptic
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nitrofurantoin a nitroimidazole (degrades DNA, bactericidal, kills anaerobic bacteria, p. colitis) Same class as metronidazole
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Drug for Gram + Vanco resistant bug
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Daptomycin- only IV
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MOA of vancomycin, carbepenems (ie imipenem/cilastatin) and monobactams (ie aztreonam)
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Cell wall synthesis inhibition just like PEN don't forget these!
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What is unique to G+ vs G- organisms
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Gram positive: teichoic acid
Gram negative: endotoxin/LPS outer membrane. Thinner peptidoglycan then G + and an extra outer membrane which G + don't have. |
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Name a G+ cocci and a G+ rod
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G+ cocci: staph and strep
G+ rod: listeria, clostridium |
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Name a gram - cocci and rod
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G- cocci: Neisseria, Moraxella
G- rod: pseudomonas, e. coli |
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Name two obligate intracellular bugs
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Rickettsia, Chlamydia are both intracellular.
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What normal commensal microbiota becomes opportuistic?
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Enterococcus (G- rod, + lactose fermenter)
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Your patient's cultures come back but she is asymptomatic. Do you treat?
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No. Can't fix the symptoms that aren't a problem.
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What lactose fermenting gram negative rod is also indole positive
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E. coli
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This gram negative rod is a non fermenter. It is oxidase positive while shigella and salmonella are oxidase negative.
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Pseudomonas aeruginosa- strict aerobe.
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You have a G + cocci in clusters that is also catalase and coagulase positive. What is it?
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S. aureus is the only staph that is also coagulase positive. It's a really bad bug and it has clumping factor.
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Name two anaerobes.
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Clostridium difficile, P. acne, B. Fragilis.
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When a bug is catalase positive ie staph what is the reaction?
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hydrogen peroxide is reduced to water and CO2
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What is protein M? What bug has it?
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protein M is in the GP of G+ strep pyogenes. It is antiphagocytic and its many > 80 types is why there are so many strains. It also helps the bug to adhere to the cell by binding lipoteichoic acids functioning like an adherin.
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What does Streptolysin O/S do and what bug has it?
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Streptolysin O lyses RBC. It is a measure of recent infection ie ASO titer. Streptolysin S is non antigenic abut is cytotoxic to RBCs. S. pyogenes has both of these enzymes.
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What is streptokinase and what bug has it?
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streptokinase activates plasminogen to plasmin which leaves fibrin and fibrinogen breaking S pyogenes out of containment by the immune system.
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What enzyme makes S. pyogenes pus thin and liquid like?
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DNAases digest the DNA in pus from S. pyogenes.
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What about S. pyogenes causes scarlet fever.
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The pyrogenic exotoxins that S. pyogenes releases cause scarlet fever with the red rash and coated strawberry tongue.
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Could you treat a group D strep infection or an enterococci infection with penicillin?
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Group D strep is not resistant to penicilin. Also differentiate between the two since Group D can not grow in 6.5% NaCl
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What is protein A and what bug has it?
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S. aureus has protein A which binds to Fc receptor of IgG resisting opsonization. S. aureus also has clumping factor which helps convert fibrinogen to fibrin. That is why staph aurues is also coagulase positive.
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What bugs cause secretory diarrhea? No inflammatory cells
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ETEC, vibrio cholerae, rotavirus, norwalk virus
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What bugs cause bloody diarrhea? +/- pus, leukocytes present, often RBCs
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camplobacter, shigella, salmonella
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Main side effects of sulfonamides?
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crystaluria (increas pH of urine), interaction with coagulants, keritinicterus, Stevens Johnson sensitization reaction,
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Coverage with sulfonamides
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broad spectrum, use for ulcerative colitis, gram positive and negative and chlamydia and toxoplasmos and UTIs
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If you're treating a UTI that is resistant to AG and to B lactams what might you consider using?
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fluroquinolones ie cipro, moxi, levofloxacin
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Your patient is worried about brown urine what drug are they taking?
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nitrofurantoin is a nitroimidazole which turns the urine brown but concentrates well in the urine acting as a UTI anticeptic. It works as a produg and interacts with the reductive pathway for bacterial energy utilization.
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On what media does Staph aureus grow
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blood and chocolate plates. NOT on MacConkey agar.
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H. influenzae requires heme and NAD thus it is only able to grow on blood agar plates adjacent to what NAD producing organism.
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Staphlococci produce NAD and so H influenzae can grow adjacently.
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What common featuer do H influenzae N meningitidis and S. pneumoniae all share?
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They are all encapsulated.
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This diplococci is encapsulated, it is alpha hemolytic, optochin sensitive. What is it?
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Strep pneumoniae is a diplococci encapsulated but that grows like a chain. It is optochin susceptible and is alpha hemolytic.
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How does Shigella spread?
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Shigella spreads from cell to cell intracellularly without ever leaving the protective environment.
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Contrast the survival methods of listeria, legionella and salmonella inside the cell.
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listeria- escaped from teh phagosome
legionella ihibits the mobilization of enzymes needed to make NAPH oxidase and salmonella uses superoxide dismutase and catalse to detoxify oxygen species. |
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Contrast the location of antibiotic concentration in the cell with aminoglycosides vs tetracyclines.
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tetracyclines are mostly in teh cytosol while aminoglycosides concentrate in the lysosomes.
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Chlamydia is non fusogenic, define this term.
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Non fusogenic means that the bacteria does not develop such that it is able to reside in the lysosome. Usually phagosome-lysis is avoided.
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Salmonella and Shigella are taken up by macropinocytosis, what is the name of this method of cellular entry?
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trigger mechanism- cell surface ruffles and then extends around the bug which is then enveloped.
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Give an example for an alpha, beta and gamma herpes virinae.
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alpha- HSV I and II
beta- grow slowly CMV "owls eye inclusions" gamma- EBV, Laposi's sarcoma |
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Your patient has a primary infection with a glandular fever, sore throat, rash, fatigue, activated T cells are dark purple and are called Downey cells. This gamma herpes virus is what stage of its infection?
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This is the lytic infection phase of EBV
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In what form does EBV lay latent?
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EBV stays latent in B cells as a circular episome.
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Mono can be caused by EBV and CMV. How can you tell the difference.
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EBV is the predominant cause of mono and it has heterophil antibodies while CMV does not.
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Reed Steinberg cells are characteristic of mono, this classic B cell tumor is caused by?
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Hodgkins Lymphoma
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How would you treat CMV pneumonia (fatal in 50% of cases)
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treat CMV pneumonia with gangcyclovir and foscarnet not acyclovir like HSV (no ability to activate prodrug)
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You see a rash that looks like "dew drops on a rose petal" what virus do you suspect?
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Varicella zoster, chicken pox.
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