I&i Bacteria, Inflammatory Diseases & Sirs

Front 1

Definition of SIRS

Back 1

widespread inflammatory response
abnormal temp, High HR &/or RR (also low PaCO2), Left shift &/or abnormal WBCs (nrml is 4000-12,000)

Front 2

Sepsis

Back 2

SIRS + evidence of infection

Front 3

Severe Sepsis

Back 3

SIRS + evidence of infection + end organ failure
(CV, Renal, Pulm, GI, Renal)

Front 4

Septic Shock

Back 4

SIRS + evidence of infection + end organ failure + hypotension

Front 5

Pathogenesis of SIRS

Back 5

Cytokines (TNF & IL-1)
Bacterial Factors (endotoxin or staph enterotoxin or TSS)
Complement Activation
Cellular injury (ischemia, less surface area, apoptosis, hypoxia b/c rigid RBCs & poli adhesion, cytotoxicity b/c endotoxin, TNF, NO)

Front 6

Cytokines in SIRS

Back 6

TNF alpha & IL-1

Front 7

Bacterial factors in SIRS

Back 7

LPS, Staph enterotoxin, TSS

Front 8

Cellular injury in SIRS

Back 8

ischemia b/c poor perfusion
decreased surface area for O2 exchange
apoptosis
hypoxia b/c RBC rigid & PMN sticky
direct cytotoxicity from endotoxin, TNF & NO

Front 9

Cause of Acute Renal Failure

Back 9

48% can be attributed to SIRS
mortality is higher if SIRS

Front 10

Patients at Risk for SIRS

Back 10

bacteremic
Comorbidities- AIDS, Renal/Liver Failure, CA, middle age/elderly

Front 11

Useful treatment for SIRS

Back 11

manage fluids
Glycemic ctrl (insulin)- PMNs need
ABs
Ionotropes
Activated Protein C- avoid clots
Hydrocortisone (for renal insuff)

Front 12

Failed Treatments for SIRS

Back 12

High Dose Corticosteroids
TNF alpha inhibitors
Anti-endotoxin ABs
Ibuprofen

Front 13

Two types of diarrhea & bugs

Back 13

Inflammatory- usually bacteria (salmonella, campylobacter, shigella)
Non-inflammatory- bacillus cereus, viral, giardia, cholera

Front 14

Signs/Symptoms of Inflammatory Diarrhea

Back 14

Abdominal pain & fever
Positive stools- WBC & RBC, possibly toxin

Front 15

Mechanism of Inflammatory Diarrhea

Back 15

direct inflammation of gut wall

Front 16

Mechanism of Non-inflammatory diarrhea

Back 16

Secretory:
disrupted homeostasis
1. Change in gut villi (blunting)- Bacillus Cereus (reheated rice), Giardia
2. Viral- direct effect on endos
3. Toxin- cholera

Front 17

Organisms in Viral Diarrhea

Back 17

Rotavirus
Norwalk
Enteric adenovirus- Ad40 &41
small children/infants
Enterovirus- echovirus, may cause meningitis
Coronavirus- astro

Front 18

Rotavirus

Back 18

most common cause diarrhea in children
sudden onset, low fevers
villous changes
watery diarrhea, +/-URI
SEVERE DEHYD w/in 1 HOUR
(member of Reo)

Front 19

Treatment of Rotavirus Diarrhea

Back 19

tx: fluids, possible hospitalization

Front 20

Norwalk

Back 20

seen in all age groups
especially outbreaks in winter
cramps, NV watery diarrhea, HA, malaise, myalgias, lw fever
(member of Calcivirus)

Front 21

Treatment of Norwalk Diarrhea

Back 21

fluids, prevent spread, antiemetics

Front 22

Common Bacteria Causing Diarrhea

Back 22

Listeria & Clostridium- only G+ (bacilli)
Salmonella-enterobacter (G- bacilli) (Non-motile)
Shigella- enterobacter (has PS capsule)
E Coli- enterobacter (ferments lactose)
Cholera- G- vibrio
Vibrio Vulnificus- vibrio, shellfish

Front 23

Characteristics of Cholera

Back 23

G- vibrio
pandemics
classical biotype is E1
emerging biotype is 0139
Does NOT invade-colonize & multiply in gut

Front 24

Treatment of Cholera

Back 24

doxycycline, Bactim (0139 is resistant), quinolones

Front 25

Signs & Symptoms of Cholera

Back 25

Rice Water Diarrhea, rushing, fullness, vomiting

Front 26

0139

Back 26

bactim resistant emerging Cholera biotype

Front 27

Characteristics of Salmonella

Back 27

G- bacillus (enterobacter)
Invades & multiplies in M cells of Peyers Patches
typhimurium & enteriditis are most common
DT104 is emerging & resistant

Front 28

Risk Factors for Salmonella

Back 28

animals fed w/antibiotics, reptiles, PPI & H2 blocker, sickle cell

Front 29

S&S of Salmonella

Back 29

N/V, fever, myalgias, HA
loose/watery
secondary sites b/c hem spread

Front 30

Treatment of Salmonella

Back 30

Quinolones, PCN (extended), 3rd gen Cephalosporins
NO ABs in Healthy Adults (increases shedding time)

Front 31

Characteristics of Shigella

Back 31

Enterobacter, non-motile, fecal/oral trnsmission
most communicable bacterial diarrhea
shiga toxin highly contagious
RNAase
endotoxin causes watery diarrhea

Front 32

S & S of Shigella

Back 32

summer/fall, refuge camps
fever, cramps, watery diarrhea
bloody mucous or stool

Front 33

Toxic megacolon

Back 33

complication of shigella
also septicemia, keratoconjunctivitis, reiters like autoimmune, Ikari syndrome in kids

Front 34

treatment for shigella

Back 34

fluids & ABx

Front 35

Characteristics of E Coli

Back 35

G- bacilli
ferment lactose
Vero toxin (sim to shigella toxin)

Front 36

S & S of E Coli

Back 36

persistant, relapsing, watery diarrhea
bloody stool but no WBCs

Front 37

Treatment for E Coli

Back 37

Supportive only
NO ABx!

Front 38

Characteristics of Listeria

Back 38

G+
found in herd animals

Front 39

S & S of Listeria

Back 39

self limiting gastroenteritis
fetal toxicity
bacteremia
CNS

Front 40

Treatment of Listeria

Back 40

High Dose Ampicillin (+/- gentomycin or bactrim)

Front 41

Clostridium

Back 41

dificile- from ABx, assocd w/ colitis
Perfringens- gas gangrene
Botulinum- preformed toxin, spores

Front 42

Vibrio Vulnificus

Back 42

G- rod
"hazzard of halfshell"
skin infection

Front 43

Cause of Food Poisoning

Back 43

Staph Aureus b/c ingest preformed enterotoxin

Bacillus Cereus from reheated rice

Front 44

Red Currant Jelly diarrhea

Back 44

Entamoeba Histolytica

Front 45

Protazoa associated with AIDS

Back 45

cryptosporidium

Front 46

Bug in dental caries

Back 46

strep mutans

Front 47

characteristics of normal flora in mouth

Back 47

gingival crevice has higest number (along with colon)
low O2 tension so anaerobes

Front 48

Strep Mutans is normal flora in ...

Back 48

dental caries (gingival crevice)

Front 49

Prevotella intermedia is normal flora in ...

Back 49

gingivitis

Front 50

veillonella parvula is normal flora in ...

Back 50

saliva- common infection from human bite

Front 51

Normally Sterile sites

Back 51

Airway below larynx
Eustacian Tube
Sinus
Uterus
Fetus
Bladder
GI & Vagina until birth
Male GU (UTI implies underlying pathology)

Front 52

Normal Bugs in oro/nasopharynx

Back 52

GAS most common
strep pneumo, staph aureus, HIB, HSV (80% of adults)

Front 53

Normal Bugs in UR tract

Back 53

Anaerobes- veillonella, actinomyces, peptostrepto, fuso
Aerobes- HIB, Strepto, staph, neisseria
Fungi- candida

Front 54

Normal Bugs in stomach

Back 54

lactobacillus & H Pylori

Front 55

Lactobacillus

Back 55

important normal flora in stomach (with H pylori)
homeostasis

Front 56

Normal Bugs in small intestine

Back 56

peptostrepto, prevotella
produce volitile FAs that protect (salmonella)
candida
giardia