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What infections does strep pyogenes cause?
LINES lymphangitis, impetigo, necrotizing fascitis, erysipelas, scarlet fever
Lymphangitis
Ix follows lymphatic channels= “RED STREAk” going up arm
Impetigo
caused by Strep. “Honey crusted lesions” (if bullous its d/t staph aureus’s elastase activity
Bullous Impetigo is caused by?
Staph aureus
Necrotizing Fasciitis
“Flesh Eating Strep”→ Compartment syndrome. 1st try to debride +Clindamycin then go to hyperbarics
Compartment syndrome 5P’s
Pain (b/c compressing arteries)-always 1st. Pallor, Poikylothermia, Paresthesia (nerves desent), Pulseness (always last)
Necrotizing Fasciitis Toxins
Streptolysin O, S
Necrotizing Fasciitis Virulence factor
M protein (M12→ PSGN. Capsule has Hyaluronic Acid
Erysipelas
Raised Edges, red, shinny, swollen, Ix of Subcutaneous fat, DO NOT BLANCH ( vs cellulitis)
Scarlet Fever
“Sand Paper Rash” (very rough skin), Strawberry tongue (also in Kawasaki). Rash on Palms and Soles
What usually causes periorbital cellulitis?
Staph aureus. Swollen eye in kid
Orbital Cellulitis
proptosis, older pt. d/t Strep PN
Cellulitis
flat red area of skin that feels hot and tender, + BLANCHING. d/t Staph Aureus
Oomphalitis
cellulitis around umbilicus of a new born. d/t Staph Aureus
Mastitis
cellulitis around breast (mom must continue to breast feed). d/t Staph Aureus
Panniculitis
cellultis as a ring around abdomen. d/t Staph Aureus
Folliculitis
infection of hair follicle. PUS at the BASE of the Hair shaft. d/t Staph Aureus
Carbuncle
small nodular indurated area w/ infection (pus). d/t Staph Aureus
Carbunculosis
large area skin infected
Furuncle
hair follicle in middle of carbuncle- NO PUS. d/t Staph Aureus
Furunculosis
lot of hair on back could be infected
Balanitis
infection of HEAD of penis. d/t Staph Aureus
Fascistic
inflammation of Fascia.Compartment syndrome. d/t Staph Aureus. Tx: open compartment
What usually causes orbital cellulitis?
Strep. Pneumonia
What kind of bug is staph?
Gram (+)
What does staph look like?
Clusters
What pigment does staph aureus make?
Gold
What pigment does staph epidermitis make?
White
What pigment does staph saprophyticus make?
None
Which staph is coagulase +?
Aureus, the rest are coagulase -
What is staph epidermitis associated with?
Shunts and central lines
What is used to treat a staph epidermitis infection?
Vancomycin
What infection is s. saphrolyticus associated with?
5-10y, 18-24y uncircumsized males
What is the mcc of acute endocarditis?
s. aureus
What is the mcc of death in burn patients in the 1st week?
s. aureus
What staph is catalase +?
All of them
Streptococcus is what kind of bug?
Gram +
What does streptococcus look like?
Cocci in chains
How does streptokinase work?
Breaks up clots by converting plasminogen to plasmin and binds fibrinogen
What is the antidote for streptokinase, urokinase or tPA?
Aminocaproic acid
What are the two group A hinese occus bugs?
s. pyogenes and s. pneumonia
What is s. pneumonia described as looking like?
Diplococci- like 2 kidney beans (only gram + diplococci)
What is the group B hinese occus bug?
s. agalactiae
What does s. agalactiae cause?
Meningitis from 0-2 months
What are the group D hinese occus bugs?
Viridans, mutans, sanguis, sulivarius, enterococcus
What strep is the most common cause of subacute bacterial endocarditis?
Viridans
What strep causes cavities?
Mutans
What is diagnostic of subacute bacterial endocarditis?
Septic emboli and line in nails
If a UTI is nitride negative, what bug is suspected?
s. enterococcus
What do you treat s. enterococcus with?
Vancomycin
In order, what are the most common causes of meningitis from 0-2m?
group b strep, e.coli, lysteria
In order, what are the most common causes of meningitis from 2m to 10y?
strep pneumonia, nisseria meningitis
In order, what are the most common causes of meningitis from 10-21y?
nisseria meningitis, strep pneumonia
What is the most common cause of meningitis >21y?
strep pneumonia
What kind of bug is cornybacterium diptheria?
Gram +
What does cornybacterium diptheria look like?
hinese letter
What is the toxin produced by cornybacterium diptheria?
Toxin that ADP-ribosylates EF-2
What can cornybacterium diptheria form in the back of the pharynx?
Pseudomembrane- never scrape off because it will hemorrhage
How is cornybacterium diptheria treated?
Antitoxin first, then antibiotic
What 5 things can cause heart block?
Lyme disease, legionella, thyphoid fever, diptheria, chaga’s disease
What kind of bug is bacillus?
Gram + spore former
What is the shell of bacillus made of?
Poly D-glutamic acid
Bacillus cereus is associated with what?
Fried rice
Bacillus anthrax is associated with what?
Wool sorter’s disease
Clostridium is what kind of bug?
Gram + spore former
What is c. perfringens associated with?
Gastroenteritis associated with holiday ham
Is c. perfringens an aerobe or anaerobe?
Strict anaerobe
What kind of gangrene does c. perfringens cause?
Gas gangrene
What is c. difficile associated with?
Gastroenteritis associated with broad spectrum antibiotics
What is the treatment for c. difficile?
Vancomycin or metronidazole
What is c. tetani associated with?
Dirty wound- rusty nail, etc
How does c. tetani work?
Inhibits the release of glycine from the spinal cord- contracted muscles and die from respiratory failure
What is an analog to c. tetani?
Stryck 9
What is the treatment for c. tetani?
Vaccinate- give toxoid for infection- antitoxin first, then antibiotics
How does c. botulinum work?
Causes flaccid paralysis by blocking the release of presynaptic AcH
What is c. botulinum associated with?
Honey and malaises in babies canned food in adults
What is c. melanogosepticus associated with?
Colon cancer
What is the only gram + to form an endotoxin?
Lysteria monocytogenes
What do adults get with a lysteria monocytogenes infection?
Gastroenteritis
What do babies get with a lysteria monocytogenes infection?
Meningitis
What is a lysteria monocytogenes infection associated with?
Cabbage and migrant workers
What shape is lysteria monocytogenes?
Comma shaped
What are the 4 comma shaped bacteria?
Lysteria monocytogenes, vibrio, h, pylori, c. jejuni
What type of bug is propionobacterium acne?
Gram + anaerobe- hides in hair follicles
Propionobacterium has Affinity for?
Propionic acid found in sebaceous glands and Progesterone.
When do females get acne the most?
2nd 2 weeks of menses d/t higher levels of Progesterone. Also caused by birthcontrol pills/shots→ acne→ 2 weeks prior to menses. And more common in Pregnany
Retinoic Acid Acne Tx
Previtamin A→ stimulates skin to grow, hence rapid turnover of cells, pushing bug out of for O2exposure. Vitamin A will stimulate PTH receptor, ie will have Increased Ca
Retinoic Acid AE
Photosensitivity (b/c new immature skin cells susceptible to damage). Absorbed in ileum→ Hyperlipidemia. Fat soluble→ teratogenic
When do you refer to dermatologist?
Cystic acne, or Nodular acne
What 5 things cause monocytosis?
STELS syphilis, TB, EBV, lysteria monocytogenes, salmonella typhi
What is the movement of lysteria monocytogenes described as?
Tumbling motility
How do you treat lysteria monocytogenes?
Ampicillin, macrolides, vancomycin
Eye Bugs
Staph Aureus, H. aegyptus, Francisella trularenis, Pseudomonas, Chlamydia, Bacillus Cereus
Staph Aureus in Eye
Stye
Hemophilus aegyptus in eye?
Swollen eyeball w/ pus
Francisella tularenis in eye?
Red eye, swollen glands, rabbits, deer
Pseudomonas in eye?
Contact lens keratitis
Chlamydia in eye?
Retina cotton exudate
Bacillus Cereus in eye?
Drug user proptosis, eye ring abscess
Mouth/Throat/Esophagus Bugs
Strep Pyogenes (#1) back of throat. Strep Pneumonia, H. influenza, N.Catarrhalis, Meningitis, gonorrhea
Strep Pyogenes causes
> Fever, Post strep GN (strain 12)
Rheumatic Fever Jones Criteria= SPECC
Subcutaneous nodules, Polyarthritis (MC-migratory only one!), Erythema Marginatum (little red dots w/ margins), Chorea (syndenham)-caudate nucleus of Basal ganglia is involved** causing movt disorder, Carditis
Acute Rheumatic Fever Carditis
MS (fish mouth appearance)>AS/MS>TS→myocarditis (after 2 weeks). Diffuse ST wave depression will be evident on EKG. Aschoff nodules will be seen.
Chronic Rheumatic fever
Endocarditis. Long term will have valves affected #1 MS>>AS/MS>> AS>> TS (4th)
Revised Jones Criteria: MAJOR criteria
1. Carditis, 2. Erythema marginatun, 3. Subcutaneous nodules, 4. Sydenham’s chorea, 5. Polyarthritis
Revised Jones: MINOR criteria
1. Fever, 2. Polyarthralgias, 3. Reversible prolongation of PR interval. 4. Elevated ESR or CRP
Revised Jones Criteria Supporting Evidence
1. Positive Throat culture or Rapid streptococcal antigen test. 2. Elevated or rising Streptococcal Antibody Titer
How do you make Rheumatic Fever Diagnosis?
2 Major and a preceding Strep throat OR can dx w/ just Chorea and a preceding Strep throat confirmed by culture or ASO titer
IgA protease Bugs in Mouth/Throat/Esophagus
N. Catarrhalis, Meningitis, Gonorrhea. Allows bacteria to live in mouth w/out IgA killing them
# 1 way to paralyze cilia
VIRUS 1st, smoke 2nd. Will make lung susceptible to ix and is how bacteria get into lungs. Cilia no longer able to sweep them up and out. S. pyogenes has no capsule so Type I pneumocytes can eat them up after Ix
MCC of sinusitis, Otitis, Meningitis, bronchitis, pneumonia
In this order: S. Pneumonia, H. Influenza, Neisseria
Otitis Externa can be caused by which bugs?
Pseudomonas aeruginosa, Strep pneumoniae
Gram+ Faculative Anaerobes in GUMS
classic clue: Foul smell and Gas. Peptococcus, peptostreptococcus, Fusobacterium, Actinomyces, Strep viridans
Fusobacterium
Painful ulcers, gum pus. Fused at edges, tapered at both ends. Vincent Angina, Trench mouth.
Vincent’s Angina
painful ulcers in back of throat
Trench Mouth
pus oozing from gums
Actinomyces
Sulfur granules, Fistula tracts or draining fistula
MCC of Subacute Bacterial Endocarditis
Strep Viridans. Left sided HD. Mitral Regurg highest risk
DOC Subacute Bacterial Endocarditis
Amoxicillin 3 gms 2 hrs b4 procedure and 1.5 gms during procedure
Strep Mutans
dental caries→ ferments glucose→lactic acid
Strep Salivarius
Ag is used to perform Cold Agglutinin Test. Cryoglobulinemia
Cryoglobulinemia
=acute Ix, therefore involves IgM. Non-bacterial; acute inflammation
5 infections that cause Cryoglobulinemia
IAM HE- Influenza, Adenovirus, Mycoplasma, Hepatitis, EBV
Eikenella found in?
Mouth flora. Human Bite (Tx: Augmentin)
Throat Bugs:
Strep pyogenes, Group C Strep (pharyngitis), N. Gonorrhea (pharyngitis w/ oral sex), Corynebacterium diptheriae
Corynebacterium diptheria looks like? Can cause?
Chinesse letters, gray pseudomembrane, suffocation. GRAM + ROD
C. diptheriae is notorious for causing?
Intracellular TRACHEITIS and releases a TOXIN which ADP-ribosylates EF2 (like pseudomonas)→ stop protein synthesis (translation)→ cells will die and mix w/ mucus and form “Gray pseudomembrane” in back of throat
Gray Pseudomembrane
C. Diptheria. Danger of blocking airway→ Death by suffocation. NEVER EVER SCRAPE! b/c its highly vascular n pt can hemorrhage into lung and die
C. diptheria Treatment
Anti-Toxin (tetatnus), then antibiotics, then Intubate pt.
C. diptheria Anti-toxin Tx (Tetatnus) can cause?
HEART BLOCK⇒ prolonged PR interval, recurrent laryngeal nerve palsey
Elek Test
pathogenic strain of C. Diptheria has a temperate bacteriophage
LUNG: strep pneumonia
Gram + diplococci
LUNG: H. influenza B
Thumb sign epiglottitis
LUNG: N. catarrhalis
mucus
LUNG: Chlamydia psittaci
parakeets, parrots
LUNG: Chlamydia pneumonia
Staccato coughing, elementary reticular bodies
LUNG: Mycoplasma pneumonia
bullous myringitis, ground glass CXR
LUNG: Legionella pneumonia
AC ducts, silver stains lung, CYEA
LUNG: Pneumocystis jirovecii
AIDS, premies, silver stains
LUNG: Clostridium botulism
Canned food, honey, inhibits Ach release
LUNG: Clostridum tetani
Rusty nail wounds, inhibits Gly release
LUNG: Bordetella pertussis
Whooping cough
LUNG: Bacillus antrhacis
Black eschar, woolsorter’s lung disease
H. Pylori Tx
Amoxicillin, Tetracycline/Metronidazole, Bismuth (suffocates bacteria), H2 blocker/pump blocker
SI normal flora are what kind of bugs?
95% are oxygenated→ Faculative Aerobes. MC Ecoli
E.Coli Propertiies
(Gram Negative ROD, Faculative Anaerobe, can ferment BOTH glucose and lactose.
Vitamins produced by E.Coli
90% of Vitamin K made from them. Folate, Biotin, Pantothenic acid (vitamin B4), helps absorb vitamin B12 in ileium
2 enzymes which require vitamin B12
Homocystine Methyl Transferase, Methyl-Malonyl CoA Mutase
E.Coli is MC cause of?
Cholecystitis (Gallbladder), Ascending Cholangitis (biliary Tract- Incrased ALP), Appendicitis, Spontaneous Bacterial peritonitis, and Abdominal Abscesses, Travelers diarrhea
MCC of Apendicitis
Trapped Fecalith and you get visceral pain b4 somatic pain
Intestinal Abscess w/ PERFORATION most commonly d/t?
Anaerobe
Distal Ileium and Colon most bugs are?
Gram -. 95% of gas is CO2 also not exposed to Oxygen.
COLON: Salmonella
raw chicken & eggs, turtles, rose typhoid spots
COLON: Campylobacter jejuni
Raw chicken & eggs, very bloody diarrhea
COLON: C. perfinges
Holidary ham and turkey, DM gas gangrene
COLON: Bacillus cereus
Fried Rice
COLON: L. monocytogenes
raw cabbage, hot dogs, spoiled milk, migrant worker
COLON: Staph Aureus
Milk
COLON: Vibrio parahaemolyticus
raw fish
COLON: HepA
Shellfish
COLON: Vibrio vulnificus
Oysters
COLON: Shigella
Day care outbreaks→ seizurs
COLON: V. Cholera
Rice water diarrhea
COLON: Yersinia enterolitica
presents like appendicitis+ reiter’s
COLON: Strep Bovis
colon cancer
COLON: Clostridium septicum
colon cancer
COLON: Bacteroides fragilis
Post-op pelvic abscess
Urinary Tract: E.Coli
Raw hamburger
Urinary Tract: Proteus mirabilis
Staghorn calculus
Urinary Tract: Klebisella Pneumonia
alcoholics, current jelly sputum
Urinary Tract: Staph Saprophyticus
young girls/college girls UTI
Urinary Tract: Enterococcus
nitrite negative
Proteus Mirabilis is found in?
Colon. MC Urease+ bug in body (can cause Struvite Stones). 2nd line in UTI
Proteus Mirabilis Tx:
Norfloxacin
Klebsiella Pneumonia
Colon. 3rd line for UTI. Encapsulated. Curant jelly sputum.
MC in Alcoholics and homeless
Klebsiella Pneumonia
What bug likes to hang out in fissures of lung and cause PN?
Klebsiella Pneumonia
Serratia marcescens
colon. Pruduces a RED pigment
Citrobacter found in? produces?
Colon. Encapsulated. Produces Citric acid
Citrobacter likes to attack?
Newborns b/w 0-2 months of age. Multiple cerebral Abscesses
Acinetobacter found in?
colon. In IC pt on ventilator or in hospital
Enterobacter found in?
colon. MCC of nitrite (-) UTI
Clostridium difficile found in?
Colon. Pseudomembranous colitis d/t chronic antibiotic use (esp. Clindamycin). Gastroenteritis after antibiotic use
Clostridium perfinges found in?
Colon. Gastroenteritis associated w/ holiday ham.
Rectum normal flora?
Group B. Strep, E.Coli, Lysteria mono (these 3 also are MC cause of Sepsis or Meningitis in New born b/c mother has them in her rectum)
Blood- N.meningitidis
DIC, Waterhouse-Friedrichson (adrenal hemorrhage)
Blood- N. Gonorrhea
Fitz-Hugh-Curtis (liver hemorrhage)
Blood- Brucella
Farmers, veternarians, spiking fever 5x/day, butchers
Blood- Pasteurella multocida
Cat/dog saliva (Tx: amoxicillin-Clavulanic acid)
Blood- R.rikettsii
Ticks⇒ RMSF
Blood- R. akari
Mites⇒ Ricketsial pox, fleshy papules
Blood- R. typhi
fleas, endemic typhus
Blood- R. Prowazekii
Lice, epidemic typhus
Blood- R. tsutsugamushi
Mites→ scrub typhus
Blood- Coxiella burnetii
Dusty barn→ Q fever, lung disease
Lymph bugs?
Yersinia Pestis, Bartonella henselae
Yersinia pestis
rats, fleas⇒ Bubonic Plague
Bartonella henselae
cat scratch—single painful LN in armpit (Tx: Bactrim or Erythromycin)
Enterococcus
Anaerobic, Gamma Hemolytic. Nitrite negative, Gram + Cocci (Faecalis, Faecium)
Enterococcus can cause?
Infectious Endocarditis after GI/GU problems; UTIs/ . Likes IC pts
Etnerococcus Tx?
Vancomycin
Vancomycin Tx for?
MRSA, Staph epidermis, Enterococcus
Vancomycin MOA
Cell wall Inhibitor. Inhibits Phospholipids carrier (NAM-NAG), Irreversible (non-competitive inhibitor)
Vancomycin Tx for?
ALL GRAM +
Vancomycin Toxicity
Ototoxicity, nephrotoxicity, RED MAN Syndrome ( d/t intense histamine release, NOT an allergic response)
Diarrhea 0-8 hrs?
Preformed Toxins (Staph aureus, Bacillus cereus, Clostridium)
Staph Areus
Gram + Cocci in CLUSTERS, Coagulase +, Catalase+
Stap Aureus Enzymes
Catalase, Beta-Lactamase, Coagulase, Staphylokinase, Lipase, Elastase, Collagenase
Staph Aureus Catalase enzyme does what?
Breaks down Hydrogen Peroxide
Staph Aureus B-lactamase enzyme does what?
Bks thru B lactam containing drugs; ie able to destroy Penicillins and Cephalosporins.
What is responsible for Staph Aureus Resistance?
B-lactamase
Staph aureus coagulase and Stpahylokinase enzymes do what?
Allow for ability to eat thru blood clots. MCC of death in 1st week after burn. MCC of Acute Endocarditis (ability to eat thru valves)
Staph aureus Lipase enzyme?
Bks down and eats thru fat. Ex. Panniculitis (subqt fat), Folliculitis (vase of hair follicle), Mastitis
Staph Aureus Elastase enzyme?
Cuts to RIGHT of Glycine, Alanine, Serine. Can cause Bullous Emphysema/pneumatocele (Pneumonia 2 weeks after flue) Acute bacterial Endocarditis
Panacinar Emphysema
alpha1-antitrypsin deficiency
Centroacinar emphysema
smoking
Distal acinar emphysema
Ageing
Bullous emphysema from S. aureus is d/t
Elastase
Staph Aureus Collagenase Enzyme?
Affects skin and bones by eating thru collagen. MCC of Osteomyelitis (Salmonella is 2nd MCC of Bone Ix)
Osteomyelitis Diagnosis
cant see it in 1st week on X-ray, ie do Bone Scan
Osteomyelitis
except sickle cell and salmonella. MC Staph Aureus
Staph Aureus Collagen Type I
skin
Staph Aureus Collagen Type II
Connective Tissue. MCC Fasciitis and Septic Arthritis (gonorrhea #2), and Folliculitis
Staph Aureus Collagen Type III
Endothelium-arteries affected.--> Vasculitis (will see shistocytes)
Staph Aureus Collagen Type IV
Basement Membrane. Scalded Skin, Kidney, Lung also affected. Can bleed into lungs and kidney
Paronychia
infection of skin around nail margin. MC d/t Staph aureus
Staph Aureus Toxins
Erythrodermix Toxin, Lecithinase, TSST, Exfoliatin/SSSS-T, Enterotoxin
Staph Aureus Erythrodermix Toxin
used to make skin RED. Causes SCARLET FEVER (remember Strep pyogenes is #1, but when staph causes it its called Erythrodermic Toxin).
Staph Aureus Lecithinase
eats Connective tissue. Causes Skin Ix→ Subcutaneous fat.
TSST: Toxic Shock Syndrome Triad:
S. Aureus Toxin. Triad- High Fever (d/t IL-1), Hypotension (Shock=systolic<100), Bright red Rash all over the body especially PALMS AND SOLES!) associated w/ retained tampon in female.
S. Aureus Exfoliatin Toxin
aka SSSS-T causes Staph Scalded Skin Syndrome
Staph Scaldd Skin syndrome
Red Rash all over body→ skin sloughs off=(+) Nikolysky sign (remember also seen in Pemphigus vulgaris). Involves PALMS AND SOLES too!
+Nikolsky sign is seen in?
SSS, Toxic Epidermal Necrolysis, Bullous Pemphigus
Staph Aureus Enterotoxin
causes Staph Aureus Gastroenteritis- food poisoning associated w/ DAIRY products→ Gastritis (ex. Custard pie)
Elastase
acute bacterial endocarditis, pneumonia 2 weeks after flu
Collagenase
eats collagen
Lipase
eats fat⇒ panniculitis
Beta lactamase
eats penicillin
Coagulase
eats thru clots
Acute Bacterial Endocarditis
staph aureus (attacks tricuspid valve)
Subacute bacterial endocaritid
strep viridans (attacks mitral valves)
Bacterial Endocarditis Tx
Nafcillin+ Gentamycin for 4 weeks
Staph Infections usually arrive after?
Flu-like symptoms
Staph Aureus Treatment?
Vancomycin (Best but expensive), Macrolides, Chloramphenicol, 1st generation Cephalosporins, Quinolones
Staph Epidermis
Gram + CLUSTERS; under epidermis. Coag+, Catalase -, Novobiocin sensitive. White Pigment
Staph epidermis Tx:
Vancomycin (DOC), Daptomycin, Tigacyclin. Linezolid for VRE (usually in armpits or groin).
Linezolid Class and MOA
Synthetic, class of Oxazolidinones. Disrupts bacterial growth by inhibiting Initiation process in protein synthesis.
Staph Saprophyticus
Coagulase -, Novobiocin resistant. NO PIGMENT. Can cause “honeymooner’s cystitis”
Staph Saprophyticus can cause?
Almost ½ of all UTIs in Sex Active young women (18-24 yrs old)→ post coital UTI, especially w/ no circumcision. And 5-10yrs old (b/c play w/themselves at this age)
MC cause of UTI
E.Coli
Streptococcus Species Immunity is?
Type specific, ie why u can get recurrent Strep Ix
Streptococcus General Characteristics
Gram + cocci in CHAINS. Groups ABCD
Streptococcus Alpha-Hemolysis
partial hemolysis→ GREEN zone
Strep Beta-Hemolysis
Complete Hemolysis→ CLEAR zone
Strep Gamma Hemolysis
No hemolysis→ RED zone
What enzyme is responsible for Beta Hemolysis?
Streptokinase.
Streptokinase action?
Used to break up clots by converting plasminogen to plasmin and it also binds up Fibrinogen in acute MI
Why would you use tPA instead of Streptokinase?
If pt had recent Strep Ix, would have build up antibodies to streptokinase and it would not work.
When is tPA used?
In acute MI’s and for Acute strokes w/in 3-41/2 hrs b/c free radicals form in 3-4 hrs
How does tPA work?
Converts plasminogen→ plasmin→ bks up clot. Bind up fibrinogen→ wont allow for anymore clots
tPA adverse effects
1-3% bleed to death.
APSAC (aminocaproic acid) can induce?
tPA reversal
Strep Pyogenes GROUP A
Beta hemolytic. Has an “A” protein, 60 different strains
Strep on Skin or throat can lead to?
PSGN (subEPIthelial humps). Only Strep throat→ Rheumatic fever
Strep Agalactiae
“Group B strep”. Beta-hemolytic. Child meningitis. #1 cause of Neonatal sepsis or meningitis in first 2 months of life
Woman pregnant w/ baby and high Group B Strep counts what do you give her?
Ampicillin IV right away as soon as comes into labor to decrease vertical transmission. If culture negative could just mean- her counts are low.
Group C strep
No name, does cause pharyngitis
Streph Pharyngitis
Anterior cervical nodes. Tx: Penicillin G
Strep Pneumoniae
aka Pneumococcus (only gram + diploocci). Alpha hemolysis. 80 strains. has IgA protease
How is Strep Pneumonia identified?
“M” Protein= Sugar capsule polysaccharide. Will see (+) Quelling Rxn. Rust-Colored Sputum*
Pneumoccoccal Vaccine (Pneumovax)
covers 23 strains, accts for 98% of Ix by Strep Pneumoniae
Who needs Pneumovax?
Everybody >65. Spelenectomized pts (occurs after age 6), >2 yrs old w/ sickle cell but definatley after age 6. (functional aspelnic after age 2. Spleen= organ that gets rid of encapsulated orgs). End organ failure ( DM, CF, Liver, renal failure pts, COPD), PSGN.
Kerr sign
anytime have splenic rupture and bleeds under diaphragm, your LEFT shoulder will hurt= Kerr sign
MCC of splenectomy
#1 Trauma, #2- Cancer
Strep Pneumoniae #1 cause of?
sinusitis, otitis, bronchitis, pneumonia (rusty colored sputum). Can ALSO cause: Otitis media (red bulging tympanic membrane, end organ failure, asplenic
Strep Pneumonia age range?
>2 yrs old Sickle Cell pts, >65 yrs old
Strep Viridans
Group D- mutans, sanguis, salivarius. Produces Green pigment. Alpha Hemolytic.
Strep Mutans causes
cavities by converting/fermenting glucose→ lactic acid; MCC of SBE of Mitral Valve
Strep Salivarius
used in cold agglutinin test in cryo (IgM antibody; acute inflam; non bacterial)
Mycotic Aneurysm
SBE. Septic emboli to the brain
Roth Spots
SBE. Septic emboli to retina
Osler’s nodes
SBE. PAINFUL septic emboli to fingers/toes
Janeway Lesions
SBE. Non-painful septic emboli to fingers/toes
Splinter hemorrhages
SBE. Septic emboli to nail bed
SBE Tx
Amoxicillin 3 g 2hrs b4 surger, 1.5 g 6 hrs after surger. Essential to protect any mucosal surface type surgery
Which bacteria form spores?
Gram positive RODS soil bugs (eg Bacillus anthracis, Clostridium,)- forms spores (D-Glu)- occurs during Lag phase
How can one destroy spores?
Autoclave (as is done to surgical equipment)- sterilization 121 degrees
What are spores made of?
Ca2+ dipicolinic acid. Contain poly D-glutamate membrane. (D-amino acid is what causes major toxicity in humans-we have L-aa)
Can spores replicate?
NO. but they can release TOXINS
Lab diagnosis basis for Cornyebacterium diphtheriae
Gram positive rods with metachromatic granules, grown on tellurite agar (aka Loffler's coagulated serum medium)
How is Bacillus characterized?
1. chains of Large Gram positive rods 2. Spore forming 3. Protein capsule
Which bacteria have a protein capsule?
Bacillus anthracis (the only one)
Baccillus Anthracis (anthrax) can cause 2 types of Infections?
Skin (cutaneous anthrax), Pulmonary Anthrax (Woolsorter’s disease)
Bacillus Anthracis is MC aquired via?
OCCUPATION. Handle livestock and not immunized b4. Handle HIDES of animals. SUSPECT history of ANIMAL Contact. If not then suspect Bioterrorist
What are the mechanisms of Cutaneous anthrax infection and disease?
1. Non-inhalation contact with bacillus anthracis → severe skin necrosis→ Formation of malignant pustule (painless ulcer w/ Poly-D glutamic acid) → Progression to bacteremia →Death
Pulmonary Anthrax
Woolsorter’s disease. Induces necrosis of lung on contact→ end up drowning in your own blood. MC used for Germ warfare (100% mortality in pulmonary form)
What organism: Development of flulike symptoms followed by fever, pulmonary hemorrhage and shock.
Inhalation anthrax: Bacillus anthracis
Bacillus Anthracis Toxins
Edema Factor, Protector Factor, Lethal Factor (one causing death)
What is edema factor?
A toxin in the Bacillus Anthracis exotoxin complex that functions as adenylyl cyclase
What bug causes contamination of this food: Reheated rice
Bacillus cereus Mnem: "Food poisoning from reheated rice? Be serious!"Gastroenteritis. + Preformed Toxin→ sx w/in 8 hrs of ingestion
Bugs w/ Preformed Toxins
Staph aureus, Bacillus anthrax and cereus, clostridium
How are clostridia characterized?
1. Gram positive rods 2. Spore forming 3. Obligate anaerobes
Clostridium Perfinges properties
gram + rod. Strict anaerobe found in soil/ feces
Clostridium Perfinges Causes?
Gastroenteritis, Gas, Dry, and Wet Gangrene
C. Perfringes Gastroenteretis
(holiday ham/turkey) via Enterotoxin. Left on counter, C. perfringes infect→ you reheat→ piss off spore→ get sick. IMMEDIATE Sx. DIARRHEA
Gas Gangrene
C. perfringes (strict anaerobe). Attacks extremeties in legs of diabetics (poor blood supply)- via Alpha toxin
Dry Gangrene
C. perfringes. Necrotic Skin. Tx: immediate amputation
Wet Gangrene
C. perfringes. Occurs when blood supply returns (this is actually bad) b/c blood going back to necrotic area will cause Gas emboli to RV⇒ block pulmonary artery= RV outlet obstruction.
Wet Gangrene Tx
Lay person on Left side in order to open pulmonary Artery, tap on Right side to bk up bubble and allow it to dissolve in lung. Requires Immediate Amputation
What to know about exotoxins released by Clostridium perfringens
alpha toxin (aka lecithinase) causes: 1. gas gangrene 2. myonecrosis 3. hemolysis (See double zone of hemolysis on blood agar.) PERFringens PERForates a gangrenous leg.
C. difficile causes
pseudomembranous colitis secondary to clindamycin or ampicillin use. (Mnemonic: DIfficile causes DIarrhea). Pseudomembranous appears as gray membrane. C. difficile lives in GI but when abx clears E.coli it grows rampantly
C. difficile MOA
Mechanism: 1. Antibiotic kills off protective flora 2. C. difficile takes hold and proliferates 3. Produces cytotoxin, an enterotoxin. 4. Cytotoxin kills enterocytes.
Treatment for C. difficile infection
1st- stop antibiotic. Then give Vancomycin (oral-most effective. Tanidazole (less s/e). Then Metronidazole (current drug used to decrease Vancomycin resistance)
How does Metronidazole work?
Promotes production of FREE RADIAL formation→ kills ALL anaerobes+ protoza. Contraindicated in G6PD pts. SE: Dysgeusia, Disulfram Rxn, Methhemoglobinemia, Hemolytic anemia
C. Botulinum (Botulism)- Toxin does what?
Inhibits pre-synaptic release of Ach→ flaccid paralysis (floppy baby)- die of resp failure b/c diaphragm stops worken, restrictive lung disease
C. Botulinum in Children
contact it from DARK CARAMEL SYRUPS (honey/molasses)- don’t give children it until 6 month old when have normal flora that cant fight against Anaerobes
C. Botulinum in Adults
ingest spores via CANNED FOODS. NEVER buy a can if its ballooned out or dented
What to know about exotoxin released by Clostridium botulinum
Properties: 1. Preformed 2. Heat-labile Mechanism: Blocks the release of acetylcholine causing: 1. Anticholinergic symptoms 2. CNS paralysis (especially cranial nerves) 3. Floppy baby syndrome
C. Botulinum Tx
Antitoxin 1st, Antibiotics 2nd
C. tetani (Tetanus) is associated w/?
associated w/ dirty wounds
C. tetani toxin does what?
Inhibits release of glycine ( normal inhibitor fxn) in spinal cord→ will cause an Increase Contraction→ resp failure. LOCK JAW, Rhizorus Sardonicus.
What to know about exotoxins released by Clostridium tetani
Blocks the release of inhibitory neurotransmitter glycine from Renshaw cells in the spinal cord. Causes "lockjaw"
C. Tetani (tetanus) Tx
Anti-immunoglobulin to bind up toxin→ inject it right into wound
Tetanus Toxin works just like?
Strychnine which is a poison. Need to give antitoxin
Dirty wound situation. Have they had a Tetanus toxoid shot within last 5 years? Tx?
Does not matter. Admin Atitoxin+ Tetanus Toxoid (also inject some into wound)
C. melangosepticum
produces a BLACK pigment. Associated w/ COLON CANCER (usually causes Endocarditis in Cancer pts)
C. melangosepticum management?
Scope them to look for colon cancer
Neurotoxins are found in what os?
C. Tetani (painful, spasms). C. Botulinum (flaccid paralysis)
Listeria monocytogenes
only Gram + who produces an ENDOTOXIN, Comma shaped, curved rod, tumbling
True or False: No Gram-positive bugs have endotoxin.
False. Listeria monocytogenes has it.
Which bacteria are beta-hemolytic?
Rods: Listeria monocytogenes Cocci: If catalase positive and coagulase positive: Staphylococcus Aureus If catalase negative, Streptococcus. Then, if bacitracin sensitive, S. pyogenes. If bacitracin resistant, S. agalactiae.
What are the important points about Listeria monocytogenes?
1. Tumbling motility 2. Meningitis in newborns 3. Unpasteurized milk. PRODUCES GRANULOMAS
How does Listeria Monocytogenes affect Neonates?
# 3 cause of Neonatal Sepsis (0-2 month) Meningitis w/ granulomas, abortions. b/c of ENDOTOXIN will Kill baby fast b/c it likes to attack placenta and cause abortions
Listeria monocytogenes affect on adults?
Gastroenteritis, heart Block
How do adults get Gastroentereitis from L. Monocytogenes?
1. Spoiled milk (MC), 2. Raw cabbage, 3. Migrant workers, 4. Hot Dogs (they contain spoiled milk vs unspoiled milk-staph areus)
What type of immune response do you have w/ L. monocytogenes?
Cell Mediated immune response (one of the few bacteria that do this). Hence attacks tissues- involves T cells and Monocytes. Doesn’t spend much time in blood
5 Causes of Monocytosis
“STELS”-Syphilis, TB, EBV, Listeria, Salmonella
MCC of Premature Rupture of Membrane (PROM) is?
Listeria Monocytogenes
Listeria monocytogenes Treatment?
Vancomycin, Macrolides, Ampicillin
4 Comma Shaped or Curved Rods?
H.Pylori, Listeria, Vibrio, Campylobacter
Antibiotics which can cover Staph Aureus?
Vancomycin, Ciprofloxacin, Erythromycin, Clindamycin, Cephalosporins
Staph Epidermis can be covered by?
Vancomycin
How is Nocardia asteroides characterized?
Gram-positive (weakly acid fast) rods forming long branching filaments resembling fungi (Actinomyces also has this description)
What disease state does Nocardia asteroides cause?
Pulmonary infection in immunocompromised patients
Type A properties?
80% of Haemophilus. Non-Type able (ie no capsule→Non-invasive disease). Gram (-) PLEOMORPHIC Rod. Looks like school of swimming fish under slide
Gram + Endotoxin/ Gram – Exotoxin
Gram + ENDOtoxin= Listeria. Gram (-) EXOtoxin= H.influenza, Bordetella Pertussis
Haemophilus Influenza Type B properties?
20% of Haemophilus. Is ENCAPSULATED= causing INVASIVE DISEASE. Capsule made up of Polyribosyl Phosphate*
What disease states does Haemophilus Influenzae Type B causes?
HaEMOPhilus causes 1. Epiglottitis (MC of it) 2. Meningitis 3. Otitis media 4. Pneumonia Does not cause flu (that’s a virus)!
Epiglottitis d/t H. Influenza Type B classic clue?
THUMB SIGN on Xray, muffled voice, leaning over drooling (don’t want to swallow) next step- intubate in O.R. under anesthesia
How is Haemophilus Influenzae characterized?
Small gram-negative coccoid rod.
How is Haemophilus Influenzae transmitted?
Aerosol
Every complication of Meningitis, one should look for?
#1- Strep. Pneumoniae, #2- H. influenza, #3- Neisseria
When is H. influenza considered #1 complication of Meningitis?
When you see a “Sub-dural Effusion” (collection in the brain)
What disease states does Haemophilus ducreyi cause?
Chancroid: 1. Painful genital ulcer (red papule with yellow-gray exudate) 2. Inguinal adenopathy
How does Chancroid present?
Ulceration w/ central necrosis* (appears as black scar, eschar, in the middle)
What is hemoplilus ducreyi the most common cause of?
Painful genital ulcers (chancroid)
What is the treatment for h. ducreyi?
Cefttriaxone
What type of gential ulcers does herpes have?
Painless
What is the treatment for herpes?
Acyclovir, pancyclovir, or valcyclovir
What 4 things can cause painful genital ulcers?
h. ducreyi, Herpes 2 (HSV-2) lymphogranuloma venereum (c. trachomatis), and granuloma inguinale (calymmatobacterium donovini)
How does HSV-II genital lesion present?
Painful. Crop of Vesicles coming together and then ulcerate. Tell by history
How does Lymphogranuloma genital lesion present?
Painful. Draining ULCERATING LN d/t chlamydial infection. Sailors
How does Granuloma Inguinale genital lesion present?
Caused by Calammotobacterium donovini (will see Donovan Bodies= macrophages w/ this bacteria in them)
What is hemoplilus ducreyi the most common cause of?
Painful genital ulcers (chancroid)
What is the treatment for h. ducreyi?
Cefttriaxone
Do gram – have a thin or thick peptidogylcan wall?
Thin
What type of gram – is hemophilis?
Pleomorphic rod
What protease does hemophilus have?
IgA protease
What is the main virulence factor of hemophilus?
Capsule
What is the invasive type of hemophilus?
Hemophilus B
What does the invasive hemophilus cause?
Meningitis, sepsis, epiglotitis
What does the non-invasive hemophilus cause?
Sinusitis, otitis, bronchitis and pneumonia
What is the #1 cause of sinusitis, otitis media, bronchitis and pneumonia?
s. pneumonia
What is the #2 cause of sinusitis, otitis media, bronchitis and pneumonia?
Hemophilus influenza
What is #1 for epiglotitis?
Hemophilus influenze type B
What are the signs of epiglotitis?
Thumb print sign, drooling, fever, stridor
What does hemophilus aegyptos cause?
Pink eye- eye bulges way out (red+swollen) looks like eye ball being pushed out
Special culture requirements for: Hemophilus influenzae
Chocolate agar with factors V (NAD) and X (hematin) Mnemonic: When a child has “flu” mom goes to five (V) and dime (X) to buy some chocolate.
Neisseria in 20% of population?
N. meningitidies & Gonorrhea reside in back of throat all the time in 20% of pop
What type of bug is nisseria?
Gram – diplococci (only 1)
Largest Encapsulated Bacteria?
N. Meningitidies. Requires MAC complex to fight it. Only one that can release its toxin w/o dying at same time. Ie releases it during LOG PHASE, all others do it during Decline phase
Special culture requirements for: Neisseria
Thayer-Martin media (Chocolate agar)
Neisseria meningitides Endotoxin
Most abundant of all bacteria. =LIPID A
Lipid A will cause?
Early Vasculitis (present w/ DIC)- Purpura, Petechiae*, Ecchymosis. Waterhouse –Friderichsen Syndrome (Meningococcemia –if bleed into adrenal glands)
Meningococcemia Sepsis is d/t?
production of TNF-alpha, IL-1B, IL-6, IL-8 (most formed secondary to LOS interaction w/ Toll-like receptor 4)
Meningococcal Lipooligosaccharide (LOS)=
causes many toxic effects seen in Meningitis and Meningococcemia. Blood LOS correlates closely w/ mortality and Morbitidy
How does meningococcal LOS differ from Enteric LPS ?
lacks repeating O-antigen of LPS
Waterhouse-Friderichsen Syndrome- look for?
Decreased Na, Increased K+= electrolyte imbalance. b/c DIC will cause adrenal hemorrhages
Waterhouse-Friderichsen Syndrome- Treatment
Replace Aldosterone and cortisol. Start Fludrocortisone to replace aldosterone. Prednisone to replace Cortisol. Give 5 mg (if get sick- triple the dose)
Neisseria Meningitides MCC of what in what age?
Meningitis in 10-21 yrs old. People in close quarters-college students
N.Meningitis Treatment, prophylaxis for close contact?
Prophylaxis for close contact→ Rifampin
What method is used to differentiate Neisseria?
Sugar fermentation
What do meningococci ferment?
MeninGococci ferment Maltose and Glucose
What type of bug is nisseria meningitis?
Gram – diplococci , Catalase +, IgA protease
What does nisseria meningitis ferment?
Maltose and glucose
What does nisseria meningitis present with?
DIC
What does nisseria meningitis cause?
Waterhouse-fredrickson syndrome- hemorrage into the adrenal gland
What is the treatment for nisseria meningitis?
Dexamethasone before antibiotic treatment to prevent hearing loss from inflammatory neurological damage (Dexamethasone will decrease swelling)
What is the most common purulent/Symptomatic STD?
nisseria gonorrhea (aka Drips)
Gonorrhea in Men?
90% symptomatic
Gonorrhea in Women?
50% symptomatic. More likely to be Asymptomatic Carrier. +Perihepatitis→ Fitz Hugh Curtis Syndrome
Fitz-Hugh-Curtis Syndrome
gonorrhea in women. Fallopian tube affected and pus drops next to liver.
How does N. Gonorrhea multiply?
Via CONJUGATION (b/c has pili)
Phase Variation occurs in?
N. Gonorrhae PILI (ie it changes slightly very year)
What is MC Asymptomatic STD in America
Chlamydia (90%)
How does nisseria gonorrhea gain access to the blood?
It has pili and climbs the uroepithelium
What does nisseria gonorrhea ferment?
Glucose
Opthalmia Neonatorum
N. gonorrhea. When baby passes thru birth canal of Asymp carrying women, it will attack the baby’s eyes
Disseminated gonococcal Infection
N. gonorrhea can become disseminated d/t its pili.--> walk up epithelium→ bladder→ blood stream
Tenosynovitis
N. gonorrhea loves to attack TENDONS and LIGAMENTS. Joints of wrist and ankles. Present with DYSURIA + PAINFUL WRIST 3 DAYS LATER!!!!
What type of arthritis does nisseria gonorrhea cause?
Gonococcal arthritis- ankle and wrist involvement and loves tendons and ligaments (common in teenagers)
How does gonorrhea present?
1. Urethritis 2. Cervicitis 3. PID 4. Prostatitis 5. Epididymitis 6. Arthritis 7. Creamy purulent discharge (mmm!)
What organism causes gonorrhea?
Neisseria gonorrheae aka Gonococcus
Nisseria catarrhalis (formally known as Moraxella) does not ferment what? Other properties?
Sugar . NO PIGMENT, No capsule, loves mucus
Where is nisseria catarrhalis the most common strain?
In the back of the throat. # 3 for respiratory infections
N.Catarrhally ix increased with what action? MC sinus it infects is?
Engaging in Oral sex Increases chances for this bug. MC sinus infected is Maxillary Sinuses.
Penicillin G and Gram negative bugs
Gram-negatives are resistant to benzyl penicillin G. The gram-negative outer membrane layer inhibits entry of penicillin G and vancomycin. May be susceptible to penicillin derivatives such as ampicillin.
What bacteria genus can live in neutrophils?
Neisseria
How are neisseria characterized?
Gram-negative cocci that resemble paired coffee beans
Gonococcus and meningococcus: Polysaccharide capsule
G: No M: Yes
Gonococcus and meningococcus: Maltose fermentation
G: No (Gonococcus ferments Glucose) M: Yes (MeninGococcus ferments Maltose and Glucose)
N. Gonorrhae 1-Dose Treatment
CeftTRIaxone (DOC w/ single gonococcal Ix-also penetrates brain better than any cephalosporin), CeFIXime, CeFOXitin. (Ciprofloxacin, Oflaxacin, Gatifloxacin= quinolones, no longer used b/c of 40% resistance)
Causes of Disulfiram-Like Reactions
1. Cephalosporins, 2. Metronidazole, 3. Procarbazine
Chlamydia 1-dose Tx
Azithromycin 1 gm, 2 gram if w/ Gonorhea too (if pt has Gonorrhea, u must cover for BOTH, but not vice versa)
What does H. pylori look like?
Gram – comma shaped
What positive enzyme is h. pylori?
Urease + (allows to survive acid pH: NH3+ HCL→ NH4CL)
H. Pylori is more common in? high association w/?
Poor sanitation. Duodenal Ulcers (95%), Gastric Ulcer (70%)
What test is the most diagnostic of an H.pylori infection?
Hydrogen breath test
What is the treatment for h. pylori?
4 drugs for 4 weeks=98% eradication. Amoxicillin (BEST), bismuth (suffocates H.pylori), H-2 blocker or a PPI
Most effective H. Pylori Tx Regimen?
PPI, Clarithromycin (biaxin) and either Amoxicillin or Metronidazole (all taken for 2 weeks)
What are the urease + bugs?
PUNCHES B protease, pseudomonas, ureoplasma urolyticum, nocardia, hlamydia us, h. pylori, s. saphrolyticus, brucellosis
E. coli is the number one infection where?
UTIs and gastroenteritis
E.Coli grows well on?
Blood, MacConkey agar (PINK color most show Beta hemolysis), + EMB AGAR*= selective and differential media
EMB Agar and E.Coli
selective and differential media. E.coli will bind to dye in agar b/c it can ferment lactose, produce a black and blue colony w/ METALLIC SHEEN
E.Coli Most important Virulence factor=?
Fimbrae (type 1,p and s) permit adhesion to uroepithelial cells. (cause of UTIs)
Traveler’s Diarrhea
MC inflammation of Duodenum, ie trouble absorbing sugars. Can detect sugars in stool by using “reducing substances”
Lab values with diarrhea?
Serum Na, Cl, K+ low, serum pH=Acidic
What is e. coli infection associated with?
Hamburger
E.Coli strain in Neonates
#2 cause of Neonatal sepsis d/t synthesis of K-1 capsular antigen (causing neonatal meningitis). K-1 antigen= major determinant of virulence
Enteroinvasive e. coli EICC is associated with what?
Regular Travelers diarrhea, loose stools
Enterotoxigenic e. coli (ETEC) is associated with what?
Rice-water diarrhea , Explosive, mc d/t poor sanitation
ETEC enterotoxins do what?
Produces Heat Stable +/or Heat Labile Enterotoxins. ADP-RIBOSYLATES Gs→ turns on, on→ Increased cAMP (via G+ protein in Gut mucosyl cells apical membrane)
G-protein Disrupters
Pertusis (inhibits Gi), Cholera and E.Coli (stimulate Gs)
Enterohemorragic e. coli (EHEC) is associated with what?
Endemic HUS (sporadic cases)- occurs 2 weeks after eating RAW hamburger infected w/ EHEC.
EHEC likes which part of human body? Lives in what part of animal body?
Likes medium sized arteries (GI/Renal). MCC of RF in children. Lives in Anus of Cows
What is 0157:H7 e. coli associated with?
Epidemic HUS
What to know about exotoxins released by E. coli
E.coli 0157:H7 produces Shiga toxin. ADP ribosylating A-B toxins Heat-labile: Permanent activation of adenylyl cyclase (cholera-like mechanism) leading to watery diarrhea Heat-stabile: Stimulates guanylate cyclase Mnemonic: Labile like the Air, Stabile like the Ground.
What is the treatment for e. coli?
Amphicillin, erythromycin, etc…
2 Gram+ that attack primarily Immunocompromised pts?
Strep bovis (strictly anaerobic), Clostridium Melangosepticum
6 Gram – that attack primarly IC pts?
Proteus Mirabilis, Klebsiella pneumonia, serratia marcescens, acinetobacter, citrobacter, Pseudomonas
What is the #2 for UTI’s?
proteus mirabilis
What is a clue for a proteus UTI?
Urease +, high pH
What is proteus associated with?
Struvite stones
What is #3 for UTI’s?
klebisella pneumonia
Who is k. pneumonia associated with?
Alcoholics, any mention of fissures with pneumonia
What does the sputum look like with k. pneumonia?
Currant jelly sputum
What 3 bugs like to attack immunocompromised?
Serratia marscensens, cirtobacter, and pseudomonas auregenosa
What color is produced by serratia marscensens?
Red pigment
What does citrobacter produce?
Citric acid
What kind of bug is citrobacter?
Gram – encapsulated
Who does citrobacter like to attack?
Immunocompromised and 0-2m babies
What does citrobacter cause?
Multiple cerebral abscesses
Who does pseudomonas auregenosa like to attack?
Diabetics, burn patients, neutropenics, and cystic fibrosis, also like plastic (endotracheal tubes, bladders caths)
What pigment does pseudomonas produce?
Gold and some green
What is the smell of pseudomonas described as?
Fruity grape smell when plated
What diseases is pseudomonas associated with?
Whirlpool folliculitis, tennis shoe folliculitis, malignant otitis externa, ichthyma gangrenosum
What is the most common cause of death in the second week of a burn patient?
Pseudomonas auregenosa
What is shigella associated with?
Gastroenteritis in daycare centers
What toxin does shigella produce? What does it cause?
Shigatoxin which causes seizures
What causes whooping cough?
Bordatella pertussis
What is special about the exotoxin of bordatella pertussis?
It is intracellular and kills cells
What is the treatment for bordatella pertussis?
Erythromycin
What causes undulating fever with 5-7 spikes per day?
Brucella
Who gets infected with brucella?
Vets and animal workers
What is pasturella multocida associated with?
Infected dog or cat bite
What is the treatment for pasturella multocida?
Amoxicillin
What is bartonella henselae associated with?
Cat scratch disease- carried by kittens, lymph nodes bulge
Cat Scratch
Bartonella Henselae
Cat Saliva
Pasturella multocida
Cat Pee
Toxoplasmosis
Cat caca
Toxocara cati
What causes tularemia?
Francisella
What is francisella associated with?
Rabbits 90% and deer 10%
How do you treat francisella?
Streptomycin
What does tularemia look like?
Fever, red eyes
What kind of bug is salmonella?
Gram – encapsulated
What is salmonella associated with?
Raw chicken and raw eggs
Why do you not treat salmonella with antibiotics?
Because it will hide in the gall bladder and precipitate cholecystitis
What causes typhoid fever?
Salmonella typhi
What is the triad of typhoid fever?
Fever, rose spots, and intestinal fire
What is salmonella typhi associated with?
Contaminated water
What do you treat s. typhi with?
Ciprofloxacin
What kind of bug is vibrio cholera?
Gram – comma shaped
What kind of diarrhea do you get with vibrio cholera?
Rice water
What 2 bugs give you rice water diarrhea?
ETEC and vibrio cholera
What is vibrio parahaemolyticus associated with?
Diarrhea associated with raw fish
What is vibrio vulnificus associated with?
Gastroenteritis associated with raw oysters
What 2 anaerobes are associated with colon cancer?
Clostridium melanosepticus and strep. Bovis
Yersinia pestis causes what?
Bubonic plague- rat or flees associated
Yersinia entercolitica causes what? What does is mimic?
Gastroenteritis and mimics appendicitis
Campylobacter jejunii causes what?
Copious bloody diarrhea
What is the D.O.C. to treat c. jejunii?
Erthyromycin
Do atypicals have cell walls?
No
What drugs cover the atypicals?
Quinolones, macrolides, and tetracyclines
What type of bug is hlamydia?
Parasite
Chlamydia trachomatis is the most common what?
Neonatal blindness, STDs, infertility in women, ectopic pregnancy, and lymphogranuloma venereum
What is the 1 dose treatment for c. trachomatis?
Azithromycin
Chlamydia pneumonia is the mcc of what?
Atypical pneumonia from 0-2y
What is c. pneumonia found to be connected to?
Alzheimer’s and coronary artery disease
Chlamydia psitacii is associated with what?
Parrots and parakeets
What is mycoplasma pneumonia the mcc of?
Atypical pneumonia from 10-30y “walking pneumonia”
Walking Pneumonia Symptoms and Treatment
Dry Cough, Tx: Fluoroquinolones
Legionella pheumophilia is associated with what?
Heating and A/C ducts
What is legionella the mcc of?
Atypical pneumonia after age 40
Ureoplasma urolyticum has what enzyme?
Urease +
What 4 pathogens are urease +?
Proteus, ureoplasma, h. pylori, pseudomonas
What pathogens silver stain?
Legionella, pneumocystis (both in Lung), Bartonella (LN)
Ixodes Tick Disease
Lyme Disease, Babesiosis, Ehrlichiosis
Lyme disease
migrating target lesion
Babesiosis
Hemolytic anemia, malaria sx
Ehrlichiosis
puncture wound near eye, dog lick
big mama anaerobes
strep. bovis, c. difficil, c. malnogo-speticus, bacteriodes fragilis
Big mama Anaerobes TX
Clindamycin, Cefoxitin, Metronidazole