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524 Cards in this Set
- Front
- Back
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What infections does strep pyogenes cause?
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LINES lymphangitis, impetigo, necrotizing fascitis, erysipelas, scarlet fever
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Lymphangitis
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Ix follows lymphatic channels= “RED STREAk” going up arm
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Impetigo
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caused by Strep. “Honey crusted lesions” (if bullous its d/t staph aureus’s elastase activity
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Bullous Impetigo is caused by?
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Staph aureus
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Necrotizing Fasciitis
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“Flesh Eating Strep”→ Compartment syndrome. 1st try to debride +Clindamycin then go to hyperbarics
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Compartment syndrome 5P’s
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Pain (b/c compressing arteries)-always 1st. Pallor, Poikylothermia, Paresthesia (nerves desent), Pulseness (always last)
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Necrotizing Fasciitis Toxins
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Streptolysin O, S
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Necrotizing Fasciitis Virulence factor
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M protein (M12→ PSGN. Capsule has Hyaluronic Acid
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Erysipelas
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Raised Edges, red, shinny, swollen, Ix of Subcutaneous fat, DO NOT BLANCH ( vs cellulitis)
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Scarlet Fever
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“Sand Paper Rash” (very rough skin), Strawberry tongue (also in Kawasaki). Rash on Palms and Soles
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What usually causes periorbital cellulitis?
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Staph aureus. Swollen eye in kid
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Orbital Cellulitis
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proptosis, older pt. d/t Strep PN
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Cellulitis
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flat red area of skin that feels hot and tender, + BLANCHING. d/t Staph Aureus
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Oomphalitis
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cellulitis around umbilicus of a new born. d/t Staph Aureus
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Mastitis
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cellulitis around breast (mom must continue to breast feed). d/t Staph Aureus
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Panniculitis
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cellultis as a ring around abdomen. d/t Staph Aureus
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Folliculitis
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infection of hair follicle. PUS at the BASE of the Hair shaft. d/t Staph Aureus
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Carbuncle
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small nodular indurated area w/ infection (pus). d/t Staph Aureus
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Carbunculosis
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large area skin infected
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Furuncle
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hair follicle in middle of carbuncle- NO PUS. d/t Staph Aureus
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Furunculosis
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lot of hair on back could be infected
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Balanitis
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infection of HEAD of penis. d/t Staph Aureus
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Fascistic
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inflammation of Fascia.Compartment syndrome. d/t Staph Aureus. Tx: open compartment
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What usually causes orbital cellulitis?
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Strep. Pneumonia
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What kind of bug is staph?
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Gram (+)
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What does staph look like?
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Clusters
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What pigment does staph aureus make?
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Gold
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What pigment does staph epidermitis make?
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White
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What pigment does staph saprophyticus make?
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None
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Which staph is coagulase +?
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Aureus, the rest are coagulase -
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What is staph epidermitis associated with?
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Shunts and central lines
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What is used to treat a staph epidermitis infection?
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Vancomycin
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What infection is s. saphrolyticus associated with?
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5-10y, 18-24y uncircumsized males
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What is the mcc of acute endocarditis?
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s. aureus
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What is the mcc of death in burn patients in the 1st week?
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s. aureus
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What staph is catalase +?
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All of them
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Streptococcus is what kind of bug?
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Gram +
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What does streptococcus look like?
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Cocci in chains
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How does streptokinase work?
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Breaks up clots by converting plasminogen to plasmin and binds fibrinogen
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What is the antidote for streptokinase, urokinase or tPA?
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Aminocaproic acid
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What are the two group A hinese occus bugs?
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s. pyogenes and s. pneumonia
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What is s. pneumonia described as looking like?
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Diplococci- like 2 kidney beans (only gram + diplococci)
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What is the group B hinese occus bug?
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s. agalactiae
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What does s. agalactiae cause?
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Meningitis from 0-2 months
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What are the group D hinese occus bugs?
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Viridans, mutans, sanguis, sulivarius, enterococcus
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What strep is the most common cause of subacute bacterial endocarditis?
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Viridans
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What strep causes cavities?
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Mutans
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What is diagnostic of subacute bacterial endocarditis?
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Septic emboli and line in nails
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If a UTI is nitride negative, what bug is suspected?
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s. enterococcus
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What do you treat s. enterococcus with?
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Vancomycin
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In order, what are the most common causes of meningitis from 0-2m?
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group b strep, e.coli, lysteria
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In order, what are the most common causes of meningitis from 2m to 10y?
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strep pneumonia, nisseria meningitis
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In order, what are the most common causes of meningitis from 10-21y?
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nisseria meningitis, strep pneumonia
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What is the most common cause of meningitis >21y?
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strep pneumonia
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What kind of bug is cornybacterium diptheria?
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Gram +
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What does cornybacterium diptheria look like?
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hinese letter
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What is the toxin produced by cornybacterium diptheria?
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Toxin that ADP-ribosylates EF-2
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What can cornybacterium diptheria form in the back of the pharynx?
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Pseudomembrane- never scrape off because it will hemorrhage
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How is cornybacterium diptheria treated?
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Antitoxin first, then antibiotic
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What 5 things can cause heart block?
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Lyme disease, legionella, thyphoid fever, diptheria, chaga’s disease
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What kind of bug is bacillus?
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Gram + spore former
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What is the shell of bacillus made of?
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Poly D-glutamic acid
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Bacillus cereus is associated with what?
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Fried rice
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Bacillus anthrax is associated with what?
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Wool sorter’s disease
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Clostridium is what kind of bug?
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Gram + spore former
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What is c. perfringens associated with?
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Gastroenteritis associated with holiday ham
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Is c. perfringens an aerobe or anaerobe?
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Strict anaerobe
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What kind of gangrene does c. perfringens cause?
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Gas gangrene
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What is c. difficile associated with?
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Gastroenteritis associated with broad spectrum antibiotics
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What is the treatment for c. difficile?
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Vancomycin or metronidazole
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What is c. tetani associated with?
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Dirty wound- rusty nail, etc
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How does c. tetani work?
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Inhibits the release of glycine from the spinal cord- contracted muscles and die from respiratory failure
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What is an analog to c. tetani?
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Stryck 9
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What is the treatment for c. tetani?
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Vaccinate- give toxoid for infection- antitoxin first, then antibiotics
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How does c. botulinum work?
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Causes flaccid paralysis by blocking the release of presynaptic AcH
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What is c. botulinum associated with?
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Honey and malaises in babies canned food in adults
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What is c. melanogosepticus associated with?
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Colon cancer
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What is the only gram + to form an endotoxin?
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Lysteria monocytogenes
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What do adults get with a lysteria monocytogenes infection?
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Gastroenteritis
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What do babies get with a lysteria monocytogenes infection?
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Meningitis
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What is a lysteria monocytogenes infection associated with?
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Cabbage and migrant workers
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What shape is lysteria monocytogenes?
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Comma shaped
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What are the 4 comma shaped bacteria?
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Lysteria monocytogenes, vibrio, h, pylori, c. jejuni
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What type of bug is propionobacterium acne?
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Gram + anaerobe- hides in hair follicles
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Propionobacterium has Affinity for?
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Propionic acid found in sebaceous glands and Progesterone.
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When do females get acne the most?
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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
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Retinoic Acid Acne Tx
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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
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Retinoic Acid AE
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Photosensitivity (b/c new immature skin cells susceptible to damage). Absorbed in ileum→ Hyperlipidemia. Fat soluble→ teratogenic
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When do you refer to dermatologist?
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Cystic acne, or Nodular acne
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What 5 things cause monocytosis?
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STELS syphilis, TB, EBV, lysteria monocytogenes, salmonella typhi
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What is the movement of lysteria monocytogenes described as?
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Tumbling motility
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How do you treat lysteria monocytogenes?
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Ampicillin, macrolides, vancomycin
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Eye Bugs
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Staph Aureus, H. aegyptus, Francisella trularenis, Pseudomonas, Chlamydia, Bacillus Cereus
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Staph Aureus in Eye
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Stye
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Hemophilus aegyptus in eye?
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Swollen eyeball w/ pus
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Francisella tularenis in eye?
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Red eye, swollen glands, rabbits, deer
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Pseudomonas in eye?
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Contact lens keratitis
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Chlamydia in eye?
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Retina cotton exudate
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Bacillus Cereus in eye?
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Drug user proptosis, eye ring abscess
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Mouth/Throat/Esophagus Bugs
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Strep Pyogenes (#1) back of throat. Strep Pneumonia, H. influenza, N.Catarrhalis, Meningitis, gonorrhea
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Strep Pyogenes causes
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> Fever, Post strep GN (strain 12)
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Rheumatic Fever Jones Criteria= SPECC
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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
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Acute Rheumatic Fever Carditis
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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.
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Chronic Rheumatic fever
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Endocarditis. Long term will have valves affected #1 MS>>AS/MS>> AS>> TS (4th)
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Revised Jones Criteria: MAJOR criteria
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1. Carditis, 2. Erythema marginatun, 3. Subcutaneous nodules, 4. Sydenham’s chorea, 5. Polyarthritis
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Revised Jones: MINOR criteria
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1. Fever, 2. Polyarthralgias, 3. Reversible prolongation of PR interval. 4. Elevated ESR or CRP
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Revised Jones Criteria Supporting Evidence
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1. Positive Throat culture or Rapid streptococcal antigen test. 2. Elevated or rising Streptococcal Antibody Titer
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How do you make Rheumatic Fever Diagnosis?
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2 Major and a preceding Strep throat OR can dx w/ just Chorea and a preceding Strep throat confirmed by culture or ASO titer
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IgA protease Bugs in Mouth/Throat/Esophagus
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N. Catarrhalis, Meningitis, Gonorrhea. Allows bacteria to live in mouth w/out IgA killing them
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# 1 way to paralyze cilia
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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
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MCC of sinusitis, Otitis, Meningitis, bronchitis, pneumonia
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In this order: S. Pneumonia, H. Influenza, Neisseria
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Otitis Externa can be caused by which bugs?
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Pseudomonas aeruginosa, Strep pneumoniae
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Gram+ Faculative Anaerobes in GUMS
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classic clue: Foul smell and Gas. Peptococcus, peptostreptococcus, Fusobacterium, Actinomyces, Strep viridans
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Fusobacterium
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Painful ulcers, gum pus. Fused at edges, tapered at both ends. Vincent Angina, Trench mouth.
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Vincent’s Angina
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painful ulcers in back of throat
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Trench Mouth
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pus oozing from gums
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Actinomyces
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Sulfur granules, Fistula tracts or draining fistula
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MCC of Subacute Bacterial Endocarditis
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Strep Viridans. Left sided HD. Mitral Regurg highest risk
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DOC Subacute Bacterial Endocarditis
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Amoxicillin 3 gms 2 hrs b4 procedure and 1.5 gms during procedure
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Strep Mutans
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dental caries→ ferments glucose→lactic acid
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Strep Salivarius
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Ag is used to perform Cold Agglutinin Test. Cryoglobulinemia
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Cryoglobulinemia
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=acute Ix, therefore involves IgM. Non-bacterial; acute inflammation
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5 infections that cause Cryoglobulinemia
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IAM HE- Influenza, Adenovirus, Mycoplasma, Hepatitis, EBV
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Eikenella found in?
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Mouth flora. Human Bite (Tx: Augmentin)
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Throat Bugs:
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Strep pyogenes, Group C Strep (pharyngitis), N. Gonorrhea (pharyngitis w/ oral sex), Corynebacterium diptheriae
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Corynebacterium diptheria looks like? Can cause?
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Chinesse letters, gray pseudomembrane, suffocation. GRAM + ROD
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C. diptheriae is notorious for causing?
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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
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Gray Pseudomembrane
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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
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C. diptheria Treatment
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Anti-Toxin (tetatnus), then antibiotics, then Intubate pt.
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C. diptheria Anti-toxin Tx (Tetatnus) can cause?
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HEART BLOCK⇒ prolonged PR interval, recurrent laryngeal nerve palsey
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Elek Test
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pathogenic strain of C. Diptheria has a temperate bacteriophage
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LUNG: strep pneumonia
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Gram + diplococci
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LUNG: H. influenza B
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Thumb sign epiglottitis
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LUNG: N. catarrhalis
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mucus
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LUNG: Chlamydia psittaci
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parakeets, parrots
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LUNG: Chlamydia pneumonia
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Staccato coughing, elementary reticular bodies
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LUNG: Mycoplasma pneumonia
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bullous myringitis, ground glass CXR
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LUNG: Legionella pneumonia
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AC ducts, silver stains lung, CYEA
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LUNG: Pneumocystis jirovecii
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AIDS, premies, silver stains
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LUNG: Clostridium botulism
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Canned food, honey, inhibits Ach release
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LUNG: Clostridum tetani
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Rusty nail wounds, inhibits Gly release
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LUNG: Bordetella pertussis
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Whooping cough
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LUNG: Bacillus antrhacis
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Black eschar, woolsorter’s lung disease
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H. Pylori Tx
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Amoxicillin, Tetracycline/Metronidazole, Bismuth (suffocates bacteria), H2 blocker/pump blocker
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SI normal flora are what kind of bugs?
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95% are oxygenated→ Faculative Aerobes. MC Ecoli
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E.Coli Propertiies
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(Gram Negative ROD, Faculative Anaerobe, can ferment BOTH glucose and lactose.
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Vitamins produced by E.Coli
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90% of Vitamin K made from them. Folate, Biotin, Pantothenic acid (vitamin B4), helps absorb vitamin B12 in ileium
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2 enzymes which require vitamin B12
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Homocystine Methyl Transferase, Methyl-Malonyl CoA Mutase
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E.Coli is MC cause of?
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Cholecystitis (Gallbladder), Ascending Cholangitis (biliary Tract- Incrased ALP), Appendicitis, Spontaneous Bacterial peritonitis, and Abdominal Abscesses, Travelers diarrhea
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MCC of Apendicitis
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Trapped Fecalith and you get visceral pain b4 somatic pain
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Intestinal Abscess w/ PERFORATION most commonly d/t?
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Anaerobe
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Distal Ileium and Colon most bugs are?
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Gram -. 95% of gas is CO2 also not exposed to Oxygen.
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COLON: Salmonella
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raw chicken & eggs, turtles, rose typhoid spots
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COLON: Campylobacter jejuni
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Raw chicken & eggs, very bloody diarrhea
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COLON: C. perfinges
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Holidary ham and turkey, DM gas gangrene
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COLON: Bacillus cereus
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Fried Rice
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COLON: L. monocytogenes
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raw cabbage, hot dogs, spoiled milk, migrant worker
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COLON: Staph Aureus
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Milk
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COLON: Vibrio parahaemolyticus
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raw fish
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COLON: HepA
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Shellfish
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COLON: Vibrio vulnificus
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Oysters
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COLON: Shigella
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Day care outbreaks→ seizurs
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COLON: V. Cholera
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Rice water diarrhea
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COLON: Yersinia enterolitica
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presents like appendicitis+ reiter’s
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COLON: Strep Bovis
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colon cancer
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COLON: Clostridium septicum
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colon cancer
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COLON: Bacteroides fragilis
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Post-op pelvic abscess
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Urinary Tract: E.Coli
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Raw hamburger
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Urinary Tract: Proteus mirabilis
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Staghorn calculus
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Urinary Tract: Klebisella Pneumonia
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alcoholics, current jelly sputum
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Urinary Tract: Staph Saprophyticus
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young girls/college girls UTI
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Urinary Tract: Enterococcus
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nitrite negative
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Proteus Mirabilis is found in?
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Colon. MC Urease+ bug in body (can cause Struvite Stones). 2nd line in UTI
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Proteus Mirabilis Tx:
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Norfloxacin
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Klebsiella Pneumonia
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Colon. 3rd line for UTI. Encapsulated. Curant jelly sputum.
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MC in Alcoholics and homeless
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Klebsiella Pneumonia
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What bug likes to hang out in fissures of lung and cause PN?
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Klebsiella Pneumonia
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Serratia marcescens
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colon. Pruduces a RED pigment
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Citrobacter found in? produces?
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Colon. Encapsulated. Produces Citric acid
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Citrobacter likes to attack?
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Newborns b/w 0-2 months of age. Multiple cerebral Abscesses
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Acinetobacter found in?
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colon. In IC pt on ventilator or in hospital
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Enterobacter found in?
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colon. MCC of nitrite (-) UTI
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Clostridium difficile found in?
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Colon. Pseudomembranous colitis d/t chronic antibiotic use (esp. Clindamycin). Gastroenteritis after antibiotic use
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Clostridium perfinges found in?
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Colon. Gastroenteritis associated w/ holiday ham.
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Rectum normal flora?
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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)
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Blood- N.meningitidis
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DIC, Waterhouse-Friedrichson (adrenal hemorrhage)
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Blood- N. Gonorrhea
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Fitz-Hugh-Curtis (liver hemorrhage)
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Blood- Brucella
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Farmers, veternarians, spiking fever 5x/day, butchers
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Blood- Pasteurella multocida
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Cat/dog saliva (Tx: amoxicillin-Clavulanic acid)
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Blood- R.rikettsii
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Ticks⇒ RMSF
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Blood- R. akari
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Mites⇒ Ricketsial pox, fleshy papules
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Blood- R. typhi
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fleas, endemic typhus
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Blood- R. Prowazekii
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Lice, epidemic typhus
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Blood- R. tsutsugamushi
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Mites→ scrub typhus
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Blood- Coxiella burnetii
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Dusty barn→ Q fever, lung disease
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Lymph bugs?
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Yersinia Pestis, Bartonella henselae
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Yersinia pestis
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rats, fleas⇒ Bubonic Plague
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Bartonella henselae
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cat scratch—single painful LN in armpit (Tx: Bactrim or Erythromycin)
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Enterococcus
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Anaerobic, Gamma Hemolytic. Nitrite negative, Gram + Cocci (Faecalis, Faecium)
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Enterococcus can cause?
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Infectious Endocarditis after GI/GU problems; UTIs/ . Likes IC pts
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Etnerococcus Tx?
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Vancomycin
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Vancomycin Tx for?
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MRSA, Staph epidermis, Enterococcus
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Vancomycin MOA
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Cell wall Inhibitor. Inhibits Phospholipids carrier (NAM-NAG), Irreversible (non-competitive inhibitor)
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Vancomycin Tx for?
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ALL GRAM +
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Vancomycin Toxicity
|
Ototoxicity, nephrotoxicity, RED MAN Syndrome ( d/t intense histamine release, NOT an allergic response)
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Diarrhea 0-8 hrs?
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Preformed Toxins (Staph aureus, Bacillus cereus, Clostridium)
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Staph Areus
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Gram + Cocci in CLUSTERS, Coagulase +, Catalase+
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Stap Aureus Enzymes
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Catalase, Beta-Lactamase, Coagulase, Staphylokinase, Lipase, Elastase, Collagenase
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Staph Aureus Catalase enzyme does what?
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Breaks down Hydrogen Peroxide
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Staph Aureus B-lactamase enzyme does what?
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Bks thru B lactam containing drugs; ie able to destroy Penicillins and Cephalosporins.
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What is responsible for Staph Aureus Resistance?
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B-lactamase
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Staph aureus coagulase and Stpahylokinase enzymes do what?
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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)
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Staph aureus Lipase enzyme?
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Bks down and eats thru fat. Ex. Panniculitis (subqt fat), Folliculitis (vase of hair follicle), Mastitis
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Staph Aureus Elastase enzyme?
|
Cuts to RIGHT of Glycine, Alanine, Serine. Can cause Bullous Emphysema/pneumatocele (Pneumonia 2 weeks after flue) Acute bacterial Endocarditis
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Panacinar Emphysema
|
alpha1-antitrypsin deficiency
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Centroacinar emphysema
|
smoking
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Distal acinar emphysema
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Ageing
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Bullous emphysema from S. aureus is d/t
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Elastase
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Staph Aureus Collagenase Enzyme?
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Affects skin and bones by eating thru collagen. MCC of Osteomyelitis (Salmonella is 2nd MCC of Bone Ix)
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Osteomyelitis Diagnosis
|
cant see it in 1st week on X-ray, ie do Bone Scan
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Osteomyelitis
|
except sickle cell and salmonella. MC Staph Aureus
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Staph Aureus Collagen Type I
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skin
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Staph Aureus Collagen Type II
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Connective Tissue. MCC Fasciitis and Septic Arthritis (gonorrhea #2), and Folliculitis
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Staph Aureus Collagen Type III
|
Endothelium-arteries affected.--> Vasculitis (will see shistocytes)
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Staph Aureus Collagen Type IV
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Basement Membrane. Scalded Skin, Kidney, Lung also affected. Can bleed into lungs and kidney
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Paronychia
|
infection of skin around nail margin. MC d/t Staph aureus
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Staph Aureus Toxins
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Erythrodermix Toxin, Lecithinase, TSST, Exfoliatin/SSSS-T, Enterotoxin
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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).
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Staph Aureus Lecithinase
|
eats Connective tissue. Causes Skin Ix→ Subcutaneous fat.
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TSST: Toxic Shock Syndrome Triad:
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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.
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S. Aureus Exfoliatin Toxin
|
aka SSSS-T causes Staph Scalded Skin Syndrome
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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!
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+Nikolsky sign is seen in?
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SSS, Toxic Epidermal Necrolysis, Bullous Pemphigus
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Staph Aureus Enterotoxin
|
causes Staph Aureus Gastroenteritis- food poisoning associated w/ DAIRY products→ Gastritis (ex. Custard pie)
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Elastase
|
acute bacterial endocarditis, pneumonia 2 weeks after flu
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Collagenase
|
eats collagen
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Lipase
|
eats fat⇒ panniculitis
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Beta lactamase
|
eats penicillin
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Coagulase
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eats thru clots
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Acute Bacterial Endocarditis
|
staph aureus (attacks tricuspid valve)
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Subacute bacterial endocaritid
|
strep viridans (attacks mitral valves)
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Bacterial Endocarditis Tx
|
Nafcillin+ Gentamycin for 4 weeks
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Staph Infections usually arrive after?
|
Flu-like symptoms
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Staph Aureus Treatment?
|
Vancomycin (Best but expensive), Macrolides, Chloramphenicol, 1st generation Cephalosporins, Quinolones
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Staph Epidermis
|
Gram + CLUSTERS; under epidermis. Coag+, Catalase -, Novobiocin sensitive. White Pigment
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Staph epidermis Tx:
|
Vancomycin (DOC), Daptomycin, Tigacyclin. Linezolid for VRE (usually in armpits or groin).
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Linezolid Class and MOA
|
Synthetic, class of Oxazolidinones. Disrupts bacterial growth by inhibiting Initiation process in protein synthesis.
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Staph Saprophyticus
|
Coagulase -, Novobiocin resistant. NO PIGMENT. Can cause “honeymooner’s cystitis”
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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)
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MC cause of UTI
|
E.Coli
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Streptococcus Species Immunity is?
|
Type specific, ie why u can get recurrent Strep Ix
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Streptococcus General Characteristics
|
Gram + cocci in CHAINS. Groups ABCD
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Streptococcus Alpha-Hemolysis
|
partial hemolysis→ GREEN zone
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Strep Beta-Hemolysis
|
Complete Hemolysis→ CLEAR zone
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Strep Gamma Hemolysis
|
No hemolysis→ RED zone
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What enzyme is responsible for Beta Hemolysis?
|
Streptokinase.
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Streptokinase action?
|
Used to break up clots by converting plasminogen to plasmin and it also binds up Fibrinogen in acute MI
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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.
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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
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How does tPA work?
|
Converts plasminogen→ plasmin→ bks up clot. Bind up fibrinogen→ wont allow for anymore clots
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tPA adverse effects
|
1-3% bleed to death.
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APSAC (aminocaproic acid) can induce?
|
tPA reversal
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Strep Pyogenes GROUP A
|
Beta hemolytic. Has an “A” protein, 60 different strains
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Strep on Skin or throat can lead to?
|
PSGN (subEPIthelial humps). Only Strep throat→ Rheumatic fever
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Strep Agalactiae
|
“Group B strep”. Beta-hemolytic. Child meningitis. #1 cause of Neonatal sepsis or meningitis in first 2 months of life
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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.
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Group C strep
|
No name, does cause pharyngitis
|
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Streph Pharyngitis
|
Anterior cervical nodes. Tx: Penicillin G
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Strep Pneumoniae
|
aka Pneumococcus (only gram + diploocci). Alpha hemolysis. 80 strains. has IgA protease
|
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How is Strep Pneumonia identified?
|
“M” Protein= Sugar capsule polysaccharide. Will see (+) Quelling Rxn. Rust-Colored Sputum*
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Pneumoccoccal Vaccine (Pneumovax)
|
covers 23 strains, accts for 98% of Ix by Strep Pneumoniae
|
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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.
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Kerr sign
|
anytime have splenic rupture and bleeds under diaphragm, your LEFT shoulder will hurt= Kerr sign
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MCC of splenectomy
|
#1 Trauma, #2- Cancer
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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
|
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Strep Pneumonia age range?
|
>2 yrs old Sickle Cell pts, >65 yrs old
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Strep Viridans
|
Group D- mutans, sanguis, salivarius. Produces Green pigment. Alpha Hemolytic.
|
|
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Strep Mutans causes
|
cavities by converting/fermenting glucose→ lactic acid; MCC of SBE of Mitral Valve
|
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Strep Salivarius
|
used in cold agglutinin test in cryo (IgM antibody; acute inflam; non bacterial)
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Mycotic Aneurysm
|
SBE. Septic emboli to the brain
|
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Roth Spots
|
SBE. Septic emboli to retina
|
|
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Osler’s nodes
|
SBE. PAINFUL septic emboli to fingers/toes
|
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Janeway Lesions
|
SBE. Non-painful septic emboli to fingers/toes
|
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Splinter hemorrhages
|
SBE. Septic emboli to nail bed
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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
|
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|
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)
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|
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)
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|
How is Bacillus characterized?
|
1. chains of Large Gram positive rods 2. Spore forming 3. Protein capsule
|
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|
Which bacteria have a protein capsule?
|
Bacillus anthracis (the only one)
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Baccillus Anthracis (anthrax) can cause 2 types of Infections?
|
Skin (cutaneous anthrax), Pulmonary Anthrax (Woolsorter’s disease)
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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
|
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|
Bacillus Anthracis Toxins
|
Edema Factor, Protector Factor, Lethal Factor (one causing death)
|
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|
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
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|
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
|
