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237 Cards in this Set
- Front
- Back
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Staph aureus color, Staph epidermidis color
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yellow, white
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S aureus virulence factors
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Protein A, teichoic acid (adherence), Capsule (inhibits phagocytosis)
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S aureus penicillin resistance?
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yes
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S aureus preferentially colonizes the ?
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nares
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For culturing staph, what is a nonselective media, and a selective media?
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sheep blood and chocolate agar are none selective, mannitol salt agar is selective
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Strep mode of metabolism?
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Oxygen tolerant anaerobic
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Strep A, hemolysis, bacitracin, pyrase,
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Beta, sensitive, positive (red)
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Pneumonia
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lecture
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Most common causitive agent
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Bacterial
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pathophysiology, 4 steps
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1. Infection of lung parenchyma by organism
2. Neutrophils migrate: pulm capiliaries alveolar spaces 3. Neutrophils phagocytose & kill injested microbe 4. Inflammation neutrophilic exudate in alveolar spaces – prevents O2 exchange (SOB) |
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Most common cause of pneumonia
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S. pneumoniae
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X-ray finding for inhalation of anthrax
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wide mediastinum
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S. pneumoniae penicillin resistence?
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yes
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Strain associated with COPD and alcoholism
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Hemophilus influenzae (penicillin resistant)
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Describe Hib vaccine
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Conjugate vaccine w/Type B polysacch
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Aspiration pneumonia, Abscess in lungs, Alcoholics, diAbetics” think....
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Klebsiella pneumoniae
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CXR presentation of Klebsiella
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CRX: upper lobe w/bulging fissure – classic presentation
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Sputum in Klebsiella
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red curant jelly
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This bacteria commonly follows H. Influenzae
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S. aureus
Staphylococcal Pneumonia |
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Pneumonia with high fevers and fiegets sign think....
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Legionella
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CXR appears worse then symptoms, walking pneumonia think....
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Mycoplasma pneumoniae
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Pneumonia in college students think....
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Chlamydophilia
Pneumoniae |
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Are the majority of bacteria in aspiration pneumonia anaerobic or aerobic.
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ANaerobic AspiratioN
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Nosocomial pneumonia is due to _____ gram ____ bacteria
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aerobic gram negative
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Characteristics of empyema
pH, glucose, gram stain, ldh |
low ph, low glucose, gram positive, high ldh
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Neisseria mode of metabolism and appearance
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aerobic gram negative diplococci
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Confirmation of the presence of Neisseria is based on a series of ________ fermentations
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carbohydrate
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Serogroups of N. Menigintidis based on
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capsular polysacchiride
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Serotypes based on
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outer membrane protein
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Only bacterial meningitis associated with epidemics?
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Meningococcal Meningitis
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Most cases are due to which serogroup
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b
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Most cases of meningitus are caused by
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strep pneumoniae, most common cause of adult menigitis
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petechial rash think....
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Meningococcemia
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Clinical manifestations of Meningococcemia
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aprehension, delirium, rapid progression, shock, high mortality
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Neck stiffness think...
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meningitis in adults, young children may only have fever and vomiting
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Classic medium for culturing Neisseria is?
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Thayer-Martin, chocolate agar with antibiotics that kill competing bacteria.
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Treat Neiserria meningitidis with
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cephalosporins
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Who gets meningococcal chemoprophylaxis?
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only those that come into close contact, give rifampin, ceftriaxone, or cipro
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Function of por protein (1) in N. Gonorrhoaea
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prevents phagolysosome fusion in neutrophils
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Function of Opa Protein (2)
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mediates attachment to epithelial cells and invasion into cells
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Function of lactoferrin binding protein
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abstracts iron
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Pathogenesis of N. Gonorrhoae
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ciliary stasis
death of ciliated cells attachment internalization intracellular replication intracellular traffic exocytosis |
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N. Gonorrhoae infection in men restricted to
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urethra
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N. Gonorrhoae infection in women restricted to
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cervix
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Pustular skin lesion think
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N. Gonorrhoae
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N. Gonorrhoae treatment
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ceftriaxone
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Moraxella commonly seen in patients with?
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COPD
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Otitis media and Sinunitus think?
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Moraxella catarrhalis
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Treament of Moraxella
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very resistant, use broad spectrum
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- Lactose fermenters
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SCEEK
Serratia, Cirobacter, E. coli, Enterobacter, Klebsiella Salmonella, Shigella & Pseudomonas aeruginosa DO NOT |
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- MacConkey Agar
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- Lactose fermentors RED – colonies are red at low pH
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Enterobacteriacea generalities
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-Doesn’t cause sore-throat
-Think COFFEe Capsular O antigen – polysach. of endotoxin Flagellar antigen Ferment glucose Enterobacteriacae |
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Most common cause of UTI, and travelers diarrhea (adults)
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E-Coli
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Pneumonia – debilitated PTs
(Red currant jelly sputum cavitary), think |
Klebsiella
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Bright Red Pigment produced by prodigiosin think
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Serratia (Lactose fermentor (SCEEK)
slow fermentor) -Model: airborne dissemination of bioterrorism -Can survive some disinfectants & non-bacterial soaps; related to outbreaks |
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Plague (bubonic, septicemic, and pnemonic)
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Yersinia Pestis
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OUTBREAK: blood bank, chocolate milk
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Yersinia Enterocolitica
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Yersinia staining uniqueness?
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bipolar staining
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ONLY seen in hospital think...
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Acinetobacter
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-Most frequent wound infection following cat/dog bite/scratch think...
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Pasteurella mulocida
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Outbreaks cruise ships (japan) think....
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Vibrios parahaemolyticus
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leeches think...
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Aeromonas
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New Orleans, oysters – alcoholics (cirrhosis ) think...
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v. vulnificus, rapidly progressive cellulitis with bacteremia, abrupt onset fevors, high mortality
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Unpasteurized milk, Undulant fever, feral pigs, animal workers think
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Brucellosis
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Where does Brucellosis live and multiply?
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Facultative intracellular parasite – multiplies in macrophages. (requires cell-mediated immunity to control), first infects lymph nodes, disseminates to liver, spleen, kidney
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Transmitted via cat flea, Bacillary angiomatosis, think
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Bartonella henselae
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Trench fever think
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Bartonella Quintana
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Andes mountains, Oroya Fever,
Bacteria penetrate RBCs (like malaria) – Carrion’s Disease: Bi-phasic -Acute: Fever, myalgia, headache -Chronic: Verruga peruana (cutaneous nodules) after 1-2 mos; may persist for yrs |
Bartonella baciiliformis
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Psedomonas aeruginosa
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Simon
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Metabolism, fermentation? oxidase? pyocynanin?
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-Gram (–) Bacillus
-Nonsporulating -Obligate aerobe except w/nitrate. -Non-fermentor -Oxidase (+) – has cyt oxidase a3. -Pyocyanin blue-green |
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“Be Pseudo"
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Burns
Endocarditis (IVDA) Pneumonia (CF) Sepsis (↑mortality) External Otitis (malignant) UTI Diabetics get.. Osteomyletis |
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#2 nosocomial pathogen
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Pseduomonas, #1 is E.Coli
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4 predisposing factors,
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immunosupression, icu, cystic fibrosis, prolonged hospitalization
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Colinization
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found on skin, moist environments
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Function of exotoxin A
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inhibits protein syn. (ADP ribosylation of EF-2
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Function of exoenzyme S
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: inhibits proteins syn.; promotes dissemination (tissues
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What allows it to produce reactive oxygen species?
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pyocyanin
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How does it protect itself from radicals
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superoxide dismutase
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lesions on butt?
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Whirl Pool Folliculitis
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Neutropenic Cancer PTs are prone to?
SPEK |
E. Coli
Klebsiella Pseudomonas S. Arueas |
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-Endocarditis in IV drug users (Detroit). think....
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Think Psuedo
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Uti Predisposing factors 4
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anatomic (short urethra), sex, foley cathetars, nosocomial
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most abundant protein in urine: binds E. Coli and prevents epithelial cell attachment.
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Tamm-Horsfall protein
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: recognizes bacterial polysaccharides; abundantly expressed in bladder & kidney
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TLR11
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most common route of infection, ascending or descending
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ascending is most common: rectal flora perineal colonization vaginal colonization introital colonization urethra bladder ( kidney).
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introital colonization is associated with?
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vaginal pH, & ↑’d w/antibiotics (esp β-lactams).
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Community aquired UTI is most likely
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Ecoli or Saprophyticus
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Hospital aquired UTI is most likely
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Pseudomonas
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Is preexisting antibody to a UTI infection preventative?
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-pre-existing Ab to the infecting org is NOT protective, immune system has little role in UTIs: NO increased incidence of UTIs in patients w/humoral or cellular immune deficiencies
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Most correlated with antibody response, upper tract or lower tract infection?
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upper
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WBC casts think...
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pyelonephritis upper tract
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What bacteria causes renal failure?
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bacterial infections don’t cause renal failure unless there is an obstruction.
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Who should not be treated for asymtomatic bacteruria
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don’t treat in adults (esp elderly) b/c tx associated w/higher mortality, treat in pregnant women and kids
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T/F ALL UTIs are ANATOMICAL
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T
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Acute Bacterial Prostatitus most commonly caused by
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E.Coli
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Prostatitis symptoms
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fever, bank pain, chills
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appearance of prostate
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warm, swollen, tender
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T/F you should massage a prostate that is inflammed.
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NO PROSTATE MASSAGE
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How is chronic prostatitus different from acute?
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non-bacterial
may be asymptomatic massage may be done |
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Problems with Prostate treatment
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hard to penetrate prostate, treat for 3 weeks.
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Fever
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Fever
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Signals received by the pre-optic nucleus are sent from the _____ hypothalamus to the _____ hypothalamus – location of the hypothalamic set point
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anterior to posterior
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example of a pyrogen
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LPS
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example of endogenous pyrogen 3
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Il-1, TNFa, IFNg
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normal fever range
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35.6 – 38.2
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two pathways to fever
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1) IL-1 ant hypothalmus, protaglandins, post hypothalmust, change set point
2)local inflammation, thermosensitive neurons, signal to ant hypothalus |
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In what situation is it better to treat the fever over the infection
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if a cns injury is present
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Fever of unknown origin
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> 3 weeks of fever (>38.4oC)
Infection most common cause Avoid “therapeutic” trials of antibiotics Make a diagnosis first |
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Acetaminophen in children may promote
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Reyes syndrome
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_
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_
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_
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_
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Sepsis
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Sepsi
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Define Bacteremia
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bacteria in blood (bad)
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Define Sepsis
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Bacteremia PLUS signs of systemic inflammatory response
Fever, tachycardia, hypotension, etc |
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Define Septic Shock
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Sepsis PLUS signs of end-organ hypoperfusion
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Septic shock more likely to be cause by Gram- or Gram+
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Gram Negative
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Sepsis caused mostly by Gram- or Gram+
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Gram +, Used to be Gram -
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Most common cause of bacteremia?
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Ecoli
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Most common cause of death due to bacteremia is caused by what organism?
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Psuedo due to debilitated host
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the TWO MAIN mediators of the pro-inflammatory response in sepsis.
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Interleukin-1 (IL-1)
Tumor necrosis factor-α (TNFα) |
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Toxins that cause sepsis similar to LPS are known as?
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Superantigens
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D-dimers are markers for what process?
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DIC
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DIC is treated with?
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anticoagulative factors
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Describe the anti-inflammatory response seen in sepsis
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Shift from a Th1 to a Th2 response to infection
See apoptosis of lymphocytes and secondary infection due to immunosuppresion |
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Clinical Manifestations of Shock on cardiovascular system 4
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reduced tpr
Compensatory increase in cardiac output Direct suppressive effect of LPS on myocardial contractility Shock results when heart cannot compensate for reduced SVR |
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Shocks effect on respiratory system
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Acute Respiratory Distress syndrome which is caused by increased microvascular permeability
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What is an anticoagulant used to treat sepsis?
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Protein C
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A prime function of IL-1 and TNFα
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up-regulate adhesion molecules in neutrophils and endothelial cells and cause their activation
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upregulation of this stimulates coagulation
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tissue factor
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Gram negative most common site of infection
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UTI
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Organs most affected by hypotension in order from first to last
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Hypotension first hits the kidneys, then the lungs, then the gut, then the heart, brain
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What Interlekins shift TH1 to TH2
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Il-6 and Il-10
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Most common bug acute endocarditus
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Staphylococcus aureus most common bug
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Most common bug subacute endocarditus
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Viridans Streptococci
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Endocarditus pathogenesis, 2 steps
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non-bacterial thrombotic endocartitus, transient bacteremia
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Strep. bovis: think....
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Colon Cancer
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Prosthetic valve endocarditis causes, 2, one is early, one is late
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Early (<60 days post-surgery): S. aureus, CNS
Late: viridans Streptococci |
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Valve commonly effected in IV drug uses?
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tricupsid (right heart)
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IV drug users are susceptible to what bacteria? 2
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s. aureus, pseudo
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Classic presentation of endocarditis
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fever, anemia, changing murmor
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Peripheral Manifestations of Endocarditis beginning with, C,S,O,J,R
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Conjunctival petecchiae
Splinter hemorrhages: nail beds Osler’s nodes: painful nodules on pads of fingers and toes Immune complex vasculitis Janeway lesions: non-tender erythematous macules on palms and soles Micro-abscesses Roth’s spots: retinal hemorrhages Immune complex vasculitis |
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Three lab finding in endocarditis beginning, A,T,M
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Anemia
Thrombocytopenia Microscopic hematuria |
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Echocardiogram with more sensitiviy for detecting endocarditis
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Transesophageal (TEE) has higher sensitivity than transthoracic (TTE) therefore is preferred
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Two categories of people that should be given antibiotic prophylaxis for endocarditis
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those having dental procedures,
and Give to high risk ONLY: Prior endocarditis Prosthetic valve Heart transplant with valve abnormalities Complicated congenital heart disease |
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What time should surgery be performed in a patient with endocarditis that requires surgery?
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ASAP
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-
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-
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-
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-
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Gram Positive Rods
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Gram Positive Rods
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Bacillus antracis spore forming or non spore forming
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spores
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Three virulence factors of anthrax
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lethal toxin, edema toxin, capsule
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CXR or anthrax
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wide mediastinum
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Clinical phases of Respiratory Anthrax
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initial 1-3 days - maliaise
secondary 1-2days, sudden progression to death |
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Two types of GI Anthrax
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abdominal and oropharnygeal
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Best way to control antrax
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controll it in animals first
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Bacillus cereus spore forming, or non spore forming
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spore forming
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Rice contaminated with bacteria think
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Bacillus ceres
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Two types of B. Cereus food poisoning
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Emetic and Diarrheal
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C. diptheriae shape on gram stain
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club shaped
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C. diptheriae transmission
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airborne droplets, colder months, crowded conditions
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C. diptheriae produces inflammation first in what location
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exudate in pharynx/trachea
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Soft tissue of neck swells, called a bull neck.... think
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C. diptheriae
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describe C. diptheriae exudate
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tough, leathery, grey
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C. diptheriae will travel two places after setting up camp in the pharynx
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cardiac toxicity, neurologic toxicity
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Listeria monocytogenes mode of transmission
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veritical
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Population at risk for Listeria monocytogenes
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old, young, pregnant, immunosuprresed
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Listeria monocytogenes incubation period
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11-70 days
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Listeria monocytogenes is enhaced by what medication
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H2 blockers
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Listeria monocytogenes lives
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intracelluarlly
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What is Granulomatosis Infantiseptica and what causes it
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Listeria monocytogenes, granulomas in infants
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Swine worker, skin lesion, diffuse rash, endocarditus think....
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Erysipelothrix
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95% of anthrax infections are of what manifestation
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cutaneous
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Bacillus ocular infections are caused by antracis or cereus, and what patient population is at risk
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cereus, IV drug users
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Bacillus Cereus rice causes
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emetic food posinening
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Bacillus Cereus meats or vegetables cause
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diarrheal food posinening
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C. Diptheriae rods are shapped like?
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clubs, chinese characters
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C. Diptheriae transmission takes place via?
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airborne droplets
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Listeria Mono horizontal transmission occurs via
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zoonosis, unpasterized milk
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Listeria Mono lives inside what type of cell?
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Macrophages
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Mycoplasma P. pathogenesis
|
affinity for epithelium, contributes to loss of cillia from host
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Mycoplasma and Ureaplasma appearance on agar
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fried egg, except Mycoplasma P. which has a mulberry appearance
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Mycoplasma P. is spread via
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aerolized droplets, single cases or mini epidemics are common
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Mycoplasma P. two clinical presentations
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Tracheobronchitis and atypical pneumonia
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Mycoplasma P. feature that may distinguish it from other atypical pnuemonias
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bullous myringitis
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What is responsilbe for causing Raynauds Phenomenon in Mycoplasma P.
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cold agglutinins
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Chlamydia morphology
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gram negative, intracelluar
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Chlamydia form that is infectious
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elementary body
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Chlamydia form that replictates
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reticulate body
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Chlamydia trachomatis clinical manifestations,
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Urethritis/Cervicits
Lymphogranuloma venerum ocular infection |
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Chlamydia trach infects what type of cells
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non-cilliated columnar epithelial cells
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birds are natural resovior, pneumonitis think
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Chlamydia psittaci
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Bordetella Pertussis transmitted via
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inhalation of aerolized bacteria
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Bordetella Pertussis attached to what cells
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cilliated epithelial cells of the bronchial tree
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3 viruluence factors of Bordetella Pertussis
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Filamentous hemagglutin - blocks phagocytosis, binds to cillia
Pertussis toxin - increases mucus secretion, prometes leukocytosis, Bacterial pili/pertactin - attachment of bacteria to respiratory epithelium |
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4 stages of Bordetella Pertussis
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incubation 7-21 days
catarrhal 1-2wks malaise paroxsymal 2-4 weeks whoop convalescent month pneumonia/cns |
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Bordetella Pertussis main cause of mortality
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complication from aspiration pnemonia
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Haemophilus influenzae growth requires what 2 supplements
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x factor and v factor
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HIB vaccine is made against what strain of Haemophilus influenzae
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B type capsule
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Haemophilus influenzae transmission occurs via
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contact secretions or airborne droplets
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Haemophilus influenzae virulence factors 4
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capsule
LPS Outer membrane proteins - iron scanvanging Fimbriae - enhance adherance present in all types |
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Clinical syndromes of Haemophilus influenzae
5 |
Arthritus
epliglotitus meningitis otitis media sinusitis |
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Haemophilus influenzae sinusitis is caused by what type of Haemophilus influenzae
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non-encapsulated strain
|
|
|
most common cause of otitis media in children
|
Haemophilus influenzae
|
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|
std common in men, tender papule with erthematous base on the genital or perianal area think
|
H. ducreyi, Chancroid
|
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Legionella pneumophila morphology
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gram neg, aerobic, intracellular
|
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Legionella pneumophila grows on this media
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charcoal yeast enriched media
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Legionella pneumophila most cases are in
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summer/fall
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Legionella pneumophila pathogenesis
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engulfed by macrophages
multiplies macrophage is killed bacteria release |
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Legionella pneumophila clinical manifestation
|
pulmonary infiltrates multi-lobar
DIC pleuritus, empyema, cavitary lung disease essentially intense inflammatory changes |
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Legionella pneumophila, extrapulmonary legionellosis occurs in?
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immunocomprimised hosts via bacteremic spread
|
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-
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-
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-
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-
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-
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-
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Skin/Soft Tissue /Bone
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Skin/Soft Tissue /Bone
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When dealing with skin infections always keep what bug in mind
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Staph A. and MSRA
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Impetigo site, bugs, and clinical features
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intraepidermal, Group A strep, Staph A, "golden stuck on crusts"
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Folliculitis site, bugs, and clinical features
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hair follicule, staph a, pustules
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Furuncles site, bugs, and clinical features
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hair follicule, staph a, deeper nodule that becomes an abscess
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Carbuncle site, bugs, and clinical features
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hair follicule/subcutaneous fat, staph a, acutley ill, develops from furnuncle, multiple drainage sites for pus
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Ecthyma, site, bugs, and clinical features
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penetrates epidermis and dermis, group a strep, punched out uclers
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Erysipelas site, bugs, comments
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Superificial cellulitis with lymphatic involvement, GAS, Lymphatic obstruction is risk factor
Sharp demarcation of bright red lesion |
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Cellulitis site, bugs, comments
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Cut and subcut, GAS, MRSA, Spreading infection
portal of entry associated lymphangitis with GAS |
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Necrotizing fasciitis, site, bugs, comments
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Subcutaneous soft tissues, fascia, muscle
Type I: polymicrobial (anaerobes, GNB, non-A Strep) Type II: GAS LIFE-THREATENING!! Pain >> physical findings Rapidly progressing Urgent surgical intervention Purplish bullae Fournier’s gangrene: scrotom/perineum |
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Clostridial myonecrosis site, bugs
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skeletal muscle, Clostridium perfringens
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“Gas gangrene”
Contaminated wounds LIFE THREATENING Severe pain Skin crepitus Foul odour Gas on plain Xray |
Clostridial myonecrosis from C. Perfringens
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Osteomyelitis – hematogenous
most common bugs in adults 3 |
staph a, strep group a or b
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Osteomyelitis – hematogenous
most common bug in infants |
E-Coli
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Osteomyelitis – hematogenous
most common bug in children |
H.Flu
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Osteomyelitis – hematogenous
most common bug in IVDU |
Pseudo
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most common etiology of osteo in kids
|
Hematogenous spread from trauma
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Osteomyelitis – contiguous focus no vascular insufficiency common bug and usual cause
|
Staph A., direct inoculation after trauma, decubitus ulcers (bedsores)
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Osteomyelitis – contiguous focus with vascular insufficiency bugs and usual cause
|
polymicrobial, minor trauma, common in diabetics
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Septic arthritis common bug infants 3
|
Group B strep, GNB, Staph A.
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Septic arthritis common bug Adolescents
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N. gonorrhoeae
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Septic arthritis common bug adults
|
Staph a.
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A patient with septic arthritis experiences pain upon what type of joint motion
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extension
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Septic Bursitis common bug
|
Staph A.
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Septic Bursitis patients experience pain on what type of motion
|
flexion
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