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154 Cards in this Set
- Front
- Back
Which bacteria gram stain poorly? (What othe stains could you use?)
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"These Rascals May Microscopicallly Lack Color"
1. Treponema - Dark Field Microscopy, Ab staining 2. Rickettsia (intracellular) 3.Mycobacteria (mycolic acid w high lipid content) - Acid Fast Stain 4. Mycoplasma (no cell wall) 5. Legionella (intracellular) - Silver stain 6. Chlamydia (intracellular), no muramic acid) |
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Bacteria with unusual cell walls?
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Mycoplasma - sterols, no cell wall
Mycobacteria - mycolic acid, high lipid content |
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Virulence Factors to evade host immune response:
1. What bug? 2. Virulence Factor? 3. Mechanism? |
S. Aureus
- protein A - binds Fc portion of IgG N. Meningitis, S. Pnuemo, H. Influenza 1. Capsule - inhibits phagocytoses 2. IgA protease - cleaves IgA Group A strep (pyogenese) - M protein (70 serotypes) - inhibits phagocytosis |
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Name all bugs with Exotoxins. (11)
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Staph. Aureus
Group A Strep (pyogenes) Corynebacterium Diptheriae Vibrio Cholera E. Coli Bordatella Perutssis Clostridia Perfrinces (not dificile) C. Tetani C. Botulinum Bacillus Antrhacis Shigella |
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Exotoxins:
Staph Aureus (name exotoxins, mechaninsm and disease) |
TSST-1 - Superantigen: binds MHC II and T-cell receptor releasing massive quantities of TNF and IL-2. Leads to rash, fever, shock
Enterotoxin - food poisoning Exfoliatin - Scalded skin syndrome |
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Exotoxins:
Group A Strep (pyogenese) (name toxin, mech, and disease) |
Scarlet fever-erythrogenic toxin (Superantigen): causes toxic syndrome like syndrome.
Steptolysin O: Hemolysin, antigen for ASO ab, marker for dx in rheumatic fever |
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Exotoxins:
Corynebacterium Diptheria |
AB toxin: B - Binds cell, A - Active toxin, ADP-ribosylates cell protein
Inactivates EF-2 (elongation factor) in throat. Leads to pharyngitis and pseudomembrane |
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Exotoxins
Vibrio Cholera |
AB toxin: ADP-ribosylates G protein --> inc adenylate cyclase (like heat labile toxin) --> inc Cl secretion and dec Na absorption. Water follows and leads to "rice water stool"
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Exotoxins:
E. Coli |
AB toxin:
Heat labile --> inc AC --> inc cAMP --> Cl secretion and diarrhea Heat stabile --> inc GC --> cGMP --> Cl secretion and diarrhea |
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Exotoxins:
Bordatella Pertussis |
Pertussis toxin (AB toxin): inhibits G-α --> inc cAMP --> whooping cough
inhibitis chemokine receptor --> inh macrophage and PMN phagocytosis |
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Exotoxins
Clostridium Perfringes |
lecinithinase (α toxin) - causes gas gangrene, double zone of hemolysis on blood agar (McConkey)
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Exotoxins
Clostridium Tetani |
Tetanus toxin (tetanospasmin) : binds neurons and inhibits release of GABA and glycine (lock jaw)
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Exotoxins
Clostridium Botulinum |
Botulinum toxin: Inhibits ACh release from motor neurons at NMJ (flaccid paralyis, canned fruit spores, honey --> floppy babies)
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Exotoxin
Bacillus Anthracis |
Antrax Toxin - 3 parts:
1. EF - edema factor - AC --> inc cAMP --> impaired PMN function and edema 2. LF - lethal factor 3. PA - protective antigen |
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Exotoxin
Shigella |
Shiga Toxin: cleaves host cell rRNA in ribosomes --> inh protein synth, inc cytokine release, (causes HUS in EHEC E. Coli O157:H7)
*Epithelial cells killed and shed leading to bloody diarrhea |
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Pigment producing bacteria on colonies?
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Staph Aureus - golden yellow
Pseudomonas - blue-green Serratia Marcescens - red pigment (think red maraschino cherries |
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Culture Requirements: Name which bugs (and fungus) require special cultures and what those are. (8)
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H. Influenza - Chocolate Agar with factor V (NAD) and X (hematin)
N. Gonorrhea - Thayer Martin median (VCN) B. Pertussis - Bordet-Gengou (potato) agar C. diptheriaea - Tellurite plate, Loffler's media M. Tuberculosis - Lowenstein-Jensen agar Lactose-fermenting enterics - pink colonies on McConkey Legionella - Charcoal yeast extract agar buffered with in iron and cysteine Fungi - Sabouraud's agar |
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Special Stains: Name the stain and its use
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Congo Red - Dx amyloid - apple green birefringence in polarized light (β-pleated sheets)
Giemsa - Borrelia, Plasmodium, trypanosomes, Chlamydia PAS - stains glycogen, mucopolysaccharides (capsules), dx Whipples disease Ziehl-Neelsen - acid fast bacteria India ink - cryptococcus neoformans (stains capsule) Silver stain - Fungi, legionella |
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Bacterial Genetics:
Explain Transformation |
DNA (any) taken up directly from environment - prokaryotes or eukaryotes
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Bacterial Genetics:
Explain Conjugation |
2 types:
1) F+ x F- :F+ plasmid contains genes required for conjugation - plasmid replicated and transferred to F- cell via pilus. ONLY Plasmid DNA, NO Chromosomal DNA Hfr x F-: Plasmid incorporates into bacterial DNA. Plasmid replication may include transfer of some Chromosomal DNA and transfer to F- cell. |
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Bacterial Genetics:
Explain Transduction |
Phage
Lytic phage infects host cell, replicates DNA, cleaves host DNA, may incorporate host DNA into capsid and phage then goes on to infect other cells Specialized: Lysogenic phage inserts genome into host cell. When it becomes lytic and brings some of host cell DNA with it as it is excised. Packaged in capsid and then infects other cells. |
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Bacterial Genetics:
Transposition |
"Jumping" DNA that can move from one location to another within chromosome. When jumping may incorporate nearby genes. Therefore can transfer genes from Chr to plasmid or plasmid to chr. Plasmid can then infect another bacteria.
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Lysogeny:
Which bacterial toxins are encoded by a bacteriophage (ie - presence of bacteriophage determines virulence)? |
ABCDE
ShigA-like Toxin Botulinum toxin Cholera toxin Diptheria toxin Erythrogenic toxin of Strep A (pyogenes) - scarlet fever |
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Obligate Aerobes
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"Nagging Pests Must Breathe"
1. Nocardia 2. Psuedomonas - burns, nosocomial pnuemonias (respirators) and CF 3. Mycobacterium TB - apices of lungs 4. Bacillus *use O2 system to generate ATP |
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Obligate Anaerobes
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Anaerobes know ABCs
1. Actinomyces 2. Bacteroides 3. Clostridium (Difficile, Tetanus, Botulinum, Perfringes) *Lack SOD and Catalase *Generally foul smelling (LCFAs), difficult to culture, produce gas in tissue (CO2, H2) *Normal Flora of GI, pathogenic elsewhere *AminO2glycosides are ineffective b/c require O2 to be activated |
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Intracellular Bugs:
Obligate? |
"stay inside when its Really Cold"
1. Rickettsia 2. Chlamydia *require host machinery to produce ATP |
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Intracellular Bugs:
Facultative |
"Some Nasty Bugs May Live FacultativeLY"
1. Salmonella 2. Neisseria 3. Brucella 4. Mycobacterium 5. Listeria 6. Francisella 7. Legionella 8. Yersinia |
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Encapsulated Bacteria?
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Quellung Rxn: Capsule swells when specific anticapsular antisera added
1. H. Influenza 2. N. Meningitis 3. Strep Pneumo 4. Klepsiella Pneumonia *Capsule is anti-phagocytic *Capsule is antigen in vaccines (Pneumovax, Hib, N. Meningitis vaccine) *Vaccines conjugated with protein inc T-cell dependent response and immunogenicity |
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Spores - Bacterial
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Gram (+) Rods
1. Clostridium - Tetani, Botulinum, Perfringes 2. Bacillus - Anthraxis, Cereus *spores formed at end of stationary phase when nutrients are limited. No metabolic activity, resistant to heat and chemical destruction, dipocolinic acid. Must autoclave to kill (surg equipment) *Botulism - spores in chili pepper germinate and produce toxin. Cooking kills toxin, not spores. Acid of stomach kills spores so they can't germinate. Everyone safe except grandma who tested a pepper before cooking and ingested uncooked toxin. |
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Urease Positive
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1. H. Pylori
2. Proteus 3. Kleibsiella 4. Ureaplasma |
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α-Hemolytic
-What does it look like? -What organisms? |
Green ring on blood agar
1. Strep Pneumo -Optochin S -Bile R -Capsule 2. Strep Viridans -Optochin R -Bile S -no capsule |
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β-Hemolytic
-What does it look like? -What organisms? |
Clearing around colonies on blood agar
1. Staph Aureus - catalase pos, coag pos 2. Group A Strep (pyogenes) - catalase neg, bacitracin sensitive 3. Group B Strep (agalactiae) - catalase neg, bacitracin res 4. Listeria -tumbling motility, meningitis in newborns, unpasteurized milk |
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γ-Hemolytic
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No hemolysis on blood agar.
Organisms = essentially everything, but if its a gram (+) coccus in strains then probably Enteroccocus (group D strep) |
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Staph Aureus
1. Main Virulence Factor? 2. Diseases (inflammatory, toxin, resistance) |
Protein A - binds Fc of IgG
Dz 1. Inflammatory -SKIN = cellulitis, impetigo, abcess/furuncles -Organ abscesses = osteomyelitis in children (#1 cause of osteomyelitis) -Pnuemonia (nosocomial, post virus, immunosupressed, Alcoholoic/IV drugs) -Acute Endocarditis (subacute = viridans) 2. Toxin Mediated -TSST-1 = Toxic shock syndrome -Exfoliatin = scalded skin syndrome -Enterotoxin = food poisoning (picnics) 3. MRSA - Tx = Vancomycin *Think of Pus, Empyema, Abcess |
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Strep Pyogenes (GAS)
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M Protein - adherence
Dz 1. Pyogenic -pharyngitis (strep throat), cellulitis, impetigo, (no abscesses, necrotizing fascitis 2. Toxigenic -Scarlet Fever, toxic shock syndrome 3. Immunologic -Glomerulonephritis -Rhuematic fever/heart dz Strep thoat --> heart or kidney Skin --> kidney (not heart) "PHaryngitis gives you PHever, and glomerulonePHritis *ASO titers detects recent infection |
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Strep Pyogenes - Rheumatic Fever symptoms?
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"No rheum for SPECCulation"
1. Subcutaneous nodules 2. Polyarthritis 3. Erythema 4. Chorea 5. Carditis (rheumatic heart dz) |
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Strep Pneumonia
1. Dz (and prevalence)? 2. Associated with what conditions? |
MOPS - Most OPtochin Sensitive
1. Meningitis - (#1 6mo-6yrs & 60 yr+, #3 6yr-60yr) 2. Otitis Media 3. Pneumonia (#4 4wk-18yr, #3 18-40, #1 40-60yr and 60yr+, 4. Sinusitis *associated w/: rusty sputum, sepsis in sickle cell, and splenectomy |
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Group B Strep (agalactia)
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"Group B = Babies, Bacitracin R, β hemolytic"
1. Pneumonia (#1 0-wks) 2. Meningitis (#1 0-6mo) 3. Sepsis |
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Enterococci (Group D strep)
1. Dzs? 2. Lancefield grouping? Difference b/n enterococci and strep? |
E. Faecalis & E. Faecium
*Opportunistic - nL Flora of URT, GU, GI, skin Dz 1. Subacute Endocarditis 2. Biliary tract infections 3. UTIs *Lancefield grouping - C-carbohydrate on cell wall *Enterococci 6.5% NaCL resistance (not GDS) *Pen G resistant *VRE - nosocomial infections |
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Staph Epidermidis
1. Dz? 2. Virulence factor 3. vs staph sapro? |
Dz
1. Infects prosthetic devices - valves, joints, catheters 2. Virulence = creates biofilm 3. Novobiocin sensitive * skin nL flora, common contaminant of blood cultures |
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Strep Viridans
1. Dz? 2. Culture: hemolysis? sensitivity? |
1. SUBacute endocarditis (sanguis = blood -->heart) - major cause
2. Dental Carries (mutans) *nL Flora of mouth - "not afraid OF-THE-CHIN = Optochin Resistant *α-hemolytic |
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Clostridia
1. Gram 2. Types, toxin, Dz & Tx 3. Spore formers? |
gram (+) rods, ANAEROBIC
1. Tetani - spore forming -AB exotoxin - inh GABA and gly release -->tetanus (lock jaw) -found in soil Tx: anti-toxin for unbound toxin, penicillin and support Vaccine - toxoid 2. Perfringes - spore forming -α-toxin (lecinthase) - gas gangrene (myonecrosis) and hemolysis Tx: Surg/Amputation, Hyperbaric chamber (no vaccine) 3. Botulinum - spore forming AB exotoxin (heat labile) - inh ACh release --> flaccid paralysis -canned fruit/vegetables (toxin) -honey (spores - germinate in infants nonacidic stomach) Tx: Anti-toxin, support, hyperbaric chamber, penicillin (no vaccine) 4. Dificile -exotoxin kills GI epithelial cells --> pseudomembranous colitis (2nd to Ab use) Tx - Metronadazole |
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Corynebacterium Diptheriae
1. Gram & Culture 2. Dz 3. ABCDEFG 4. Tx |
Gram (+) Rod w/metachromatic granules- club shaped, Lysogeny - bacteriophage encodes toxin
"TELL YOUR InTErn not to LOAF around" -Tellurite agar -Loeffer's coagulated blood serum Dz 1. Pharyngitis - Pseudomembrane (darker than strep throat) - colization 2. Myocarditis - toxin 3. Neuron -toxin -peripheral n palsy -Guillain Barre like -Paltal paralysis and other cranial neuropathies ABCDEFG ADP-Ribosylation (AB toxin) Beta-prophage Corynebacterium Diptheriae Elongation Factor-2 Granules Tx: Antitoxin, Pen, Vaccine (toxoid) |
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Bacillus Antrhacis
1. Gram 2. Epidemiology 3. Dz 4. Tx |
Gram (+) rod, spore forming
Protein capsule (D-glu) - antiphagocytic Woolsorter's Dz - inhale spores from contaminated wool Dz 1. Contact --> malignant pustule (painless ulcer), progress to bactermia and death -Black skin lesions -vesicular papules covered by black eschar 2. Inhalation of spores --> flulike --> fever, pulm hemorrhage, mediastinitis, shock Tx: Cirpo, doxy |
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Listeria Monocytogenes
1. Gram/characteristics 2. Dz 3. Tx |
Gram (+) rod, intracellular
*Unpasteurized milk, cheese *Listeriolyis O and Phospholipases allow exit from phagolysosome, enter epithelial cells, move cell-cell via "actin-rockets" *tumbling motility Dz 1. Neonatal Meningitis (#3) 2. Meningits in immunosuppressed 3. Septicemia in pregnant (amnionitis, abortion, granulomatosis infantiseptica) Tx: Amp, Bactrim |
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Actinomyces vs Nocardia
1. Same 2. Differences 3. Tx |
Both: Gram (+) rods, long branching filaments resembling fungi
Actinomyces Israeli anaerobe, nl Flora mouth/GI, cause oral/facial abcess, pus drains through sinus tract in skin *Sulfur granules Tx: Pen, drain abscess Nocardia Asteroides -aerobe *wealy acid fast (confused for TB), soil - not nL flora, inhaled --> pneumonia, pulmonary abscess (in immunocompromised Tx: Bactrim |
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Neisseria
1. Both: gram, glucose met, virulence factor, Cx 2. Compare: Capsule, maltose ferment, vaccine, transmission, Dz 3. Tx |
Gram (-) cocci, glucose fermenters, IgA protease
Cx: Chocolate Agar, Thayer Martin Agar VCN (Vanc, Colistin, Nystatin) Gonococci -no capsule -no maltose fermentation -no vaccine -sexually transmitted Dz: Gonorrhea --> PID, septic arthritis, neonatal conjunctivitis Meningococci -polysaccharide capsule -maltose fermenter -vaccine (capsule - not B) -resp/oral secretions Dz: Meningitis, meningococcemia, waterhouse-Friderichsen syndrome (adrenal gland hemorrhage, hypotension, petechial rash) Tx: 3rd gen cephalosporin Rifampin prophylaxis for contacts |
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Haemophilus Influenzae
1.Gram, Cx, characteristics 2. Dz 3. Tx |
Gram (-) coccobacillus,
Cx: Chocolate agar with factors V (NAD) and X (Hematin) Aerosol Transmission, mainly type B (vaccine to capsule B - conjugated to Diptheria toxoid) Dz - haEMOPhilus 1. Epiglottitis 2. Meningitis (#3 6mo-6yrs) 3. Otitis Media 4 Pneumonia Tx: Ceftriaxone Rifampin prophylaxis for meningitis contacts |
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Enterobacteriaceae (Family)
1. Species 2. Common Virulence Factors |
Species
1. Salmonella 2. Shigella 3. Enterobacter 4. E. Coli 5. Kleibsiella 6. Proteus 7. Serratia Virulence - think COFFEe Capsule - K antigen Oligosacharide - O (LOS) Flagella - H antigen Ferment Glucose Enterobacteriaceae *all oxidase negative |
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Klebsiella
1. Dz & epidemiology 2. Characteristic of sputum 3. 3As |
Dz
Pneumonia - alcoholics and diabetics *Red Currant Jelly Sputum 3As - Aspiration Pneumonia Abscess in lungs Alcoholics |
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Lactose Fermenting Enteric Bacteria
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Lactose is KEE, McConKEE (pink colonies)
1. Kleibsiella 2. E. Coli 3. Enterobacter 4. (Citrobacter) |
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Salmonella vs Shigella
1. Both 2. Salmonella 3. Shigella 4. Tx |
Both non-lactose fermenting, invade epithelial cells, bloody diarrhea
SALMONella 4Fs: Feces, Food, Fingers, Flies -flagella (can swim), disseminate hematogenously -H2S 1. Gastroenteritis 2. Chronic Carrier (gall bladder) 3. Sepsis 4. Osteomyelitis in sickle cell 5. Typhoid Fever - fever, abdmL pain, hepatosplenomegaly, rose spots on abdomen Tx: Cipro or ceftriaxone -for diarrhea can prolongue course and make a chronic carrier Shigella 1. Bloody diarrhea with mucus and pus *no flagella but intracellular propulsion using actin polymerization *more virulent 10 org (vs 10^5 for salmonella) Tx: Fluoroquinolones |
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Yersinia Enterocolitica
1. Transmission 2. Dz & Dzs mimmicked 3. Tx |
Transmission: Puppy feces, pork, milk, day-care centers
Dz 1. Acute enterocolitis w fever, diarrhea and abdmL pain (mimmick chron's or appendicitis) Tx: no Ab other than for septicemia |
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Food Poisoning (Bacterial)
7 bugs and associated food? |
1. S. Aureus - mayonaise, meats, custard (picnic)
2. C. Perfringes - reheated meat 3. C. Botulinum - self canning 4. Vibrio parahemolyticus & Vulnificus - shellfish (also can cause wound contamination) 5. Bacillus cereus - reheated rice 6. E. Coli 0157:H7 - undercooked meat 7. Salmonella - poultry, meat, eggs *S Aureus and B cereus start quickly and end quickly |
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Bloody Diarrhea
1. Organism 2. How to recognize 3. Tx |
All bacteria gram (-) rods
1. Campylobacter (most common cause of gastroenteritis) -S-shaped (gull-winged), Campy plate (abiotics) at 42° C, oxidase pos Tx: Fluoroquinolone (cipro) 2. Salmonella -non-lactose fermenting, oxidase neg -flagellar motility Tx: none 3. Shigella - w/ mucus & pus - lactose neg, ox neg -no flagella -low ID50 -shiga toxin (phage encoded) Tx:Fluoroquinolones (cipro) 4. EHEC (Enterohemorrhagic E. Coli) - w/out fever and pus - lactose pos, - Shiga-like toxin --> Hemorrhagic colitis, HUS (O157:H7) Tx: Cephalosporins (cipro) 5. EIEC (Enteroinvasive E. Coli) - w/ mucous, pus & fever -lac pos -ivades mucosa Tx: Cephalosporins (cipro) 6. Yersinia Enterocolitica - w/ fever & abdmL pain -lac neg -day care outbreaks, -pseudoappendicitis Tx: none 7. C. Difficile (gram + coccobacillus), anaerobe, flagella - can cause bloody or watery diarrhea -pseudomembranous colitis Tx: Metronidazole 8. Entamoeba Histolytica - Protozoan |
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Watery Diarrhea
1. Organism 2. How to recognize 3. Tx |
1. ETEC - (Enterotoxigenic E. Coli)
-lac + -LT -->cAMP (same as Cholera) -ST -->cGMP Tx: (none), cipro 2. Vibrio Cholera (rice water stools) -Comma shaped, single flagella -lac neg, ox? Tx: ORS, (doxy, fluoroquinolones) 3. C. Perfringens -gram + coccobacillus, anaerobe, non-motile, spore forming -also causes gas gangrene Tx: (penicillin?) 4. Protozoa - Giardia (streams), Cryptosporidium (immunocompromised) Tx: Metronidazole Amphotericin B/ Flucytosine 5. Viral (infants & children) -Gastroenteritis (vomitting & diarrhea), fever, abdmL pain -Rotavirus (most common, major cause of infant death) -Norwalk (noro) virus -cruise ships -Adenovirus Tx: ORS |
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cAMP inducers
1. organism 2. mech of action |
1. V. Cholera --> Gs --> ADP-Ribosylaton of AC --> inc cAMP--> NaCl secretion (rice water stools)
"turns the on, ON" 2. ETEC - Heat Labile toxin (same mech as cholera) Heat Stablie = cGMP 3. D. Pertussis --l Gi --> whooping coucgh "turns the off, OFF" -also promotes lymphocytosis by inhibiting chemokine receptors 4. Bacillus Anthracis - EF = AC --> inc cAMP --> massive edema *1-3 ADP ribosylate, 4 is an AC itself |
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Legionella Pneumophila
1. Dz 2. Stain, Cx 3. Transmission 4. Tx |
Dz
1. Legionaire's Dz (severe pneumonia) 2. Pontiac Fever (mild influenza) Silver stain (gram - rod, but stians poorly) Cx - Charcoal yeast extract w/ iron and cysteine Transmission: Aerosol from water source, not human-human, (ventilators, AC, etc) Tx: Erythromycin "think of french Legionnaire, with Silver helmet, sitting around Charcoal fire with Iron dagger = no Sissy (Cysteine)" |
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Pseudomonas Aeruginosa
1. Dz 2. Association 3. Characteristics 4. Tx |
PSEUDOmonas
Pneumonia (exp in CF) Sepsis (black lesions on skin) External otitis (swimmer's ear) UTI Drug use and Diabetic Osteomyelitis + hot tub folliculitis Associated w/ burns, hot tubs/swimming pools, and hospitals Gram (-) rod, non-lactose ferment, ox pos, obligate aerobe, blue-green colonies (pyocyanin), grape-like scent Endotoxin: fever, shock Exotoxin A: --l EF2 (same mech as diptheria) Tx: Aminoglycoside (gentamycin) + ticarciliin or piperacillin |
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Helicobacter Pylori
1. Dz (& risk factors) 2. Characteristics 3. Tx |
Dz
1. Gastritis 2. 90% of Duodenal ulcers 3. Risk Factor: Gastric ulcer, gastric adenocarcinoma, lymphoma Gram (-) rod (gull-wing), many flagella Urease pos --> alkaline env't (neut acid), Tx: Triple Tx - 1. bismuth, metronidazole, tetracycline or ampicillin 3. Metronidazole, PPI (omeprezole), clarithromycin |
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Zoonotic Infections
1. organism 2. dz 3. transmission/reservoir |
"Big Bad Bugs From Your Pet"
1. Bartonella Henselae Catch scratch fever Cat scratch 2. Borrelia Burgdorferi Lyme Dz Tick bite (ixodes) live on deer and white footed mice 3. Brucella spp. Brucellosis Undulent Fever Unpasturized dairy products, animal contact 4. Francisella Tularensi Tularemia Rabbits, tick bite, deer 5. Yersinia Pestis Plague Flea bit, rodent- rats, prarie dogs 6. Pasteurella Multocida Cellulitis Cat or dog bite |
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Gardnerella Vaginalis
1. Dz 2. Characteristics 3. transmission 4. Tx |
Vaginitis - white gray vaginal discharge w fishy smell, non-painful
Pleomorphic - gram variable rod, Clue cells - vaginal epithelial cells covered w/ bacteria -associated w/ Mobiluncus (anaerobe) Transmission: sexual Tx: Metronidazole |
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Mycobacterium
1. Stain & Characteristics 2. Dz 3. S&S 4. Tx |
Dx: AFS, catalase pos, facultative intracellular (mØs), non-motile, no capsule, no pili
1. Tuberculosis S&S - fever, night sweats, weight loss and hemoptysis Tx: Rif & INH - 6 mo, Pyrazinamide & ethambutol 2 mo if Res: add streptomycin 2. Mycobacterium Avium Complex S&S - pnuemonia & disseminated dz in immunocompromised Tx: Amoxacillin, rifampin, ethambutol, streptomycin 3. Leprosy S&S- hypopigmented region that is anesthisized Tx: Dapsone, rifampin, clofazimine 4. M. Kansasii - pulm TB like symp 5. M. scrofulaceum - cervical lymphadenitis in kinds |
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Mycobacteria Leprae
1. Dz 2. S&S 3. Dx 4. Reservoir 5. Tx |
Dz
1. Tuberculoid -TB like -cell mediated immunity 1 or 2 unilateral skin lesions 2. Lepromatous - severe-lethal - no cell mediated immunity S&S- bilateral skin (hypopig, lumps, bumps, leonine faces, saddle nose), nerves (peripheral neuropathy), eyes (blindness), testes (infertitlity) Dx: Clinical -Skin or nerve biopys of AF Bacilli or Granuloma (tb-like) -Cannot be grown on lab media Reservoir: Armadillos Tx: Dapsone (hemolysis and methemoglobinemia) + rifampin and/or clofazimine |
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Rickettsia (general)
1. Characteristics 2. Transmission 3. Tx |
Obligate intracellular, require host CoA and NAD
Transmission: arthropod (except coxiella) Tx: Tetracycline (Doxy!) S&S: Triad: HA, fever, petechial rash (vasculitis) |
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Rickettsia (specific)
1. Match Dz w/ bug 2. w/ vector 3. w/ rash |
1. Rocky Mountain spotted fever - rickettsia rickettsia
- tick - extremities --> trunk 2. Endemic Typhi - R. Typhi - fleas - trunk --> extremities 3. Epidemic Typhus - R. Prowazekii -lice -trunk - extremities 4. Ehrlichiosis (Brill's Dz) - Erlichia - tick -no rash 5. Q Fever - Coxiella Burnetii -inhaled (no vector) -no rash "Q is Queer b/c it has no rash, no vector, no Weil-felix, causative org can survive outside, not ricketsia" - |
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1. Patient presents with rash on palms and soles what is your differential?
2. Patient also complains of fever, HA and was hiking on the east coast a few weeks ago. What is you Dx? 3. What confirmatory test would you do? |
1. Rocky Mountain spotted fever, Syphilis, Coxsackie virus A (hand, foot, and mouth)
2. RMSF - Triad of fever, HA, rash that spreads from ext --> trunk. Org = R. ricketsia. Despite name it is endemic to east coast - ticks 3. Weil-Felix reaction: assay for Anti-Ricketsial Abs that cross react w/ proteus antigen + = RMSF & Typhus - = Q Fever |
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Chlamydia
1. spp --> dz 2. Dx & characteristics 3. Tx |
Dz
1. Chlamydia Trachomatis = urethritis, conjuctivitis, reactive arthitis (rider's dz) --> PID Elementary Body (EB) = Enter via Endocytosis Reticulate Body (RB) = Replicate by fission - transmission: sexual 2. C. Pneumonia & C. Psittaci - atypical pneumonia from contact w birds -transmitted via aerosol Dx: Giemsa stain or Fluorescent Ab- cytoplasmic inclusion bodies (intracellular org) -cell wall lacks muramic acid Tx: erythromycin or tetracycline (Doxy! + Ceftriaxone for gonorrhea) |
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Chlamydial serotypes
1. match serotype with dz |
ABC = African, Blindness (conjuntivitis), Chronic Infection
D-K: urethritis/PID, ectopic preg, neonatal pneumonia or conjunctivitis Tx: neonate w/ oral erythromycin L1-3 = Lymphogranuloma venereum (acute lymphadenitis - positive Frei test) |
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Spirochetes
Organisms and stain? |
"BLT" "B is Big"
Borellia (big size)- Lyme Dz -light microscopy w aniline dyes (wright or giemsa) Leptospira Treponema - Dark field microscopy |
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Leptospira Interrogans
1. Dz 2. Reservoir/Transmission 3. Dx 4. Tx |
Dz
1. Leptospirosis - flu-like symp, fever, HA, abdmL pain, and jaundice -Tropics 2. Weil's Dz (icterohemorrhagic leptospirosis) - severe form with jaundice, azotemia from liver & kidney dysfunction, fever, hemorrhage, anemia Reservoir: water contaminated with animal urine Dx: Culture blood or CSF (week 1), urine (wk 2-mos) on protein rich, aerobic media -Question mark spirochetes Tx: Penicillin, Doxy |
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Patient presents with expanding "bulls-eye" rash and flu-like symptoms
1. Dx and organism 2. Reservoir/Transmission 3. Complications w/out Tx (stages?) 4. Tx |
1. Lyme Dz - Borellia Burgdorferi
2. White footed mouse and white tailed deer transmit via ixodes tic 3. Stage 1: Erythema Chronicum Migrans, flu-like symp Stage 2: Neurologic manifestations (CN7 - BELL's palsy, meningitis, peripheral neuopathy) Cardiac (heart block) Stage 3: Monoarthritis (knee) or migratory polyarthritis Tx:Doxy |
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Treponemal Dz
1. match spp w/ dz |
1. Treponemes = syphilis
2. Pertenue = yaws (tropical infection, not STD) -1° & 2° ulcerative skin lesions - condyloma like -3° gummas of skin and bone Tx: pen, plastic surgery |
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27 yo male presents w/ painless penile ulceration w/ a hard indurated edge
1. Dx and Bug 2. Dx and Bug had lesion been painful 3. Stages of Dz 4. Dx 5. Tx & Rxn |
1. Syphilitic chancre - Treponema Pallidum
2. Chancroid lesion from H. Ducreyi 3. Stage 1: painles chancre Stage 2: Disseminated Dz w/ constitutional symptoms, maculopapular rash (palms & soles, condyloma lata. 1° and 2° chancres are very contagious (lots of bugs) Latent Stage: Stage 3: Gummas, aortitis, neurosyphilis (tabes dorsalis -broad based ataxia, positive romberg, charcot joints, stroke w/out HTN), Argyll Roertson pupil (prostitute's pupil - accomodates, doesn't react) Congenital: Saber shins, sadlle nose, CN VIII deafness, hutchinson teeth 4. Dx - Dark Field Microscopy VDRL vs FTA FTA-ABS -specific for treponemes, positive earliest, remains positive longest "FTA-ABS = Find The Antibody - ABSolutely" Tx: PenG or Doxy Jarisch-Herxheimer rxn: acute worsening of symp |
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VDRL vs FTA
Dx the following 1. VDRL +, FTA + 2. VDRL +, FTA - 3. VDRL - , FTA + 4. What can cause VDRL false positives |
1. Active syphilis infection
2. Probably false positive 3. Successfully treated FTA-ABS - Find The Antibody - ABSolutely -most specific - + earliest - + longest 4. VDRL = Viruses (mono, hepatitis), Drugs, Rheumatic fever, Lupus & Leprosy - VDRL detects Abs that react w/ cardiolipin (non-specific test) |
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Mycoplasma Pneumonia
1. Dz 2. S&S 3. Dx 4. Epidemiology 5. Tx |
1. Atypical "walking" pneumonia
2. insidious onset, HA, nonproductive cough, diffuse interstitial infiltrate - CXR looks worse than patient 3. No gram stain b/c no cell wall -Hight tighter of cold agglutinins -Cx - Eaton's agar 4. <30 yo, military recruits, prisons 5. Tx: tetracycline or erythromycin (no pens b/c no cell wall) |
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Dermatophytes
-name them |
Candida, malassezia furfur, microsporum, trichophyton and epidermophyton
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Candida Albicans
1. Dzs - what patients 2. Transmission 3. Dx 4. Tx |
Dz: Systemic or superficial fungal infection
Thrush esophagitis (immunocomp) Endocarditis (IV drug) Vaginitis (post-Abiotic) Diaper rash Transmission: Inhalation of spores (no person-person) Dx: budding yeast w/ pseudohyphae at 20°C, germ tube formation at 37° C Tx: Nystastin for superficial, amphotericin B for systemic |
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Tinea
1. Dzs = fungus 2. Dx 3. Tx |
1. Versicolor - Malassezia furfur
-hot humid weather Dx: "spaghetti and meatball" appearance on KOH prep Tx: topical miconazole, selenium sulfide 2. Tinea pedis, cruris, corporis, capitis - Microsporum, Trichophyton, Epermophyton - pruritic resions in a ring w/ central clearing = ring worm Reservoir: pets (microsporum) Dx: Mold hyphae on KOH (not dimorphic) Tx: Topical azoles |
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Systemic Mycoses
1. Fungus 2. Region 3. Dz 4. Dx 5. Tx |
1. Histoplasmosis
Region: Mississipi & Ohio river valleys - bird (starling) and bat droppings Dz: Pneumonia Dx: yeast inside mØs ("histiocyte = MØ in skin") 2. Blastomycosis Region: East of Miss & Central America Dz: Inflammatory lung dz, disseminate to skin and bone, forms granulomatous nodules Dx: Big, Broad Based Budding Cold = mold Heat = yeast Cx - sabouraud's agar 3. Coccidiomycosis Region: SW US, Cali, San Joaquin Valley or desert Dz: "Valley fever", pneumonia, meningitis, disseminate to bone and skin Dx: spherule filled w/ endospores 4. Paracoccidiomycoses Region: Rural Latin Amer Dz: Lung involvement --> disseminate Dx: Captain's wheel (mickey mouse) budding yeastt *all are dimorphic cold = mold heat = yeast (except coccidio) *all can cause pneumonia --> disseminate *mimmick TB Tx: local: fluconazole or ketoconazole, systemic: amphotericn B |
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Opportunistic Fungal Infectons
1. Fungus 2. Dz 3. Dx |
1. Candida Albicans
Dz: Thrush in immunocompromised Vulvovaginitis (high pH, diabetics, abiotics) disseminated (any organ) Chronic mucocutaneous Dx: germ test tube - look like sperm, Cx: Pseduohyphae budding yeast 2. Aspergillus Fumigatus Dz Allergic bronchopulmonary aspergillosis Lung cavity aspergilloma ("fungus ball") - in immunocomp and CGD Dx: Mold w/ septate hyphae that branc at 45° angle (V), fruiting bodies - conidophores 3. Cryptococcus Neoformans Dz Crypto meningitis Cryptococcosis Dx: Heavily encapsulated yeast = india ink, not dimorphic, found in soil & pigeon droppings. Cx on sabouraud's agar. Latex agglutination test detects polysacch capusle "soap bubble" in brain Narrow based unequal budding 4. Mucor and Rhizopus Dz Mucormycosis, infarction and necrosis of distal tissue (proliferate in vessels), prefers DKA patients, rhinocerebral frontal lobe abscess Dx: Mold w. irregular nonseptate hyphae branching at wide angles (90°) |
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Pneumocystic Jiroveci (formerly carinii)
1. Dz 2. Transmission 3. Dx 4. Tx |
Dz:
Asymp Diffuse Interstitial Pneumonia (immunocomp) Transmission: Inhaled yeast (thought to be protozoa - cw lacks ergosterol) Dx: CXR - diffuse bilateral Lung biopys or lavage - methenamine silver stain Tx: Bactrim (lacks ergosterol in cell wall), pentamidine, dapsone Prophylaxis - when CD4 < 200 |
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Sporthrix Schenkii
1. Dz 2. Dx 3. Tx |
Dz: Sporotrichosis - introduced via rose thorn --> local pustules or ulcer w/ nodules along draining lymphatics (ascending lymphangitis) = sporotrichoid spread
Little systemic illness Dx: Clinical, cigar-shaped budding yeast in pus Tx: Itraconazole, KI |
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DNA Viruses
1. Name them 2. dsDNA or ssDNA 3. Enveloped or naked 4. Linear or circular 5. Icosahedral or Helical 6. Replicate in nucleus or cytoplasm |
HHAPPPPy
1. Herpes - envelope 2. Hepadnavirus - envelope 3. Adenovirus 4. Parvovirus - only, ssDNA 5. Papillovirus 6. Polyomavirus 7. Poxvirus - envelope *all dsDNA except parvovirus "part of a virus" *all naked except Herpes (acquires from nuclear membrane), Hepadnavirus, Poxvirus *all linear except adenovirus (partial circular), polyomavirus and poxvirus *all Icosahedral *all replicate in nucleus except poxvirus (carries own DNA-dept RNA pol) |
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RNA Viruses
1. Name them 2. enveloped? 3. dsRNA or ssRNA 4. circular or linear 5. Icosahedral or Helical 6. Replicate in nucleus or cytoplasm |
1. Picornavirus (enterovirus) - naked, icosahedral
2. Calicivirus - naked, icosahedral 3. Reovirus - naked, dsRNA, icosahedral 4. Flavivirus -icosahedral 5. Togovirus - icosahedral 6. Retrovirus - icosahedral 7. Coronavirus - helical 8. Orthomyxovirus - helical 9. Paramyxovirus - helical 10. Rhabdovirus - helical 11. Filovirus - helical 12. Arenavirus - circular, helical 13. Bunyavirus - circular, helical 14. Deltavirus - circular, helical * all replicate in cytoplasm except retroviruses and influenza |
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RNA and DNA virus
- be able to replicate the table on p. 162-163 of first aid |
-DO IT!
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Viral Vaccines
1. Live attenuated 2. Killed |
1. Live = humoral and cell mediated immunity
MMR - Measles, Mumps, Rubella VZV, Polio (sabin), Yellow Fever, (small pox) 2. Killed = humoral only Rabies, Influenza, Polio (salk), HAV "RIP Always" |
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(-) strand RNA viruses
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"Always Bring Polymerase Or Fail Replication Horribly"
Arenavirus Bunyavirus Paramyxovirus Orthomyxovirus Filovirus Rhabdovirus hepatitis Delta virus |
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Segmented Viruses
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BOAR
Bunyavirus Orthomyxovirus (Infuenza 8 segments - genetic shift --> worldwide pandemics) Arenavirus Reovirus |
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Herpesviruses
1. Virus 2. Dz 3. Transmission 4. Other characteristics |
1. HSV1
Dz: Herpes Labialis, Gingivostomatitis, keratoconjunctivitis, temporal lobe encephalopathy Transmission: respiratory secretions, saliva 2. HSV-2 - Herbes genitalis (genital warts), neonatal herpes Transmission: sexual contact, perinatal 3. VZV Dz: Chicken pox, shingles, encephalitis, pneumonia Transmission: Respiratory secretions 4. EBV Dz: Infectious Mononucleosis (heterophilic Abs), Burkitt's lymphoma 5. CMV Dz: Congenital infection, mononucleosis (neg monospot - no heterophilic Abs), pneumonia Dx: "Owl's eye" appearance of infected cells Transmission: Congential, transfusion, sexual contact, saliva, urine, transplant 6. HHV-8 Dz: Kaposi's Sarcoma (HIV patients) Transmission: sexual contact |
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HSV identification
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"Tzanck heavens I do not have Herpes"
Tzanck test - a smear of an opened skin vesicle to detect multinucleated giant cells. Use to assay for HSV-1, 2, VZV. Infected cells also have Cowdry A inclusions. |
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EBV
1. Dz 2. S&S 3. Epidemiology 4. Dx 5 Associated cancer |
Dz: Mononucleosis - B cells
S&S: fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (esp post auricular nodes) Epidemiology: 15-20 yo (kissing dz) Dx: (+) heterophilic Ab test (monospot test = agglutination of sheep RBCs) Abnormal cytotoxic T cells (atypical lymphocytes) Cancer: Hodgekin's and endemic Burkitt Lymphoma |
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Picornavirus
1. Name viruses 2. associated dz |
"PERCH on a peak (pico)"
1. Poliovirus 2. Echovirus 3. Rhinovirus -common cold > 100 serotypes 4. Coxsackievirus - Aseptic Meningitis 5. HAV |
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Yellow Fever Virus
1. Dz 2. S&S 3. Reservoir 4. Transmission 5. Dx |
Dz: Yellow Fever (flavivirus, flavie = yellow)
S&S: high fever, black vomitus, and jaundice Reservoir: Human or Monkey Transmission: mosquitos (arbovirus) Dx: Councilman bodies (acidophilic inclusions) seen in liver --> jaundice |
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Rubella Virus
1. Viral family 2. Dz 3. Severity and transmission |
Togavirus
Dz: German (3day) Measles S&S: Fever, lymphadenopathy, arthralgias, fine truncal rash -mild in children -severe in neonate (mother prenatal screen) -TORCH infection - crosses placenta |
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Rotavirus
1. Viral family (characteristics) 2. Dz 3. Mech |
Reovirus (segmented dsRNA, naked)
DZ: Gastroenteritis - most important cause in infants in world Mech: villous destruction --> dec absorption Na and H2O --> diarrhea and dehydration |
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Influenza Virus
1. Viral fam (characteristics) 2. Dz 3. Virulence factors 4. Drift vs Shift 5. Tx 6. Vaccine |
1. Orthomyxovirus (segmented (-) ssRNA virus, enveloped)
2. Dz: Influenza --> fatal bacterial infection 3. Neuraminidase & Hemagluttinin 4. Drift = mutation (minor) 5. Shift = recombination (major, pandemic) 6. Tx: Amantadine and Rimantadine --l Hg, A only (high level of resistance, no longer used) Zanamivir, Oseltamivir --l neuraminidase, useful for A and B Killed vaccine - 2As and B |
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Paramyxovirus
1. Epidemiology 2. Dz |
Children
1. Parainfluenza - croup 2. Mumps 3. Measles 4. RSV - bronchiolitis, pneumonia (#1 4wk-6yo) |
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Rubeola virus
1. Dz 2. S&S |
Dz: Measels
S&S: 3Cs - Cough, Coryza, Conjunctivitis Koplik spots (red spots w/ blue-white center on buccal mucosa) = Dx -rash spreads head to toe Rare - SSPE (subacute sclerosing panencephalitis - years later), Encephalitis, Giant cell pneumonia |
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Mumps virus
1. Viral fam 2. Dz |
Paramyxovirus
S&S: Parotitis, Orchitis --> sterility, and aseptic Meningitis "Mumps makes your parotid glands and testes as big as POM-poms" |
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Rabies Virus
1. Transmission, epidemiology, progression 2. Dz and S&S 3. Dx |
Transmission: Bite of infected animal (bat, raccoon, skunk > dog in US) --> retrograde transport (dynein) to CNS = long incubation period
Dz/S&S: Fatal encephalitis, seizures, hydrophobia, hypersalivation (anterograde transport - kinesin), pharyngeal spasm Dx: Negri bodies - cytoplasmic inclusions in neurons Bullet shaped capsid |
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Arbovirus
|
"Fever Transmitted by Bites"
Flavivirus 1. Dengue (break bone fever) 2. WNV 3. Yellow fever 4. St. Louis Encephalitis Togavirus 1/2. E & W Equine Encephalitis Bunyavirus 1. California Encephalitis 2. Crimean-Congo hemorrhagic fever |
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"Lots of Spots" Viruses
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Rubella - German (3day) measles
Rubeola - Paramyxovirus, measles Varicella - Herpes virus, chicken pox, shingles Vareola - Poxvirus, small pox Vaccinia - Poxvirus, cow pox vaccine |
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Hepatitis Viruses
1. Name viral family for A-E |
1. Hep A - Picornavirus
2. Hep B - Hepadnovirus (dna) 3. Hep C - Flavivirus 4. Hep D - Deltavirus 5. Hep E - Calicivirus |
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Hepatitis A
1. Viral fam 2. S&S, Dx 3. Transmission 4. Incubation 5. Carrier? 6. Vaccine? |
A: Asymp, Acute, Alone (no carriers
1. Picornavirus 2. Asymp --> mild = flu-like, dark urine, jaundice, anti-HAV IgM 3. Fecal-oral 4. short (3 weeks) 5. no carriers 6. Vaccine --> anti-HAV IgG (vaccine or past infection) |
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HBV
1. Viral fam 2. S&S, Dx 3. Transmission 4. Incubation 5. Carrier? 6. Vaccine? 7. Mech |
1. Adenovirus
2. S&S - mild - severe hepatitis ----> cirrhosis, hepatocellular carcinoma Dx: HBsAG = infection Anti-HBsAG IgG = past infection, or vaccine 3. Blood born - parenteral, sexual and maternal-fetal 4. long (3 months) 5. Chronic carriers 6. Vaccine yes - anti-HBsAg IgG 7. Mech - RNA pol transcribes RNA from DNA template. Reverse transcriptase transcribes DNA genome from RNA intermediate. However, Virion enzyme is DNA-dependent DNA pol |
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Make the Hep B Dx:
(-) HBsAg (-) anti-HBc (-) anti-HBsAg |
Susceptible - no acute dz, no previous infection, no vaccine
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Make the Hep B Dx:
(-) HBsAg (+) anti-HBc (+) anti-HBsAg |
Immune due to natural infection - no current infection
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Make the Hep B Dx:
(-) HBsAg (-) anti-HBc (+) anti-HBsAg |
Immune due to vaccine
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Make the Hep B Dx
(+) HBsAg (+) anti-HBc (+) anti-HBc IgM (-) anti-HBsAg |
Acutely infected - in window period
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Make the Hep B Dx:
(+) HBsAg (+) anti-HBc (-) anti-HBc IgM (-) anti-HBsAg |
Chronic infection
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HCV
|
1. Flavivirus
2. Asymp --> mild -----> cirrhosis, heptocellular carcinoma Dx: HCV Ab = previous or ongoing infection HCV RNA (PCR) = ongoing infection 3. Parenteral (IV drugs), some sex 4. 6-8 wks 5. Carriers 6. no vaccine Hep C: Chronic, Common, Carriers, Carcinoma |
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HDV
1. Viral fam 2. Infection restraints 3.symp/prognosis, Dx 4. Carriers? |
1. Deltavirus
2. Requires HBsAg as its envelope. 3. Coinfect or Superinfect w/ HBV --> worse prognosis Dx: HDVAg or HDV RNA = ongoing infeciton 4. Carriers |
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HEV
1. Viral fam 2. Transmission 3. S&S, Dx 4. Epidemiology |
1. Calicivirus
2. Enteric transmission (Fecal-oral) "A &E - vowels hit your bowels" 3. Dz resembles HAV anti-HEV IgM PCR RNA from stool 4. High mortality rate in pregnant women |
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Opportunistic Infections in Aids
1. Brain 2. Eyes 3. Mouth & Throat 4. Lungs 5. GI 6. Skin 7. Genitals |
1. Cryptococcal meningitis, Toxoplasmosis, CMV encephalitis, AIDS dementia, PML (JC virus)
2. CMV retinitis 3. Thrush (Candida albicans), HSV, CMV, oral leukoplakia (EBV) 4. PCP (PJP), TB, Histoplasmosis 5. Cryptosporidium, MAC (Mycobacterium avium-intracellulare complex), CMV colitis, non-Hodgekins lymphoma (EBV), Isospora belli (parasite) 6. Shingles (VZV), Kaposi's sarcoma (HHV8) 7. Genital herpes (HSV2), warts (HPV), cervical cancer (HPV) |
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HIV-associated infections and CD4 count
1. <400 2. <200 3. <100 4. <50 |
1. Oral thrush, tinea pedis, shingles, reactivation TB, bacterial infections (H. flu, S. Pneumo, Salmonella)
2. Reactivation HSV, cryptosporidiosis, Isospora, disseminated coccidiodomycosis, PCP 3. Candidal esophagitis, toxoplasmosis, histoplasmosis 4. CMV retinitis & esophagitis, disseminated MAC, cryptococcal meningoencephalitis |
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Neoplasm associated with HIV
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Kaposi's Sarcoma (HHV8), Invasive cervical carcinoma (HPV), 1° CNS lymphoma, non-Hodgekin's lymphoma
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HIV encephalitis
1. timing 2. mech 3. Dx |
1. late
2. virus accesses CNS via Macrophages 3. Microglial nodules w multinuclated giant cells |
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Prions
|
1. CJD (Creutzfeldt-Jacob Dz) - rapidly progressive dementia
-spongiform encephalopathy -nl prions α-helix --> β pleated sheet 2. Kuru (canibals) 3. Scrapie (Sheep) 4. Mad cow dz |
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Dominant nL Flora
1. Skin 2. Nose 3. Oropharynx 4. Dental plaque 5. Colon 6. Vagina |
1. Staph epidermidis
2. Staph epidermidis, colonized by S. Aureus (int nares) 3. Strep viridans 4. Step mutans (viridans) 5. Bacteroides fragilis > E. Coli 6. Lactobacillus, colonized by E. coli and GBS |
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Common Cause of Pneumonia
1. Neonates (<4wk) 2. Children (4wk - 18yr) 3. Adults (18-40yo) 4. Adults (40-65yo) 5. Elderly |
1. GBS
E. Coli 2. Viruses (RSV) Mycoplasma Chlamydia Pneumonia Strep Pneumo 3. Mycoplasma Chlamydia Pnuemonia Strep Pnuemonia 4. Strep Pneumo H. Flu Anaerobes Viruses Mycoplasma 5. S. Pneumo Viruses Anaerobes H. Flu Gram (-) Rods |
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Pneumonia - Special Groups
1. Nosocomial 2. Immunocomp 3. Aspiration 4. Alchoholic/IV Drug 5. Postviral 6. Atypical |
1. Staphylococcus, gram (-) rods
2. Staphylococcus, gram (-) rods, fungi, viruses, PCP - HIV 3. Anaerobes 4. Strep Pneumo, Klebsiella, Staphylococcus 5. Staphylococcus, H. Flu 6. Mycoplasma, Legionella, Chlamydia |
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Common Causes of Meningitis
1. Newborn (0-6 wk) 2. Children (6mos-6yr) 3. 6 yr - 60 4. 60 + yrs |
1. GBS
E. Coli Listeria 2. Strep Pneumo N. Meningitis H. Flu (B) Enteroviruses (coxsackie) 3. N. Meningitis Enterovirus Strep Pneumo HSV 4. S. Pneumo Gram (-) rods LIsteria Viral: Enterovirus (coxsackie), HSV, HIV, WNV, VZV In HIV: Cryptococcus, CMV, Toxoplasmosis (brain abscess), JC virus (PML) |
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CSF findings in Meningitis
(Pressure, Cell type, Protein, Sugar) 1. Bacterial 2. Viral 3. Fungal |
1. Inc pressure, Inc PMNs, Inc protein, Dec glucose
2. Inc pressure, Inc Lymphocytes, Inc protein, Dec glucose 3. nL/Inc pressure, Inc Lymphocytes, nL protein, nL sugar |
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Osteomyelitis
1. Most Common 2. Sexually active 3. Diabetic/Drug Addict 4. Sickle Cell 5. Prosthetic replacement 6. Vertebral 7. Cat/Dog bites and scratches |
1. Staph Aureus
2. N. gonorrhea (rare), septic arthritis more common 3. Pseudomonas Aeruginosa 4. Salmonella 5. S. Aureus and S. Epidermidis 6. TB (potts dz) 7. Pasteurella multocida |
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UTIs
1. Ambulatory 2. Hospital 3. Epidemiology 4. Predisposing factors |
1. E. Coli (50-80%), Staph Saprophyticus (10-30%) - 2nd most common cause in young sexually active women, Kleibsiella (8-10%)
2. E. Coli, Proteus, Klebsiella, Serratia, Pseudomonas 3. 10:1 women 4. Flow obstruction, kidney surgery, cath, gyn abnLties, diabets, pregnancy |
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UTI bugs
1. Serratia Marcescens 2. Staph Saprophyticus 3. E. Coli 4. Enterobacter Cloacae 5. Klebsiella pneumonia 6. Proteus Mirabilis 7. Psuedomonas Aeruginosa |
1. Some strains - red pigment, nosocomial, drug resistant
2. 2nd leading cause in sexually active women 3. Leading cause. Colinies have metallic green sheen on EMB agar 4. Often nosocomial and drug resistant 5. Large mucoid capsule and viscous colonies 6. Motility causes swarming on agar, produces urease, struvite stones 7. Blue-green pigment and fruity odor (grapes), usually nosocomial and drug resistant |
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ToRCHeS Infections
1. Name 2. Dz |
1. Toxoplasma gondii - "classic triad" of chorioretinitis, intracranial calcifications and hydrocephalus. May be asymp at birth
2. Rubella - deafness, cataracts, heart defects (PDA, pulm art stenosis), and mental retardation 3. CMV - petechial rash, intracranial calcifications, mental retardation, hepatosplenomegaly, microcephaly, jaundice, 90% are asymp at birth 4. HIV - hepatosplenomegaly, neurologic abnormalities, frequent infection 5. HSV-2 - encephalitis, conjunctivitis, vesicular skin lesions. Often asymp at birth 6. Syphilis - cutaneous lesions, hepatosplenomegaly, jaundice, saddle nose, saber shins, hutchinson teeth, CNVIII deafness, rhinitis (snuffles) Others: Listeria, E. Coli, GBS can be acquired placentally or from birth canal |
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Osteomyelitis
1. Most Common 2. Sexually active 3. Diabetic/Drug Addict 4. Sickle Cell 5. Prosthetic replacement 6. Vertebral 7. Cat/Dog bites and scratches |
1. Staph Aureus
2. N. gonorrhea (rare), septic arthritis more common 3. Pseudomonas Aeruginosa 4. Salmonella 5. S. Aureus and S. Epidermidis 6. TB (potts dz) 7. Pasteurella multocida |
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UTIs
1. Ambulatory 2. Hospital 3. Epidemiology 4. Predisposing factors |
1. E. Coli (50-80%), Staph Saprophyticus (10-30%) - 2nd most common cause in young sexually active women, Kleibsiella (8-10%)
2. E. Coli, Proteus, Klebsiella, Serratia, Pseudomonas 3. 10:1 women 4. Flow obstruction, kidney surgery, cath, gyn abnLties, diabets, pregnancy |
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UTI bugs
1. Serratia Marcescens 2. Staph Saprophyticus 3. E. Coli 4. Enterobacter Cloacae 5. Klebsiella pneumonia 6. Proteus Mirabilis 7. Psuedomonas Aeruginosa |
1. Some strains - red pigment, nosocomial, drug resistant
2. 2nd leading cause in sexually active women 3. Leading cause. Colinies have metallic green sheen on EMB agar 4. Often nosocomial and drug resistant 5. Large mucoid capsule and viscous colonies 6. Motility causes swarming on agar, produces urease, struvite stones 7. Blue-green pigment and fruity odor (grapes), usually nosocomial and drug resistant |
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ToRCHeS Infections
1. Name 2. Dz |
1. Toxoplasma gondii - "classic triad" of chorioretinitis, intracranial calcifications and hydrocephalus. May be asymp at birth
2. Rubella - deafness, cataracts, heart defects (PDA, pulm art stenosis), and mental retardation 3. CMV - petechial rash, intracranial calcifications, mental retardation, hepatosplenomegaly, microcephaly, jaundice, 90% are asymp at birth 4. HIV - hepatosplenomegaly, neurologic abnormalities, frequent infection 5. HSV-2 - encephalitis, conjunctivitis, vesicular skin lesions. Often asymp at birth 6. Syphilis - cutaneous lesions, hepatosplenomegaly, jaundice, saddle nose, saber shins, hutchinson teeth, CNVIII deafness, rhinitis (snuffles) Others: Listeria, E. Coli, GBS can be acquired placentally or from birth canal |
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STDs
1. Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge |
1. Gonorrhea - N. Gonorrhea
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STDs
2. Painless chancre - possible complications if not diagnosed |
Syphilis - Treponema Pallidum
Secondary - Fever, lymphadenopathy, skin rashes, condylomata lata Tertiary - Gummas, tabes dorsalis, general paresis, aortitis, Argyll Robertson pupil |
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STDs
5. Painful penile, vulvar, or cervical ulcers; can cause systemic symptoms such as fever, HA, myalgia |
Genital Herpes - HSV-2 (1)
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STDs
6. Urethritis, cervicitis, conjunctivitis, Reiter's syndrome, PID |
Chlamydia - C. Trachomatis
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STDs
7. Ulcers, lymphadenopathy, rectal strictures |
Lymphogranuloma Venerum - C. Trachomatis (L1-L3)
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STDs
8. Vaginitis, strawberry colored mucosa |
Trichomoniasis - Trichomonas vaginalis (see motile trophozoites on wet mount)
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STDs
9. Opportunistic infections, Kaposi's sarcoma, lymphoma |
AIDS - HIV
|
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STDs
10. Genital warts, koilocytes |
Condylomata acuminata - HPV 6 & 11
|
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STDs
11. Jaundice |
Hepatitis B
|
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STDs
12. Painful genital ulcer, inguinal adenopathy |
Chancroid - H. Ducreyi
|
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STDs
13. Noninflammatory, malodorous discharge (fishy smell), positive whiff test, clue cells |
Bacterial Vaginosis - Gardnerella vaginalis
|
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Cervical motion tenderness (chandelier's sign), purulent cervical discharge
1. Dx 2. Most likely organisms 3. Areas affected/complications |
1. PID
2. C. trachomatitis - subacute, often unDx, most common STD in US N. Gonorrhea - Acute, high fever Others: Gardnerella - clue cells, Trichomonas - motile wet prep 3. Endometritis, Salpingitis --> ectopic, infertility, chronic pelvic pain, adhesions; hydrosalpinx, and tubo-ovarian abscess |
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Nosocomial infection
1. Newborn Nursery 2. Urinary Cath 3. Resp therapy equipment 4. Work in renal dialysis unit 5. Hyperalimentation 6. Water aerosols (humidifier?) |
1. RSV, CMV
2. E. Coli, Proteus 3. Pseudomonas 4. HBV 5. Candida albicans 6. Legionella |
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If all else fails:
1. Pus, empyema, abscess |
1. Staph aureus
|
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If all else fails
2. Peds infection |
2. H. Flu (including epiglotitis)
|
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If all else fails
3. Pneumonia in cystic fibrosis, burn wounds |
3. Pseudomonas
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If all else fails
4. Branching rods in oral infection |
4. Actinomyces israelli
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If all else fails
5. Traumatic open wound |
5. Clostridium perfringes
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If all else fails
6. Surgical wound |
6. Staph Aureus
|
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If all else fails
7. Dog or Cat bite |
7. Pasteurella multocida
|
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If all else fails
8. Currant jelly sputum |
8. Kleibsiella
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9. Sepsis/Meningitis in newborn
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9. Group B Strep
|