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370 Cards in this Set

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What are the differences between First tail and second tail of the IgMs?
First tail:
Hydrophobic and membrane spanning
No Sulf-hydryl group
Second Tail:
Hydrophilic
Contains an SH group
IgM translocated into ER lumen
What is the orders of the isotype in relation to gene location?
IgM/IgD, IgG, IgA, and IgE
Describe the characteristics of B1 cells?
Mostly IgM
Don't have memory
Produce T-cell independent reactions (Can't class switch so stuck in IgM mode)
Limited somatic hypermutation
Responds to CARBOHYDRATE antigen and may respond to protein antigen
Describe the characteristics of B2 cells
Have memory
Respond principally to protein antigens
T-cell dependent reactions
High levels of somatic hypermutation
At what age is T-cell repertoire mainly determined?
10-12 yo
In which order is the T-cell chains made?
Beta first
Failure of Beta goes to gamma delta
Success of Beta goes to alpha
Characterize the gamma delta T cells
minor population of T cells
Concentrated in the skin
Functionally and topographically sub-specialized forms of Tcells
Neonates and infants make a transient population that survive at most 1-2wks after birth
What is a double positive cell in reference to T cells?
CD3, CD4, and CD8 expression awaiting to undergo positive and negative seleciton
What do the different sections of thymus primarily contain (cortex and medulla)
Cortex:
Rich in epithelial cells and thymocytes
Medulla:
Close to where cells are secreted in to circulation
Rich in macrophages and dendritic cells
What is the predominant T-cell type?
CD4
What percentage of T-cells from the bone marrow make it through positive thymic education?
2%
How long might a Naive T-cell circulate for in hopes of finding their corresponding antigen?
years
What steps would occur when a Naive T-cell enters a lymph node from a high endothelial venule?
If T0cell does not encounter its antigen, it leaves the secondary lymphoid tissue via the efferent lymph.
If a T-cell does encounter its antigen it is "trapped" and activated by AgPCs and proliferates and differentiates into a multitude of effector cells. It leaves through the efferent lymph to go to the site of infection
What are the molecular processes that occur for crossing of naive T and B cells from high endothelial venules into lymph nodes?
Step 1: L-selectin on naive T0cells binds to vascular addressins GlyCAM-1 and CD34 on high endothelial venules. Vascular addressin MAdCAM-1 is expressed by capillaries in mucosal tissue
Step 2: Chemokines on the endothelial surface activate integrin LFA-1 (on the surface of all T-cells, which binds to the Ig superfamilies ICAM-1 and ICAM-2 on the vascular endothelial surface
Step 3: Diapedesis occurs as T-cells squeeze through the endothelium via PCAM receptors and finally into the secondary lymphoid tissue
How long might a Naive T-cell circulate for in hopes of finding their corresponding antigen?
years
What steps would occur when a Naive T-cell enters a lymph node from a high endothelial venule?
If T0cell does not encounter its antigen, it leaves the secondary lymphoid tissue via the efferent lymph.
If a T-cell does encounter its antigen it is "trapped" and activated by AgPCs and proliferates and differentiates into a multitude of effector cells. It leaves through the efferent lymph to go to the site of infection
What are the molecular processes that occur for crossing of naive T and B cells from high endothelial venules into lymph nodes?
Step 1: L-selectin on naive T0cells binds to vascular addressins GlyCAM-1 and CD34 on high endothelial venules. Vascular addressin MAdCAM-1 is expressed by capillaries in mucosal tissue
Step 2: Chemokines on the endothelial surface activate integrin LFA-1 (on the surface of all T-cells, which binds to the Ig superfamilies ICAM-1 and ICAM-2 on the vascular endothelial surface
Step 3: Diapedesis occurs as T-cells squeeze through the endothelium via PCAM receptors and finally into the secondary lymphoid tissue
What are the steps in T-cell screening within a Lymph node?
Step 1: both T0cells and AgPCs express LFA-1 (integrin). LFA-1 on T-cells binds to Ig superfamily ICAM-1 and ICAM-2 on AgPCs with low affinity. LFA-1 on AgPCs bind to Ig superfamily ICAM-3 on T-cells
Step 2: Ig superfamily CD2 on T-cells binds to LFA-3 on AgPCs
What co-stimulatory molecule on professional AgPCs distinguishes them and binds to T-cells and what do they bind to?
B7 binds to CD28 on the T-cell
What happens after the T-cell becomes activated by B7:CD28 interaction?
B7 is then bound to CTLA-4
What is the purpose of CTLA-4?
It functions as a down regulator so that over proliferation of the T-cells don't occur
What are the three "Professional" antigen presenting cells?
Dendritic Cells
Macrophages
B-cells
Describe what happens to Dendritic cells from peripheral tissues to the lymph nodes?
Immature dendritic cells in tissue take up antigen and migrate to lymph nodes
Become mature (interdigitating reticular cells) and no longer take up antigent.
Express high levels of MHCII and costimulatory and adhesion molecules
Produce high levels of cytokines and chemokines
They present obth Viral Ag on MHC I and extracellular pathogens on MHC II
Describe what a Macrophage does in relation to T-cell stimulation?
It is a phagocytic cell that presents peptides on MHC II to CD4 T cells.
Expresses co-stimulatory molecule upon degradation of intracellular pathogen
Also present to CD8 via MHC-I when infected
Describe what a B-cell does in relation to T-cell stimulation?
B-cells use their surface receptors to internalize specific antigen by receptor-mediated endocytosis delivering it to the surface through MHC II
What cytokine is important to dividing T-cells?
IL-2 causes both proliferation and differation
Naive T-cells express the low affinity receptor for IL-2
Upon actiavtion IL-2 and the high affinity receptors are induced
When IL-2 binds the T-cell is triggered to divide
IL-2 has both an autocrine and paracrine effects
What happenes to T-cells once they become effectors?
They increase expression of CD2 and LFA-1 but decrease expression of L-selectin in exchange for VLA-4 which allows them to bind adhesion molecules on endothelial cells of blood vessels at infected and inflamed sites
They no longer require a second signal
What cytokines do CD4 TH1 and TH2 cells produce?
CD4 TH1: IFN Gamma and TNF Alpha
CD4 TH2: IL-3, IL-4, IL-5, and IL-10
How many times do neutrophils and CD8 cells release their cytotoxins?
Neutrophils: 1x
CD8: over and Over
What do Cytotoxic T-lymphocytes secrete as a cytotoxin and what does it do?
Interferon Gamma
It inhibits the replicatoin of viruses in infected cells, increase MHC I expression and helps to activate nearby macrophages
What do Fas molecules and Fas ligands do?
Fas molecules on the target call and Fas ligand on the EFFECTOR T-cells can induce apoptosis
What two signals are needed to stimulate a macrophage?
Interferon-gamma
T-cell CD40 ligand interaction with macrophage CD40
What is the difference between CD8 cytotoxins and CD4 TH1 cytokins?
CD8s are premade
CD4TH1s are made during response
What are the primary selectin and integrin bindings between a T-cell and an APC during stimulaiton?
T-Cell:
LFA-1 binding to ICAM-1 and ICAM-2
C2 binding to LFA-3
ICAM-3 to LFA-1
On a B-cell what is the name for the motif that gets phosphorylated in connection to binding of antigen by the antibody?
ITAMS or ITIMS (immunoreceptor tyrosine activation motifs and immunoreceptor tyrosine inhibitory motifs)
What does ITAMS and ITIMS do?
When multiple crosslinking on a B cell occurs they are phosphorylated. If doubly phosphorylated they will activate two Syk proteins (tyrosine kinases) that autophosphorylate each other to eventually enact some nuclear change.
How many proteins make up the B-cell co-receptor, what are they, and what do they do?
3
CD19, CR2 (CD21), and CD81
CR2 binds to C3d (complement protein on the pathogen membrane
CD19 brings the tail of CD19 in close proximity to the Lyn tyrosine kinase
Phosphorylation of Cd19 tail enhanses a nuclear signal for proliferation and differentiation
How many thymus independent antigens are there, what are they, and what do they do?
2
TI-1 and TI-2
TI-1: cell walls and capsules of bacterial pathogens
Ex. Peptidoglycan (Binds TLR2 on the B-cell membrane)
Ex. LPS binds LPS binding protein which binds CD14 on B-cell membrane
Formation of IgM only
TI-2: Include pathogens with highly repetitive polysaccharide or protein epitopes
Ex. flagella of bacteria due to repetitive nature
However, can also form IgG not just IgM
Which B-cell is the only one that recognizes TI-2 antigens and when do they begin to develop?
B-1 cells
Develop around 5 years of age
What three processes for B-cells require T-cell help?
Somatic hypermutation
Memory formation
Isotype Switching
On a follicular dendritic cell's surface what captures antibodies and what captures complement to be presented?
FcR captures antibodies bound to antigen
CR3 receptor captures antigen bound to complement
What are the stimulatory isotype switching cytokines in a TH2 cell?
IL-4, IL-5, IL-10, and TGF beta for IgM, IgG2, IgG4, IgA, and IgE
What are the stimulatory isotype switching cytokines in a TH1 cell?
IL-12 and IFN-gamma for IgG1
What is the name of receptor that is used to secrete IgM and IgA across barriers in the lung ang gut?
Poly-Ig receptor (unidirectional transport unlike FcRn)
Once secreted following transcytosis what is the poly-Ig called and what is the poly-Ig bound to IgA called?
The Poly-Ig is called secretory component
The antibody is now referred to as secretory IgA
What receptor can transport IgG across the membrane?
FcRn - pH dependent binding(Fc gamma receptor - multidirectional transport unlike Poly-Ig receptor)
What process is described by antibody dependent cellular cytotoxicity?
ADCC is a process by which antibody-coated cells are killed by NK cells (NK's have a low affinity Fc-gamma [CD16] which requires that antibodies be crosslinked)
What is the most common immune protein deficiency in humans?
Partial lack of C4 (Lack of C4A can lead to SLE)
What is the purpose of C1INH?
Binds C1r and C1s and prevents them from binding to C1q
What is the purpose of C4BP?
Binds to C4b causeing the release of C2b and the recruitment of factor I which degrades C4b
What is the purpose of Factor H?
Directly attacks C3b forming a region in the C3b suscptible to factor I degradation
What is the purpose of DAF?
Inhibits C3 convertase formation. Causes release of Bb.
What is the purpose of Membrane Co-factor protein (MCP)?
It is also to release Bb from the C3 convertase but also it makes C3b susceptible to Factor I
What does Properdin (factor P) do?
Binds to and stabilizes the C3bBb so that degradation cannot occur
What does CD59 do?
Prevents Mac Attack
name the antibacterial peptides that protect the skin, gut, and lungs and how do they work?
Alpha defensins - neutrophil granules in the form of cryptdins made by paneth cells of hte cmall intestines
Beta Defensins - secretino by epithelial cells of the epidermis, respiratory tract, and GI tract
Defensins kill pathogens by disrupting their membranes. Require lower ionic concentrations of sweat, tears, or lumen of gut
What are the macrophage receptors and what do they bind with?
Fc - receptors for IgG
CR1 (complement receptor) - C3b
CR3 and CR4 - bind iC3b, cleavage product of C3b
CD14 - binds LPS-LBP
Mannose Receptor - binds lectins (CHO molecules)
Scavenger receptor binds molecules with sialic acid (S. pyrogenes and S. Aureus)
Glucan receptors - Bind sugars not present on human cells
TLR- various bindings
What do TLR's bind to?
Pathogen-Associated Molecular patterns (PAMPS)
Includes: DNA, LPS, Peptidoglycan, flagellin, mannin, etc.
What does TLR-3, TLR-4, TLR-5, and TLR-9 bind to?
TLR-3: Double stranded RNA (Virus)
TLR-4: LPS (Gram Neg)
TLR-5: Flagellin (Gram Neg - Only TLR that binds directly to a microbial product)
TLR-9: DNA CpG motifs (Bacteria - Only intracellular receptor that sense microbial genomic DNA)
Describe the MyD88 dependent pathway of TLR activation (Fast)
MD2 ligand binds TLR-4
TLR-4 sensitizes LPS and allows LPS to bind with CD14
CD14 allows MyD88-mediated cascade
MyD88 is an intracellular adaptor molecule that activates IRAK (IL-1 receptor associated kinase 4) and TRAF6 (TNF-receptor associated kinase 6) Cascade started by MyD88 causes the degradation of the inhibitory Molecule IkappaB that allows NFKappaB to enter the nucleus and being transcription of Inflammatory cytokines
Describe the MyD independent pathway of TLR activation (Slow)
TLR3 affects NFkappaB and causes slow cytokine making
What do IL-1 Beta and TNF-alpha?
Local effects - both increase the permeability of the vascular endthelium and allow IgG complement, neutrophils, and other WBC to enter the tissue
Il-1Beta induces fever and cause an increase in production of IL-6
TNF-alpha induces fever and is the main cytokine responsible for causing septic shock
What does IL-6 do?
TH2 cytokine
Local Effects: Increase lymphocyte activation and increases plasma cell antibody production
Systemic effects: it causes fever and induces acute phase protein production by hepatocytes
What does IL-8 or CXCL8 do?
Binds CXCR1 and CXCR2
Local effects: acts as a chemotactic facto rand recruits neutrophils, basophils, and T-cells to the site of infeciton
What does IL-12 do?
TH1 cytokine
Local Effects: Activates NK cells and induces the differentiation of CD4 cells into TH1 cells
What are the acute phase proteins and what is their net effect?
C0reactive protein and Mannose-binding protein
They increase the supply of the recognition molecules of innate immunity and activate compliment
What does C-reactive protein do?
Binds to the microbial surface and then associates with C1q initiating the classical complement pathway
What does Mannose-Binding Lectin (MBL)?
In the lectin pathway of complement activation, MBL binds mannose on the surface of yeast and bacteria. Cleaves C4 and C3 to form the classical C3 convertase
What PMN has a special receptor to specifically recognize N-formylmethionine?
Neutrophils
What are 3 things that IFN alpha and beta do in the face of a cytoplasmic infection?
Induces resistance to viral replication in all cells
Increase MHC class I expresssion and antigen presentation in all cells, thus making virus-infected cells more visible to CTLs
Activate NK cells to kill virus infected cells
What is the mechanism for release of IFNs?
IRF3 (IFN Response Factor 3) detects viral assualt and induce translocation to the nucleus with NFkappaB and AP-1 to promote transcirption of IFN-beta
What are two ways that IFN-beta functions?
Paracrine: IFN-beta stimulates local uninfected neighboring cells to also undergo an interferon response and thus preparing that cell for a possible viral infection
Autocrine: IFN-Beta also binds a receptor on itself that stimulates IRF7 (IFN Response Factor 7).
What do CTLs secrete as a feedback loop to stop NK cell actions?
IL-10
What would happen if a cell were infected by a vrus and the MHC-I was down regulated to bypass the T-cell adaptive immunity?
NK cells notice the decrease in MHC Class I and kill it
What is the meaning of Autologous and Allogenic?
Autologous: Cells derived from the same individual
Allogenic: same species, genetically different
What are T-cells that express an NK cell receptor called?
NKG2D (they are not NK cells)
They also carry a gamma-delta receptor
Infected epithelial cells express what two proteins and what do theose proetins resemble?
They express MIC-A and MIC-B. They are like MHC I-like.
What is the Th1/Th2 paradigm for stimulation of TH1?
Dendritic cells release IL-12 causing NK cells to release IFN-gamma which prevents gorowth/activation of Naive CD4 cells into TH2 cells and facilitates the differentiation of naive CD4 cells into TH1 cells
What is the Th1/Th2 paradigm for facilitating Th2?
Inflammatory condition - IL-4 produced and lack of IL-12 and IFN-gamma favor TH2 differentiation. TH2 secrete IL-10 which prevents TH1 response by inhibiting DC and macrophage antigen processing and presentation
TGF-beta inhibits the growth/activation of TH1 cells
What type of CD45 do Naive and memory T cells express?
Naive: CD45RA
Memory: CD45RO
What promotes survival of memory cytotoxic T-cells and memory B-cells?
IL-15
What inhibits memory T cells?
IL-2
Describe Antigenic drift
A point mutation which causes significant differences in the viral surface antigens and in particular hemaggglutinin
Describe Antigenic shift
A third party host that can obtain virus from 2 different sources provides an environment where their genetic segments can recombine in such a way that they produce hemagglutinin that is significantly different from the original and against which previous antibodies are ineffective
Describe Antigenic variation
An infectious organism can produce a variable surface protein that can be selected for when the primary representation has had an immunity built up to it, thereby continuously reinfecting the host
Describe Latency in reference to infections
Virus resides and waits till the right time to infect
What is inhibit humoral immunity?
Surface of virus0infected cells have an Fc Gamma receptor oreiented so that the antibodies face out instea dof binding. Or the infectious agent encodes their own complement receptor
What is inhibition of the onset of inflammation
Virally encoded soluble cytokines block proinflammatory cytokines
Inhibits adhesion molecules
Secretes little TLRs that mimic TLRs
What is an example of inducing of immunosuppression for viral escape from immune protection
Viruses that produce IL-10 to deactivate TH1 instead of activating it.
Describe SCIDs
Many possible causes
Complete absence of T-cells and/or B-cells
Patient susceptible to almost all organisms
Describe what would happen in an MHC-I deficiency?
CTLs are not present
Describe what would happen in an MHC-II deficiency?
Absence of CD4 T-cells
Describe what happens in an X-Linked hyper IgM syndrome
Because you don't have the ability to isotype switch, you only have an increase in IgM
Individuals are very susceptible to extracellular organisms
Describe what would happen in if someone had a selective deficiency in IgA?
No IgA synthesis
Very susceptible to respiratory infections
Upper respiratory system IgA predominates
Down in the lung, IgG is more prevalent so less likely to get an infection there
What happens in X-Linked agammaglobulinemia
B cells do not progress beyond the pre-B cell stage
Important protein kinase on the X-chromosome missing. THerefore, missing a Tyrosine kinase for B-cells to mature
What would happen with a deficiency in C5-C9?
Susceptibitlity to infections by Neisseria
What would happen from a deficiency in DAF, CD59?
Not protected from attack by the alternative complement pathway
Autoimmune like conditions invluding paroxysmal nocturnal hemoglobinuria (acidosis during sleep is thought to cause hemolysis due to enhancement of complement pathway)
Describe the components of the quintessential HIV?
Nucleocapsid - protects RNA
Reverse transcriptase
Protease - breaks up the polyprotein encoded by the genome
Integrase - allows the cDNA to be incorporated into host's genome
gp160 - envelope glycoproteins necessary to infect gp120 and gp41
What are the 9 essential proteins of HIV-1?
gag(Group specific antigen) - proteins form the nuclear protein and stabilize RNA
pol (polymerase) - reverse transcriptase, protease break up polyprotein, integrase enzyme which integrates viral genome to host
env (envelope) - transmembrane glycoproteins (gp120 binds CD4 and CCR5, GP41 required for virus fusion)
nef (Negative-regulation factor) - Pulls CD3 and MHC class I off the membrane (maybe not true anymore)
What is Human Beta Defensin 3?
Antagonist of the HIV-1 coreceptor CXCR4
when stressed the CXCR4 coreceptor is pulled off the membrane. This may protect the cell.
What are the stages of HIV/
Infection with large drop in T cell numbers
Seroconversion - phase of infection when antibodies agains thte infecting agent are first detected (T-cell levels rise)
Protease inhibitors prolong the depletion (asymptomatic phase)
Level of T-cells becomse too low and opportunistic infections
What does haart stand for?
Highly active anti-retroviral therapy
In what clinical context would a defect in immune function present itself as most significant?
Pediatrics
What deficiency is the most common primary immunodificiency?
Antibody deficiency
What type of symptoms would suggest an underlying immune problem?
Single episode of osteomyelitis, septic arthritis, or meningitis
Two episodes of sepsis or pneumonia
several episodes of sinusitis, bronchitis, or pneumonia
What are the 10 warning signs of PID from Jeffrey Modell Foundation)?
Eight or more new ear infections (otitis media) within 1 year
Two or more serious sinus infections w/in 1 yr
Two or more months on antibiotics with little effect
Two or more pneumonias within one year
Failure of an infant to gain weight or grwo normally
Recurrent deep skin or organ abscesses
Persistent thrush somehwere after age 1
Need for IV antibio to clear infections
Two or more deep seated infections
Family history of PID
What is stage 1 of testing if PID is suspected?
H and P with height and weight
Lab tests: CBC and differential with quantitative Ig profile
What is stage 2 of testing if PID is suspected
Ab response
response to vaccination
Ig subclass analysis
What is Stage 3 of PID testing?
candida and tetanus skin test
lymphocyte surface markers
mononuclear lymphocyte proliferation study
Neutrophil oxidative burst study
What is Stage 4 of PID testing?
Complement screen for CH50, C3, and C4
Enzyme measurements
Phagocyte studies
NK cytotoxic studies
studies of Complement AH50
Neo antigen to test antibody production
cytokine receptor study
family genetic study
What are specific CD markers for B cells?
CD19, CD20, CD21
What is the primary biological mechanism of clearance of solubilized immune complexes in humans?
RBC will bind to complement and be filtered by the spleen
Describe Contact hypersensitivity and identify the type of hypersensitivity reaction it is?
Typically occuring in individuals who are sensitive to metals. Prototype hapten is poison ivy. Pentadecacatechol acts as a hapten which mediates a CD4 response and elicits and allergic reaction. Second exposure can call in basophils and other cells leading to a permeability change
Type IV hypersensitivity
Describe granulomatous response and identify the type of hypersensitivity reaction it is
Exposure to antigen is chronic and the antigen is not eliminated by the cell-mediated response, the chronic exposure can give rise to a granulomatous response
Type IV hypersensitivity
What does the AIRE gene do?
Allows ectopic expression of non-thymus tissue-specific antigens in the thymus
Presence of tissue-specific proteins in the htymus means that peptides derived from these proteins can be bound by MHC class I and II molecules to form complexes that participate in negative selection of the T-cell repertoire
If AIRE gene is wiped out, only have thmuse antigens expressed, therefore, no negative selection fro other organs outside of the thymus
What does C4 do?
Involed with antigen clearance and opsonization.
Polymorphisms increase the susceptibility of SLE.
What does CTLA-4 do?
Turns off the immune response
Deficiency will cause an overimmune response
What does Fas and FasL do?
Causes apoptosis of autoreactive B-cells. Without it develop an autoimmune response due to longer lasting self reactive cells
What does FoxP3 do?
Associated with T-regulatory cells
Knowck out that gene, get a deficiency of regulatory T cells and you get this autoimmune polyendocrine disease called IPEX
What happens during SLE autoimmune disease?
Cells are infected by a virus and cause a surface expression of a second signal along with the expressions of MHC bound DNA and intranuclear antigens
What is the process of plasmapherises in the treatement of autoimmune disease?
Autoimmune processes are cellular or humoral
Remove large volume of blood
replace the red blood cells
Administer back some Intravenous Immunoglobulin (IVIg)
Adverse Effect: Downregulate the B cell responses via the Fc inhibitory receptors by adding the IVIg
What is the process of Immunosupression in the treatment of autoimmune disease?
Often done with steroids
Cyclosporin A is a drug that inhibits the production of cytokines like IL-2
Neutralize the T-cell responses by reducing cytokine communications
Do bacterial capsules present well to the groove on top of the MHC?
No because the groove is specific for peptides
What kind of response to bacterial capsules do we get?
IgM with no memory therefore T-independent
How can you create antibodies to the polysaccharide?
Conjugate it to a protein so that the protein sticks in the MHC pocket and the hapten sticks out to be recognized
No T-cell immunity generated
What is the purpose of the various adjuvants?
All adjuvants:
Create a greater immune response, act as an antigen depot, and allow a slow release of the antigen into circulation
Freund's incomplete: Oil-in water emulsion
Aluminum Hydroxide:
Conjugate carrier gel made from alum
What does Azothioprine do in reference to tissue transplants?
It is a cytotoxic drug
Converted into a nucleotide derivative
Derivative is designed to hit nucleic acid metabolism
What does cyclophosphamide do in reference to tissue transplantation?
Functions as a cross-linking agent.
Have 2 active chlorine.
Cross-link between DNA strands so that the strands can't separate
What does methotrexate do in reference to tissue transplantation?
Works on vitamin pathways and nucleotide pathways to kill cells
What are some signal transduction specific drugs in relation to tissue transplantation?
Cyclosporin A, Rapamycin, and Tacrolimus
They act in the cytoplasm on some of the proetins that are involved in calcium metabolism
Prevent formation of IL-2
What makes up Gram (+) bacteria outer layers?
THICK peptidoglycan
Lipoteichoic acid and Teichoic acids interwoven into the peptidoglycan
Cytoplasmic membrane
What makes up Gram(-) bacteria outer layers?
Outer membrane (LPS: called O-antigens, Porins (AKA outer membrane proteins), Lipoproteins)
Cell wall (peptidoglycan layer [thinner in gram (-)])
Periplasmic space
Cytoplasmic membrane
What type of motion and pili do bacteria typically use?
Type IV pili
Twitching Motility
In regards to flagella what is the H and K antigens?
H is flagella
K is capsule
What are two types of Plasmids that bacteria carry?
R-Plasmids: carry genes encoding enzymes or proteins that conver antibiotic resistance
Virulence plasmids: carry genes encoding toxins or other virulence factors
What is a mesosome?
Invaginations of the cell membrane involved in chromosomal segregation and septation
Bacteria divide by binary transverse fission
What is an endospore?
Resting phase of bacteria
Formed when the environment is not very suitable for the bacteria such as lack of nutrients, water, etc.
What are four phases of bacterial growth?
Lag phase - adaptation to new surroundings
Log phase - bacteria exponential growth
Stationary phase - nutrients start becoming scarce and toxic metabolites begin to build up (death = growth)
Death or Decline Phase - toxic metabolites build up even further and the nutrients run out
What is metabolic parsimony in reference to bacteria?
Lack of nutrients force use of new nutrients. Very efficient in how they spend energy to prevent waste
What is meant by countermeasures in reference to bacteria?
Ex. Iron
Bacteria have developed siderofores which have a higher binding affinity for iron that the cells in our bodies.
What is Passive diffusion?
Nutrients move by virtue of a concentration gradient
What are siderophores in relation to passive diffusion?
Proteins on the outside of the cell with a higher affinity for iron. Bring nutrients into a cell whether there is a concentration gradient or not. Diffusion uses NO energy from the cell
What is active transport in relation to a bacteria?
Pumps that rely on energy to bring in sugars, most amino acids, organic acids, and many inorganic ions even against the concentration gradient
What is group translocation in relation to a bacterial cell?
Similar to active transport, but the nutrient is modified before being brought into the cell
What are the three pathways of bacterial nutrient production?
Emden-Myerhof-Parnas (EMP) pathway (AKA: glycolytic or anaerobic pathway)
Tricarboxylic acid cycle (TCA)
Pentose Phosphate Pathway
What is the CNA plate specific for?
Gram positive bacteria
What does the MacConkey plate select for?
Gram negative bacteria and lactose fementing bacteria
Color changes pink when the bacteria are able to ferment lactate because the pH is lowered
What is the name of the first antibiotic (discovered by Gerhard Domagk)?
Prontosil Rubrum: red azo dye that prevented mice from dying of streptococcal infection.
What does prontosil do and how does it work?
It blocks the synthesis of folic acid.
What does Trimethoprim do?
Blocks the enzyme dihydrofolate reductase fond in humans and bacteria but is 50,000X more potent for bacteria so that the bacteria are unable to make folic acid
How do Aminoglycosides such as Streptomycin work?
It binds to the 30S ribosomal subunit and kill the bacteria by blocking initiation of hte peptide chain
How do Marcrolides such as Erythromycin work in reference to bacterias?
Binds to the 50S subunit and prevent chain elongation, a reversible phenomenon. bacteriostatic
How does Rifampin work and what does it work on?
Rifampin blocks RNA polymerase and is an anti-TB drug
What is the definition for Adhesins?
Allow a microbe to bind to a variety of eukaryotic cells
Prevents the microbe from being removed by washing or flushing actions
eg. urinary tract infections
What is the definition for Invasins?
Allow the microbe to enter eukaryotic cells that are not professional phagocytes
Advantage for microbe to be intracellular
What is the definition for Aggressins?
Directly damage the host or actively promote the spread of a pathogen
ex. toxins and proteases
What is the definition for Modulins?
Modulate host cell activity with pathogenic consequences.
LPS modulates T cells and macrophages into expressing toxic levels of cytokines
In regards to Extrachomosomal Genetic Elements, more specifically plasmids, what are Replicons?
Plasmids that can replicate independently from chromosomes
In regards to extrachromosomal genetic elements, more specifically plasmids, what are episomes?
Plasmids that can integrate into the host bacterium's chromosome
Once integrated, can mediate chromosomal transfer from one cell to another
What has the properties of being circular, doublestranded DNA elements, encode virulence determinants or resistance to antibiotics, and present as a single element or as multiple copies?
Plasmids
What is quorum sensing?
Quorum sensing is the ability of bacteria to communicate and coordinate behavior via signaling molecules.
What is a quorum sensing molecule for gram-negative bacteria?
Acyl homoserine lactones (AHL's)
Small diffusible signaling molecule
What are the details of conjugation in bacteria?
Transfer of genetic material (usually a plasmid) from one cell to another
Sex pilus is sued as a conduit for getnetic exchange
DNA is transferred as a single stranded molecule and becomes double stranded after transfer
Endonucleases do not affect the transfer of DNA
Integrated plasmid (episome) promotes transfer of genomic DNA, which integrates into recipient DNA
Usually occurs between related species
What are the details of Transposition in bacteria
Transposons inserts itself into chromosomes
Can cause frameshift mutations
can also carry drug resistance markers
Normally transferred via plasmids
Of the simple transposons what do they consist of?
Insertion sequences: inverted repeats that flank the transposase gene
Transposase gene: helps the DNA insert into the bacterial chromosome
What are the composite transposons?
Genes in addition to the transposase that are flanked by inverted repeats
Additional genes are usually for antibiotic resistance or virulence
What are pathogenicity islands?
genes encoding a large number of virulence factors that are flanked by transposon-like mobile elements
Mobile and can be transferred horizontally to other bacteria
Typically found in virulent organisms and not environmental isolates
What are the four staphylococcus?
Aureus
Epidermidis
Saprophyticus - Often invovled in UTI
Lugdunensis - similar disease to S. aureus
which is the only staph that is coagulase positive?
S. aureus
What test will differentiate between staph and strept?
Catalase
Only Staphylococcus is Catalase positive
What are the different methods of staph typing and description?
Phage typing - different phage attach to different strains of staph
Multi locus enzyme electrophoresis (MLEE) - types different enzymes according to strain of staph
Pulse field gel electrophoresis - replaced MLEE, cut up chromosomal DNA and run on gel
Multi locus sequence typing
staph protein A typing - virulence factor with a lot of mutations
Ribotyping - rRNA types differ among strains
What are the different methods of staph typing and description?
Phage typing - different phage attach to different strains of staph
Multi locus enzyme electrophoresis (MLEE) - types different enzymes according to strain of staph
Pulse field gel electrophoresis - replaced MLEE, cut up chromosomal DNA and run on gel
Multi locus sequence typing
staph protein A typing - virulence factor with a lot of mutations
Ribotyping - rRNA types differ among strains
What are the different methods of staph typing and description?
Phage typing - different phage attach to different strains of staph
Multi locus enzyme electrophoresis (MLEE) - types different enzymes according to strain of staph
Pulse field gel electrophoresis - replaced MLEE, cut up chromosomal DNA and run on gel
Multi locus sequence typing
staph protein A typing - virulence factor with a lot of mutations
Ribotyping - rRNA types differ among strains
What are the virulence factors of S. aureus?
Adhesins
Invasins
Cell walls
Micro-capsule
Protein A
Toxins
What are the virulence factors of S. aureus?
Adhesins
Invasins
Cell walls
Micro-capsule
Protein A
Toxins
What are the virulence factors of S. aureus?
Adhesins
Invasins
Cell walls
Micro-capsule
Protein A
Toxins
What are the S. aureus virulence adherance factors?
Clumping factor: coagulase
Fibronectin binding protein: extracellular matrix is covered by fibronectin
Biofilm
What are the S. aureus virulence adherance factors?
Clumping factor: coagulase
Fibronectin binding protein: extracellular matrix is covered by fibronectin
Biofilm
What are the S. aureus virulence adherance factors?
Clumping factor: coagulase
Fibronectin binding protein: extracellular matrix is covered by fibronectin
Biofilm
What are the methods of avoidance of immunity for staph aureus?
Encapsulated in biofilm
Protein A
Capsule to prevent phagocytosis
What are the methods of avoidance of immunity for staph aureus?
Encapsulated in biofilm
Protein A
Capsule to prevent phagocytosis
What are the methods of avoidance of immunity for staph aureus?
Encapsulated in biofilm
Protein A
Capsule to prevent phagocytosis
What are two ways that S. aureus prevents opsonization?
When no Ab bind: capsule prevents Ab binding to peptidoglycan, capsule coats the organism but appear to be labeled as self
Ab do bind: capsule is large neought that it blocks the receptors necessary for opsonization
What are two ways that S. aureus prevents opsonization?
When no Ab bind: capsule prevents Ab binding to peptidoglycan, capsule coats the organism but appear to be labeled as self
Ab do bind: capsule is large neought that it blocks the receptors necessary for opsonization
What are the three toxins of S. aureus?
Exotoxins: destroy tissue, RBCs, WBCs causing inflammation
Superantigens: "suicide by staph" because toxin is released (include enterotoxins)
Teichoic acid: mechanisms similar to TLR system and cause phagocytes to release cytokines leading to WBC recruitment, inflammation, and tissue destruction
What are the three toxins of S. aureus?
Exotoxins: destroy tissue, RBCs, WBCs causing inflammation
Superantigens: "suicide by staph" because toxin is released (include enterotoxins)
Teichoic acid: mechanisms similar to TLR system and cause phagocytes to release cytokines leading to WBC recruitment, inflammation, and tissue destruction
Following infection or internalization of S. aureus what are the two options available?
Parental form: produce alpha-toxina nd kill host
Small colony variant: hang out for up to years, then produce alpha-toxin and kill host
Following infection or internalization of S. aureus what are the two options available?
Parental form: produce alpha-toxina nd kill host
Small colony variant: hang out for up to years, then produce alpha-toxin and kill host
General info on S. aureus
Harder to culture and harder to kill (slow growing - typically Abs are designed to kill growing bacteria)
General info on S. aureus
Harder to culture and harder to kill (slow growing - typically Abs are designed to kill growing bacteria)
What are the virulence factors for S. aureus?
Clumping factor
FBP
Protein A
Collagen binding protein
Teichoic acid
What are the virulence factors for S. aureus?
Clumping factor
FBP
Protein A
Collagen binding protein
Teichoic acid
What are two ways that S. aureus prevents opsonization?
When no Ab bind: capsule prevents Ab binding to peptidoglycan, capsule coats the organism but appear to be labeled as self
Ab do bind: capsule is large neought that it blocks the receptors necessary for opsonization
What are two spreading factors of S. aureus which destroys the extracellular matrix?
Hyaluronidase: strain which causes cellulitis
Staphylokinase
What are the three toxins of S. aureus?
Exotoxins: destroy tissue, RBCs, WBCs causing inflammation
Superantigens: "suicide by staph" because toxin is released (include enterotoxins)
Teichoic acid: mechanisms similar to TLR system and cause phagocytes to release cytokines leading to WBC recruitment, inflammation, and tissue destruction
What are two spreading factors of S. aureus which destroys the extracellular matrix?
Hyaluronidase: strain which causes cellulitis
Staphylokinase
Following infection or internalization of S. aureus what are the two options available?
Parental form: produce alpha-toxina nd kill host
Small colony variant: hang out for up to years, then produce alpha-toxin and kill host
General info on S. aureus
Harder to culture and harder to kill (slow growing - typically Abs are designed to kill growing bacteria)
What are the virulence factors for S. aureus?
Clumping factor
FBP
Protein A
Collagen binding protein
Teichoic acid
What are two spreading factors of S. aureus which destroys the extracellular matrix?
Hyaluronidase: strain which causes cellulitis
Staphylokinase
What destroys host defense molecules in a staph aureus infection?
Lipase
Protease V8 (destroys Ab, proteinaceous host defense molecules)
What are the superantigens produced by S. aureus?
Enterotoxins: Producs of lysogenic conversion
TSST-1: causes toxic shock syndrome (APC produce IL-1 and TNF --> fever; CD4 produce IL-2 and gamma IFN --> nausea, vomiting, diarrhea...)
Exfoliative toxin: considered a protease
Induces host cell to make metalloproteinases and turns on immune system which is the cause of disease
What are the methods of quorum sensing for gram negatives vs. gram positives?
Gram (-): sugars
Gram (+): peptides
What are some things that Staph. Pyodermas cause?
Folliculitis - infected hair follicles. Once pus is let out it heals
Furnucles - boil
Carbuncle - multiple skin lesions (boils) connected by sinuses in the connective tissue
Impetigo - crusting vesicle formation of the skin (serous, looks like honey and common in children)
Paronychina - infection fo the nail bed. Usually on the sides, sometimes underneath
Cellulitis - spreading connective tissue infections
Eye infections - stye, belpharitis, keratitis
What are the big 3 location of staph infections?
Heart
Bone
Brain
What organism causes the quintessential food poisoning from mayonaise sitting in a potato salad dish?
Staph: releases a super antigen toxin that is toxic to gut and stomach nerves
Symptomes are clear within 24 hours with diarrhea and vomiting for 2-6 horus
No fever
No therapy necessary
What are the associated factors of TSS?
Progression from erythroderma to erythematous mucus membranes to desquamation (peeling off may start in the fingernails) to finally hair and nail loss accompanied by:
fever, pain, hypotension, confusion, headache, diarrhea
Where does the exfoliative toxin production stem from?
Chromosomal DNA or
Plasmids
Two toxins - one heat labile and one is heat stabile
How long would you treat for a staph infection?
2 wks
up to 6 or more for prolonged infection
Remove devices if necessary
Look for pus and drain it
watch for resistance
What is the most common staph?
Epidermidis: it's all ove rthe normal flora of the skin
What is one staph that is similar to aureus, and is highly virulent?
Ludgunensis
Describe staph saprophyticus.
Vaginal adherence by hemagglutin
Bacteria from stool spreads to urinary tract during sexual activity
S. saprophyticus adhere to the urinary tract and releases urease
Once the bacteria adheres using hemagglutin 1 in the urinary tract and travels up the bladder it utilizes hemagglutin 2 which combines with urease to cause an infection.
What are some characteristics of Staph Vax?
Staph Vaccination
Effective in dialysis patients
Phagocytosis
prevents bacteremia
What are four major pyogens?
Gram positive: Staph and strept
Gram negatives: Neisseria and Haemophilus
What four pyogens can cause meningitis?
Gram Positive: Staph and Strept
Gram negatives: Neisseria and Haemophilus
What can cause endocarditis?
Staph, Strept, and Neisseria
What can cause Otitis Media?
staph, Strept, and Haemophilus
What is the primary method of bacterial classification for Streptococci?
Type of Hemolysis
How is Strept classified immunologically?
Through serogroups based on antigenic variation of the cell surface associated structures
Based on Carbohydrate (C-carbohydrate) or glycerol teichoic acid
Which Strept serogroups contain C-carbohydrate (as a hint they are also beta hemolytic)
C, A, B, G
Which strept serogroups contain teichoic acid?
N and D
Which of the strept groups cause alpha-hemolysis (as a hint they do not contain C-carbohydrates or glycerol teichoic acid)?
Strept. Viridans (strept. Pneumonia...)
Grp. A strept the largest number of dieseas from all strept have 2 basic syndromes from skin infection (impetigo) and/or a pharyngeal infection. what are they?
Acute (suppurative disease) -Pustules in throat, lesions in skin, organism may cause bacteremia and septicemia (ex. fasciitis), can be cultured and treated with antibiotics
Non-suppurative sequelae - ARF and PSGN, usually cannot be cultured, Ab therapy not effective
What does the M-protein of GAS do?
Mediates attachment to the epithelial cells via fibronectin, allows multiplication and toxin production of GAS
Confers type specificity - opsonin antibody epitopes
What are the antiphagocytic properties of GAS and GGS' M-protein?
Binds fibrinogen which masks C3b binding sites
Binds factor H of the alternate complement pathway that can inhibit both C3 convertase and C5 convertase
What does lipotechoic acid (LTA) do for GAS?
Facilitates attachment of strept to fibronectin by a 2 way process
Helps orient the M protein
Antigenic but does not confer immunity
What does F-protein do for GAS?
Binds fibronectin, facilitating attachment and subsequent colonization
Three cell surface structures that facilitate attachment of strept to epithelial cells?
M-protien (Only one that confers immunity)
LTA
F-protein
What does M-like protein do (Hint: analogous to Protein A of the Staph groups)?
Binds Fc region of Ig to present outward so that it appears as self
Binds alpha-2 macroglobulin that can inhibit PMN proteases
What does Plasminogen Binding Protein do for GAS?
binds plasminogen that can bind activators such as tPA, urokinase, and streptokinase that convert plasminogen to plasmin a broad spectrum protease
Aids in the dissolution of host protein structures thus facilitating tissue spread in such diesease as necrotizing fasciitis, cellulitis and erysipelas
Plasmin is a potent activator of the alternate complement pathwy
What does the hyaluronic acid capsule do for GAS?
indistinguishable from ground substance hyaluronic acid so that encapsulated organisms tend not to be phagocytized
What does 60kD Rheumatic Fever Associated Antigen (RFAA) do for GAS?
implicated in generation of antibodies that cross react with cardiac tissue proteins that contribute to the pathogeneis of ARF in a manner similar to that for M-protein
Is streptolysin O antigenic?
Yes
If the source of the GAS infection is skin would the ASO titer be high and what other test can be performed?
ASO titer will be low and performe a DNAse B test because it will not be blunted
What are three streptococcal pyrogenic exotoxins?
Superantigens SpeA, SpeB, and SpeC
Which of the 3 strept pyrogenic exotoxins are encoded by phages?
SpeA and SpeC
What is SpeA from GAS implicated in?
Scarlet fever, necrotizing fasciitis, and TSS
Describe SpeB from GAS
present in all GAS, some G and some C
Cysteine protease, responsible for massive tissue destruction and invasiveness
Highly virulent serotype M1
SpeB along with SpeA thought to be highly involved in the spread of necrotizing fasciitis
What do DNAse A, B, C, and D do for strept Group A
reduces viscosity of pus and spread infection from abscesses
Streptokinase does what and comes from what?
Comes from Strept Groups C, A, G, E
Complexes with host plasminogen to activate plasminogin to plasmin
Group A strepts produce C5a for what purpose?
Degrade C5a to reduce inflammation and phagocyte recruitment
Group A strepts produce IgA Protease for what purpose?
Splits secretory IgA (sIgA) to prevent opsonization of streptococcus
Through the Jones Criteria when should one test for ARF or PSGN in the possible event of GAS?
2 Major or 1 Major/1 Minor
Majors: carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
Minors: preveious ARF, or rheumatic heart disease, arthalgia, fever, anomalous erythrocyte sed rate, C-reactive proteins, leukocytosis, or prolonged PR interval
What is the order for GAS testing for ARF or PSGN?
Jones criteria, ASO titer, and DNAse B
Which Strept groups can cause Post-streptococcal Glomerulonephritis?
Groups C, A, G
What antibiotic is Group A strept susceptible to? It is used in determining if it is GAS.
Bacitracin
What are the 3 types of group B strept diseases that we learned?
Early Neonatal (III - capsule)
Delayed Neonatal (III - capsule)
Adult Onset (II - capsule)
GAS rarely enters the blood stream. So, if you do a Gram-stain (positive), Beta-hemolytic, catalase negative, chainforming coccus... what could it be?
Group B strept
In vertical transmission (also what is meant by this) to type III capsular neonatal GBS what are the associated symptoms?
Bacteremia
Septicemia
Pneumonia
Meningitis
Vertical transmission (Mother to child during birth)
In Horozontal transmission (also what is meant by this)of type III capsular neonatal GBS what are the associated symptoms?
Bacteremia
Septicemia
Pneumonia
Meningitis
Horizontal Transmission means between caregivers and other infants; nosocomial)
What are four methods of diagnosing GBS?
Characterization of microbes on blood agar plate: small zone of hemolysis
Resistance to: bacitracin, STX, and other agents
CAMP positive test
Agglutination with specific Antisera to Group B
What type of Hemolysis is Group C strept?
Beta
What organisms are in Group A, B, and C strept?
A: S. Pyogenes
B: S. Agalactaie
C: S. Equisimilis, S. Zooepidemicus, S. dysglactaiae, and S. equi
Does strept C make streptokinase?
Yes
What type of hemolysis is Group G strept?
Beta
What type of hemolysis is Group D and what are the classifications of Group D?
Gamma hemolytic
Broken down into Enteroccous and Non-enterococus
Can group D be classified as opportunistic pathogens and how are they differentiated from each other and from the rest of the Streptococci?
Yes they are opportunistic
Can be differentiated from the rest of the Strept by ability to survive in 40% bile salts.
Can be differentiated from each other by the ability to survive in salt
Which Group D strept is resistant to penicillin?
Enterococcus Strept. Faecalis
What are the Enterococcus and the non-enteroccous strepts?
Enterococcus: faecalis, faecium, zymogenes
Non-enterococcus: bovis and equinis
What are the alpha-hemolytic streptococci?
Viridans
Which Viridans is pathologic and what can it cause?
Strept Mutans and it causes endocarditis
Which strept occurs as a diplococci and has a capsule (primary virulence factor)? What type of hemolysis is it?
S. Pneumonia
Alpha
S. pneumonia is primarily a pathogen for what organism?
Humans!!!
Spread by aerosols
What are the primary causes of otitis media?
S. Pneumonia (>50%)
Haemophilus Influenza (30%)
S. pyogenes (10-15%)
What is the most common cause of bacterial meningitis?
S. Pneumonia
Vaccination for S. Pneumonia comprises how many variant at what percentage of the population?
23 variants at 90%
What is the main virulence factor (anti-phagocytic) of S. Pneumonia?
Capsule
What component of S. Pneumonia causes spread in lung and what causes damage to alveolar tissue?
Spread in lung: neuraminidase
damage to alveolar tissue: pneumolysin
What type of test is used to differentiate between Neisseria sub groups?
Cystine Trypticase Agar (CTA)
What percentage of arthritis might be caused by untreated gonococcal infection?
20-40%
What type of protein determines parasite directed endocytosis for Neisseria?
P1A: through epithelial cells and BM to the blood stream
When attacked they infiltrate the PMNs and prevent degranulation
Infected PMNs are what you give to a sexual partner
(P1B causes no invasion)
Why is there no natural immunity in the prevention of Gonorrhea?
No capsule presented
Antigen repertoire of pili over 1 million
Protein I of porin has 18 serotypes, Protein II has a few
Protein III causes production of blocking antibodies
Produces IgAse
Serum resistant gonococci: sialic acid is added to the LOS through sialotransferase to protect from C3 breakdown
How do you culture bacteria out with a Thayer-Martin VCN agar?
Use a candle in a jor for high CO2
Use chocolate agar with Vancomycin (kills gram positives), Colistin (Kills all other gram negatives), and Nystatin (Kills fungi)
what other tests besides Thayer-Martin VCN agar can be used to test for Neisseria?
Oxidase test: positive - turns pink, then black with oxidase reagent
CTA (Sugar thing) determines fermentation pattern of Neisseria species for diagnosis
What is opthalmia nenatorum and wha tis the treatment?
It is the transfer of either gonorrhea or chlamydia to the newborn which can cause blindness
Treatment with 1% silver nitrate for Gonorrhea and 0.5% erythromycin, plus 1% tetracycline for some reason
Once infected with Neiserria meningitis how long from onset of symptoms to the time of death?
within hours
What other organisms besides Neisseria can cause Meningitis?
Strept Pneumonia, E. coli, and Haemophilus Influenzae
Neisseria attach ciliated or non-ciliated columnar epithelial cells?
Non-ciliated (however causes extrusion of fallopian tube ciliated cells thereby causing salpingitis)
what is the mortality percent for untreated acut meningococcemia?
About 100% typically fatal within 24-48 hours
(Only 15% if treated with appropriate antibiotics)
How could you tell the different between meningitis from Neisseria, s. Pneumonia, H. Influenzae, and E. coli?
Take a CSF and look for Gram (-)
what is the basis for sub-classifying meningococcus into 12 serogroups?
The capsule
What is the one exception to the serogroup specific immunity of Neisseria Meningococcus??
Group B, contains a residue, sialic acid, that looks like self and is therefore non-immunogenic
How is Meningococcus spread?
By respiratory droplets on close contact (very delicate and must have moisture where it lands)
Attaches to the microvilli of non-ciliated columnar epithelium of hte nasopharynx via pili and subsequently PII
What is Waterhouse-Friderichsen syndrome?
It is diffuse intravascular clotting causing Petechiae and Ecchymoses, occuring in 5-15% of patients
(This is initiated by Meningococcus translocating across the cell into the blood stream to the skin)
What are the endotoxic effects of LOS released from the meningococci?
Mediates activity of TNF, IL-1 and other cytokines that cause tissue damage
Do meningococci occur in epidemics?
Yes
Deficiency in MAC attack leaves susceptibility to what type of bacterial infections?
Neisseria and Gram (-)
What is the main virulence factor of Neisseria Meningococci?
Capsule
What Groups of Meningococci now have vaccines?
A, C, Y, W135
What is the morphology of Haemophilus?
Gram negative
Pleomorphic coccobacilli
How is Haemophilus classified (Based on it's requirement of)?
H and Y factor (Heme and NAD respectively)
Because of the requirement for heme what would you need to use to recognize H. Influenzae?
Chocolate agar
What are the 4 major species of Haemophilus?
Influenzae,
Aegyptius
Ducreyi
Parainfluenza
What is the method of transmission for H. Influenzae?
Inhalation of droplets, similar to meningococcus
How many types of H. Influenzae are there?
2 types:
capsulated and Non-encapsulated
How many types of encapsulated H. influenzae are there?
6
Major cause of meningitis in infants
we only have vaccine to Type b
What are some diseases of the non-encapsulated H. Influenzae?
Meningitis
Epiglottitis
Otitis Media: Second most common cause (Strept is #1)
How is H. Influenzae transmitted?
Inhalation of droplets
What disease does H. Aegyptius cause and how is it transmitted?
Pink eye and brazilian purpuric fever
Transmission: contact with the eyes with hands, clothing, etc.
What does H. Ducrei cause?
chancroid (It is an STD)
It is a cofactor for HIV
Transmitted by: sexual intercourse or skin to skin contact with the lesion
secondary event of lesions is bubos and swelling of the lymph nodes
Describe H. Parainfluenzae
Similar to influenzae but can cause meningitis, endocarditis, peurpural sepsis, sinusitis
Less pathogenic than influenzae
What do both H. Influenzae and Neisseria not produce?
Exotoxin
what strain is associated with virtually all invasive disease of Heamophilus Influenzae and what is the name of it?
Group B and it is known as "Hib"
What is the difference between Hib's capsule versus other types?
Hib: pentose sugars, ribose and ribitol phosphate
Others: hexoses or hexosamines
How is the Hib capsule referred to and what does it promote??
Referred to as PRP (polyribose phosphate)
Promotes opsonization
There are many similarities between Haemophilus Influenzae and Neisseria. Knowing this what is the similarities and differences in surface proteins?
PI: two types PIa and PIIa (both)
PIII: Does not cause induction of blocking Abs (Haemophilus)
PII: believed to facilitate attachment
What appears to be the actual major virulence factor in H. Influenzae?
The LOS because you can make antibodies to the capsule
What is the difference between meningococcus and H. influenzae meningitis?
Influenzae can cause further neurological damage in 10% of post-infected patients.
Can cause blindness, deafness,and hydrocephalus
Mental retardation is possible
How many vaccines are available for H. Influenzae b?
Three vaccines
What is PRP-D vaccine?
Vaccine: Hib PRP capsular material conjugated to diptheria toxoid
What is HbOC vaccine?
Hib vaccine
Variation of the PRP-D vaccine
PRP conjugated to CRM197 (non-toxic fragment of the diptheria toxoid)
What is hte PRP-OMP vaccine?
Hib vaccine
PRP is conjugated to the outer membrane protein of Neisseria meningitidis
"Double Whammy"
Which meningococcus cannot have a vaccine made to its capsule and since it can't what can a vaccine be made for?
Group B meningococcus can't have a vaccine because of sialic acid making it look like self.
Therefore, vaccine is made to its outer membrane
How do you clinically identify the source of meningitis infection?
Gram stain CSF
Sputum sample plating on chocolate agar (not same for Neisseria because of VCN)
Place one paper with X factor, one with V, and one with Both to determine which Haemophilus species
What do you do if you do not have a chocolate agar plate?
Do a satellite test: Streak blood plate with S. aureus that has beta-lysin tha tbursts the RBCs and releases hemin
NAD is produced as a byproduct of the staph metabolism.
H influenza colonies grow near the areas of hemolysis
What are the main species of Bordetella?
Pertussis: etiologic agent in whooping cough
Parapertussis: Milder form of pertussis, accounts for up to 20% of pertussis infections
Bronchiseptica: kennel cough in dogs and pigs, can cause disease in immunocompromised humans
What are some features of Bordetella?
Gram negative, nonsporing, coccobacilli
Similar to haemophilus species
Spread by aerosols or direct contact
In regards to epidemiology of B. Pertussis what is the typical world emerging pattern?
Sharp outbreaks or epidemics of disease in cycles of two to four years
How many stages of B. Pertussis disease are there and briefly describe each of them.
Four stages:
Incubation stage (7-10 days) - attachment of organsim to ciliated epithelial cells
Catarrhal, Prodomal or pre-paroxysmal stage (1-2wks) - Highly infectious
Paroxysmal or Spasmodic stage (2-4 wks) - Most dangerous stage of disease
Convalescent stage (3-4+ wks) - protective immunity generated (antibodies good for about 10-15 years)
What are the details of the incubation stage of B. pertussis?
Slightly infectious
Can isolate organsism
Responsive to antibiotics
Symptoms: slight cough, runny nose, slight fever
What are some details about the Catarrhal, prodomal or pre-paroxysmal stage?
Rapid multiplication
This mucus generated, productive cough with expulsion of bacteria into environment
Epithelium intact, inflamed submucosa, enlarged peribronchial nodes
Risk of secondary infection
Patient often dies of the secondary infection
Responsive to antibiotic therapy
Symptoms: rhinorrhea, malaise, fever, anorexia
What the details of Paroxysmal or Spasmodic stage (2-4 weeks)?
Most dangerous
Repetitive whoop cough
Leukocytosis
Hypoglycemia (may lead to neurological damage)
Partially immune patients (from previous immunization etc) may not have spasmodic cough or leukocytosis
NOT responsive to antibiotics
What are the details fo the Convalescent stage (3-4+ wks)
Diminished cough
Leukocyte count and blood sugar return to normal possible complications: Secondary bronchopneumonia and acute encephalopathy
Protective immunity generated for 10-15 yrs
What are the virulence factors of B. Pertussis?
Filamentous Hemagluttinin (Fha)
Pertussis Toxin
what does Filamentous hemagluttinin (Fha) do in B. pertussis?
Binds and immobilizes cilia (i.e. ciliary stasis): host is more susceptible to secondary infection by other organisms, inhibits phagocyte killing
What does Pertusses Toxin do?
A-B toxin secreted during in vivo and in vitro growth (6 protein units - 1 enzyme units and 5 binding)
Causes disease
Abs to pertussis toxin prevents colonization of epithelial cells and provides effective protection against infection
What are the mechanisms of Pertussis toxin?
2 parts (binding and active (toxic protion)
B portion binds the cells and A portion dissociates and acts on mechanisms inside the cell
Pertussis toxin is an ADP ribosylating toxin
B. pertussis toxin causes binding, internalization, increased cAMP and eventually causes PK activation. What does this protein kinase action do?
Histamine sensitizing causing susceptibility to anaphylaxis
Islet of Langerhans increasing insulin synthesis (hypoglycemia)
Inhibition of phagocytic activity of macrophages and killing of PMNs, monocytes nad killer cells
Supproession of antibody synthesis which may contribute to predisposition to developing secondary pulmonary infections
what does adenylate cyclase have to do with B pertussis?
Toxin causes stimulation of Adenylate cyclase yielding increased cAMP causing all the affects associated with increased protein kinase
What are two other types of B. Pertussis toxins and what do they do?
Dermonecrotic toxin: kills epithelial cells
Tracheal cytotoxin: part of peptidoglycan of organism, released into extracellular fluid, kills ciliated cells similar to gonococcal LOS
What types of vaccines are available for Pertussis?
Killed suspension mixed with purified diptheria and tentanus toxoids
Acellular vaccines (fewer side effects than whole cell vaccine, Take a component of organisms that you think will develop protective Abs and incorporate it into vaccine, Fha component)
Fha component removed from vaccine for possible neurological side effects
What component was removed from the acellular vaccine due to possible neurological side effects?
Fha
What is the latest and greatest Pertussis vaccine?
DTaP containing Haemophilus influenzae type B meningitis called DTaPHib
What are the two states of anaerobes?
Vegetative and Spores
What are the properties of spores?
Very resistant to heat and chemical reagents
Survive autoclaving (must first autoclave, bring to 37oC, then kill by sterilization if spores went to vegetative state)
The spores can last for centuries
Only germinate in anaerobic environment
What kind of bacteria is responsible for methane gas production in the nether regions?
Anaerobes
What are the types of infections produced by anaerobic bacteria?
Intra-abdominal infections
Pulmonary infections
Pelvic infections
Brain abscesses
Skin and soft tissue infections
Oral and dental infections
Bacteremia and endocarditis
How should anaerobic clinical specimins be processed?
'sterile abscess'
Sample of bacteria should be placed in anaerobe jar, roll tube, or glove box
Simply put NOT strept/staph must use proper technique
What are the various types of non-spore forming anaerobes?
G+ cocci: Peptostreptococcus spp and Gemella spp
G+ bacilli: Actinomyces spp, proprionibacterium spp, and Lactobacillis spp
G- bacilli: Over two dozen (most important - baceriodes spss, prevontella spp, fusobacterium spp)
Briefly describe what actinomyces spp do?
colonize UG tract, Gi tract, and female genital tract
Contacted from soil or water
Opportunistic
What are the spore forming species and organisms of anaerobeS?
G+: Clostridium spp
All toxin mediated disease (exotoxins)
C.tetani --> tetanus --> spastic paralysis, lockjaw
C. botulinum --> botulism, food poisoning --> flaccid paralysis (opposite of spastic)
C. perfringens --> necrosis --> gas gangrene --> food poisoning --> enteritis necroticans, diarrhea
C. difficile --> pseudomembranous colitis 00> only one foun din normal GI flora
What part of C.tetani is the virulence factor?
Toxins! (toxin spreads, not organism)
What is the usual cause of death for C.tetani infections?
Muscle spasms (respiratory arrest)
What tissue does tetanus toxin affect?
Nervous
What are the types of tetanus?
generalized tetanus
localized tetanus
cephalic tetanus
neonatal tetanus
What are the various toxins form c. tetani?
Tetanolysin: hemolysin, degraded by cholesterol, not pathologically important
Tetanospasmin (aka tetanus toxin) --> causes disease: enters nervous system through neuromuscular junction of alpha Motor neurons.
Blocks release of glycing and GABA
causes spasms
leads to spastic paralysis
what is the case fatality for untreated tetanus?
90% for newborns and 40% for adults
Why is there no innate immunity?
Potency of the toxin.
Too small amount for an immune response, but enough to have adverse effects
What type of paralysis does C. botulinum cause?
Flaccid
How many distinct neurotoxins does C. Botulinum have?
7 serologically distinct A-G
Are the toxins from Botulinum active or inactive upon release?
Inactive. Must be cleaved by a protease
What is a differentiating effect of infection between toxins vs. organisms in the GI tract?
Typically toxins such as C. Botulinum and Staph Aureas are rapid acting while Salmonella must proliferate and grow before toxin release which takes time
Which C. Botulinum toxin is the most potent?
Toxin A
What are the three different diseases associated with C. Botulinum?
Food poisoning: ingestion of a preformed toxin
Wound Botulism: wound infected by spore and survives due to anaerobic environment
Infant botulism: Ingestion of spores, which then germinate in the infant's GI tract
What is the main food culprit in infant botulism?
HONEY! Unpasturized honey has spores from bees feet
Where is most of botulinum toxins effects?
In the PNS
What is the cause of death in C. botulinum toxin and for which toxins is the mortality higher?
Death is typically from respiratory failure or cardiac failure with mortality going in order of toxin A then E then B from greatest to least respectively
What is the correlation of fatality rates to dosage to time for incubation?
Fatality rate is directly proportional to Dose! DUH!
Fatality rate is inversely proportional to incubation time of the disease
What are the four therapies for wound or food poisoning botulism?
Eliminate the source of toxin
Eliminate any unabsorbed toxin
Neutralizae any unbound toxin with specific antitoxin
Proved general supportive care
In food poisoning what are the possible antibiotic therapies that you can use to get rid of left over toxin
Unabsorbed toxins may be eliminated by stomach lavage or high enemas
Cathartics may be used to eliminate residual toxin but they may have adverse effects like bowel paralysis
In wound botulism what are the possible antibiotic therapies to eliminate the offending organism?
Debridgement (eliminating the anoxic conditions)
Antibiotic therapy with penicillin used to eliminate the offending organism
What causes pseudomembranous colitis?
iatrogenic such as clindamycin
What is a treatment for c. difficile infection from clindamycin usage?
Metronidazole first
Then if that doesn't work Vancomycin
How many types of C. Perfringens are there?
A, B, C, D, and U guessed it... E
How many diseases is C. perfringens responsible for and what are they?
3
Gas Gangrene
Food Poisoning - Type A
Necrotizing enteritis - Type C
What occurs in Gas Gangrene?
Anaerobic event due to trauma to muscle with impaired blood flow.
Proliferation of C. perfringens causing release of destructive enzymes:
Alpha toxins - necrosis and lysis of cell membranes
Theta toxins: also contribute to tissue destruction
Hemolysins
Collagenases
Proteases
Lipases
Why is Gas gangrene called Gas gangrene?
Exotoxins cause foul-smelling exudates, forming gas bubbles from products of anaerobic fermentation
How is host defense in Gas Gangrene?
Ineffective: because diesease is caused by enzymes which will not elicit an immune response
What is the major cause of food poisoning in the US?
C. perfringens: symptoms clear in 24 hours onset is typically 8-22 hours following ingestion
In necrotizing enteritis what is the culprit?
ingestion of Toxin from C. Perfringens type C