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28 Cards in this Set

  • Front
  • Back
Anaerobic bacteria
Clostridium- G(+)
Bacteriodes fragilis - G(-)
Peptostreptococcus - G(+)
Actinomyces israeli - G(+)
Which bacteria cause Atypical Pneumonia?
What are the most important questions to ask in Hx of probable infectious disease?
1. Rapidity of onset*
2. chronology*
3. severity of symptoms*
4. Specific exposures
5. Previous AB therapy
6. Predisponsing habits
List ex. of non-specific/ systemic symptoms of infectious disease
1. Fever
2. Myalgias/arthralgias
3. Anorexia/Weight loss
4. Malaise/fatigue
List ex. of specific, localized symptoms of infectious disease?
1. RT: Cough
2. Localized pain, swelling, erythema
3. GI: N/V/D
4. GU:(dysuria, Urinary frequency and urgency)
5. Headache/neurologic prob.
List ex. of systemic, physical symptoms of infectious disease.
1. Fever (H or L)
2. Bacterial Indicators: Toxic? High fever, hypothermia, tachycaridia, generalized distress, dec. attention to external environ)
4. Vital Signs - tachypnea, pulse-temp dissociation, orthostatic hypotension
List ex. of localized, physical symptoms of infectious disease.
1. Localized tenderness, swelling, erythema
2. Rash
3. Lymphadenopathy
4. Abnormal lung exam
5. Heart murmur
6. Purulent drainage
7. Enlarged or tender liver or spleen
8. Altered mental status or other neurologic deficit
List 6 laboratory indicators of infectious disease
1. WBC Count (4k-11k cells/mm3)
2. Anemia
3. Elevated inflammatory markers (RBC sed rate M: 0-20 mm/h vs. F: 0-30mm/h), c-reactive protein)
4. Purulent Secretions
5. Pyuria (0-5 wbc in sed of cc/ms urine)
6. Positive Cultures (consider contamination)
What types of infections does Leukocytosis rule IN?
Acute Viral Illness (lymphocytosis-atypical)
Chronic Bacterial Infec:
(Also Lymphocytosis: 2k-4.5k)
1. Tuberculosis
2. Brucellosis
3. Mycoplasma infections

Subacute and chronic infecions with granulomatous inflammation

1. Tuberculosis
2. Brucellosis
3. Salmonellosis
What types of infections does Leukocytosis(>11k cells/mm3) rule OUT?
Intracellular bacteria

Leukocytosis (>11k cells/mm3) signals what type of infection? Which WBC type is usually most elevated?
1. Bacterial, but could be viral, fungal, or non-infectious causes

2. Neutrophils (B) 3-5%
Neutrophils (S) 54-62%
What is a Left Shift and when does it occur?
L-shift: Neutrophilia in an acute bacterial infection--> banded, metamyelocytes, myelocytes = all are immature neutrophils that escape to periph blood from bone marrow

Occurs 4-24 hrs after initiating stimulus
Monocytosis ((M) 3-7)is typically a sign of what type of infection?
Subacute and chronic infecions with granulomatous inflammation

1. Tuberculosis
2. Brucellosis
3. Salmonellosis
By what mechanism do infectious diseases cause anemia? What types of ID case anemia? Give one ex.
Cytokine-mediated suppression of bone marrow function, including dec. production of RBC and replacement with inflamm cells

Types of ID: Chronic infectious disease w/ persistent acute phase response

Ex: Tuberculosis
RBC Sedimentation Rate and C-reactive protein are elevated in what types of infections? Give Ex.
Chronic infections with persistent acute phase response

Ex: Subacute bacterial endocarditis or osteomyelitis

This is a non-specific response so it will be elevated in other inflamm condit and in cancer
List types of Direct Microscopy
-Gram stain of exudate or body fluid

For cytologic specimens or tissue sections:
-Acid fast stain of mycobacteria (also tissue sec)
-Silver stain (GMS) of fungi

-Wet Mount of urine sediment to look for cells, bacteria
-smaller sample size needed
What are the advantages of direct microscopy over microbial culture for Dx ID?
Useful for:
-early diagnosis, directing empiric therapy
-Checking quality of specimen
-Distinguishing normal flora from pathogen
-Avoiding need to culture of specimens that don't grow well in culture (ie. from anaerobic lung abscess)

-fast, easy, and cheap
What are rules for proper microbial specimin culture?
1. Collect specimens prior to starting microbial therapy
2. Avoid normal flora
3. Examine abnormal fluids and exudates
4. Communicate suspected Dx to lab
5. For serious systemic infections culture blood:
-Disinfect skin overlying vein
-20cc (no less than 10cc to maintain sensitivity)
-Draw blood by aseptic insertion
-Incubate for 1 wk, slow growers need 2-3wks
-Subculture + specimens
-Do antibiotic susceptibility testing
When is broth dilution method of antibiotic susceptibility testing preferred over disc diffusion?
-ABS= more rigorous
-Indicated for difficult to treat infections (endocarditis, osteomyelitis)
-Use to determine MIC, MBC
Name 4 organisms detected by antigen test.
-Cryptococcal neoformans (capsule polysac)in blood or CSF
-Legionella in urine
-Histoplasma Capsulatum (capsular in blood or urine)
-HIV p24 in core antigen blood (most useful in acute setting prior to seroconversion)
Name 3 organisms detectable by latex agglutination tests (no more sensitive than GS)
Polysaccharid Ags
S. pneumoniae
H. Influenzae
N. Meningiditis
What type of bacteria can be detected by an endotoxin assay (ie Limulus Test)?
Gram Negative (duh, I know)
Limulus Test: endotox initiates coagulation of a particular protein extract
Pathogen-Specific Antibody Detection is useful for what pathogens?
Elevated IgM - acute
4 fold rise in IgG - conval.
1. Viral infections (EBV)
2. Fungal infections (Coccidiodomycosis, Histoplasmosis)
3. Atypical, intracellular bacteria infections (Salmonella, Brucella, Legionella, Rickettsia, Chlamydia)
What host factors should you consider in designing an optimal antimicrobial regimen?
1. Adequate penetration
2. Hx of allergic rxns
3. Co-morbid conditions which might contrib to toxicity (liver, renal disease, p-450 abnormality)
Once organism and susceptibilities known, what fx for AB regimen?
-Narrow vs. broad spectrum
-Oral vs. IV
What are the potential causes of AB failure (aside from resistance/compliance)?
-Choice of AB, Dosing
-A focus of infection that needs to be drained
What Fx have contributed to AB resistance?
-Heavy reliance/misuse on a particul drug or class
When is combination therapy indicated?
1. prevent emergence of resistance (TB)
2. To obtain synergistic, additive activity
3. Shorten course of therapy (endocarditis)
4. Serious infections caused by pseudomonas or enterococus (penicillin + aminoglycoside)
polymicrobial infections