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197 Cards in this Set
- Front
- Back
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Polysaccharide made of D-glutamate
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Bacillus anthracis
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Dipicolinic acid
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In spores to resist dehydration, heat and chemicals
B. anthracis, Clostridium, C. tetani |
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Glycocalyx role
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Mediate adherence to surfaces (ex. indwelling catheter)
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Unique things to Gram + and Gram - cell walls
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Gram +; Lipoteichoic acid (induces TNF and IL-1), larger cell wall
Gram -; Endotoxin/LPS (Lipid A induces TNF and IL1, O polysaccharide is antigen); Periplasm btw wall and cell membrane (may have B-lactamases) Both can have Pili, Flagellum, Capsules, |
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Branching filamentous bacteria
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Nocardia (weak acid fast)
Actinomyces Nocardia is obligate aerobe, Actinomyces is obligate anaerobe |
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Cell wall enriched in sterols
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Mycoplasma
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Cell wall with high lipid content
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Mycobacteria (mycolic acid)
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Special Stains: Giemsa
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Chlamydia
Borrelia Rickettsiae Trypanosomes Plasmodium Most hard to see on gram stain |
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Special stains: Silver Stain
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Fungi (pneumocystis)
Legionella Helicobacter pylori |
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Special Culture: H. influenzae
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Chocolate agar with factors V (NAD+) and X (hematin)
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Special Culture: Neisseria
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Thayer-Martin (VPN) media - Vancomycin (gram + inh.), Polymyxin (gram - inh. exc. neisseria), Nystatin (fungi inh.)
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Special Culture: Legionella
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Charcoal yeast extract agar buffered with cystein and iron
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Special Culture: Fungi
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Sabouraud's agar
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Obligate Aerobes
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Norcardia
Pseudomonas aeruginosa (burn wounds, diabetes, nosocomial pneumonia, CF pneumonia) Mycobacterium TB Bacillus Nagging Pests Must Breathe |
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Obligate Anaerobes
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Clostridium
Bacteroides Actinomyces Produce gas in tissue, can't use aminoglycosides (need O2 to enter) |
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Facultative intracellular bugs
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Salmonella
Neisseria Brucella Mycobacterium Listeria Francisella Legionella Yersinia pestis Some Nasty Bugs May Live FacultativeLY |
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Encapsulated bacteria, test
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SHiNE SKiS
Strep pneumo H. influenzae type B Neisseria meningitidis E. coli Salmonella Klebsiella pneumoniae group b Strep Quellung reaction - if encapsulated, swells when anticapsular antisera added Vaccines to capsule + protein conjugate; Capsule alone only generates IgM (Pneumovax) vs long term in H. influenzae type B or Meningococcal |
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Catalase + organisms
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Pseudomonas, E. coli, S. aureus
Also Listeria, Aspergillus, Canddida, Serratia |
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Urease positive bugs
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Proteus
Ureaplasma Klebsiella S. epidermidis S. saprophyticus (novobicin resistant) Can cause staghorn caliculi Also Cryptococcus, H. pylori, Norcardia |
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Yellow sulfur granules
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Actinomyces
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Virulence factor: Protein A
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Binds Fc part of Ig, prevents opsonization and phagocytosis
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Virulence factor: IgA protease
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Secreted by SHiN (s. pneumo, H. influenzae type B, Neisseria) and cleaves IgA to colonize respiratory mucosa
also N. gonorrhea |
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Virulence factor: M protein
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Helps present phagocytosis
In group A strep Rheumatic fever antigen |
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Exotoxin vs Endotoxin
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Exotoxin - Both types can make, Secreted, polypeptide, genes from outside, High toxicity, high titer Abx, Toxoid vaccine, destroyed rapidly (ex. Tetanus, botulism, diphtheria)
Endotoxins - Most gram-negative's outer membrane, not secreted, LPS, from chromosome, low fatality, causes fever and shock due to TNF and IL1, poorly antigenic, no vaccines, stable in heat, (ex. Meningococcemia, gram - sepsis) |
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Exotoxin: Corynebacterium diphtheriae
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Diphtheria toxin; Inactivates EF-2 by ribosylation; pharyngitis with pseudomembranes in throat and severe lymphadenopaty
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Exotoxin: Pseudomonas aeruginosa
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Exotoxin A; Inactivates EF-2 by ribosylation; Host cell death
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Exotoxin: Shiga toxin
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Shigella or Shiga like toxin from EHEC (O157:H7); Inactivates 60S ribosome by removing adenine from rRNA. GI mucosal damage, cytokine release leading to HUS. No invasion in EHEC but in shigella
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ETEC toxins
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Heat-labile - upregulates cAMP, Cl- secretion to gut and water follows
Heat stable - upregulates cGMP, less NaCl reabsorption and water reabsorption from gut |
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Exotoxin: Edema factor
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Bacillus anthracis
Mimics adenylate cyclase to raise cAMP Causes edematous borders of black eschar in anthrax |
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Exotoxin: Cholerae toxin
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Upregulates cAMP by permanently activating Gs, Cl- secretion and water follows
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Exotoxin: Bordetella pertussis
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Upregulates cAMP by disabling Gi, impairs phagocytosis
Causes whooping cough |
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Exotoxin: Tetanospasmin vs Botulinum toxin
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Both cleave snares so NT's can be released
Tetanospasmin - prevents inhibitory NT release (GABA and glycine) in spinal cord so rigid Botulinum toxin - prevents ACh release at NMJ so get flaccid paralysis |
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Exotoxin: Alpha toxin
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C. perfringens, phospholipase that degrades tissue and cell membranes via phospholipase C degredation (lecithinase), myonecrosis and hemolysis
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Exotoxin: Streptolysin O
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Strep pyogenes
Degrades cell membranes (RBCs), elevated in rheumatic fever |
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Exotoxin: TSST-1
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S. aureus, Brings MHCII and TCR together to overwhelm IFNgam and IL2 activation to cause shock
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Exotoxin: Streptococcus pyogenes for toxic shock
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Exotoxin A, Brings MHCII and TCR together to overwhelm IFNgam and IL2 activation to cause shock
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Exotoxin: C. diff
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Toxin A - binds brush border
Toxin B - destroys actin causing pseudomembranes |
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Bacterial transformation
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Taking up naked DNA from environment or cell lysis
Seen in SHiN bacteria; Adding deoxyribonuclease will inhibit |
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Bacterial Transposition
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Segment of DNA that can jump (excise adn reintegrate) to transfer. Ex. plasmid to chromosome and vice versa
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Transduction Generalized vs Specialized
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Generalized - packaging event, lytic phage leads to cleavage of bacterial DNA, packaged in viral capsid, infects another bacteria and transfers
Specialized - excision event, Lysogenic phage, viral DNA incorporates to bacterial chromosome, when phage DNA excised, takes more DNA than came with |
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Genes encoded in phages
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ABCDE
ShigA like toxin (EHEC) Botulinum toxin Cholera toxin Diphtheria toxin Erythrogenic toxin of Strep pyogenes |
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Gram+ algorithm
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Branching = Nocardia (aerobe, acid fast) or Actinomyces (anaerobe)
Cocci - 1) Catalase + in clusters = Staph a) Coagulase + = S. aureus b) Coagulase -, Novobicin sensitive (S. epidermidis) or resistant (S. saprophyticus) 2) Catalase - in chain = Strep a) Alpha hemolysis (green) - S. pneumo (+ quellung, optochin sens.) or S. Viridans (no capsule, optochin resis.) b) Beta hemolysis (clear) - S. pyogenes (bacitracin sens.) or S. agalactiae (bacitracin resis.) c) Gamma hemolysis (none) - Enterococcus (Growth in bile and 6.5% NaCl); or nonenterococcus (s. bovis; growth in bile but not 6.5% NaCl) Rods Clostridium (anerobe) Corynebacterium Listeria (tumbling motility) Bacillus (aerobe) Mycobacterium (acid-fast) |
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Gram + cocci, catalase +, coagulase -, novobicin sensitive
Infects prosthetic devices, IV catheters, makes biofilms |
S. epidermidis
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Things S. pneumo most commonly causes
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MOPS
Meningitis Otitis media (in kids) Pneumonia Sinusitis "rusty sputum", IgA protease |
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Babies get pneumonia, meningitis, sepsis, osteomyelitis
Produces CAMP factor to enlarge hemolysis area if plated with S. aureus, Hippurate positive |
Gram + cocci, catalase -, B hemolytic, Bacitracin resistant
Group B strep Can give penicillin prophylaxis |
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Bacterial endocarditis causes
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Acute, severe - S. aureus
Dental procedure, Gram + cocci, catalase -, optochin resistant, alpha hemolysis - S. viridans, S. mutans, or S. sanguis Gram + cocci, catalase -, gamma hemolysis, grows in bile but not 6.5% NaCl - S. bovis (colon cancer often) |
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Antibiotics associated with C. diff, treatment
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Ampicillin, Clindamycin
Metronidazole or oral Vancomycin to treat |
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Meningitis in immunocompromised or neonate, Key diagnostic features, treatment
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Listeria monocytogenes
Tumbling motility, may for "actin rockets", facultative intracellular from unpasteurized milk/cheese and deli meats or birth canal AMPICILLIN to treat |
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Osteomyelitis in
a) Normal b) Kids c) HbS d) Vertebral body e) Diabetic f) Prosthesis g) Sexually Active h) Cat and dog bites/scratches |
a) Normal - S. aureus
b) Kids - Group B. strep c) HbS - Salmonella d) Vertebral body - TB e) Diabetic - Pseudomonas suspect f) S. aureus or S. epidermidis g) N. gonorrhea (rare), septic arthritis more common h) Pasteurella multocida |
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Disseminated acid fast disease in AIDS pt, drug resistant
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M. avium intracellulare, Azithromycin to treat prophylactically when counts too low
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TB virulence factors
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Cord factor - grows in chain, prevents macrophage maturation and induces TNFa release
Sulfatides - inhibit phagolysosomal fusion |
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Leprosae forms
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Mycobacterium leprae, anesthetic lesions
a) Lepromatous - diffuse on skin, communicable, low cell-mediated immunity and Th2 resposne b) Tuberculoid - few skin plaques, hgih cell mediated immunity and Th1 response Treat with dapsone, rifampin for tuberculoid, add clofazimine if lepromatous |
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Gram - lab algorithm
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Comma shaped, oxidase +
a) Grows at 42 = Campylobacter b) Grows in alkaline media = V. cholerae Diplococci a) Maltose fermenter = N. meningitidis; also capsule b) Nonmaltose = N. gonorrhoeae "Coccoid" rods a) H. influenzae; chocolate agar with factors V and X b) Pasteurella - animal bites c) Brucella d) Bordetella pertussis, whooping cough; potato agar (Bordet-Gengou) Rods 1) Lactose fermenter (MacConkey) a) Fast = Klebsiella, E. coli, enterobacter b) Slow = Citrobacter, Serratia 2) Lactosenonfermentor, oxidase + a) Pseudomonas b) H. pylori; urease +, silver stain 3) Lactose nonfermenter, oxidase - a) Shigella, HUS, Shiga toxin b) Salmonella, motile c) Proteus, urease +, UTI |
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EHEC unique ID
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DOES NOT grow on sorbitol or produce B-galactosidase like other E.coli
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Waterhouse-Fiderichsen Syndrome
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Acute adrenal infarction due to N. meningococci infection
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H. influenzae diseases
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EMOP
Epiglottisis - MAIN ONE prior to vaccination Meningitis Otitis media Pneumonia Suspect in NONVACCINATED child |
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ID for Legionella
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Mild flu
Gram - rod, Silver stain Charcoal yeast with iron and cysteine needed to grow Antigen in urine HYPONATREMIA Macrolide or quinolone to treat |
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When to suspect Pseudomonas aeruginosa
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Gram - rod, Lactose nonfermenter, oxidase +, fruit odor, blue-green pigment. Exotoxin A inactivates EF2 by ribosylation
PSEUDO Pneumonia in CF Sepsis with BLACK SKIN LESIONS External otitis (swimmer's ear) UTI Drug use and Diabetic Osteomyelitis Aminoglycosides to treat, extended-spectrum penicillin |
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E. coli virulence factors
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Fimbrae - cystitis and pyelonephritis
K capsule - pneumonia, neonatal meningitis LPS endotoxin - septic shock ETEC has heat labile and heat stabile toxins EHEC has shiga like toxin (removes adenosine from 60S rRNA) |
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Klebsiella suspicion
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Gram - rod, lactose fast fermenter, CAPSULE (so not E. coli)
4 A's Aspiration pneumonia, Abscess in lungs and liver, Alcoholics, diAbetics VERY mucoid due to capsule; can cause nosocomial UTIs |
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Salmonella vs Shigella
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Salmonella - flagella, hematogenously can spread, produce H2S, invades mucosa and causes monocytic response; Can cause typhus (M cells to spleen, liver, marrow; sepsis and "rose spots" on abdomen with hemorrhagic GI tract)
Shigella - no flagella, cell to cell transmission, no H2S, Invades and causes PMN response Both don't ferment lactose (not EHIC or EHEC) and can cause bloody diarrhea |
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Main antecedant to Guillan Barre
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Campylobacter jejuni
Bloddy diarrhea, comma shaped, oxidase +, grows at 42 degrees |
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Spirochetes
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Borrelia
Leptospira Treponema (dark field to see) |
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Animal urine contact
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Leptospira interrogans, flu like symptoms, jaundice, photophobia with conjunctivitis
May gate azotemia from liver and kidney dysfunction, fever, hemorrhage and anemia |
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Lyme disease signs
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Borrelia Burgdorferi
Stages 1) - erythema chronicum migrans 2) Neurologic (facial nerve palsy) and cardiac (AV node block) 3) MSK and migratory polyarthritis, encephalopathy, polyneuropathy, |
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Syphilis tests, Congenital syphilis signs
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Painless chancre first, then disseminated maculopapular rash, then gummas (granulomas), aortitis (vasa vasorum destruction), neurosyphilis (dorsal columns), Argyll Robertson pupil (constricts to accomodation but not light)
Tests VDRL - screen. False + in viruses (mono, hepatitis), drugs, Rheumatic fever, lupus and leprosy FTA-ABS - confirm Congenital - saber shins, saddle nose, sensorineural deafness, Hutchinson's teeth, mulberry molars. Transmitted in 1st trimester |
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Zoonotic bacteria: Catch scratch
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Bartonella
Necrosis and lymphadenopathy |
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Zoonotic bacteria: Bloody diarrhea
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Campylobacter, puppies or livestock
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Zoonotic bacteria: Parrots, other birds
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Psittacosis, Chlamydophila psittaci
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Zoonotic bacteria: Mycobacterium leprae
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Armadillos, humans with lepromatous leprosy
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Rickettsia prowazekki vs rickettsii vs typhi
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All intracellular and need CoA and NAD+
Prowazekii - epidemic typhus from louse Rickettsii - Rocky Mountain spotted fever, rash Starts at wrist & ankles, moves to trunks, palms, soles. Typhi - endemic typhus from fleas, Rash starts center and spreads sparing palms and soles Doxycycline for all |
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Gardnerella vaginalis presentation
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Fishy smell
Gram-variable rod Gray vaginal discharge NOT STD but associated with sexual activity Loss of lactobacillus Clue cells, Metronidazole to treat |
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Palm and sole rash
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Coxsackievirus A - hand foot and mouth disesae
Rocky Mountain spotted fever Secondary syphilis |
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Chlamydia forms
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Intracellular (needs ATP); Elementary body is infectious and endocytosed. REticulate body repicates by fission
C. trachomatis - STD, reactive arthritis, conjunctivitis, PID C. pneumoniae, C. psittaci - atypical pneumonia Treat with azithromycin or doxycycline ABC - blindness due to follicular conjunctivitis in Africa D-K - Urethritis/PID, ectopic pregnancy, neonatal pneumonia (STACCATO cough) or neonatal conjunctivitis L1-L3 - Lymphogranuloma venereum - granuloma on vulva; lymphatic infection, rectal strictures |
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"Walking pneumonia", insidious, headache, nonproductive cough, diffuse infiltrate, X-ray looks worse
Military recruits or prisons |
Mycoplasma
High cold agglutin titer (IgM) Macrolide or fluoroquinolone treats NOT penicillin because no cell wall |
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Systemic Mycoses: Histoplasmosis
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Mississippi and Ohio River valley, pneumonia
Macrophages filled with Histoplasma Bird or bat dropping |
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Systemic Mycoses: Blastomycosis
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East of Miss. River, Central America
Inflammatory lung disease, can go to bone and skin, granulomatous nodules Broad based buds |
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Systemic Mycoses: Coccidioidomycosis
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Southwestern US, pneumonia and meningitis, can go to bone and skin. Post-earthquakes or San Joaquin Valley
Spherules with endospores |
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Systemic Mycoses: Paracoccidioidomycosis
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Latin America
Budding yeast with captain's wheel |
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Malassezia furfur
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Fungus
Lipid degradation damages melanocytes causing hypopigmented or hyperpigmented patches Hot, humid weather (cruise ex.) Miconazole or selenium sulfide to treat "spaghetti and meatball" on KOH prep |
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Candida albicans
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Systemic or superficial fungus; oral or esophageal thrush in immunocompromised, vulvovaginitis, diaper rash, may cause endocarditis in drug users
GERM TUBES at 37 degrees |
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Aspergillus vs Mucor and Rhizopus
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Aspergillus - invasive in immunocompromised or makes fungus ball, Acute angles, true hyphae
Mucor and RHizopus - DKA, proliferate in vessel walls, necrosis, go to brain, frontal lob abscess. Black necrotic escher |
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Cryptococcus neoformans ID
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Encapsulated yeast
Pigeon droppings Can cause meningitis in immunocompromised but starts in lungs Mucarmine stain, India ink, Latex agglutination test |
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Fungal pneumonia in immunocompromised
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Pneumocystis jirovecii
TMP-SMX, prophylaxis under 200 |
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Sporothrix schenckii
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Dimorphic cigar shaped budding yeast, lives on vegetation
Introduced to skin via trauma, ulcer along lymphatic lines on skin |
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Malaria treatment
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Chloroquine - blocks heme polymerase
Mefloquine - chloroquine resistance Quinidine - if lifethreatening, make sure no G6PD def Primaquine - vivax/ovale for hypnozoite (G6PD test) |
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Parasite treatments
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Metronidazole for Giardia or Entamoeba
Mebendazole Sulfadiazine+Pyrimethamine Praziquantel for flukes and tapeworms |
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Parasite hints: Brain cysts, seizures
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T. solium (cysticercosis);
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Parasite hints: Liver cysts
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Echinococcus granulosus; anaphylaxis if rupture
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Parasite hints: B12 def
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Diphyllobothrium latum
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Parasite hints: Biliary tract disesae, cholangiocarcinoma
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Clonorchis sinensis
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Parasite hints: Hemoptysis
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Paragonimus westermani
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Parasite hints: Portal HTN
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Schistosoma mansoni
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Parasite hints: Hematuria, bladder cancer
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Schistosoma haematobium
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Parasite hints: Microcytic anemia
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Ancylostoma, Necator
Barefoot |
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Parasite hints: Perianal pruritus
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Enterobius
Scotch tape test, mebendazole |
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Recombination vs Reassortment
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Recombination - gene exchange across two chromosomes with significant homology
Reassortment - segmented genome exchange, high freq. recombination. Causes influenza pandemic |
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Complementation
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1 of 2 viruses is a mutation with nonfunctional protein, nonmutated complements to make protein for both
ex. Hep D |
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Phenotypic mixing
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Simultaneous infection with 2 viruses
Genomes can be partially coated with surface proteins of both types, so can infect different cells. Next generation though is normal coating |
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Live vs Killed virus vaccines
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Live - attenuated, rarely revert, last longer - smallpox, yellow fever, VZV, Sabin's polio, MMR, nasal influenza
Deat - Rabies, Influenza shot, Salk Polio and HAV |
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Only ssDNA virus
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Parvovirus
ex. B19, aplastic crisis risk, erythema infectiosum (fifth disease), hydrops fetalis |
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Only dsRNA virus
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Reoviridae
Rotavirus - childhood diarrhea, loss of villi, reduced absorption of Na+, K+ loss too Only impt one |
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+ strand RNA viruses
- strand RNA viruses |
I went to a RETRO TOGA party where I drank FLAVored CORONA and ate HIPPY, CALIfornia PICles
Retrovirus Togavirus Flavavirus Coronavirus Hepevirus Calicivirus Picornavirus Negative strand - needs RNA dep RNA pol with it to work Arenavirus Bunyavirus Paramyxovirus Orthomyxovirus Filovirus Rhabdovirus Always Bring Polymerase Or Fail Replication |
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Only diploid virus
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Retrovirus (2 + ssRNA molecules)
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Herpesviruses common ones
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dsDNA
HSV-1 - oral and genital lesions, temporal lobe encephalitis (most common sporadic encephalitis in US), keratoconjunctivitis; latent in trigeminal ganglia HSV-2 - genital and oral lesions, latent in sacral ganglia VZV - chickenpox and zoster, latent in dorsal root or trigeminal ganglia EBV - mononucleosis, Burkitt's lymphoma, Hodgkin's lymphoma, nasopharyngeal carcinoma, latent in B cells, atypical lymphocytes CMV - immunosuppresed pt infection, esp. transplants, congenital defects, owl's eye inclusions, latent in mononuclear cells HHV6&7 - roseaola HHV8 - Kaposi sarcoma Tzanck test to visualize multinucleated giant cells, PCR test of choice |
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Hepadnavirus common ones
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dsDNA
HBV, has RT but not a retrovirus |
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Adenovirus common ones
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Naked, dsDNA
Causes common cold, pink eye, pneumonia in tight groups (day care), febrile pharyngitis |
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Parvovirus common ones
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Naked, ssDNA
B19 - aplastic crisis risk, erythema infectiosum (fifth disease), hydrops fetalis |
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Papillomavirus common ones
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dsDNA
HPV, 16 and 18 can cause cancer |
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Poxvirus common ones
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dsDNA
Molluscum contagiosum - flesh colored dome lesions with central dimple |
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Picornaviruses common ones
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PERCH
SS + RNA Poliovirus - Salk and Sabin vaccines (IPV/OPV) Echovirus - aseptic meningitis Rhinovirus - cold Coxsackievirus - aseptic meningitis, hand, foot, mouth disease, myocarditis HAV - acute hepatitis |
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Norwalk virus
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Norovirus in Calicivirus family
Viral gastroenteritis |
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Flaviviruses common ones
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SS + RNA
HCV Yellow fever Dengue St. louis encephalitis West Nile virus |
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Togaviruses common ones
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Rubella
Eastern equine encephalitis Western equine encephalitis |
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Retroviruses
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Have RT
HTLV - Tcell leukemia HIV |
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Paramyxovirus common ones
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Parainfluenza - croup
RSV - bronchiolitis in babies (RIBAVIRIN treats) Measles, Mumps |
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Orthomyxovirus, virulence factors
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Influenza
Hemagglutinin - viral entry Neuraminidase - progeny virion release |
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Genetic shift vs drift
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Shift - pandemics, reassortment of genome (high frequency recombination)
Drift - epidemics, minor change based on mutation |
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Rubella vs Rubeolla
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Rubella (togavirus) german measles - milder, fever, truncal rash starts at head and moves down. MORE lymphadenopathy than rubeola (measles paramyxovirus)
Measles - koplic spots, cough, coryza, conjunctivitis, rash from head to toe and includes heands and feet. Also rubeola is congenital |
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Mumps virus presentation
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Parotitis
Orchitis aseptic Meningitis |
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Rabies virsu presentation
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Negri bodies in cytoplasm of neurons (Purkinje cells of cerebellum)
Retrograde transport, fever, malaise, agitation, photophobia, hydrophobia, paralysis, coma, death From bat, raccoon, skunks |
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Hepatitis viral differences
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HAV, HEV - fecal oral, short course, HAV often asymptomatic. HEV associated with mortality in pregnant women
HBV - DNA virus (ONLY ONE) - STD or parenteral, INTEGRATES to host genome HCV - RNA flavivirus, blood, parenteral, long course, chronic, cirrhosis, carcinoma; Cold cryoglobulinemia HDV - broken virus, perenteral, sexual, superinfection if already have HBV |
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HBV antigens and antibodies
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HBsAg - means virus infection
Anti-HBs - immunity to Hep B HBcAg - core of HBV Anti-HBc - previous infection of Hep B, if just anti-HBs may have vaccine, IgM for recent, IgG for chronic. Positive in window period before antiHBs HBeAg - active viral replication Anti-HBe - low transmissibility |
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HIV proteins, role
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env - formed from gp160 cleavage
a) gp120 - attach to CD4 T cell b) gp41 - fusion and entry gag - capsid, gp41 pol - RT, aspartate protease, integrase Binds CCR5 early and CXCR4 late co receptor on T cells or CCR5 on macrophages If mutated CCR5 have immunity (homozygous) or resistance (heterozygous) Diagnose with ELISA and Western blot confirmation |
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Bacterial mimic of appendicitis
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Yersinia enterocolitica
Also can be nontyphoidal salmonella or campylobacter jejuni |
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Pneumonia causes in
a) Neonates b) Children c) Adults d) Elderly |
a) Neonates - Group B strep, E. coli
b) Children - RSV, mycoplasma, Chalmydia trachomatis, C. pneuonia, S. penumonia c) Adults - S. pneumonia, Mycoplasma, C. pneumonia; As age H. influenzae, viruses, anaerobes d) Elderly - S. penumo, Influenza, anaerobes, H. influenza, gram - rods (oral cavity) |
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Special pneumonia cases
a) Nosocomial b) Immunocompromised c) Aspiration d) Alcoholic, IV drug use e) CF f) Post viral g) Atypical |
a) Nosocomial - Staphylococcus, enteric gram - rods
b) Immunocompromised - Staph, enterics, fungi, viruses, pneumocystis jirovecii c) Aspiration - anaerobes d) Alcoholic, IV drug use - S. pneumo, Klebsiella, Staph e) CF - Pseudomonas, Staph, S. pneumo f) Post viral - Staph, H. influenzae, S. pneumo g) Atypical - Mycoplasma, Legionella, Chlamydia |
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Main Abx for Gram - coverage
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Ceftriaxone
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Main Abx for Gram + coverage
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Vancomycin
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UTIs predisposing factors, DX markers, Main causes
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Women (short urethra), obstruction, surgery, catheter, GU malformation (reflux or vesicopelvic malformation), diabetes, and pregnancy
Positive leukocyte esterase = bacterial Positive nitrite test = gram negative bacterial UTI WBC casts = pyelonephritis Causes 1) E. coli - #1, green on EMB agar 2) S. saprophyticus - gram + cocci, catalase +, coag -, novobicin resistant, sexually active women 3) Klebsiella pneumoniae - Gram - rod, lactose fermenter, urease + 4) Serratia - red pigment, nosocomial 5) Proteus mirabilis - motility, swarming on agar, urease +, STRUVITE STONES 6) Pseudomonas aeruginosa - blue green pigment, fruity odor, nosocomial, drug resistant. Gram - rod, aerobe, oxidase +, nonfermenter |
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ToRCHeS infections
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T. gondii, rubella, CMV, HIV, HSV2, syphilis
Others may include Group b strep (meningitis), E. coli, and listeria (meningitis); parvovirus B19 can cause hydrops fetalis |
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Rash, lymphadenopathy, arthritis for mom, PDA (or pulm artery hypoplasia), cataracts, deafness and "blueberry muffin rash" for baby
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Rubella, respiratory droplet spread
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Asymptomatic for mother, Chorioretinitis, hydrocephalus and intracranial calcifications for child
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Toxoplasma gondii, cat or meat
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Asymptomatic or lesions for mom, encephalitis, vesicular lesions
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HSV2, skin or mucous membrane contact
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Stillbirth, hydrops fetalis, facial abnormalities (notched teeth, saddle nose, short maxilla, saber shins, sensorineural deafness
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Congenital syphilis
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Sensorineural hearing loss, seizures, petechial rash, "blueberry muffin" rash
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CMV
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Hand, foot and mouth disease
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Coxsackie virus A
Vesicular rash on palms, soles Ulcers in oral mucosa |
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Bug hints: Pus, empyema, abscess
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S. aureus
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Bug hints: Pneumonia in CF, burn infection
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P. aeruginosa
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Bug hints: Traumatic open wound
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C. perfringens, gas gangrene
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Bug hints: "currant jelly" sputum
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klebsiella
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Bug hints: Dog or cat bite
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Pasteurella multocida
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Bug hints: PAS stain
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T. whipplei
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Bug hints: Sepsis/meningitis in newborn
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Group B strep
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Bug hints: health care provider
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HBV (needle stick)
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Bug hints: Fungus in DKA
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Mucor or rhizopus
90 branches without hyphae |
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Bug hints: Asplenic pt
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Encapsulated SHiN
S. pneumo H. influenzae B N. meningitidis |
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Bug hints: CGC
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Catalase +, esp. s. aureus
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Bug hints: Neutropenia
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C. albicans, Aspergillus
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Bug hints: Facial nerve palsy
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Borrelia burgdorferi
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Penicillin, MOA, Use, Resistance
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Binds penicillin binding proteins (transpeptidases) to block cross-linking of peptidoglycan
Used for Gram +, and N. meningitidis, T. pallidum, and syphilis. Resistance - B-lactamases that cleave B-lactam ring |
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Oxacillin, nafcillin, dicloxacillin, MOA, use, resistance
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Penicillinase resistant penicillins; bind PBP's and block cross linking; B lactamases stopped because of bulky B-lactam ring
Use: S. aureus skin infections esp. MRSA is resistant Resistance - Altered PBP target site |
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Ampicillin, Amoxicillin
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Aminopenicillins; wider spectrum. Sensitive to penicillinase so needs B lactamase inhibitors when given
Use - Extended spectrum for Gram + and Gram - including many enterococci Resistance - B lactamases |
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Ticarcillin, piperacillin
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Antipseudomonasl that work like penicillins to bind PBP and prevent cross links
Pseudomonas and gram - rods, needs B lactamase inhibitor b/c penicillinase susceptible Resistance - B lactamases |
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B-lactamase inhibitors
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Clavulanic Acid
Sulbactam Tazobactam CAST Added to penicillin antibiotics (aminopenicillins [ampi and amox], antipseudomonals [Ticarcillin, piperacillin) to enhance effect and protect from B lactamases |
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Cefazolin, Cephalexin
Cefoxitin, Cefaclor |
1st and 2nd gen cephalosporins, B-lactam drugs resistant to penicillinases
Gram + cocci, Proteus, E.coli, Klebsiella, H. influenzae DO NOT cover LAME Listeria, Atypicals, MRSA and enterococci |
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Ceftriaxone, Cefotaxime
Cefepime |
3rd and 4th gen cephalosporins; B-lactams resistant to penicillinases
3rd gens for serious Gram- resistant to others (n. gonorrhea, N. meningitis 4th gens help for Pseudomonas and gram+ too |
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Azotreonam
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Monobactam resistant to B-lactamases
Prevents peptidoglycan cross links by binding PBP3 SYNERGISTIC with Aminoglycosides and no cross allergy with penicillins GRAM - rods only; penicillin allergic or can't tolerate aminoglycosides (renal tox) |
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Imipenem, MOA, use, what must always be given
Meropenem |
Imipenem - Broad spectrum B-lactamase resistant carbapenem, MUST ge given with cislastatin to reduce renal inactivation of drug
For Gram + cocci, gram - rods, and anaerobes Meropenem is more stable and lacks tox |
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Vancomycin, MOA, use, Resistance
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Binds D-ala D-ala part of cell wall precursors to inhibit wall formation
GRAM POSITIVE KILLER, especially resistant organisms NOT problems - Nephrotox, Ototox, Thrombophlebitis Resistance from changing second ala to lac to avoid |
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Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin, MOA, use, resistance
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Aminoglycosides
Bind 30S, inhibit formation of initiation complex, cause mRNA misreads and kill bacteria Req. O2 for uptake NOT FOR ANAEROBES Use - severe gram- Tox - Nephro, Ototox (esp. with loop diuretic) Resistance - Transferase enzymes that inactivate drug via acetylation, phosphorylation or adenylation |
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Tetracycline, Doxycycline, Demeclocycline, Minocycline, MOA, use, resistance
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Tetracyclines that Bind 30S, inhibit aminoacyl-tRNA attachment
Don't take with milk, antacids or iron preps that inhibit absorption Use - Borrelia, M. pneumonia, Rickettia, Chlamydia. INTRACELLULARS Resistance - decreased uptake or increased efflux via pumps |
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Azithromycin, clarithromycin, Erythromycin, MOA, use, resistance
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Macrolides, Bind 50S and inhibit translocation
Used for atypical pneumonia (mycoplasma, legionella, chlamydia), Chlamydia STD, gram + cocci allergy to penicillin Resistance via methylation of rRNA site it binds to |
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Chloramphenicol, MOA, use, resistance
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Binds 50S, blocks peptidyltransferase
Use - meningitis but toxic (aplastic anemia, gray baby syndrome due to UDP-glucuronyl transferase lack) Resistance - plasmid acetyltransferase to inactivate drug |
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Clindamycin, MOA, use, resistance
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Blocks peptide transfer (transpeptidation) at 50S.
Used for ANAEROBIC infections in aspiration or 1st line for lung abscesses; |
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Sulfamethoxazole, Sulfisoxazole, Sulfadiazine, MOA, use, resistance
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Sulfonamides
PABA antimetabolites that inhibit DHP synthase Use - Everything, Simple UTI's often Tox - G6PD, nephrotox, phototox, kernicterus, displace things from albumin Resistance - Altered DHP synthase, less uptake or more PABA made |
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Trimethroprim, MOA, use, resistance
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Inhibits bacterial DHF reductase (similar to methotrexate)
Use - combination with sulfonamides (TMP-SMX) for sequential block in folate synthesis UTI's, Shigella, Salmonella, Pneumocystis pneumonia prophylaxis Can cause Megaloblastic anemia, leukopenia, granulocytopenia due to marrow effect, leukovorin to rescue |
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Ciprofloxacin, Norfloxacin, Levofloxacin, Ofloxacin, Sparfloxacin, Moxifloxacin, Gatifloxacin, Enoxacin, Nalidixic acid, MOA, use, resistance
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Fluoroquinolones, inhibit DNA gyrase (topoisom. II), and topoisom. IV. NOT WITH ANTACIDs
Use - Gram - rods in UTIs and GI tract Tox - tendon rupture in kids or elderly on steroids, may prolong QT Resistance - chromosome encoded DNA gyrase mutation, efflux pumps |
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Anaerobes above waist diaphragm vs below
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Above - Clindamycin
Below - Metronidazole |
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Metronidazole, MOA, use,
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FREE radical toxic metabolites to damage bacterial DNA or protozoa
Use - GET GAP Giardia Entamoeba Trichomonas Gardnerella vaginalis Anaerobes H. pylori (+ PPI and clarithromycin (macrolide)) |
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Tuberculosis Drug Plan MOA, tox, resistance
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RIPE
Rifampin - Blocks DNA dep RNA Pol - 4R's (RNA Pol inh, Revs up P450, Red/orange body fluids, Rapid resistance) Isonizid - Needs to be activated by bacterial catalase peroxidase, blocks mycolic acid synthesis. Neurotox, hepatotox, Pyridoxine Def (B6) Pyrazinamide - Acidifies intracellular environment to aid phagolysosome killing, Hyperuricemia and hepatotox Ethambutol - Blocks arabinosyltransferase to reduce carb polymerization of mycobacterium cell wall. Optic neuropathy and red green color blindness |
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Antimicrobial prophylaxis: Meningococcal infection
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Ciprofloxacin, rifampin for children
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Antimicrobial prophylaxis: Recurrent UTIs
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TMP-SMX
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Antimicrobial prophylaxis: endocarditis with surgical or dental procedures
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Penicillins
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Antimicrobial prophylaxis: Pregnant woman with group B strep
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Ampicillin
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Antimicrobial prophylaxis: Prevent post surgical S. aureus infection
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Cefazolin
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Antimicrobial prophylaxis: Prevent gonococcal or chlamydial conjunctivitis in newborn
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Erythromycin ointment
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Antimicrobial prophylaxis: HIV
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TMP-SMX for pneumocystis and toxoplasmosis when CD4 < 200 and <100 resp
Azithromycin for MAC when under 50 |
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Treating MRSA and VRE
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MRSA - Vancomycin
VRE - Linezolid and streptogramins |
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Amphotericin B, MOA, use, tox
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Antifungal, Binds ergosterol and forms membrane pore
Use - systemic mycoses, fungal meningitis Must supplement K and Mg for eletrolytes and nephrotox |
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Nystatin, MOA, use, tox
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Binds ergosterol to form pore
TOPICAL b/c toxic systemically, swish and swallow for candida |
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Fluconazole, ketoconazole, clotrimazole, miconazole, itraconazole, voriconazole, MOA, use, tox
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Azoles - inhibit fungal sterol synthesis by inhibiting enzyme converting lanosterol to ergosterol
Use - less serious systemic mycoses, chronic suppression of cryptococcal meningitis, candidal infections Tox - Ketoconazole and gynecomastia, liver dysfunction via CYP450 |
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Flucytosine, MOA, use
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Inhibits DNA and RNA biosynthesis by conversion to 5-FU via cytosine daminase
Systemic fungal infections with AMB combo Bone marrow suppresion |
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Capsofungin, micafungin MOA, use, tox
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Inhibits cell wall synthesis by inhibiting B-glucan synthesis
Use - invasive aspergillosis, Candida Causes histamine release (Flushing) |
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Terbinafine MOA, use, tox
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Inhibits squalene epoxidase
Treats dermatophytes espectially oncychomycosis Abnormal LFTs, visual disturbance |
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Grisofulvan MOA, use, tox
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Interferes with microtubule function, disrupts mitosis. Deposits in keratin tissues (nails)
Used for superficial infection and dermatophytes Teratogenic, carcinogenic, increases P450 |
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Zanamivir, oseltamivir MOA, use
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Inhibit influenza neuraminidas, decreases RELEASE of virus for influenza A and B
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Ribavirin, MOA, use
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Inhibits guanine nucleotide synthesis by competitively blocking IMP dehydrogenase
Use - RSV, HCV chronic Hemolytic anemia risk |
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Acyclovir, MOA, use
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Activated/phosphorylated by HSV/VZV thymidine kinase, guanosine analog, Inhibits viral DNA polymerase by chain termination. No effect on latent forms. Daily valacyclovir can reduce frequency
HSV and VZV; weak for EBV, none for CMV b/c less activation |
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Ganciclovir MOA, use
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5' monophosphate formed by CMV viral kinase, guanosine analog to inhibit DNA polymerase
CMV esp. immunocompromised Tox - leukopenia, neutropenia, thrombocytopenia, renal tox |
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Foscarnet MOA, use
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Viral DNA polymerase inhibitor binds to pyrophosphate binding site on enzyme, NO ACTIVATION needed
Use - CMV retinitis, gangiclovir or acyclovir failure Nephrotox |
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Cidofovir, MOA, use
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Preferentially inhibits viral DNA polymerase, doesn't require activation
Use - CMV retinitis, acyclovir resistance Nephrotox, give probenecid and IV saline to reduce |
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HIV therapy: Protease inhibitors
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All end in -navir
Block cleavage of HIV mRNA products to functional proteins, inhibit maturation Can cause Hyperglycemia, GI prob, lipodystrophy |
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Tenofovir, Emtricitabine, Abacavir, Lamivudine, Zidovudine, Didanosine, Stavudine
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HIV drugs that competitively inhibit nucleotide binding to RT and terminate DNA chain
Tenofovir doesn't need activation; ZDV for general prophylaxis Bone marrow suppression so give G-CSF and EPO, rash and anemia |
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Nevirapine, Efavirenze, Delavirdine
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RT binders at different site from NRTIs no activation needed
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Raltegravir
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HIV integrase inhibitor, can cause hypercholesterolemia
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IFNs use
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Glycoproteins that block replication of viruses and normally made by viral infected cells
IFNa - HBV and HCV, karposi sarcoma IFNb - MS IFNgam - NADPH oxidase def Can cause neutropenia, myopathy |
