Streptococcus 1 & 2 (Hamil)

Front 1

Lipoteichoic acid binds to ________

Back 1

fibronectin

Front 2

ASO titer levels are used diagnostically for ________ but useless for ______ infections because...

Back 2

rheumatic fever, skin infections because the cholesterol in the skin sequesters streptolysin O so that antibodies cannot even be made to it

Front 3

SPEB is a ______ protease that cleaves ______ to active _____ and also degrades ________ and _______ helping to facilitate spread of the infection

Back 3

cysteine, IL-1beta to active IL-1, fibronectin, vitronectin

Front 4

lack of inflammatory cells in an infected foci of a Group A strep infection because of elaboration of a _____ peptidase that cleaves surface bound ____, delaying PMN migration into the infected foci

Back 4

C5a, C5a

Front 5

pharyngitis/tonsilitis caused by group ____ strep and is frequently accompanied by _____ and _____________

Back 5

A, exudate, cervical lymphadenopathy

Front 6

The most pathogenic of the streptococci is ________

Back 6

Group A (Streptococcus Pyogenes)

Front 7

Scarlet fever is a form of what type of disease Group A Strep can cause? What about Rheumatic fever?

Back 7

Scarlet fever is a form of acute suppurative disease (direct result of bacterial invasion), whereas rheumatic fever is a post-streptococcal/immunologic sequella infection

Front 8

Name the three types of post-streptococcal sequella infections you are likely to see with Group A Strep

Back 8

1) acute rheumatic fever
2) acute glomerulonephritis
3) guttate psoriasis

Front 9

What is the most common feature of rheumatic fever?

Back 9

arthritis

Front 10

Acute Rheumatic Fever occurs exclusively following _____________ infection by _________ streptococcus, and usually occurs ____-____ days after the infection start having symptoms of the rheumatic fever

Back 10

pharyngitis/tonsilitis ("strep throat", group A strep (pyogenes), 10-15 days

Front 11

Explain the autoimmune disorder hypothesis about rheumatic fever

Back 11

There is cross-reactivity taking place between components of the streptococcal M proteins and the cardiac sacrolemmal proteins

Front 12

the ______ of group A strep is non-antigenic because it...

Back 12

capsule, mimics the hyaluronidate in our own connective tissue ground substance

Front 13

guttate psoriasis is due to ....

Back 13

the result of superantigenic stimulation of T cells by streptococcal pyrogenic exotoxin C with subsequent selective accumulation of Vbeta2 and T cells in involved skin

Front 14

chronic valvular heart disease may result in ________ from group A strep infection

Back 14

rheumatic fever

Front 15

different types of ________ appear to be responsible for either acute glomeronephritis or acute rheumatic fever

Back 15

M Proteins

Front 16

Antibiotics (prevent/don't fully prevent) disease in rheumatic fever, and (prevent/don't fully prevent) disease in acute glomerulonephritis

Back 16

prevents disease, does not fully prevent

Front 17

Impetigo is so much more common in young children than adults because

Back 17

adults have already had it as kids and are protected from their Abs against it

Front 18

Impetigo spreads very commonly in households via

Back 18

towels

Front 19

In lymphangitis (frequently associated with cellulitis) what does to patient present to you with?

Back 19

Usually will have lymph node tenderness (ie in the groin area) but with no real signs in the region, because this may preceed the actual soft tissue manifestation itself. So, you'll let them go but they'll come right back tomorrow and now you can see the infection (streaking of the lymph nodes)

Front 20

Many predisposing factors to group A cellulitis name some

Back 20

Athlete's foot (TREAT THE ATHLETES FOOT TOO or else you'll just get recurring infections), edema due to CHF, obesity

Front 21

Erysipelas (a deeper cellulitis) is more commonly associated with a compromise in lymphatic or venous drainage. What are the two main scenarios with this?

Back 21

1) women who have had a masectomy and a lymph node dissection with (disrupts drainage from that arm)
2) People who have had their saphenous vein harvested for CABG - don't have good drainage out of their legs anymore
***KEY WITH THESE PEOPLE IS LEAVE THEIR EXTREMITIES ALONE! NO NEEDLES IN THEM!

Front 22

What group of antibiotics are alternative agents to treat with if patient has a penicillin allergy

Back 22

Well, I'd assume you'd always first switch to cephs if its a minor skin rash, but if its a dangerous penicillin allergy, you can switch to the macrolides

Front 23

Individuals with an attack of rheumatic fever are at an increased risk to develop repeated attacks; these recurrences can be decreased with long-term _____________

Back 23

penicillin prophylaxis

Front 24

Name three characteristic signs of scarlet fever

Back 24

1) strawberry tongue
2) sandpaper rash
3) diffuse bright scarlet erythema of the skin and mucous membranes

Front 25

Whats the most common cause of a simple cellulitis?

Back 25

Group A Strep

Front 26

Disease caused by Streptococcus __________ is characteristically in neonates and post-partum women or in older individuals with compromising illnesses

Back 26

agalactiae (Group B Strep)

Front 27

Important to differentiate group D strep (Streptococcus gallolyticus) from enterococcus for two reasons?

Back 27

1) Strep gallolyticus (used to be bovis) has a clinical association with carcinoma of the colon
2) Enterococcus is very antibiotic resistant, Group D strep are VERY penicillin susceptible

Front 28

Immunity to group B streptococci is mediated by antibody to a type-specific carbohydrate (eg, type I, II, III, IV, V)

Back 28

so basically breaks down your Lancefield group for this one (Group B polysaccharide) further into individual types

Front 29

Typically see Group B infection in mothers and babies when the mom hasn't had ________

Back 29

prenatal care

Front 30

Risk factors for a Group B infection during birthing process...

Back 30

premature rupture of membranes, prolonged labor, mom has an absence of antibody to the type-specific carbohydrate

Front 31

in neonates there is _____ and ______ onset neonatal infections from Group B strep. Describe what could occur in both

Back 31

early (within 7 days), late (beyond 7 days)...in early can present with either bacteremia, meningitis, or pneumonia. In late is common to present as bacteremia WITH meningitis

Front 32

From Group B strep, post-partum women get...

Back 32

choriomnionitis, endometritis, and bacteremia

Front 33

Adults who get a strep group B (agalactiae) infection commonly, frequently have an underlying problem...

Back 33

usually diabetes mellitus, or could be cirrhosis, cancer, etc

Front 34

There is a very strong association between _______ or _______ caused by Streptococcus gallolyticus and lesions of the gastrointestinal tract, particularly colonic neoplasms

Back 34

bacteremia, endocarditis

Front 35

The rule for treatment of endocarditis is you have to use a _________ antibiotic

Back 35

bacteriocidal, need an antibiotic that kills the bacteria, using one that just inhibits growth is not sufficient... cidal is when MIC and MBC are within 32:1 dilution of eachother

Front 36

If you have NO MBC no matter what your antibiotic is _____

Back 36

static

Front 37

If your MBC and MIC are greater than a 32:1 ratio then it is a ________ antibiotic

Back 37

tolerant

Front 38

Soooo, problem with killing enterococcus with penicillin alone is that the MBC is way too high, so our MBC and MIC are too far apart and thus we are dealing with a tolerant antibiotic. So, we add a synergistic drug (an aminoglycoside) to bring down the MBC closer to the MIC, within the 32:1 range again to be considered bacteriocidal

Back 38

Soooo, problem with killing enterococcus with penicillin alone is that the MBC is way too high, so our MBC and MIC are too far apart and thus we are dealing with a tolerant antibiotic. So, we add a synergistic drug (an aminoglycoside) to bring down the MBC closer to the MIC, within the 32:1 range again to be considered bacteriocidal

Front 39

Most enterococcal infections occur in _______ patients (they are the 2nd or 3rd most common cause of _____________ infections)

Back 39

hospitalized, nosocomial

Front 40

Never use a _________ as first line treatment alone for endocarditis treatment because...

Back 40

aminoglycoside, because enterococci have high-level aminoglycoside resistance, just add aminoglycoside in as synergy to your penicillin to get your antibiotic cidal again (bring MBC and MIC within 32:1 of eachother)

Front 41

Viridans group of strep are divided into 4 large groups what are they?

Back 41

S. mitis, S. mutans, S. salivarius, S. sanguis

Front 42

Viridans group of strep are a major part of the human _____ and ____ flora

Back 42

oral and bowel, normally adhere to teeth, buccal mucosa, and tongue

Front 43

Viridans streptococci are the cause of 2 major diseases of importance:

Back 43

1) leading cause of infective endocarditis in some areas
2) responsible for dental carries (the most common infectious disease worldwide!)

Front 44

Microaerophilic streptococci are known as ______, and the three ones to know..., and as a group just know they have a propensity to cause ___________

Back 44

milleri, S. constallatus, S. intermedius, S. morbillorum, have a propensity to cause pyogenic (puss-filled) foci (ie brain abscesses, empyema (in lung), hepatic abscesses)

Front 45

Which one is the fish pathogen?

Back 45

Streptococcus iniae