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45 Cards in this Set

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Lipoteichoic acid binds to ________
fibronectin
ASO titer levels are used diagnostically for ________ but useless for ______ infections because...
rheumatic fever, skin infections because the cholesterol in the skin sequesters streptolysin O so that antibodies cannot even be made to it
SPEB is a ______ protease that cleaves ______ to active _____ and also degrades ________ and _______ helping to facilitate spread of the infection
cysteine, IL-1beta to active IL-1, fibronectin, vitronectin
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
C5a, C5a
pharyngitis/tonsilitis caused by group ____ strep and is frequently accompanied by _____ and _____________
A, exudate, cervical lymphadenopathy
The most pathogenic of the streptococci is ________
Group A (Streptococcus Pyogenes)
Scarlet fever is a form of what type of disease Group A Strep can cause? What about Rheumatic fever?
Scarlet fever is a form of acute suppurative disease (direct result of bacterial invasion), whereas rheumatic fever is a post-streptococcal/immunologic sequella infection
Name the three types of post-streptococcal sequella infections you are likely to see with Group A Strep
1) acute rheumatic fever
2) acute glomerulonephritis
3) guttate psoriasis
What is the most common feature of rheumatic fever?
arthritis
Acute Rheumatic Fever occurs exclusively following _____________ infection by _________ streptococcus, and usually occurs ____-____ days after the infection start having symptoms of the rheumatic fever
pharyngitis/tonsilitis ("strep throat", group A strep (pyogenes), 10-15 days
Explain the autoimmune disorder hypothesis about rheumatic fever
There is cross-reactivity taking place between components of the streptococcal M proteins and the cardiac sacrolemmal proteins
the ______ of group A strep is non-antigenic because it...
capsule, mimics the hyaluronidate in our own connective tissue ground substance
guttate psoriasis is due to ....
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
chronic valvular heart disease may result in ________ from group A strep infection
rheumatic fever
different types of ________ appear to be responsible for either acute glomeronephritis or acute rheumatic fever
M Proteins
Antibiotics (prevent/don't fully prevent) disease in rheumatic fever, and (prevent/don't fully prevent) disease in acute glomerulonephritis
prevents disease, does not fully prevent
Impetigo is so much more common in young children than adults because
adults have already had it as kids and are protected from their Abs against it
Impetigo spreads very commonly in households via
towels
In lymphangitis (frequently associated with cellulitis) what does to patient present to you with?
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)
Many predisposing factors to group A cellulitis name some
Athlete's foot (TREAT THE ATHLETES FOOT TOO or else you'll just get recurring infections), edema due to CHF, obesity
Erysipelas (a deeper cellulitis) is more commonly associated with a compromise in lymphatic or venous drainage. What are the two main scenarios with this?
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!
What group of antibiotics are alternative agents to treat with if patient has a penicillin allergy
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
Individuals with an attack of rheumatic fever are at an increased risk to develop repeated attacks; these recurrences can be decreased with long-term _____________
penicillin prophylaxis
Name three characteristic signs of scarlet fever
1) strawberry tongue
2) sandpaper rash
3) diffuse bright scarlet erythema of the skin and mucous membranes
Whats the most common cause of a simple cellulitis?
Group A Strep
Disease caused by Streptococcus __________ is characteristically in neonates and post-partum women or in older individuals with compromising illnesses
agalactiae (Group B Strep)
Important to differentiate group D strep (Streptococcus gallolyticus) from enterococcus for two reasons?
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
Immunity to group B streptococci is mediated by antibody to a type-specific carbohydrate (eg, type I, II, III, IV, V)
so basically breaks down your Lancefield group for this one (Group B polysaccharide) further into individual types
Typically see Group B infection in mothers and babies when the mom hasn't had ________
prenatal care
Risk factors for a Group B infection during birthing process...
premature rupture of membranes, prolonged labor, mom has an absence of antibody to the type-specific carbohydrate
in neonates there is _____ and ______ onset neonatal infections from Group B strep. Describe what could occur in both
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
From Group B strep, post-partum women get...
choriomnionitis, endometritis, and bacteremia
Adults who get a strep group B (agalactiae) infection commonly, frequently have an underlying problem...
usually diabetes mellitus, or could be cirrhosis, cancer, etc
There is a very strong association between _______ or _______ caused by Streptococcus gallolyticus and lesions of the gastrointestinal tract, particularly colonic neoplasms
bacteremia, endocarditis
The rule for treatment of endocarditis is you have to use a _________ antibiotic
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
If you have NO MBC no matter what your antibiotic is _____
static
If your MBC and MIC are greater than a 32:1 ratio then it is a ________ antibiotic
tolerant
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
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
Most enterococcal infections occur in _______ patients (they are the 2nd or 3rd most common cause of _____________ infections)
hospitalized, nosocomial
Never use a _________ as first line treatment alone for endocarditis treatment because...
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)
Viridans group of strep are divided into 4 large groups what are they?
S. mitis, S. mutans, S. salivarius, S. sanguis
Viridans group of strep are a major part of the human _____ and ____ flora
oral and bowel, normally adhere to teeth, buccal mucosa, and tongue
Viridans streptococci are the cause of 2 major diseases of importance:
1) leading cause of infective endocarditis in some areas
2) responsible for dental carries (the most common infectious disease worldwide!)
Microaerophilic streptococci are known as ______, and the three ones to know..., and as a group just know they have a propensity to cause ___________
milleri, S. constallatus, S. intermedius, S. morbillorum, have a propensity to cause pyogenic (puss-filled) foci (ie brain abscesses, empyema (in lung), hepatic abscesses)
Which one is the fish pathogen?
Streptococcus iniae