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223 Cards in this Set
- Front
- Back
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Which organisms are found in macrophages?
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Histoplasma capsulatum, Listeria monocytogenes, Legionella pneumophila, Mycobacterium tuberculosis, Neisseria gonorrhoeae
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Which organism is catalase +?
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Staphylococcus
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Which organism is catalase -?
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Streptococcus
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Which organisms are B- hemolytic?
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Streptococcus pyogenes, streptococcus, agalactiae
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What are the ATYPICAL causes of CAP?
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Chlamydia pneumonia, Mycoplasma pneumonia, Legionella pneumophila
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What are the five causes of CAP?
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Strep pneumo, H. influenza, chlamydia pneumonia, mycoplasma pneumonia, legionella pneumophila
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Which organisms are found in macrophages?
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Histoplasma capsulatum, Listeria monocytogenes, Legionella pneumophila, Mycobacterium tuberculosis, Neisseria gonorrhoeae
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Which organisms are encapsulated?
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Strep pneumo
Strep pyogenes Strep agalactiae Bacillus anthracis Neisseria meningitidis Salmonella Klebsiella pneumophilia, oxytoca Haemophillus influenzae Pseudomonas aeruginosa Cryptococcus neoformans |
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Which organism is catalase +?
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Staphylococcus
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Which organism is catalase -?
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Streptococcus
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Which organisms are B- hemolytic?
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Streptococcus pyogenes, streptococcus, agalactiae
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What are the ATYPICAL causes of CAP?
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Chlamydia pneumonia, Mycoplasma pneumonia, Legionella pneumophila
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What are the five causes of CAP?
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Strep pneumo, H. influenza, chlamydia pneumonia, mycoplasma pneumonia, legionella pneumophila
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Which organism is coagulase positive?
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Staphylococcus aureus
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Which organisms are coagulase negative?
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Staph epidermidis, Staph saprophyticus
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Which organisms can cause endocarditis?
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Staph aureus, Staph epidermidis, Strep agalactiae, Strep viridans, Strep bovis, Enterococcus faecalis, Enterococcus faecium, Corynebacterium jeikeium, Salmonella, Candida,
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True or false? Staph epidermidis causes pneumonia.
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FALSE
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Which reagent is used to separate S. epidermidis from S. saphrophyticus?
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Novobiosin. S. sap is resistant to novobiosin.
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How can you treat Staph epidermidis?
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SMX/TMP, Ampicillin, Nitrofurantoin
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Which organism is alpha hemolytic?
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Streptococcus pneumonia
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What does autolysin in Strep pneumoniae do?
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Found in the cell wall, activation triggers cell lysis releasing virulence factors
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What does pneumolysin in Strep pneumoniae do?
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It is a virulence factor that damages cell membranes/matrix
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How is macrolide resistance mediated by strep pneumo?
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Alteration in ribosomal target or Efflux
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How is quinolone resistance mediated by strep pneumo?
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Efflux or parC mutations (alteration in DNA gyrase target)
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Which bacteria has a capsule made of hyaluronic acid?
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Strep pyogenes
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What are the toxic extracelluar components produced by Strep pyogenes?
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Pyrogenic exotoxins, streplysin O, streptolysin S, streptokinase
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What is the capsule of S. agalactiae made of and what is its significance?
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Polysaccharide capsule, anti-phagocytic
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90% of enterococcus infections are caused by which species?
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Enterococcus faecalis
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The most common infection caused by peptostreptococcus is?
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Aspiration pneumonia
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Peptostreptococcus is often found with this organism…
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Bacteroides fragilis
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Which organism makes edema factor and lethal factor? Are these endo or exotoxins?
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Bacillus anthracis; exotoxins
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What can be used to treat bacillus anthracis?
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Cipro
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How do you treat Listeria monocytogenes?
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Ampicillin +/- aminoglycoside or SMX/TMP
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Which organism causes rhomboencephalitis?
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Listeria monocytogenes
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How does Neisseria gonorrhoeae attach to epithelial cells?
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pili
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Can you use Penicillin to treat Neisseria gonorrhoeae? Why or why not?
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No because of PPNG (penicillinase producing neisseria gonorrhea)
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What can you use to treat Neisseria gonorrhea?
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Rocephin (ceftriaxone) for gonorrhea, Azithromycin 1mg for Chlamydia
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Can you use Quinolones to treat Neisseria gonorrhea?
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No because of quinolone resistance
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1% silver nitrate solution is used for…
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Prophylaxis or treatment for newborn ophthalmic infections caused by Neisseria gonnorhoeae
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Rifampin can be used for prophylaxis upon for which organism?
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Neisseria meningitidis
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Waterhouse-Friderichsen Syndrome is caused by?
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Neisseria meningitidis
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What are the characteristics of Waterhouse-Friderichsen Syndrome?
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Sepsis +/- meningitis with meningococcal emboli, Disseminated Intravascular Clotication (DIC), adrenal gland hemorrhage
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How does E. coli generate energy?
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Reduces nitrates to nitrites
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True or false? E. Coli can ferment lactose.
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TRUE
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Which organism causes hemorrhagic colitis?
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E. Coli serotype 0157 and H7
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Which strain of E. coli produces verotoxin?
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Enterohemorrhagic E. coli (EHEC)
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Can E. coli be combated with beta lactamase inhibitors?
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No
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True or false? Salmonella ferments lactose
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FALSE. Salmonella does not ferment lactose.
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What kind of infections does Salmonella cause?
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Gastroenteritis, enteric fever Typhoid (rare)
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True or False? Klebsiella ferments lactose
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TRUE
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True or False? Enterobacter ferments lactose
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TRUE
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True or False? Proteus ferments lactose
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FALSE, proteus does not ferment lactose
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What features does proteus have to move in the urinary tract?
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Flagella and fimbriae
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Which organism produces urease which hydrolyzes area to ammonium hydroxide increasing the urinary pH the result is often renal stones with UTI?
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Proteus
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What are the infections caused by proteus?
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UTI, pneumonia, sepsis, surgical wound infectious in hosp. patients
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True or False? Providencia ferments lactose
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FALSE, providencia does not ferment lactose
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How does Haemophilus influenzae attach to the mucosa?
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IgA protease
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How would you classify the shape of Haemophilus influenze?
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coco-bacilli
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How would you classify the shape of Neisseria gonorrhoeae and meningitidis?
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Diplococci
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How would you classify the shape of Moraxella catarrhalis?
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Diplococci
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What does Moraxella catarrhalis normally cause?
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Sinusitis, bronchitis, COPD exacerbation, otitis media
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Where is Moraxella catarrhalis normally found?
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Respiratory tract flora
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Which bacteria produces pyocyanin?
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Pseudomonas aeruginosa
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What kind on infections does Pseudomonas aeruginosa cause?
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Ventilator pneumonia, post-surgical and ICU infections, otitis media
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True or False: Septra is a good agent to treat Pseudomonas aeruginosa.
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False. Septra doesn't work for pseudomonas in the body. It does work in test tubes where it doesn't have folic acid.
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What infection does Legionella pneumophilia cause?
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Community Acquired Pneumonia (Atypical)
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What are the symptoms of "warm month pneumonia"?
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Pneumonia with hyponatremia
Fever >40 degrees Nonproductive cough Diarrhea Myalgia Bradycardia Unilateral-lower lobe pneumonia |
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What agents should not be used to treat Legionella pneumophilia?
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Beta-lactams
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How is a Legionella pneumophilia infection diagnosed?
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Culture or
Direct fluorescent antibody testing |
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Which organisms are cocobacilli?
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Hemophillus influenzae
Actinetobacter baumannii Legionella pneumophilia |
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Which organism is known for causing Valley Fever?
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Coccidioides immitis
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How can Coccidioides immitis be diagnosed?
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CAT scan
Antigenic skin testing Serology for IgM or IgG antibodies |
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How can Coccidioides immitis be treated?
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Amphotericin B infusion
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What can be used to diagnose histoplasmosis?
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Cultures
Antibody titer Skin reaction |
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Penicillins: Bacteriostatic or Bactericidal
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Bactericial for the most part
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Site of action of penicillins
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PBP's
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Mechanism of action of penicillins
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inhibit certain enzymes required to make the cell wall
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Penicilins are synergistic and additive with
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Synergistic: aminoglycosides Additive: quinolones (organism specific)
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Mechanism of resistance for penicillins
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Altered cell wall penetration due to PBP affinity alteration
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If you have strep pneumo and you give ampicillin, what happens?
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You get resistant to ALL penicillins and all first and second generation cephalosporins. Only 3d generation ceph's will work
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What is the most potent ceph for strep pneumo?
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Ceftriaxone (Rocephin)
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What drug's excretion into urine is blocked by probenecid?
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Natural Penicillins
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Natural penicillins penetrate all tissues, except for what? Any exceptions?
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prostate, eyes, and CSF unless inflammation occurs
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What do you use to treat syphilis
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Pen G benzathine
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What dose of Pen G benzathine do you use to treat S. pneumoniae (pharyngitis)?
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1.2 - 2.4 M units Q week
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What is the PO formulation of Penicillin? What are the doses?
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Pen V, 125, 250, 500mg QID (tablets or solution)
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Which drug has high N. meningitis (non ppng) susceptibility, and what is the preferred admin route? Dosing?
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Pen G, IV most preferred (PO and IM also available). 2-4 M units IV q4-6h
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LFT increase and thrombophlebitis are problems with what drugs?
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Nafcillin and oxacillin
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What does the acyl side chain do in penicillinase resistant organims?
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it prevents beta lactamase from destroying the ring
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Which penicillin is hepatically metabolized?
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Penicillinase resistant penicilins
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What types of organisms would Cloxacillin be inefficiant towards?
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Enterococcus, listeria, and streptococcus
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T or F: Dicloxacillin 200mg PO TID with food
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False, food decreases absorption and dosing is 125, 250, 500 mg Po QID
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Amoxicillin is more active against which gram type of bacT?
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gram -
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What bacT are aminopenicillins effective against?
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E. coli, H. flu, klebsiella, Listeria, enterococcus
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If a patient has a strep infection, what drug would you avoid?
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ampicillin, amoxicillin
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If you give ampicillin and allopurinol, what happens?
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you get a rash, which is a non allergic rxn
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Renal adjustment is required in which penicillins?
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aminopenicillins, carboxypenicillins (ticarcillin), Ureidopenicillins (piperacillin)
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What is the IV dose of ampicillin
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1-3g q4-6h
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Which penicillin can you take food with
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amoxicillin
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what drug is ineffective toward SPACE organisms?
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Ticarcillin
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which drugs are ineffective toward strep?
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amox, penicillin
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Which drugs must be adjusted in renal impairement
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ampicillin, ticarcillin, piperacillin
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Platelet dysfunction occurs with which drug
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ticarcillin
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Which drugs are effective against enterobactericiae
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ticarcillin, pipercillin
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Ticarcillin Dose
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2-4g IV q4-6h
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What electrolyte problems does ticarcillin cause?
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Na overload, hypokalemia
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Which drug has a zwitter ion, and what does that mean for the drug?
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Piperacillin, it has good gram - penetration
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What drugs are effective against enterococcus?
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aminopencillins, ureidopenicillins
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Which drug is the BEST against P. aeruginosa?
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piperacillin
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Which drug causes neutropenia?
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piperacillin
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Ampicillin + sulbactam
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unasyn
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augmentin
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amox + clavulanic acid
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ticarcillin + clavulanic acid
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timentin
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Zosyn
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piperacillin + tazobactam
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which drug is good against moraxella and klebsiella?
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any combo drug (unasy, augmentin…)
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what does e.coli, H flu, b frag, moraxell and klebsiella have in common
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they all are treated with combo drugs.
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What are tazobactam, sulbactam and clavulanic acid?
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beta lactamase inhibitors (NOT antibiotics)
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What is ineffective against SPACE and ESBL producers
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Zosyn
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Zosyn dose
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3.375 - 4.5g IV q4-6h
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Timentin Dose
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3.1g IV q4-6h
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Which patients are susceptivle to the pulmonary reactivation disease caused by histoplasma capsulatum?
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Smokers
COPD Emphysema |
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Name the four types of candida:
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Candida albicans
Candida krusei Candida tropicalis Candida glabrata or torulopsis |
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How can you distinguise candida on culture?
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Candida is seen as an oval budding yeast with pseudohyphae.
Cream colored |
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What are the common infections caused by Candida?
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Candidemia
Thrush Vulvovaginitis Diaper rash Onychomycosis Urosepsis Meningitis Valvular endocarditis |
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Which Candida species is the most resistant to drugs?
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C. glabrata or torulopsis
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How is Cryptococcus neoformans transmitted?
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Pigeon feces are aerosolized by the wind
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How can Cryptococcus neoformans be seen?
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India ink- used to dissolve other stuff so spherical budding yeast can be seen
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With normal immune function, Cryptococcus neoformans presents as
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normal flu or cold like syndrome
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What effects does Cryptococcus neoformans have on the CSF?
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Increased pressure, protein, WBC
Decreased glucose |
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Which patients are at risk for Aspergillis fumigates infections?
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Immunocompromised:
AIDS Transplant Steroids Leuks Heavy Smokers Diabetics (sometimes) |
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What are the problems associated with Aspergillis fumigates?
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Allergic aspergillosis asthma
Invasive Aspergillosis |
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What are the complications of invasive aspergillosis?
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Invasive pneumonia progresses to dyspnea and apnea--> hemoptysis, thrombosis, necrosis of tissue, necrotic pneumonia
Can also travel to the groin, bowel, kidney and liver. |
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Which systemic fungi are considered opportunists?
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Aspergillis
Candida Cryptococcus Pneumocystis Rhizopus |
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Which organisms are anti-phagocytic?
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Streptococcus pneumonia
Streptococcus pyogenes Streptococcus agalactiae |
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What infections does Corynebacteria diphtheriae cause?
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Conduction abnormalities
Diphtheria Pneumonia Heart Failure |
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Where is corynebacterium jeikeium normally found and what are it's implications?
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Skin organism (like stratum corneum)
Opportunistic infections |
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Which organisms are diplococci?
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Neisseria gonorrhea
Neisseria meningitidis Moraxella catarrhalis Listeria monocytogenes |
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What kind of infectious is caused by Entamoeba histolytica?
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Amoebic dysentery
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How is amoebic dysentery diagnosed?
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Endoscopy
Colonoscopy Swallow string |
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Describe some of the characteristics of entamoeba histolytica:
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Feeds and moves by engulfing food via pseudopodia.
Found as cysts in foods and water. Once ingested, attach to large intestines as trophozoites (mobile). Feed on intestinal bacteria, secrete enzymes --> local ulceration and necrosis |
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What is the most common parasitic disease diagnosed in the U.S?
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Giardia lamblia
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What kind of infection does Giardia lamblia cause?
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Foul smelling, watery diarrhea (no blood)
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Which part of the GI tract does Giardia inhabit?
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Duodenum
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How is Giardia lamblia transmitted?
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Fecally contaminated food or water
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Which intracellular parasite lives in the epithelial cells of the small intestines?
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Cryptosporidium
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How does a Cryptosporidium infection occur?
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Ingestion of oocytes found in the feces of house pets and dairy cows.
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Which parasite is named the "love bug"?
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Trichomonas vaginalis
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How does a Trichomonas vaginalis infection present in females?
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Yellow/green
Foul smelling discharge |
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How does a Trichomonas vaginalis infection present in males?
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White discharge or
asymptomatic carriers |
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Which organisms have flagella?
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Proteus
Giardia lamblia Trichomonas vaginalis |
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Which parasite causes malaria?
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Plasmodium
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Whar are the signs and symptoms of malaria?
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Increased BP and RR
Shortness of breath Heart failure |
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What is the most dangerous form of malaria?
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P. falciparum
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How can you treat malaria?
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Chloroquine
Atovaquone Mefloquin Primaquin |
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Which organism produces a "mono-like" disease in adults and brain lesions and encephalitis in newborns and HIV patients?
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Toxoplasmosis gondii
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What can be done to prevent a toxoplasmosis gondii infection?
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Prophylaxis with CD4 count<100
Bactrim DS or Septra QD |
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Which individuals are most sensitive to toxoplasmosis gondii infections?
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Pregnant women (fetus
HIV patients has no IgE) |
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What is the presentation of toxoplasmosis gondii in healthy adults?
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Asymptomatic
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Which gram negative bacteria produces IgA protease?
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Haemophillus influenzae
Neisseria gonorrhoeae Neisseria meningitidis |
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Which organisms ferment lactose?
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E. coli (except EIEC strain)
Klebsiella pneumophilia, oxytoca Enterobacter |
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Which organisms are non-lactose fermenters?
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Salmonella
Proteus Providencia Pseudomonas aeruginosa Actinetobacter baumannii |
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Which organisms are oxidase positive?
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Pseudomonas aeruginosa
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Which organisms are oxidase negative?
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E. coli
Enterobacter Klebsiella Proteus Providencia Salmonella |
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Which organisms have no cell wall and what are the implications?
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Mycoplasma pneumoniae
Ureplasma urealyticum Cannot be treated with cell wall active antibiotics (beta-lactam antibiotics such as penicillins, cephalosporins) |
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What causes bloody diarrhea?
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Entamoeba histolytica
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What causes non bloody, super smelly and watery diarrhea?
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Giardia lamblia
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Where do entamoeba histolytic live in the body, and in what form?
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large intestine as trophozoites
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Which protozoa can you diagnose by swallowing a string?
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Giardia lamblia and entamoeba histolytica
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Why can a fecal exam yield a false negative in giardia lamblia?
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the cysts inhabit the duodenum
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Which protozoa is a flagellate?
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Giardia lamblia
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What are oocysts from?
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Cryptosporidium
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What lives in the small intestine?
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Cryptosporidium
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Cryptosporidium causes serious infections in which type of patients?
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HIV patients
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Metronidazole is used to treat which protozoas
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Trichomonal vaginalis, entamoeba histolytica
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Where can trichomonas vaginals infect to cause problems in men and women
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cervix, seminal vesicles, and prostate
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Which plasmodium is considered the most dangerous?
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P. falciparum
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How do you diagnose malaria?
|
parasite in the RBC
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How do you use to treat malaria?
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chloroquine, atovaquone, primaquin, mefloquin
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What can chronic malaria cause?
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heart failure due to lack of o2, which causes bp to increase. Makes the heart work too hard for too long
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What are mild plasmodiums?
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P. malariae, vivax, and ovale
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Why is toxoplasmosis gondii bad for fetuses?
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Mom has high level of IgE, and so baby fetus gets it too but you cant treat their anaphylactic reaction.
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how do you get infected?
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cat poo and infected or undercooked meat
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what are symptoms of toxoplasmosis gondii
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mono like. Newborns/HIV patients develop brain lesions, encephalitis. Can die
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What do you use to prophylax t. gondii?
|
bactrim DS once a day. Also covers pneumocystic pneumonia
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What is kaposi's sarcoma?
|
herpes
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How can you treat a Clostridium botulinum infection?
|
Horse antiserm
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What organism causes flaccid paralysis?
|
Clostridium botulinum
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Which organisms are anaerobic, spore-forming, gram positive rods?
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Clostridium botulinum
Clostridium difficile Clostridium perfringens Clostridium tetani |
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Which organism produces toxin A and B? What do these toxins cause?
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Clostridium difficile produces toxins A and B.
Cause diarrhea and side effects |
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Which infections are caused by Clostridium difficile?
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Antibody associated diarrhea
Pseudomembranous colitis Acute abdomen and sepsis |
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How do you treat a Clostridium difficile infection?
|
Probiotics for little kids
Clindamycin Oral metronidazole Oral vancomycin |
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What is the suspicious finidng of a Clostridium difficile infection?
|
Spinach green diarrhea without signs of infection (fever, immune response)
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What is the clinical significance of the BI/NAP1/027 strain of Clostridium difficile?
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Higher relapse rates
Greater mortality rate |
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Which organism produces a Binary toxin and what does this toxin do?
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Binary toxin is produced by BI/NAP1/027 strain of Clostridium difficile.
Binary toxin helps new toxin bind to your intestines. |
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How is the BI/NAP1/027 strain of Clostridium difficile diagnosed?
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Restriction endonuclease analysis
PCR ribotyping or toxinotyping to identify tcdC deletions |
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What kind of resistance does the BI/NAP1/027 strain of Clostridium difficile cause?
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Fluoroquinolone resistance
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Which gene mutation prevents toxin production inhibition in C. diff?
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tcdC gene
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What causes gas gangrene?
|
Clostridium perfringens
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Which anaerobic bacteria causes gas gangrene and food poisoning?
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Clostridium perfringens
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Which patients are at risk for getting Clostridium perfringens infections?
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Diabetics with bad foot wounds
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Which toxin is produced by Clostridium tetani? What does it do?
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Tetanospasmin toxin
inhibits lysine release --> all muscles flex at the same time. Patient can die of lactic acidosis |
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What is the treatment of Clostridium tetani?
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Antitoxin
Antibiotics Ventilation Muscle relaxants Analgesics |
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What agent can be used to treat Bacteroides fragilis?
|
Metronidazole
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What enzyme does Bacteroides fragilis produce and what is it's significance?
|
Beta lactamase --> beta lactams are ineffective
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Which organism causes primarily intra-abdominal infections?
|
Bacteroides fragilis
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Which organism causes syphillis?
|
Treponema pallidum
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What assays can be used for treponema pallidum?
|
Fluorescent Treponemal Antibody Absorption (FTA-ABS)
Microhemagglutinin Treponema Pallidum (MHA-TP) tests |
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What are the characteristics of the primary stage of syphillis?
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Genial lesion (chancre), usually painless and disappears in 2-6 weeks
Lymphadenopathy |
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What lab values do you look for when diagnosing syphillis?
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RPR
VDRL |
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What are the characteristics of the secondary stage of syphillis?
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Up to two years of:
fatigue, fever, myalgia, small oral sores on and off, local or regional alopecia, rash on palms of hand and soles of feet |
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What are the characteristics of the latent stage of syphillis?
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+/- symptoms that are mild
Transmission via sexual contact still possible + serology |
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What are the characterisitics of the tertiary stage of syphillis?
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Neuro-syphillis
Cardiovascular syphillis |
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Which organism is a large spirochete that causes wheal and muscle pain that comes and goes?
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Borrelia Burgdoferi
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How is lyme disease diagnosed?
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serology
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What are the characteristics of the 3 stages of lyme disease?
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Stage 1: erythema migrans
Stage 2: arthritis, arthralgia, cardiac conduction disturbances, meningitis Stage 3: progressive CNS dysfunction, fatigue |
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How can you treat Lyme disease?
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IV Rocephin
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Chlamydia trachomatis has two distinct forms. What are they and what are their characteristics?
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Elementary body: extracellular living, cannot replicate
Reticulate body: intracelluar, divides by binary fusion |
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How can Chlamydia trachomatis be diagnosed?
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Giemsa stain
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How do you treat an mycobacterium avium intracellulare infection?
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Biaxin 250mg QD-TID or 2000mg Qweek w/12 refills
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Which patients are at risk for a MAC (mycobacterium avium complex)?
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AIDS patients
Impaired immunity |
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What are the common symptoms of mycobacterium avium intracellulare infection?
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fever, chills, diarrhea, night sweats
fatigue, weight loss lymphadenopathy |
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When should you start prophylaxis for mycobacterium avium intracellulare infection?
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If CD4 cont <50cells/mm3, then start prophylaxis with azithromycin or clarithromycin
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How can mycobacterium avium intracellulare be stained?
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Heat or detergent
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