Microbiology - Respiratory Infections

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Endemic areas for Histoplasma

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Ohio and MS river valleys

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Mech of spread for Histoplasma

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inhalation conidia from soil contaminated by of bird or bat feces

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Etiology of Actinomyces

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Gram positive, filamentous, non acid fast, anaerobic

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Describe spread of Actinomyces

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Is normal flora so it is endogenous

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Infection with what organism is increased with steroid use?

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Nocardia

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Etiology of Nocardia

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Gram positive, acid fast

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Describe spread of Nocardia

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through soil dust

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Possible complication of Nocardia infection

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CNS abscess

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Etiology of Influenza A

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enveloped virus with 8 segments of neg sense RNA

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Means of developing Staph aureus pneumonia

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aspiration

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Lab value for Na with Legionella infection

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decreased Na

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Test to dx Legionella

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direct antigen on urine

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What causes tissue damage in Legionella infection?

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PMNs and T cells

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Etiology of Klebsiella

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mucoid on culture, lactose fermenting, indole negative

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Possible complication of Klebsiella pneum

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bacteremia

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Who should receive the pneumo vaccine?

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Sickle cell pt (no spleen)

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What organism has a pos cold agglutinin (IgM agglutinates RBCs)?

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Mycoplasma pneum

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Tx for Mycoplasma pneum

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Erythromycin (no cell wall, so no beta-lactams)

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SE of Isoniazid

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liver injury

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Etiology of EBV

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enveloped ds linear DNA

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EBV causes increase in what lab values?

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AST, ALT, bilirubin, alkaline phosphatase

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Who is at greatest risk for complications with EBV infection?

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African kids with malaria

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Action of Pertussis toxin

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inactivates Gi which increases cAMP activity and increases protein kinase activity

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DOC for Strep pneum that is resistant to penicillin

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cefotaxime

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Organism that causes cauliflower lesion on skin (verrucous) and undergoes broad base budding

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Blastomyces

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Organism that causes erythema nodosum and forms septae to form endospores

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Coccidiodes

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Endemic areas for Coccidiodes

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desert

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Tx for Coccidiodes

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fluconazole

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Describe spread of Coccidiodes

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via arthroconidia

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Etiology of diphtheria

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Gram positive rod, aerobic, grows on tellurite agar

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What type of toxin does diphtheria produce?

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bacteriophage A-B toxin

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Tx for diphtheria

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antitoxin

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Manifestations of Adenovirus infection (2)

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pharyngitis and conjunctivits

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Possible complication of Adenovirus

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ARDS

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Describe macroconidia of Histoplasma

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has fingerlike projections

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Most common organisms of rhinitis (2)

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rhinovirus and coronavirus

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Most common organisms of AOM (3)

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Strep pneumo, H influ, Moraxella

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Most common organisms of sinusitis (3)

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Strep pneumo, H influ, Moraxella

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Most common organisms of eye infections (unilateral) (7)

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Adenovirus, CMV, HSV, S aureus, Neisseria gonorrhea, Chlamydia, Toxoplasma

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Most common organisms of pharyngitis (5)

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Adenovirus, EBV, Mycoplasma, Strep pyogenes, Corynebact diphtheriae

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Type of organism that causes the following: bulging and inflamed TM, opaque liquid in middle ear, occuring after common cold

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Gram neg cocci (Moraxella)

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Main reason to give antibiotics for AOM

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to prevent further suppurative complications like chronic effusions of middle ear that don't respond well to antibiotics

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Tx of STI infection in 2 week old

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Erythromycin

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Etiology of agent: fever, sore throat, red left eye with feeling of sand in it, hx of playing in water

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naked, ds-linear DNA (adenovirus)

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What virulence factor is most likely to be involved in pathogenesis of petechiae on soft palate during a strep pyogenes infection?

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erythrogenic toxin

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Which important Gram pos bacterium is catalase positive?

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Staph aureus

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Are all streptococci catalase negative?

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yes

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2 organisms that are gamma hemolytic

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enterococcus and staphylococcus epidermidis

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Course of action if the following: 5 yo immigrant with fever, sore throat, dyspnea, lymphadenopathy, whitish-gray adherent membrane over tonsils/pharynx

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passive immunization against diphtheria toxin

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Mech by which non-capsular strains become capsular

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transformation

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Mech by which nontoxic strains become toxic

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trunsduction (via lysogeny)

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Mech by which drug sensitive strains become resistant

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conjugation (plasmids)

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Mech of diphtheria toxin

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inactivates EF2

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oncogenic DNA viruses (2)

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EBV, HBV

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Most common organisms of croup (2)

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parainfluenza, RSV

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Most common organisms of epiglottitis (1)

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HiB

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Most common organisms of bronchitis (3)

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resp viruses, Mycoplasma pneum, H influ (AECB)

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Most common organisms of bronchiolitis (3)

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RSV, influenza, pneumovirus

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Dx: barking cough, wheezing, preceeded by coryza, perioral cyanosis, virus is nonseg neg sense ssRNA, nucleocapsid with surface spikes of hemagluttinin

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parainfluenza

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Toxin associated with following sx: increased cough with repetitive dry cough followed by inspir whistle; incomplete immunizations

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ADP-ribosylase

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ADP-ribosylase associated with pertussis causes what change in lymphocytes?

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preferential increase in lymphocytes by inhibiting chemokine receptor

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special media for pertussis

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Boredet-Gengou charcoal blood agar with cephalexin

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Common organisms of typical pneumonia (4)

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Strep pneumo, Klebsiella, E coli and GBS

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Common organisms of atypical pneumo (9)

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Mycoplasma pneum, Chlamydophila pneum, Legionella pneum, Influenza, RSV, Adenovirus, Sin Nombre, SARS, H5N1

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Common organisms of TB/chronic pneum (5)

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TB, Histoplasma, Blastomyces, Coccidioides, Actinomyces

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Common organisms of pneumo in comorbids (9)

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Pseudomonas (CF), MDR-GNB (ICU), S aureus (flu), anaerobes (elderly), Nocardia (CMI), Pneumocystis (HIV), Aspergillis and Candida (neutropenic), CMV (AIDS/transplant)

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What best differentiates Strep mutans from Strep pneumo

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Strep pneumo is Optochin sensitive

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Tx for a Gram neg rod that is mucoid in colony, oxidase neg, lactose fermenting and causes cough, fever, muscle aches, chest pain

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ceftriaxone and gentamicin (3rd or 4th ceph plus aminoglycoside) (for Klebsiella)

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Dx: fever, cough, muscle aches, delirium, watery diarrhea, clear sputum, urine antigen test confirms dx

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Legionella pneum

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special media for Legionella

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BCYE with Fe and cysteine

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Target of drug used to tx influenza

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neuraminidase

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What genetic changes of influenza are responsible for a number of epidemics and pandemics?

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reassortment

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Dx: CXR shows ground-glass appearance and air bronchograms in lung fields

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bronchiolitis

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INH must be given with what vitamin?

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B6

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Drug that is directed against the synthesis of ergosterol

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fluconazole

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Dx and Tx: fever, chills, hemoptysis, cytotoxic chemotherapy for leukemia, CXR with multiple nodular infiltrates, Galactomannan positive

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Aspergillus; drug that causes pores in membrane by binding with ergosterol

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Dx: works with wool, cyanosis, hemoptysis, chest pain, fever, rales, mediastinitis

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anthrax

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Anthrax produces what type of toxin?

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adenyl cyclase toxin