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Medical Microbiology > 1. Infectious Diseases in the 21st Century > Flashcards

1. Infectious Diseases in the 21st Century Flashcards

1. To describe the change in bacterial infectious diseases in recent years with specific examples 2. To explain drivers for the change in bacteria infectious diseases in the community and hospital and to consider antibiotic resistance

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1
Q

What countries are mostly effected by infectious diseases?

A

Middle and low income countries

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2
Q

What is the impact of infectious diseases on high income countries?

A
  1. Generally infectious diseases are diseases of the elderly and healthcare.
  2. Often misrepresented and underrepresented
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3
Q

Why are infectious diseases underrepresented in rich countries?

A
  1. You can only out 2 causes of death on a death certificate.
  2. These infections often finish you off, so they can be 3rd or 4th on the list.
  3. e.g., a cancer patient’s death is recorded as cancer not the infectious disease that kills them
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4
Q

Why do lower-income countries have more infectious diseases?

A
  1. These are often preventable infections/deaths.
  2. due to poor sanitation, poor education and reduced access to Antimicrobials
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5
Q

Why are infectious diseases reducing globally?

A
  1. Vaccination
  2. Sanitation
  3. Clean water
  4. Better education
  5. Better nutrition
  6. Better access to healthcare
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6
Q

What is the exception to infectious diseases reducing?

A

HIV/AIDS due to it being relatively new and hard to treat.
It has started to reach a plateau.

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7
Q

What is the biggest infectious disease killer in the UK?

A
  1. Pneumonia
  2. Especially community transmitted infections
  3. There is a clear link between infection and death
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8
Q

Reducing Bacterial infection: sanitation

A

This breaks the faecal oral transmission route.

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9
Q

Reducing Bacterial infection: Vaccination

A
  1. Prevents spread and serious infection
  2. But vaccines can be hindered by their success and lose effectiveness as they reduce the disease burden. eg TB vaccine
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10
Q

Reducing Bacterial infection: Pasteurisation

A
  1. Reduce the impact of zoonotic diseases that are transmitted through food.
  2. bovine TB vs TB
  3. Most people dying of TB in Victorian England was bovine TB from milk
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11
Q

What is the most common form of TB?

A

Mycobacterium tuberculosis

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12
Q

Is M. bovis still an issue in the UK?

A
  1. No due to pasteurisation and farming measures.
  2. Can be an issue for immunocompromised people.
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13
Q

How many cases of TB are currently in the UK?

A

about 9000 but it is stable

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14
Q

What was the 1st antibiotic used to treat TB?

A

Streptomycin

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15
Q

What has caused a reduction of TB in the UK?

A

BCG vaccine and improvements to living conditions.

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16
Q

Why is multi-drug resistance to TB increasing?

A
  1. Due to the amount of time needed to treat TB due to slow replication.
  2. Antibiotics need to be taken for months which can cost a lot of money for people without free healthcare.
  3. Poor healthcare systems can reduce the amount of effective treatment.
  4. This is an unusual way to develop resistance but it is due to TB’s nature.
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17
Q

Why is TB increasing in the UK?

A
  1. Overcrowding
  2. Poor living standards
  3. Immigration - despite screening programs
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18
Q

Why was genomic surveillance of TB introduced?

A
  1. To treat transmission pathways
  2. Reduce transmission
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19
Q

What are the problems with genomic surveillance of TB?

A
  1. Expensive
  2. Only available to people who access healthcare
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20
Q

Why has treatment of TB improved due to genomic Surveillance?

A

We can use surveillance to predict resistance and treatment sensitivity.

21
Q

Why does improved healthcare lead to increasing infection?

A
  1. Operating on people and making holes means that areas of the body are exposed to microbes they otherwise wouldn’t be
  2. Extreme treatment like chemo causes immunosuppression or conditions like leaky gut.
  3. Access ports and tubes create perfect surfaces for colonisation.
22
Q

What healthcare treatments are only possible due to antibiotics?

A
  1. Complex operations
  2. Orthopaedic surgery
  3. Induced immune compromisation like transplants
  4. Anti-cancer chemotherapy
  5. Aging population with comorbidities
  6. Premature babies survival and medicine
23
Q

What are Healthcare associated infections (HAIs)?

A

Opportunistic infections.

24
Q

Where does the bacteria in HAIs come from?

A
  1. Already in the person’s body eg S.pneumoniae, E. coli, C. diff, MRSA
  2. From the environment eg pseudomonas aeruginosa ( these mostly effect immunosuppressed people)
25
Q

How is pneumonia an opportunistic infection?

A
  1. Community transmission
  2. The patient has a viral infection, so they get mucusy.
  3. The opportunistic bacteria collects in the mucus.
  4. You then breathe in the mucus.
  5. The bacteria from the throat enters the lungs and causes pneumonia.
26
Q

What makes pneumonia worse?

A

Immunosuppression so the bacteria in the lungs cannot be cleared.

27
Q

How can pneumonia progress?

A
  1. Problems breathing
  2. Reduced lung function and oxygen levels
  3. Can quickly progress to death
28
Q

Why would pneumonia gain resistance?

A

People with mild pneumonia who don’t seek healthcare due to inconvenience.

29
Q

What normally causes pneumonia?

A

S. pneumoniae
H. Influenzae

30
Q

What can also cause pneumonia?

A
  1. Staph. aureus
  2. Pseudomonas aeruginosa
  3. Klebsiella spp.
31
Q

How many people have C. Diff in their microbiome?

A

3%

32
Q

What keeps C. Diff in check?

A

Other members of the microbiome that compete for resources and nutrients

33
Q

When does a C. Diff infection occur?

A
  1. The patient receives broad-spectrum antibiotics to treat an infection
  2. There is nothing left to prevent C. Diff.
  3. C. Diff is not killed due to being a spore former.
  4. These spores can then spread through the hospital due to diarrhoea and enters the environment.
  5. The disinfectant struggles to kill the spores.
34
Q

why does C. Diff have high mortality?

A

Due to it mostly effecting elderly or debilitated.

35
Q

What did the UK do to reduce C. Diff infections?

A
  1. Introduce mandated reporting
  2. Introducing fines for every case a hospital has.
  3. Better diagnosis leading to isolation of patients.
  4. Better disinfectants and using bleach to kill spores.
36
Q

Why did COVID cause an increase in C. Diff?

A

Due to the removal of some infection control measures.

37
Q

Define multi-drug resistance

A

Resistant to 3 or more classes of antimicrobials

38
Q

Why is Multi-drug resistance a problem in ICUs?

A
  1. Poor lung function
  2. Immunosuppression
  3. lots of tubes and ports that are good for bacterial growth and entry
39
Q

MDR enterobacteriaceae as a HAI

A
  1. ESBL producers
  2. Generally gut bacteria, so they get everywhere and in wounds.
40
Q

MRSA as a HAI

A
  1. More likely to infect healthier patients
  2. As it is more virulent (more ways of causing harm, it is more likely to cause harm in healthy people)
41
Q

What is a Healthcare associated infection (HAI)?

A

A bacterial infection associated with time in hospital.

42
Q

Non-fermenting Gram-negative Bacilli as HAIs

A
  1. Environmental
  2. Really good at surviving on surfaces like plastic
    eg. Pseudomonas aeruginosa
43
Q

What are the antibiotics that can treat gram negative bacteria?

A
  1. Limited to 3 classes usually due to size and the gram negative cell wall.
  2. ß-lactams
  3. Fluoroquinolones
  4. Aminoglycosides
44
Q

What are the antibiotics that can treat gram positive bacteria?

A
  1. Vancomycin and many others
  2. Massive chemicals that wouldn’t be able to enter gram negatives
  3. More treatment options and less resistance
45
Q

Why does TB have its own range of antibiotics?

A
  1. Not very useful for other things due TB’s different biology.
  2. Very toxic drugs
46
Q

What happens when you have had antibiotic treatment?

A

You are more likely to get a resistant infection but this effect wears off after a year.

47
Q

What is a main driver of antibiotic resistance?

A

Lots of antibiotic use

48
Q

Why is antibiotic use reducing?

A

By paying and incentivising GPs to not prescribe them

49
Q

Why is resistance not reducing despite reduced use in the UK?

A
  1. Due to globalisation and different measures in different countries.
  2. Resistant bacteria being bought back by travellers

Medical Microbiology (17 decks)

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