156 - Miscellaneous Bacterial Infections with Cutaneous Manifestations Flashcards
1
Q
Bioweapon potential A
A
Anthrax
Tularemia
Plague
2
Q
Bioweapon potential B
A
Brucellosis
Glanders (Burkholderia mallei)
Melioidiosis (Burkholderia pseudomallei)
BBB
3
Q
Gram-positive bacteria
A
Bacillus anthrasis Listeria monocytogenes Erysipelothrix rhusiopathiae Streptococcus iniae Corynebacterium diphtheriae
4
Q
Gram-negative bacteria
A
Francisella tularensis Yersinia pestis Brucella Burkholderia mallei Pasteurella multocia Streptobacillus moniliformis Spirillum minus Mycoplasma Vibrio vulfinicus Aeromonas hydrophila Burkholderia pseudomallei Chromobacterium violaceum
5
Q
Worldwide, especially developing agrarian areas
Painless edematous plaque with central black ulcer or eschar; “malignant pustule”; “malignant edema”
Goats, sheep, cattle, or products made from them
A
Anthrax
6
Q
Etiologic agent: Anthrax
A
Bacillus anthrasis
7
Q
Anthrax route of inoculation
A
Cutaneous
Inhalational
GI
Injectional
8
Q
_____ anthrax has a distinct clinical course because it presents without an eschar; more virulent with a much higher mortality rate
A
Injectional
9
Q
Injectional anthrax resulted from exposure to
A
Contaminated heroin
10
Q
Major virulence factors of Bacillus anthracis
A
Poly-gamma-D-glutamic acid capsule
Tripartite anthrax toxin
11
Q
The tripartite anthrax toxin contains 3 proteins
A
Protective antigen
Lethal factor
Edema factor
12
Q
Best target for anthrax vaccines or immunotherapy
A
Protective antigen
13
Q
Y/N: Lesional progression in anthrax is caused by the bacteria and is responsive to antibiotic therapy
A
No - caused by toxins and is unaffected by antibiotic therapy
14
Q
Naturally occurring anthrax is treated with
A
Penicillin or doxycycline
15
Q
Recommended initial treatment for confirmed or suspected bioterrorism-associated anthrax
A
Fluoroquinolone
16
Q
Humanized monoclonal antibody that has specificity for the bacterial protective antigen, to be used in cases of inhalational anthrax
A
Raxibacumab
17
Q
Infectious propagule in anthrax
A
Spore
18
Q
Y/N: Anthrax is not transmitted from person-to-person
A
Yes
19
Q
Y/N: Untreated cutaneous anthrax, particularly if nonedematous, is a largely self-resolving disease
A
Yes
20
Q
Y/N: Patients with injectional, inhalational, or GI anthrax should be placed in intensive care units
A
Yes
21
Q
Temperate and gold regions, North America, Europe
Ulceroglandular: painful papule that ulcerates and forms eschar
Tick bites, lagomorphs (rabbits and hares), rodents
A
Tularemia
22
Q
Etiologic agent: Tularemia
A
Francisella tularensis
23
Q
6 major clinical presentations of tularemia
A
Glandular Ulceroglandular Oculoglandular Oropharyngeal Typhoidal Pneumonic
24
Q
Most common form of tularemia in the US
A
Ulceroglandular
25
Most common tick vectors of tularemia
```
Dermacentor variabilis
Amblyomma americanum
Ixodes sp (in Europe)
```
26
Y/N: Tularemia has human-to-human transmission
No human-to-human transmission
27
Treatment for tularemia
Aminoglycoside antibiotic, such as gentamicin (or streptomycin, if available) or
Fluoroquinolone
Alternative:
Tetracycline antibiotic, such as doxycycline
28
Antibiotic prophylaxis for tularemia
Ciprofloxacin
29
Worldwide, especially southwestern US and India
Buboes (tender regional lymphadenopathy) followed by purpura and gangrene ("black death")
Flea bites, spread from infected rodents
Plague
30
Etiologic agent: Plague
Yersinia pestis
31
3 clinical forms of plague
Bubonic
Bubonic-septicemic
Pneumonic
32
Original drug of choice for plague
Streptomycin
33
Preferred treatment for plague since streptomycin is not widely available
Gentamicin
34
Other treatments for plague
Doxycycline
| Cotrimoxazole
35
Antibiotic prophylaxis for plague
Doxycycline
| Cotrimoxazole
36
Worldwide, especially developing agrarian areas
Variable; skin manifestations present in <5% of patients; characteristic undulant fever
Cattle, sheep, goats, or untreated milk
Brucellosis
37
Etiologic agent: Brucellosis
Brucella melitensis
| Brucella abortus
38
Most common source of human brucellosis
Contaminated unpasteurized milk or cheese
39
Brucellosis is more common in (children/adults)
Children
40
Most frequently involved organs
Joints
Reproductive organs
Liver
CNS
41
For brucellosis cultures, _____ specimens have the highest yield
Bone marrow
42
Treatment for brucellosis
Prolonged multidrug therapy with doxycycline combined with either streptomycin or gentamicin
WHO: Doxycycline and rifampicin
43
Rare and focal in Asia, Middle East
Nodule with cellulitis that ulcerates; ulcer is painful and has irregular edges with a gray-yellow base; later, deep abscesses and sinuses
Donkeys, mules, horses
Glanders
44
Etiologic agent: Glanders
Burkholderia mallei (formerly Pseudomonas mallei)
45
Glanders is usually fatal in _____, but may cause a chronic suppurative condition, called farcy, in _____
Donkeys and mules
| Horses
46
Presentation of glanders
Acute localized infection
Chronic cutaneous infection
Acute pulmonary disease
Septicemia
47
Characteristic eruption of bacteremic spread of glanders
Crops of papules, bullae, and pustules
| Mucopurulent, bloody nasal discharge is common
48
Treatment for glanders
Sulfadiazine
49
Worldwide
Rapid onset of cellulitis at bite site followed by necrosis
Dog or cat bite
Pasteurella infection
50
Y/N: Pasteurella multocida is a normal flora in oropharynx of many domestic animals
Yes
51
Because most animal bite wounds show polymicrobial contamination, _____ should be started
Amoxicillin-clavulanic acid
52
Drug of choice if Pasteurella is cultured
Penicillin
53
Worldwide, especially Asia
Morbiliform eruption with fever followed by arthritis; palms and soles have a characteristic desquamation
Rats or their excreta
Rat-bite fever (streptobacillary)
54
Etiologic agent: Rat-bite fever
Streptobacillus moniliformis
| Spirillum minus
55
More common form of rat-bite fever is caused by
Streptobacillus moniliformis
56
Japanese name of spirillary rat-bite fever
Sodoku
57
Best way to confirm the diagnosis of streptobacillary rat-bite fever
Blood cultures
58
In (S. moniliformis/S. minus) infection, the incubation period is shorter (usually <10 days vs >14 days), the bite site usually heals before systemic symptoms begin, the rash is more peripheral, and arthritis is more common (60% vs 20%)
S. moniliformis
59
Treatment of choice for someone who becomes ill after a rat bite
Amoxicillin-clavulanic acid
Allergic to penicillin: doyxcycline
60
Once S. moniliformis is identified, _____ is the drug of choice
Penicillin
61
Although there are no established guidelines, one might consider a prompt prophylactic course of _____ after any rat bite
Penicillin or
| Doxycycline
62
Cool coastal regions worldwide
Extremely painful nodule on finger
Seals or sea lions, and similar marine mammals (order Pinnipedia)
Seal finger
63
Etiologic agent: Seal finger
Mycoplasma
| Has not been fully confirmed
64
Seal finger does not respond to the _____ antibiotics frequently prescribed presumptively for cellulitis caused by Staphylococcus, Streptococcus, or Erysipelothrix
Beta-lactam
65
Treatment of choice for seal finger
Tetracyclines
66
Worldwide
In neonates, generalized petechiae, papules, and pustules
In neonates, infected mother with transfer in utero or shortly after birth
Listeriosis
67
Listeria monocytogenes is found widely in
Soil, water, vegetation, and the gut flora of humans and other animals
68
Exposure to Listeria monocytogenes occurs through
Fecal-oral contamination
69
Human listeriosis is most common in
Pregnant women
Neonates
Patients with AIDS
Foodborne outbreaks
70
Approximately _____% of humans are fecal carriers of Listeria
5
71
Highest incidence of human listeriosis is seen among
Infants in the perinatal period
72
Generally ineffective for listeriosis
Cephalosporins
73
Treatment for listeriosis
IV amplicillin (or penicillin)
Penicillin-allergic: cotrimoxazole or erythromycin
74
Worldwide; particularly common along the Gulf of Mexico
Necrotizing fasciitis, hemorrhagic bullae often beginning as a wound infection
Warm saltwater or brackish water or undercooked seafood
Vibrio vulfinicus infection
75
V. vulfinicus clinical syndromes
Gastroenteritis
Primary sepsis
Primary wound infection
76
Antibiotics of choice for V. vulfinicus infection
Combination of doxycycline and ceftazidime
77
Some authors consider a course of prophylactic _____ for an immunocompromised person with a high-risk exposure
Oral doxycycline
78
Worldwide
Cellulitis evolving to abscess formation; exudate often has a foul or fishy odor; often beginning as wound infection
Fresh or brackish water, contaminated fish
Aeromonas hydrophila
79
Increasing number of soft-tissue infections caused by Aeromonas hydrophila are associated with the medical use of
Leeches (Hirudo medicinalis)
80
A. hydrophila produces beta-lactamase and is resistant to
First-generation penicillins
| Cephalosporins
81
Treatment for Aeromonas hydrophila infection
Third-generation cephalosporins
Fluoroquinolones
Aminoglycosides (but not streptomycin)
82
```
Wet tropical areas, especially Southeast Asia and Northern Australia
Indolent abscesses; suppurative parotitis (in children)
Wet soil (classically rice paddies), flooded regions
```
Melioidosis
83
Etiologic agent: Melioidosis
Burkholderia pseudomallei (formerly Pseudomonas pseudomallei)
84
Peak incidence of melioidosis during
Rainy monsoon seasons
85
Principal clinical presentations of melioidosis
Acute melioidosis with suppurative skin lesions, pneumonia, or septicemia
Chronic melioidosis, the more common form of the disease, with involvement of the lungs, skin, bones, joints, liver, and spleen
86
Most commonly used test in Southeast Asia for melioidosis because it is simple to perform and cheap
Indirect hemagglutination assay
87
Treatment for melioidosis
IV antibiotics (usually ceftazidime and carbapenem) followed by several months of high-dose oral therapy with trimethoprim-sulfamethoxazole or amoxicillin-clavulanic acid
88
Worldwide
Tender violaceous plaque on hand at site of injury
Contaminated fish, shellfish, poultry, meat, and animal products
Erysipeloid
89
Etiologic agent: Erysipeloid
Erysipelothrix rhusiopathiae
90
Clinical forms of erysipeloid
Local nonsuppurative cutaneous infection (erysipeloid of Rosenbach)
Diffuse chronic cutaneous form
Subacute bacterial endocarditis, particularly of the aortic valve
Bacteremic form without endocarditis
91
Y/N: Erysipeloid often involves the web spaces but spares the terminal phalanges and does not progress beyond the wrist
Yes
92
Treatment of choice for erysipeloid
High-dose penicillin or ampicillin
Cannot take penicillins: third-generation cephalosporins
93
Worldwide, especially freshwater fish farms
Rapid onset of hand cellulitis following a puncture wound
Contaminated farm-raised fish
Streptococcus iniae
94
In dolphins, S. iniae causes slow-growing nodular abscesses of the skin and subcutaneous tissues, giving it the vernacular name
"Golf ball disease"
95
Most cases of erysipeloid have been reported in _____, where the practice of buying live fish for home preparation is common
China and in Asian communities in North America, particularly Toronto
96
Most people who develop S. iniae infection are
Elderly individuals of Asian descent
97
Treatment of choice for S. iniae infection
Penicillin
98
Other treatments for S. iniae infection
Cephalosporins
Macrolides
Quinolones
Vancomycin
99
S. iniae infection is resitant to
Tetracyclines
100
Worldwide, especially the tropics
Papules, petechiae, jaundice
Contaminated freshwater, moist soil, or animal urine
Leptospirosis
102
Etiologic agent: Leptospirosis
Leptospira interrogans
103
Etiologic agent: Diphtheria
Corynebacterium diphtheriae
104
Most important reservoirs of Leptospira interrogans
Rodents
105
Y/N: Infected humans can also serve as transient reservoirs of Leptospira interrogans. Reservoir animals excrete leptospires in their urine
Yes
106
Leptospiroris is most prevalent among
Children who play or swim in contaminated water
| Adults with occupational exposure
107
Y/N: Most human leptospirosis infections are asymptomatic, self-limited, and detectable only on serologic surveys
Yes
108
Clinical forms of leptospirosis
Mild anicteric form that resolves without complications
| Severe, icteric form (Weil disease)
109
Phases of leptospirosis
Acute bacteremic phase
| Delayed immune or convalescent phase
110
Caused by L. interrogans serovariant autumnalis
Distinctive rash that appears on the fourth or fifth day of illness, consisting of slightly raised, 1- to 5-cm tender, erythematous papules on the shins
Pretibial fever of Fort Bragg fever
111
Direct isolation of leptospires is possible from the _____ during the acute phase or from _____ during the convalescent pahse
Blood or CSF
| Urine
112
Effective and can be taken prophylactically for short-term exposure in a hyperendemic area for leptospirosis
Doxycycline 200 mg once weekly
113
90% of acute febrile illness caused by Corynebacterium diphtheriae affects the
Pharynx and mucous membranes of the upper respiratory tract
114
Only natural host of Corynebacterium diphtheriae
Humans
115
Routine childhood immunization for diphtheria is directed againts
Diphtheria's exotoxin, not the bacteria itself
116
Types of skin involvement in diphtheria
Primary cutaneous diphtheria
| Wound diphtheria
117
Type of diphtheria that accounts for almost all cases of cutaneous diphtheria reported in the US
Wound diphtheria
118
Most important other manifestations of diptheria are the toxin's effects on
Heart
| Nerves
119
Antibiotic of choice for cutaneous diphtheria
High-dose IV penicillin
Unable to take penicillin: erythromycin
120
Pharyngeal cultures for diphtheria should be repeated _____ after completing treatment
2 weeks
121
Adults should receive a dose of tetanus and diphtheria toxoid every
10 years
122
Antibiotic prophylaxis for diphtheria
Oral erythromcyin
| Penicillin
123
Corynebacterium ulcerans is a common organism in
Cattle
124
_____ disease is most common in Corynebacterium ulcerans infection
Pharyneal
125
Corynebacterium _____, which causes lymphadenitis in ruminants, occasionally causes a similar necrotizing lymphadenitis in humans
pseudotuberculosis
126
An organism closely related to corynebacteria, _____ (formerly Corynebacterium equi), causes pulmonary disease in AIDS patients
Can cause skin and soft-tissue infections in healthy individuals, especially those exposed to horse manure or after an injury contaminated with soil
Rhodococcus equi
127
Worldwide where immunization is not practiced
Pustule or superinfected abrasion, evolving to an ulcer with gray membrane at base
Asymptomatic human carriers
Diphtheria
