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Fitz 9th > 156 - Miscellaneous Bacterial Infections with Cutaneous Manifestations > Flashcards

156 - Miscellaneous Bacterial Infections with Cutaneous Manifestations Flashcards

1
Q

Bioweapon potential A

A

Anthrax
Tularemia
Plague

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2
Q

Bioweapon potential B

A

Brucellosis
Glanders (Burkholderia mallei)
Melioidiosis (Burkholderia pseudomallei)

BBB

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3
Q

Gram-positive bacteria

A 
Bacillus anthrasis
Listeria monocytogenes
Erysipelothrix rhusiopathiae
Streptococcus iniae
Corynebacterium diphtheriae
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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
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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

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6
Q

Etiologic agent: Anthrax

A

Bacillus anthrasis

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7
Q

Anthrax route of inoculation

A

Cutaneous
Inhalational
GI
Injectional

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8
Q

_____ anthrax has a distinct clinical course because it presents without an eschar; more virulent with a much higher mortality rate

A

Injectional

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9
Q

Injectional anthrax resulted from exposure to

A

Contaminated heroin

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10
Q

Major virulence factors of Bacillus anthracis

A

Poly-gamma-D-glutamic acid capsule

Tripartite anthrax toxin

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11
Q

The tripartite anthrax toxin contains 3 proteins

A

Protective antigen
Lethal factor
Edema factor

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12
Q

Best target for anthrax vaccines or immunotherapy

A

Protective antigen

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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

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14
Q

Naturally occurring anthrax is treated with

A

Penicillin or doxycycline

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15
Q

Recommended initial treatment for confirmed or suspected bioterrorism-associated anthrax

A

Fluoroquinolone

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16
Q

Humanized monoclonal antibody that has specificity for the bacterial protective antigen, to be used in cases of inhalational anthrax

A

Raxibacumab

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17
Q

Infectious propagule in anthrax

A

Spore

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18
Q

Y/N: Anthrax is not transmitted from person-to-person

A

Yes

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19
Q

Y/N: Untreated cutaneous anthrax, particularly if nonedematous, is a largely self-resolving disease

A

Yes

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20
Q

Y/N: Patients with injectional, inhalational, or GI anthrax should be placed in intensive care units

A

Yes

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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

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22
Q

Etiologic agent: Tularemia

A

Francisella tularensis

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23
Q

6 major clinical presentations of tularemia

A 
Glandular
Ulceroglandular
Oculoglandular
Oropharyngeal
Typhoidal
Pneumonic
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24
Q

Most common form of tularemia in the US

A

Ulceroglandular

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25
Q

Most common tick vectors of tularemia

A 
Dermacentor variabilis
Amblyomma americanum
Ixodes sp (in Europe)
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26
Q

Y/N: Tularemia has human-to-human transmission

A

No human-to-human transmission

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27
Q

Treatment for tularemia

A

Aminoglycoside antibiotic, such as gentamicin (or streptomycin, if available) or
Fluoroquinolone

Alternative:
Tetracycline antibiotic, such as doxycycline

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28
Q

Antibiotic prophylaxis for tularemia

A

Ciprofloxacin

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29
Q

Worldwide, especially southwestern US and India
Buboes (tender regional lymphadenopathy) followed by purpura and gangrene (“black death”)
Flea bites, spread from infected rodents

A

Plague

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30
Q

Etiologic agent: Plague

A

Yersinia pestis

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31
Q

3 clinical forms of plague

A

Bubonic
Bubonic-septicemic
Pneumonic

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32
Q

Original drug of choice for plague

A

Streptomycin

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33
Q

Preferred treatment for plague since streptomycin is not widely available

A

Gentamicin

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34
Q

Other treatments for plague

A

Doxycycline

Cotrimoxazole

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35
Q

Antibiotic prophylaxis for plague

A

Doxycycline

Cotrimoxazole

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36
Q

Worldwide, especially developing agrarian areas
Variable; skin manifestations present in <5% of patients; characteristic undulant fever
Cattle, sheep, goats, or untreated milk

A

Brucellosis

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37
Q

Etiologic agent: Brucellosis

A

Brucella melitensis

Brucella abortus

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38
Q

Most common source of human brucellosis

A

Contaminated unpasteurized milk or cheese

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39
Q

Brucellosis is more common in (children/adults)

A

Children

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40
Q

Most frequently involved organs

A

Joints
Reproductive organs
Liver
CNS

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41
Q

For brucellosis cultures, _____ specimens have the highest yield

A

Bone marrow

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42
Q

Treatment for brucellosis

A

Prolonged multidrug therapy with doxycycline combined with either streptomycin or gentamicin
WHO: Doxycycline and rifampicin

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43
Q

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

A

Glanders

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44
Q

Etiologic agent: Glanders

A

Burkholderia mallei (formerly Pseudomonas mallei)

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45
Q

Glanders is usually fatal in _____, but may cause a chronic suppurative condition, called farcy, in _____

A

Donkeys and mules

Horses

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46
Q

Presentation of glanders

A

Acute localized infection
Chronic cutaneous infection
Acute pulmonary disease
Septicemia

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47
Q

Characteristic eruption of bacteremic spread of glanders

A

Crops of papules, bullae, and pustules

Mucopurulent, bloody nasal discharge is common

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48
Q

Treatment for glanders

A

Sulfadiazine

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49
Q

Worldwide
Rapid onset of cellulitis at bite site followed by necrosis
Dog or cat bite

A

Pasteurella infection

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50
Q

Y/N: Pasteurella multocida is a normal flora in oropharynx of many domestic animals

A

Yes

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51
Q

Because most animal bite wounds show polymicrobial contamination, _____ should be started

A

Amoxicillin-clavulanic acid

52
Q

Drug of choice if Pasteurella is cultured

A

Penicillin

53
Q

Worldwide, especially Asia
Morbiliform eruption with fever followed by arthritis; palms and soles have a characteristic desquamation
Rats or their excreta

A

Rat-bite fever (streptobacillary)

54
Q

Etiologic agent: Rat-bite fever

A

Streptobacillus moniliformis

Spirillum minus

55
Q

More common form of rat-bite fever is caused by

A

Streptobacillus moniliformis

56
Q

Japanese name of spirillary rat-bite fever

A

Sodoku

57
Q

Best way to confirm the diagnosis of streptobacillary rat-bite fever

A

Blood cultures

58
Q

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%)

A

S. moniliformis

59
Q

Treatment of choice for someone who becomes ill after a rat bite

A

Amoxicillin-clavulanic acid

Allergic to penicillin: doyxcycline

60
Q

Once S. moniliformis is identified, _____ is the drug of choice

A

Penicillin

61
Q

Although there are no established guidelines, one might consider a prompt prophylactic course of _____ after any rat bite

A

Penicillin or

Doxycycline

62
Q

Cool coastal regions worldwide
Extremely painful nodule on finger
Seals or sea lions, and similar marine mammals (order Pinnipedia)

A

Seal finger

63
Q

Etiologic agent: Seal finger

A

Mycoplasma

Has not been fully confirmed

64
Q

Seal finger does not respond to the _____ antibiotics frequently prescribed presumptively for cellulitis caused by Staphylococcus, Streptococcus, or Erysipelothrix

A

Beta-lactam

65
Q

Treatment of choice for seal finger

A

Tetracyclines

66
Q

Worldwide
In neonates, generalized petechiae, papules, and pustules
In neonates, infected mother with transfer in utero or shortly after birth

A

Listeriosis

67
Q

Listeria monocytogenes is found widely in

A

Soil, water, vegetation, and the gut flora of humans and other animals

68
Q

Exposure to Listeria monocytogenes occurs through

A

Fecal-oral contamination

69
Q

Human listeriosis is most common in

A

Pregnant women
Neonates
Patients with AIDS
Foodborne outbreaks

70
Q

Approximately _____% of humans are fecal carriers of Listeria

A

5

71
Q

Highest incidence of human listeriosis is seen among

A

Infants in the perinatal period

72
Q

Generally ineffective for listeriosis

A

Cephalosporins

73
Q

Treatment for listeriosis

A

IV amplicillin (or penicillin)

Penicillin-allergic: cotrimoxazole or erythromycin

74
Q

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

A

Vibrio vulfinicus infection

75
Q

V. vulfinicus clinical syndromes

A

Gastroenteritis
Primary sepsis
Primary wound infection

76
Q

Antibiotics of choice for V. vulfinicus infection

A

Combination of doxycycline and ceftazidime

77
Q

Some authors consider a course of prophylactic _____ for an immunocompromised person with a high-risk exposure

A

Oral doxycycline

78
Q

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

A

Aeromonas hydrophila

79
Q

Increasing number of soft-tissue infections caused by Aeromonas hydrophila are associated with the medical use of

A

Leeches (Hirudo medicinalis)

80
Q

A. hydrophila produces beta-lactamase and is resistant to

A

First-generation penicillins

Cephalosporins

81
Q

Treatment for Aeromonas hydrophila infection

A

Third-generation cephalosporins
Fluoroquinolones
Aminoglycosides (but not streptomycin)

82
Q 
Wet tropical areas, especially Southeast Asia and Northern Australia
Indolent abscesses; suppurative parotitis (in children)
Wet soil (classically rice paddies), flooded regions
A

Melioidosis

83
Q

Etiologic agent: Melioidosis

A

Burkholderia pseudomallei (formerly Pseudomonas pseudomallei)

84
Q

Peak incidence of melioidosis during

A

Rainy monsoon seasons

85
Q

Principal clinical presentations of melioidosis

A

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
Q

Most commonly used test in Southeast Asia for melioidosis because it is simple to perform and cheap

A

Indirect hemagglutination assay

87
Q

Treatment for melioidosis

A

IV antibiotics (usually ceftazidime and carbapenem) followed by several months of high-dose oral therapy with trimethoprim-sulfamethoxazole or amoxicillin-clavulanic acid

88
Q

Worldwide
Tender violaceous plaque on hand at site of injury
Contaminated fish, shellfish, poultry, meat, and animal products

A

Erysipeloid

89
Q

Etiologic agent: Erysipeloid

A

Erysipelothrix rhusiopathiae

90
Q

Clinical forms of erysipeloid

A

Local nonsuppurative cutaneous infection (erysipeloid of Rosenbach)
Diffuse chronic cutaneous form
Subacute bacterial endocarditis, particularly of the aortic valve
Bacteremic form without endocarditis

91
Q

Y/N: Erysipeloid often involves the web spaces but spares the terminal phalanges and does not progress beyond the wrist

A

Yes

92
Q

Treatment of choice for erysipeloid

A

High-dose penicillin or ampicillin

Cannot take penicillins: third-generation cephalosporins

93
Q

Worldwide, especially freshwater fish farms
Rapid onset of hand cellulitis following a puncture wound
Contaminated farm-raised fish

A

Streptococcus iniae

94
Q

In dolphins, S. iniae causes slow-growing nodular abscesses of the skin and subcutaneous tissues, giving it the vernacular name

A

“Golf ball disease”

95
Q

Most cases of erysipeloid have been reported in _____, where the practice of buying live fish for home preparation is common

A

China and in Asian communities in North America, particularly Toronto

96
Q

Most people who develop S. iniae infection are

A

Elderly individuals of Asian descent

97
Q

Treatment of choice for S. iniae infection

A

Penicillin

98
Q

Other treatments for S. iniae infection

A

Cephalosporins
Macrolides
Quinolones
Vancomycin

99
Q

S. iniae infection is resitant to

A

Tetracyclines

100
Q

Worldwide, especially the tropics
Papules, petechiae, jaundice
Contaminated freshwater, moist soil, or animal urine

A

Leptospirosis

102
Q

Etiologic agent: Leptospirosis

A

Leptospira interrogans

103
Q

Worldwide where immunization is not practiced
Pustule or superinfected abrasion, evolving to an ulcer with gray membrane at base
Asymptomatic human carriers

A

Diphtheria

103
Q

Etiologic agent: Diphtheria

A

Corynebacterium diphtheriae

104
Q

Most important reservoirs of Leptospira interrogans

A

Rodents

105
Q

Y/N: Infected humans can also serve as transient reservoirs of Leptospira interrogans. Reservoir animals excrete leptospires in their urine

A

Yes

106
Q

Leptospiroris is most prevalent among

A

Children who play or swim in contaminated water

Adults with occupational exposure

107
Q

Y/N: Most human leptospirosis infections are asymptomatic, self-limited, and detectable only on serologic surveys

A

Yes

108
Q

Clinical forms of leptospirosis

A

Mild anicteric form that resolves without complications

Severe, icteric form (Weil disease)

109
Q

Phases of leptospirosis

A

Acute bacteremic phase

Delayed immune or convalescent phase

110
Q

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

A

Pretibial fever of Fort Bragg fever

111
Q

Direct isolation of leptospires is possible from the _____ during the acute phase or from _____ during the convalescent pahse

A

Blood or CSF

Urine

112
Q

Effective and can be taken prophylactically for short-term exposure in a hyperendemic area for leptospirosis

A

Doxycycline 200 mg once weekly

113
Q

90% of acute febrile illness caused by Corynebacterium diphtheriae affects the

A

Pharynx and mucous membranes of the upper respiratory tract

114
Q

Only natural host of Corynebacterium diphtheriae

A

Humans

115
Q

Routine childhood immunization for diphtheria is directed againts

A

Diphtheria’s exotoxin, not the bacteria itself

116
Q

Types of skin involvement in diphtheria

A

Primary cutaneous diphtheria

Wound diphtheria

117
Q

Type of diphtheria that accounts for almost all cases of cutaneous diphtheria reported in the US

A

Wound diphtheria

118
Q

Most important other manifestations of diptheria are the toxin’s effects on

A

Heart

Nerves

119
Q

Antibiotic of choice for cutaneous diphtheria

A

High-dose IV penicillin

Unable to take penicillin: erythromycin

120
Q

Pharyngeal cultures for diphtheria should be repeated _____ after completing treatment

A

2 weeks

121
Q

Adults should receive a dose of tetanus and diphtheria toxoid every

A

10 years

122
Q

Antibiotic prophylaxis for diphtheria

A

Oral erythromcyin

Penicillin

123
Q

Corynebacterium ulcerans is a common organism in

A

Cattle

124
Q

_____ disease is most common in Corynebacterium ulcerans infection

A

Pharyneal

125
Q

Corynebacterium _____, which causes lymphadenitis in ruminants, occasionally causes a similar necrotizing lymphadenitis in humans

A

pseudotuberculosis

126
Q

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

A

Rhodococcus equi

Fitz 9th (108 decks)

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