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Year 2: Clinical Pathology > Advanced Microbiology - Tests and Treatments > Flashcards

Advanced Microbiology - Tests and Treatments Flashcards

1
Q

Specific symptoms for infection

Resp, CNS, skin and soft tissue, urogenital

A 
Resp = cough
CNS = neck stiffness
SST = redness and swelling
URO = dysuria
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2
Q

Non specific infections symptoms (6)

A 
Temp >38
night sweats and chills
Fever
Rigor/ shaking
confusion
dehydration
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3
Q

Infection signs in a Full blood count (FBC) (2)
Chronic?
Acute? - Bacterial = ? and Viral = ?

A

Hb - haemoglobin drop due to aneamia in chronic disease

WCC - white cell count = elevated in infection BUT drop in sepsis
Neutrophils = bacterial
Lymphocytes = viral

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4
Q

Inflammatory markers in serum samples + levels (2)

A

C reactive protein <5 mg/l

Procalcitonin <0.5 um/l

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5
Q

Chest Xray - use?

A

Respiratory infections

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6
Q

Blood lactate and gasses use?

A

used to monitor severe sepsis

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7
Q

How do HCP identify the pathogen (4)

A

Use history = most common cause
Culture - ID, typing and sensitivity to antiBs
Direct detection - whole organisms or part of (antigens or DNA) by microscopy + staining
Immunological tests - Body’s immune response so indirect (antibodies)

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8
Q

Culturing process (3)

A

Obtain (aseptic), incubate - growth detection

Gram staining and Morphology (cocci, bacilli, chains or groups) under light microscope

Agar plate incubation for sensitivity testing (don’t grow around AntiB it is sensitive to) = which AntiB + dose.

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9
Q

MALDI-TOF MS

A

Rapid technique to ID pathogen

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10
Q

Direct detection Vs Culturing

A 
DD is:
Quicker + less labour intensive
All organism (culture and non culturable)

Culturing - sensitivity testing allows targeted therapy to be applied

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11
Q

Direct Detection examples - for what organisms, type of samples? CSF, sputum and blood

A

PCR
Viral = Influenza
Bacterial = Strept pneumoniae
Fungal = Candida spp and aspergillus spp

CSF, sputum and blood

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12
Q

Seroconversion (Part of immunological test)

A

Change from negative to positive antibodies

ONLY possible if two samples are taken from same patient: acute (during infection) and convalescent (after)

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13
Q

Retesting for infection?

A

Only if symptoms change

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14
Q

Local vs general infection testing

A 
Local = sample/ swab from the affect area
General = bloods and blood cultures for sepsis
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15
Q

Meningitis tests

A

Lumbar puncture an cultures CSF
Bloods - cultures
In immunosupressed = PCR for TB

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16
Q

Lumbar puncture results - variation in opening pressure normal = 5-20 cm of H2O (viral, bacterial and fungal or V, B, F)

A

viral - normal
Bacterial - Increase
Fungal - Variable

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17
Q

Lumbar puncture results - Appearance (normally clear) VBF?

A 
Viral = clear
Bacterial = turbid
Fungal = variable
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18
Q

Lumbar puncture results - WBC count (normally <3 x10^6/l)

A 
Viral = <1000
bacterial = >500
Fungal = variable
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19
Q

Lumbar puncture results - Protein (normally 0.2 - 0.5 g/l)

A 
Viral = <1 
Bacterial = >1
Fungal = <0.5
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20
Q

Lumbar puncture results - Glucose ratio CSF: Blood (normally 0.6)

A 
Viral = more in CSF >0.6
Bacterial = less in CSF <0.4
Fungal = less in CSF <0.4
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21
Q

Encephalitis tests

A

CSF + viral PCR

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22
Q

ENT infection tests - for specific conditions

A

Otitis Media = swab pus if perforated eardrum
Otitis Externa = swab ear canal

NOTE: mixed with normal skin flora

Pharyngitits = throat swab

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23
Q

Respiratory tract infection tests:

A

Nose and throat swabs - influenza for those vulnerable, or at risk of transmission

CURP test for pneumonia
high = sputum and blood culture

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24
Q

TB vaccination screening tests

A

Mantoux skin test

IGRA - iterferon G releasing assay (blood)

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25
Q

TB + pulmonary symptoms tests

A

Sputum culture or PCR

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26
Q

Skin and soft tissue infection test

A

Wound swabs - impertigo, cellulitis, erysipelas and diabetic foot IF skin is broken and signs of infection

Clean margin sample - post surgery/ amputation in Necrotising fascitis and diabetic foot

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27
Q

Urine sample - infection markers

A

WBC, RBC, epithelial cells - cultures and specificity

Kass criteria for significant bacteruria

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28
Q

Infectious diarrhea tests?

A

Stool sample - give history so lab can ID viral, bacterial or parasitic cause

Parasite suspected = 3 samples

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29
Q

H.Pylori tests = 4 - stop PPIs before testing

A

Antibody testing -
Antigen stool testing - inexpensive
Urea breath test = gold standard
Biopsy of colon + urease test

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30
Q

Test of Cholangitis (5)

A

Bloods, blood cultures, CT, aspiration cultures

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31
Q

Endocarditis
bloods - special condition
Other? (2)

A

3 blood samples at different times of the day
Electrocardiogram
Seology for rare and fastidious bacteria
PCR for valve replacements

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32
Q

Hepatitis and syphilis tests

A

PCR and serology

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33
Q

Antibodies signify (serology)

A

Infected currently (igM) or ever previously infected (IgG)

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34
Q

Antigens signify (serology)

A

current infections (but negative result can mean infection is still present)

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35
Q

PCR detects

A

RNA and DNA of living or dead parts of pathogen - signifies current infection

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36
Q

Hep A serology

A

Feacal
Antigen - HAV
IG - anti-HAV

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37
Q

Hep C Serology

A

Antibody remains life long in chronic disease and carriers

Negative = cleared infection

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38
Q

Hep B serology

A 
Antigen = chronic or acute infection
Ig = long term chronic
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39
Q

What can help you determine what organism most likely caused the infection? (4)

A

body site
Immunological status
microbiology history
risk factors

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40
Q

Aspects of pharmokinetics to consider when prescribing anti-microbials

A

distribution
interactions
adverse effects

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41
Q

Gram negative means

A

Bacterial have two cell walls

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42
Q

Eukaryotes DNA is?

A

separate from the cytoplasm eg. in a nucleus

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43
Q

Antibiotics VS antimicrobial agents

A

AntiB = chemicals produced by microbes (usually fungi) to kill other microbes

Antimicrobial agents = AntiBs, antifungals, Anti-virals - synthetic

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44
Q

different aspects of antimicrobial agents (4)

A

Activity
Spectrum
toxicity
Pharmcological properties

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45
Q

Static (Eg. bacteriostatic)

A

Prevent protein synthesis/ growth of pathogen –> allows immune system to kill it

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46
Q

cidal (eg. bacteriocidal)

A

Kills the cells (eg. cell wall lysis)

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47
Q

Minimum inhibitory concentation (MIC)

A

min conc of antimicrobial where visible growth is inhibited

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48
Q

Minimum bacteriocidal concentration (MBC)

A

min conc of antimicrobial where most of the organism are killed (in human depends on about available at site)

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49
Q

Low MIC

A

<01.mg/L = Sensitive organism

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50
Q

Synergism for antimicrobials

A

Activity of two together is greater then the effect of one

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51
Q

antagonism for antimicrobials

A

one agent diminishes the effect of another

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52
Q

Indifference for antimicrobials

A

neither agents have an affect on the other

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53
Q

Antimicrobial spectrum -what?

Broad = what kind of treatment
Narrow = what kind of treatment
A

range of pathogen sensitive to an antimicrobial agent (AMA)
Broad = kills most - empirical therapy
Narrow = kills a specific few - targeted therapy

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54
Q

Peptidoglycan

A

Compontent of cells walls that are a target for antibiotics

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55
Q

Synthesis Inhibitory agents

A

B-lactams and glycopeptides

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56
Q

Types of B-lactams

A

Penicillin
Cephalorsporins
Carbapenems
Monobactams

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57
Q

Effect of B-lactams

A

interfere with transpeptidases that crosslink peptidolycan = cell wall lysis

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58
Q

Names of Penicillins (3)? Spectrum?

A

amoxicillin, benzylpenicillin, flucloxacillin - narrow spectrum

59
Q

Names cephalorsporins (2) ? spectrum?

A

Cefuroxime and ceftazidime - broad spectrum

60
Q

names some carbapenems (2) spectrum?

A

meropenem, imipenem - EXTREMELY broad spectrum

61
Q

Names some monbactams (give for those allergic to penicillin) - spectrum?

A

aztreonam - gram negative only

62
Q

B-lactamas enzymes

A

hydrolyses penicillin - made/released by resistant bacterial

63
Q

B-lactam/B-lactamase inhibitor combinations (BLBLI) examples (1) - spectrum

A

B-lactam with B-lactamase inhibitors - broadens the spectrum (C diff risk)
Amocixillin -clavulunate (Augementin)

64
Q

Examples of glucopeptide (2) - spectrum

A

Vancomycin, teicoplanin = broad spectrum gram positive

65
Q

Echinocandins (3) –> effect

A

andiulafungin, caspofungin, micafungin.

Inhibit 3-glucan synthase = deformed cell walls

66
Q

Protein synthesis inhibitors (4)

A

Aminoglycosides
Macrolides,
Tetracycline
Oxazolidinones

67
Q

Examples of Aminoglycosides (2) which subunit?

A

Gentomicin, amikacin

Bind to 30s subunit

68
Q

Examples of Macrolides, (3) which subunit?

A

Erythromycin, clarithromycin and clindamycin

Bind to 50s subunit

69
Q

Tretracylcina or doxycyline

A

bind to 30s subunit

70
Q

DNA synthesis inhibition antimicrobials (4)

A

Trimethoprin
Sulfonides
Co-trimoxazole
Quinolones and Fluroquinolones

71
Q

Examples of Sulfonides (3)

A

Sulfamethoxazole
Sulfadiazines
sulfametho + trimethoprin

72
Q

Examples of Quinolones and fluroquinolones (3)

A

Nalidixic acid
ciprofloaxacin
levofloaxacin

73
Q

RNA synthesis inhibitors antimicrobials - use?

A

Rifampicin - treat TB

74
Q

Cell membrane inhibitors antimicrobials (2) + spectrum

A

Colistin - gram negative

Daptomycin - gran positive

75
Q

Antifungals (4)

A

Azoles
Terbinafines
amphotericin B and nystatin
Echinocandins

76
Q

Examples of azoles (2) and use?

A

Clotrimazole and fluconazole - to treat vaginal thrush

77
Q

Innate factors (interactions between the antimicrobial and pathogen) of resistance (3)

A

Absent target - eg. antifungal used against bacteria
Decreased permeability of cell wall - eg. antimicrobial cant enter the cell
Drug Efflux - active transport of antimicrobial into cells

78
Q

Acquired resistance - how?

A

acquisition of the gene that codes of the resistance mechanism by:
New mutation OR transfer

79
Q

Types of Acquired resistance (2) + examples

A

Target modification - MRSA alters penicillin binding protein so no B-lactams can bind

Antibiotic modified by enzymes - B-lactamases

80
Q

Methods of Horizontal ‘Resistance’ transfer (3) and how?

A

Conjunction - single gene on plasmid vis pilus
Trasnduction - virus moves DNA from one bacteria to another
Transformation - Introduction + uptake of foreign genetic material = expressed

81
Q

What is a transposon?

A

A mobile segment of DNA that can pick up a resistant gene and insert it in the plasmid or chromosome

82
Q

Vertical transfer of resistance?

A

chromosomal or plasmid bourne resistance transfer from mother to daughter cell in bacterial division

83
Q 
Examples of resistance bacteria (4)
MRSA
VRE or GRE
ESBL 
MDR-TB
A

MRSA - methicillin-resistant staphylococcus aureus
Vancomycin or glycopeptide resistant enterococci
Extended spectrum B-lactases producting enterobacteria
Multi-drug resistant TB

84
Q

Empirical Therapy

A

1st line OR traditional therapy - given based on the most like organism. Usually broad spectrum. Whilst waiting results of sensitivity test

85
Q

Targeted therapy

A

2nd line - following sensitivity test, more specific.

Usually more expensive and toxic.

86
Q

Uses for sensitivity testing for resistant strands (2)

A

Informing treatment

Epidemiology and surveillance data

87
Q

3 uses of antivirals

A

Acute viral infections in the community = Herpes simplex, chickenpox in children, singles in elderly
Chronic injections - HIV and Hep
Immunosupressed

88
Q

Polymerases?

Polymerase inhibitors?

A

Enzymes involved in DNA replication in all cell

Types of Antivirals - targeted to specific viruses polymerases

89
Q

Nucleoside Reverse Transcriptase inhibitors (NRTI) mode of action?

A

Analogue of nucleic acids that interfere with the reverse transcription in retroviruses

90
Q

Examples of NRTI for HIV + that type of analogue (5)

Not Purine = adenosine and Guanosine

A 
Azidothymidine (AZT) - thymidine
Zidovudine - thymidine
Laminvidine - cytosine
Abacavir - Purine 
Tenofovir - purine
91
Q

Examples of NRTI for HepB

A

Lamividine - cytosine

and Tenofovir - purine

92
Q

Hepresvirus polyermase inhibitors - examples? method? What viruses? (2)

A

Aciclovir - nucleoside analogue chain terminator - Herpes simplex and Varicella Zoster

Ganciclovir - Broad spectrum BUT toxic - Herpes simples, VZV and Cytomeglovirus, HHV

93
Q

Hep C RNA polyermase inhibitors (2) Example? method?

NOTE Hep C is curable so long as the virus is kept at bay enough for the immune system to fight it

A

Interferons - natural innate immune response + indigenous

Sofosbuvir - cytosine analogue

94
Q

Non nucleotide reverse transcriptase inhibitors (HIV treatment)

Bind at a different site

A

Efavirens

Nevirapine

95
Q

Protease inhibitors - mode of action?

A

Virus make proteins using the host cells ribosomes. Proteins for replication and infectivity = sites for antivirals

96
Q

HIV protease inhibitors (booster for HAART treatment) (3)

A

Atazanavir
Darunavir
Ritoanvir

97
Q

Hep C protease inhibitors (2)

A

Paritaprevir

grazoprevir

98
Q

Neuraminidase inhibitors for influenza A and B

A

oseltamivir

zanamavir

99
Q

Ribavirin - used to treat?

A

Respiratory synctical virus
Hep C
Hep E

100
Q

HIV drugs types (method of action)

A 
Nucleoside reverse transcripitase inhibitors - NRTI 
non-nucleoside RTI, 
protease inhibitors - PI 
Enter inhibitors 
integrase inhibitors
101
Q

HAART?

A

highly active Antiretroviral therapy

102
Q

HAART - drugs involved

A

2NTRI and one NNTRI
OR
2 NTRIs with booster PI (given when CD4 starts to fall)

103
Q

HAART = affect

A

> 10 years adequate suppression

104
Q

Enter inhibitors (2) mode of action - HIV treatment
T20
CCR5

A

Enfuviritide or T20 - given by IV injection prevents fusion

Maracviroc - CCR5 chemokine receptor antagonist

105
Q

Intergrase?

A

Enzyme that inserts Viral DNA into the host genome

106
Q

Intergrase inhibitors ? - retrovirus inhibitors

A

Raltegravir

Dolutegravir

107
Q

Futures of HIV treatment

A

CCR5 delta 32/ delta 32 stem cell transplant

Stem cells with Human luekocyte antibodies have CCR5 delta 32 receptors that don’t allow the entry of HIV

108
Q 
Treatments for Gram Positive Bacteria
Staph and strep
Enteroccoci 
Cornyebactera
Clostridia
A 
Vancomycin
Teicoplanin
Gentaycin
Benzylpenicillin
Flucloxacillin
109
Q

Gram Positive Staph and Step usually found in what infection locations? (4) + specific pathogens?

A

Skin and Soft Tissues (SST) - wounds - Beta Heamolytic and Group A Strep, S. aureus
Sore throat = Group A strep
Pneumonia - LRTI. Community S. Pneumoniae VS Hospital S. aureus
Meningitis CNS - S. Pneumoniae
Blood stream - septiceamia

110
Q

Gram Positive bacteria are resistant to? (2)

A

Cephalosporins

Metronidazole

111
Q

Clostridia - site of infection?

A

Gangrenous wounds

Intra-abdominal

112
Q

Gram Negative Colliforms examples (4)

A

E.coli
Klebsiella
eneterobactor
salmonella

113
Q

Treatments for Gram negative coliforms (5)

A 
Gentamicin
cephalosporins
ciprofloxacin
Tazocin
Trimethroprim
114
Q

Gram negative Coliforms are resistant to?

A

Amoxillicin

115
Q

Sites of infections for Colifoms (6)

A 
GI 
UTI 
Ventilator acquired pneumonia
wound infection
Billiary tract
septiceamia
116
Q

Gram Negative Psuedonomas SPP treatment (3)

A

Aminoglycoside - Gentamicin
ciprofloxacin
Taxocin

117
Q

Gram Negative Bacteroids (anaerobes) treatments? (4)

A

Metronidazole
Co-amoxiclav
tazocin
clindamycin

118
Q

Gram Negative Psuedonomas sites of infection? (5)

A 
Chronic leg ulcers
Bronchiectasis
catheters 
septicemia
Pneumonia
119
Q

Gram Negative Anaerobes site of infection ?

A

GI

Soft tissue

120
Q

Pseudonomas are resistant to?

A

Most other antiBs

121
Q

Gram negative Anaerobes are resistant to? (6)

A 
Benzlpenicilin
amoxicillin
cefuroxime
gentamicin
quinolones
Macrolides (erythromycin)
122
Q

Site of infections for Gram Negative Cocci
Heamophilus influenza
M. Catarrhalis

A

Sinusitis
Community Pneumonia
Meningitis

123
Q

AntiBs that impair kidneys function (avoid in AKI and CKI patient) - NOTE: groups of AntiBs (5)

A 
Gentamicin
Penicillins
cephalosporins
sulfonamides
Vancomycin
124
Q

C diff Risk antibiotics (broad spectrum) (5)

A 
cefuroxime
cephalosporins 
pipercillin-tazobactam
cephalosporins 
quinolones
125
Q

Penicillin G?

Penicillin V?

A 
G = Benzylpenicilin
V = phenoxymethylpenicillin
126
Q

Oral and IV AnitBs? (6)

A 
Flucoxillin
Amoxicillin
Clindamycin
Ciprofloxacin 
Metonidazole (anti-parasitic)
Cefuroxime
Eyrthromycin
127
Q

When can vancomicin be giving orally?

A

For C-diff as it wont be absorbed in the gut so remains to treat the infection

128
Q

Only IV AntiBiotics? (5)

A 
Penicillin G
Ampicillin
Vancromycin 
teicoplanin 
Gentamicin 
Clarithromycin
129
Q

IM Antibiotic (3)

A

Gentamicin
Erythromycin
Pen G

130
Q

Broad Spectrum B-lactams? - which part is the B-lactamase inhibitor?

A

Co-amoxiclav - Clavulanuc acid

Tazocin - Tazobactam

131
Q

Narrow Spectrum B-lactams

Includes Stept, anaerobes, Gram Negative cocci - N. Meningitis

A

Pen G and Pen V
Flucoxicillin
Amoxicillin

132
Q

Marcolides in ascending order of size of spectrum?

A

erythromycin, clarithyromycin and Azithromycin

133
Q

Synergistic agent with B-lactams? for Strep

A

Gentamicin

134
Q

Gram negative and Gram positive Bacteria killing Floroquinones?

A 
Neg = ciprofloxacin 
Pos = levofloxacin
135
Q 
What treats atypical infections (pneumonia)? + examples
eg. by: 
Chlamydia
Mycoplasma
legionella 
Coagulase negative Staph
A

Marolides eg Erythromycin

Fluoroquinones eg. Ciprofloxacin

Vancomycin

136
Q

Line infection (eg. Catheter) most likely cause?

A

Coagulase negative Staph

137
Q

Coagulase negative staph
Treatment?
Resistant to?

A

Treat = gentamicin or Vancomycin

Resistant to = flucloxacillin and methicilin

138
Q

Treatment for Community acquired pneumonia?

A

Co-amoxiclav

139
Q

Sepsis

A

Presence of infection with systemic manifestations

140
Q

Septic shock

A

hypotension persists despite fluid resus

141
Q

Severe sepsis

A

sepsis induced hypoprofusion or organ dysfunction

142
Q

BUFALO = 3 things to take, 3 things to give

A

Blood cultures, urine output and serum lactate

O2 (15l/min) –> 92% sats,
Fluids (IV 500-1000 ml Hartman’s bolus) and
Antibiotics (broad spectrum within an hour)

143
Q

Precursor of Calcitonin and is raised in blood in systemic bacterial infections

A

Procalcitonin

144
Q

Serum Lactate

A

Marker for sepsis

Year 2: Clinical Pathology (10 decks)

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