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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
TB + pulmonary symptoms tests
Sputum culture or PCR
26
Skin and soft tissue infection test
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
27
Urine sample - infection markers
WBC, RBC, epithelial cells - cultures and specificity Kass criteria for significant bacteruria
28
Infectious diarrhea tests?
Stool sample - give history so lab can ID viral, bacterial or parasitic cause Parasite suspected = 3 samples
29
H.Pylori tests = 4 - stop PPIs before testing
Antibody testing - Antigen stool testing - inexpensive Urea breath test = gold standard Biopsy of colon + urease test
30
Test of Cholangitis (5)
Bloods, blood cultures, CT, aspiration cultures
31
Endocarditis bloods - special condition Other? (2)
3 blood samples at different times of the day Electrocardiogram Seology for rare and fastidious bacteria PCR for valve replacements
32
Hepatitis and syphilis tests
PCR and serology
33
Antibodies signify (serology)
Infected currently (igM) or ever previously infected (IgG)
34
Antigens signify (serology)
current infections (but negative result can mean infection is still present)
35
PCR detects
RNA and DNA of living or dead parts of pathogen - signifies current infection
36
Hep A serology
Feacal Antigen - HAV IG - anti-HAV
37
Hep C Serology
Antibody remains life long in chronic disease and carriers | Negative = cleared infection
38
Hep B serology
``` Antigen = chronic or acute infection Ig = long term chronic ```
39
What can help you determine what organism most likely caused the infection? (4)
body site Immunological status microbiology history risk factors
40
Aspects of pharmokinetics to consider when prescribing anti-microbials
distribution interactions adverse effects
41
Gram negative means
Bacterial have two cell walls
42
Eukaryotes DNA is?
separate from the cytoplasm eg. in a nucleus
43
Antibiotics VS antimicrobial agents
AntiB = chemicals produced by microbes (usually fungi) to kill other microbes Antimicrobial agents = AntiBs, antifungals, Anti-virals - synthetic
44
different aspects of antimicrobial agents (4)
Activity Spectrum toxicity Pharmcological properties
45
Static (Eg. bacteriostatic)
Prevent protein synthesis/ growth of pathogen --> allows immune system to kill it
46
cidal (eg. bacteriocidal)
Kills the cells (eg. cell wall lysis)
47
Minimum inhibitory concentation (MIC)
min conc of antimicrobial where visible growth is inhibited
48
Minimum bacteriocidal concentration (MBC)
min conc of antimicrobial where most of the organism are killed (in human depends on about available at site)
49
Low MIC
<01.mg/L = Sensitive organism
50
Synergism for antimicrobials
Activity of two together is greater then the effect of one
51
antagonism for antimicrobials
one agent diminishes the effect of another
52
Indifference for antimicrobials
neither agents have an affect on the other
53
Antimicrobial spectrum -what? ``` Broad = what kind of treatment Narrow = what kind of treatment ```
range of pathogen sensitive to an antimicrobial agent (AMA) Broad = kills most - empirical therapy Narrow = kills a specific few - targeted therapy
54
Peptidoglycan
Compontent of cells walls that are a target for antibiotics
55
Synthesis Inhibitory agents
B-lactams and glycopeptides
56
Types of B-lactams
Penicillin Cephalorsporins Carbapenems Monobactams
57
Effect of B-lactams
interfere with transpeptidases that crosslink peptidolycan = cell wall lysis
58
Names of Penicillins (3)? Spectrum?
amoxicillin, benzylpenicillin, flucloxacillin - narrow spectrum
59
Names cephalorsporins (2) ? spectrum?
Cefuroxime and ceftazidime - broad spectrum
60
names some carbapenems (2) spectrum?
meropenem, imipenem - EXTREMELY broad spectrum
61
Names some monbactams (give for those allergic to penicillin) - spectrum?
aztreonam - gram negative only
62
B-lactamas enzymes
hydrolyses penicillin - made/released by resistant bacterial
63
B-lactam/B-lactamase inhibitor combinations (BLBLI) examples (1) - spectrum
B-lactam with B-lactamase inhibitors - broadens the spectrum (C diff risk) Amocixillin -clavulunate (Augementin)
64
Examples of glucopeptide (2) - spectrum
Vancomycin, teicoplanin = broad spectrum gram positive
65
Echinocandins (3) --> effect
andiulafungin, caspofungin, micafungin. | Inhibit 3-glucan synthase = deformed cell walls
66
Protein synthesis inhibitors (4)
Aminoglycosides Macrolides, Tetracycline Oxazolidinones
67
Examples of Aminoglycosides (2) which subunit?
Gentomicin, amikacin | Bind to 30s subunit
68
Examples of Macrolides, (3) which subunit?
Erythromycin, clarithromycin and clindamycin | Bind to 50s subunit
69
Tretracylcina or doxycyline
bind to 30s subunit
70
DNA synthesis inhibition antimicrobials (4)
Trimethoprin Sulfonides Co-trimoxazole Quinolones and Fluroquinolones
71
Examples of Sulfonides (3)
Sulfamethoxazole Sulfadiazines sulfametho + trimethoprin
72
Examples of Quinolones and fluroquinolones (3)
Nalidixic acid ciprofloaxacin levofloaxacin
73
RNA synthesis inhibitors antimicrobials - use?
Rifampicin - treat TB
74
Cell membrane inhibitors antimicrobials (2) + spectrum
Colistin - gram negative | Daptomycin - gran positive
75
Antifungals (4)
Azoles Terbinafines amphotericin B and nystatin Echinocandins
76
Examples of azoles (2) and use?
Clotrimazole and fluconazole - to treat vaginal thrush
77
Innate factors (interactions between the antimicrobial and pathogen) of resistance (3)
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
Acquired resistance - how?
acquisition of the gene that codes of the resistance mechanism by: New mutation OR transfer
79
Types of Acquired resistance (2) + examples
Target modification - MRSA alters penicillin binding protein so no B-lactams can bind Antibiotic modified by enzymes - B-lactamases
80
Methods of Horizontal 'Resistance' transfer (3) and how?
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
What is a transposon?
A mobile segment of DNA that can pick up a resistant gene and insert it in the plasmid or chromosome
82
Vertical transfer of resistance?
chromosomal or plasmid bourne resistance transfer from mother to daughter cell in bacterial division
83
``` Examples of resistance bacteria (4) MRSA VRE or GRE ESBL MDR-TB ```
MRSA - methicillin-resistant staphylococcus aureus Vancomycin or glycopeptide resistant enterococci Extended spectrum B-lactases producting enterobacteria Multi-drug resistant TB
84
Empirical Therapy
1st line OR traditional therapy - given based on the most like organism. Usually broad spectrum. Whilst waiting results of sensitivity test
85
Targeted therapy
2nd line - following sensitivity test, more specific. | Usually more expensive and toxic.
86
Uses for sensitivity testing for resistant strands (2)
Informing treatment | Epidemiology and surveillance data
87
3 uses of antivirals
Acute viral infections in the community = Herpes simplex, chickenpox in children, singles in elderly Chronic injections - HIV and Hep Immunosupressed
88
Polymerases? | Polymerase inhibitors?
Enzymes involved in DNA replication in all cell | Types of Antivirals - targeted to specific viruses polymerases
89
Nucleoside Reverse Transcriptase inhibitors (NRTI) mode of action?
Analogue of nucleic acids that interfere with the reverse transcription in retroviruses
90
Examples of NRTI for HIV + that type of analogue (5) Not Purine = adenosine and Guanosine
``` Azidothymidine (AZT) - thymidine Zidovudine - thymidine Laminvidine - cytosine Abacavir - Purine Tenofovir - purine ```
91
Examples of NRTI for HepB
Lamividine - cytosine | and Tenofovir - purine
92
Hepresvirus polyermase inhibitors - examples? method? What viruses? (2)
Aciclovir - nucleoside analogue chain terminator - Herpes simplex and Varicella Zoster Ganciclovir - Broad spectrum BUT toxic - Herpes simples, VZV and Cytomeglovirus, HHV
93
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
Interferons - natural innate immune response + indigenous Sofosbuvir - cytosine analogue
94
Non nucleotide reverse transcriptase inhibitors (HIV treatment) Bind at a different site
Efavirens | Nevirapine
95
Protease inhibitors - mode of action?
Virus make proteins using the host cells ribosomes. Proteins for replication and infectivity = sites for antivirals
96
HIV protease inhibitors (booster for HAART treatment) (3)
Atazanavir Darunavir Ritoanvir
97
Hep C protease inhibitors (2)
Paritaprevir | grazoprevir
98
Neuraminidase inhibitors for influenza A and B
oseltamivir | zanamavir
99
Ribavirin - used to treat?
Respiratory synctical virus Hep C Hep E
100
HIV drugs types (method of action)
``` Nucleoside reverse transcripitase inhibitors - NRTI non-nucleoside RTI, protease inhibitors - PI Enter inhibitors integrase inhibitors ```
101
HAART?
highly active Antiretroviral therapy
102
HAART - drugs involved
2NTRI and one NNTRI OR 2 NTRIs with booster PI (given when CD4 starts to fall)
103
HAART = affect
>10 years adequate suppression
104
Enter inhibitors (2) mode of action - HIV treatment T20 CCR5
Enfuviritide or T20 - given by IV injection prevents fusion Maracviroc - CCR5 chemokine receptor antagonist
105
Intergrase?
Enzyme that inserts Viral DNA into the host genome
106
Intergrase inhibitors ? - retrovirus inhibitors
Raltegravir | Dolutegravir
107
Futures of HIV treatment
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
``` Treatments for Gram Positive Bacteria Staph and strep Enteroccoci Cornyebactera Clostridia ```
``` Vancomycin Teicoplanin Gentaycin Benzylpenicillin Flucloxacillin ```
109
Gram Positive Staph and Step usually found in what infection locations? (4) + specific pathogens?
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
Gram Positive bacteria are resistant to? (2)
Cephalosporins | Metronidazole
111
Clostridia - site of infection?
Gangrenous wounds | Intra-abdominal
112
Gram Negative Colliforms examples (4)
E.coli Klebsiella eneterobactor salmonella
113
Treatments for Gram negative coliforms (5)
``` Gentamicin cephalosporins ciprofloxacin Tazocin Trimethroprim ```
114
Gram negative Coliforms are resistant to?
Amoxillicin
115
Sites of infections for Colifoms (6)
``` GI UTI Ventilator acquired pneumonia wound infection Billiary tract septiceamia ```
116
Gram Negative Psuedonomas SPP treatment (3)
Aminoglycoside - Gentamicin ciprofloxacin Taxocin
117
Gram Negative Bacteroids (anaerobes) treatments? (4)
Metronidazole Co-amoxiclav tazocin clindamycin
118
Gram Negative Psuedonomas sites of infection? (5)
``` Chronic leg ulcers Bronchiectasis catheters septicemia Pneumonia ```
119
Gram Negative Anaerobes site of infection ?
GI | Soft tissue
120
Pseudonomas are resistant to?
Most other antiBs
121
Gram negative Anaerobes are resistant to? (6)
``` Benzlpenicilin amoxicillin cefuroxime gentamicin quinolones Macrolides (erythromycin) ```
122
Site of infections for Gram Negative Cocci Heamophilus influenza M. Catarrhalis
Sinusitis Community Pneumonia Meningitis
123
AntiBs that impair kidneys function (avoid in AKI and CKI patient) - NOTE: groups of AntiBs (5)
``` Gentamicin Penicillins cephalosporins sulfonamides Vancomycin ```
124
C diff Risk antibiotics (broad spectrum) (5)
``` cefuroxime cephalosporins pipercillin-tazobactam cephalosporins quinolones ```
125
Penicillin G? | Penicillin V?
``` G = Benzylpenicilin V = phenoxymethylpenicillin ```
126
Oral and IV AnitBs? (6)
``` Flucoxillin Amoxicillin Clindamycin Ciprofloxacin Metonidazole (anti-parasitic) Cefuroxime Eyrthromycin ```
127
When can vancomicin be giving orally?
For C-diff as it wont be absorbed in the gut so remains to treat the infection
128
Only IV AntiBiotics? (5)
``` Penicillin G Ampicillin Vancromycin teicoplanin Gentamicin Clarithromycin ```
129
IM Antibiotic (3)
Gentamicin Erythromycin Pen G
130
Broad Spectrum B-lactams? - which part is the B-lactamase inhibitor?
Co-amoxiclav - Clavulanuc acid | Tazocin - Tazobactam
131
Narrow Spectrum B-lactams | Includes Stept, anaerobes, Gram Negative cocci - N. Meningitis
Pen G and Pen V Flucoxicillin Amoxicillin
132
Marcolides in ascending order of size of spectrum?
erythromycin, clarithyromycin and Azithromycin
133
Synergistic agent with B-lactams? for Strep
Gentamicin
134
Gram negative and Gram positive Bacteria killing Floroquinones?
``` Neg = ciprofloxacin Pos = levofloxacin ```
135
``` What treats atypical infections (pneumonia)? + examples eg. by: Chlamydia Mycoplasma legionella Coagulase negative Staph ```
Marolides eg Erythromycin Fluoroquinones eg. Ciprofloxacin Vancomycin
136
Line infection (eg. Catheter) most likely cause?
Coagulase negative Staph
137
Coagulase negative staph Treatment? Resistant to?
Treat = gentamicin or Vancomycin | Resistant to = flucloxacillin and methicilin
138
Treatment for Community acquired pneumonia?
Co-amoxiclav
139
Sepsis
Presence of infection with systemic manifestations
140
Septic shock
hypotension persists despite fluid resus
141
Severe sepsis
sepsis induced hypoprofusion or organ dysfunction
142
BUFALO = 3 things to take, 3 things to give
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
Precursor of Calcitonin and is raised in blood in systemic bacterial infections
Procalcitonin
144
Serum Lactate
Marker for sepsis

Year 2: Clinical Pathology (10 decks)

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