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1
Q

pseudomonas manifestation in ear is called?

A

swimmer’s ear/otitis externa; gross, pus exudates; its just gross;

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1
Q

treatment for c. perfringens

A

penicillin works; use w/clindamycin (inhibits toxin synthesis)

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2
Q

coxiella

relavent species?

epidemiology?

A

C. burnetii is most relavent species

found in animal reservoirs; commonly seen in farmers, ranchers, vets

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2
Q

diagnosis of bordatella

A

culture on bordet-gengou or regan-lowe mediums

PCR, serology

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2
Q

where does pseudomonas hang out?

who gets these infecitons?

A

loves wet places/fluids!

its ubiquitious in community and hospital

poeple w/compomised host defenses, disturbed barriers(burns, catheters, etc), and CF pts

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3
Q

h. influenzae diseases(encapsulated and unencapsulated)

A

Hib - meningitis, conjuctivitis, cellulitis, epiglottitis, bacteremia, arthritis (ABCCME)

unencapsulated - otitis media, sinusitis, bronchitis, pneumonia (BOPS)

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4
Q

describe the microbiological characteristics of acinetobacter

A

GN coccobacillus

non-lactose fermenter; oxidase NEGATIVE

aerobic and non-motile

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5
Q

range of symptoms for **C. pneumoniae **infection

treatment?

A

common cold-like symptoms to atypical CA-pneumonia

infection is very common; virtually everyone is infected at one point in lifetime.

treat with doxycycline, erythromycin, quinolones(levofloxacin) at least 10 days

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5
Q

diseases caused by m. hominis, m. genitalium & u. urealyticum

A

recovered colonies in 70-80% of SAAs; usually act as normal flora

opportunistic STIs; usually infect w/other pathogens

u. urealyticum can cause NGU

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6
Q

Polymyxin B. Colistin clinical use

A

Serious resistant GN infections; inhaled resistant GN pneumonia

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6
Q

treatment for actinomyces

A

prolonged penicillin

surgical debridement

can use erythromycin, clindamycin too

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7
Q

name the virulence factors of coagulase negative staphylococci

A

slime layer(biofilm)

many same enzymes as s. aureus

NO TOXINS

antimicrobial resistance common

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7
Q

bordatella toxins/virulence factors

A
  1. pertussis toxin (PTX):
  • ADP-ribosyl transferase(Gi protein target)
  • causes lymphocytosis(systemic disease); bad prognosis
  • immunosuppressive when infecting, then causes inflamm later…bad

_ other toxins:_

a) adenylate cyclase toxin – targets and inactivates neutrophils
b) tracheal cytotoxin and **lipopolysaccharide - **combine to destroy cilia on epthelial cells

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8
Q

ampicilin. amoxicilin adverse effects

A

in addition to hypersensitivity�.GI distress is common; maculopapular rash if treating mono(100% of pts)

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8
Q

treatment for a pneumococcal meningitis

A

ceftriaxone and vancomycin

….macrolide if atypical

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8
Q

mycoplasma morphology

A

NO WALL….evolved from GP

TINY(0.3-1u)

pleimorphic–>weird shapes

‘fried egg colony’ - most types

‘mulberry colony’ m. pneumoniae

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9
Q

Vancomycin. activity

A

GP ONLY! MRSA activity; enterococci if susceptible; anaerobes

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9
Q

newborn pt presents with erythematous skin with desquamation and widespread fluid filled, thin walled blistering. Culture from blister sample is negative for any bacteria. What toxin-related disease is on the differential?

A

scalded skin syndrome via exfoliative toxin from s. aureus

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11
Q

amoxicillin. administration

A

PO

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12
Q

cephalosporin resistances in general

A

intrinsic: pseudomonas. enterococci; membrane permeability; altered PBPs; B-lactamases

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12
Q

Fosfomycin. administration

A

PO/Powder

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13
Q

treatment for c. tetani

A

clean wound

metronidazole

passive immunization w/tetanus immunoglob

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14
Q

Daptomycin. clinical use

A

complex GP infections(soft tissue; bacteremia/endocardidits)

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14
Q

what is a localized SSSS

A

staphylocococcus scalded skin syndrome when localized, it is called bullous impetigo; blisters are filled with bacteria and inflammatory cells; local spread from infected wound

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15
Q

types of moraxella infections and treatment

A

otitis media, sinusitis, conjuctivitis(rarely systemic) treat with amoxicilin/clavulanate use cephalosporins for more serious

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15
Q

what disease does acinetobacter causeusually?

A

similar to pseudo:

catheter associated UTI(CAUTI)

ventilator associated pneumonia(VAP)

central line associated blood stream infeciton(CLABSI)

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16
Q

clinically relevant legionella spp.

A

L. pneumophilia

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17
Q

microbiological/lab characteristics of pneumococci

A

GP catalase negative alpha-hemolysis susceptible to optochin soluble in bile salts

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18
Q

virulence factors for mycoplasma

A
  1. hemolysins(alpha or beta)
  2. polysaccharide capsule
  3. Toxins
    1. m. pneumoniae - CA-resp distress syndrome(CARDS) toxin
    2. ADP ribosylating
    3. vacuolating toxin
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19
Q

metronidazole adverse effects

A

metallic taste;

HA, vertigo, confusion, psychosis,

disulfram-like effect w/alcohol(vomit, flush)

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20
Q

rifampin clinical use

A

prophylaxis for n. meningitidis, s. aureus mycobacterial infections

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21
Q

bordatella treatment

A
  1. azithromycin or clarithromycin to prevent spread(doesnt stop symptoms)
  2. supportive therapy - hydration, nutrition, oxygen
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22
Q

clostridium perfringens unique microbiology

A

large rectangular rods and “double zone” of hemolysis

rarely makes spores; aerotolerant; grows in culture fast

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22
Q

atypical pneumia presentation

A

more low grade flu-symptoms

can have extrapulmonary symptoms

diffuse disease, interstitial

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23
Q

cefepime activity

A

EXTREMELY GN active including pseudomonas; one of broadest spectrum agents available; still has GP activity; resistant to almost all b-lactamases 4th gen

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23
Q

stains for acid fast bacteria

A

carbolfuchsin

counter stain methylin blue

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23
Q

diagnostic microbiological charasteristics of pseudomonas

A

non-lactose fermenting

oxidase positive

aerobic GN rod

smells like grapes

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24
Q

leading cause of infectious/preventable blindness in world?

treatment?

A

trachoma

treat with erythromycin/macrolides

tetracyclines have chlamydia too but werent mentioned

treatment for trachoma is only effective in childhood….

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25
Q

name the tetracyclines, mechanism and activity

A

doxycycline tetracycline minocycline reversibly bind 30S subunit blocking tRNA access to mRNA broad GN(no pseudo) staph, strep(some CA-MRSA) some anaerobic atyps: chlamydia, mycoplasma 4(tetra) minos by the dox

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26
Q

treatment for a pneumococcal otitis

A

amoxicillin if fever is persistant dont need to treat right away

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26
Q

sequelae of chlamydia pneumoniae

A

ATHEROSCLEROSIS

MS

chronic bronchitis

asthma

COPD exacerbation

reactive arthritis

AAA

stroke

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26
Q

propionibacteria is responsible for what diseases?

A
  1. acne
  2. opportunistic diseases via foreign bodies
    • prosthetic heart valves
    • prosthetic joints
    • vascular catheters
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27
Q

causes woody, sulfur granules in its abcesses

has a molar tooth appearance upon culture

A

actinomyces israelii

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27
Q

type of clostridium tetani manifestation

A
  1. generalized - masseter cntrcn; opisthotonos(back cntrcn); airway can become compromised from constant thoracic cntrcrn
  2. localized - limited to site of inoculation; can develop into general
  3. cephalic: injury to head/neck, in developing coutnries; characterized by cranial nerve involvement
  4. neonatal: umbilical stump exposed to clay/dung
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28
Q

what are viridan streptococci?

A

alpha(partial) and gamma(none) hemolyzers

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29
Q

carbapenem administration

A

IV

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30
Q

isoniazid mechanism, clinical use

A

inhibits mycolic acid cell-wall syntehsis via O2 dependent pathways used for mycobacterial infections

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31
Q

carbapenem activity

A

VERY BROAD SPECTRUM; GN w/pseudomonas; GP;Anaerobes ertapenem = no pseudo/acinetobacter spp.

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32
Q

what disease is mobiluncus associated with

what is the treatment for this disease

A

bacterial vaginosis

metronidazole; however, note that mobiluncus is resistant to metronidazole

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33
Q

treatment for h. influenzae

A

amoxicillin for non-invasive(unencapsulated); amoxicillin-clavulanate for resistant strands

3rd gen cephalosporin(cefotaxamine) for invasive Hib(meningitis)

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33
Q

top bacterial causes of sinusitis

A

strep pneumoniae

haemophilus influenzae

moraxella catarrhalis

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34
Q

manifestation of c. diff

A

ranges from anti-biotic diarrhea to life-threatening pseudomembranous colitis

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35
Q

phases of bacterial growth curve

A

lag phase - making machinery

log phase - GROWIN WOOOO

stationary phase - uh oh, running out of shit

decline phase(death phase) - aahgalkjf;lakshhg;lksdf

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35
Q

sterilization for things that could be damaged by moist heat(gauzes, dressings, powders)

A

Hot air sterilization

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36
Q

Dicloxacillin. administration

A

PO

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36
Q

bacteroides fragilis cause what infecitons?

A

characterized by abcess formation

intraabdominal

pelvic/endometritis

surgical wound infections

skin/soft tissue infections after surgery/trauma

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37
Q

vats dis

A

mobiluncus

comma shaped, GP non-spore, anaerobic rod

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38
Q

who is at higher risk for legionella infections?

A

elderly/immunocompromised

smoking, chronic lung disease, TLR5(flagellum) polymorphism

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39
Q

Polymyxin B. Colistin activity

A

GN bactilli only

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40
Q

cefoxitin clinical use

A

prophylaxis for intra-abdominal surgery 2nd gen

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40
Q

antiseptic

A

substance used to prevent multiplication of microroganism when applied to living systems; bacteriostatic

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41
Q

what causes methicillin resistance?

A

acquiring mecA –> PBP2a b-lactams cant bind their target enzyme(transpeptidase)

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41
Q

suppurative vs non-suppurative infections of s.pyogenes

A

suppurative(pus producing):

  • pharyngitis(can be complicated by scarlet fever)
  • impetigo, erysipelas, necrotizing fasciitis, strep. TSS

non-suppurative:

  • rheumatic fever, rheumatic heart disease
  • glomerulonephritis
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41
Q

germicide

A

substance that kills vegetative bacteria and SOME spores

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41
Q

bacteroides fragilis is resistant to….

what should you treat with?

A

penicillins

metronidazole and antibiotics to cover other bugs in infection

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42
Q

structure of peptidoglycans

A

NAG-NAM sugar backbone

peptide cross-bridges and side chains(additional layers)

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43
Q

how is staphylococci differentiated from streptococci and enterococci?

A

microscopic morphology catalase +

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44
Q

ceftriaxone, ceftazidime activity

A

excellent GN activity 3rd gen

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44
Q

what are the constitutive s. aureus toxins?

A

hemolysins - destroy erythrocytes

leukocidin - destroys leukocytes and macrophages

cytolytic peptides - recruit PMN then kill em(overproduced in CA-MRSA)

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45
Q

disinfectant

A

substance used on non-living objects to render them non-infectious

kills vegetative bacteria, fungi, viruses but no spores

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46
Q

s. aureus virulence factors

A

capsule(sticky)

Protein A: binds IgGs, inhibits phagocytosis

MSCRAMM: adhesion proteins

enzymes

toxins

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46
Q

Thermophilic

mesophilic

psychrophilic

A

thermo - optimal temp is 65+-10ºC, min 35-40ºC

mesophilic - optimal temp is 37!!!(most pathogenic) min is 10-15ºC

**psychrophilic **

  • facultative - similar to mesophilic but grow down to 0ºC
  • obligate - opt is 17ºC, killed over 20ºC
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46
Q

factors involved in antibiotic resistance in biofilms

A
  1. cells grow slow in there so they arent affected as much
  2. cells in biofilm can get word that antibiotics are present and express stress responses to induce resistance
  3. antibiotics have trouble penetrating
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46
Q

top causes of pharyngitis

A

VIRUSES cause 90%

GAS for the rest

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48
Q

ampicillin, amoxicillin activity

A

widens spectrum to some GN(H. flu. E. coli; NOT pseudomonas)

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48
Q

what two resistances prevent vancomycin use?

A

VISA(vanco intermediat s. aureus) –> thickened wall

VRE(vanco resistant entero) –> changes d-ala binding to

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48
Q

pyrogenic exotoxins produced by s. pyogenes

A

SpeA, SpeC - superantigens; responsible for scarlet fever and toxic shock syndrome; HLA dependent; encoded by bacteriophages

SpeB - cleaves IgG

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49
Q

treatment for acinetobacter?

complications?

A

need broad spectrums:

cephalosporin

carbapenem

amp/sulbactam

aminoglycoside

tigecycline

polymyxins

this drug can have lots of resistances

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50
Q

what MUST you do if you see a pt with streptococcus **bovis **

this is Group __ strep

A

colonoscopy

s. bovis group(including s.gallolyticus) is a Group D strep that is highly associated with colon cancer

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51
Q

Vancomycin. administration

A

IV/PO PO for c.diff; not absorbed

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52
Q

cephalexin. administration

A

PO

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53
Q

describe the non-constitutive toxins of s. aureus and their associated syndromes

A

exfoliative toxin –>scalded skin syndrome

enterotoxin(premade) –> food poisoning

toxic shock syndrome toxin –> sepsis

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53
Q

streptolysin O, streptolysin S

A

hemolysins produced by s. pyogenes

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55
Q

cephalosporins activity

A

GN increases w/generations(except 5); most have som GP ; no good against enterococci; only 1 good against MRSA. not much anaerobe activity

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56
Q

tigecycline, mechanism, activity, problems

A

semi-synthetic tetracycline very broad spectrum GN(no pseudo) GP(MRSA and VRE) most anerobes resistance develops rapidly…limits use; also increased mortality w/pneumonia pts….

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57
Q

diseases caused by legionella

A
  1. Legionnaires Disease - severe pneumonia
    • fever, nonproductive cough, chills, HA
    • cerebellar involvement often
    • 15-20% moretality
    • need antibiotics
  2. Pontiac Fever - flu like symptoms(mild)
    • high attack rate, but
    • no person-person spread
    • no therapy needed
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58
Q

common presentations of streptococci pneumoniae

A

otitis, sinusitis, bronchitis, pneumonia, meningitis, bacteremia

most common bacterial cause of otitis, meningitis

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60
Q

ceftriaxone clinical use

A

community acquired pneumonia meningitis(penetrates CSF) UTI

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61
Q

Nafcillin. Dicloxacillin clinical use

A

primarily used for methicillin-susceptible S. aureus

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62
Q

liquid disinfection

A

filtration! uses tiny pores that remove microorganisms(cant get rid of viruses)

used for enzymes, vaccines, antibiotics

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63
Q

Daptomycin cannot be used where?

A

inhibited by pulmonary surfactant. DON�T USE FOR PNEUMONIA; bactericidal

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65
Q

adverse effects of TMP-SMX

A

common - HANV, rash

less - hyperkalemia, hepatitis, pancreatits

rare - SCAR, anemias, thrombocytopenias, separates drugs from albumin, kernicterus

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66
Q

first line agents against MSSA bacteremia

A

nafcillin, cefazolin(dont need vanco, dapt if not MRSA)

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68
Q

unique PK/PD of rifampin

A

p450 inducer; can decrease concentrations of other drugs in body

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69
Q

M protein

A

virulence factor for s. pyogenes

adhesive - binds many serum proteins including factor H and CD46 on keratinocytes

forms antibodies that react w/cardiac myosin and sarcolemma

strongly antiphagocytic

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70
Q

osler node vs janeway lesion what are these?

A

osler node is PAINFUL; erythematous nodule on thumb pad

janeway lesion is not paintful; erythematous nodule on hypothenar emminence

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72
Q

name the B-lactamase drug combos

A

ampicillin-sulbactam amoxicillin-clavanic acid piperacillin-tazobactam

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74
Q

Penicillin G. administration

A

IV

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74
Q

adverse effects of fluoroquinolones

A

Common - HANV(HA,nausea, vomiting) ab pain, dizzy

less common - long QT, tendon rupture, cartilage problems in kids, pregos can cause c.diff

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75
Q

describe empiric therapy for staphylococcal infections

what are good empiric outpatient therapies?

A

if pt. is sick(bacteremia/pneumonia)-

  • vancomyicn
  • daptomycin
  • linezolid
  • ceftaroline

if pt. is not “sick”(outpatient skin/soft tissue) -

  • clindamycin
  • TMP/SMX
  • doxycycline
  • linezolid
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76
Q

process of Gram staining

A

crystal violet

iodine to lock in stain to GP

declolorize w/alcohol(GN lose color)

counter stain with safranin

GN will be pink(safranin); GP will be purple(crystal violet)

77
Q

ceftazidime. administration

A

IV

78
Q

Penicillin G. adverse effects

A

hypersensitivity reactions(rash. hives/anaphylaxis. serum sickness. immune mediated cytopenias. acute interstitial nephritis); seizures at high doses

79
Q

pour plates

A

used to asses # colonizing bacteria present in an original sample;

you dilute it down; count colonies; then back calculate original sample

79
Q

fusobacterium nucleatum causes infections where?

A

oropharynx

think gingivitis to pharyngitis to jugular venous thrombophlebitis

these infections are dangerous; can move up and down in parapharyngeal spaces(DANGER ZONE)

80
Q

name all the drugs with GP only activity

A

nafcillin dicloxacillin vancomycin daptomycin bacitracin mupirocin clindamycin linezolid tedezolid

80
Q

1 bacterial cause of pharyngitis?

A

streptococcus pyogenes (group a strep)

fever, absence of cough, purulent exudate, cervical lymphadenopathy

80
Q

treatment for group b strep

A

penicillin

vancomycin or clindamycin if allergic

81
Q

Nafcillin. resistance?

A

altered PBP encoded by mecA–>PBP2a(MRSA); cant bind it anymore

82
Q

GN coccobacilli

no capsule

small

causes whooping cough

A

bordatella

b. pertussis specifically

83
Q

mycoplasma species associated with HIV/AIDS

A

m. fermentans, m. penetrans increase HIV virulence

84
Q

obligate aerobes

obligate anaerobes

facultative anaerobes

microaerophils

A

obligate aerobes - need O2 for respiration

obligate anaerobes - killed by O2; use fermentation

facultative anaerobes - prefer O2 but dont need it; respiraiton or fermentation

microaerophils - can withstand low levels of O2

86
Q

Carbapenems resistance?

A

any weird acquired metallo-beta-lactamases. KPCs can still be resistant to carbapenems

88
Q

adverse effects of rifampin

A

orange secretions, hepatitis, GI and heme issues

89
Q

Vancomycin resistance?

A

alteration of vancomycin binding site (vanA.B.C.D.E),VRE; thickened cell wall(VISA)

90
Q

Lemierre’s Syndrome

A

phayngitis is complicated by peritonsillar abscess

spreads through parapharyngeal spaces to the internal jugular vein

causes thrombophlebitis which can embolize and spread to lungs where it forms MORE ABCESSES!

91
Q

scarlet fever

manifestation?

A

uncommon manifestation of acute infection, usually pharyngitis

manifests from SpeA, SpeC release

rash starts at trunk

capillary fragility

strawberry tongue and peripheral desquamation in later stages

92
Q

name the relavent anaerobic, GP, non-spore, rods

A

actinomyces

lactobacillus

mobiluncus

propriobacterium

94
Q

Fosfomycin. clinical use

A

UTI only

96
Q

fidoxamicin mechanism, use

A

blocks RNA polymerase by not letting DNA open PO drug approved for c.diff infections does not cross GI; very narrow spectrum(only effects some GP in gut); preserves flora better than others

97
Q

corynebacterium

relavent species?

morphology?

disease, toxins?

treatment?

A

corynebacterium diphtheriae

aerobic GP rod

Diptheria: acute resp. infection w/pseudomembrane formation in throat

  • resp. failure, myocarditis, neuritis, death
  • uncommon in US
  • mediated by diptheria toxin - inhibits protein synthesis

Treatment: antitoxin serum plus erythromycin or penicillin

98
Q

ethambutol use

A

inhibits arabinogalactan, lipoarabinomannan synthesis used for mycobacterial infections

100
Q

treatment options for this?

A

pharyngitis; GAS(s. pyogenes)

penicillin

if allergic: macrolides, clindamycin

101
Q

Asepsis

A

state of being free of microorganisms

102
Q

fevers, chills, purulent sputum, dyspnea

what pseudomonas syndrome does this describe

A

pneumonia caused by pseudomonas

104
Q

name all the drugs with pseudomonas activity

A

piperacillin/pip-tazo ceftazidime cefapime meropenem imipenem fosfomycin - UTI only aminoglycosides(gentamicin, amikacin, tobramycin, streptomycin)

106
Q

name the most common pathological route of infection for:

s. epidermidis

s. saprophyticus

s. lugdenensis

A

s. epidermis(and others) commonly adhere to prosthetic joints, valves, and shunts

s. saprophyticus commonly causes UTIs

s. lugdenensis commonly causes native valve endocarditis

107
Q

sterilization w/moisture, high pressure and temperature

A

autoclave

108
Q

where does chromosomal replicaiton occur in bacteria?

A

@ cell membrane

septum forms between copies

108
Q

bacterial pneumonia presentation

A

sudden onset

sustained fever

pleuritic chest pain

purulent cough

lobar consolidaiton

effusion

109
Q

what is the s. milleri group?

what disease manifestation are they associated with?

A

unofficial name for virdans group of bacterial:

(s. anginosis, s. constellatus, s. intermedius)

can display beta, alpha or gamma hemolysis

unusual propensity to cause abcess - liver, brain, periodontal

angie intermediately looks at constellations

110
Q

clinically relevant haemophilus species

A

**H. influenzae **(most important)

**H. ducreyi **(chancroid, genital ulcers)

111
Q

bacteroides fragilis morphology

A

anaerobic GN rod

LPS w/out endotoxin activity

has an important anti-phagocytosis capsule; stimulates abcess formation

111
Q

diseases caused by c. perfringens

A
  1. food poisoning: ab cramps; watery diarrhea; from contaminated meat products; heat-labile enterotoxin
  2. soft tissue infections: cellulitis, fasciitis, myonecrosis(gas gangrene); DANGEROUS; hemorrhagic bullae, severe pain, edema, pallor, subq emphysema; microscopy helpful!
  3. bacteremia: most blood isolates are useless
112
Q

required factors for culturing haemophilus?

A

need X factor(hemin) and V factor(NAD)

requires chocolate agar: heated blood agar which causes the release of these factors

114
Q

36 y/o female pt presents with an acute onset erythematous rash with desquamation. Pt has a fever and hypotension. what s. aureus toxin causes these symptoms??

A

TSST-1 is most common causes toxic shock syndrome

115
Q

two relevant species of chlamydia pathogenic to humans

two relavent veterinary species of chlamydia

A
  • c. trachomatis*
  • c. pneumoniae*
  • c. psittaci*
  • c. abortus*
116
Q

treament for:

  1. actinomyces
  2. lactobacilli
  3. mobiluncus
  4. propionibacteria
A
  • *actinomyces** - penicillin; erythromycin, clindamycin
  • *lactobacilli** - penicillin, or combo; resistant to vanc
  • *mobiluncus** - resistant to metronidazole but still used to treat bacterial vaginosis
  • *propionibacteria** - benzoyl peroxide, penicillin, tetracyclines, erythromycin, clindamycin
118
Q

pt presents with acute onset diarrhea, NV, and abdominal pain. pt has no fever. later, a bacterial culture returns with s. aureus bacteria found in stool. what was the cause of this disease?

A

the CAUSE is the pre-formed enterotoxin created by s. aureus it is both heat stable AND a superantigen, inducing peristalsis and inflammation(NVD)

120
Q

piperacillin. administration

A

IV

121
Q

pyogenic cutaneous disease caused by s. aureus

A

impetigo, folliculitis, furuncles, carbuncles, wound infection

121
Q

lactobacillus diseases?

type of pt infected?

treatment?

A

sepsis, and endocarditis(if previous valve problems)

pts are immunocompromised

treat with penicillin/gentamicin

122
Q

clindamycin, mechanism, activity, adverse reaction

A

binds 50S subunit GP only! “above the diaphragm” classically some CA-MRSA adverse reaction is c. diff infection

122
Q

Daptomycin. activity

A

GP ONLY! MRSA activity; enterococci(including VRE). anaerobes

123
Q

where is acinetobacter found?

where do infections usually occur?

A

found in water/soil; colonizes skin, respiratory tract, GI tract

primarily a nosocomial pathogen, particularly ICU

124
Q

morphology of coxiella

A

GN, intracellular bacillus

related to legionella

125
Q

treatment for fusobacterium nucleatum

A

b-lactam+/-b-lactamase inhibitor

debride abcess!

127
Q

Polymyxin B and colistin adverse effects

A

nephrotoxicity. neurotoxicity

128
Q

unique molecules on surface of GP bacteria

A

teichoic acids, lipotechoic(LTA) polymers

LTA is recognized by TLR2

130
Q

ceftaroline activity

A

MRSA activity; broad GP activity. no enterococci; only some gram-neg activity. no pseudomonas�similar activity to that of gen3

132
Q

treatment for s. agalactiae infection?

A

penicillin

if allergic: vancomycin or clindamycin

screen pregnant women and treat those that are colonized when at term

134
Q

Penicillin G. clinical use

A

Grp A and B strep. and Streptococcus pneumoniae; anaerobic infections(dental abscess. human bites); syphilis

135
Q

developmental cycle of chlamydia infection

A
  1. elementary body(EB) binds host cell and is internalized in a vacuole(inclusion)
  2. EB differentiates into a reticulate body(RB) which is metabolically active and starts to grow
  3. RBs multiply and at about 20-40hrs after infeciton, differentiate back into EBs
  4. once 100-1000 EBs form, the inclusion is mature and it can lyse to spread to other cells!
136
Q

clinically relevant mycoplasma species

A

m. pneumoniae

m. hominis

m. genitalium

m. fermentens

ureaplasma urealyticum

138
Q

name the carbapenems

A

meropenem imipenem ertapenem doripenem(black boxed)

138
Q

cefazolin, cephalexin(1st gen) clinical use

A

surgical prophylaxis. soft skin/tissue infections(resistance limiting)

139
Q

clostridium tetani

pathogenesis

manifestation

A

introduced to body via dirty nail, splinter, dirty needle

mediated by tetanus toxin(A/B peptides); a-peptide inhibits GABA/glycine which are inhibitory NTs; causes SPASTIC PARALYSIS

140
Q

Daptomycin. administration

A

IV

141
Q

disinfection

A

process of removing/killing MOST microorganisms on or in a material

141
Q

peptostreptococcus is found where?

what diseases does it cause?

A

mucosal surfaces AND skin

Causes:

  1. sinusitits(can travel to brain, lungs)
  2. intraabdominal infections
  3. endometritis, pelvic abcesses
  4. cellulitis, nec fasc
  5. osteomyelitis

as an anaerobe, this will create abcesses

142
Q

most clinically relavent moraxella species

A

m. catarrhalis

144
Q

H. influenzae virulence factors

A
  • polysacchardie capsule(if encapsulated obviously)
  • adherence factors
    • pili
    • HMW adhesins(unencapsulateD)
  • lipooligosaccharide(LOS)- can be modified by sialic acid terminal addition
  • biofilm formation(LOS sialylation)
145
Q

most clinically relevant acinetobacter spp?

A

acinetobacter baumannii

146
Q

vats dat

A

clumped GP, nonspore anaerobic rods

propionibacteria!

147
Q

how are legionella infections spread?

A

aerosolized water sources:

  • showers
  • whirlpools
  • humidifiers
  • tap water/faucets
  • cooling towers
148
Q

where do enterococci colonize?

most important virulence factor?

A

GI tract!

antibiotic resistance is most common virulence factor…comes from antibiotic use affecting microbiome…

149
Q

diseases caused by C. trachomatis

A
  1. inclusion conjuctivits - primary infection
    • opthalmia neonatorum in newborns
  2. follicular conjuctivitis(trachoma) - chronic infection
  3. pneumonia syndrome of newborn
  4. genital STI

newborns get infection passed to them from mama at birth;

150
Q

cefepime. administration

A

IV

151
Q

cefoxitin. administration

A

IV

152
Q

most common Group A strep species?

most common Group B strep species?

what determines grouping?

A

group A - s. pyogenes

group B - s. agalactiae

groups are determined by its common cell wall carbohydrate

153
Q

types of patients commonly getting enterococcal UTI

A

males hospitalized, catheterized pts not common in healthy, non-hospitalized females

155
Q

Penicillin V. administration

A

PO

156
Q

most common species of enterococci how do their treatments differ?

A

E. faecalis - ampicillin/penicillin are drugs of choice; use ampicillin AND aminoglycoside for endocarditis

E. faecium - vancomycin is drug of choice; resistant to ampicillin; use vancomycin AND aminoglycoside for endocarditis

157
Q
  • s. maltophila*
  • b. cepacia*

full names?

where are these guys contracted?

A
  • stenotrophomonas maltophila*
  • burkhoderia cepacia*

more ICU bugs

treat steno w/TMP-SMX

158
Q

toxins of c. diff

A
  1. enterotoxin(toxin A) - attracts PMN and makes them release cytokines
  2. cytotoxin(toxin B) - destroys cellular cytoskeleton of colon(destroy actin)
160
Q

name the aminoglycosides and their mechanism and activity

A

gentamicin amikacin tobramycin streptomycin binds 30S ribosome; stops protein synthesis only GN(w/pseudo) activity; cant’ penetrate GP wall w/out synergy

161
Q

what are the virulent enzymes in s. aureus related to tissue destruction?

A

coagulase, hyaluronidase, catalase, fibrinolysin, lipases, nucleases

162
Q

ceftriaxone penetration, half life

A

high degree of CSF penetration; EXTREMELY long t1/2. can q24h dose for outpatient IV

163
Q

ecthyma gangrenosum can result from what manifestation of a pseudomnas infection?

A

ecthyma gangrenosum is a buzzword for pseudomonas

**pseudomonal bacteremia secondary to pneumonia or other infection **can cause this ischemic necrotic ulceration w/raised violaceous margins

164
Q

Colistin(polymyxin E). administration

A

IV

165
Q

name the macrolides, mechanism, and activity

A

azithromycin clarithromycin erythromycin binds 50S subunit, blocks translocation broad GN(no pseudo) GP: staph,strep, pneumo(if susc.) atyp: myco, legionella, chlamydia

167
Q

epidemiology of bordatella

A
  • HIGHLY contagious; spread via aerosols
  • majority of cases in young children, most deaths
  • adults have less severe symptoms but are likely reservoirs
169
Q

metronidazole

mechanims, activity

A

diffuses into bacteria and produces free radicals

activity: ANAEROBES“below diaphragm”
includes b. fragilis; protozoa

170
Q

top causes of acute otitis media

A

strep pneumoniae

haemophilus influenzae

moraxella catarhallis

171
Q

treatment of c. botulism

A

ventilatory support

metronidazole

trivalent botulinum antitoxin

173
Q

Nafcillin, dicloxacillin activity

A

GP ONLY; narrow specturm; think penicillin G with overcoming certain b-lactamases

174
Q

what diseases are caused by actinomyces?

A

actinomycoses:

  1. cerebral
  2. cervicofacial(angle of mandible)
  3. thoracic - can cause aspirate pneumonias; can move through lungs to make draining lesion
  4. abdominal - appendicitis can perforate, cause bacteremia and allow lesions in liver
  5. pelvic
176
Q

cefoxitin activity

A

excellent anaerobic activity 2nd generation

177
Q

Penicillin G. resistance?

A

B-lacatamases hydrolyze b-lactam ring; PBPs can be modified on transpeptidase; decreased perm.; efflux pumps

179
Q

pyogenic systemic disease caused by s. aureus

A

pneumonia

empyema

osteomyelitis

septic arthritis

endocarditis

bacteremia

180
Q

what infeciton precedes acute rheumatic fever

what is the incubation period

A

10-30 days following a pharyngitis from a GA-strep infection

181
Q

pathogenesis of actinomyces israelii

A

pt’s mucosal barrier is disrupted, allowing the actinomycoses to travel

surgery, trauma, radiation, aspiration, foreign body, diverticulitis, appendicitis

182
Q

top causes of bacterial pneumonia

A
  1. strep pneumoniae
  2. haemophilus influenzae
  3. staph aureus
  4. GAS
184
Q

ampicillin. amoxicilin clinical use

A

community acquired HEENT/upper resp infectsion; community acquired UTI

185
Q

treatment for moraxella infections

A

treat m. catarrhalis with amoxicillin/clavulanate, cephalosporins

just like haemophilus

187
Q

prevnar

pneumovax

A

both pneumococcal vaccines

prevnar - given to all children

pneumovax - 65+ y/o

188
Q

pathogenesis for L. pneumophilia

A
  1. attach/entry into alveolar macrophages(bind C’, type IV pili)
  2. inhibit fusion of phagolysosome
  3. begins replicating in vacuole
  4. secretes virulence factors via Dot/Icm type IV secretion system
  5. keeps growing till cell lyses then moves to next cell
189
Q

morphology of peptostreptococcus

A

GP cocci; anaerobe

190
Q

anti-tubercular drugs

A

isoniazid, rifampin, streptomycin, ethambutol, pyrazinamide

192
Q

diagnostics for legionella

A

hard to gram stain

  • use Giminez(smears) or Dieterle(tissue) stains
  • urine antigen test(detects LPS serogroup 1)
  • direct fluorescent a-body test from sputum
193
Q

piperacillin-tazobactam. activity

A

adds S.aureus (not MRSA). B-lactamase producing GN and anaerobes; AND PSEUDOMONAS

194
Q

morphology of haemophilus

A

small, GN, coccobaccilli

195
Q

ampicillin. administration

A

IV

197
Q

Carbapenems. clinical use

A

empiric treatment for serious infections and resistant infections

198
Q

ceftriaxone. administration

A

IV

199
Q

most common bacterial infection of burn pts?

A

pseudomonas!

200
Q

Fosfomycin resistance?

A

can develop rapidly on the transporter that brings the drug into the bacteria

201
Q

what streptococcal subgroup is s. pneumoniae a part of?

A

the mitis subgroup

202
Q

treatment of c. diff

A

discontinue any implicated antibiotics

give oral metronidazole, (oral vanc if bad)

disinfect room

STOOL TRANSPLANT

203
Q

most clinically relevant pseudomonas species?

A

pseudomonas aeruginosa

204
Q

name all the cephalosporins in order by generation

A

1st gen: cefazolin cephalexin(PO) 2nd gen cefoxitin 3rd gen ceftriaxone ceftazidime 4th gen cefepime 5th gen ceftaroline

206
Q

neonate gets fever in first 4-6 weeks of life

doc orders an LP

what is the doc looking for?

A

group B strep: s. agalactiae

normally colonizes GI/GU(can be picked up in birthing canal)

sepsis and meningitis are risks for both early and late onset!

208
Q

what drugs cover pseudomonas

A

pip/tazo

cefepime

ceftazadime

aminoglycosides

imipenem

meropenem

fluoroquinolones(ciprofloxacin)

aztreonam

polymyxins

209
Q
A
210
Q

relavent bordetella species

A

**b. pertussis **(whoopin cough)

**b. parapertussis **(milder disease)

211
Q

ceftaroline. administration

A

IV

213
Q

piperacillin-tazobactam. administration

A

IV

214
Q

disease caused by mycoplasma pneumoniae

treatment?

A

CA-pneumonia(walking) –>

  • leading pneumonia for school age children
  • dry cough, malaise, low fever, scratchy sore throat

treatment: doxycyclin, erythromycin, azithromycin, levoflaxin, ciproflaxin (tetracyclines, macrolides, fluoroquinolones)

215
Q

sterilization

A

inactivation or elimination of ALL viable organism and their spores

217
Q

what are the major/minor criteria for rheumatic fever?

A

major:

  • polyarthritis
  • carditis
  • chorea
  • erythema marginatum
  • subcutaneous nodules

minor:

  • arthralgia
  • fever
  • elevated CRP or ESR
  • 1st degree heart block

need 2 major or 1 major and 2 minor to declare

218
Q

Penicillin G. activity

A

GN: cocci only; GP: cocci and anaerobes; spirochetes. enterococci

219
Q

carbopenam. adverse effects

A

hypersensitivity(cross-reaction w/penicillin)

220
Q

stages of bordatella disease

A
  • *1. catarrhal stage** - cold-like symptoms, highly infectious, 2 weeks
  • *2. paroxysmal stage** - severe cough paroxysms, apnea, may cause hypoxia, striking leukocytosis

**3. ** convalescent stage - cough may persist for several months, bacteria absent

**4. ** critical pertussis in infants

   - **lymphocytosis**, apnea, can progress to respiratory failure and death
221
Q

cefazolin. administration

A

IV

223
Q

describe the h. influenzae vaccine

A

PRP(polyribosyl ribitol phosphate) attached to protein conjugate

224
Q

rifaximin use

A

traveler’s diarrhea enteric drug; does not absorb across gut

225
Q

clostridium botulinum

how does it manifest?

what are the 3 forms?

A

botulinum toxin, prtctd in GI, blocks neurotransmission at peripheral cholinergic synapses; inactivates proteins that release ACh

FLACCID PARALYSIS

  1. foodborne - toxin is found in food
  2. wound - organism contaminates wound; multiplies; makes toxin
  3. infant - organism is ingested w/food; multiplies in GI, maks toxin
227
Q

Vancomycin oral

A

does not cross GI tract given orally; used for c. diff

228
Q

describe these “types” of flagellum

amphitrichous

lophotrichous

peritrichous

monotrichous

A

amphitrichous - single on each end

lophotricous - multiple flagellum; same spot

peritrichous - multiple in all directions

monotrichous - single

229
Q

Nafcillin. administration

A

IV

230
Q

hot tub folliculitis

A

low grade fever, self-limited, benign tender pruritic papules from infected water source

caused by pseudomonas

231
Q

top causes of atypical pneumonia

A
  1. VIRUSES
  2. mycoplasma pneumoniae
  3. chlamydia pneumoniae
  4. legionella pneumophilia
232
Q

coxiella

diseases?

treatment?

A

Q fever(self-limiting flu-like illness) –> chronic form includes endocarditis

Treat with doxycycline

233
Q

chlamydia virulence factors

A
  1. adherence proteins
  2. autotransport(T5S) - moves polymorphic membrane proteins to surface; need for adherence, antigen variation
  3. Type III Secretion(T3S) - molecular syringe; injects virulence factors across membrane of cell/inclusion
  4. clostridial toxins
235
Q

unique molecules on surface of acid-fast bacteria

classic acid fast bacteria?

A

mycolic acid

wax d

arabinogalactans

sulfolipids

mycobacterium are acid-fast

236
Q

treatment for legionella

A

fluoroquinolones(levofloxacin) for CA-pneumonia

  • change to azithromycin if legionella is diagnosed
237
Q

sanitization

A

cleaning process which reduces pathogen levels to produce a healthy/clean environment

238
Q

virulence factors for pseudomonas?

A
  1. pili, flagella for adherence/movement
  2. LPS(endotoxin)
  3. polysaccharide capsule(slime coat)
  4. Exotoxin A(ETA): similar to diptheria toxin; causes necrosis
  5. T3S: exoenzyme S, secreted toxins
  6. degradative enzymes
239
Q

Daptomycin. adverse effects

A

GI distress. HA. elevated CPK(creatine phosphokinase)/rhabdomyolysis(avoid statins)

240
Q

most common forms of botulinum toxin in US

where is c. botulinum found?

A

toxins A, B, E

found on soil, surface of fruit/veggies, marine sediment

241
Q

aztreonam activity, clinical use

A

GN only, used w/b-lactam allergy occasionally; limited immunogenic potential

242
Q

clinical presentation of c. botulinum

A

cranial neuropathies w/symmetric descending paralysis

243
Q

ceftazidime clinical use

A

pseudomonas activity; very broad GN

244
Q

Vancomycin. clinical use

A

only use instead of b-lactam if: empiric therapy for severe infection. resistant GP infection. allergy to b-lactam; used for C. diff via oral dose

245
Q

Vancomycin. adverse effects

A

Red Man Syndrome; dose-related ototoxicity; nephrotoxicity(avoid co-administration with other agents)

246
Q

Polymyxin B. administration

A

IV

247
Q

when you have a patient that works with exotic birds, ducks, poultry farms, etc, and has flu-like/pneumonia symtpoms, what goes on your differential?

A

chlamydia

C. pssittaci

treat with doxy or tetracyclines

248
Q

aztreonam. administration

A

IV

249
Q

treatment for H. influenzae

A

unencapsulated/non-invasive - amoxicillin; amoxicillin-clavulanate for resistant strands

Hib(meningitis) - cefotaxamine(3rd gen cephalo)

250
Q

Bacitracin. activity

A

GP only, topical

251
Q

recovered colonies in 70-80% of SAAs; usually act as normal flora

opportunistic STIs; usually infect w/other pathogens

u. urealyticum can cause NGU

A

diseases caused by m. hominis, m. genitalium & u. urealyticum

Bacteriology -NM (12 decks)

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