All Flashcards
pseudomonas manifestation in ear is called?
swimmer’s ear/otitis externa; gross, pus exudates; its just gross;
treatment for c. perfringens
penicillin works; use w/clindamycin (inhibits toxin synthesis)
coxiella
relavent species?
epidemiology?
C. burnetii is most relavent species
found in animal reservoirs; commonly seen in farmers, ranchers, vets
diagnosis of bordatella
culture on bordet-gengou or regan-lowe mediums
PCR, serology
where does pseudomonas hang out?
who gets these infecitons?
loves wet places/fluids!
its ubiquitious in community and hospital
poeple w/compomised host defenses, disturbed barriers(burns, catheters, etc), and CF pts
h. influenzae diseases(encapsulated and unencapsulated)
Hib - meningitis, conjuctivitis, cellulitis, epiglottitis, bacteremia, arthritis (ABCCME)
unencapsulated - otitis media, sinusitis, bronchitis, pneumonia (BOPS)
describe the microbiological characteristics of acinetobacter
GN coccobacillus
non-lactose fermenter; oxidase NEGATIVE
aerobic and non-motile
range of symptoms for **C. pneumoniae **infection
treatment?
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
diseases caused by m. hominis, m. genitalium & u. urealyticum
recovered colonies in 70-80% of SAAs; usually act as normal flora
opportunistic STIs; usually infect w/other pathogens
u. urealyticum can cause NGU
Polymyxin B. Colistin clinical use
Serious resistant GN infections; inhaled resistant GN pneumonia
treatment for actinomyces
prolonged penicillin
surgical debridement
can use erythromycin, clindamycin too
name the virulence factors of coagulase negative staphylococci
slime layer(biofilm)
many same enzymes as s. aureus
NO TOXINS
antimicrobial resistance common
bordatella toxins/virulence factors
- 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
ampicilin. amoxicilin adverse effects
in addition to hypersensitivity�.GI distress is common; maculopapular rash if treating mono(100% of pts)
treatment for a pneumococcal meningitis
ceftriaxone and vancomycin
….macrolide if atypical
mycoplasma morphology
NO WALL….evolved from GP
TINY(0.3-1u)
pleimorphic–>weird shapes
‘fried egg colony’ - most types
‘mulberry colony’ m. pneumoniae
Vancomycin. activity
GP ONLY! MRSA activity; enterococci if susceptible; anaerobes
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?
scalded skin syndrome via exfoliative toxin from s. aureus
amoxicillin. administration
PO
cephalosporin resistances in general
intrinsic: pseudomonas. enterococci; membrane permeability; altered PBPs; B-lactamases
Fosfomycin. administration
PO/Powder
treatment for c. tetani
clean wound
metronidazole
passive immunization w/tetanus immunoglob
Daptomycin. clinical use
complex GP infections(soft tissue; bacteremia/endocardidits)
what is a localized SSSS
staphylocococcus scalded skin syndrome when localized, it is called bullous impetigo; blisters are filled with bacteria and inflammatory cells; local spread from infected wound
types of moraxella infections and treatment
otitis media, sinusitis, conjuctivitis(rarely systemic) treat with amoxicilin/clavulanate use cephalosporins for more serious
what disease does acinetobacter causeusually?
similar to pseudo:
catheter associated UTI(CAUTI)
ventilator associated pneumonia(VAP)
central line associated blood stream infeciton(CLABSI)
clinically relevant legionella spp.
L. pneumophilia
microbiological/lab characteristics of pneumococci
GP catalase negative alpha-hemolysis susceptible to optochin soluble in bile salts
virulence factors for mycoplasma
- hemolysins(alpha or beta)
- polysaccharide capsule
-
Toxins
- m. pneumoniae - CA-resp distress syndrome(CARDS) toxin
- ADP ribosylating
- vacuolating toxin
metronidazole adverse effects
metallic taste;
HA, vertigo, confusion, psychosis,
disulfram-like effect w/alcohol(vomit, flush)
rifampin clinical use
prophylaxis for n. meningitidis, s. aureus mycobacterial infections
bordatella treatment
- azithromycin or clarithromycin to prevent spread(doesnt stop symptoms)
- supportive therapy - hydration, nutrition, oxygen
clostridium perfringens unique microbiology
large rectangular rods and “double zone” of hemolysis
rarely makes spores; aerotolerant; grows in culture fast
atypical pneumia presentation
more low grade flu-symptoms
can have extrapulmonary symptoms
diffuse disease, interstitial
cefepime activity
EXTREMELY GN active including pseudomonas; one of broadest spectrum agents available; still has GP activity; resistant to almost all b-lactamases 4th gen
stains for acid fast bacteria
carbolfuchsin
counter stain methylin blue
diagnostic microbiological charasteristics of pseudomonas
non-lactose fermenting
oxidase positive
aerobic GN rod
smells like grapes
leading cause of infectious/preventable blindness in world?
treatment?
trachoma
treat with erythromycin/macrolides
tetracyclines have chlamydia too but werent mentioned
treatment for trachoma is only effective in childhood….
name the tetracyclines, mechanism and activity
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
treatment for a pneumococcal otitis
amoxicillin if fever is persistant dont need to treat right away
sequelae of chlamydia pneumoniae
ATHEROSCLEROSIS
MS
chronic bronchitis
asthma
COPD exacerbation
reactive arthritis
AAA
stroke
propionibacteria is responsible for what diseases?
- acne
- opportunistic diseases via foreign bodies
- prosthetic heart valves
- prosthetic joints
- vascular catheters
causes woody, sulfur granules in its abcesses
has a molar tooth appearance upon culture
actinomyces israelii
type of clostridium tetani manifestation
- generalized - masseter cntrcn; opisthotonos(back cntrcn); airway can become compromised from constant thoracic cntrcrn
- localized - limited to site of inoculation; can develop into general
- cephalic: injury to head/neck, in developing coutnries; characterized by cranial nerve involvement
- neonatal: umbilical stump exposed to clay/dung
what are viridan streptococci?
alpha(partial) and gamma(none) hemolyzers
carbapenem administration
IV
isoniazid mechanism, clinical use
inhibits mycolic acid cell-wall syntehsis via O2 dependent pathways used for mycobacterial infections
carbapenem activity
VERY BROAD SPECTRUM; GN w/pseudomonas; GP;Anaerobes ertapenem = no pseudo/acinetobacter spp.
what disease is mobiluncus associated with
what is the treatment for this disease
bacterial vaginosis
metronidazole; however, note that mobiluncus is resistant to metronidazole
treatment for h. influenzae
amoxicillin for non-invasive(unencapsulated); amoxicillin-clavulanate for resistant strands
3rd gen cephalosporin(cefotaxamine) for invasive Hib(meningitis)
top bacterial causes of sinusitis
strep pneumoniae
haemophilus influenzae
moraxella catarrhalis
manifestation of c. diff
ranges from anti-biotic diarrhea to life-threatening pseudomembranous colitis
phases of bacterial growth curve
lag phase - making machinery
log phase - GROWIN WOOOO
stationary phase - uh oh, running out of shit
decline phase(death phase) - aahgalkjf;lakshhg;lksdf
sterilization for things that could be damaged by moist heat(gauzes, dressings, powders)
Hot air sterilization
Dicloxacillin. administration
PO
bacteroides fragilis cause what infecitons?
characterized by abcess formation
intraabdominal
pelvic/endometritis
surgical wound infections
skin/soft tissue infections after surgery/trauma
vats dis
mobiluncus
comma shaped, GP non-spore, anaerobic rod
who is at higher risk for legionella infections?
elderly/immunocompromised
smoking, chronic lung disease, TLR5(flagellum) polymorphism
Polymyxin B. Colistin activity
GN bactilli only
cefoxitin clinical use
prophylaxis for intra-abdominal surgery 2nd gen
antiseptic
substance used to prevent multiplication of microroganism when applied to living systems; bacteriostatic
what causes methicillin resistance?
acquiring mecA –> PBP2a b-lactams cant bind their target enzyme(transpeptidase)
suppurative vs non-suppurative infections of s.pyogenes
suppurative(pus producing):
- pharyngitis(can be complicated by scarlet fever)
- impetigo, erysipelas, necrotizing fasciitis, strep. TSS
non-suppurative:
- rheumatic fever, rheumatic heart disease
- glomerulonephritis
germicide
substance that kills vegetative bacteria and SOME spores
bacteroides fragilis is resistant to….
what should you treat with?
penicillins
metronidazole and antibiotics to cover other bugs in infection
structure of peptidoglycans
NAG-NAM sugar backbone
peptide cross-bridges and side chains(additional layers)
how is staphylococci differentiated from streptococci and enterococci?
microscopic morphology catalase +
ceftriaxone, ceftazidime activity
excellent GN activity 3rd gen
what are the constitutive s. aureus toxins?
hemolysins - destroy erythrocytes
leukocidin - destroys leukocytes and macrophages
cytolytic peptides - recruit PMN then kill em(overproduced in CA-MRSA)
disinfectant
substance used on non-living objects to render them non-infectious
kills vegetative bacteria, fungi, viruses but no spores
s. aureus virulence factors
capsule(sticky)
Protein A: binds IgGs, inhibits phagocytosis
MSCRAMM: adhesion proteins
enzymes
toxins
Thermophilic
mesophilic
psychrophilic
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
factors involved in antibiotic resistance in biofilms
- cells grow slow in there so they arent affected as much
- cells in biofilm can get word that antibiotics are present and express stress responses to induce resistance
- antibiotics have trouble penetrating
top causes of pharyngitis
VIRUSES cause 90%
GAS for the rest
ampicillin, amoxicillin activity
widens spectrum to some GN(H. flu. E. coli; NOT pseudomonas)
what two resistances prevent vancomycin use?
VISA(vanco intermediat s. aureus) –> thickened wall
VRE(vanco resistant entero) –> changes d-ala binding to
pyrogenic exotoxins produced by s. pyogenes
SpeA, SpeC - superantigens; responsible for scarlet fever and toxic shock syndrome; HLA dependent; encoded by bacteriophages
SpeB - cleaves IgG
treatment for acinetobacter?
complications?
need broad spectrums:
cephalosporin
carbapenem
amp/sulbactam
aminoglycoside
tigecycline
polymyxins
this drug can have lots of resistances
what MUST you do if you see a pt with streptococcus **bovis **
this is Group __ strep
colonoscopy
s. bovis group(including s.gallolyticus) is a Group D strep that is highly associated with colon cancer
Vancomycin. administration
IV/PO PO for c.diff; not absorbed
cephalexin. administration
PO
describe the non-constitutive toxins of s. aureus and their associated syndromes
exfoliative toxin –>scalded skin syndrome
enterotoxin(premade) –> food poisoning
toxic shock syndrome toxin –> sepsis
streptolysin O, streptolysin S
hemolysins produced by s. pyogenes
cephalosporins activity
GN increases w/generations(except 5); most have som GP ; no good against enterococci; only 1 good against MRSA. not much anaerobe activity
tigecycline, mechanism, activity, problems
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….
diseases caused by legionella
-
Legionnaires Disease - severe pneumonia
- fever, nonproductive cough, chills, HA
- cerebellar involvement often
- 15-20% moretality
- need antibiotics
-
Pontiac Fever - flu like symptoms(mild)
- high attack rate, but
- no person-person spread
- no therapy needed
common presentations of streptococci pneumoniae
otitis, sinusitis, bronchitis, pneumonia, meningitis, bacteremia
most common bacterial cause of otitis, meningitis
ceftriaxone clinical use
community acquired pneumonia meningitis(penetrates CSF) UTI
Nafcillin. Dicloxacillin clinical use
primarily used for methicillin-susceptible S. aureus
liquid disinfection
filtration! uses tiny pores that remove microorganisms(cant get rid of viruses)
used for enzymes, vaccines, antibiotics
Daptomycin cannot be used where?
inhibited by pulmonary surfactant. DON�T USE FOR PNEUMONIA; bactericidal
adverse effects of TMP-SMX
common - HANV, rash
less - hyperkalemia, hepatitis, pancreatits
rare - SCAR, anemias, thrombocytopenias, separates drugs from albumin, kernicterus
first line agents against MSSA bacteremia
nafcillin, cefazolin(dont need vanco, dapt if not MRSA)
unique PK/PD of rifampin
p450 inducer; can decrease concentrations of other drugs in body
M protein
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
osler node vs janeway lesion what are these?
osler node is PAINFUL; erythematous nodule on thumb pad
janeway lesion is not paintful; erythematous nodule on hypothenar emminence
name the B-lactamase drug combos
ampicillin-sulbactam amoxicillin-clavanic acid piperacillin-tazobactam
Penicillin G. administration
IV
adverse effects of fluoroquinolones
Common - HANV(HA,nausea, vomiting) ab pain, dizzy
less common - long QT, tendon rupture, cartilage problems in kids, pregos can cause c.diff
describe empiric therapy for staphylococcal infections
what are good empiric outpatient therapies?
if pt. is sick(bacteremia/pneumonia)-
- vancomyicn
- daptomycin
- linezolid
- ceftaroline
if pt. is not “sick”(outpatient skin/soft tissue) -
- clindamycin
- TMP/SMX
- doxycycline
- linezolid
process of Gram staining
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)
ceftazidime. administration
IV
Penicillin G. adverse effects
hypersensitivity reactions(rash. hives/anaphylaxis. serum sickness. immune mediated cytopenias. acute interstitial nephritis); seizures at high doses
pour plates
used to asses # colonizing bacteria present in an original sample;
you dilute it down; count colonies; then back calculate original sample
fusobacterium nucleatum causes infections where?
oropharynx
think gingivitis to pharyngitis to jugular venous thrombophlebitis
these infections are dangerous; can move up and down in parapharyngeal spaces(DANGER ZONE)
name all the drugs with GP only activity
nafcillin dicloxacillin vancomycin daptomycin bacitracin mupirocin clindamycin linezolid tedezolid
1 bacterial cause of pharyngitis?
streptococcus pyogenes (group a strep)
fever, absence of cough, purulent exudate, cervical lymphadenopathy
treatment for group b strep
penicillin
vancomycin or clindamycin if allergic
Nafcillin. resistance?
altered PBP encoded by mecA–>PBP2a(MRSA); cant bind it anymore
GN coccobacilli
no capsule
small
causes whooping cough
bordatella
b. pertussis specifically
mycoplasma species associated with HIV/AIDS
m. fermentans, m. penetrans increase HIV virulence
obligate aerobes
obligate anaerobes
facultative anaerobes
microaerophils
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
Carbapenems resistance?
any weird acquired metallo-beta-lactamases. KPCs can still be resistant to carbapenems
adverse effects of rifampin
orange secretions, hepatitis, GI and heme issues
Vancomycin resistance?
alteration of vancomycin binding site (vanA.B.C.D.E),VRE; thickened cell wall(VISA)
Lemierre’s Syndrome
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!
scarlet fever
manifestation?
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
name the relavent anaerobic, GP, non-spore, rods
actinomyces
lactobacillus
mobiluncus
propriobacterium
Fosfomycin. clinical use
UTI only
fidoxamicin mechanism, use
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
corynebacterium
relavent species?
morphology?
disease, toxins?
treatment?
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
ethambutol use
inhibits arabinogalactan, lipoarabinomannan synthesis used for mycobacterial infections
treatment options for this?
pharyngitis; GAS(s. pyogenes)
penicillin
if allergic: macrolides, clindamycin
Asepsis
state of being free of microorganisms
fevers, chills, purulent sputum, dyspnea
what pseudomonas syndrome does this describe
pneumonia caused by pseudomonas
name all the drugs with pseudomonas activity
piperacillin/pip-tazo ceftazidime cefapime meropenem imipenem fosfomycin - UTI only aminoglycosides(gentamicin, amikacin, tobramycin, streptomycin)
name the most common pathological route of infection for:
s. epidermidis
s. saprophyticus
s. lugdenensis
s. epidermis(and others) commonly adhere to prosthetic joints, valves, and shunts
s. saprophyticus commonly causes UTIs
s. lugdenensis commonly causes native valve endocarditis
sterilization w/moisture, high pressure and temperature
autoclave
where does chromosomal replicaiton occur in bacteria?
@ cell membrane
septum forms between copies
bacterial pneumonia presentation
sudden onset
sustained fever
pleuritic chest pain
purulent cough
lobar consolidaiton
effusion
what is the s. milleri group?
what disease manifestation are they associated with?
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
clinically relevant haemophilus species
**H. influenzae **(most important)
**H. ducreyi **(chancroid, genital ulcers)
bacteroides fragilis morphology
anaerobic GN rod
LPS w/out endotoxin activity
has an important anti-phagocytosis capsule; stimulates abcess formation
diseases caused by c. perfringens
- food poisoning: ab cramps; watery diarrhea; from contaminated meat products; heat-labile enterotoxin
- soft tissue infections: cellulitis, fasciitis, myonecrosis(gas gangrene); DANGEROUS; hemorrhagic bullae, severe pain, edema, pallor, subq emphysema; microscopy helpful!
- bacteremia: most blood isolates are useless
required factors for culturing haemophilus?
need X factor(hemin) and V factor(NAD)
requires chocolate agar: heated blood agar which causes the release of these factors
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??
TSST-1 is most common causes toxic shock syndrome
two relevant species of chlamydia pathogenic to humans
two relavent veterinary species of chlamydia
- c. trachomatis*
- c. pneumoniae*
- c. psittaci*
- c. abortus*
treament for:
- actinomyces
- lactobacilli
- mobiluncus
- propionibacteria
- *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
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?
the CAUSE is the pre-formed enterotoxin created by s. aureus it is both heat stable AND a superantigen, inducing peristalsis and inflammation(NVD)
piperacillin. administration
IV
pyogenic cutaneous disease caused by s. aureus
impetigo, folliculitis, furuncles, carbuncles, wound infection
lactobacillus diseases?
type of pt infected?
treatment?
sepsis, and endocarditis(if previous valve problems)
pts are immunocompromised
treat with penicillin/gentamicin
clindamycin, mechanism, activity, adverse reaction
binds 50S subunit GP only! “above the diaphragm” classically some CA-MRSA adverse reaction is c. diff infection
Daptomycin. activity
GP ONLY! MRSA activity; enterococci(including VRE). anaerobes
where is acinetobacter found?
where do infections usually occur?
found in water/soil; colonizes skin, respiratory tract, GI tract
primarily a nosocomial pathogen, particularly ICU
morphology of coxiella
GN, intracellular bacillus
related to legionella
treatment for fusobacterium nucleatum
b-lactam+/-b-lactamase inhibitor
debride abcess!
Polymyxin B and colistin adverse effects
nephrotoxicity. neurotoxicity
unique molecules on surface of GP bacteria
teichoic acids, lipotechoic(LTA) polymers
LTA is recognized by TLR2
ceftaroline activity
MRSA activity; broad GP activity. no enterococci; only some gram-neg activity. no pseudomonas�similar activity to that of gen3
treatment for s. agalactiae infection?
penicillin
if allergic: vancomycin or clindamycin
screen pregnant women and treat those that are colonized when at term
Penicillin G. clinical use
Grp A and B strep. and Streptococcus pneumoniae; anaerobic infections(dental abscess. human bites); syphilis
developmental cycle of chlamydia infection
- elementary body(EB) binds host cell and is internalized in a vacuole(inclusion)
- EB differentiates into a reticulate body(RB) which is metabolically active and starts to grow
- RBs multiply and at about 20-40hrs after infeciton, differentiate back into EBs
- once 100-1000 EBs form, the inclusion is mature and it can lyse to spread to other cells!
clinically relevant mycoplasma species
m. pneumoniae
m. hominis
m. genitalium
m. fermentens
ureaplasma urealyticum
name the carbapenems
meropenem imipenem ertapenem doripenem(black boxed)
cefazolin, cephalexin(1st gen) clinical use
surgical prophylaxis. soft skin/tissue infections(resistance limiting)
clostridium tetani
pathogenesis
manifestation
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
Daptomycin. administration
IV
disinfection
process of removing/killing MOST microorganisms on or in a material
peptostreptococcus is found where?
what diseases does it cause?
mucosal surfaces AND skin
Causes:
- sinusitits(can travel to brain, lungs)
- intraabdominal infections
- endometritis, pelvic abcesses
- cellulitis, nec fasc
- osteomyelitis
as an anaerobe, this will create abcesses
most clinically relavent moraxella species
m. catarrhalis
H. influenzae virulence factors
- 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)
most clinically relevant acinetobacter spp?
acinetobacter baumannii
vats dat
clumped GP, nonspore anaerobic rods
propionibacteria!
how are legionella infections spread?
aerosolized water sources:
- showers
- whirlpools
- humidifiers
- tap water/faucets
- cooling towers
where do enterococci colonize?
most important virulence factor?
GI tract!
antibiotic resistance is most common virulence factor…comes from antibiotic use affecting microbiome…
diseases caused by C. trachomatis
-
inclusion conjuctivits - primary infection
- opthalmia neonatorum in newborns
- follicular conjuctivitis(trachoma) - chronic infection
- pneumonia syndrome of newborn
- genital STI
newborns get infection passed to them from mama at birth;
cefepime. administration
IV
cefoxitin. administration
IV
most common Group A strep species?
most common Group B strep species?
what determines grouping?
group A - s. pyogenes
group B - s. agalactiae
groups are determined by its common cell wall carbohydrate
types of patients commonly getting enterococcal UTI
males hospitalized, catheterized pts not common in healthy, non-hospitalized females
Penicillin V. administration
PO
most common species of enterococci how do their treatments differ?
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
- s. maltophila*
- b. cepacia*
full names?
where are these guys contracted?
- stenotrophomonas maltophila*
- burkhoderia cepacia*
more ICU bugs
treat steno w/TMP-SMX
toxins of c. diff
- enterotoxin(toxin A) - attracts PMN and makes them release cytokines
- cytotoxin(toxin B) - destroys cellular cytoskeleton of colon(destroy actin)
name the aminoglycosides and their mechanism and activity
gentamicin amikacin tobramycin streptomycin binds 30S ribosome; stops protein synthesis only GN(w/pseudo) activity; cant’ penetrate GP wall w/out synergy
what are the virulent enzymes in s. aureus related to tissue destruction?
coagulase, hyaluronidase, catalase, fibrinolysin, lipases, nucleases
ceftriaxone penetration, half life
high degree of CSF penetration; EXTREMELY long t1/2. can q24h dose for outpatient IV
ecthyma gangrenosum can result from what manifestation of a pseudomnas infection?
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
Colistin(polymyxin E). administration
IV
name the macrolides, mechanism, and activity
azithromycin clarithromycin erythromycin binds 50S subunit, blocks translocation broad GN(no pseudo) GP: staph,strep, pneumo(if susc.) atyp: myco, legionella, chlamydia
epidemiology of bordatella
- HIGHLY contagious; spread via aerosols
- majority of cases in young children, most deaths
- adults have less severe symptoms but are likely reservoirs
metronidazole
mechanims, activity
diffuses into bacteria and produces free radicals
activity: ANAEROBES“below diaphragm”
includes b. fragilis; protozoa
top causes of acute otitis media
strep pneumoniae
haemophilus influenzae
moraxella catarhallis
treatment of c. botulism
ventilatory support
metronidazole
trivalent botulinum antitoxin
Nafcillin, dicloxacillin activity
GP ONLY; narrow specturm; think penicillin G with overcoming certain b-lactamases
what diseases are caused by actinomyces?
actinomycoses:
- cerebral
- cervicofacial(angle of mandible)
- thoracic - can cause aspirate pneumonias; can move through lungs to make draining lesion
- abdominal - appendicitis can perforate, cause bacteremia and allow lesions in liver
- pelvic
cefoxitin activity
excellent anaerobic activity 2nd generation
Penicillin G. resistance?
B-lacatamases hydrolyze b-lactam ring; PBPs can be modified on transpeptidase; decreased perm.; efflux pumps
pyogenic systemic disease caused by s. aureus
pneumonia
empyema
osteomyelitis
septic arthritis
endocarditis
bacteremia
what infeciton precedes acute rheumatic fever
what is the incubation period
10-30 days following a pharyngitis from a GA-strep infection
pathogenesis of actinomyces israelii
pt’s mucosal barrier is disrupted, allowing the actinomycoses to travel
surgery, trauma, radiation, aspiration, foreign body, diverticulitis, appendicitis
top causes of bacterial pneumonia
- strep pneumoniae
- haemophilus influenzae
- staph aureus
- GAS
ampicillin. amoxicilin clinical use
community acquired HEENT/upper resp infectsion; community acquired UTI
treatment for moraxella infections
treat m. catarrhalis with amoxicillin/clavulanate, cephalosporins
just like haemophilus
prevnar
pneumovax
both pneumococcal vaccines
prevnar - given to all children
pneumovax - 65+ y/o
pathogenesis for L. pneumophilia
- attach/entry into alveolar macrophages(bind C’, type IV pili)
- inhibit fusion of phagolysosome
- begins replicating in vacuole
- secretes virulence factors via Dot/Icm type IV secretion system
- keeps growing till cell lyses then moves to next cell
morphology of peptostreptococcus
GP cocci; anaerobe
anti-tubercular drugs
isoniazid, rifampin, streptomycin, ethambutol, pyrazinamide
diagnostics for legionella
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
piperacillin-tazobactam. activity
adds S.aureus (not MRSA). B-lactamase producing GN and anaerobes; AND PSEUDOMONAS
morphology of haemophilus
small, GN, coccobaccilli
ampicillin. administration
IV
Carbapenems. clinical use
empiric treatment for serious infections and resistant infections
ceftriaxone. administration
IV
most common bacterial infection of burn pts?
pseudomonas!
Fosfomycin resistance?
can develop rapidly on the transporter that brings the drug into the bacteria
what streptococcal subgroup is s. pneumoniae a part of?
the mitis subgroup
treatment of c. diff
discontinue any implicated antibiotics
give oral metronidazole, (oral vanc if bad)
disinfect room
STOOL TRANSPLANT
most clinically relevant pseudomonas species?
pseudomonas aeruginosa
name all the cephalosporins in order by generation
1st gen: cefazolin cephalexin(PO) 2nd gen cefoxitin 3rd gen ceftriaxone ceftazidime 4th gen cefepime 5th gen ceftaroline
neonate gets fever in first 4-6 weeks of life
doc orders an LP
what is the doc looking for?
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!
what drugs cover pseudomonas
pip/tazo
cefepime
ceftazadime
aminoglycosides
imipenem
meropenem
fluoroquinolones(ciprofloxacin)
aztreonam
polymyxins
relavent bordetella species
**b. pertussis **(whoopin cough)
**b. parapertussis **(milder disease)
ceftaroline. administration
IV
piperacillin-tazobactam. administration
IV
disease caused by mycoplasma pneumoniae
treatment?
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)
sterilization
inactivation or elimination of ALL viable organism and their spores
what are the major/minor criteria for rheumatic fever?
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
Penicillin G. activity
GN: cocci only; GP: cocci and anaerobes; spirochetes. enterococci
carbopenam. adverse effects
hypersensitivity(cross-reaction w/penicillin)
stages of bordatella disease
- *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
cefazolin. administration
IV
describe the h. influenzae vaccine
PRP(polyribosyl ribitol phosphate) attached to protein conjugate
rifaximin use
traveler’s diarrhea enteric drug; does not absorb across gut
clostridium botulinum
how does it manifest?
what are the 3 forms?
botulinum toxin, prtctd in GI, blocks neurotransmission at peripheral cholinergic synapses; inactivates proteins that release ACh
FLACCID PARALYSIS
- foodborne - toxin is found in food
- wound - organism contaminates wound; multiplies; makes toxin
- infant - organism is ingested w/food; multiplies in GI, maks toxin
Vancomycin oral
does not cross GI tract given orally; used for c. diff
describe these “types” of flagellum
amphitrichous
lophotrichous
peritrichous
monotrichous
amphitrichous - single on each end
lophotricous - multiple flagellum; same spot
peritrichous - multiple in all directions
monotrichous - single
Nafcillin. administration
IV
hot tub folliculitis
low grade fever, self-limited, benign tender pruritic papules from infected water source
caused by pseudomonas
top causes of atypical pneumonia
- VIRUSES
- mycoplasma pneumoniae
- chlamydia pneumoniae
- legionella pneumophilia
coxiella
diseases?
treatment?
Q fever(self-limiting flu-like illness) –> chronic form includes endocarditis
Treat with doxycycline
chlamydia virulence factors
- adherence proteins
- autotransport(T5S) - moves polymorphic membrane proteins to surface; need for adherence, antigen variation
- Type III Secretion(T3S) - molecular syringe; injects virulence factors across membrane of cell/inclusion
- clostridial toxins
unique molecules on surface of acid-fast bacteria
classic acid fast bacteria?
mycolic acid
wax d
arabinogalactans
sulfolipids
mycobacterium are acid-fast
treatment for legionella
fluoroquinolones(levofloxacin) for CA-pneumonia
- change to azithromycin if legionella is diagnosed
sanitization
cleaning process which reduces pathogen levels to produce a healthy/clean environment
virulence factors for pseudomonas?
- pili, flagella for adherence/movement
- LPS(endotoxin)
- polysaccharide capsule(slime coat)
- Exotoxin A(ETA): similar to diptheria toxin; causes necrosis
- T3S: exoenzyme S, secreted toxins
- degradative enzymes
Daptomycin. adverse effects
GI distress. HA. elevated CPK(creatine phosphokinase)/rhabdomyolysis(avoid statins)
most common forms of botulinum toxin in US
where is c. botulinum found?
toxins A, B, E
found on soil, surface of fruit/veggies, marine sediment
aztreonam activity, clinical use
GN only, used w/b-lactam allergy occasionally; limited immunogenic potential
clinical presentation of c. botulinum
cranial neuropathies w/symmetric descending paralysis
ceftazidime clinical use
pseudomonas activity; very broad GN
Vancomycin. clinical use
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
Vancomycin. adverse effects
Red Man Syndrome; dose-related ototoxicity; nephrotoxicity(avoid co-administration with other agents)
Polymyxin B. administration
IV
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?
chlamydia
C. pssittaci
treat with doxy or tetracyclines
aztreonam. administration
IV
treatment for H. influenzae
unencapsulated/non-invasive - amoxicillin; amoxicillin-clavulanate for resistant strands
Hib(meningitis) - cefotaxamine(3rd gen cephalo)
Bacitracin. activity
GP only, topical
recovered colonies in 70-80% of SAAs; usually act as normal flora
opportunistic STIs; usually infect w/other pathogens
u. urealyticum can cause NGU
diseases caused by m. hominis, m. genitalium & u. urealyticum
