Bacterial Flashcards
1
Q
pertussis etiology
A
- Bordatella pertussis
- highly contagious infection
- transmitted via resp droplets
2
Q
Who is at risk from a pt with pertussis?
A
- elderly
- pregnant
3
Q
What is the clinical case definition of pertussis?
A
- acute cough lasting at least 14d with one of paroxysmal cough, posttussive emesis, or inspiratory whoop
4
Q
How is pertussis confirmed?
A
- culture
- PCR
- leukocytosis with absolute/strikingly increased lymphocytosis
5
Q
What is the pathogenesis of pertussis?
A
- 2ndary bacterial infx
- primarily a toxin mediated dz
6
Q
complications of pertussis in infants
A
- hospitilazation
- PNA
- seizures
- encephalopathy
7
Q
What is the MC patient population for pertussis?
A
- children
8
Q
Define catarrhal phase
A
- 1st stage of pertussis
- URI sx x1w
(congestion, rhinorrhea, sneezing, low-grade fever, tearing, coryza)
9
Q
Define paroxysmal phase
A
- 2nd stage of pertussis
- severe paroxysmal coughing fits (older infants/toddlers w/ or w/o cough; infants
10
Q
Define convalescent phase
A
- 3rd stage of pertussis
- chronic cough lasting weeks to months (resolving sx p ~1m of onset)
11
Q
pertussis treatment
A
- older than 1mo = macrolide abx (erythromycin, clarithromycin, aythromycin)
- older than 2mo w/ macrolide allergy = bactrim (TMP-SMZ)
- under 1 mo = azythromycin
12
Q
Why are erythromycin and clarithromycin not recommended in infants?
A
- increased risk for infantile hypertrophic pyloric stenosis (IHPS)
13
Q
pertussis presentation
A
- 3-12d incubation period
- 3 stages
- petechiae above nipple line
14
Q
pt education about pertussis tx
A
- tx generally ineffective @ changing clinical course but decreases contagiousness
- abx given in paroxysmal stage doe not affect duration and severity
15
Q
define acute rheumatic fever
A
- systemic immune (autoimmune-like) process occurring 15-20d after group A streptococcal pharyngitis
16
Q
acute rheumatic fever symptoms
A
- Sydenham chorea
- carditis
- subQ nodules
- erythema marginatum
- migratory polyarthritis
17
Q
acute rheumatic fever pathophysiology
A
- migratory arthritis
- Sydenham chorea (St. Vitus’ Dance)
- carditis
- genetics
18
Q
When should you consider carditis in acute rheumatic fever?
A
- new/changing valvula murmurs
- cardiomegaly
- CHF
- pericarditits
19
Q
What are the labs/EKG for acute rheumatic fever?
A
- elevated ESR and CRP
- prolonged PR interval
20
Q
How is acute rheumatic fever dx’d?
A
- T. Ducket Jones criteria
- except chorea or possibly indolent carditis means you win the dx regardless of having the other sxs
21
Q
What is the work-up for acute rheumatic fever?
A
- throat culture
- ASO
- antistrep antibodies
22
Q
images for acute rheumatic fever?
A
- EKG
- CXR
- Echo
23
Q
acute rheumatic fever treatment
A
- PCN
- PCN allergy = oral cephalosporins
24
Q
T/F: Abx will lessen the course/frequency/severity of cardiac dz from acute rheumatic fever.
A
- false, no change
25
What is the treatment of severe carditis 2ndary to acute rheumatic fever?
- corticosteroids
- rest
- digoxin
26
What is the tx for Sydenham chorea?
- haloperidol
| - antimicrobial prophylaxis
27
botulism etiology/epidemieology
- Clostridium botulinum
- gram (+), spore forming rod
- neurotoxin inhibits ACh release @ neuromuscular jxn --> weakness, flaccid paralysis, respiratory arrest
28
When does the cure for botulism occur?
- only after sprouting new n. terminals
29
types of botulism
- infant (IB)
- foodborne (FBB)
- wound (WB)
30
infant botulism transmission
- bee honey
31
foodborne botulism transmission
- improper canning or home-prep of food
32
wound botulism transmission
- s/p traumatic injury
33
botulism presentation
- sudden onset 7 D's leading to paralysis
- GI sx (N/V)
- CN palsies
- ANS (opposite of SLUDGE)
34
What are the 7 D's of botulism presentation?
- diplopia
- dry mouth
- dysphagia
- dysarthria
- dysphonia
- decreased muscle strength
- dilated, fixed pupils
35
botulism workup
- wound cultures
- EMG
- mouse neutralization bioassay
36
botulism tx
- antitoxin
- supportive care
- PCN only for WB
37
What are the 3 species of chlamydia and the diseases that can result from each?
- C. pneumoniae = PNA
- C. psittaci = psittacosis or ornithosis
- C. trachomatis = STDs and PNA
38
S and S of C. pneumoniae PNA
- 3-4w incubation period
- gradual, biphasic onset
- follows URI
- prolonged cough and malaise
- hoarseness
- H/A
- pharyngeal erythema w/o exudate
- TTP sinus
- rhonchi and rales
39
S and S of C. psittaci PNA
- incubation period of 5-14d +
- sudden onset constitutional sx
- nonproductive cough, initially absent
- chest pain
- high fever
- pulse-temp dissociation
- sleepy
- splenomegaly
- maculopapular rash
- meningitis or encephalitis
40
S and S of C. trachomatis PNA
- 2-3mo old
- staccato cough
- tachypnea
- afebrile
- scattered crackles w/o wheezing
41
Describe chlamydia
- small
- gram (-)
- obligate intracellular
42
What do the 15 immunotypes of C. trachomatis cause?
- A-C = chronic conjunctivitis
- D-K = genital tract infx
- L1-L3 = genital ulcer dz
43
What is the MC cause of STDs in US?
- chlamydia
44
diagnostic tests for C. pneumoniae PNA
- IgM titer
- PCR
- cell culture
45
diagnostic tests for C. psittaci PNA
- paired acute/convalescent sera
| - seriologic tests
46
diagnostic tests for C. trachomatis PNA
- CBC = eosinohilia in kids
| - screen parents
47
general chlamydia PNA tx
- tetracyclines (bacteriostatic)
| - macrolides (inhibit bacterial growth)
48
abx tx for all 3 types of chlamydia PNA
- C. pneumoniae = doxycycline (except in kids)
- C. psittaci = tetracycline/doxycyline
- C. trachomatis = erythromycin
49
Who is most at risk for chlamydial GU infx?
- adolescent female (squamocolumna jxn)
50
What are the S&S of chlamydial GU infx in females?
- mucopurulent cervicitis
- PID -->Fitz-Hugh-Curtis syndrome
- dyspareunia
- hx of sexual activity w/o condoms
- most asymptomatic
51
What are the sx's of chlamydial GU infx in males?
- urethritis
- epididymitits
- hx or sexual activity w/o condom
- fever
52
What other infx are often associated with chlamydial GU infx?
- gonorrhea
- HIV
- syphillis
53
What is one of the leading causes of infertility in women?
- C. trachoma
54
C. trachomatis GU tx
- 1st: azythromycin and doxycycline
| - 2nd: erythromycin, PCN, and sulfisoxazole
55
What are the complications of chlamydial GU infx?
- HIV
- reactive arthritis syndrome
- miscarriage
- preterm delivery
- urethral scarring
56
How do you work up chlamydial GU infx?
- urine sample
- CBC for eosinophilia
- HIV
- HCG
57
presentation of C. trachomatis trachoma
- chronic follicular or intese conjunctival inflam
- tarsal conjunctiva scarring
- entropion and trichiasis
- corneal abrasions, scarring, opacifications leading to blindness
58
Who else, besides the patient must be tested in chlamydial GU infx?
- sexual partners
59
What is a contraindication to using doxycycline or ofloxacin?
- pregnancy
60
Who should be regularly screened for C. trachoma?
- all sexually active, nonpreg women 24y/o
| - NO routine screenings women > 25 y/o
61
What imaging can be done for C. trachoma?
- US
- CT
- CXR
62
Who should be admitted with C. trachomatis?
- adolescents with PID
63
What is the post therapy instructions?
- no sex until all partners have been cured
| - no sex for 1 week or until end of longer abx regimen
64
Define C. trachomatis trachoma
- chronic keratoconjunctivitis
| - repeated reinfection
65
What are the metabolic derangements of cholera?
- hypoglycemia
- acidosis
- hyponatremia
- hypokalemia
- hypocalcemia (Chvostek, Trousseau signs)
66
C. trachomatis trachoma tx
- oral azythromycin + tetracycline eye ointment
| - facial cleanliness
67
types of C. trachomatis trachoma
- follicular (TF)
- inflam ( TI)
- conjunctival scarring (TS)
- trichiasis (TT)
68
cholera etiology
- Vibrio cholerae
69
What is the hallmark sign of cholera?
- profuse secretory diarrhea (rice water stool)
70
What is the priority of cholera tx?
- hydration with electolytes
71
describe the diphtheria toxin
- A and B fragments
72
cholera pathophys
- comma, shaped, gram (-) aerobic or facultative anaerobic bacillus
- not acid- resistant (cant survive in the stomach ==> high infectious dose)
- overwhelms large intestine with excessive fluid loss from small intestine
73
cholera presentation
- sudden onset
- rice water stool
- dehydration
74
diphtheria presentation
- 2-5d incubation period
- non-specific, general URI sx
- *localized or coalescing pseudomembrane*
- cervical adenopathy = bull neck
- fever and nasopharyngeal sx
- cardiac and neuro toxicity
75
cutaneous diphtheria presentation
- indolent, non-healing ulcers covered with grey membrane
| often co-infx w/ S. aureus and strep
76
What is the work up for cholera?
- stool culture
- serologic testing
- chem 7
77
non pharm cholera tx
- cholera cots (dont pee in the bucket or else ovehydration will kill pt)
78
pharm cholera tx
- doxy
- TCN
- TMP-SMZ (bactrim)
- ciprofloxacin
79
What does chlamydia PNA look like?
- mycoplasma PNA
80
What is the tx for chlamydia PNA?
- macrolide
81
What is the etiology of diphtheria?
- Coynebacterium diphtheriae
| - aerobic gram (+) rod
82
How does diphtheria manifest?
- URI
| - cutaneous infx
83
diphtheria pathophys
- adheres to mucosal epithelial cells
- endosomes release endotoxin causing localized inflam rxn
- causes tissue destruction & necrosis
84
describe the diphtheria toxin
- A and B fragments
85
How is the diphtheria toxin moved in the body?
- lymph
| - blood
86
What is the MC cause of death of diphtheria?
- airway obstruction/suffocation s/p psuedomembrane aspiration
87
cutaneous diphtheria presentation
- indolent, non-healing ulcers covered with grey membrane
| often co-infx w/ S. aureus & strep
88
diphtheria workup
- culture
- gram stain
- toxigenicity (detection of toxin)
- CBC
- serum troponin
- EKG
89
diphtheria tx
- erythromycin or PCN for 14d
| - horse serum antitoxin
90
Define gonorrhea
- purulent infx of mucuous membrane caused by Neisseria gonorrhea
91
Besides gonorrhea, what else does N. gonorrhea cause?
- opthalmia neonatorum
| - systemic neonatal infx
92
What is the most common site of gonorrhea infx in women and what does it result in?
- cervix
| - endocervicitis & urethritis, complicated by PID
93
What is the most common site of gonorrhea infx in men?
- anterior urethritis
94
What are gonococcal complications?
- ectopic pregnancy
- high risk for HIV
- having gonorrhea is a risk factor for getting other STIs
- conjunctivitis
95
How is gonorrhea transmitted?
- male to female
96
gonorrhea S+S
- anal, vaginal, penile, or pharyngeal d/c
| - PID
97
PID sx
- lower abd pain
- dysuria
- cervical motion tenderness
- adnexal tenderness
- bleeding
- perihepatitis
98
Define disseminated gonococcal infx (DGI)
- gonorrhea that has spread
99
DGI S+S
- arthritits/dermatitis syndrome (joint and tendon pain with rash) (Lover's Heels)
- 2nd stage = septic arthritis
100
gonococcal work up
- culture
- seriologic tests
- STD panel
- NAAT, PCR, LCR
101
gonorrhea tx
```
- ceftriaxone IM
OR
- cefixime + azythromycin or doxy
(also tx for chlamydia)
- eval and tx sex partners
```
102
What is not recommended in the tx of gonorrhea?
- fluoroquinolones
| - TCN
103
PID tx
- cefalosporins
104
salmonella epidemiology
- consumption of contaminated foods
| - large inoculum unless in low acidic stomach (requires fewer) or postvaccine (requires more)
105
salmonella pathophysiology
- selectively attaches to specialized epithelial cells of the Peyer patches
106
nontyphoidal enterocolitis presentation
- loose, bloodless stools
- smaller vol stool than cholera
- resolves w/in 3-7d
107
typhoid fever presentation
- nonspecific features
- 10-14d incubation period
- H/A, malaise, myalgia, lethargy
- dry cough
- *stepwise, low grade fever progression*
- *bradycardia @ fever peak*
- *rose spots*
- coated tongue
- change in BM
108
salmonella work up
- blood cultures
| - stool cultures
109
T/F: Abx do not shorten salmonella duration of sx and may prolong duration of convalescent carriage.
- true
110
T/F: Abx are often used for uncomplicated nontyphoidal Salmonella gastroenteritis.
- false
111
What is the treatment for Salmonella bacteremia?
- single bactericidal drug for 10-14d
112
What are the surgical interventions for typhoid fever?
- cholecystectomy
- splenectomy
- endarterectomy
113
Shigella pathophys
- fecal-oral route
- ingestion of contaminated food or water
- fomites
- sexual contact
- vectors (housefly)
- low infectious dose
- can withstand low pH
114
Shigella symptoms
- sudden onset severe abd cramping
- high fever
- emesis
- anorexia
- large vol. watery diarrhea
- seizures
- tenesmus
115
Shigella signs
- elevated T
- tachycardia and tachypnea
- dehydration
- abd tenderness
- CNS sx
- anemia
- renal failure
116
Shigella work-up
- CBC
- blood culture
- stool exam and culture
- enzyme immunoassay for toxin
117
Shigella tx
- fluid + electrolytes
- antipyretics
- *VIt A*
- Zn
- beta lactams, quinolones, macrolides
118
What do you not give for Shigella?
- antidiarrheals
119
tx of travelers diarrhea
- doxy
120
What are the types of tetanus?
- neonatal
- cephalic
- local
- generalized
121
What causes tetanus?
- Clostridium tetani
122
What is formed by the C. tetani spores?
- 2 toxins: tetanolysin & tetanospamin
123
local tetanus presentation
- muscle rigidity near site of injury
124
general tetanus presentation (early)
- local muscle spasms
- neck/jaw stiffness
- dysphagia
- hyperirritability
125
general tetanus presentation (late)
- trismus
- drooling
- risus sardonicus
- descending muscle rigidity
126
tetanus tx
- immunizations
- ICU admit & supportive care
- benzodiazepines
- vecurnonium
- magnesium sulfate
- metronidazole NOT PCN
