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cdc yellowbook > bacterial infection (ABC) > Flashcards

bacterial infection (ABC) Flashcards

1
Q

what is bacteria name causing anthrax?

A

bacillus anthracis, gram +, encapsulated, spor-forming, nonmotile, nonhemolytic, rod-shaped

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2
Q

how do you get anthrax?

A

from infected animals

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3
Q

anthrax infection can occur via…

A

cutaneous (spores), ingestion (eating meat), injection (heroin), inhalation (aerosolized spores from hides or wool)

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4
Q

anthrax is most common in which area?

A

agricultural regions in sub-Saharan Africa, Central and South America, central and southwestern Asia, SE and E Europe

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5
Q

most reported form of anthrax in humans is??

A

cutaneous anthrax (95-99%)

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6
Q

who is at greatest risk for anthrax infection?

A

safari areas - direct contact with animals or carcasses; limited meat inspection area; exposed to livestock byproducts; immigrants and refugees in areas of low socioeconomic development and limited food availability

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7
Q

symptoms of cutaneous anthrax?

A

itching-> painless papule->vesicle that enlarges and ulcerates-> depressed black eschar 7-10 days; edema around lesions; head, neck, forearms, hands are most common sites affected; malaise and headache; 1/3 febrile

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8
Q

symptoms of ingestion anthrax?

A

1-7 days after eating; fatal 40%; fever, chills;
Oropharyngeal anthrax - sore throat, difficulty swallowing, swelling of the neck, regional lymphadenopathy, airway compromise and death
Intestinal anthrax - nausea, vomiting, diarrhea (bloody), marked ascites or coagulopathy can develop, shortness of breath and altered mental status, with shock and death occurring 2-5 days after disease onset.

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9
Q

symptoms of injection anthrax?

A

within 1-4 days; death more than 1/4; swelling, erythema, excessive bruising at the injection site, pain, septic

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10
Q

symptoms of inhalation anthrax?

A

within a week; 45% fatal; prodromal period –> cough, shortness of breath, chest pain, nausea/vomit (similar to influenza, corona, pneumonia) –> altered mental status, shortness of breath

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11
Q

what is anthrax meningitis?

A

develop from hematogenous spread of any of the clinical forms of anthrax - severe headache, altered mental status, meningeal signs, neurologic deficits of any kind

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12
Q

how do you diagnose anthrax?

A

unexplained fevers or new skin lesions; travel history; bacterial culture; detection of bacterial DNA, antigens, or toxins; or detection of a host immune response to B. anthracis; thoracic imaging studies to detect a widened mediastinum or pleural effusion;

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13
Q

how to treat anthrax?

A

1st line: ciprofloxacin (or levo, moxi) or doxy
2nd line: clindamycin, penicillin (if susceptible)

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14
Q

how to prevent anthrax?

A
  • vaccine only for researchers working in anthrax-endemic areas handling animals/products or military in that area
  • avoid contact with animal carcasses; don’t eat meat from animals butchered after having been found dead or ill
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15
Q

which bacteria causes ‘trench fever’?

A

Bartonella quintana

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16
Q

which bacteria cause Carrion disease?

A

bartonella bacilliformis

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17
Q

which bacteria causes cat scratch disease?

A

bartonella henselae

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18
Q

how is Bartonella quintana trasmitted?

A

by human body louse (worldwide)

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19
Q

how is Bartonella bacilliformis transmitted?

A

by infected phlebotomine sand flies (Lutzomyia)

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20
Q

how is Bartonella henselae trasmitted?

A

scratches from domestic or feral cats (kittens) ; bite of infected cat fleas ; worldwide

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21
Q

where is Carrion disease at risk ?

A

in the Andes Mountains at 1000-3000 m (~3300-9800 ft) elevation - most in Peru, but some in Bolivia, Chile, Colombia and Ecuador

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22
Q

Clinical presentation of Bartonella quintana infection?

A

fever, headache, transient rash, bone pain, mainly in the shins, neck, and back

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23
Q

Clinical presentation of Carrion disease?

A
  1. acute phase (Oroya fever) - fever, myalgia, headache, anemia
  2. eruptive phase (verruga peruana) - red-to-purple nodular skin lesions
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24
Q

Clinical presentation of Cat Scratch Disease?

A

papule or pustule, enlarged, tender lymph nodes 1-3 weeks after exposure, prolonged fever
atypical - follicular conjunctivitis, encephalitis, neuroretinitis, osteomyelitis, or infection of the liver or spleen

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25
Q

clinical presentation of bacillary angiomatosis?

A

Bacillary angiomatosis (epithelioid angiomatosis) is an uncommon disease characterized by neovascular proliferation in the skin or the internal organs (peliosis) due to an infection with Bartonella henselae or Bartonella quintana. It commonly occurs in immunocompromised as well as immunocompetent patients.

skin, subcutaneous, or bone lesions - caused by B. henselae or B. quintana;
peliosis hepatis manifests as liver lesions and is caused by B. henselae - both occur primarily in ppl with HIV

26
Q

how to diagnose bartobella quintana?

A

Serology, PCR testing, or blood culture
Endocarditis - elevated serology and by PCR or culture of excised heart valve tissue.

27
Q

how to diagnose Carrion Disease?

A

Oroya fever - blood culture or direct observation of the bacilli in peripheral blood smears; PCR and serologic testing can help

28
Q

how to diagnose CSD?

A

exposure history; serology; PCR or culture of lymph node aspirates

29
Q

how to treat B. quintana infection?

A

doxycycline + gentamicin

30
Q

how to treat Carrion Disease / Oroya fever?

A

chloramphenicol or ciprofloxacin

31
Q

how to treat CSD? (Cat scratch disease)

A

resolve without treatment - but azithromycin with extensive lymphadenopathy or to shorten the course of disease

A small % of ppl will develop disseminated disease with severe complication - neuroretinitis: doxycycline + rifampin

32
Q

what causes brucellosis?

A

by drinking/eating unpasteurized dairy products (milk, butter, soft cheese, ice cream) or eating undercooked meat (less risk); contacting with infected animals (via skin wounds, mucous membranes, or inhalation)

33
Q

what is the bacteria causing brucellosis?

A

Brucella spp - gram negative coccobacilli, facultative, intracellular.
Main spp - Brucella abortus (most widespread) , B. melitensis (most frequent), B. suis (feral swine and caribou or reindeer), B. canis (dogs)

34
Q

Regard to brucellosis, what animal is affected and where?

A

cattle, goat, sheep
Africa, Central and South America, Asia, eastern Europe, along the Mediterranean Basin, and the Middle East
In North America, Brucella spp. are endemic to the feral swine population and wildlife around the Greater Yellowstone Area.

35
Q

exposure to Brucella during pregnancy?

A

risk of miscarriage!

36
Q

clinical presentation and incubation time of brucellosis?

A

2-4 weeks incubation –> nonspecific (arthralgia, fatigue, fever, headaeh, malaise, myalgia, night sweats)

37
Q

what is the most common complication of brucellosis?

A

osteoarticular involvement, reproductive system involvement
rare endocarditis (cause of death)

38
Q

how to diagnose brucellosis?

A

blood culture but isolation rates can vary depending on stage of infection, previous use of antimicrobial drugs, type and volume of clinical specimen, and culture method used. - bacteria longer to grow

serologic testing - most common - serum agglutination test (SAT) to detect IgM, IgG, IgA.

39
Q

how to treat Brucellosis?

A

uncomplidated - doxycycline ( or oral tetracycline) and rifampin more than 6 weeks

complicated - add aminoglycoside 4-6 months

B. abortus RB51 is resistant to rifampin; modify treatment for brucellosis caused by this strain (doxy+trimethoprim-sulfamethoxazole)

40
Q

what is the causing bacteria of campylobacteriosis?

A

Campylobacter jejuni, C. coli, and more than 18 other species
Gram -, curved microaerophilic bacteria

41
Q

how to get campylobacteriosis?

A

eat contaminated foods (undercooked chicken), drink contaminated water or dairy products (unpasteurized milk)
contact with pets (kittens and puppies) and farm animals (cows, poultry)
rarely fecal-oral route

42
Q

which area and which season is affected by campylobacteriosis?

A

worldwide, but greatest risk Africa, Asia, and South America, where food handling practices and sanitation might not be adequate/ rural area ; year-round in low- and middle- income countries and late summer and fall seasonality in developed countries.

43
Q

how to diagnose campylobacteriosis?

A

stool specimens/rectal swabs - before antimicrobial treatment (within 2 hours of stool sample collection)

44
Q

what is the clinical presentation of campylobacteriosis?

A

incubation 2-4 days –> diarrhea (frequently bloody), ab pain, fever, occasionally nausea/vomit
severe: dehydration, bloodstream infection, symptoms mimicking acute appendicitis or ulcerative colitis.
complications: irritable bowel syndrome, reactive arthritis, Guillain-Barre syndrome (C. jejuni - 5-41% of all GBS cases!)

45
Q

how to treat campylobacteriosis?

A

self-limited in healthy people, lasting less than 1 week
empiric antibiotics - azithrom - firstline; rates of AB resistance, especially fluoroquinolone resistance, have risen sharply in the past 20 years (South America and SE Asia)

46
Q

what bacteria causes cholera?

A

toxigenic Vibrio cholerae O-group 1 (O1, global) or O-group 139 (O139, few areas in Asia)

47
Q

how is cholera trasmitted?

A

water - untreated drinking water
raw food/undercooked food - fish & shellfish

48
Q

where is cholera endemic?

A

~50 countries: South and SE Asia, Africa, India, Pakistan, the Caribbean, Haiti, the Dominican Republic, Cuba

49
Q

who is more at risk of cholera?

A

who do not follow handwashing recommendations,
do not use latrines or other sanitation systems
low gastric acidity
blood type O (risk of severe disease)

50
Q

what are symptoms of cholera?

A

acute watery diarrhea
severe diarrhea (~10%) - rice-water stools often accompanied by nausea and vomiting that can rapidly lead to severe volume depletion.
if untreated >50% fatal; if treated <1%

51
Q

how to diagnose cholera?

A

stool sample

52
Q

how to treat cholera?

A

rehydration!
doxycycline - first-line for children, adults and pregnant people (recent systemic review among young children and pregnant people receiving doxycycline did not demonstrate a safety risk)
multidrug-resistant isolates - doxycycline and tetracycline; erythromycin and azithromycin are alternative

53
Q

what is the name of vaccine for cholera?

A

Vaxchora, PaxVax in US (CVD 103-HgR, a live, attenuated, single-dose oral cholera vaccine)
2-64 yrs age, 1 dose at least 10 days before traveling, 3-6 months effective)

Dukoral in Canada (2 doses, 1-6 weeks apart, 2-5 years need 3 doses, given 1-6 weeks apart; 2 years and older, 2 years effective)

54
Q

when do you prescribe cholera vaccine?

A

people travelling active cholera transmission area - endemic or epidemic cholera caused by toxigenic V. cholerae O1.

55
Q

how effective is Vaxchora vaccine?

A

90% at 10 days, 80% at 3 months

56
Q

how is Vaxchora administered? is revaccination recommended?

A

mixed in 100ml water; 2-5 years, 50ml given;
the safety and efficacy of revaccination have not been established

57
Q

Vaxchora is not currently licensed for use in …

A

< 2 years or adults >65 yeras; pregnant or lactating ppl, immunocompromised ppl

58
Q

interaction between Vaxchora and chloroquine and other antibiotics?

A

chloroquin reduced the immune response to the vaccine - chloroquin should start > 10 days after Vaxchora
antibiotic might reduce efficacy - wait till 2 weeks after antibiotic

59
Q

what is precautions of Vaxchora?

A

shed in the stool for more than 7 dyas

60
Q
A

cdc yellowbook (26 decks)

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