Bacterial Infections II: Atypical Flashcards
Mycoplasma, Legionella, Chlamydia are all ????
atypical causes of pneumonia
Small bacteria lacking a cell wall are _____
mycoplasma
Where are mycoplasma commonly found?
Commonly found lining mucous membrane of genitourinary tract and respiratory tract
_____ most associated with acute infection - pneumonia
M. pneumoniae
Filamentous organism
Attaches to epithelial membranes - especially the respiratory tract
Causes epithelial injury and activates immune response
What am I?
mycoplasma
Transmitted via respiratory droplets
Incubation period - 2-3 weeks
Most common during fall and summer
Most common in young adults; high school students, college students, military, etc.
Community-acquired rates increasing
What am I?
mycoplasma
What kind of infection is characterized by Gradual onset
Milder form of “pneumonia”
Scant sputum production
Often associated with pharyngitis and/or AOM
“Bullous myringitis”
Cough
Extrapulmonary manifestations
Also referred to as “Walking Pneumonia”
mycoplasma
How is mycoplasma pneumoniae diagnosed?
Labs - often normal or nonspecific
Typically, a “clinical” diagnosis
Diagnosed by NP swab
What does the chest xray look like on a pt with mycoplasma pneumoniae?
Chest X-ray - often nondiagnostic patchy infiltrates (no lobar consolidation)
What is the empiric antimicrobial treatment of choice for possible M. pneumoniae community acquired pneumonia?
macrolides
Infections of genital/reproductive tract, eye, and respiratory tract in infants are ____
Chlamydia trachomatis
Obligate intracellular bacteria
Do not contain a peptidoglycan cell wall
What am I?
Chlamydia
_____ is the Second most common cause of “atypical” pneumonia
Chlamydia Pneumoniae
Must you distinguish between C. pneumoniae and M. pneumoniae before treatment?
No, they are treated the same
What treatment would you prescribe for chlamydia pneumoniae?
macrolides
What does Chlamydia Psittaci present as?
“Atypical” pneumonia
Fever, chills, cough, HA
Contact with birds (usually pet birds)
7–15-day incubation period
Pneumonia s/s and the have a pet bird at home.
What am I?
Chlamydia Psittaci
What is the treatment for Chlamydia Psittaci?
tetracycline
erythromycin
What is the most common STD?
Chlamydia Trachomatis
What is the incubation period for Chlamydia Trachomatis?
7-14 days, often asymptomatic
Female - cervicitis, urethritis, PID
Male - urethritis, epididymitis, prostatitis
Both sexes - conjunctivitis, lymphogranuloma venereum
What am I?
Chlamydia Trachomatis
Mucopurulent discharge
Red, inflamed, friable cervix
PID - pelvic pain, dyspareunia, cervical motion tenderness
What am I?
Chlamydia
Trachomatis
Mucoid/watery urethral discharge
Dysuria
Epididymitis - testicular pain; palpable, swollen epididymis
What am I?
Chlamydia
Trachomatis
What is the diagnostic test for Chlamydia Trachomatis?
culture
gram stain is not helpful
What is the Ddx for cervicitis?
What is the treatment of choice for urogenital chlamydia?
Z- Max or doxy BID for 7 days
What are the complications of Chlamydia Trachomatis
Pregnancy complications - PROM (premature rupture of the membranes)
Infertility (from PID)
Transmission to newborn
Perihepatitis (Fitz Hugh-Curtis syndrome)
What is Fitz Hugh-Curtis syndrome?
a rare chronic condition that causes inflammation of the liver capsule and adhesions, leading to pain in the upper right quadrant of the abdomen. It’s a complication of pelvic inflammatory disease (PID) that can be caused by infections with Neisseria gonorrhoeae or Chlamydia trachomatis.
What are three diseases commonly associated with spirochetes?
Syphilis
Lyme Disease
Leptospirosis
Syphilis is caused by what bacteria?
Treponema pallidum
______ transmitted by direct contact with infectious lesion during sexual activity
Syphilis
What is the incubation period for syphilis?
21 days before symptoms
What are the clinical stages of syphilis?
Primary Syphilis
Secondary Syphilis
Tertiary Syphilis (Late Syphilis)
Neurosyphilis
Latent Syphilis
Early syphilis occurs ???
Within the first year
very infectious
What is the symptom free period between early and late syphilis?
Latent syphilis = Infectious w/in 1st year of primary infection
Is Tertiary/late syphilis contagious?
NOT contagious
When do sx appear in a syphilis pt? Name a definite sign?
Symptoms appear 3-4 weeks after contact
chancre: painless ulcer
How is syphilis diagnosed?
Culture of ulcer
Serologic tests: Non-treponemal antibody test
If positive then Treponemal antibody test: TPPA and FTA used to confirm diagnosis
When will a RPR test be positive on a pt who has syphilis?
Positive 4-6 weeks after infection; 1-2 weeks after presence of chancre
What is the treatment for syphilis?
benzathine penicillin G 2.4 million units IM in a single dose (Bicillin L-A)
pencillin VK
amoxicillian
Do you need to report syphilis to the local health department?
YES!!
When does secondary syphilis begin? Are you still infectious?
Begins several weeks to 6 months after chancre
***Still Infectious
In secondary syphilis, you will see dissemination of ______ throughout body produces systemic symptoms
T. pallidum
What is condyloma lata?
genital warts
Are all clinical manifestations of ______
secondary syphilis
early latent syphilis is ???? after the primary infection. Is it still infectious?
within the first year
Yes
late latent syphilis is ???? after the primary infection. Is it still infectious?
after the first year
NOT infectious
What is the presence of gummas indicate?
tertiary syphilis
infiltrative tumors
Skin, bones, internal organs (liver)
Skin & mucous membrane lesions - gumma
Bone lesions - marked bone pain
Respiratory distress - gumma deposits in lungs
Liver disease/cirrhosis
Cardiovascular lesions
Aneurysms
Neurosyphilis
What am I?
Tertiary syphilis
Neurosyphilis is most common during what stage?
late syphilis
What is Asymptomatic neuroinvasion?
T. pallidum infects CSF; no symptoms yet
Impairment of proprioception and vibration sense
Wide based gait; inability to walk in the dark
Muscle hypotonia and hyporeflexia
Paresthesia; sharp, recurring pains; pain “crises”
Inability to control bladder
What am I?
Tabes dorsalis
What is tabes dorsalis? What disease is it associated with?
Chronic progressive degeneration of posterior columns of spinal cord
neurosyphilis
How do you dx neurosyphilis?
same as syphilis plus lumbar puncture
What is the treatment for neurosyphilis?
PCN
What are some risk factors for neurosyphilis?
HIV
Non-HIV
Male gender
Age 45 years and older
What bacteria is associated with Lyme disease?
Borrelia burgdorferi
Where is lyme disease more common?
More common in northeastern and north central US
Erythema migrans - flat “bulls’ eye” lesion with central clearing, HA, myalgias, fatigue.
What am I?
Lyme disease
When does the bulls eye lesion tend to appear? What % of patients do NOT show this symptom?
occurs 1 week after tick bite
10-20% of patients do not present with lesion
What does stage 2 of lyme disease present like?
Bacteremia
Secondary skin lesions and rash
Worsening of flu-like symptoms
Cardiac involvement (4-10% of patients)
Neurologic manifestations (10-15% of patients)
What does stage 3 lyme disease present like?
Musculoskeletal (60%)
Joint pain: arthritis (knee)
Neurologic
Skin
What criteria do you need to establish lyme disease as the cause?
A person exposed to a tick bite who:
*Developed erythema migrans
or
*Had at least one late manifestation
and
*Laboratory confirmation
What lab test do you order to check for lyme disease?
ELISA (Enzyme linked immunosorbent assay) - detects antibodies to B. burgdorferi
Confirm with Western Blot
What is the treatment of choice for Lyme Disease? Pregnant pt?
doxy
amoxicilin
How long should you continue treatment for lyme disease?
10-21 days
Who do you treat prophalaxis for lyme disease?
_____ is transmitted to humans by ingestion of food or drink contaminated by urine of the infected animal (rat)
Leptospirosis
_____ manifestations can range from minor to fatal liver and kidney disease
Leptospirosis
How is Leptospirosis dx?
serologic testing
What is the treatment for Leptospirosis?
doxy
_____ is the most serious rickettsial disease
Rocky mountain spotted fever
Dermacentor (wood tick, dog tick) is the cause of _____
Rocky Mountain Spotted Fever
What states are Rocky Mountain Spotted Fever commonly found in?
N. Carolina, Tennessee, Oklahoma, Arkansas, Missouri
How long does it take for Rocky Mountain Spotted fever s/s to appear?
2-14 days after tick bite
fever, chills, HA, N/V, myalgias, insomnia, and characteristic rash
Rash - faint macules progressing to papules, then to petechiae
Rash appears on first on wrists and ankles and spreads centrally
Can progress to delirium, lethargy, seizures, and coma
What am I?
Rocky Mountain Spotted Fever
What is the treatment of choice for RMSF?
Doxy BID
Typhus, Ehrlichiosis and Anaplasma all produce symptoms of ____, _____ and ______.
What is the treatment?
Fever, rash, myalgia
Doxy
