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Bacterial infections of the blood Flashcards

1
Q

What is bacteremia?

A

Bacterial infection of the blood

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2
Q

True or false: bacteremia is not uncommon, and can occur from trauma to a body site that has normal flora

A

True

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3
Q

What type of bacteremia results from dental extraction?

A

Transient–goes away quickly

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4
Q

What type of bacteremia results from pneumococcal pneumonia?

A

Intermittent

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5
Q

What type of bacteremia results from gram negative sepsis? What is the consequence of this?

A

Intermittent, but constantly there

Need to take multiple cultures to “catch” the bacteria

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6
Q

What type of bacteremia results from an intraabdominal abscess?

A

Intermittent, with disappearing amounts

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7
Q

What type of bacteremia results from infective endocarditis?

A

Continuous and low

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8
Q

What type of bacteremia results from catheter bacteremia?

A

Continuous

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9
Q

What are the three possible consequences of bactermia?

A
  1. Transient and benign
  2. Sepsis/shock
  3. Endocarditis
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10
Q

What is sepsis?

A

Systemic inflammatory response syndrome (SIRS) that has a proven or suspected microbial etiology

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11
Q

Is bacteremia required for sepsis?

A

No–microbial could release toxins into the blood

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12
Q

What are the signs that occur with SIRS/sepsis? How many of these signs are needed to make a diagnosis of sepsis?

A

Fever/hypothermia
Tachypnea
Tachycardia
Abnormal WBC

Need to have at least two of these

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13
Q

What is severe sepsis?

A

Sepsis with one more more signs of organ dysfunction

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14
Q

What is septic shock?

A

Severe sepsis + hypotension (systolic pressure <90 mmHg)

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15
Q

What is refractory septic shock?

A

Septic shock that lasts for >1 h and does not respond to fluid and pharmacological treatment

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16
Q

What is multiorgan failure?

A

Dysfunction of >1 organ, as well as disseminated intravascular coagulation

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17
Q

What are the inflammatory cytokines that result in sepsis?

A

IL-6
TNF-alpha
DIC

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18
Q

What causes the organ failure in sepsis?

A

DIC

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19
Q

What general type of microorganism is usually responsible for sepsis (viruses, bacteria, fungi, or parasites)?

A

Bacteria

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20
Q

True or false: bacteremia is required to have bacterial sepsis?

A

False–exotoxins can cause sepsis

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21
Q

What is the pathophysiology behind sepsis?

A

Gram Negative LPS (or other PAMPs) causes release of cytokines

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22
Q

How can gram positive bacteria cause septic shock?

A

Release of exotoxins or peptidoglycan

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23
Q

How do fungi cause sepsis?

A

PAMPs associated with yeast like teichoic acid

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24
Q

LPS binds to what?

A

CD14 and TLR4

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25
Which major cytokines does TLR4 recruit that causes sepsis?
TNF-alpha IL-1 IL-6
26
What is the gram stain, morphology of staph Aureus? Catalase?
Gram positive cocci in clusters Catalase positive
27
What is TSST-1?
Superantigen from Staph. Aureus
28
Toxic shock syndrome is caused by what now?
Wound infections
29
How does strep pyogenes Toxic shock syndrome compare to staph toxic shock syndrome?
Most patients are bacteremic with strep, unlike staph Aureus intoxications
30
Most patients who develop strep toxic shock syndrome have what? What species of strep causes this?
Necrotizing fasciitis Strep Pyogenes (GAS)
31
What are the pyrogenic exotoxins? What are the types that strep pyogenes has?
Superantigens that are produced by strep pyogenes (A, B, and C)
32
How do you diagnose sepsis?
Symptoms + Blood cultures
33
What percent of blood cultures in pts with septic shock will be positive?
40-70%
34
What happens to the sensitivity of cultures when you take many?
Increases
35
In pts that are on abx therapy, are cultures still useful?
no
36
What is the treatment for hypotension seen in sepsis? Hypoxia?
IVF | Ventilatory therapy
37
What is the treatment for DIC seen in sepsis? (2)
Transfusion, heparain
38
What is the treatment for sepsis of unknown etiology?
Vancomycin/gentamicin
39
Which two bacteria present with erythroderma (in sepsis)?
Step pyogenes or staph aureus
40
What are the presenting symptoms with neisseria meningitidis (for sepsis)?
Sepsis + petechiae in skin
41
What are the presenting symptoms with rickettsia rickettsii?
Petechial skin lesions | h/o tick bite
42
What are the presenting symptoms with vibrio vulnificus?
Hemorrhagic skin lesions who has recently eaten raw oysters
43
What is the endocardium?
The innermost layer of the tissues that lines the chambers of the heart
44
Most endocarditis infections occur where within the heart?
On cardiac heart valves
45
What are the symptoms of acute endocarditis? What is the usual pathogen?
Acute onset of high fever usually Staph Aureus
46
What are the symptoms of subacute endocarditis? What is the usual pathogen that causes this?
Nonspecific but weight loss, and night sweats Usually associated with viridans strep
47
What are the four clinical features of endocarditis?
1. New or unchanging heart murmur 2. Splenomegaly 3. Skin lesions 4. Retinal lesions
48
What are Roth spots?
Retinal hemorrhages that can be caused by endocarditis
49
What are splinter hemorrhages?
Red linear streaks in the nail bed. Can be caused by endocarditis
50
What are janeway lesions? Painful?
**Painless** lesions on palms or soles of the feet
51
What are the Osler nodes? Painful?
**Painful**, subcutaneous nodule sin the pads of the digits
52
What are the two most common etiological agents of endocarditis?
1. Viridans strep | 2. Staph Aureus
53
What percent of endocarditis cases are caused by enterococci?
5-18%
54
What percent of endocarditis cases are caused by fungi?
2-4%
55
What is the gram stain and morphology of strep? Catalase result?
Gram positive cocci in chains. Aerobic | Catalase negative
56
What is GAS?
Strep pyogenes
57
What is GBS?
Strap agalactiae
58
What is GDS?
Enterococcus
59
What are the three strep groups that are not labeled in the lancefield groups?
Strep viridans group: Strep pneumonia Strep mutans Strep mitis
60
S mitans and S salovarius can cause what serious disease?
Endocarditis
61
What are the hemolytic results of the viridans strep?
Alpha
62
True or false: viridans strep are normal flora
True
63
What is the treatment for infections with viridans strep?
PCN or vanco if resistant
64
How does the virulence compare for strep compared to staph
Less
65
How can you tell difference between strep viridans from strep pneumonia (since both are Alpha-hemolytic)?
Optochin test Pneumonia is susceptible
66
What are the two risk factors required for endocarditis?
1. Susceptible cardiovascular substrate (prosthetic heart valve) 2. Source of bacteremia
67
Why are IV drug users susceptible to endocarditis?
Constant exposure to bacteria
68
What is the average age of onset for endocarditis?
70 years
69
What is the common nosocomial cause of bacterial endocarditis?
Central catheter placement
70
What is the pathophysiology of endocarditis?
Vegetations on the heart valves where there are cardiac abnormalities
71
How does splenomegaly occur with endocarditis?
Septic emboli
72
What are the two major criteria for diagnosing endocarditis?
1. Positive blood culture with a typical organism | 2. Evidence of endocardial involvement (echo)
73
What are some of the minor criteria for endocarditis?
1. Fever 2. Predisposition 3. Vascular phenomenon
74
What is the treatment for endocarditis?
Prolonged, aggressive IV abx
75
What is the MOA of superantigens?
Stimulate T cells by binding to MHC II in the V-beta region of the T cell receptor
76
Endocarditis with acute onset is likely caused by what pathogen?
Staph Aureus
77
Endocarditis with subacute onset is likely caused by what pathogen?
Viridans strep
78
What are the two general genera of bacteria that are the usual suspects for endocarditis?
Strep (enterococci too) or staph
79
What causes the DIC seen in sepsis?
Impairment of the protein C pathway of coagulation

Microbio (50 decks)

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