Bacteriology Flashcards
1
Q
What is the treatment for MRSA prosthetic valve endocarditis?
A
Vancomycin + Rifampin + Gentamycin
6 weeks + 6 weeks + 2 weeks
2
Q
For what organism is there evidence to use Ampicillin + Ceftriaxone in endocarditis?
A
Enterococcus
CID 2013
Instead of Amp + Gent
2
Q
How to do sus testing for Bacillus species?
A
?
3
Q
What does LAP test stand for and what does it detect?
A
LAP = Leucine aminopeptidase
Leucine naphthylamide is hydrolyzed by LAP to leucine and free naphthylamine
Disks are impregnated with Leucine naphtylamide. In the prescence of LAP from a positive organism there is hydrolysis and the free naphthylamine couples with the DMACA reagent and forms a red colour
4
Q
What 5 catalase negative, gram positive cocci are LAP positive?
A
Enterococcus species Streptococcus pneumoniae Streptococcus pyogenes Pediococcus Lactococcus
5
Q
What does PYR stand for and what does it detect?
A
PYR = pyrrolidonyl aminopeptidase
L-pyroglutamic acid B-naphthylamide impregnated in disk, hydrolysis by PYR yields B-naphthylamide which couples with the DMACA reagent and makes a pink/red colour.
6
Q
2 nonsuppurative sequelae of group A streptococcus?
A
- Rheumatic fever
2. Poststreptococcal acute glomerulonephritis
7
Q
What is the capsule of Group A strep composed of and what is its function?
A
Hyaluronic acid - retards phagocytosis by PMNs and macrophages
Poor immunogen as it resembles human connective tissue
8
Q
What is the main virulence factor of Group A Strep?
A
M Protein - inhibits phagocytosis by inhibiting activation of the alternate complement cascade
9
Q
What gene encodes M protein in Strep pyogens?
A
emm gene
10
Q
What is the difference between serotype and genotype in strep pyogenes?
A
Serotype = antigenic difference of the M protein Genotype = nucleotide difference of the M gene
11
Q
For serological diagnoses what is the difference between
1) Whole blood
2) Plasma
3) Serum
4) Buffy Coat
A
Whole blood = all components of the blood
Plasma = The liquid component of blood that holds the blood cells in suspension - includes clotting factors, antibodies, proteins
Serum = Blood plasma without the clotting factors
Buffy coat = WBCs and Platelets, no erythrocytes
http://upload.wikimedia.org/wikipedia/commons/1/11/Blood-centrifugation-scheme.png
12
Q
3 Neisseria species that are rods
A
N. elongata
N. bacilliformis
N. weaveri
13
Q
3 Neiseria species that have yellow pigment
A
N. flavescens
N. sicca
N. subflava
14
Q
1 Neisseria species that is catalase negative
A
N. elongata
(subspecies elongata and nitroreducens)
15
Q
3 Neisseria species that are ascacholytic
A
N. cinerea N. elongata N. flavescens Also.. N. weaveri N. bacilliformis
16
Q
4 Antimicrobials in Modified Thayer Martin Agar
A
Vancomycin
Colistin
Nystatin
Trimethoprim (for swarming proteus)
18
Q
4 Mechanisms of cephalosporin resistance for N. gonorrhea
A
Alterations in: penA: PBP2 mtrA: depression in efflux pump penB1b: porin ponA: PBP2
19
Q
4 Types and associated species of Shigella
A
A - S. dysteneriae
B - S. flexneri
C - S. boydii
D - S. sonnei
20
Q
3 nonmotile members of Enterobacteriaceae
A
1) Shigella
2) Klebsiella
3) Plesiomonas
21
Q
1 Shigella species that produces gas
A
Shigella flexneri serotype 6
22
Q
Does shigella produce gas from glucose?
A
No
23
Q
Incubation period for Shigella infection
A
1-3 days (up to one week maximum)
24
Q
How long is Shigella shed in the stool for after infection?
A
1-4 weeks
25
3 virulence factors of Shigella
1) Invasiveness (220 KB plasmid)
2) Shiga toxin (prevents protein synthesis)
3) Type III Secretion System (injects about 20 proteins which stimulate bacterial entry into cells)
26
Sus testing for Shigella
Can test like any other Enterobacteraceae, but a lot of tested agents are not useful clinically (ex Cefuroxime, Cefazolin)
Usually test Amp, Septra and a Fluoroquinolone
27
1 drug used to treat Shigella which does not have CLSI interpretations
Azithromycin
28
What is the mechanism of resistance of Shigella to fluoroquinolones
Mutation in gyrA gene (encodes the DNA gyrase)
29
Empiric first line therapy for adult with Shigella
Cipro or Levo x 3 days, Alternate is Azithro x 3 day
30
Empiric therapy for children with Shigella
Ceftriaxone IV x 5 days , alternate azithro x 3 days
31
Why do we usually not give antibiotics for EColi 0157?
Due to the association with HUS
32
3 most common species of Yersinia
1) Y. pestis
2) Y. enterocolitica
3) Y. pseudotuberculosis
33
What causes plague?
Yersinia pestis
34
What is the vector for plague?
Fleas (rodents, squirrels) - bites human
Also can get from handling of animal tissues
Rarely from inhalation of cat resp secretions
35
How is plague spread human to human
Only pneumonic plague via coughing, droplet precatutions
36
What risk level is Y. pestis?
Level 3
37
```
Oxidase
Urease
Catalase
Motility
for Yersinia pestis
```
Ox neg, urease neg, catalase pos, nonmotile
38
2 distinguishing lab tests between Y. pests and Y. enterocolitica?
Urease and Motility. Y. pestis is negative for both, Y. enterocolitica is positive for both. Motility is only positive at room temperature.
39
7 Y. pestis virulence factors
1) F1 Antigen = capsule, antiphagocytic
2) Murine phospholipase = for flea midgut colonization
3) V Antigen
4) Type 3 Secretory System
5) Protease - bubonic and pneumonic forms
6) LPS
7) Requires iron for growth
40
3 clinical syndrome of plague
1) Bubonic
2) Pneumonic (via hematogenous spread)
3) Septicemic
41
Drug of choice for Yersinia pestis?
Aminoglycosides
| Levofloxacin is FDA approved based on animal data
42
3 ways to catch Yersinia enterocolitica?
1) Ingestion of undercooked contaminated pork
2) Ingestion of unpasteurized milk
3) Fecal oral from another human
43
2 organisms that can grow at 4 degrees Celsius
Listeria
| Yersinia
44
TSI reaction for Yersinia
A/A, no gas, no H2S
45
Incubation period for Yersinia enterocolitica?
4-7 days
46
3 clinical manifestations of Yersinia enterocolitica
1) Gastroenteritis
2) Septicemia
3) Mesenteric adenitis (pseudo-appendicitis)
47
Iron chelation therapy (desferozamine) increases risk for what 4 organisms?
1) Yersinia
2) Zygomyces
3) Vibrio vulnificus
4) Neisseria meningitis
48
1 Selective media for Yersinia enterocolitica
```
CIN Media (cefsulodin-irgasan-novobiocin)
Bulls Eye colonies (pale with red center)
```
49
Name 3 organisms that Yersinia serology cross reacts with?
1) Brucella
2) Vibrio
3) Ecoli
50
2 situations when antibiotic therapy recommended for Yersinia enterocolitica?
Invasive infections
Immunocompromised patients
Gent, Septra, Doxy, Cipro
51
Vibrio:
| motility, oxidase lactose and glucose fermentation reactions
Motility positive
Oxidase positive
Non lactose fermentation
Glucose fermentation positive
52
What are 2 Vibrio serogroups that produce cholera toxin?
1) O1
| 2) O139
53
How to differentiate between Classical and El-Tor Vibrio cholera
Beta hemolysis and VP reaction:
| El Tor is generally beta hemolytic and VP is usually positive
54
What is the strain of the cholera outbreak now in Haiti?
Vibrio cholera, 01, El Tor
55
Enrichment broth for Vibrio cholera?
Alkaline peptone water
56
Media recommended for culturing Vibrio?
TCBS - Thiosulphate Citrate Bile Salt
| Contains sucrose and sucrose fermentation turns the organism yellow
57
Susceptibility of 0129 disks for Vibrio and Aeromonas
Vibrio susceptible
| Aeromonas resistant
58
Treatment of cholera in adult and pregnant woman?
Adult: Doxycycline 300 mg po X 1
Pregnant: Azithromycin 1 g po X 1
59
What colour are colonies of Vibrio vulnificans on TCBS agar?
Green (they are non sucrose fermenting)
60
Will vibrio choleae grow without salt added?
Yes
61
3 complexes in the family Aeromoniceae
1) A. hydrophila complex
2) A. caviar complex
3) A. veronii complex
62
```
Aeromonas:
Hemolysis?
Glucose ferments?
Oxidase?
Ampicillin S or R?
Vibrio 0129 disks S or R?
```
```
Beta hemolysis
Glucose fermenter
Oxidase positive
Ampicillin R
Vibrio 0129 disks R
```
63
Antibiotic therapy for Aeromonas
Cipro
Aminoglycosides, 3GC, Doxy sometimes in combination
Can develop beta lactamases (ESBL, maybe MBL)
64
Family of Plesiomonas shigelloides
Enterobacteriaceae (but it's Ox pos!)
65
```
Plesiomonas:
Hemolytic
MAC
Sucrose fermentation?
Oxidase
O/129
```
```
Nonhemolytic
Late lactose fermenter
No sucrose fermentation (colorless or light green on HEK)
Oxidase positive
O-129 susceptible (like vibrio)
```
66
3 organisms that are glucose fermenting and oxidase positive
1) Vibrio
2) Aeromonas
3) Plesiomonas
67
Gas and motility reaction for an inactive Ecoli?
Gas - negative
| Motility - negative
68
What genes are in the quinolone resistance determining region (QRDR) in Enterobacteracae?
gyrA - DNA gyrase
gyrB - DNA gyrase
parC - Topoisomerase IV
parE - Topoisomerase IV
69
What is the causative agent of Human Monocytic Ehrlichiosis (HME)?
Vector?
Erlichia chaffeensis
Lone Star Tick (Amblyomma americanum)
70
What is the causative agent of Human Granulocytic Anaplasmosis (HGA)?
Vector?
Anaplasma phagocytophilum
Ixodes perculcatus group
71
Treatment for Human Monocytic Ehrlichiosis?
Doxycycline 100 mg PO BID x 7-14 days
72
Treatment for Human Granulocytic Anaplasmosis?
Doxycycline 100 mg PO BID x 7-14 days
73
What are the 2 morphological forms of Coxiella brunettii?
1) Large Cell Variant - metabolically active within a vacuole of the host cell
2) Small Cell Variant - no active growth, survival and transmissible form (essentially spores). Can survive for years in the environment
Note Coxiella can be metabolically active in the extracellular phase as well (as a LCV)
74
Conditions to inactivate Coxiella burnetii transmissible form?
Small Cell Variant
| Heat to 63 degrees Celsius for 40 min
75
What is the difference between Phase I and Phase II forms of Coxiella burnetii?
Phase I - virulent form, found in animals and humans infected with Q fever
Phase II - avirulent form, found when organism is grown in lab tissue or embryonated eggs
In labs the phase I eventually changes to phase II (it's a change in LPS, phase I has the intact LPS antigen but phase II lacks the complete LPS)
76
What is the main virulence factor of Coxiella burnetii?
Phase I LPS
77
2 ways humans get infected with Coxiella burnetii?
1) Aerosol transmission from parturient animals (goats, sheep, cattle)
2) Consumption of unpasteurized milk from infected animals
78
3 clinical forms of Coxiella burnetii infection?
1) Acute febrile illness
2) Chronic infection usually involving cardiovascular system
3) Postinfectious chronic fatigue syndome
79
Intracellular life cycle of Coxiella burnetii?
Phase I organism prevents phagocytosis of the host cell allowing the LCV to grow within host cell. When nutrients are deplete it reverts to the SCV and can survive in the cell in a latent state. During immunosupression can revert back to LCV and cause a Q fever relapse.
80
4 system based manifestations of chronic Q fever?
1) Cardiovascular - Endocarditis
2) Gastrointestinal - Granulomatous hepatitis
3) CNS - Meningitis, meningoencephalitis
4) Skeletal - Chronic osteomyelitis
81
What is the PCR target to detect Q fever from blood or buffy coat samples?
Multicopy IS1111 insertion sequence
Another target used is com1 which is single copy
82
What is the most sensitive method to isolate Coxiella burnetii?
```
Animal inoculation (into mice then homogenize their spleen 2 weeks later)
Other methods include cell culture, embryonated eggs, or shell vial assay
```
83
What typing system to use to type Coxiella burnetii?
There is none!
| Trick question
84
3 serological tests for Coxiella burnetii and which is the gold standard?
1) Indirect Immunofluorescence Antibody (IFA)
2) Complement Fixation (CF) - rarely used
3) ELISA - only for phase II
IFA = Gold Standard
85
What types of Antibodies does IFA for Coxiella burnetii detect?
IgG, IgM, and IgA for both Phase I and Phase II
86
2 definitions to diagnosis acute Q fever and 1 for chronic Q fever with indirect immunofluorescent antibody assay?
Acute:
1) Fourfold increase in Phase II IgG between acute and convalescent serology
2) Single sample with Phase II IgG titre >= 200 and a phase II IgM >=50
Chronic:
Phase I IgG titre >800
87
Treatment Q Fever?
1) Acute
2) Chronic
3) Infective Endocarditis
4) Pregnancy
1) Doxycycline 100 mg PO BID x 14 days
2) Chronic = Difficult to treat. Repeated Doxy with relapses
3) Infective Endocarditis = Doxycycline 100 mg PO BID + Hydroxychloroquine 600 mg/day for at least 18 months (24 months if PV)
4) Pregnancy = SMX-TMP 1600/320 x >=35 days
88
5 genera in Parvovirinae?
1) Erythrovirus - Genotype 1 = Human Parvovirus B19
2) Dependovirus
3) Parvovirus
4) Amdovirus
5) Bocavirus
6) PARV4 - not much known about this one
89
Where does Parvovirus B19 replicate?
The nucleus of erythroid precursor cells
90
What are the 2 cellular receptor for Parvovirus B19?
1) Blood group P antigen
| 2) Globoside
91
What 5 cells types have globoside receptors that can be bound to by Parvovirus B19?
1) Erythroid precursors
2) Cardiac myocytes
3) White blood cells
4) Platelets
5) Trophoblasts
92
What is the incubation period for parvovirus B19 infection?
6-10 days
That is for the fever, headache, myalgias, chills
EI comes later
93
3 ways that Parvovirus B19 is transmitted?
1) Respiratory route
2) Vertical transmission
3) Via blood products
94
What is the incubation period for Erythema Infectiousum?
17-19 days
95
5 clinical syndromes caused by Parvovirus B19?
1) Erythema Infectiousum
2) Transient Aplastic Crisis
3) NonImmune Hydrops Fetalis
4) Arthropathy
5) Chronic Pure Red Cell Aplasia
96
What is the treatment for Chronic Red Cell Aplasia due to Parvovirus B19?
IVIG
But you can get Parvo from IVIG... A vicious circle!
97
What is the pathognomotic finding on bone marrow aspirate for Parvovirus B19?
Giant Pronormoblasts (Giant Proerythroblasts)
98
How to grow Parvovirus B19 in culture?
Requires undifferentiated, actively replicating erythroid cells (i.e. bone marrow or fetal cord blood cells)
Only in research labs
99
2 organisms inhibited by SPS in blood culture bottles?
1) Neisseria gonorrhea
| 2) Capnocytophaga canimorsus
100
2 risk factors for Capnocytophaga septicaemia?
1) Neutropenia
| 2) Splenectomy
101
2 Catalase and Oxidase positive species of Capnocytophaga?
1) Capnocytophaga canimorsus
2) Capnocytophaga cynodegmi
The other 7 species are Catalase and Oxidase negative
102
What is the indole reaction for Capnocytophaga species?
Negative
103
3 Antibiotics with limited activity against Capnocytophaga?
1) Aminoglycosides
2) TMP-SMX
3) Fluoroquinolones
104
2 clinical syndromes caused by Acanthamoeba species?
1) Acanthamoeba Keratitis
| 2) Chronic granulomatous amoebic encephalitis (GAE)
105
3 media to grow Bordetella pertussis?
1) Regan-Lowe
2) Bordet-Gengou
3) Stainer-Schlote
106
Name 3 oxidase negative Bordetella species?
1) B. parapertussis
2) B. holmesii
3) B. trematum
107
Name 3 motility positive Bordetella?
1) B. bronchoseptica
2) B. hinzii
3) B. trematum
108
How do aminoglycosides get across the gram negative outer cell membrane?
Oxygen dependant transporter (aminoglycosides do not work in anaerobic environment)
109
Indole reaction of Klebsiella oxytoca?
Positive
110
2 partially acid fast gram positive rods with yellow or orange pigment?
1) Gordonia
| 2) Rhodococcus
111
Only spore forming aerobic gram positive rod?
Bacillus species
112
Motility reaction for Listeria and Erysipelothrix?
Listeria - Positive at 20-25 degrees celcius
| Erysipelothrix - Negative
113
Catalase reaction of Lactobacillus, Archanobacterium and Bacillus?
Lactobacillus - Negative
Arcanobacterium - Negative
Bacillus - Mostly Positive
114
3 major clinical forms of anthrax?
1) Cutaneous
2) Inhalational
3) Ingestion
115
3 protein components of anthrax toxin?
1) Lethal toxin
2) Edema toxin
3) Protective antigen
116
2 food poisoning syndromes of Bacillus cerus?
1) Diarrheal type
| 2) Emetic type
117
3 toxins implicated in diarrheal illness of Bacillus cerus?
1) Hemolycin BL (Hbl)
2) Nonhemolytic enterotoxin (Nhe)
3) Cytotoxin K (CytK)
118
1 toxin implicated in emetic illness of Bacillus cerus?
Cerulide
119
2 stains to detect Bacillus anthracis capsule?
1) India ink
| 2) M'Fadyean
120
Method to stain spores from Bacillus species?
Heat fix
Flood with 10% aqueous malachite green for 45 min
Wash
Counterstain with safranin for 30 seconds
121
Unique feature on gram stain of Paenibacillus alvei?
Tapered ends
122
4 members of Bacillus cereus group?
1) B. cereus
2) B. anthracis
3) B. thuringiensis
4) B. mycoides
123
2 Bacillus species that are motility negative?
1) B. anthracis
| 2) B. mycoides
124
Egg yolk reaction of Bacillus cereus group?
Positive (B. cereus and anthracis)
125
3 methods of genotyping Bacillus anthracis?
11) MLST
2) MLVA (Multiple-Locus Variable-Number Tandem Repeat Analysis)
3) Single nucleotide polymorphism
126
3 treatment options for Bacillus anthracis in Penicillin allergic patients?
1) Fluoroquinolones
2) Chloramphenicol
3) Tetracylcines
** Cephalosporins are not appropriate to treat anthrax, even if test susceptible in vitro**
127
Post exposure prophylaxis for inhalational anthrax?
60 days of either Cipro, Doxy or Levo
| PLUS 3 doses of anthrax vaccine
128
Treatment of anthrax in pregnant women and children?
Amoxicillin
129
Can Bacillus cereus be treated with Penicillin?
No - it has a broad spectrum B-lactamase. Resistant to all aminopenicillins and cephalosporins
Also is resistant to trimethoprim.
130
Treatment for ophthalmic infection with Bacillus cereus?
Clindamycin + Gentamycin
131
Listeria:
- Catalase
- Oxidase
- VP
- Methyl Red
- Esculin hydrolysis
All positive except Oxidase is negative
132
Listeria:
- Urease
- Gelatin
- Indole
- H2S
All negative
133
4 select agars to culture Listeria?
1) Lithium chloride-phenylethanol-moxalactam (LPM)
2) Oxford
3) Modified-Oxford
4) PALCAM
134
Listeria monocytogenes and Listeria ivanovii reactions on CAMP?
L. monocytogenes + with S. aureus
| L. ivanovii + with R. equi
135
Listeria monocytogenes:
- Mannose reaction
- Rhamnose reaction
- Xylose reaction?
Mannose +
Rhamose +
Xylose -
136
Typing method for Listeria?
PFGE (ApaI and AscI)
Also MLVA, MLST, SNP, DNA Microarray, and sequence based
137
Treatment for Listeria?
Ampicillin + Gentamicin
138
Treatment for Listeria in penicillin allergy?
Trimethoprim-sulfamethoxazole
139
Method of antimicrobial susceptibility testing for Listeria?
Microbroth dilution (pen, amp, tmp-smx)
140
1 species of Erysipelothrix?
E. rhusiopathie
141
Erysipelothrix:
- Indole
- VP
- Methyl red
- Urease
- H2S
All negative except H2S
142
Colony morphology of Erysipelothrix?
1) Smooth - pinpoint, then entire edges, transparent
2) Rough - fatter, opaque, irregular edge
Alpha hemolysis
143
Erysipelotrix:
Glucose
Lactose
Sucrose
Glucose - Positive
Lactose - Positive
Sucrose - Negative
144
3 typing methods for Erysipelothrix?
1) PFGE
2) RAPD
3) Ribotyping
145
Treatment for Erysipelothrix? Any intrinsic resistance?
Treatment = Penicillin or Ampicillin, alternatives broad spectrum Ceph or Fluoroquinolones
Intrinsic resistance = Vancomycin!
Also usually R to Aminoglycosides and TMP-SMX
146
2 species and gram stains for Rothia.
1) R. dentocariosa: GPB
| 2) R. mucilaginosa: GPC
147
3 corynebacterium that lack mycolic acids?
1) C. amycolatum
2) C. atypicum
3) C. kroppenstedtii
** Even coryne with mycolic acids though are NOT partially acid fast**
148
Catalse reaction for Cellumonas? Exceptions?
All catalase positive except C. fermentans and C. humilata
149
Catalase reaction for Arcanobacteria and Gardnerella?
Negative
150
3 systemic effects of diphtheria exotoxin?
1) Myocarditis
2) Neuritis
3) Kidney damage
151
2 organisms susceptible to SPS in blood culture bottles?
1) Gardnerella vaginalis
| 2) Neisseria gonorrhea
152
3 species of Corynebacterium able to harbour the diphtheria tox gene?
1) C. diphtheriae
2) C. ulcerans
3) C. pseudotuberculosis
153
2 selective media for C. diptheriae?
1) Tinsdale
| 2) Cystine-Tellurite Blood Agar (CTBA)
154
What do colonies of C. diptheriae look like on Tinsdale agar?
Black colonies (tellurite reductase) with brown halo (cystinase)
155
CAMP reaction of Arcanobacterium haemolyticum?
CAMP inhibition reaction (inhibits the hemolysis of the S. aureus)
156
Name 5 urease positive corynebacterium?
1) C. urealyticum
2) C. ulcerans
3) C. pseudotuberculosis
4) C. pseudodiphtheriticum
5) C. riegelii
157
2 Corynebacterium that hydrolyses esculin?
1) C. kroppenstedtii
| 2) C. glucuronolyticum
158
2 Corynebacterium that are reverse camp positive (CAMP inhibition)?
1) C. ulcerans
2) C. pseudotuberculosis
*C. diphthericiae is CAMP negative
159
3 Corynebacterium that are O/129 resistant?
1) C. pseudotuberculosis
2) C. amycolatum
3) C. imitans
160
6 Corynebacterium with yellow pigment?
1) C. aurimucosum
2) C. falsenii
3) C. glucuronolyticum
4) C. liptophiloflavum
5) C. mucifaciens
6) C. timonense
161
Treatment for C. diphtheriae?
Penicillins or Macrolides
| PLUS Antitoxin
162
Corynebacterium that can cause pneumonia?
C. pseudodiphtheriticum
163
1 other corynebacterium besides C. diphthericiae that can cause diphtheria?
C. ulcerans
164
2 multidrug resistant Corynebacterium?
1) C. urealyticum
| 2) C. jeikeium
165
3 characteristics of Leifsonia aquatica?
1) Motile
2) DNase activity
3) Yellow pigment
166
1 method for typing of C. diphtheriae?
Ribotyping
167
Method and media for corynebacterium susceptibility testing?
Broth microdilution method
| Cation Adjusted Mueller Hinton broth with 2-5% lysed horse blood
168
Test to verify toxin producing C. diptherium?
Elek test
169
Where is the tox gene for C. diptherium?
On a bacteriophage
170
Incubation period of diphtheria?
2-5 days
171
Another form of diphtheria aside from pharyngitis?
Cutaneous diphtheria
172
How to stain for metachromatic granules in C. diphtherium?
Loeffler's stain
173
Tube motility reaction of Listeria?
Umbrella
174
Rash in a baby with listeria in utero exposure?
Granulosum infantosepticum
175
List 4 branching gram positive aerobic rods?
| - Which are modified acid fast?
1) Actinomadura
2) Dermatophilus
3) Nocardia - Only one that is acid fast
4) Streptomyces
Rhodococcus can have individual cells that can branch and it is modified acid fast.
176
List 6 aerobic acid fast gram positive rods?
1) Gordonia
2) Mycobacterium
3) Nocardia
4) Rhodococcus
5) Segniliparus
6) Tsukamurella
177
Does Rhodococcus equi have ariel hyphae?
No (may be occasionally seen microscopically)
178
What is the causative agent of Madura foot?
```
Acinomadura species (madurae and pelletieri)
Molecular methods to get species
```
(draining sinuses, traumatic, chronic, slow)
179
2 species of Nocardia resistant to Ceftriaxone?
1) N. farcinica
| 2) N. otitidiscaviarum
180
1 species of Nocardia resistant to Amikacin?
N. transvalensis complex
181
Are nocardia species susceptible or resistant to Clarithromyin? What are 2 exceptions?
Resistant
| Except: N. nova complex and N. pseudobraziliensis
182
Pulmonary finding of rhodococcus?
Cavitation
183
Difference between the modified acid fast stain and the acid fast stain?
Modified uses a weaker decolorizer (1%H2SO4) than the mycobacterial stain (3% HCl).
184
2 agents of infection where granules may be seen?
1) Nocardia braziliensis
| 2) Actinomyces
185
2 selective media for isolating Nocardia?
1) Modified Thayer Martin Agar
| 2) Selective BCYE
186
What antimicrobials are in selective BCYE agar?
Polymyxin B
Anisomycin
Vancomycin or Cefamandole
187
2 aerobic actinomycetes that generally produce aerial hyphae?
1) Nocardia
| 2) Streptomyces
188
2 aerobic actinomycetes that are resistant to lysozyme (i.e. grow in broth containing lysozyme)?
1) Nocardia
| 2) Tsukamurella
189
1 Nocardia species that will grow at 45 degrees?
N. wallacei
190
Urease reaction of Nocardia and 1 exception?
Positive
| Except Nocardia cyriacigeorgica is negative
191
Rhamose reaction of Nocardia and 1 exception?
Negative
| Except Nocardia farcinica is able to utilize rhamose
192
Identification of Nocardia to the species level?
Molecular methods - Gene sequencing
| 16S rRNA gene, HSP gene, secA1 gene
193
Antimicrobial susceptibility method for Nocardia?
Broth microdilution
194
2 antimicrobials most species of Nocardia are susceptible to?
1) Trimethoprim-Sulfamethoxazole
| 2) Linezolid
195
3 cases where Septra may not be adequate to treat Nocardia?
1) CNS nocardiosis
2) Disseminated disease
3) HIV infection
196
2 species of streptococcus that are PYR positive?
1) Streptococcus pyogenes
| 2) Streptococcus pneumoniae
197
3 gram positive cocci with intrinsic vancomycin resistance?
1) Leuconostoc
2) Weissiella
3) Pediococcus
198
4 gram positive cocci susceptible to bacitracin (10-25 mm)?
1) Micrococcus
2) Aerococcus
3) Kocuria
4) Rothia
199
2 gram positive cocci that are oxidase positive?
1) Micrococcus
| 2) Staphylococcus intermedius
200
3 staphylococci that are positive for clumping factor?
1) Staph auerus
2) Staph lugdenensis
3) Staph schleiferi subsp. schleiferi
201
7 staphylococci that are positive for tube coagulase?
1) Staph aureus
2) Staph aureus subsp. anaerobius
3) Staph delphini
4) S. intermedius
5) S. pseudointermedius
6) S. schleiferi subsp. coagulans
7) S. lutrae
202
Does Pasteurella grow on MacConkey?
NO!!!!
203
Treatment of Vibrio vulnificans?
Ceftriaxone + Ciprofloxacin
204
Etiology of a 2 week old afebrile baby with conjunctivitis followed 2 weeks later by a pneumonia, with peripheral eosinophils?
Chlamydia trachomatis
205
Treatment of inhalational anthrax?
Ciprofloxacin + Meropenem + Linezolid
206
What enzyme does an ONPG test detect?
B-galactosidase
207
What is the difference between monotrichous flagella and peritrichous flagella?
Monotrichous has only one polar flagella, but peritrichous has multiple projecting in all directions
208
How can flexirubin pigment production be detected?
Put a loopful of cells in a drop of 20% KOH on a slide, a red colour indicates flexirubin pigments
209
What clinically relevant gram negative non fermenter is H2S positive?
Shewanella species
210
3 gram negative non fermenters that are indole positive?
1) Chryseobacterium
2) Elizabethkingia
3) Empedobacter
211
For which gram negative non fermenter is motility best demonstrated at room temperature?
Sphingomonas species
212
KIA interpretations:
- butt and slant yellow
- only butt yellow
- no yellow
Butt and slant yellow = ferments lactose and glucose
Only butt yellow = negative for lactose fermentation, positive for glucose fermentation
No yellow = Nonfermenter
213
4 oxidase negative gram negative non fermenters?
1) Acinetobacter
2) Stenotrophomonas
3) Bordetella parapertussis and holmesii
4) Pseudomonas luteola and oryzihabitans
214
6 yellow gram negative non fermenters?
1) Elizabethkingia meningoseptica
2) Chrysiobacterium
3) Pseudomonas luteola, oryzihabitans, stutzeri
4) Sphingomonas
5) Burkholderia cenocepacia
6) Paracoccus yeei
215
1 purple pigmented non fermenter?
Chromobacterium violacium
216
4 pink pigmented non fermenters?
1) Roseomonas
2) Methylobacterium
3) Azospirillum
4) Asaia
217
Methylobacterium reactions:
- Urease
- Trypsin
- B-Galactosidase
- Nitrate reductase
- Desferrioxamine
```
Positive
Positive
Negative
Negative
Resistant
```
218
4 Gram Negative bacteria that require Chocolate agar for growth?
1) Neisseria gonorrhoeae
2) Haemophilus spp
3) Bartonella
4) Francisella spp.
219
Francisella reactions:
- Oxidase
- Urease
- Growth on Blood Agar
- What 2 agars does it grow well on?
Negative
Negative
Weak growth on BA
Grows well on Chocolate and BCYE
220
Stenotrophomonas maltophilia reactions:
- Oxidase
- Indole
- Trypsin
- PYR
- H2S
```
Negative
Negative
Positive
Negative
Negative
```
221
Elizabethkingia meningoseptica reactions:
- Oxidase
- Urease
- Trypsin
- Indole
- H2S
- PYR
- Mannitol
- Glucose
```
Oxidase Positive
Urease Negative
Trypsin Positive
Indole Positive
H2S Negative
PYR Positive
Mannitol Positive
Glucose Positive
```
222
Gram negative bacteria susceptible to Vancomycin?
1) Sphingomonas
223
Sphingomonas species reactions:
- Oxidase
- Trypsin
- Indole
- PYR
- Urease
- H2S
- Esculin
- Alkaline phosphatase
- Vancomyin
- Desferrioxamine
- Oxidase Positive
- Trypsin Positive
- Indole Negative
- PYR Negative
- Urease Negative
- H2S Negative
- Esculin Positive
- Alkaline phosphatase Positive
- Vancomyin S
- Desferrioxamine R
224
Do Neisseria species have flagella?
No
225
How many different serogroups of Neisseria meningitis are there?
List them
12
| A, B, C, H, I, K, L, X, Y, Z, W135, 29E
226
Catalase reaction of Neisseria species and 2 exceptions?
Positive
| Except N. elongata subsp elongata and subsp nitroreducens are catalase negative
227
What 3 underlying conditions are at increased risk for invasive meningococcal disease?
1) Properdin deficiencies
2) Late complement deficiencies
3) Splenic impairment (incl asplenia)
228
Symptoms of Neisseria gonorrhoeae in males?
Acute urethritis
- urethral discharge
- dysuria
10% asymptomatic males
Untreated symptoms resolve in several weeks
229
Complications of gonorrhoea in males?
1) Epididymitis
2) Penile edema
3) Abscess of glands
230
Symptoms of gonnorhea in women?
1) Vaginal discharge
2) Dysuria
3) Intermenstrual bleeding
231
4 manifestations of pelvic inflammatory disease?
1) Endometritis
2) Salpingitis
3) Tubo-ovarian abscess
4) Peritonitis
232
What is Fitz-Hugh-Curtis syndrome?
Acute perihepaitis following direct extension of N. gonorrhoea from the fallopian tube to the liver capsule and surrounding peritoneum
233
3 manifestations of disseminated gonococcal infection?
1) Septic arthritis
2) Polyarthritis
3) Dermatitis
234
4 complications of invasive meningococcal disease
1) Arthritis
2) Pericarditis
3) Cranial nerve dysfunction
4) Cerebral infarct
235
3 symptoms of chronic meningococcemia?
1) Low grade relapsing fever
2) Arthritis
3) Rash
236
What type of swab to avoid for gonorrhoea and why?
Calcium alginate
| - toxicity to organism and inhibit PCR reactions
237
How to prevent the effects of SPS in blood culture bottles on Neisseria meningitis and gonorrhoea?
Add gelatine (1g/litre)
238
2 advantages and 5 disadvantages of NAATs for diagnosis of Neisseria gonorrhoeae?
Advantages
1) Increased sensitivity compared to culture
2) Less stringent collection and transportation conditions
Disadvantages:
1) High cost
2) Carryover contamination
3) High QC requirements
4) Absence of antibiotic resistance data
5) Susceptible to inhibition
239
4 selective media for culture of Neisseria gonorrhoeae?
1) Modified Thayer Martin
2) Martin Lewis (ansiomycin instead of nystatin)
3) GC-Lect Agar (allows for vanco sus GC)
4) New York City Agar
240
Oxidase reaction of Neisseria species?
Positive
241
5 asacchrolytic Neisseria species?
1) N. bacilliformis
2) N. elongata
3) N. weaveri
4) N. cinerea
5) N. flavescens
242
N. gonorrhoeae typing systems (3)
1) PFGE
2) Mutiantigen sequence typing
3) MLST
243
Required agar for susceptibility testing of Neisseria gonorrhoea?
GC Agar + 1% growth supplement
244
Treatment of pharyngeal gonorrhoea?
IM Ceftriaxone
245
Mechanism for rifampin resistant Neisseria meningititis?
Point mutation in rpoB gene (RNA polymerase B subunit)
246
What is special about Neisseria meningititis conjunctivitis?
Requires chemophrophylaxis of close contacts due to high immediate risk of invasive disease
247
What Neisseria species besides gonorrhoeae has caused ocular infections in infants?
Neisseria cinerea
248
What 2 commensal Neisseria species have decreases susceptibility to penicillin?
1) N. mucosa
| 2) N. lactamica
249
```
Which of the following have a flagella?
Actinobacillus
Capnocytophaga
Eikenella
Kingella
Pasteurella
Chromobacterium
```
Chromobacterium
250
What is a risk factor for Pasteurella infection?
Liver cirrhosis
251
Risk factor for oxidase negative Capnocytophaga infection?
Neutropenia
252
2 risk factors for Chromobacterium violaceum infection?
Chronic Granulomatous Disease
| G6PD Deficiency
253
What are the oxidase and catalase positive species of Capnocytophaga?
1) C. canimorsus
| 2) C. cynodegmi
254
Where have most Dysgonomonas capnocytophagoides strains been isolated from?
Stools of immunocompromised patients
255
How is Kingella kingae transmitted?
Respiratory droplets
256
2 clinical syndromes from Streptobacillus moniliformis infection?
1) Rat bite fever (rodent bite)
| 2) Haverhill fever (consumption of contaminated food or water)
257
2 infections that Aggregatibacter actinomycetemcomitans can cause?
1) Juvenille and adult periodontitis
| 2) Infective Endocarditits
258
2 risk factors for Capnocytophaga canimorsum infection
1) Splenctomy
| 2) Alcoholics
259
2 virulence factors of Kingella kingae?
1) RTX toxin
| 2) Type IV pili
260
5 virulence factors of Pasteurella?
1) Capsule
2) LPS
3) RTX cytotoxin
4) Surface adhesins
5) Iron acquisition proteins
261
3 clinical manifestations of rat bite fever?
1) Fever
2) Migratory polyarthritis
3) Maculopapular rash on the extremities
262
Gram stain of Kingella spp?
Short gram negative rods with square ends, lie together in pairs or clusters
263
Colony morphology of Actinobacillus actinomycetemcomitans?
Agar: star lik configuration
Liquid: granules
264
Aggregatibacter:
Indole
Ornithine Decarboxylase
Urease
Negative
Negative
Negative
265
```
Chromobacterium
Hemoloysis
Oxidase
Catalase
Lysine
Maltose
Mannitol
```
```
Beta
Oxidase Positive
Negative
Negative
Negative
```
(Nonpigmented strains can look like Aeromonas)
266
Colony morphology of Streptobacillus?
Agar: Fried egg
Liquid: Puff balls
267
```
Eikenella:
Catalase
Oxidase
Indole
Nitrate
Ornithine
```
```
Catalase Negative
Oxidase Positive
Indole Negative
Nitrate Positive
Ornithine Positive
```
268
Kingella kingae:
Catalse
Oxidase
Indole
Negative
Positive
Negative
269
3 drugs Pasteurella are usually resistant to?
1) Oral narrow spectrum cephalosporins
2) Macrolides
3) Amikacin
270
```
Pasteurella multocida:
Catalase
Oxidase
Indole
Urease
Ornithine
```
All positive, except Urease is negative
271
What is X and V factor?
```
X = protoporphyrin IX (metabolic intermediate in the hemin biosynthetic pathway)
V = Nicotniamide complexed as NAD or NADP
```
272
Which haemophilus species require both X and V factor for growth?
1) H. influenzae
2) H. aegyptius
3) H. haemolyticus
273
What are the different serotypes of the typable Haemophilus influenza species?
a, b, c, d, e, f
274
Catalase reaction for Haemophilus and 1 exception?
Positive, except H. ducreyi is negative
275
Difference between Haemophilus influenzae and H. aegyptius?
Xylose fermentation: Positive for H. influenzae
276
Biochemical tests used to assign biotypes to H. influenzae and H. parainfluenzae?
Indole, Ornithine, Urease
277
6 disease conditions that put persons at risk for systemic non typable H. influenza infection?
1) Functional or anatomic asplenia
2) Sickle cell disease
3) Complement deficiencies
4) Hodgkin's Disease
5) Congenital or Aquired hypogammaglobulinemia
6) T cell immunodeficiency (HIV)
278
Incubation period of Haemophilus ducreyi?
2-7 days
279
SPS in blood culture bottles affects the growth of what 3 organisms?
1) Neisseria gonorrhoeae and meningititis
2) Capnocytophaga
3) Haemophilus parainfluenzae
280
What causes Brazilian Purpuric fever?
Haemophilus influenzae biogroup III
281
2 commercial media supplements that provide X and V factors?
1) IsoVitaleX
| 2) Vitox
282
2 methods for capsular serotyping of H. influenzae?
1) Slide agglutination assay
2) Fluorescent microscopy
3) Molecular methods
4) PFGE
283
What are the 2 Beta lactamases that can be produced by H. influenzae? And to what drugs do they confer resistance?
1) TEM1
2) ROB1
Resistance to Penicillin, Amoxicillin and Ampicillin
Plasmid associated
284
What causes B-lactame resistance in B-lactam negative H. influenzae species?
Altered penicillin binding protein
285
Media and test conditions for H. influenzae susceptibility testing?
Haemophilus Test Media Agar / Broth
Disk Diffusion / Broth Microdilution (no Etest!)
35 degrees 5-7% CO2 / Ambient
16-18 hours / 20-24 hours
286
What is the incubation period for Haemophilus type b meningitis?
2-4 days post infection
287
Who is Haemophilus influenza transmitted?
Respiratory droplet
| Contact with oral or nasal secretions
288
5 conditions that place patients at highest risk for haemophilus type b infection?
1) Splenic dysfunction
2) Antibody deficiency
3) Daycare attendance
4) Inuit community
5) Cochlear implant
289
For what 5 conditions should persons >5 years of age receive 1 dose of Hib vaccine?
1) Primary immunodeficiency
2) Malignant hematological disorder
3) HIV
4) Anatomical or functional asplenia
5) Cochlear implant
290
What is the Hib vaccine recommendations for solid organ transplants and HSCT?
SOT:
Pre transplant = 1 dose
Post transplant = 1 dose if not vaccinated pre transplant
HSCT:
Post transplant = 3 doses
291
When do household contacts of an invasive case of Hib require Hib prophylaxis and with what?
If there is a child <48 months in the home who is immunocompromised or has not had a full primary series of vaccine then the entire household should have Rifampin daily for 4 days
292
What are the hospital isolation requirements for invasive Haemophilus influenza?
Droplet isolation until 24 hours post effective antibiotics
293
What are the hospital isolation requirements for invasive Haemophilus influenza?
Droplet isolation until 24 hours post effective antibiotics
294
Name 5 species of Legionella?
1) pneumophila
2) micdadei
3) longbeachae
4) bozmanae
5) dumoffii
295
What is one test to distinguish Camplyobacter jejuni from other Campylobacter species?
Hippurate hydrolysis
| Positive for C. jejuni, negative for all other species
296
What Campylobacter species will grow at 25 degrees?
Campylobacter fetus
297
What is the name of the Dog Tick?
Dermacentor variabilis
298
What is the name of the Wood Tick?
Dermacentor andersoni
299
What is the name of the Lone Star Tick?
Amblyomma americanum
300
What 4 diseases are transmited by the Lone Star Tick?
1) Erlichiosis
2) Tularemia
3) STARI
4) Heartland Virus
301
What 3 diseases are transmitted by the Wood Tick?
1) RMSF
2) Tularemia
3) Colarado Tick Fever
302
What 2 diseases are transmitted by the Dog Tick?
1) RMSF
| 2) Tularemia
303
What 4 diseases are transmitted by the Black Legged Tick?
1) Lyme
2) Anaplasmosis
3) Babesia
4) Powassan
304
What are the 6 syndromes that can be caused by Francisella tularensis?
1) Ulceroglandular
2) Glandular
3) Oculoglandular
4) Pharyngitis
5) Pneumonia
6) Typhoidal
305
6 organisms which are related to Eschars?
1) Rickettsia africae
2) Rickettsia conorii
3) Rickettsia akari
4) Rickettsia felis
5) Rickettsia parkeri
6) Orientia tsutsugamushi
306
What are the 3 stages of pertussis disease?
1) Catharral
2) Paroxsymal
3) Convalescent
307
Treatment for Listeria in Pencillin allergic patients?
Septra
