Basic Bacteriology And mycology Flashcards
1
Q
Name structures and specialized structure of bacterias
A
Flagellum/ pilus fimbria and spore
2
Q
What is the chemical composition and function of flagellum
A
Proteins/motility
3
Q
What is the chemical composition and function of pilus or fimbria
A
Glycoprotein and they mediate adherence of bacteria to cell surface sex pilus forms during conjugation
4
Q
Chemical composition and function of spores
A
Keratin like coat dipicolinic acid, peptidoglycan, DNA. Gram + only survival resiste dehydration heat chemicals
5
Q
What are the structures of cell envelope chemical composition
A
Discrete layer usually made of polysaccharide (and rarely proteins)
6
Q
What is the function of the capsule
A
Protects against phagocytosis
7
Q
What is the chemical composition of slime layer and their function
A
Loose network of polysaccharides and they mediates adherence to surface, plays a role in biofilm formation
8
Q
What is the chemical composition of outer membrane
A
Outer leaflet contains endotoxin (LPS/LOS).
Embedded proteins: porins and other outer membrane proteins (OMPs)
Inner leaflet: phospholipids
9
Q
What are the outer membrane and what is their function
A
Gram negative only. Endotoxin: lipid A induces TNF and IL-1; antigenic O polysaccharide component. Most OMPs are antigenic. Porins: transport across outer membrane
10
Q
Space between cytoplasmic membrane and outer membrane in gram negative bacteria peptidoglycan in middle is
A
Periplasm
11
Q
What is the function of periplasm
A
Accumulates components exiting gram negative cells, including hydro lyric enzymes (eg beta lactamases)
12
Q
What is the chemical composition of cell wall and their function
A
Peptidoglycan is a sugar backbone with peptide side chains cross linked by transpeptidase. Function: netlike structure gives rigid support, protects against osmotic pressure damage
13
Q
Is a phospholipid bilayer sac with embedded proteins (penicillin binding proteins PBPs) and other enzymes
A
Cytoplasmic membrane
14
Q
Where is lipoteichoic acids and where do they extended itself
A
Gram positive and extend from membrane to exterior
15
Q
What is the function of cytoplasmic membrane
A
Site of oxidative and transport enzymes; PBPs involves in cell wall synthesis.
16
Q
What does lipoteichoic acid do
A
Induce TNF Alfa and IL-1
17
Q
What structure are unique of gram positive bacteria
A
Lipoteichoic acid
18
Q
What are the structures common to both
A
Flagellum
Pilus
Capsule
Cell wall
Peptidoglycan
Cytoplasmic membrane
19
Q
What are the structures unique to gram negative
A
Endotoxin LPS Poron that composes outer membrane. And wide periplasmic space containing Beta lactamase
20
Q
Is the first lab test in bacterial identification. Bacteria with thick peptiglycan layer retain crystal violet dye en who are positive to this stain and bacteria’s who has thin peptidoglycan layer turn red or pink (they are negative) with counterstain
A
Gram stain
21
Q
These Little Microbes May Unfortunately Lack Real Color But Are Everywhere (gram negative bacteria’s)
A
Treponema m, leptospira, mycobacteria, mycoplasma, ureaplasma, Legionella, Ricketsia, Chlamydia, Bartonella, Anaplasm, Ehrlichia
22
Q
Why treponema and leptospira are gram negative bacteria’s
A
Because they have too thin peptidoglycan layer to be visualized
23
Q
Why mycobacteria is gram negative
A
Because cell wall has high lipid content
24
Q
Why mycoplasma and ureaplasma are gram negative
A
They don have cell wall
25
Why legionella, rickettsia, chlamydia, bartonella, ana plasma and ehrlichia are gram negative
Because they are primarily intracelular; also chlamydia lack classic peptidoglycan because of decrease it muramic acid
26
what are the bacteria’s which have giemsa stain positive (CLuMsy Rick TRiPped on a BORRowed HELICOpter PLAStered in GEMS)
chlamydia, rickettsia, trypanosomes, borrelia helicobacter pylori plasmodium
27
What stain periodic acid schiff stain and mention one stain bacterial use
Stain glycogen, mucopolysaccharides it can be use to diagnose Whipple disease causes by tropheryma whipplei
28
Uses of Ziegler Nelson stain also called carbon fuchsin
It is usefully to identify acid fast bacteria eg. Mycobacteria, Nocardia; stains mycolic acid un cell wall, Protozoa (eg cryptosporidiumboocysts)
29
Alternative stain to Ziehl-Neelsen stain (carbon fuchsin) that is more often used for screening (inexpensive more sensitive)
Auramine rhodamine stain
30
Uses for India ink stain
Cryptococcus neoformans; mucicarmine can also be used to stain thick polysaccharide capsule red
31
Uses of silver stain HELiCOPters Are silver)
Helicobacter pylori, legionella, bartonella henselae, and fungi (eg Coccidioides, pneumocystis jorovecii, aspergillus fumigatus)
32
Used to identify many bacteria, viruses, pneumocystis jirovecii, giardia and cryptosporidium
Fluorescent antibody stain
33
Give an example of fluorescent antibody stain
FTA-ABS for syphilis
34
What is the media used to isolation H. Influenzae and what does it contain
Chocolate agar, factors V (NAD+) and X (hematin)
35
To what bacteria’s is the Thayer Martin agar
N gonorrhoeae and N meningitidis
36
What does media Thayer Martin agar contain Very Typically Cultures Neisseria
Selectively favors growth of Neisseria by inhibiting growth of gram positive organism with vancomycin, gram negative organism except Neisseria with trimethoprim and colisión and fungi nystatin
37
What are the media for isolation Bordetella pertussis
Border Gengou agar and regan lowe medium
38
What do medium bordet gengou agar and regan lowe medium
Potato extract/ charcoal, blood and antibiotic
39
What is the name of media to isolation c diphtheriae
Tellurite agar, Loffler medium
40
What are the media to isolation M tuberculosis
Löwenstein-Jensen medium, middlebrook medium, rapid automated broth cultures
41
For what bacteria is the Eaton agar
M pneumoniae
42
What does Eaton agar M pneumoniae require
It require cholesterol
43
For what kind of bugs is use MacConkey agar
Lactose fermenting enterics
44
What does the McConckey agar do
Fermentation produces acid, causing colonies to turn pink
45
What is the name of media to isolation E. coli and please mention a characteristic of this media
Eosin methylene blue (EMB) agar. Colonies with green metallic sheen
46
What are the bugs which grow up in charcoal yeast extract agar buffered with cysteine and iron (the ella siblings, BRUCE, FRANCIS, a LEGIONnaire and a PASTEUR built the Sistine (cysteine) chapel out of charcoal and iron
Brucella, Francisella, Legionella, Pasteurella
47
What is the media for isolation fungi
Sabouraud agar
48
Give examples of anaerobes bacteria’s (anaerobes Can’t Breathe Fresh Air)
Clostridium, bacteroides, fusobacterium, and Actinomyces Israelii
49
Describes the characteristics of anaerobes bacteria’s
They lack catalase and or superoxide dismutase and are thus susceptible to oxidative damage. Generally foul smelling (short chain fatty acids) are difficult to culture and produce gas in tissue (CO2 and H2)
50
What does the aminO2glycosides are ineffective against anaerobes
Because these antibiotics require O2 to enter into bacterial cell
51
This kind of bacteria’s may use O2 as a terminal electron acceptor to generate ATP, but can also use fermentation and other O2 independent pathways
Facultative anaerobes
52
Name the facultative anaerobes examples
Streptococci, staphylococci and enteric gram negative bacteria
53
What kind of intracelular bacteria exists
Obligate intracelular and facultative intracellular
54
What are the obligate intracelular bacteria’s (stay inside cells when it is Really Chilly and Cold
Ricketssia, Chlamydia and Coxiella
55
Name the facultative intracellular (Sone Nasty Bugs May Live FacultativeLY)
Salmonella Neisseria brucella mycobacterium listeria francisella legionella Yersinia pestis
56
Name the encapsulated bacteria’s (Please SHINE my SKiS)
Pseudomonas aeruginosa, streptococcus pneumoniae Haemophulis influenzae type B, Neisseria meningitidis, E. coli, salmonella, klebsiella pneumoniae and group B Strep
57
Who opsonized the encapsulated bacteria’s
Spleen
58
What happens in the asplenics people (No Spleen Here)
They have less opsonized h ability and thus increase risk for severe Infections and need vaccines to protect against: N meningitidis S pneumoniae H influenzae
59
What are the uses of bacterial capsule
Capsules serve as an anti phagocytic virulence factor. Capsular polysaccharide +/- protein conjugate can serve as an antigen in vaccine. A polusaccharide antigen alone cannot be presented to T cells; immunogenicity can be enhanced by conjugating capsule antigens to a carrier protein
60
Why are the urease positive organism (Pee CHUNKSS)
Proteja, cryptococcus, H pylori, ureaplasma, Nocardia, klebsiella, S epidermjdis, S saprophyticus.
61
How bacterial urease works
Urease hydrolysis urea to release ammonia and CO2 increase pH. Predisposes to struvite (magnesium ammonium phosphate) stones particularly proteus
62
How works catalase positive organism
Catalase degrades H2O2 into H2O and bubbles of O2 before it can be converted to microbicidal products by the enzyme meyloperoxidase.
63
What kind of people have recurrent infections with certain catalase positive organism
Who have chronic granulomatous disease (NADPH oxidase deficiency)
64
Name the catalase positive organism Cats Have BeeN to PLACESS
Bordetella pertussis, Helicobacter pylori, Burkholderia cepacia, Nocardia, pseudomonas, Listeria, Aspergillus, Candida, E. coli, Serratia, Staphylococcci
65
What are the pigment producing bacteria
Actinomyces israelii (yellow sulfur granules) which are composed of filaments of bacteria m.
S aureus golden yellow pigment
P aeriginosa bluee green pigment (pyocyanin and pyoverdin)
Serratia marceacens red pigment
66
What are the bacteria’s who in vivo biofilm producing bacteria
S epidermidis, viridans streptococci (S mutans, S sanguinis), P aureginosa and nontypeable (unencapsulated) H influenzae
67
In what kind of biofilm growth a epidermidis
Catheter and prosthetic device infections
68
In what kind of biofilm there is Viridans streptococci (s mutans and S sanguinis)
Dental plaques, infective endocarditis
69
In what kind of biofilm it produce pseudomonas aureginosa
Respiratory three colonization in patients with cystic fibrosis, ventilator associated pneumoniae, contact lens associated keratitis
70
In what kind of biofilm it is produce nontypeable (unencapsulated) H influenzae
Otitis media
71
They are gram positive bacteria Can form spores when nutrientes are limited
Spore forming bacteria
72
How are the spores
They are lack of metabolic activity and are highly resistant to heat and chemicals. Core contains dipicolinic acid
73
Why the spores are heat resistant
By their core contains dipicolinic acid responsible for heat resistance
74
How the spores can died
Autoclave bye ateaminb121celcius grade for 15 minutes. Hydrogen peroxide and iodine based agents ara also sporicidal
75
Give examples of spore forming bacteria
B anthracis (anthrax), B cereus (food poisoning), C botulinum (botulism) C difficult (pseudo membranous colitis) C perfringens (as gangrene) C tetani (tetanus).
76
Is the characteristic which promote evasion of host immune response
Bacterial virulence factors
77
Name the bacterial virulence factors
Capsular polysaccharide, Protein A, IgA protease, M protein
78
Higlhy charged, hydrophilic structure, Acts as barrier to phagocytosis and complement mediated lysis. Major determinant of virulence
Capsular polysaccharide
79
Binds Fc region of IgG prevents opsonization and phagocytosis. Expressed by S aureus
Protein A
80
What is IgA protease
Enzyme that cleaves IgA, allowing bacteria to adhere to and colonize mucous membranes. Secreted by S pneumoniae, H influenzae type b, and Neisseria
81
Who secreted IgA protease SHiN
S pneumoniae H influenzae type b and Neisseria
82
Helps prevent phagocytosis. Expressed by group A streptococci. Sequence homology with human cardiac myosin (Molecular Mimicry) possible underlies the autoimmune responses seen in acute rheumatic fever
M protein
83
Bacterial genetics processes
Transformation, conjugation, transduction, transposition
84
Competent bacteria can bind and import short pieces of environmental naked bacterial chromosomal DNA (from bacterial cell lysis). The transfer and expression of newly transferred genes is called ?
Transformation
85
What bacterias specially has transformation SHiN
S pneumoniae, H influenzae type b, and Neisseria
86
What preventing transformation ?
Adding deoxyribonuclease degrades naked DNA
87
Types of conjugation
F+ x F - and Hfr x F-
88
F+ plasmid contains genes required for sex pilus and conjugation. Bacteria without this plasmid are termed F-
F+XF-
89
What is mating bridge
A single strand of plasmid DNA is transferred across the conjugal bridge that is call mating bridge. No transfer of chromosomal DNA
90
HfrXF-
F+ plasmid can become incorporated into bacterial DNA termed high-frequency recombination (Hfr) cell. High frequency recombination may integrate some of those bacterial genes. Recipient cell remains F - but now may have new bacterial genes
91
What types of transduction exits
Generalized and specialized
92
A packing error. Lytic phage infects bacterium, leading to cleavage of bacterial DNA. Parts of bacterial chromosomal DNA may become packaged in phage capsid. Phage infects another bacterium transferring these genes
Transduction generalized
93
An excision event. Lysogenic phage infects bacterium; viral DNA incorporates into bacterial chromosome. When phage DNA is excised flanking bacterial genes may be excised with it. DNA is packaged into phage capsid and can infect another bacterium
Specialized transduction
94
Genes for the following 5 bacterial toxins are encoded in a lysogenic phage (ABCD’S)
Group A strep erythrogenic toxin, B botulinum toxin, Cholera toxin, Diphteria toxin, Shiga toxin
95
A jumping process involving a transposon (specialized segment of DNA) which can copy and excise itself and then insert into the same DNA (eg plasmid or chromosome)
Transposition
96
Give and example of transposition
Critical in creating plasmids with multiple drug resistance and transfer across species lines eg. Tn 1546 with vanA from Enterococcus to S aureus
97
Describe characteristics (source, secreted from cell, chemistry, location of genes and toxicity) of exotoxins
Source: certain species of gram + and gram negative bacteria, they are secreted from cell, their chemistry is polypeptide, the location of genes are plasmid or bacteriophage, their toxicity is high (fatal dose on the order of 1 microgramo)
98
Name the clinical effects, mode of action, antigenicity, vaccines, heats stability and typical disease of exotoxins
Various effects, various modes, induces high titer antibodies called antitoxins, toxoid a used as vaccines, destroyed rapidly at 60 Celsius grade (except staphylococcal enterotoxin and E. coli heat stable toxin). Typical diseases tetanus botulism diphtheria cholera
99
Endotoxin source, secreted from cell, chemistry, location of genes and toxicity:
Source: Outer cell membrane of most gram negative bacteria, secreted from cell: No, Chemistry: lipid A component of LPS (structural part of bacteria; released when lysed). Location of genes: bacterial chromosome. Toxicity Low (fatal dose on the order of hundreds of micrograms)
100
Clinical effects, mode of action, antigenicity, vaccines, heat stability, typical diseases
1.Fever, Shock (hypotension), DIC
2. Induces TNF, IL-1 and IL-6
3. Poorly antigenic
4. Stable at 100 C for 1 h
5. Neningococcemia; sepsis by gram negative rods
101
Name the 14 bacterias with exotoxins
Corynebacterium diphtheriae, pseudomonas aureginosa, shigella spp, enterohemorrhahic E. coli, enterotoxigenic E. coli, bacillus anthracis, vibrio cholerae, bordetella pertussis, clostridium tetani, clostridium botulinum. Clostridium perfringens, streptococcus pyogenes and staphylococcus aureus
102
Bacteria with exotoxins which inhibit protein synthesis
Corynebacterium diphtheriae, pseudomonas aeruginosa, shigella spp, entero hemorrhagic E. coli
103
What is the toxin and mechanism of corynebacterium diphtheriae
Diphtheria toxin. Inactivate elongation factor (EF-2) through ADP rybosylation
104
Manifestation of corynebacterium diphtheriae
Pharyngitis with pseudo membranes in throat and severe lymphadenopathy (bull neck) myocarditis
105
What is the toxin, mechanism and manifestation of pseudomonas aeruginosa
Exotoxin A, inactivate elongation factor (EF-2) through ADP ribosylation. Host cell death
106
What is the shared toxin mechanism and manifestation of shigella spp, enterohemorrhagic E. coli
Shiga toxin. Inactivate 60S ribosome by removing adenine from rRNA. Damage GI mucosa causing dysentery enhances cytokine release hemolytic uremic syndrome (HUS; prototypically in EHEC serotype O157:H7)
107
What is the difference between shigella spp and enterohemorrhagic e Coli
EHEC does not invade host cells unlike shigella
108
What are the bacteria’s with exotoxins which increase fluid secretion
Enterotoxigenic E. coli, bacillus anthracis, vibrio cholerae
109
What are the two toxins of enterotoxigenic E. coli
Heat labile toxin (LT) and heat stable toxin (ST)
110
What is the mechanism and manifestation of enterotoxigenic E. Coli heat labile toxin LT
Overactivates adenylate Cyclase (increase cAMP) that conducts to cloró secretion in gut and H2O efflux causing watery diarrhea
111
What are the mechanism and bacteria’s (CAPE) which share this mechanism of heat stable toxin of enterotoxigenic E. coli
Overactivates guanylate Cyclase (increase cGMP) causing decrease resorption of NaCl and HO2 in gut, cholera, anthracis, pertussis, E. Coli (increase cAMP)
112
Toxins, mechanism of action and manifestation of bacillus anthracis
Anthrax toxin mimics adenylate Cyclase (increase cAMP) likely responsible characteristics edematous borders of black eschar in cutáneos anthrax
113
Toxin, mechanism and manifestations of cholerae toxin
Overactivates adrnylate Cyclades (increase cAMP) by permanently activating Gs. Voluminous rice water diarrhea
114
Bacteria with exotoxins which inhibit phagocytosis ability
Bordetella pertussis
115
Toxin and mechanism of bordetella pertussis
Pertussis toxin activates adenylate cyclase (increase cAMP) by inactivating inhibitors subunit G I
116
Manifestations of bordetella pertussis
Whooping cough: child coughs on expiration and whoops on inspiration, can cause 100 day cough in adults associated with posttuauve emesis
117
Bacteria’s with toxins who inhibit release of neurotransmitter
Clostridium tetani and clostridium botulinum
118
What are the toxins and shared mechanism of clostridium tetani and botulinum
Tetani spasm in and botulinum toxin
Both are protests that cleave SNARE (soluble NSF attachment protein receptor) a set of protein requires for neurotransmitter release via vesicular fusion
119
Manifestation of clostridium tetani
Toxin prevents release inhibitory (GABA and glycine) neurotransmitter from renshaw cell in spinal cord results in spastic paralysis tissue sardonicus trismus (lockjaw) opisthotonos
120
Manifestations of clostridium botulinum
Infant botulism caused by ingestion of spores (from soil, raw honey) toxin produced in vivo. Foodborne botulism caused by ingestion of preformed toxin ( from canned foods)
121
What are the bacteria’s with exotoxins which puse cell membranes
Clostridium perfringens and streptococcus pyogenes
122
What are the bacteria’s with toxins which has superantigens causing shock
Staphylococcus aureus and streptococcus pyogenes
123
What is the toxin and mechanism of clostridium perfringens
Alpha toxin. Phospholipase (lecithinase ) that degrades tissue and cell membranes
124
Manifestations of clostridium perfringens
Degradation of phospholipids causes myonecrosis (gas gangrene) and hemolysis (doble zone of hemolysis on blood agar)
125
What is the name of streptococcus pyogenes that muse cell membranes and how is it mechanism
Streptolysin O. Protein that degrades cell membrane.
126
Manifestation of streptolysin O of streptococcus pyogenes
Lyses RBC contributes to beta hemolysis host antibodies against toxin ASO used to diagnose rheumatic fever (do not confuse with immune complexes of poststreptococcal glomerulonephritis)
127
What is the toxin of staphylococcus and how it’s works
Toxic shock syndrome toxin (TSST-1) cross links B region of TCR to MHC class II on APCs outside of the antigen binding site conducts ton overwhelming release of IL-1, IL-2, IFN gamma and TNG Alfa conducts to shock.
128
How are the manifestation of staphylococcus aureus
Toxic shock syndrome: fever, rash, shock; other toxins cause scalded skin syndrome (exfoliating toxin) and food poisoning (heat stable enterotoxin)
129
What are the manifestations of endotoxins ENDOTOXINS
Edema, nitric oxide, DIC/Death, Outer membrane, TNF Alfa, O antigen + core polysaccharide + lipid A, eXtremely heat stable IL-1 and IL-6 Neutrophil chemotaxis Shock
130
Composition of endotoxin
LPS found in outer membrane of gram negative bacteria (both occurs and rods). Composed of O antigen + core polysaccharide + lipid A (the toxic component). Neisseria have lipooligosaccharide. Released upon cell lysis or by living cells by blebs detaching from outer surface membrane
131
Name three main effects of endotoxin
Macrophage activation (TLR4 CD14 ) complement activation and tissue factor activation
132
What does the macrophage activation (TLR4/CD14) of endotoxin do?
Deliver IL-1, IL-6 which cause fever TNF Alfa which cause fever and hypotension and nitric oxide which cause hypotension.
133
What does complement activation of endotoxin and their lipid A component do ?
It active C3a which cause histamine release: hypotension and edema and C5a which cause neutrophil chemotaxis.
134
What does Tissue factor activation of endotoxin (an their lipid A component) do?
Ig axtivates coagulation cascade and causes DIC
135
How is the division of gram + bacteria’s regarding gram positive lab algorithm
By their shape: Bacili, cocci and branching filaments
136
How does bacilli and branching filaments gram positive bacteria are divided
Between aerobic, anaerobic
137
How does cocci gram + bacteria are divided ?
Catalase negative and positive
138
What are the bacilli aerobic ? And what are the bacili anaerobic ?
Listeria bacillus corynebacterium/ clostridium cutibacterium (formely propionibacterium)
139
What are the aerobic branching filaments gram + bacteria’s and anaerobic
Nocardia (weakly acid fast) / anaerobic: actinomyces ( not acid fast)
140
What are the gram positive cocci which are catalase negative and how is their subsequent classification by hemólisis
Streptococcus/ Alfa hemolytic, Beta hemolytic and gamma which are not hemolytic
141
How are the Alfa hemolytic streptococcus and how are they divided
They are partial hemolysis green organism and they are divided by optochin sensitivity and bile solubility
142
Who are the streptococcus Alfa hemolytic optochin sensitivity and bile solubility negative
Viridiana streptococci (no capsule) S mutans and S mitis
143
Who are the Alfa hemolytic streptococcus optochin sensitivity and bile solubility positive
S pneumoniae (encapsulated)
144
How are the beta hemolytic streptococcus and how does it is divided
They do complete hemolysis that is clear (no green) and they are divided by bacitracin sensitivity and PYR status
145
Who are the bacitracin sensitivity and PYR negative beta hemolytic streptococcus
Group B S agalactiae
146
Who is the beta hemolytic streptococcus bacitracin sensitivity and PYR positive
Group A S pyogenes
147
What are the gamma (no hemolysis grows in bile ) streptococcus and how are they divided
They are: non enterococcus S gallolyticus who is negative to growth in 6.5% NaCl and PYR status and enterococcus E. Faecium and E. Faecalis who are positive to growth in 6.5% NaCl and PYR status
148
Who is the gram + cocci that is catalase positive and how is he divided
Staphylococcus coagulase negative and positive
149
How is coagulase negative divided
By novobiocin sensitivity
150
Who is the staphylococcus coagulase negative nonsensitive novobiocin and novobiocin sensitivity positive
S saprophyticus / s epidermis respectively
151
What is PYR
Pyrrolidonyl aminopeptidase
152
Partial oxidation of hemoglobin greenish or brownish color without clearing around growth on blood agar. Include s pneumoniae and viridans
Alfa hemolytic bacteria
153
Complete lysis of RBCs conducts to pale clear area surrounding colony in blood agar. Include staphylococcus aureus m, streptococcus pyogenes (group A strep), streptococcus agalactiae (group B strep) listeria monocytogenes
Beta hemolytic bacteria
154
What is the classification of staphylococcus aureus
Gram + beta hemolytic catalase + coagulase + cocci in clusters
155
What is the main virulencia factor of staphylococcus aureus and how it is work
Proteínas A, binds Fc-IgG, inhibiting complement activation and phagocytosis.
156
Staphylococcus aureus commonly are ?
Nares, ears, axilla and groin.
157
What Kind of diseases causes staphylococcus aureus
Inflammatory disease: skin infections, organ abscesses, pneumoniae (often after influenza virus infection), infective endocarditis, septic arthitis and osteomyelitis
Toxin mediated disease: toxic shock syndrome (TSST-1) scalded skin syndrome (exfoliative toxin), rapid onset food poisoning (enterotoxins)
158
Why Methicillin resistant S aureus MRSA is resistant
Due to altered penicilin binding proteins (conference by mecA gene). Come atraían release Panton valentine leukocidin PVL which kills leikocytes and caídes tissue necrosis
159
How works TSST-1 (toxic shock syndrome)
TSST-1 is a superantigen that binds to MHC II and T cell receptor resultona in polyclonal T cell and cytokines release
160
Manifestation of Staphylococcal toxic syndrome
Fever vomiting diarrhea rash desquamation shock, end organ failure. TSS results in increase AST, ALT, increase bilirrubin. Associated with prolonged use of vaginal tampons or nasal packing. Compare with streptococcus pyogenes TSS is associated with painful skin infection
161
S aureus food poisoning by ingestion of preformed toxin has a short incubation period that is ?
2-6 Hours and enterotoxins are heat stable don’t destroyed by cooking
162
How does S aureus makes abscess
S aureus makes coagulase and toxins. Forms fibrin clot around itself
163
Staphylococcus epidermidis classification and characteristics
Gram + catalase + coagulate - urease + cocci in clusters. Novobiocin sensitive does not fermented mannitol
164
Where is the staphylococcus epidermidis
Normal microbiota skin, contaminates blood cultures, infects prosthetic devices (eg hip implant, heart valve) and IV catheters by producing adherent biofilms
165
What is the classification and characteristics of staphylococcus saprophyticus
Gram +, catalase +, coagulase - urease + cocci in clusters. Novobiocin resistant.
166
Where is staphylococcus saprophyticus
Normal microbiota of female genital tract and perineum and is the second most common cause of uncomplicated UTI in young females (most common is E. coli)
167
What is the Streptococcus pneumoniae clasification and characteristics
Gram +, Alfa hemolytic, lancet shaped diplococci. Encapsulated IgA protease. Optochin sensitive and bile soluble.
168
What are the most commonly diseases causes by streptococcus MOPS
Meningitis, Otitis media in children’s , Penumonia, sinusitis
169
Pneumococcal penumonia is associated with?
Rusty sputum
170
Who are the patients predispose to streptococcus pneumoniae
Patients with anatomic or functional hypoesplenia or asplenia are predisposed to infection
171
What are the two types of pneumococcal vaccines
Conjugate (PCV13, PCV 15, PCV20) and polysaccharide (PPSV23) formulations
172
What is the classification and characteristics of viridana group streptococci
Gram +, Alfa hemolytic cocci optochin resistant and bile insoluble.
173
Where is viridans group streptococci normally ?
Normal microbiota of the oropharynx
174
Streptococcus belong to viridans group which cause varies
Streptococcus mutans and S mitis
175
What kind of streptococcus belong to viridans group streptococci causes endocarditis
S sanguinis makes dextrans that bind to fibrin- platelet aggregates on damage heart valves cause infective endocarditis
176
What are the streptococcus pyogenes (group A streptococci) classification and characteristics
Gram + cocci in chains. Bacitracin sensitive, beta hemolytic, pyrrolidonyl arylamidase (PYR) + (positive)
177
Name diseases that are caused by streptococcus pyogenes
Pyogenic - pharyngitis, cellulitis, impetigo (honey crusted lesions), erysipelas.
Toxigenic - scarlet fever, toxic shock-like syndrome, necrotizing fasciitis
Immunologic- rheumatic fever, glomerulonephritis
178
Mechanism of M protein of streptococcus pyogenes
Hyaluronic acid capsule and M protein inhibit phagocytosis
179
What are the diagnose test which can diagnose strep pharyngitis
Via throat swab which can be tested with an antigen detection assay (rapid in office results) or cultured on blood agar (results in 48 hours)
180
Key virulence factors of streptococcus pyogenes
DNase, erythrogenic exotoxin, streptokinase, streptolysin O. ASO titer or anti DNase B antibodies indicate recent S pyogenes infection
181
What are scarlet fever characteristics
Blanching sandpaperlike body rash strawberry tongue and circumoral pallor in the setting of group A streptococcal pharyngitis (erythrogenic toxin +)
182
What are the characteristics of streptococci agalactiae (group B streptococci)
Gram + cocci, bacitracin resistant, beta hemolytic. Polysaccharide capsule confers virulence. Produces CAMP factor, which enlarges the area of hemolysis formed by S aureus.
183
Where is streptococci agalactiae (group B streptococci) and what diseases cause ?
Colonizes vagina; causes pneumonia, meningitis and sepsis mainly in babies.
184
What is the utility of looking for streptococcus agalactiae (group B streptococci) and what are the tests
Screen pregnant patients at 35-37 weeks of gestation with rectal and vaginal swabs. Patients with positive culture recieve intrapartum penicillin/ampicillin prophylaxis. This bacteria has a hippurate tests + and pyrrolidonyl arylamidase PYR -
185
What are the characteristics of streptococcus galllolyticus? Where is it ? And what kind of diseases cause
Gram + cocci (formerly S bovis) colonizes gut, causes bacteremia and infective endocarditis. Patients with S gallolyticus endocarditis have more incidence of colon cancer
186
What are the characteristics of enterococci (what includes)
Gram + cocci. Include E. Faecalis and E faecium they are catalase negative pyrrolidonyl arylamidase (PYR) positive typically nonhemolytic they are pinicilin G resistant.
187
What kind of infection cause enterococci
UTI, biliary tracts infection, and infective endocarditis (following GI/GU procedures). VRE (vancomycin resistant enterococci) are an important cause of health care associated infection
188
What are the bacteria’s characteristics of bacillus anthracis
Gram + spore forming rod that produces anthrax toxin, exotoxin consisting of protective antigen, lethal factor, has a polypeptide capsule (poly D glutamate). Colonies show a halo of projections sometimes called Medusa head appearance
189
How does bacillus anthacis acts
Lethal factor (inhibits MAP kinase, macrophage apoptosis) and edema factor (acts as adenylyl cyclase this increase intracellular cAMP upsetting homeostasis results in edema and necrosis.
190
Describe how is cutaneous anthrax
Painless papule surrounded by vesicles that has evolution? To a ulcer with black eschar (painless necrotic) that uncommonly progresses to bacteremia and death
191
Describe how is pulmonary anthrax
Inhalation of spores, most commonly from contaminated animals or animal products although also a potential bio weapon. Causes flulike symptoms that rapidly progress to fever pulmonary hemorrhage, mediastinitis (CXR may show widened mediastinum) and shock. Also called woolsorter disease.
192
What is the prophylaxis of bacillus anthracis when there is exposition and what is a important complication of both types of anthrax
Ciprofloxacin or doxycycline. Both cutaneous and pulmonary anthrax may be complicated by hemorrhagic meningitis
193
What are the characteristics of Bacillus cereus
Gram + rod
194
What does bacillus cereus cause (disease manifestations)
Food poisoning. Spores survive cooking rice (reheated rice syndrome) keeping rice warm results in germination of spores and enterotoxin formation. Emetic type cause nausea and vomiting within 1-5 horas. Caused by very life a preformed toxin. Diarrheal type causes watery nonbloody diarrhea and GI pain within 8-18 hours. Management supportive care (antibiotics are ineffective against toxins)
195
What kind of disease cause clostridioides difficile and how it’s works and
Produces toxins A and B which damage enterocytes. Both toxins lead to watery diarrhea—> paeudomembranous colotis. Often secondary to antibiotic use especially clindycin, ampicillin cephalosporins, fluoroquinolones; associated with PPI. Fulminant infection: toxic mega colon ileus shock
196
What are the diagnostic methods of clostridioides difficile and treatment
Diagnosed by PCR or antigen detection of one or both toxins in stool. Treatment: oral vancomycin or fidaxomicin for recurrent cases, consider repeating prior regimen of fecal microbiota transplant
197
What bacteria’s are include in “clostridia”?
Clostridium tetani, clostridium botulinum, clostridium perfringens
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Describe characteristics of clostridia
Gram +, spore forming, obligate anaerobic rods. Tetanus toxin and botulism toxin are proteases that cleave SNARE proteins involved in neurotransmission
199
Describe how works clostridium tetani
Pathogen is noninvasive and remains localized to wound site. Produce tetanospasmin an exotoxin causing tetanus. Tetanospasmin spread by retrograde axonal transport to CNS and blocks release of GABA and glycine from renshaw cells in spinal cord. Causes spastic paralysis trismus (lockjaw) risks sardonic (raised eyebrows and open grin) opisthotonos (spasm of spinal extensors)
200
How does tetanus prevents
Tetanus vaccine. Treat with antitoxin +/- vaccine booster, antibiotics, diazepam (for muscular spasm) and wound debridement
201
What is opisthotonos
Spasms of spinal extensors
202
Produces a heat labile toxin that inhibits ACh release at the neuromuscular junction, causing botulism. In babies ingestion of spores (eg in honey) in adults disease is causes by ingestion of preformed toxin in canned food
Clostridium botulinum
203
How is the name of the disease caused by clostridium botulinum spores in babies
Floppy baby syndrome
204
Name the 5 D’s of symptoms of botulism
Diplopia, dysarthria, dysphagia, dyspnea, descending flaccid paralysis. They don’t present with sensory deficits
205
Treatment of botulism
Human botulinum immunoglobulin
206
Name some therapeutics uses of botulism toxin
Local botulinum toxin A (Botox) injections used to treat focal dystonia, hyperhydrosis, muscle spasm and cosmetics reduction of facial wrinkles
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Produces Alfa toxins (lecithinase that is a phospholipase) that can cause myonecrosis (gas gangrene presents as soft tissue crepitus) and hemolysis
Clostridium perfringens
208
What happens if the food is contamined by clostridium perfringens
If heavely spores contaminated food is cooked but left standing too long at less of 60C spores germinate results in vegetative bacteria conducts to heat labile enterotoxin late onset 10-12 hours. Food poisoning symptoms resolution in 24 hours
209
Which what kind of condition is associated spontaneous gas gangrene
This could be by hematogenous seeding associated with colonic malignancy is most commonly causes by clostridium septicum
210
What are the bacteria’s characteristics of corynebacterium diphtheriae
Gram + rods. Causes diphtheriae via exotoxin inhibits protein synthesis via ADP ribosylation of EF-2, leading to possible necrosis in pharynx cardiac and CNS tissue.
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What are the characteristics of diphteria disease
Transmitted via respiratory droplets. Symptoms include pseudomembranous pharyngitis (grayish white membrane) with lymphadenopathy (bulls neck appearance) toxin dissemination may cause myocarditis arrhythmias neuropathies.
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What are the labs diagnosis to diphtheria
Gram + rods with metachromatic ( blue and red) granules on Löffler media and + Elek test for toxin
Black colonies on cystine tellurite agar.
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Treatment and prevent to diphtheria
Toxoid vaccine prevents diphtheria. Treatment diphteria antitoxin +/- erythromycin or penicillin
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ABCDEFG describe the characteristics of corynebacterium diphtheriae
ADP rybosilation (inhibition pathway of protein synthesis)
Beta prophage (who encodes exotoxin)
Corynebacterium
Diphtheria
Elongation factor 2 (owner of ADP ribosylation)
Granules
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Is gram + facultative intracellular rod that is acquired by ingestion of unpasteurized dairy products and cold deli meats transplacental transmission by vaginal transmission during birth. Grows well at refrigeration temperatures (cold enrichment)
Listeria monocytogenes
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Why listeria monocytogenes avoid antibody
Aldrin’s rocket tails via actin polymerization that allow intracellular movement and cell to cell spread across cell membranes thereby avoiding antibody
217
What are the characteristics of listeriolysis
Generates pores in phagosomes, allowing its scape into cytoplasm characteristics tumbling motility in broth.
218
Diseases that can be caused by listeria monocytogenes
Amnionitis, septicemia, and spontaneous abortion in pregnant patients; granulomatosis infantiaseptica, meningitis in immunocompromised patients, neonates and older adults; mild, self limited gastroenteritis in healthy individuals
219
What is the treatment of lysteria monocytogenes is ?
Ampicillin
220
Bacterial characteristics of Nocardia and actinomyces
Both are gram + and form long, branching filaments resembling fungi
221
Name at least three main differences between Nocardia vs actinomyces
Nocardia: aerobe, acid fast (weak), found in soil. Actinomyces: aerobe, not acid fast and is found in normal oral reproductive and GI microbiota
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What are the main diseases manifestation of Nocardia and what is the treatment
Causes pulmonary infections in immunocompromised (can mimic TB but with negative PPD); cutaneous infections after trauma in immunocompetent; can spread to CNS resulting in cerebral abscess
Treatment with sulfonamides (TMP-SMX)
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What are the main diseases by actinomyces and treatment
Causes oral facial abscesses that drain through sinus tracts; often associated with dental Caries/ extraction and other maxilla facial trauma; forms yellow sulfur granules; can also cause pelvic inflammatory disease with intrauterine dispositive. Treatment with penicillin
224
Bacterial characteristics of mycobacteria
Acid fast rods
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What kind of mycobacteria is there
Mycobacterium tuberculosis (TB often resistant to multiple drugs) M avium (cause disseminated non TB disease in AIDS; often resistant to multiple drugs) M scrofulaceum (cervical lymphadenitis in children) and M Marinum (hand infection in aquarium handlers)
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What are the main symptoms of TB
Include fever, night sweats, weight loss, cough (nonproductive or productive$ hemoptysis
227
What structure appears in virulent M tuberculosis
Cord factor that create a serpentine cord , activates macrophages (promoting granuloma formation ) and induces release of TNF Alfa. Sulfatides (surface glycolipids) inhibit phagolysosomal fusion
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What does PPD positive means
If current infection or past exposure
229
When PPD is negative
On no infection and I’m immunocompromised patients especially with Low CD4 cell count
230
iGRA ( interferon gamma realease assay) has fewer ?
False positive from BCG vaccination
231
Who are in highest risk of m tuberculosis a
reactivation
Immunocompromised individuals eg HIV, organ transplant recipients TNF Alfa inhibitors use
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Where does the deactivation is in lungs
Has predilection for the apices of the lung ( due to the bacteria bienvenida highly aerobic)
233
What is the ghon complex
Primary infection foci is a ghon complex and they are on hiliar nodes and ghon focus usually mild lower lobes
234
What percentage of TB is progressive primary tuberculosis and what predispose it
And name manifestations
Less than 10% is associated with AIDS and malnutrition
Can cause bacteremia but also progressive lung disease, meninges, spleen adrenal gland joints and long bones lymph nodes lung liver
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How is the way of more than 90% of primary tb isn’t progressive
By healing by fibrosis calcification and has PPD +
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What are the lesions of secundary TB
Fibrovaseuous cavitary lesion ?usually upper lobes
In lung cavity caseations and scars and suprarrenal caseation
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What is the other name of leprosy
Hansen disease
238
What is the bacteria that cause leprosy and what are their characteristics
Mycobacterium leprae, an acid fast bacillus that likes cool temperatures (infects skin and superficial nerves) glove and stocking loss of sensation and cannot be grown in vitro
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What is the diagnostic test of leprosy and what is their reservoir
Skin biopsy or tissue PCR. Reservoir in United States: armadillos
240
What are the two forms leprosy
Lepromatous and tuberculoid
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Describe lepromatous
Present diffusely over the skin with leonine facies and is communicable. (High bacterial load) characterized by low cell mediated immunity with a largely th2 response. Lepromatous form can be lethal
242
Describe tuberculoid way of leprosy
Limited to a few hypoesthetic hairless skin plaques characterized by high cell mediated immunity with a largely th1 type response an low bacterial load
243
What are the treatments for leprosy lepromatous and leprosy tuberculoid
Tuberculoid form: dapsone and rifampin and clofazimine is added for lepromatous form
244
How does gram negative can be divided
By their shape as diplococci, cocobacilli, bacilli and curved rods
245
How is the diplococci clasification
Aerobic with maltose fermentation negative and positive
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What are the bacteria’s gram negative diplococci maltose fermentation negative
N gonorrhoeae and moraxella
247
What is the clasification of N meningitidis
Gram negative diplococci aerobic maltose fermentation positive
248
What are the gram negative coccobacilli
Haemophilus influenzae, bordetella pertussis, Pasteurella, brucella, francisella tularensis acinetobacter baumanii
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How gram negative curved rods are divided
Oxidase positive that grows in 42C, grows in alkaline media, and produces urease
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What is the bacteria which is gram negative curved rods oxidase + and grows in 42 C
Campylobacter Jenjuni
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What is the clasification of vibrio cholerae
Gram negative curved rods oxidase positive grows in alkaline media
252
Gram negative curve rods oxidase positive produce urease
Helicobacter pylori
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How gram negative bacilli are classify
By lactose fermentation negative and positive. And negative are classified agin regard their oxidase is positive or negative. And lactose fermentation positive that it’s divided in fast and slow
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The gram negative bacilli lactose fermentation negative oxidase negative are subdivided in ?
H2S production on TSI agar negative and positive
255
What is the classification of shigella yersinia
Gram negative bacilli lactose fermentation negative oxidase negative H2S production on TSI agar negative
256
What is the salmonella and proteus classification
Gram negative bacilli lactose fermentation negative oxidase negative and H2S production on TSI agar positive
257
They are gram negative bacilli lactose fermentation negative oxidase positive
Pseudomonas and burkholderia
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What are the clasification of E. coli klebsiella and enterobacter
They are gram negative bacilli lactose fermentation positive fast
259
What is the citrobacter and serratia clasification
They are gram positive bacilli lactose fermentation positive slow
260
Describe the bacterial characteristics of neisseria
Gram negative diplococci. Metabolize glucose and produce IgA proteases. Contain lipooligosaccharides (LOS) with strong endotoxin activity. N gonorrhoeae is often intracellular (within neutrophils) acid production: meningococci maltose and glucose gonococci glucose
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What are the differences between gonococci and meningococci about polysaccharide capsule acid maltose detection and vaccines
Gonococci doesn’t have polysaccharide capsule, and meningococci has polysaccharide capsule. Gonococci doesn’t have maltose acid detection and meningococci has, gonococci doesn’t have vaccine due to antigenic variation of pilus proteins and meningococci has vaccine (type B vaccine available for at risk individuals)
262
What is the transmitted via of gonococci and what kind of diseases it is caused
Sexually or perinatally. Causes gonorrhoeae, septic arthritis, neonatal conjunctivitis (2-5 days after birth) pelvic inflammatory disease PID and fits Hugh Curtis syndrome
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What is the diagnosis method and treatments of gonococci
Diagnosed with NAAT, condoms reduce sexual transmission, erythromycin eye ointment prevents neonatal blindness. Treatment: single dose IM ceftriaxone of chlamydial confection not excluded by molecular testing add doxycycline
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How is the transmitted via, diseases, diagnosis method and treatment of meningococci
Respiratory and oral secretion. Causes meningococcemia with Petechial hemorrhages and gangrene of toes, meningitis, Waterhouse friderichsen syndrome . Diagnosed via culture based tests or PCR. Treatment is ceftroaxone or penicillin G
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What are the prophylaxis of meningococci in close contacts
Rifampin, ciprofloxacin, or ceftriaxone
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Is an acute hemorrhagic adrenal insufficiency
Water hose friderichsen syndrome
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Describe the bacterial characteristics of hemophilia influenzae
all gram negative coccobacillary rod is no type able (unencapsulated) produce IgA protease
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What are the diseases and findings of haemophilus influenzae
Strains of it are the most common cause of mucosal infections (otitis media, conjunctivitis, bronchitis) as well as invasive infections. Causes epiglotitis endoscopic appearance can be cherry red, thumb sign on lateral neck d ray meningitis otitis media and pneumonia
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What is the culture media of haemophilus influenzae
Factors V (NAD+) and X (hematin) for growth; can also be grown with S aureus which provides factor V via RBC hemolysis
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What is the vaccine of haemophilus influenzae and how is
Contains type b capsular polysaccharide (polyribosylribitol phosphate) conjugated to diphteria toxoid or other protein. Given between 2 and 18 months of age
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What is the treatment of hemophilia influenzae
Amoxicillin +/- clavulanate for mucosal infections; ceftriaxone for meningitis, rifampin prophylaxis for close contacts
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Describe the bacterial characteristics of burkholderia cepacia complex
Aerobic, catalase + gram negative rod. Often multidrug resistant. Infection is a relative contraindication to undergoing to lung transplantation due poor prognosis
273
How is transmitted burkholderia cepacia complex
Causes pneumoniae in and can be transmitted between patients with cystic fibrosis.
274
Describe the bacterial characteristics of bordetella pertussis
Gram negative aerobic coccobacillus. Virulence factors include pertussis toxin (disables G) adenylate Cyclase toxin ( cAMP) and tracheal cytotoxin.
275
What are the three clinical stages of bordetella pertussis
1. Catarrhal-low grade fevers, Coryza
2. Paroxysmal paroxysms of intense cough followed by inspiratory whoop whooping cough posttusive vomiting
3. Convalescent - gradual recovery of chronic cough
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How is prevented bordetella pertussis
Tdap, DTap, vaccines.
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A interesting finding in lymphocytes in bordetella pertussis
Produce lymphocytosis unlike most acute bacterial infections
278
What is the treatment of bordetella pertussis
Macrolides if allergic use TMP SMX
279
Describe the bacterial characteristics of brucella
Gram negative aerobic cocobacillus. Survive Macario haves in the reticuloendothelial system. Can form a caseating granulomas
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How is transmitted, manifestations and treat brucella
Via ingestion of contaminated animal products (eg unpasteurized milk) typically presents with undulant fever, night sweats and arthralgia. Treatment doxycycline + rifampin or streptomycin
281
Describe the characteristic bacterial of legionella pneumophila
Gram negative rod. Gram strains poorly- use silver stain. Grow on charcoal yeast extract medium with iron and cysteine. Is detected by antigen in urine.
282
Transmission findings and treatment
Aerosol transmission from environmental water source habitat (eg air condition systems hot water tanks). Labs may show hyponatremia. Outbreaks associated with cruise ships, nursing homes. No person to person transmission treatment with macrolide or quinolone
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How is the legionnaires disease
Severe pneumoniae, often unilateral and lobar, fever, GI and CNS symptoms. Risk factors include older age, tobacco smoking, chronic lung disease.
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What is Pontiac fever
Is a mild flulike symptoms by legionella pneumophila
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Describe the bacterial characteristics on pseudomonas aureginosa
Aerobic motile catalase positive gram negative rod Non lactose fermenting oxidase + frequently found in water increase virulence in acidic environments. Has a grape like odor mucous polysaccharide capsule may contribute to chronic pneumonia in patients with cystic fibrosis due to biofilm. Produce phospholipase C (degrades cell membranes, Endotoxin (fever shock ) Exotoxin A )inactivated EF-2) pigments proceeding and pyocianin (bluer green pigment) also generates ROS
286
Diseases associated with pseudomonas aureginosa
Pneumonia, sepsis, ecthyma gangrenosum, UTIS Diabetes Osteomyelitis Mucoid polysaccharide capsule Otitis externa (swimmers ear) nosocomial (health care associated) infections addiction skin infections (hot tubs folliculitis,wound infection in burn victims) corneal ulcers /keratitis in contact lens wearers minor eye trauma
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It’s a tepid progressive necrotic cutaneous lesion caused by pseudomonas bacteremia. Typically seen in immunocompromised patients
Ecthyma gangrenosum
288
Treatments of pseudomonas aureginosa
Anti pseudomonas penicillin’s in combination with beta lactamase inhibitor
3rd and 4th generation cephalosporin (eg ceftazidime cefepime )
Monobactams
Fluoroquinolones
Carbapenems
Despite antipaeudomonal activity aminoglycoside mono therapy is avoided due to poor performance in acidic environments
289
Despite the bacterial characteristics of salmonella and shigella
Are gram negative rods, non lactose fermenters, oxidase negative and can invade the GI tract via M cells of peyer patches
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What are the reservoirs, spread, H2S production, fagella, virulence factors and infectious dose of salmonella typhi
Humans only, hematogenous spread, yes, yes, endotoxin Vi capsule, high large inoculum required, acid labile inactivated by gastric acid
291
What are the effect of antibiotics on fecal excretion, immune response, vaccine and unique properties of salmonella
Prolongs duration, primarily monocytes, oral vaccine contains live attenuated s typhi IM vaccine contains Vi capsular polysaccharide. Cause fever typhoid with salmon colored truncated macular rash abdominal pain pulse temperature dissociation later GI ulceration and hemorrhage. Treat with ceftriaxone or fluoroquinolones. Carries state with gallbladder colonization
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GI symptoms of salmonella typhi
Constipation followed by diarrhea
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Reservoirs, spread, H2S production, flagella, virulence factors, infectious dose (ID50), effect of antibiotics on decal excretion and immune response od salmonella except typhi
Humans and animals, hematogenous spread, yes, yea, endotoxin, high ID50, prolongs duration, PMNs in disseminated disease
294
What about GI symptoms, vaccine and unique propierties of salmonella except typhi
Diarrhea (possibly bloody) no vaccine, poultry, eggs, let’s and turtles are common source. Treatment is supportive antibiotics are not indicated in immunocompetent individuals
295
What are the reservoir, spread, H2S production flagella virulence factors infections dose (ID50)
Humans only, cell to cell NO hematogenous spread, No No, endotoxin Shiga toxin (enterotoxim). Los very small inoculjm required acid stable
296
What the effect of antibiotics on decal excretion, immune response, GI manifestations, vaccine, unique propierties
Shortens duration , primarily PMN cramps abdominal pain teneamus bloody mucoid stools no vaccine
297
In order of decreasing severity in toxin produced of shigella are
A dysenteries, fkexneri Boydii a sonnei
298
Charcateristcs of yersinia enterocolitica
Gram negative pleomorphic rod cocobacilli with polar staining. Usually transmitted form peg feces contaminated milk or pork. Can use acute bloody diarrhea, pseudoappendicitis (right lower abdominal pain due to mesenteric adenitis and or terminal ileitis) reactive arthritis in adults
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Lactose fermenting enteric bacteria
Fermentation of lactose pink colonies on MacConkey agar. Examples include Citrobacter, E. coli, enterobacter, klebsiella serratia
300
How is the EMB what with lactose fermenting enteric bacteria
Lactose fermenters grow as purple black colonies E. Coli grows colonies with a green sheen
301
Its gram negative índole + Rod. His virulencia factores are fimbriae P pilli,
Cause cystitis and pyelonephritis and K cápsule cause pneumonia neonatal meningitis, LPS endotoxin- septic shock
E. Coli
302
Name the 4 types (strain/cepa) of E. coli
Enteroinvasive E. coli, enterotoxigenic E. coli, enteropathogenic E. coli and enterohemorrhagic E. coli
303
Toxins and mechanism of enteroinvasive E. coli- EIEC- and how is it presentation
Microbe invade intestinal mucosa and causes necrosis and inflammation . Dysentery clinical manifestations similar to shigella
304
Produces heat labile and heat stable enterotoxins there is no inflammation or invasion is cause of travelers diarrhea (watery)
Enterotoxigenic E. coli
305
What are the enteropathogenic E. coli toxin and mechanism and presentation
Not toxin produced, adheres to apical surface, flattens villi and prevents absorption causing diarrhea usually in children (think EPEC and pediatrics)
306
Which is the most common serotype of enterohemorrhagic E. coli in US usually trabamittes vianundercooked meat raw leafy vegeta les
O157:H7
307
Anemia, thrombocytopenia, and acute kidney injury due to microthrombi forming on damaged endothelium is triad of ? And what is the toxin
Hemolytic uremic syndrome, Shiga toxin
308
Name the findings of HUS
Mechanical hemolysis (with schistocytes on peripheral blood smear) platelet consumption and decrease renal blood flow
309
What are the presentation of enterohemorrhagic E. coli
Dysentery (toxin alone causes necrosis and inflammation) doesn’t ferment sorbitol (vs other E. coli)
310
Gram negative rod intestinal microbiota that causes lobar pneumoniae more common in patients with heavy alcohol use or with impaired host defenses
Klebsiella
311
Has very mucous colonies caused by abundant polysaccharide capsules. Dark red currant jelly sputum (blood/mucus) also cause of healthcare associated UTIs associated with evolution of multi drug resistant
Klebsiella
312
Describe ABCDE of klebsiella
Aspiration pneumonia
aBscess in lung and liver
Currant jelly sputum
Diabetes mellitus
EtOH over use
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Is a gram negative, comma or S shaped with polar flagella oxidase + grows at 42 Celsius grades
Campylobacter jejuni
314
Is the major cause of bloody diarrhea especially in children. Fecal oral transmission through person to person contact or via ingestion of undercooked contaminated poultry or meat unpasteurized milk
Campylobacter jejuni
315
Campylobacter jejuni is a common antecedent of what diseases
Guillain barre syndrome and reactive arthritis
316
Gram negative flagellated comma shaped oxidase +grows in alkaline media endemic to developing countries produce profuse rice water diarrhea via enterotoxin that permanently activates Gs increase cAMP acid all bile high ID50 (large inoculum) unless host has decrease gastric acidity
Vibrio cholerae
317
Transmitted via ingestion of contaminated water or uncooked food (raw shellfish). Treat promptly with oral rehydration solution
Vibrio cholerae
318
Gram negative bacillus usually found in marine environments cause severe wound infections or septicemia due to exposure to contaminated sea water. Presenta as cellulitis that can progress to necrotizing fasciitis in high risk patients specially those with liver disease (cirrhosis hemochromatosis). Serious wound infection el requires surgical debridement
Vibrio vulnificus
319
Is a curved flagellated (motile) gram negative rod. That is triple +: catalase + oxidase + and urease + (can use urea breath test or decal antigen test for diagnosis. Urease produce ammonia, creating an alkaline environment which help to survive
Helicobacter pylori
320
Where does h pylori colonize and what kind of diseases cause
Antrum of stomach causes gastritis and peptic ulcers (specially duodenal) risk factor for peptic ulcer disease, gastric adenocarcinoma and MALT lymphoma
321
What about h pylori in United States
Most common initial treatment is triple therapy/ amoxicillin (metronidazole of peniclinnallergy + clarithromycin + proton pump inhibitor antibiotics cure pylori, bismuth based for quadruple therapy if concerned about macro life resistente
322
How are the characteristics of spirochetes
Spiral shaped bacteria with axial filaments.
323
What bacteria’s are included in spirochetes
Leptospira treponema and borrelia
324
What are the diagnosis method is spirochetes
Only borraría can be visualized using aniline dyes (weight or hienas stain) in light microscopy due to size. Treponema is visualized bye dark field microscopy or direct fluorescent antibody microscopy (DFA)
325
What is jarisch herxheimer reaction
Flulike symptoms (fever, chills, headache, myalgia) after antibiotics are started due to host response to sudden release of bacterial antigens. Usually occurs during treatment of spirochetes infections
326
Is a disease caused by borrelia burdogferi which is transmitted by the oxides deer tick (also vector for ana plasma spp and Protozoa babesia)
Lyme disease
327
What is the natural reservoir of borrelia burdogferi
reservoir is the mouse; deer are essential to tick life cycle but don’t harbor borrelia
328
How many stage does Lyme disease has and what are they
Stage 1 early localized that includes erythema migraña (typical bull eyes configuration is pathognomonic but not always present flulike) symptoms
Stage 2 early disseminated: secondary lesions, carditis, AV block, facial, nerve (bell) palsy, migratory myalgias /transient arthritis
Stage 3 late disseminated: encephalopathy chronic arthritis peripheral neuropathy
329
Describe FACE of Lyme disease
Facial nerve palsy ( typically bilateral) arthritis cardiac block erythema migraña
330
What is the treatment of Lyme disease
Doxycycline (first line) amoxicillin (pregnant patients children menor de 8 asños ceftroazibe if IV therapy required
331
Spirochete with hoook shaped ends found in water contaminated with animal urine
Leptospira interrogansn
332
What types of Leptospira interrogans is there
Lepoatoapiros and Weil
333
Describe the symptoms of leptospirosis
Flulike symptoms myalgias of calves jaundice photophobia with conjunctival suffusing (erythema without exudate) prevalent among surges and in tropics
334
Describe Weil disease
Icterohemorragic leptospirosis severe form with jaundice and azotemia from liver and kidney, fever, hemorrhage and anemia
335
How many types of syphilis are there
Primary, secondary, tertiary and congenital syphilis
336
Who is the cause of syphilis
Caused by spirochete treponema pallidum
337
Localized disease presenting with painless chancre. Use fluorescent or dark field microscopy to visualize treponema in fluid from chanchreDEL+
Primary syphilis
338
Disseminated disease with constitutionally symptoms maculopapular rash (including palms and soles) condylomata lata (smooth painless, wart like white lesions on genitals) lymphadenopathy patchy hair loss also confirmarle with dark field microscopy
Secondary syphilis
339
What are the serologic tests
VDRL/RPR (nonspecific) confirm diagnosis with specific test (FTS-ABS)
340
What is latent syphilis
Syphilis + serology without symptoms
341
Describe tertiary syphilis
Gummas (chronic granulomas) aortitis (vasa vasorum destruction) neurosyphilis (tabes dorsalis general paresis) argyl Robertson pupil. Signs: broad based ataxia + Romberg, Charcot joint, stroke without hypertension
342
What is argyl Robertson pupil
Pupils that constricts with accommodation but is not reactive to light
343
Presents with facial abnormalities such as rhagades (linear scars at angles of mouth) snuffles (nasal discharge ) saddle nose notched (huntchinson) teeth mulberry molars and short maxilla, saber shins CNVIII deafnes
Congenital syphilis
344
In pregnancy syphilis patients when it is transmitted
First trimester
345
About diagnosis syphilis with VDRL and RPRnon treponema tests
VDRL and RPR detects nonspecific antibody that reacts with beef cardiolipin. Quiantotatibe inexpensibe and widely available test sensitive but not specific. Non treponema tests revert to negative after treatment and treponema remain+
346
Name the false positive of VDRL
Pregnancy, viral infection (eg BEV hepatitis) Drugs (eg chlorpromazine procainamide) Rheumatic fever (rare) lupus (anti cardiolipin) and leprosy
347
What are the treponema specific tests of syphilis
FTA-ABS and TPPA
348
Direct testing of syphilis
Darkrfiels microscopy and PCR
349
Is a bacteria who can not make their own ATP. They are obligate inttacellular organism that cause 2 firmas of mucosal infections
Chlamydiae
350
What are the intracellular shape of chlamydiae
Elementary body’s and reticulate body
351
Describe how are the two bodies intracellular
Elementary body (small dense)
Reticulate body replicates in cells by fission reorganizes into elementary mejor bodies
352
Disease caused by chlamydiae
Chlamydiae trachomata’s causes neonatal and follicular adult conjunctivitis nongocococal urethritis PID and reactive arthritis. Atípical pneumonia by chlamydophyla strains
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Chlamydophyla pneumoniae and chlamydophila psitacci cause ?
Atypical pneumonia
354
What is the reservoir of C psittaci
Avians reservoir
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Name the treatment and diagnosis to chlamydiae
PCT,NAAT. Cytoplasmic inclusions (reticulate bodies) are seen on giemsa or fluorescent antibody stained smear. Treatment doxycycline azithromycin (for pregnancy) add ceftriaxone for possible concomitant
356
Name the chlamydia trachomatis serotype a
Types A,B and C
Types D-
Types L1, L2 L3
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What kind of disease cause type A,B and C chlamydia trachomatis
Chronic infection, cause blindness due to follicular conjunctivitis in resource limited areas
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What kind of disease cause chlamydia trachomatis serotype D-K
Urethritis PID ectopic pregnancy neonatal pneumoniae (staccato cough) with eosinophilia neonatal
Conjunctivitis (1-2 weeks after birth)
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What kind of disease cause Types IL1? IL2 and
Lymphohganoma venereum
360
Describe lymphogranuloma venereó
Shall painless ulcers on genital swollen painful ingiinal lymph nodes that ulcerate (bulboes) treats with doxycycline
361
It’s a pleomorphic gram variable rod involved in bacterial vaginosis presents gray vaginal discharge with fishy smell non painful (vs vaginitis). Associated with sexual activity but not sexually transmitted
Gardenerella vaginalis
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What is the pathophysiology cause of vaginosis
Is characterized by overgrowth of certain anaerobic bacteria in vagina (due to decreased lactobacilli)
363
Describe the clue cells of gardenerella infection
Are vaginal epithelial cells covered with Gardnerella have stippled appearance along outer margin
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Name the test of gardenerella and describe. What is the treatment of gardenerella
Amine whiff test-mixing discharge with 10% KOH enhances fishy odor. Vaginal pH more than 4.5 during infection. Metronidazole or clindamycin
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Name the eighteen zoonotic bacteria
Anaplasma spp. Bartonella spp. Borrelia burgdorferi, borrelia recurrentis, brucella spp. campylobacter. Chlamydophila psittaci. Coxiella burnetii, ehrlichia chaffeensis, francisella tularensis, Leptospira spp, mycobacterium leprae, pasteurella multocida, rickettsia prowazekii, rickettsia rickettsii, rickettsia typhi, salmonella spp (except S typhi) yersinia pestis
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What is a zoonosis
Infectious disease transmitted between animals and humans
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Disease and transmission and source of anaplasma spp
Anaplasmosis, oxides ticks (live on deer and mice)
368
Disease and transmission and source of bartonella spp
Cat scratch disease, bacillary angiomatosis. Cat scratch
369
Disease and transmission and source of borrelia burgdorferi
Lyme disease, oxides ticks (live on deer and mice)
370
Borrelia recurrentis disease, transmission and source
Relpasing fever, louse and it’s recurrent due to variable surface antigens
371
Brucella spp disease, transmission and source
Brucellosis/undulant fever. Unpasteurized dairy; inhalation of protein contact with infected animal tissue or fluids
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Campylobacter disease transmission and source
Bloody diarrhea. Feces from infected pets/animals contaminated meats foods hands
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Chlamydophila psittaci disease, transmission and source
Psittacosis. Parrots other birds
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Coxiella burnetii disease, transmission and source
Q fever, aerosols of cattle/sheep amniotic fluid
375
Ehrlichia chaffeensis disease, transmission and source
Ehrlichiosis, amblyomma (lone star tick)
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Francisella tularensis disease, transmission and source
Ticks, rabbits, deer flies.
377
Leptospira spp disease, transmission and source
Leptospirosis, animal urine in water; recreational water use
378
Mycobacterium leprae disease, transmission and source
Leprosy humans with lepromatous leprosy, armadillo (rare)
379
Pasteurella multocida disease, transmission and source
Celulitis, osteomyelitis.
Animal bite, cats, dogs
380
Rickettsia prowazekii disease, transmission and source
Epidemic typhus, human to human via human body louse
381
Rickettsia rickettsii disease, transmission and source
Rocky Mountain spotted fever. Derma ventor (dog tick)
382
Rickettsia typhi disease, transmission and source
Endemic typhus,fleas
383
Salmonella spp (except S typhi ) disease, transmission and source
Diarrhea (which may be bloody) vomiting fever abdominal cramps. Reptiles and poultry
384
Yersinia pestis disease, transmission and source
Plate. Fleas (rats and prairie dogs are reservoirs)
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What is the treatment of rickettsial diseases and vector borne illnesses
Doxycycline
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What are the rickettsial diseases and vector borne illnesses with rash common (2) and rash rare (3)
Rash common: Rocky Mountain spotted fever and typhus
Rash rare: Ehrlichiosis, anaplasmosis, Q fever.
387
Where does Rocky Mountain spotted fever used to occurs country and body part
North Carolina rash typically starts at wrists and ankles and then spreads to trunk, palms and soles.
388
Classic triad of Rocky Mountain spotted fever
Headache, fever, rash (vasculitis)
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Which diseases have palms and soles -CARS-
Coxsackievirus A infection (hand, foot and mouth disease), Rocky Mountain spotted fever, and 2 Syphilis
390
What are the two rickettsia that can cause typhus (Rickettsii on the wrists, typhus on the trunk)
R typhi endemic (fleas) and R prowazekii (human body louse) rash starts centrally and spreads out, sparing palms and soles
391
Name a cellular finding of herlichiosis
Monocytes with morulae (mulberry like inclusions) in cytoplasm
392
Name findings of anaplasmosis
Granulocytes with morulae in cytoplasm
393
What are the clinical findings of Q fever
Presents with headache, cough, flulike symptoms pneumonia, possibly in combination with hepatitis. It’s common cause of culture negative endocarditis
394
What is the pathogen of walking pneumonia (insidious onset, headache, nonproductive cough, patchy or diffuse interstitial infiltrate macular rash).
Mycoplasma pneumoniae
395
Occurs frequently in those are less of 30 years old; outbreaks in military recruits, prisons, colleges. It’s a atypical pneumoniae bacteria
Mycoplasma pneumoniae
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What is the treatment of mycoplasma pneumoniae
Macrolides, doxycline, or fluoroquinolone (penicillin ineffective since mycoplasma has no cell wall) not seen on gram stain.
397
Grown on Eaton agar, CXR appears more severe than patient presentation. Can cause atypical variant of stevens jhonson syndrome typically in children and adolescents
Mycoplasma pneumoniae
398
All of them can cause pneumonia and can disseminate all are caused by dimorphic fungi: cold (20c) mold; heat 37 yeast.
Systemic mycoses
399
What is the unique systemic mycoses that is a spherule (not yeast) in tissue
Coccidioides
400
Endemic location of histoplasmosis and pathological features
Mississippi and Ohio river valleys. Macrophages filled with histoplasmosis (smaller than RBC)
401
Signs and symptoms of histoplasmosis and notes
Palatal tongue ulcers splenomegaly. Pacitopenia erythema nodosum. Associated with bird or bat droppings (caves) diagnosis via urine/serum antigen
402
Endemic location, pathological features, signs and symptoms of blastomycosis
Eastern and central US, Great Lakes. Broad based budding of blastomyces same size as RBC) inflammatory lung disease. Disseminated to bone/ skin (verrucous lesiona may mimics SCC)
403
Endemic southwestern IS California, spherule filled with Endosco tea of coccidioides (much larger than RBC) Disseminated to bone skin erythema nodosum or multiforme arthalgias (desert rheumatism) can cause meningitis
Coccidioidomycosis
404
Is associated with dust exposure in endemic areas (archeological excavations earthquakes)
Coccidiodomycosis
405
Para coccidioidomycosis is endemic in what location? What are the pathological features signs and symptoms
Latin America, budding yeast of paracoccidiodes with captains wheels formation (much larger than RBC)
406
Similar to blastomycosis is more frequent in males than females
Paracoccidioidomycosis
407
Name the opportunistic fungal infections pathogens 4
Candida albicans, aspergillus fumigatus, cryptococcus neoformans, mucor and rhizopus spp
408
It’s a dimorphic; forms pseudo hyphae and budding yeast at 20celsius germ tubes at 37. Cause systemic or superficial fungal infection cause oral and esophageal thrush immunocompromised for example
Candida albicans
409
Name the kind of diseases that candida albicans can cause and in what kind of people happenes
Causes oral and esophageal thrush in immunocompromised (neonates steroids diabetes AIDS) vulvovaginitis (diabetes use of antibiotics) diaper rash, infective endocarditis (people who inject drugs). Disseminated candidiases (especially in neutropenia patients) chronic mucocutaneous candidiasis
410
What is the treatment of Candida albicans
Oral fluconzole topical azoles for vaginal; nystatin, azoles or rarely echinocandins for oral; fluconazole, echinocandins or amphotericin B for esophageal or systemic disease
411
What is the morphologic of asoergillus fumigatus
Acute angle 45 grades branching of septate hyphae
412
Causes invasive aspergillosis in immunocompromised patients especially those with neutrophil dysfunction (eg chronic granulomatous disease) because aspergillus is catalase +
Aspergillus fumigatus
413
In adittion asprergillosis what other disease aspergillus fumigatus can cause
Aspergillus I’m pre existing lung cavities especially after TB infection. Some species of aspergillus produce aflatoxin. Allergic bronchopulmonary aspergillosis ABPA
414
What does aflatoxin induce
TP53 mutations leading to Hepato cellular carcinoma
415
What is the treatment plan f aspergillosis and aspergillosis
Vírico azoles or echinocandins (second line)
416
What is ABPA
Hypersensitivity response to aspergillus growing in lung mucus. Associated with asthma and cystic fibrosis may cause bronchiectasis and eosinophilia
417
It’s a pathogen with 5 to 10 micrómetros narrow budding heavily encapsulated yeast not dimorphic PAS+ staining found in soil, pigeon droppings. Acquired through inhalation with hematogenoua dissemination to meníngea
Cryptococcus neoformans
418
It’s highlighted with India ink (clear halo) and mucicarmine (red inner capsule). Latex agglutination test detects polysaccharide capsular antigen and is more sensitive and specific to diagnosis to?
Cryptococcus neoformans
419
How is manifested cryptococcosis
Which can manifest with meningitis pneumonia and or encephalitis (soap bubble lesions in brain) primarily immunocompromised
420
How is the treatment cryptococcus neoformans
Amphotericin B + flucytosine followed by fluconazole for cryptococcal meningitis
421
They are broad nonseptate hyphae branching at wide angles causes of mucormycosis mostly in patients with DKA and/or neutropenia. Inhalation of spores
Mucor and rhizopus spp
422
How is the pathway of entrance of Mucor and rhizopus
Inhalation spores fungi proliferate in blood vessel walks penetrate cribiform plate and enter brain
423
Clinical finding of Mucor mycosis
Rhinocerebral frontal lobe abscess cavernous sinus thrombosis. Hedeache facial pain black necrotic eschar on face; may have cranial nerve involvement.
424
What is the treatment of Mucor and rhizopus
Surgical debridement amphotericin B or isavuconazole
425
Cause pneumonia a diffuse interstitial pneumonia. It’s a yeastlike fungus (was originally classified as protozoan). Most infection are symptomatic. Immunosupression (eg AIDS) predispose to disease.
Pneumocystis jiroveci pneumonia
426
How is the damage caused by pneumocystis jiroveci in tc or chest imagings
Diffuse bilateral ground glass opacities on chest imaging with pneumatoceles.
427
How is made the diagnosis in pneumocystis jiroveci infection
Bronchoalveolar lavage or lung biopsy. Disc shaped yeast seen in methenamine silver stain of lung tissue or with fluorescent antibody
428
What is the treatment and prophylaxis of pneumocystis jiroveci
TMP SMX, pentamidine, dapsone (prophylaxis as single agent or treatment in combination with tmp) atovaquone.
429
In what moment it’s necessary start prophylaxis for pneumocystis jiroveci in people living with HIV
CD4 + Less than 200 cells/mm3
430
It’s a dimorphic fungus exists as a cigar-shaped yeast at 37 Celsius grade in the human body and as hyphae with spores in soil (Conodia) lives on vegetation.
Sporothrix schenckii
431
How is aquired sporothrix schenckii and how is manifested
Spores are traumatically introduced into the skin typically by a thorn cause local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis) disseminated disease possible in immunocompromised host
432
What is the rose gardeners disease
Sporotrichosis by sporothrix schenckii
433
What is the treatment of sporothrix psi’s
Itraconazole or potassium iodide (only for cutaneous lymphocutaneous)
