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Microbiology > Block 2: Gram Negative Bacteria - Diagnosis, Tx, & Prevention > Flashcards

Block 2: Gram Negative Bacteria - Diagnosis, Tx, & Prevention Flashcards

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1
Q

In terms of diagnosis for Legionnaires Disease, what are the 3 staining techniques?

And which is best?

A
  1. Gram negative but poorly staining

Gram stain of sputum = neutrophils, no GNB

  1. DFA (direct fluorescent antibody) staining of specimens

3. Dieterle silver-stain - visualized best with this method

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2
Q

What is the Tx for Burkholderia cepacia?

A

TMP-SMX

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3
Q

What additional test could be used in the diagnosis of N. meningitidis/M**enin**Gococcus?

A

A sugar utilization test:

(increased) protein

(decreased) sugar

Breaks down Maltose and Glucose

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4
Q

The Hib vaccine is highly effective in preventing its disease. What is the vaccine composed of?

A

It is a polyribitol capsule conjugated with protein

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5
Q

What is the Tx for Pertussis?

A

Newer Macrolides

(clarithromycin, azithromycin)

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6
Q

Tx for H. influenza?

A
  1. For encapsulated/typeable strains causing invasive infections:

Ceftriaxone or Cefotaxime

  1. For non-encapsulated/non-typeable strains causing otitis media and sinusitis:

Ampicillin, Cefuroxime (2nd gen cephalosporins)

Amoxicillin-Clavulanate combo

*Non-typeable can be commonly resistant to ampicillin, due to beta-lactamase production

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7
Q

How do you treat N. meningitidis?

A

Don’t start with Ampicillin/Penicillin, wait for AST report to confirm susceptibility

But since many strains of it are resistant to them, add:

Cefotaxime – empirical therapy for neonates and young infants

Ceftriaxone – empirical therapy for other age groups

•Note: once AST report is received and the strain shows susceptibility to penicillin/ampicillin then use this and stop empirical drugs

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8
Q
  1. What test can be used to diagnose H. influenza - meningitis? (which test)
  2. Can you confirm this with a culture?
A
  1. CSF Gram stain

GN coccobacilli and numerous PMN’s/neutrophils will be seen on stain.

  1. Yes, on chocolate agar ( will have Factor X and V)
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9
Q

Pseudomonas aeruginosa can be intially treated with_______________, if multi drug-restance is not apparent.

A

Anti-pseudomonal beta-lactams:

–Extended spectrum penicillins

ex. Piperacillin,and to a lesser extent, Ticarcillin and Carbenicillin

OR

–3rd generation cephalosporin – Ceftazidime

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10
Q

Let’s say someone isn’t affected by N. meningitidis. What should be administered has a future Tx/Prevention?

A

•Conjugate meningococcal vaccine (MCV4)

  • Contains capsular polysaccharides* from A, C, Y & W-135 serogroups
  • CDC recommends 11-12 year olds be vaccinated and a booster dose at 16 years*

•New vaccine in US for serogroup B approved by FDA

Ages 10 through 25 years of age

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11
Q

Besides staining, what other ways can be used to diagnose Legionnaire’s Disease?

A

Culture – BCYE (buffered charcoal yeast extract) -w/ iron and L-cysteine

Urine Antigen Detction - Detects only one serotype of Legionella – the most common – if another serotype is causing the disease then a negative test is misleading

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12
Q

Macrolides, Azithromycin and Clarithromycin can be used to treat which bacterial strain; that also causes a milder form of illness known as Pontiac Fever?

A

Legionella pneumophila

(Legionnaire’s Disease)

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13
Q

Pertussis has a developed vaccine against its strains. There are two types. What are they called and what age groups are categorized as?

A

–DTaP: for children 2 months through 6 years of age

♦ (5 Doses)

–Tdap: for everyone 11 years and older, including pregnant women (between 27 to 36 weeks)

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14
Q

What is the most reliable and rapid indicator in the diagnois of N. meningitidis?

And, what else would you see in abundance when viewing the results of this method?

A

Gram stain CSF

You would see many GN diplococci and PMNS (neutrophils)

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15
Q

What is the DOC for Gonoccocus Tx?

A

DOC: Ceftriaxone (intramuscular) + Azithromycin/Doxycycline

*Ceftriaxone for N.gonorrhoeae

*Azithromycin/Doxycycline for Chlamydia trachomatis (to eradicate concurrent infection)

Chlamydia trachomatis can be a common co-infection with it.

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16
Q

How do you prevent pertussis in a newborn baby?

A

***Expectant mothers - should receive Tdap vaccine during each pregnancy (at 27-36 weeks)***

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17
Q
  1. How can you diagnose N. Gonorrheae?

Note: There is a difference in technique between men and women.

  1. And what can be used as an overall diagnosis technique?
A

1.

Gram stain of specimens

–Diagnosis of genital infection in males ONLY

-Gram stain of penile discharge showing neutrophils with intracellular gram-negative diplococci is diagnostic

–No value for other specimens

Culture on Thayer Martin medium (selective)

–Chocolate agar with added antibiotics (VCNT) to suppress commensal microbiotia in specimens

–VCNT = vancomycin, colistin, nystatin and trimethoprim

–For female genital specimens – ONLY endocervical

2.

Nucleic acid amplification techniques (NAATs)

–NAATs are very sensitive, recommended for all specimens being tested for N.gonorrhoeae

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18
Q

What should be given to all close contacts to treat N. meningitidis?

A

Close contacts should be given prophylaxis. This is necessary because it was spread through respiratory droplets.

Mainly: Rifampin or Ciprofloxacin

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19
Q

There are two main techniques to diagnose Pertussis. What are they?

A

•Direct Fluorescent Antibody (DFA) test

using nasal secretions*

•_Nasopharyngeal culture_s

–Bordet-Genou medium / Regan-Lowe medium (charcoal-containing)*

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20
Q

How is Pseudomonas diagnosed/cultured?

There are 3 ID’s that can be used.

A

P. aeruginosa identified with*

–positive oxidase test

– blue-green pigmentation

–Fruity smell

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21
Q

If there is drug resistnance apparrent with a strain of Pseudomonas aeruginosa, what would be given in terms of antibiotics?

A

Due to common drug resistance – use 2-drug combinations

–Antipseudomonal beta-lactam + aminoglycoside

•eg.Piperacillin + Tobramycin

–Anti-pseudomonal beta-lactam + fluoroquinolone

–Antipseudomonal penicillin + beta-lactamase inhibitor

•eg.Piperacillin + Tazobactam

•Eg. Ticarcillin + clavulanate

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22
Q

What is the DOC for Hemophilus ducreyi - Chancroid STD?

A

Erythromycin

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23
Q

What are the reasons that N. meningitidis has become pencillin resistant?

A

The mechanism is due to:

•Production of beta-lactamases (rare)

•Production of altered PBPs (penicillin binding proteins) – emerging

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24
Q
  1. What other test can be used in the diagnosis of N. meningitidis?
  2. Is this method as reliable as a Gram stain CSF?
  3. What other bacterial pathogens causing meningitidis, could use this technique?
A
  1. CSF Bacterial Antigen Detection Test
    * -Latex agglutination test detects capsular antigen (rapid test)*
  2. No, the Gram stain CSF is the better method
  3. S. pneumoniae, H.influenzae type b, N.meningitidis, Group B Streptococcus, E.coli K1
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25
Q

Why is Antiobiotic Susceptibility testing sometimes performed when identifying Pseudomonas?

A

This is important to taken into consideration because some of its strains show mult-drug resistance.

  • *They are known to mutate their Porin Proteins. This can restrict the flow of the the antiobiotics passed the cell wall.
  • *They are also known to prouduce man beta-lactamases, which inactivate the major beta-lactams (penicillins, cephalosporins, carbapenams)
  • -They also can contain multi-drug efflux pumps*
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26
Q

What can Gonococus be resistant to?

A

Resistant to:

penicillin, PPNG (penicillinase-producing N.gonorrhea)

Beta lactams: Beta-lactamase production

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27
Q

Tx for ETEC?

A

TMP/SMX

Rehydration

28
Q

Tx for EPEC?

A

Flouroquiolones

Rehydration

29
Q

Tx for EHEC?

A

Simple rehydration is sufficient.

**AVOID antiobiotics, because this could increase the risk of Hemolytic Uremic Syndrome (HUS)

30
Q

Tx for EIEC?

A

Simple rehydration is sufficient

31
Q

Tx for UPEC?

A

Fluoroquinolones (norfloxacin) - complicated

TMP-SMX - uncomplicated

32
Q

Tx for NMEC K1?

A

Cefotaxime: This is the Empirical DOC for the development of neonatal meningitis

33
Q

Klebsiella Tx?

What else is unique about this bacteria?

A

3rd generation Cephalosporins (Ceftriaxone Cefotaxime)

Extended spectrum Beta-Lactamase strains​:

Imipenem (Carbapenem - beta-lactam)

Aztreonam (monobactam - for penecillin allergy)

​

  • It is multi-drug resistant: beta-lactamases, effluc pumps, altered porins

*** Carbapenem-resistant Enterobacteriaceae (CRE) “Superbug”

34
Q

What would be an effective Tx for Proteus?

A

TMP-SMX

Flouroquinolones

35
Q

What are the Tx’s for Syphillis?

A

Benzathine penicillin (long lasting) - for primary and secondary

Penicillin G for congenital and late/tertiary syphillis.

IF ALLERGIC, use doxycycline.

36
Q

Tx for Brucella?

A

Rifampin + Doxycycline for a minimum of 6 weeks

37
Q

What is used to treat chlamydia pneumonia?

A

Azithromycin/Erythromycin

+

Doxycycline??

38
Q

Treatment for Shigella?

A

First try TMP-SMZ. May not work since resistance is commmon.

Next choice is: Ciproflaxin or Azithromycin

39
Q

What’s special about Ureaplasma?

What is a common clinical finding?

What is it’s Dx and Tx?

A

It has NO cell wall and is an opportunistic pathogen.

Urethritus in women

Diagnose using Urease Test and treat with Erythromycin

40
Q

Tx for MAC?

A

Rifampin

41
Q

Tx H. ducreyi?

A

DOC: Erythromycin

42
Q

Diagnosis and Tx for Nocardia?

A

Co-Trimoazole (TMP-SMX)

Long Course

43
Q

Diagnosis and Tx for Actinomycetes?

A

DOC is Penicillin V (6 months to 1 year) Metronidazole NOT effective

44
Q

Diagnosis and Tx for Mycobacterium Leprae?

A

Long-term multidrug regimen includes rifampicin & dapsone* Clofazimine added for lepromatous leprosy
Dapsone for close family contacts

45
Q

Diagnosis and Tx for Mycobaterium TB?

A
46
Q

Diagnosis and Tx for Rickettsia?

A
47
Q

Diagnosis and Tx for Anaplasma/Ehrichchia?

A

Doxycycline

48
Q

Diagnosis and Tx for Mycoplasma pneumonia?

A

Erythromycin/Azithromycin

Doxycycline

49
Q

Diagnosis and Tx for Coxiella burnetti?

A

Doxycycline/Azithromycin

50
Q

Diagnosis and Tx for Leptosporia interoggans?

A

Doxycycline

51
Q

Diagnosis and Tx for Boriella?

Burgdorferi?

Recurrentis?

A
  1. PCR is best fir Diagnosis

Doxycycline

  1. Doxycycline
52
Q

Diagnosis and Tx for Y. Pestis?

and what about Entercolitica?

A

Streptomycin

53
Q

Diagnosis and Tx for Salmonella Typhi?

A

TREATMENT:

  • Fluoroquinolones (Ciprofloxacin)
  • 3rd generation cephalosporins

Vaccines:

• Oral vaccine - live attenuated strains of S. typhi

54
Q

Diagnosis and Tx for Non-Typhoidal Salmonella?

A

Usually self resolving

55
Q

Diagnosis and Tx for Francisella?

A

Streptomycin

56
Q

Diagnosis and Tx for Pasteurella M.?

A

Amoxicillin - Clav

57
Q

What is the Diagnosis and Tx for Bartonella?

A

Azithromycin (CSD)

or

Aminoglycosides for the others

58
Q

Diagnosis and Tx for C. Jejuni?

A

Fluids

Ciproflaxin for severe gastroenteritis or septic pts.

59
Q

Diagnosis and Tx for Vibrio Cholera?

A

Doxycycline or Ciproflaxin

60
Q

Diagnosis and Tx for H. pylori?

A

Proton pump inhibitor + Ampicillin + Clarithromycin

61
Q

Diagnosis and Tx for Bacteriode fragilis?

A

Metronidazole, Clindamycin

62
Q

Gardenerella Vaginalis Diagnosis and Tx?

A

Oral Metronidazole

63
Q

Diagnosis and Tx for Serratia?

A

Not mentioned

64
Q

Diagnosis and Tx for Enterobacter?

A

Not mentioned

65
Q

Diagnosis and Tx for Moraxella catahralas?

A

Not mentioned

66
Q
A

Microbiology (15 decks)

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