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1
Q

Corynebacterium diphtheriae
Toxin and mechanism
Manifestation

A 
Diphtheria toxin (exo) - inactivates EF2
Pharyngitis with pseudomembranes in throat and severe lymphadenopathy (bull neck)
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2
Q

Pseudomonas aeruginosa
Toxin and mechanism
Manifestation

A

Exotoxin A - inactivates EF2

Host cell death

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3
Q

Shigella
Toxin and mechanism
Manifestation

A 
Shiga toxin (exo) - inactivate 60S ribosome by removing adenine from rRNA 
GI mucosal damage causing dysentery, enhances cytokine release causing HUS
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4
Q

EHEC
Toxin and mechanism
Manifestation

A

Shiga-like toxin (exo) - inactivate 60S ribosome by removing adenine from rRNA
SLT enhances cytokine release, causing HUS but doesnt invade cells

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5
Q

ETEC
Toxins and mechanism
Manifestation

A

Heat-labile toxin (exo) - overactivates adenylate cyclase (increase cAMP) –> increase Cl- secretion in gut and H20 efflux
Heat-stable toxin (exo) - overactivates guanylate cyclase (cGMP) –> decrease resorption of NaCL and H2O in gut
Watery diarrhea: labile in the Air (adenylate) and stable on the Ground (guanylate)

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6
Q

Bacillus anthracis
Toxin and mechanism
Manifestation

A 
Edema factor (exo) - mimics the adenylate cyclase enzyme (increase cAMP)
Reponsible for characteristic edematous borders of black eschar in cutaneous anthrax)
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7
Q

Vibrio cholerae
Toxin and mechanism
Manifestation

A 
Cholera toxin (exo) - overactivates adenylate cyclase (increase cAMP) by permanetly activating Gs --> increase Cl- secretion in gut and H2O efflux
Voluminous "rice-water" diarrhea
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8
Q

Bordetella pertussis
Toxin and mechanism
Manifestation

A 
Pertussis toxin (exo) - overactivates adenylate cyclase (increase cAMP) by disabling Gi, impairing phagocytosis to permit survival of microbe 
Whooping cough: coughs on expiration and "whoops" on inspiration
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9
Q

Clostridium tetani
Toxin and mechanism
Manifestation

A

Tetanospasmin (exo) - cleave SNARE protein required for neurotransmitter release
Muscle rigidity and “lock jaw” - prevents release of inhibitory (GABA and glycine) NT in spinal cord

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10
Q

Clostridium botulinum
Toxin and mechanism
Manifestation

A 
Botulinum toxin (exo) - cleave SNARE protein required for NT release
Flaccid paralysis, floppy baby - toxin prevents release of stimulatory (ACh) signals at NMJ
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11
Q

Clostridium perfringes
Toxin and mechanism
Manifestation

A 
Alpha toxin (exo) - phopholipase that degrades tissue and cell membranes 
Degradation of phospholipid C - myonecrosis (gas gangrene) and hemolysis
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12
Q

Streptococcus pyogenes
Toxin and mechanism
Manifestation

A 
Streptolysin O (exo) - Protein that degrades cell membrane 
Lyses RBC, contributes to B-hemolysis - host antibodies against toxin (ASO) used to diagnose rheumatic fever
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13
Q

Staphylococcus aureus
Toxin and mechanism
Manifestation

A

Toxic shock syndrome toxin (TSST-1), exo - bring MHC II and TCR in proximity to outside of antigen binding site to cause overwhelming release of IFN-gamma and IL2 –> Shock
TSS: fever, rash, shock; other toxins - scalded skin and food poisoning

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14
Q

Streptococcus pyogenes
Toxin and mechanism
Manifestation

A

Exotoxin A - bring MHC II and TCR in proximity to outside of antigen binding site to cause overwhelming release of IFN-gamma and IL2 –> Shock
Toxin shock syndrome: fever, rash, shock

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15
Q

What are the effects on Endotoxin?

A 
Edema
Nitric Oxide --> hypoTN
DIC/Death --> from coagulation cascade
Outer membrane
TNF-a --> fever, hypoTN
O-antigen
eXtremely heat stable
IL-1 --> fever
Neutrophil chemotaxis

Activates complement (C3a –> hypoTN, edema and C5a –> PMN chemotaxis)

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16
Q

Four phases of bacterial growth

A

Lag: metabolic activity w/o division
Exponential/log: rapid cell division
Stationary: nutrient depletion slows growth/spore formation in some
Death: prolonged nutrient depletion and buildup of waste products lead to death

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17
Q

Where does penicillins and cephalosporins act in growth phase?

A

Exponential/lag phase - peptidoglycan is made here

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18
Q 
Staphylococcus aureus 
Morph:
Virulence: 
Dz:
Toxin:
A

Staphylococcus aureus
Morph: gram + cocci in clusters, catalase/coagulase +
Virulence: protein A binds Fc-IgG to inhibit complement fixing and phagocytosis
Dz: (1) inflamm dz: skin infxn, organ abscess, pneumonia (2) toxin mediated: TSS, scalded skin, food poisoning (3) MRSA resistant to B lactams (4) bacterial endocarditis, osteomyelitis
Toxin: TSST-1 binds MHC-II and Tcell receptor for Tcell activation; food poisoning due to preformed enterotoxins;

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19
Q

Staphylococcus epidermidis
Commonly infects?
Where is it found?
Problem with taking blood?

A

Staphylococcus epidermidis: prosthetic devices and intravenous catheters by producing adherent biofilms.
Component of normal skin flora Contaminates blood cultures

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20
Q 
Streptococcus pneumoniae
Morph: 
Virulence: 
Dz:
Clinical presentation:
A

Streptococcus pneumoniae
Morph: lancet shaped, gram + diplococci, optochin sensitive
Virulence: capsule, IgA protease
Dz: MCC meningitis, otitis media, pneumonia, sinusitis
Clinical presentation: rusty sputum, sepsis in sickle cell anemia and splenectomy

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21
Q 
Viridans group streptococci
Morph: 
Normally found:
Dz:
Clinical presentation:
A

Viridans group streptococci
Morph: a-hemolytic, optochin resistant
Normally found: oropharynx
Dz: dental caries (mutans), subacute bacterial endocarditis (s. sanguis - sticks to damaged valves by making glycocalyx)
Not afraid of-the-chin (in mouth, optochin resistant)

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22
Q

Streptococcus pyogenes (group A)
Morph:
Dz:
Clinical presentation:

A

Streptococcus pyogenes (group A)
Morph: bacitracin sensitive
Dz: (1) pyogenic: pharyngitis, cellulitis, impetigo (2) toxigenic: scarlet fever, toxic shock like syndrome, necrotizing fasciitis (3) immunologic: rheumatic fever, acute glomerulonephritis
Clinical presentation: antibodies to M protein enhance defense but also give rise to rheumatic fever; Scarlet fever: rash sparing face, strawberry tongue, scarlet throat

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23
Q

Rheumatic Fever
Bug
Criteria
Cause

A 
Streptococcus pyogenes - group A
J - Joints polyarthritis
O - carditis
N - Nodules (subcutaneous)
E - Erythema marginatum
S - Sydenham's chorea 
Pharyngitis --> rheumatic fever from antibodies to M protein
Impetigo --> glomerulonephritis
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24
Q 
Streptococcus agalactiae (group B)
Morph: 
Normally found:
Dz:
Clinical presentation:
A 
Streptococcus agalactiae (group B)
Morph: bacitracin resistant, b-hemolytic
Normally found: vagina, BABIES
Dz: pneumonia, meningitis, sepsis
Clinical presentation: screen pregnant women at 35-7 weeks, hippurate test positive, produces CAMP factor
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25
Q 
Enterococci (group D streptococci)
Morph: 
Normally found:
Dz:
Clinical presentation:
A

Enterococci (group D streptococci)
Morph: penicillin G resistant, grow in 6.5% NaCl and bile
Normally found: colonic flora
Dz: UTI, biliary tract infxn, subacute endocarditis
Clinical presentation: vancomycin resistant are important cause of nosocomial infections

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26
Q

Streptococcus bovis
Normally found:
Dz:
Clinical presentation:

A

Streptococcus bovis
Normally found: the gut
Dz: bacteremia and subacute endocarditis
Clinical presentation: colon cancer patients

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27
Q 
Corynebacterium diphtheriae
Morph: 
Toxin:
Normally found:
Dz:
Clinical presentation:
A

Corynebacterium diphtheriae
Morph: gram + rods, metachromatic granules, Elek’s test, black colonies on cystine-tellurite agar
Toxin: exotoxin by beta-prophage inhibits EF-2
Dz: diphtheria
Clinical presentation: pseudomembranous pharyngitis, lymphadenopathy, myocarditis, arrhythmias
ABCDEFG: ADP-ribosylation, Beta-prophage, Corynebacterium, Diphtheria, EF2, Granules

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28
Q 
Spores 
Formed when?
Properties?
How to kill?
Kinds of bacteria?
A

Form at end of stationary phase when nutrients are limited
Resistant to heat/chemicals, dipicolinic acid in core, no metabolic activity
Have to autoclave at 121 C for 15 min
Bacillus anthracis, Clostridium perfringens, C. tetani, B. cereus, C. botulinum, Coxiella burnetii

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29
Q 
Clostridium tetani
Morph: 
Toxin:
Dz:
Clinical presentation:
A

Clostridium tetani
Morph: Gram +, spore forming, obligate anaerobe, bacilli
Toxin: tetanus toxin (exo) - proteases cleave releasing proteins for NT
Dz: tetanic paralysis (blocks glycine and GABA release from Renshaw cells in spinal cord)
Clinical presentation: spastic paralysis, trismus (lockjaw), risus sardonicus

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30
Q 
Clostridium botulinum
Morph: 
Toxin:
Dz:
Clinical presentation:
A

Clostridium botulinum
Morph: gram +, spore forming, obligate anaerobic bacilli
Toxin: preformed, heat-labile toxin inhibits ACh release at NMJ
Dz: Botulism
Clinical presentation: flaccid paralysis - ingestion of preformed toxin in adults and ingestion of spores in honey in babies (floppy baby)

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31
Q 
Clostridium perfringens
Morph: 
Toxin:
Dz:
Clinical presentation:
A

Clostridium perfringens
Morph: gram +, spore forming, obligate anaerobic bacilli
Toxin: alpha toxin (lecithinase - phospholiapse)
Dz: myonecrosis and hemolysis
Clinical presentation: gas gangrene

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32
Q 
Clostridium difficile
Morph: 
Toxin:
Dz:
Clinical presentation:
A

Clostridium difficile
Morph: gram +, spore forming, obligate anaerobic bacilli
Toxin: toxin A - enterotoxin binds brush border of the gut; toxin B - cytotoxin destroys cytoskeletal structure of enterocytes
Dz: pseudomembranous colitis (toxin B)
Clinical presentation: secondary to antibiotic use (clindamycin or ampicillin), diarrhea, tx with metronidazole or oral vanc

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33
Q 
Anthrax - cutaneous
Morph: 
Toxin:
Dz:
Clinical presentation:
A

Anthrax - cutaneous (contact)
Morph: bacillus anthracis - gram +, spore forming, polypeptide capsule
Toxin: anthrax toxin
Dz: black eschar caused by lethal factor and edema factor
Clinical presentation: black painless skin lesions (necrosis surrounded by edematous ring) –> bacteremia and death

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34
Q 
Anthrax - pulmonary
Morph: 
Toxin:
Dz:
Clinical presentation:
A

Anthrax - pulmonary (inhalation)
Morph: bacillus anthracis - gram +, spore forming, polypeptide capsule
Toxin: anthrax toxin
Dz: Woolsorters’ disease
Clinical presentation: flu-like symptoms –> fever, pulmonary hemorrhage, mediastinitis, shock

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35
Q 
Bacillus cereus
Morph: 
Toxin:
Dz:
Clinical presentation:
A 
Bacillus cereus
Morph: spore forming 
Toxin: cereulide a preformed toxin
Dz: reheated rice syndrome 
Clinical presentation: food poisoning, N/V 1-5 hours and diarrheal type (watery, nonbloody)/GI pain (8-18 hrs)
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36
Q

Listeria monocytogenes
Morph:
Dz:
Clinical presentation:

A

Listeria monocytogenes
Morph: facultative intracellular microbe; tumbling motility (actin rockets)
Dz: amnionitis, septicemia, spontaneous abortion; granulomatosis infantiseptica; neonatal meningitis; meningitis in IC, gastroenteritis in healthy
Clinical presentation: ingesting unpasteurized milk/cheese/deli meats or vaginal transmission; ampicillin for infants, IC, eldery

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37
Q 
Actinomyces
Morph: 
Normally found:
Dz:
Clinical presentation:
A

Actinomyces
Morph: long branching filaments, gram + anaerobe
Normally found: oral flora
Dz: oral/facial abscess
Clinical presentation: drain through sinus tracts to form sulfur granules, treat with penicillin

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38
Q 
Nocardia
Morph: 
Normally found:
Dz:
Clinical presentation:
A

Nocardia
Morph: long branching filaments, gram + aerobe, acid fast
Normally found: soil
Dz: pulmonary infections in IC and cutaneous infections after trauma in healthy
Clinical presentation: treat with sulfonamides

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39
Q

Mycobacterium tuberculosis
Clinical:
Virulence:

A

Mycobacterium tuberculosis
Clinical: fever, night sweats, weight loss, hemoptysis
Resistant to multiple drugs
Virulence: cord factor in virulent strains inhibit macrophage maturation and induces release of TNFa. Sulfatides (surface glycolipids) inhibits phagolysosomal fusion.

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40
Q

Mycobacterium kansaii

Clinical:

A

Mycobacterium kansaii

Clinical: pulmonary TB like symptoms

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41
Q

Mycobacterium avium-intracellulare

Clinical:

A

Mycobacterium avium-intracellulare

Clinical: disseminated non-TB disease in AIDS, resistant to multiple drugs, treat prophylactically with azithro

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42
Q

PPD + when…

A

current infection, past exposure, BCG vaccinated

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43
Q

PPD - when…

A

No infection or anergic (steroids, malnutrition, immunocompromised) and sarcoidosis

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44
Q

Primary tuberculosis progression - 4 outcomes

A

Infection with Mycobacterium tuberculosis to nonimmune host –> hilar nodes and Ghon focus (Ghon complex) –>

(1) heal by fibrosis - immunity/hypersensitivity/TB +
(2) progressive lung disease - HIV/malnutrition/ –> death
(3) severe bacteremia - miliary tuberculosis –> death
(4) Preallergic lymphatic or hematogenous dissemination –> dormant tubercle bacillin in several organs –> reactivation later

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45
Q

Secondary tuberculosis progression

A

Mycobacterium tuberuclosis infection to partially immune hypersensitized host –> reinfection –> secondary TB of fibrocaseous cavitary lesion in upper lobes

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46
Q

Reactivation of tuberculosis outcomes - 2

A

(1) Secondary tuberculosis
(2) Extrapulmonary tuberculosis
CNS (parenchymal tuberculoma or meningitis)
Vertebral body (Pott’s disease)
Lymphadenitis
Renal
GI

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47
Q

Leprosy
Morph:
Dx: 2 types
Clinical:

A

Leprosy
Morph: mycobacterium leprae, acid-fast bacillus that like cool temp
Dx: (1) Lepromatous: diffusely over skin and is communicable (low cell mediated immunity with humoral Th2 reponse) (2) Tuberculoid: few hypoesthetic, hairless skin plaques (high cell mediated immunity with largely Th1 type immune response)
Clinical: infects skin and superficial nerves, glove and stocking loss of sensation; multidrug therapy of dapsone and rifampin for 6 mo for tuberculoid and dapsone, rifampin, clofazimine for 2-5 years for lepromatous

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48
Q 
Neisseria gonorrhoeae
Morph:
Virulence:
Transmission:
Dz:
Clinical:
A

Neisseria gonorrhoeae
Morph: Gram - diplococci, ferment glucose, no polysaccharide capsule or maltose fermentation
Virulence: IgA proteases
Transmission: sexually
Dz: gonorrhea, septic arthritis, neonatal conjunctivitis, PID, Fitz-Hugh Curtis syndrome
Clinical: no vaccine, tx with ceftriaxone + azithromycin for possible chlamydia

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49
Q 
Neisseria meningiditis
Morph:
Virulence:
Transmission:
Dz:
Clinical:
A

Neisseria meningiditis
Morph: Gram - diplococci, ferment glucose, polysaccharide capsule and maltose fermenter
Virulence: IgA protease
Transmission: respiratory/oral
Dz: meningococcemia and meningitis, Waterhouse-Friederichsen syndrome
Clinical: tx ceftriaxone or penicillin G

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50
Q 
Haemophilus infulenzae 
Morph:
Virulence:
Transmission:
Dz: 
Clinical:
A

Haemophilus infulenzae
Morph: Gram - rod, culture on chocolate agar and requires V (NAD+) and X (hematin)
Virulence: capsule type B (vaccine), IgA protease
Transmission: aerosol
Dz: epiglottitis (cherry red), meningitis, otitis media, pneumonia
Clinical: tx with ceftriaxone, rifampin for close contact prophylaxis, vaccine b/t 2-18 months

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51
Q 
Legionella pneumophila
Morph:
Virulence:
Transmission:
Dz: 
Clinical:
A

Legionella pneumophila
Morph: Gram - rod, silver stain, charcoal yeast extract with iron and cysteine
Virulence:
Transmission: aerosol from water source
Dz: (1) Legionnaires’ disease - severe pneumonia, fever, GI, CNS (2) Pontiac fever - mild flu like syndrome
Clinical: look for Ag in urine, macrolide or quinolone, hyponatremia

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52
Q 
Pseudomonas aeruginosa
Morph:
Virulence:
Transmission:
Dz: 
Clinical:
A

Pseudomonas aeruginosa
Morph: aerobic gram - rod, non-lactose, oxidase +, pyocyanin pigment, grape-like odor
Virulence: endotoxin (fever, shock) and extoxin A (inactivates EF2)
Transmission: water source
Dz: Pneumonia, Sepsis (black lesion), external otitis (swimmer’s ear), UTI, drug use, diabetic osteomyelitis, hot tub folliculitis, malignant otitis externa (DM)
Clinical: wound and burn infxn, cystic fibrosis; tx with aminoglycoside plus extended spectrum penicillin

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53
Q 
EIEC
Morph:
Virulence:
Transmission:
Dz: 
Clinical:
A

EIEC
Morph: gram - rod
Virulence: fimbriae (cystitis, pyelonephritis), K capsule (pneumonia, neonatal meningitis), LPS endotoxin (shock)
Transmission: invasive to intestinal mucosa
Dz: necrosis and inflammation
Clinical: dysentery

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54
Q 
ETEC
Morph:
Virulence:
Dz: 
Clinical:
A 
ETEC
Morph: gram - rod
Virulence: fimbriae (cystitis, pyelonephritis), K capsule (pneumonia, neonatal meningitis), LPS endotoxin (shock), labile/stable toxin
Dz: no inflammation or invasion
Clinical: Traveler's diarrhea (watery)
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55
Q 
EPEC
Morph:
Virulence:
Dz: 
Clinical:
A

EPEC
Morph: gram - rod
Virulence: fimbriae (cystitis, pyelonephritis), K capsule (pneumonia, neonatal meningitis), LPS endotoxin (shock)
Dz: adheres to apical surface, flattens villi, prevents absorption
Clinical: diarrhea in children

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56
Q 
EHEC
Morph:
Virulence:
Dz: 
Clinical:
A

EHEC
Morph: gram - rod, O157:H7, doesnt ferment sorbitol
Virulence: fimbriae (cystitis, pyelonephritis), K capsule (pneumonia, neonatal meningitis), LPS endotoxin (shock), Shiga-like toxin
Dz: HUS, endothelium swells and narrows lumen leading to mechanical hemolysis and decrease renal BF
Clinical: anemia, thrombocytopenia, acute renal failure; dysentery (toxin)

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57
Q 
Klebsiella
Morph:
Virulence:
Dz: 
Clinical:
A

Klebsiella
Morph: gram -, lactose fermenter
Virulence: abundant polysaccharide capsule
Dz: lobar pneumonia in alcoholics/diabetics when aspirated, nosocomial UTI
Clinical: red currant jelly sputum, aspiration pneumonia, abscess in lungs/liver, alcoholics, diabetics

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58
Q 
Salmonella 
Morph:
Transmission:
Dz: 
Clinical:
A

Salmonella
Morph: flagella, hydrogen sulfide, doesnt ferment lactose
Transmission: hematogenous, animal reservoirs
Dz: invades intestinal mucosa and cause monocytic response, blood diarrhea
Clinical: antibiotics may prolong symptoms

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59
Q 
Shigella
Morph:
Transmission:
Dz: 
Clinical:
A

Shigella
Morph: does not ferment lactose
Transmission: cell to cell, human reservoir
Dz: invade intestinal mucosa and cause PMN infiltration, blood diarrhea
Clinical: antibiotics prolong excretion or organisms in feces

60
Q 
Campylobacter jejuni
Morph:
Transmission:
Dz: 
Clinical:
A

Campylobacter jejuni
Morph: comma or S-shaped, oxidase positive, 42 C
Transmission: fecal-oral transmission through foods (poultry, meat, unpasteurized milk)
Dz: bloody diarrhea in children
Clinical: antecedent to GBS and active arthritis

61
Q 
Vibrio cholerae
Morph:
Virulence:
Dz: 
Clinical:
A

Vibrio cholerae
Morph: comma-shaped, oxidase positive, alkaline media
Virulence: toxin permanently activates Gs –> increase cAMP
Dz: rice-water diarrhea
Clinical: rehydration necessary

62
Q

Yersinia enterocolitica
Transmission:
Dz:
Clinical:

A

Yersinia enterocolitica
Transmission: pet feces, contaminated milk or pork
Dz: mesenteric adenitis
Clinical: mimics Crohn’s appendicitis

63
Q

Helicobacter pylori
Morph:
Dz:
Clinical:

A

Helicobacter pylori
Morph: curved gram - rod, urease +
Dz: gastritis in duodenal ulcers (creates alkaline environment)
Clinical: RF for peptic ulcer, gastric adenocarcinoma, lymphoma; tx with PPI, clarithromycin, amoxicillin, metronidazole

64
Q

Spirochetes

Morph:

A

Spirochetes
Morph: spiral shaped bacteria with axial filaments
Forelia, Leptospira, Treponema (BLT)
Clinical:

65
Q 
Leptospira interrogans
Morph:
Transmission:
Dz: 
Clinical:
A

Leptospira interrogans
Morph: spirochete
Transmission: water contaminated with animal urine
Dz: leptospirosis (flu like symptoms, jaundice, photophobia with conjunctivitis), Weil’s disease (severe form with jaundice and azotemia from liver/kidney dysfunction; fever, hemorrhage, anemia)
Clinical: surfers in tropics

66
Q 
Borrelia burgdorferi
Stages:
Transmission:
Dz: 
Clinical:
A

Borrelia burgdorferi
Stages: (1) erythema chronicum migrans (bulls eye rash), flu like symptoms (2) neurologic and cardiac (facial palsy, AV block) (3) MSK (migratory polyarthritis), neuro (encephalopathy, polyneuropathy), cutaneous manifestations
Transmission: Ixodes tick, mouse reservoir, NE USA
Dz: facial palsy, arthritis, cardiac block, erythema migrans
Clinical: tx with doxycycilne, ceftriaxone

67
Q 
Syphilis
Morph:
Screen:
Dz: 
Clinical:
A

Syphilis
Morph: Treponema pallidum
Screen: VDRL screen and confirm FTA-ABS
Dz: Primary - painless chancre; Secondary - maculopapular rash (palms, soles), condylomata lata; Tertiary - gummas, aortitis (vasa vasorum), neurosyphilis (tabes dorsalis), Argyll Robertson pupil, broad based ataxia, + Romberg, Charcot joint, stroke w/o HTN; Congenital: saber shins, saddle nose, CN VIII deafness, Hutchinson’s teeth, mulberry molars
Clinical: treat with pen G, placental transmission typically occurs at first trimester

68
Q

Salmonella typhi

Clinical presentation

A

Salmonella typhi
Clinical presentation: typhoid fever, found only in humans, rose spots on the abdomen, fever, headache, diarrhea, can remain in gallbladder as carrier state

69
Q

Argyll Robertson pupil

A

constricts with accommodation but is not reactive to light (tertiary syphilis)
Prostitute’s pupil - accommodate but doesnt react

70
Q

VDRL false positive

A

VDRL detects Ab that reacts with beef cardiolipin; false positive for viral infection (mono, hepatitis), some drugs, rheumatic fever, SLE, leprosy

71
Q

Jarisch-Herxheimer reaction

A

Flu-like syndrome immediately after antibiotics are started - due to killed bacteria releasing pyrogens

72
Q

Bartonella spp

A

Cat scratch disease from cat scratch

73
Q

Borrelia burgdorferi

A

Lyme disease from Ixodes ticks (deer and mice)

74
Q

Borrelia recurrentis

A

Recurrent fever from louse (variable surface antigens)

75
Q

Brucella spp

A

Brucellosis/undulant fever from unpasteruized dairy

76
Q

Campylobacter

A

Bloody diarrhea from puppies/livestock (fecal-oral, ingestion of undercooked meat)

77
Q

Chlamydophila psittaci

A

Psittacosis from parrots and other birds

78
Q

Coxiella burnetii

A

Q fever from aerosols of cattle/sheep amniotic fluid

79
Q

Ehrlichia chaffeensis

A

Ehrlichiosis from Lone Star tick

80
Q

Francisella tularensis

A

Tularemia from ticks/rabbits/deer fly

81
Q

Leptospira spp

A

Leptospirosis from animal urine

82
Q

Mycobacterium leprae

A

Leprosy from armadillos and humans with lepromatous leprosy

83
Q

Pasteurella multocida

A

Cellulitis, osteomyelitis from animal bites, cats, and dogs

84
Q

Rickettsia prowazekii

A

Epidemic typhus from louse

85
Q

Rickettsia rickettsii

A

Rocky Mountain spotted fever from Dermacentor tick bite

86
Q

Rickettsia typhi

A

Endemic typhus from fleas

87
Q

Yersinia pestis

A

Plague from fleas (rats and prairie dogs are reservoirs)

88
Q 
Gardnerella vaginalis
Morph:
Transmission:
Dz:
Clinical:
A

Gardnerella vaginalis
Morph: pleomorphic, gram variable rod
Transmission: sexual activity but not STD
Dz: vaginosis with Clue cells or vaginal epithelial cells covered with bacteria
Clinical: gray vaginal discharge with fishy smell, non-painful; metronidazole

89
Q

Rocky Mountain spotted fever
Morph:
Clinical:

A

Rocky Mountain spotted fever
Morph: Rickettsia rickettsii, obligate intracellular organisms need CoA and NAD+
Location: distributed in US
Clinical: rash at wrists and ankles spreads to trunk, palms, soles

90
Q

Typhus
Morph:
Clinical:

A

Typhus
Morph: R. typhi and R. prowazekii
Clinical: endemic fleas = R. typhi; epidemic human body louse = R. prowazekii –> rash starts centrally and spreads out sparing palms and soles

Palm and sole rash also in Coxsackievirus A, Rocky Mountain spotted, secondary Syphilis

91
Q

Ehrlichiosis

A

Tick - Ehrlichia

Monocytes with morula (berry-like inclusions) in cytoplasm

92
Q

Anaplasmosis

A

Tick - anaplasma

Granulocytes with morula in cytoplasm

93
Q

Q Fever

A

Tick feces and cattle placenta release spores that are inhaled as aerosols from Coxiella burnetii
Pneumonia

94
Q 
Chlamydiae
Morph: 
Transmission:
Dz:
Clinical:
A

Chlamydiae
Morph: Chlamydia trachomatis, obligate intracellular organism; lacks muramic acid in cell wall
Transmission: Elementary body enters cell via endocytosis and reticulate body replicates in cell by fission (form seen on tissue culture)
Dz: reactive arthritis, conjunctivitis, nongonococcal urethritis, PID –> trachomatis; atypical pneumonia –> pneumoniae/psittaci;
Clinical: treat with azithromycin or doxycycline; cytoplasmic inclusions on Giemsa or fluorescent antibody stained smear

95
Q

what type of chlamydiae trachomatis causes chronic infection, blindness due to follicular conjunctivits in Africa?

A

A, B, C

96
Q

what type of Chlamydia trachomatis causes urethritis/PID, ectopic pregnancy, neonatal pneumonia (staccato cough), neonatal conjunctivitis?

A

D-K

97
Q

What type of chlamydia trachomatis causes lymphogranuloma venereum?

A

L1, L2, L3

98
Q

Mycoplasma pneumoniae
Morph:
Dz:
Clinical:

A

Mycoplasma pneumoniae
Morph: no cell wall (sterols instead), Eaton’s agar
Dz: walking pneumonia in <30 yoa
Clinical: insidious onset, headache, nonproductive cough, diffuse interstitial infiltrate; high titer of cold agglutinins (IgM); tx with macrolide or fluoroquinolone; military recruits and prisons

99
Q

Histoplasmosis
Morph:
Location:
Dz:

A

Histoplasmosis
Morph: dimorphic fungi, Macrophage filled with Histoplasma
Location: Mississippi and Ohio River valleys
Dz: pneumonia from bird or bat droppings, treat with fluconazole or itraconazole for local and amphotericin B or systemic infections

100
Q

Blastomycosis
Morph:
Location:
Dz:

A

Blastomycosis
Morph: dimorphic fungi, broad-base budding
Location: states E of Mississippi River and Central America
Dz: inflammatory lung disease and can disseminate to skin and bone, granulomatous nodules, treat with fluconazole or itraconazole for local and amphotericin B or systemic infections

101
Q

Coccidioidomycosis
Morph:
Location:
Dz:

A

Coccidioidomycosis
Morph: dimorphic fungi, spherule filled with endospores
Location: SW US, California - increased after earthquake; San Joaquin Valley or desert “valley fever”
Dz: pneumonia, meningitis can disseminate to bone and skin, treat with fluconazole or itraconazole for local and amphotericin B or systemic infections

102
Q

Paracoccidioidomycosis
Morph:
Location:
Dz:

A

Paracoccidioidomycosis
Morph: dimorphic fungi, budding yeats with captain’s wheel formation
Location: Latin America
Dz: pneumonia, treat with fluconazole or itraconazole for local and amphotericin B or systemic infections

103
Q

Tinea versicolor
Morph:
Location:
Dz:

A

Tinea versicolor
Morph: Malassezia furfur, spaghetti&meatball on KOH prep
Location: hot, humid weather
Dz: degradation of lipids produces acids that damage melanocytes and cause hypopigmented/hyperpigmented patches; topical miconazole, selenium sulfide (Selsum)

104
Q

Tinea pedis, cruris, corporis, capitis, unguium
Morph:
Location:
Dz:

A

Tinea pedis, cruris, corporis, capitis, unguium
Morph: dermatophytes
Location:
Dz: pruritic lesion with central clearing resembling a ring caused by dermatophytes

105
Q

Candida albicans
Morph:
Dz:
Clinical:

A

Candida albicans - systemic or superficial fungal infection
Morph: dimorphic yeast, pseudohyphae and budding yeast
Dz: oral and esophageal thrush in IC, vulvovaginitis, diaper rash, endocarditis in IVDA, disseminated candidiasis, chronic mucocutaneous candidiasis
Clinical: tx topical azole for vaginal, fluconazole or caspofungin for oral/esophageal, fluconazole or amphotericin B or caspofungin for systemic

106
Q

Aspergillus fumigatus
Morph:
Dz:

A

Aspergillus fumigatus
Morph: septate hyphae that branch at 45 angle
Dz: invasive aspergillosis in IC and chronic granulomatous dz; allergic bronchopulmonary aspergillosis in asthma; aspergillomas in lung cavities especially after TB infection, produce aflatoxins assocaited with HCC

107
Q

Cryptococcus neoformans
Morph:
Dz:
Clinical:

A

Cryptococcus neoformans
Morph: yeasts with wide capsular halos and unequal budding in India ink, encapsulated
Dz: meningitis, cryptococcosis
Clinical: soil and pigeon droppings through inhalation w/ hematogenous dissemination to meninges; Sabouraud’s agar, stains with India ink, latex agglutination test detects polysaccharide capsular antigen; Soap bubble lesions

108
Q

Mucor and Rhizopus
Morph:
Dz:
Clinical:

A

Mucor and Rhizopus
Morph: irregular, borad, nonseptate hyphae branching at wide angles
Dz: mucormycosis, rhinocerebral and frontal lobe abscesses
Clinical: ketoacidotic diabetic and leukemic patients - proliferate in blood vessel walls when excess ketone and glucose –> penetrate cribriform plate and enter brain; presents with HA, facial pain, black necrotic eschar on face, cranial nerve involvement

109
Q

Pneumocystis jirovecii
Morph:
Dz:
Clinical:

A

Pneumocystis jirovecii
Morph: disc shaped yeast on methenamine silver stain, diffuse bilateral CXR appearance
Dz: pneumocystis pneumonia (PCP) - diffuse interstitial pneumonia
Clinical: inhaled, most are asymptomatic but IC predisposes to disease. Lung biopsy or lavage and tx with TMP-SMX, pentamidine ,dapsone

110
Q

Sporothrix schenckii
Morph:
Dz:
Clinical:

A

Sporothrix schenckii
Morph: dimorphic, cigar shaped budding yeast leives on vegetation, spores
Dz: sporotrichosis
Clinical: traumaticaly introduced into the skin (thorn), causes local pustule or ulcer with nodules draining along lymphatics; tx with itraconazole or potassium iodide

111
Q 
Giardia lambli
Morph:
Transmission:
Dz: 
Clinical:
A

Giardia lambli
Morph: protozoa; trophozoites or cysts in stool
Transmission: cysts in water
Dz: Giardiasis
Clinical: bloating, flatulence, foul-smelling, fatty diarrhea; tx with metronidazole

112
Q 
Entamoeba histolytica
Morph:
Transmission:
Dz: 
Clinical:
A

Entamoeba histolytica
Morph: protozoa, flask shaped ulcers, trophozoites with RBC in cytoplasm or cysts in stool
Transmission: cysts in water
Dz: amebiasis
Clinical: bloody diarrhea, liver abscess (anchovy paste exudate), RUQ pain (flask shaped ulcer); tx with metronidazole, iodoquinol for asymptomatic cyst passers

113
Q 
Cryptosporidium
Morph:
Transmission:
Dz: 
Clinical:
A 
Cryptosporidium
Morph: cysts on acid-fast stain
Transmission: cysts in water
Dz: diarrhea
Clinical: severe diarrhea in AIDS or mild in healthy; prevention by filtering water; nitazoxanide in healthy hosts
114
Q 
Toxoplasma gondii
Morph:
Transmission:
Dz: 
Clinical:
A

Toxoplasma gondii
Morph: protozoa, ring enhancing lesion
Transmission: cysts in meat or cat feces, crosses placenta
Dz: brain abscess in HIV
Clinical: congenital - chorioretinitis, hydrocephalus, intracranial calcifications; dx by biopsy/serology; tx with sulfadiazine and pyrimethamine

115
Q 
Naegleria fowleri
Morph:
Transmission:
Dz: 
Clinical:
A

Naegleria fowleri
Morph: amoebas
Transmission: swimming in freshwater lakes enters through cribriform plate
Dz: rapidly fatal meningoencephalitis
Clinical: seen in spinal fluid, amphotericin has been effective for few survivors

116
Q 
Trypanosoma brucei/gambiense/rhodesiense
Morph:
Transmission:
Dz: 
Clinical:
A 
Trypanosoma brucei/gambiense/rhodesiense
Morph:
Transmission: Tsetse fly - painful bite 
Dz: African sleeping sickness
Clinical: enlarged lymph nodes, recurring fever, somnolence, coma; detect in blood smear; tx with Suramin for blood borne disease or melarsoprol for CNS penetration
117
Q 
Plasmodium
4 types and characteristics
Transmission:
Dz: 
Clinical:
A

Plasmodium
(1) vivax - 48 hr w/ fever 1&3 days, dormant in liver (2) ovale - same as vivax (3) falciparum - sever, irregular, parasitized RBC occlude capillaries in brain/kidney/lungs (4) malariae - 72 hr cycle
Transmission: anopheles mosquito
Dz: malaria
Clinical: fever, headache, anemia, splenomegaly; dx w/ blood smear - trophozoite ring, RBC schizont with merozoites;
tx with chloroquine - blocks heme polymerase or mefloquine, life threatening –> IV quinidine, vivax/ovale –> primaquine for hypnozoite

118
Q 
Babesia
Morph:
Transmission:
Dz: 
Clinical:
A 
Babesia
Morph: protozoa
Transmission: NE USA, Ixodes tick 
Dz: Babesiosis
Clinical: fever, hemolytic anemia; asplenia increase risk of severe illness; blood smear - ring form with maltese cross; tx with atovaquone + azithromycin
119
Q 
Trypansoma cruzi
Morph:
Transmission:
Dz: 
Clinical:
A

Trypansoma cruzi
Morph: protozan
Transmission: S. America, Reduviid bug (kissing bug w/ painless bite)
Dz: Chagas disease
Clinical: dilated cardiomyopathy, megacolon, megaesophagus; blood smear for dx; tx with nifurtimox

120
Q 
Leishmania donovani
Morph:
Transmission:
Dz: 
Clinical:
A 
Leishmania donovani
Morph:
Transmission: sandfly
Dz: visceral leishmaniasis (kala-azar) 
Clinical: spiking fevers, hepatosplenomegaly, pancytopenia; dx macrophages containing amastigotes; tx with sodium stibogluconate
121
Q 
Trichomonas vaginalis
Morph:
Transmission:
Dz: 
Clinical:
A 
Trichomonas vaginalis
Morph: trophozoites on wet mount 
Transmission: STD
Dz: vaginitis
Clinical: foul-smelling, greenish discharge; itching and burning; tx with metronidazole for patient and partner
122
Q

Enterobius vermicularis
Transmission:
Dz:
Treat:

A

Enterobius vermicularis (pinworm)
Transmission: food contaminated w/ eggs
Dz: intestinal infection causing anal pruritius (scotch tape test)
Treat: Bendazole or pyrantel pamoate

123
Q

Ascaris lumbricoides
Transmission:
Dz:
Treat:

A

Ascaris lumbricoides
Transmission: fecal-oral, eggs visible in feces
Dz: intestinal infection
Treat: Bendazoles

124
Q

Strongyloides stercoralis
Transmission:
Dz:
Treat:

A

Strongyloides stercoralis
Transmission: larvae in soil penetrate skin
Dz: intestinal infection causing vomiting, diarrhea, anemia
Treat: Ivermectin or albendazole

125
Q 
Ancylostoma duodenale
Necator americanus
Transmission:
Dz:
Treat:
A 
Ancylostoma duodenale
Necator americanus
Transmission: larvae penetrate skin
Dz: intestinal infection causing anemia by sucking blood from intestinal walls
Treat: Bendazoles or pyrantel pamoate
126
Q

Dracunculus medinensis
Transmission:
Dz:
Treat:

A

Dracunculus medinensis
Transmission: drinking water
Dz: skin inflammation and ulceration
Treat: slow extraction of worm

127
Q

Onchocerca volvulus
Transmission:
Dz:
Treat:

A

Onchocerca volvulus
Transmission: female blackfly bite
Dz: hyperpigmented skin and river blindness; allergic reaction to microfilaria
Treat: ivermectin

128
Q

Loa loa
Transmission:
Dz:
Treat:

A

Loa loa
Transmission: deer fly, horse fly, mango fly
Dz: swelling in skin, worm in conjunctiva
Treat: diethylcarbamazine

129
Q

Wuchereria bancrofti
Transmission:
Dz:
Treat:

A

Wuchereria bancrofti
Transmission: female mosquito
Dz: blocks lymphatic vessels, elephantiasis (9 mos to 1 yr to become symptomatic)
Treat: diethylcarbamazine

130
Q

Toxocara canis
Transmission:
Dz:
Treat:

A

Toxocara canis
Transmission: food contaminated with eggs
Dz: visceral larva migrans
Treat: albendazole or mebendazole

131
Q

Taenia solium
Transmission:
Dz:
Treat:

A

Taenia solium
Transmission: ingestion of larvae encysted in undercooked pork OR ingestion of eggs
Dz: intestinal infection OR cysticercosis, neurocysticercosis
Treat: Praziquantel or that plus bendazoles for neurocysticercosis

132
Q

Diphyllobothrium latum
Transmission:
Dz:
Treat:

A

Diphyllobothrium latum
Transmission: ingestion of larvae from raw freshwater fish
Dz: Vitamin B12 deficiency –> anemia
Treat: Praziquantel

133
Q

Echinococcus granulosus
Transmission:
Dz:
Treat:

A

Echinococcus granulosus
Transmission: ingestion of eggs from dog feces
Dz: cysts in liver, causing anaphylasix if antigens released
Treat: -bendazoles

134
Q

Schistosoma
Transmission:
Dz:
Treat:

A

Schistosoma
Transmission: snails host, cercariae penetrate skin of humans
Dz: liver and spleen granulomas, fibrosis, inflammation; chronic infection with S. haematobium can lead to SCC of bladder
Treat: Praziquantel

135
Q

Clonorchis sinensis
Transmission:
Dz:
Treat:

A

Clonorchis sinensis
Transmission: undercooked fish
Dz: biliary tract inflammation –> pigmented gallstones and associated with cholangiocarcinoma
Treat: praziquantel

136
Q

Paragonimus westermani
Transmission:
Dz:
Treat:

A

Paragonimus westermani
Transmission: undercooked crab meat
Dz: lung inflammation and secondary bacterial infection, hemoptysis
Treat: praziquantel

137
Q

Parasite - brain cysts, seizure

A

Taenia solium (cysticercosis)

138
Q

Parasite - liver cysts

A

Echinococcus granulosus

139
Q

Parasite - Vitamin B12 deficiency

A

Diphyllobothrium latum

140
Q

Parasite - Biliary tract disease, cholangiocarcinoma

A

Clonorchis sinensis

141
Q

Parasite - hemoptysis

A

Paragonimus westermani

142
Q

Parasite - portal HTN

A

Schistosoma mansoni

143
Q

Parasite - hematuria, bladder cancer

A

Schistosoma haematobium

144
Q

Parasite - microcytic anemia

A

Ancylostoma, Necator

145
Q

Parasite - perianal pruritus

A

Enterobius

Microbiology (7 decks)

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