Chapter 156 - Miscellaneous Bacterial Infections With Cutaneous Manifestations Flashcards
Most common form of anthrax associated with lowest morbidity
Cutaneous anthrax
Natural pathogens of anthrax (3)
Sheep
Goats
Cattle
Anthrax is CDC Category __
A
There is no potential for human to human transmission of inhalational anthrax.
True or False
True
MC route of transmission of anthrax
Percutaneous inoculation of spores
Injectional anthrax is more __ than cutaneous anthrax with ___ mortality rate.
Insidious without eschar
Higher
Major virulence factors of anthrax (2)
- Poly-D-glutamic acid capsule
- Tripartite anthrax toxin
(Protective antigen, lethal factor, edema factor)
Best target for vaccines or immunotherapy of anthrax
Protective antigen
True pustules are pathognomonic for anthrax.
True or False
False, rare
‘Malignant pustule’
Important feature for differentiating anthrax from brown recluse spider bite
Painless necrotic ulcer
Naturally occurring anthrax is treated with
Penicillin
Doxycycline
Weaponized anthrax or bioterrorism associated anthrax is treated with
Fluroquinolones, even in pregnant or on children
FDA -license humanized monoclonal antibody approved for cases of inhalational anthrax
Raxibacumab
Smears and cultures from vesicles or from the necrotic tissue beneath the eschar became negative within __ hours of initiation of penicillin therapy for anthrax
6
Mortality rate of untreated cutaneous anthrax is roughly
5-20%
Most common form of tularemia in the United States
Ulceroglandular disease
Most common tick vectors of tularemia (3)
Dermacentor variabilis
Amblyomma americanun
Ixodes
Mosquitoes may serve as mechanical vectors of waterborne variant of tularemia (F. Tularensis holarctica)
True or False
True
Type of Francisella that infect patients with inherited defects in phagocytosis such as chronic granulomatous disease
Francisella philomiragia
Painful red ulcer evolving into a necrotic chancriform ulcer covered by a black eschar with regional lymphadenopathy
Tularemia
Culture of F. Tularensis
Cysteine-supplemented blood agar
Treatment for tularemia (3)
Aminoglycoside (Gentamicin) 10 days
Fluroquinolone 10 days
Doxycycline 15 days
Prophylaxis for tularemia
Ciprofloxacin
Types of tularemia (5)
Ulceroglandular: 5% mortality rate Oculoglandular Oropharyngeal Typhoidal: 30% mortality rate Pulmonary: 30% moratlity rate
Most common form of plague; Form of plague with highest mortality
Bubonic plague
Pneumonic plague
Flea vector associated with epidemic plague in the Old World
Xenopsylla cheopis
Plague is considered a CDC category __ biologic weapon
A
Hallmark of bubonic plague
Tender regional LN with extensive subcutaneous edema
In anthrax, most common site of buboes in adults; in children
Inguinal buboes
Cervical and axillary buboes
Diagnosis of plague is suggested with a convalescent passive hemagglutinin titer greater than ___
1:16
Preferred treatment but not FDA approved for plague
Gentamicin x 10 days
Use as postexposure prophylaxis for plague
Doxycyline x 10 days
Cotrimoxazole
All forms of plague are nearly always fatal.
True or False
False, pneumonic and septicemic
Most important way to prevent plague
Rodent control prevention
Brucellosis involve 4 organ systems
Joints
Reproductive organs
Liver
CNS
Reservoirs for Brucella
Domesticated animals
2 species that commonly infect human
Brucella melitensis
Brucella abortus
Most common source for human infection
Contaminated unpasteurized milk or cheese
Cause of mortality of most brucellosis patients
Endocarditis
Culture of Brucella sp
Specimen for culture
8 to 10% CO2
BM biopsy
Cross reactions with ___ are known and recent ___ baccination may stimulate false positive Brucella agglutination
F. Tularensis
Cholera
Treatment for brucellosis
Doxycyline and Rifampin for 6 weeks
Brucella is categorized as Category ___ bioweapon
B
Brucella is an intracellular pathogen hence AIDS patients have a more frequent or more severe disease.
True or False
False, do not
Matching type
- Fatal endocarditis
- Abortion in cattle
- Caseation necrosis
A. Abortus
B. Melitensis
C. Canis
D. Suis
B
A
D
Skin lesions occur in <5% of patients as violaceous papulonodular eruption on trunk and lower extremities.
True or False
True
For cultures, ___ have the highest yield
Bone marrow specimens
Causative agent of glanders
Burkholderia mallei
Characteristic eruption of glanders is crops of pustules, papules, bulla with prominent involvement of ____
Nasal mucosa
Common manifestation of glanders
Mucopurulent bloody nasal discharge
Counterpart of glanders in animals
Farcy
Agglutination titer of ___ for brucellosis is sufficient to begin treatment
1:160
Treatment for glanders
Sulfadiazine
+
Ceftazidime, Gentamicin, Doxycycline, Imipenem, Ciprofloxacin
Subcutaneous and viscera abscesses of glanders should be treated for ___
1 year
Treatment for pasteurella multicida
Co-amoxiclav
Cat teeth are longer and sharper and may cause (2)
Septic arthritis
Osteomyelitis
Characteristic for pasteurella multocida
Necrotizing cellulitis
2 etiologic agent of rat bite fever
Streptobacillus moniliformis
Spirillum minus
Classic triad of rat bite fever
Fever
Polyarthralgia
Acral rash
Confirmatory diagnosis of rat bite fever
Blood cultures
Matching type
- Less than 10 days incubation period
- Bite occurs concurrently with systemic symptoms
- 60% arthritis
- Rash most prominent on palms, soles, and around joints
A. Streptobacillus moniliformis
B. Spirillum minus
A
B
A
A
MOT of rat bite fever
Rat bite
Or
Contact with rat contaminated food or drink
Culture of rat bite fever sp
Trypticase soy broth
Supplemented thioglycolate