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Clinical Microbiology > Clinical Microbiology 2 > Flashcards

Clinical Microbiology 2 Flashcards

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1
Q

Describe the treatment regimen used for TB

A

6 month course of combination antituberculent therapy;
- Rifampicin - Bacteriocidal to slow replicating organisms in necrotic foci
- Isoniazid - Bacteriocidal to fast growing mycobacteria
- Pyrazinasmide - Bacteriocidal even against slow growing mycobactria intracellularly
- Ethambutol - Bacteriocidal against slow growing mycobacteria
NB: P+E removed after 4 months

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2
Q

Describe the structure of a granuloma

A

Central caseous necrosis surrounded by epithelioid macrophages, which are in turn surrounded by lymphocytes

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3
Q

What is the common cold?

A

Most colds are caused by the Rhinovirus (RNA virus) but can also be caused by corona viruses (RNA viruses)

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4
Q

What is pharyngitis?

A

An inflammatory condition of the pharynx and/or tonsils. It is common in children and teenagers but tends to resolve in 3-7. The most common cause is the adenovirus (DNA virus)

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5
Q

What is croup?

A

A distinctive cough that occurs in children which is caused most often by the parainfluenza virus which causes inflammation of the larynx

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6
Q

What is bronchiolitis?

A

A common viral LRTI in children that causes a runny nose, dry wheezy cough and difficulty breathing. It is caused by the Respiratory Syncytial Virus (RSV) which causes the bronchioles to become inflamed and plugged with mucus

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7
Q

Describe the classification of the influenza virus

A

A - Can cause epidemics and pandemics
B - Will not cause a pandemic
C - Causes a mild infection

Further categorised by Haemagglutinin and Neuraminidase e.g. H1N1

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8
Q

What is antigenic drift?

A

In antigenic drift of the influenza virus there are continuous point mutations in the haemagglutinin receptor that is used to bind to human cells

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9
Q

Describe the vaccination used for influenza

A

2 types;

  • Inactivated;
    • 2 A types
    • 1 B type
  • Live; nasal spray for children
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10
Q

What is antigenic shift?

A

The process by which influenza pandemics occur;

1) Animal containing the virus can infect an intermediate host which passes on to humans
2) A mixture of genetic material of viruses in multiple species is passed on to humans
3) A strain from an animal that is passed directly on to a human

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11
Q

Describe the CURB65 tool used in pneumonia

A 
C - Confusion 
U - Urea >7
R - Respiratory rate >30
B - BP; diastolic <90
65 - Age 65+

If the patient has 2 or more points then they are likely to have severe pneumonia

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12
Q

Describe the SIRS criteria used to assess a patient for sepsis

A
  • Temperature 38°C
  • Heart Rate >90bpm
  • Respiratory Rate >20/min
  • White Blood Cells 12

If the patient has two or more points then they have sepsis

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13
Q

What are the most common congenital infections?

A 
T - Toxoplasma
O - Other (syphillis, HIV, chickenpox etc.)
R - Rubella
C - Cytomegalovirus
H - Herpes Simplex
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14
Q

Describe passive immunisation

A

Transmission of immunoglobulins .g. hepatits immunoglobulins. However this is a short term immunisation so lifelong immunity does not occur

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15
Q

Describe active immunity

A

Transmission of the antigen to allow the body to develop its own life long immunity

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16
Q

What are live attenuated vaccines?

A

e.g. Polio
Contains a version of the living microbe which has been weakened so that it cannot cause disease. Weakened by growing inside a chicken embryo so that the microbe is adapted to dividing in chicken cells

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17
Q

What are the advantages and disadvantages of live vaccines?

A

Advantages;
- Closest to natural infection so strongest immune response
- Life long immunity after 1 or 2 doses
Disadvantages;
- Could become virulent
- Cannot be given to the immunosuppressed

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18
Q

What are inactivated vaccines?

A

e.g. Influenza
Contains a microbe which has been inactivated by chemicals (e.g. formaldehyde), heat or radiation. This destroys the genetic material therefore preventing it from being able to replicate

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19
Q

What are the advantages and disadvantages of inactivated vaccines?

A 
Advantages;
- Cannot revert to virulent form
- Can be used in immunosuppressed 
- Easy to store
Disadvantages;
- Elicits weaker immune response
- Life long immunity is not always achieved so boosters may be required
20
Q

What are toxoid vaccines?

A

e.g. Tetanus
In some infections, it is not the bacteria that causes infection, but the toxins it produces. These toxins can be inactivated using heat, chemicals or radiation

21
Q

What are the advantages and disadvantages of toxoid vaccines?

A 
Advantages;
- Toxoids cannot become virulent 
- Easy to store
- Individual cannot infect others
Disadvantages;
- Requires adjuvants and boosters
- Local reactions at injection sites
22
Q

What are subunit vaccines?

A

e.g. Hepatitis
A subunit contains only the antigens of the microbe that is being vaccinated against. Some vaccines may only contain a specific region of the antigen

23
Q

What are the advantages and disadvantages of subunit vaccines?

A 
Advantages;
- Antigens cannot become virulent and cause disease
- Easy to store
- Individual cannot infect others
- Can determine whether the person has been vaccinated 
Disadvantages;
- Requires adjuvants and booster doses
- Local reactions at the injection site
24
Q

What are conjugate vaccines?

A

e.g. Haemophilus Influenza Type B
Some bacteria possess a polysaccharide coat which disguises its antigens from the immature immune system. A conjugate vaccine contains carrier proteins that are attached to polysaccharides to allow the immune system to recognise them

25
Q

What are the advantages and disadvantages of conjugate vaccines?

A 
Advantages;
- Cannot become virulent and cause disease
- Easy to store
- Individual being vaccinated cannot infect others
Disadvantages;
- Requires adjuvants and booster doses 
- Local reactions at injection site
- Expensive
26
Q

What is gonorrhoea?

A

A gram negative, intracellular diplococci

27
Q

Describe the T spot test

A

1) Blood sample is centrifuged
2) The middle layer is comprised of Peripheral Blood Mononuclear Cells
3) The sample is diluted and added to wells coated with IFN-γ antibodies
4) Wells are incubated
5) TB codes for proteins; 2 of which are used to challenge the T-cells in the blood
6) If challenged, T cells release IFN-γ
7) When washed with substrate solution the wells have spots at the bottom

28
Q

Describe the classification of chlamydia

A

Types D to K cause genital chlamydia, however there are also L types which can cause LGV; an infection of the lymphatics which can lead to many symptoms such as rectocolitis

29
Q

What treatments are used for chlamydia?

A

Genital chlamydia - Azithromycin

LGV - 3 weeks of doxycycline

30
Q

Describe the natural history of syphilis infection

A

1) Exposure
2) Primary lesion - Chancre (3 weeks)
3) Secondary lesion - Rash (8-16 weeks)
4) Latent syphilis
5) Tertiary syphilis - CVS, neurological etc. (10-40 years)

31
Q

Describe the treatment used for syphilis

A

Intra-gluteal injection of Bicillin

32
Q

Describe the treatment of HSV

A

Acyclovir - A 5 days course of treatment which requires 5 tablets a day

33
Q

What is Chronic Granulomatous Disease?

A

An inherited disorder which tends to be X-linked. This causes a defect in the gene coding for NADPH oxidase and so the patient will have few oxygen radicals and defective intracellular killing. This leads to recurrent bacterial and fungal infections

34
Q

What are the three phases of infection following a solid organ transplantation?

A

<1 month - Surgical Infection e.g. E. Coli
1-6 months - Opportunistic Infections e.g. Aspergillus
6 months - Community acquired infection e.g. pneumococcus, listeria, salmonella

35
Q

Describe the treatment used for neutropenic sepsis

A
  • Pipericillin
  • Tazobactam
  • Gentamicin
36
Q

What is Varicella Zoster?

A

A herpes virus that causes chicken pox and in the elderly it will cause shingles. In the immunocomprimised it may disseminate e.g. to the eCNS

37
Q

What is Cytomegalovirus?

A

A herpes virus which causes a mild illness that may be asymptomatic or glandular fever. In the immunocomprimised this infection will be far more severe with increased risk of bacterial infection

38
Q

What is Epstein Barr Virus?

A

A herpes virus that causes infectious mononucleosis in most patients, however in the immunocomprimised, malignant disease can arise

39
Q

What are adenoviruses?

A

Adenoviruses are a huge family of viruses that can cause a wide range of complications in the immunocomprimised including hepatitis, nephritis and colitis

40
Q

What are polyomaviruses?

A

Around 90% of people will have polyomavirus lying dormant in their urinary tract and kidney, however this doesn’t become a problem until we are immunocomprimised, at which point it may cause haemolytic cystitis

41
Q

What are the two main types of immunodeficiency?

A

Primary - (Congenital) Resulting from genetic defects which are inherited
Secondary - (Acquired) As a result of other diseases or conditions

42
Q

What are the main types of primary immunodeficiency?

A
  • Humoral defect (50%) - B Cells and antibodies
  • Combined humoral and cellular immunodeficiencies (20%) - B and T cells
  • Cell mediated defect (10%) - T cells
  • Phagocytic dysfunction (18%) - Granulocytes
  • Complement deficiency (2%)
43
Q

What are humoral defects? (Immunodeficiency)

A

A lack of antibodies e.g.

  • IgA deficiency
  • Hyper IgM syndrome
44
Q

What are cell mediated defects? (Immunodeficiency)

A

T cells fail to provide sufficient signals to the B cells e.g.
- Severe Combined Immunodeficiencies (SCID) - A mutation in the cytokine receptors. This causes the T cells and NK cells to fail which means the B cells cannot efficiently produce antibodies

45
Q

What are phagocytic defects? (Immunodeficiency)

A

A problem with the number and or functioning of the phagocytes e.g.
- Chronic Granulomatous Disease

Clinical Microbiology (2 decks)

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