E4 Flashcards
What is the normal flora of the nose?
- staph epidermis and staph aureus
- corynebacterium
What are the characteristics of staph epidermis?
- gram positive cocci
- catalase positive
- coagulase negative
- novobiocin sensitive positive
What are the characteristics of staph aureus?
- gram positive coci
- catalase positive
- coagulase positive
What are the characteristics of corynebacterium?
- gram positive rod
- non-spore forming
What are the normal flora of the nasopharnx?
- streptococcus
- viridans: strep mutans, strep mitis, strem milieri
- moraxella cat
- bacterioids
What is group A strep?
S. pyogenes
-beta hemolytic
What is group B strep?
S. agalactial
-beta hemolytic
What is group D strep?
S. Bovis and Enterococcius faecalis
What does strep pyogens present as?
- pharyngitis: red throat, patches of pus, tiny hemorrhage and fever
- beta hemolytic
- negative catalase
How is strep pyogens diagnosed?
-rapid strep test that targets cell wall
What are the virulence factors of strep pyogens?
- M protein virulence factor: antiphagocytic 80 serotypes
- capsule in more virulent strains
What do the 9 SPE superantigens of strep pyogens cause?
Scarlet fever, toxic shock, necrotizing fascitis
What is scarlet fever?
SPE release
-red skin, white tongue
What is acute rheumatic syndrome?
Fever, joint and chest pain and cross reaction with self MHC
What is necrotizing fascitis?
SPE release, skin infections
What is acute glomerulonephritis?
1-4 weeks psot strep pyogens
- deposition of immune complexes in glomerulus
- immune response= edema, hypertension, proteinuira, hematuria
What does corynebacterium cause and how does it present?
Diptheria
-mild sore thorat, fever, fatigue, malaise, neck swelling, white grey membrane of clotted blood and epithelial cells (cant scrape away)
How does diptheria do damage?
toxin mediated
- exotoxin from bacteriophage
- B subunit binds host
- A subunit ianctivates elongation factor 2 to stop protein synthesis and casue cell death
How is diptheria mnaged?
toxoid vaccine
What bacteria cause conjunctivitis?
H influenzae and strep pneumo
What is H influenzae?
gram negative rods
How is pink eye treated?
- remove from school
- handwashing
- local gentamicin or ciprofloxiciin
What causes otitis media?
H influenzae, strep pneumo, moraxella catarrhalis
What causes sinusitis?
Strep pneumo, H influenzae, moraxella catarrhalis
What disease does chlamydia cause?
Trachoma, adult and neonate conjunctivitis, and infant pneumonia
What are the components of chlamydia?
smal obligate parasite
- elementary body: metabolically inactive, infectious
- reticulate body: metbolically active, noninfectious
How does chlamydia do damage?
direct destruction of host cells during replication
- granuloma formation of immune response
- start with follicular conjunctivitis = inflammation and scarring and turning inward, abrasive surface = more inflammation and blindness
What are the considerations when dealing with adult inclusion conjucntivits?
Same disease as genital
-treat for both
What are the considerations when dealing with infant with conjunctiviitis?
-exposed at birth so treat topically and for pneumonia
What is chlamydophila pneumoniae?
- pneumonia, bronchitis, and sinusitis
- very common tends to resolve on own
- severe = affects 1 lobe of lung
- involved in atherosclerosis
What is assoicated with chlamydia psittaci?
parrots
-treat with macrolides
what are the symptoms of the common cold?
- rhinitis
- pharyngitis
- no high fever, LRT involvement, or respiratory distress
- complications: otitis media, sinus infection, exaserbation of asthma
What is rhinovirus?
- picornavirus, nonenveloped
- lots of serotypes
- in respiratory secretions = transmission
- low inoculum with 1-3 day incubation time
What is non-sars coronavirus?
- enveloped favored for cooler temperature
- transmit in large droplets
- incubation 3 days, peak in spring and winter
What is adenovirus?
- nonenveloped with fiber proteins
- 1, 2 and 5
- transmission: oral, droplet inhalation, conjunctiva
- Gi: 40 and 41
What is coxsackie virus?
entero nonenveloped
-transmission: oral-fecal
What is Hand, Foot, Mouth?
caused by coxsackie B
- fever, lesions on soles, palms, and oral areas
- children and caregivers
What is croup?
caused by parainflunenza type 1
- swelling of subglottic larynx causing seal cough
- mild to severe depending on stridor at rest
- steeple sign on xray
- children under 6
What is Herpangia?
caused by coxsackie virus
- sudden fever with white ulcers on soft palate
- children 1-7
What is the treatment for croup?
- mild stridor not present at rest: humidified air and hydration
- severe stridor at rest: O2, Epi, Glucocorticoids
What are the syptoms of RSV?
- most common cause of bronchiolitis and pneumonia in kids under 1 year
- bronchiolitis: expiratoyr wheeze, air trapping, subcostal retraction
What is ribaverin?
treatment for RSV
- inhaled
- inhibits nucleotide biosyntehsis and mRNA capping
- poor antiviral
What is passive immunoprophylaxis?
treatment for RSV
- given durign 1st year of life if at risk during RSV seaseon
- in 2nd year if immunocompromised
- uses palizumab = human mouse monoclonal antibody
What are the symptoms of uncomplicated influenza?
myalgia, headache, fever, chills, cough 2-6 week duration
-2 day incubation
What is hemagglutinin?
attachment protein of influenza that agglutinates RBC
What is neuraminidase?
cleaves sialic acid so influenza virus can release from cell and spread to other cells
What is influenza type A?
wide host range
- severe disease
- endemic and pandemic
- antigenic drift and shift
What is influenza type B?
- human host
- occassionally severe
- occassional epidempic
- antigenic drift
What is influenza type C?
- human and swine host
- mild disease
- limited outbreak
- antigenic drift
What is antigenic drift?
small changes in polymerase mutation and replication
-significant every 2-3 years
What is antigenic shift?
reassortment of 2 viruses
-causes pandemic
What is an innactivated influenza vaccine?
- inactivated virus
- intramusuclar: anyone 6mo/o or older even with chronic medical issues (3 o 4)
- intradermal: 18-64y/o (3)
What is the live attenuated influenza vaccine?
intranasal
2-49 y/o non-pregnant (4)
What is recombinant influenza vaccine?
- hemagglutinin protein
- intramusuclar: 18-49 y/o trivalent
what is amantadine and rimantadine?
- influenza drug
- block replication before release
- agaisnt influenza A but there is a lot of resistant
What is zantamivir, oseltamivir, and peramivir?
inhibit vrion relase and spread
- agsint influenza A and B
- must be given early on in uncomplciated
- z= inhale, o = oral, p = IV
What is primary influenza pneumonia?
- influenza A
- affects children and elderly
- 1-4 days after onset = increase cough, tachypnea, dyspnea, acute respiratory distress
- sputum: gram negative, PMN cell
- CXR: bilateral interstitial
What is bacterial pneumonia secondary to influenza?
- 1 week after symptoms
- return of fever and repiratory distress
- find s pneumoniae, s aureus, and H influenzae
What is the primary agent of fungal sinusitis?
Zygomycoses
What are zygomycoses?
- common in environment, uncommon infection
- non septate hyphae
- predisposed: immunosuppressed, burn, diabetic
- diagnose: hyphae at 90 degree angles
- treat: amphotericin B
What disease does zygomycoses cause?
Rhinocerebral zygomycoses: infection of sinuses to neighboring tissues
-diabetics
What is the treatment for PCP?
trimethoprim and sulfamethazole
aids pt = prophylaxis and suppressive therapy
WHat is the treatment for zygomycoses?
Amphotericin B
What is pneumocysits carinii pneumonia (PCP)?
lethal form of pneumonia
- immunocompromised AIDs pt
- difficult to grow in lab
- infected by inhalation of cysts
- symptoms: dyspnea, non-productive cough and fever
- interstital pneumonitis with cellualr infiltrate
- diagnose:j biopsy and stain
- treat: trimethoprim and sulfamethoxazole
- aids pt = prophylaxis and suppressive therapy
What is C albicans?
- oral candidasis or thrush
- infants, immunosuppressed adults, AIDS
- present: erythema, white patch of uccal mucosa, throat, tongue, and gums
- diagnose: germ tube in culture
- treat: oral nystatin or azoles
What is the treatment for thrush?
-oral nystatin or azoles
What is Histoplasm capsulatum?
- histoplasmosis
- found in midwest
- found in soil in humid conditions with lots of bird droppings
- infection = inhalation of conida
- destruction = through macrophages, yeast forms and disseminate through lymphatic system
- pulmonary: only in lung seen as small calcified lesions
- chronic and disseminated: immunocompromised, macrophages to spleen, liver, and lymph can be life threatening
- diagnose: cultivate, Ag detection
- treat: amphotericin b (severe), or azole (AIDS)
What is the treatment for histoplasmosis?
- severe = amphotericin B
- AIDS pt = Azole
What is blastomyces dermatitidis?
- blastomycosis
- missouri river valley dogs and horses
- hard to find in envrionemtn
- pulmonary with ability to disseminate to skin and ulcer
- acute clinical: cough, fever, flu-like
- chronic: cough, night sweat, wt loss
- disseminated: skin lesion, bone infection, prostate infection
- diagnose: obs in culture
- treat: amphotericin b, azole (uncomplicated)
How is blastomycosis treated?
- severe = amphotericin b
- uncomplicated = azole
What is paracocciiodes brasillenses?
- pracoccidiomycosis
- regions of south and cetnral america
- similar to toehrs
- diagnose: direct observation, culture, and serology
What is cocidioideimmitus?
- cocidiomycosis
- -valley fever in arizona
- epidemics associated with drought-rain-drought
- diagnose: sphorules in biopsy
- treat: azole and amphotericin b
What is the treatment for coccidiomycosis?
azole and amphotericin b
What is cryptococcsis meningitis?
slow developing meningitis
- common in aids
- diagnose india ink
- combo of amphotericin b and furoaltosine
What is treatment for crypto meningitis?
amphotericin b and furoaltosine
What is aspergillomas?
- aspergillus
- rarely pathogenic except in immunosuppressed
- a. fumigatus adn a flavus
- always a mold
- spectrum of disease caused by hyphal growth
- acute: asperguillomas, lung lesions of hyphae and fibrin, unilateral and asymptomatic
- disseminated: can be fatal, into lung parenchyma = blood vessel = clot and hemorrage
- diagnose: septate hyphae at 45 degree
- treat: azole, echinocandin, amphotericin b, and surgery
How do you treat aspergillus?
azole, echinocandin, amphotericin b and surgery
What are the characteristics of typical pneumonia?
-sudden
-toxic facies
productive cough
bloody sputum
high fever
frequent pleurisy
frequent consolidation
elevated left shift WC
CXR: defined lobe
cause = strep pneumo
What are the characteristics of atypical pneumonia?
gradual well facies nonproudctive cough scant sputum lwo fever rare pelurisy rare consolidation normal to elevated WBC cxr: patchy infiltrate cause = mycoplasm pneumo
What is the treatment for atypical pneumonia?
tetracycline and erythromycin
What is epiglottitis?
- strep pyogens, staph aureus, kelbsiella pneumoniae
- infection and swelling of epiglottis can close airway
What is hamophilus influenzae b?
- can cause sinusitis, otitis media, pneumonia, bacteremia
- polysaccharide capusle made of polyribosylripitol phosphate (PRP)
- pediatric pathogen
- transmit: respiratory droplets
- virulence: LPS, IgA, protease, PRP caspule
- diagnose: culture gram negative, PRP, serum/urine Ag
treat: severe = broad cephalosporin, mild = amoxicilin - hib vaccine
What is the treatment for H. influenzae b?
- conjugate vaccine
- severe = broad cephalosporin
- mild = amoxicillin
What is mycoplasm pneumo?
acute bacterial bronchitis
-sign: dry cough, treat symptoms
What is pertussis?
whooping cough
- gram negative fastidious
- toxins = increase lung secretions and decrease clearance
- in humans, under 1 yr or unvaccinated
- worst of symptoms is when contagious
- major adhesin: filamentous hemagglutinin bind to epithelal cells
- major toxin: pertussis toxin = increase cAMP to increase secretions
- diagnose: sound, culture, nucleic acid test
- treat: macrolides
- vaccinate: DTaP detox toxin, peractin, and filament hemagglutinin
What is the treatment for whooping cough?
macrolides
What is strep pneumo?
- normal gram postive cocci, alpha hemolytic with lots of serotypes
- present: cough, fever, chest pain, rust colored sputum and poor O22
- diagnose: gram stain, culture, urine test for polysaccharide
- treat: penicillin for sensitive, marolide if not, both if severe
- vaccines: 23 adn 13 valent
What is the treatment for strep pneumo?
- sensitive = penicllin
- non senstive = macrolide
- severe = both
What is staph aureus?
- gram postiive clusters catalase postive and coag postiive
- coagulace
- protein A binds Fc
- PVL = severe necrotizing
- resistant to beta lactams = MRSA
- treat: penciillin/cephalosporin, if resistant - linezolid or vancomycin
What is the treatment for staph aureus and MRSA?
Staph: penicllin/ cephalosporin
MRSA: linezolid or vancomycin
What is klebsiella pneumoniae?
gram negative rod, non-motile, mucoid, oxidase negative
- produce beta lactamases
- present: lobar pneumonia, bloody sputum
- virulence factors: LPS and capsule
- treat: macrolides
- prevent: disinfect environment
What is treatment for klebseilla pneumoniae?
macrolides
What is pseudomonas aerugionsa?
gram negative rod, obligate aerobe, smell like grapes
- metabolize all organic
- grow in nutrient free o2, hand soap, and dilute antiseptic
- grow in biofilms
- pneumonia, septicemia, endocarditis, ecthyma
- predisposed: burn, immunosuppressed, ventilator, CF
- virulence: Toxin A (riboxylate EF2), capusle, pyocyanin (toxin to host), pyoverdin (iron uptake)
- treat: ticarcillin/pipercillin and aminoglycoside
What is the treatment for pseudomonas aeruginosa?
-ticarcillin/pipercillin and aminoglycoside
What is mycoplasm pneumoniae?
smallest disease causing bacteria
- no peptidoglycan = beta lactams dont work
- restricted to humans
- low infectious dose - tracheobronchitis
- p1 adhesin: binds base of cilia and cause escalator issue = mucus fills lungs
- symptoms: bronchopneumonia, anemia, patchy infiltrates
- long process
- diagnose: cold agglutinin: non specific, pcr, serolgoy
- treat: tetracycline and macrolide
What is the treatment for mycoplasm pneumoniae?
Tetracycline and macrolide
What is chlamydophila pneumoniae?
atypical pneumonia
- athersclerosis, asthma, ms, rehumatoid arthritis
- dianose: microimmunofluoresence and PCR
- treat: tetracycline and macrolide
What is legionella pneumoniae?
gram negative rod, difficult to culture
- form man made water aerosolized
- virulence: attach to alveolar macrophage inject with T4ss into host, hijack cell, no lysosome fuse, recruit to LCV, replicate at high numbers
- in cell as LCV = recruits stuff to feed it
- clinical: progressively ill 3-6 dyas, chills, diarrhea, confusion
- diagnose: WBC, CXR (patchy), fluorescent Ab, nucleic acid amp.
- treat: macrolide or fluoroquinolone
What is the treatment for legionella?
macrolide or fluoroquinolone
What is mycobacterium tuberculosis?
Gram +, acid fast
- latent and active phases
- humans only reservoir
- transmit: aersolized respiratory secretions
- granuloma form in lungs
- alveolar macrophage engulf = t and NK cells = granuloma
- primary asymptomatic = clear, latent or active
- cell mediated: causes necrosis and inflammation with granuloma
- disseminated: millet seeds in organs
- symtpoms: wt loss, night sweats, cough
- diagnsois: rapid lab test, chon focus and complex on CXR or focal infiltrate
- tuburculin skin test not good if have had vaccine
- IFN-gamma measure T cell realse with Mtb Ag
- treat: INH, ethambutol, pyrazamide, and rifampin for 2 mo then INH and rifampin for 4-6mo
- lots of resistance
- vaccine: in endemic countries
What is the treatment for MTb?
INH, ethambutol, pyrazamide, and rifampin for 2 mo and then INH and rifampin for 4-6 mo
What is mycobacterium avium and itnracellulare?
- pulmonary infection like TB
- common in immunocompromised
What is mycobacterium kansaii?
elderly chronic granulomatous pulmonary disease
