FA - Micro - Systems Flashcards
Normal dominant flora - nose?
S.epi - colonized by S.aureus.
Normal dominant flora - Skin?
S.epi
Normal dominant flora - oropharynx?
Viridans group strep
Normal dominant flora - dental plaque?
S.mutans
Normal dominant flora - colon?
B.fragilis>E.coli
Normal dominant flora - vagina?
Lactobacillus - colonized by E.coli and group B strep.
Normal flora - neonates by C-section?
Have NO FLORA but are rapidly colonized after birth.
Food poisoning - starts quickly/ends quickly?
- S.aureus
2. B.cereus
Food poisoning - B.cereus source?
Reheated rice.
Food poisoning - C.perfringens source?
Reheated meat dishes.
Food poisoning - E.coli O157:H7 source?
Undercooked meat.
Food poisoning - Salmonella source?
Poultry, meat, and eggs.
Food poisoning - S.aureus source?
- Meats
- Mayonnaise
- Custard
==> PREFORMED TOXIN.
Food poisoning - V.parahemolyticus and V.vulnificus source?
Contaminated SEAfood.
V.vulnificus besides food poisoning?
Wound infections from contact with contaminated water or shellfish.
Mention altogether the most important food poisoning bugs.
- B.cereus
- S.aureus
- C.botulinum
- C.perfringens
- E.coli O157:H7
- Salmonella
- V.parahemolyticus and V.vulnificus
Bugs causing bloody diarrhea?
- Campylobacter
- E.histolytica
- EHEC
- EIEC
- Salmonella
- Shigella
- Y.enterocolitica
Bloody diarrhea - Campylobacter?
- Comma- or S-shaped organism.
2. Growths at 42C.
Bloody diarrhea - E.histolytica?
- Protozoan
- Amebic dysentery
- Liver abscess
Bloody diarrhea - EHEC?
- O157:H7.
- Can cause HUS.
- Makes Shiga-like toxin.
Bloody diarrhea - EIEC?
Invades colonic mucosa.
Bloody diarrhea - Salmonella?
- Lactose(-)
- Flagellar motility
- Animal reseervoir
- Especially POULTRY/EGGS
Bloody diarrhea - Shigella?
- Lactose(-)
- Very low ID50
- Shiga toxin - Human reservoir only
- Bacillary dysentery
Bloody diarrhea - Y.enterocolitica?
- Day-care outbreaks
2. Pseudoappendicitis
Watery diarrhea bugs?
- C.difficile
- C.perfringens
- ETEC
- Protozoa
- V.cholerae
- Viruses
Watery diarrhea - C.difficile?
- Pseudomembranous colitis
- By antibiotics
- Occasionally bloody diarrhea
Watery diarrhea - C.perfringens?
Also causes GAS GANGRENE.
Watery diarrhea - ETEC?
- Traveler’s diarrhea
2. Heat-labile and heat-stable toxins
Watery diarrhea - Protozoa
- Giardia
2. Cryptosporidium (immunocompromised)
Watery diarrhea - V.cholerae?
- Comma-shaped organisms
- Rice-water diarrhea
- Often from INFECTED SEAfood
Watery diarrhea - Viruses?
- Rotavirus
- Norovirus
- Adenovirus
Common causes of pneumonia - neonates (<4wk)?
- Group B strep
2. E.coli
Common causes of pneumonia - children (4wk-18y)?
- Viruses - RSV
- Mycoplasma
- C.trachomatis (infants-3y)
- C.pneumoniae (school-aged children)
- S.pneumoniae
Common causes of pneumonia - adults (18-40yr)?
- Mycoplasma
- C.pneumoniae
- S.pneumoniae
- Viruses ==> Influenza.
Common causes of pneumonia - adults (40-65y)?
- S.pneumoniae
- H.influenza
- Anaerobes
- Viruses
- Mycoplasma
Common causes of pneumonia - Elderly?
- S.pneumoniae
- Influenza virus
- Anaerobes
- H.influenza
- Gram(-) rods
Common causes of pneumonia - Alcoholic/IVDA?
Alcoholics ==> Klebsiella + Anaerobes (eg Peptostreptococcus, Fusobacterium, Prevotella, Bacteroides).
IVDA ==> S.pneumo + S.aureus.
Common causes of pneumonia - Aspiration?
Anaerobes
Common causes of pneumonia - Atypical?
- Mycoplasma
- Legionella
- Chlamydia
Common causes of pneumonia - CF?
- Pseudomonas
- S.aureus
- S.pneumoniae
- B.cepacia.
Common causes of pneumonia - Immunocompromised?
- Staph
- Enteric gram(-) rods
- Fungi
- Viruses
- P.jiroveci (with HIV)
Common causes of pneumonia - Nosocomial?
- Staph
- Pseudomonas
- Other enteric gram(-) rods
Common causes of pneumonia - Postviral?
- S.pneumo
- H.influenza
- S.aureus
Common causes of meningitis - Newborn (0-6mo)?
- Group B strep
- E.coli
- Listeria
Common causes of meningitis - Children (6-6yr)?
- S.pneumoniae
- N.meningitis
- H.influenza type B
- Enteroviruses
Common causes of meningitis - 6-60y?
- S.pneumoniae
- N.meningitidis (#1 in teens)
- Enteroviruses
- HSV
Common causes of meningitis - 60+y?
- S.pneumoniae
- Gram(-) rods
- Listeria
Meningitis empirical treatment?
- Vancomycin
- Ceftriaxone
- Add ampicillin if Listeria is suspected.
Viral causes of meningitis?
- Enteroviruses (Coxsackie)
- HSV-2 (HSV-1=encephalitis)
- HIV
- West Nile virus ==> ALSO causes encephalitis.
- VZV
In HIV - causes of meningitis?
Cryptococcus spp.
CSF findings in meningitis - Bacterial?
- UP pressure
- UP PMNs
- UP protein
- DOWN sugar
CSF findings - Fungal/TB?
- UP pressure
- UP lymphocytes
- UP proteins
- DOWN sugar
CSF findings in meningitis - viral?
- Normal/UP pressure
- UP lymphocytes
- Normal/UP protein
- Normal sugar
Osteomyelitis - assume no other info is available?
S.aureus (MC overall)
Osteomyelitis - sexually active?
N.gonorrhoeae (rare) - septic arthritis more common.
Osteomyelitis - IVDA?
- P.aeruginosa
- Candida.
- S.aureus.
Osteomyelitis - sickle cell?
- Salmonella
2. S.aureus
Osteomyelitis - prosthetic joint replacement?
- S.aureus
2. S.epi
Osteomyelitis - vertebral involvement?
- S.aureus.
2. Myco TB (Pott).
Osteomyelitis - cat and dog bites?
P.multocida
Osteomyelitis - target group?
Children
Osteomyelitis - Radiograph or MRI?
MRI ==> Acute infection + Detailing anatomic involvement.
X-RAY ==> Useful in CHRONIC osteomyelitis.
Cystitis presents with?
- Dysuria
- Frequency
- Urgency
- Suprapubic pain
- WBCs (but NOT WBCs casts) in urine.
Cystitis - mechanism in MALES - infants, elderly?
- Congenital defects (Infants).
- Vesicoureteral reflux (Infants)
- Enlarged prostate (elderly)
Pyelonephritis symptoms?
- Fever
- Chills
- Flank pain
- Costovertebral angle
- Tenderness
- Hematuria
- WBC casts
UTI - how more common in women?
10X! - shorter urethras colonized by fecal flora.
UTI - Predisposing factors besides female?
- Obstruction
- Kidney surgery
- Catheterization
- GU malformation
- Diabetes
- Pregnancy
UTI - Diagnostic markers?
- Leukocyte esterase test (+) ==> Evidence of WBC activity.
- Nitrite test (+) ==> Reduction of urinary nitrates by bacterial species (eg E.coli).
- Urease test (+) ==> Urease-producing bugs (eg Proteus, Klebsiella).
UTI bugs - E.coli - features?
- Leading cause of UTI.
2. Colonies show green metallic sheen on EMB agar.
UTI bugs - Staph sapro - features?
2nd leading cause of UTI in sexually active women.
UTI bugs - K.pneumoniae - features?
- 3rd leading cause of UTI.
2. Large mucoid capsule and viscous colonies.
UTI bugs - Serratia marcescens - features?
- Some strains produce a red pigment.
2. Often nosocomial and drug resistant.
UTI bugs - Enterococcus - features?
Often nosocomial and drug resistant.
UTI bugs - P.mirabilis - features?
- Motility causes “swarming” on agar.
- Produces urease
- Associated with struvite stones
UTI bugs - P.aeruginosa - features?
- Blue-green pigment and fruity odor
2. Usually nosocomial and drug resistant
UTI - diagnostic tests - Leucocyte esterase (+)?
Bacterial UTI.
UTI - diagnostic tests - nitrite tests?
Gram(-) bugs.
UTI - Urease test (+)?
- Klebsiella
2. Proteus
UTI - urease (-)?
- E.coli
2. Enterococcus
Mention altogether the most important UTI bugs.
- E.coli
- S.sapro
- K.pneumoniae
- Serratia marcescens
- Enterococcus
- P.mirabilis
- P.aeruginosa
3 common vaginal infections?
- Bacterial vaginosis
- Trichomonas vaginitis.
- Candida vulvovaginitis
Bacterial vaginosis - signs/symptoms?
- No inflammation
2. Thin, white discharge with fishy odor
Bacterial vaginosis - lab findings?
- Clue cells
2. pH>4.5
Bacterial vaginosis - Treatment?
Metronidazole
Trichomoniasis - signs/symptoms?
- Inflammation ==> Strawberry cervix.
2. Frothy, grey-green, foul-smelling discharge
Trichomoniasis - Lab findings?
- Motile trichomonads
2. pH>4.5
Trichomoniasis - treatment?
Metronidazole - treat sexual partner.
Candida vulvovaginitis - signs/symptoms?
- Inflammation
2. Thick, white, “cottage cheese” discharge
Candida vulvovaginitis - lab findings?
- Pseudohyphae
2. pH NORMAL (4-4.5)
Candida vulvovaginitis - treatment?
-azoles
ToRCHeS infections - Transmission?
Mostly transplacentally, or via delivery (especially HSV-2).
Non specific signs common to many ToRCHeS infections?
- HSM
- Jaundice
- Thrombocytopenia
- Growth retardation
Besides ToRCHeS, other important infectious agents?
- S.agalactiae
- E.coli
- Listeria
- B19 –> Hydrops fetalis
T.gondii - transmission?
Cat feces or ingestion of undercooked meat.
T.gondii - maternal manifestations?
- Usually asymptomatic
2. Lymphadenopathy (rarely)
T.gondii - neonatal manifestations?
Classic triad: 1. Chorioretinitis 2. Hydrocephalus 3. Intracranial calcifications \+/- "BLUEBERRY MUFFIN RASH"
Rubella - transmission?
Respiratory droplets.
Rubella - maternal manifestations?
- Rash
- Lymphadenopathy
- POLYARTHRITIS/POLYARTHRALGIA
Rubella - neonatal manifestations?
Classic triad: 1. PDA (or pulmonary artery hypoplasia) 2. Cataracts 3. Deafness \+/- "blueberry muffin" rash.
CMV - transmission?
- Sexual contact
2. Organ transplants
CMV - Maternal manifestations?
- Usually asymptomatic
2. Mononucleosis-like illness
CMV - Neonatal manifestations?
- Hearing loss
- Seizures
- Petechial rash
- “Blueberry muffin” rash
- PERIVENTRICULAR CALCIFICATIONS
HIV -transmission?
- Sexual contact
2. Needlestick
HIV - maternal manifestations?
Variable presentation depending on CD4+ count.
HIV - neonatal manifestations?
- Recurrent infections
2. Chronic diarrhea
HSV-2 - transmission?
Skin or mucous membrane contact.
HSV-2 - maternal manifestations?
- Usually asymptomatic
2. Herpetic (vesicular) lesions
HSV-2 - Neonatal manifestations?
- Encephalitis
2. Herpetic (vesicular) lesions
Syphilis - transmission?
Sexual contact
Syphilis - maternal manifestations?
Chancre (1o) and disseminated rash (2o) are the two stages likely to result in fetal infection.
Syphilis - neonatal manifestations?
- Often stillbirth
- Hydrops fetalis
==> IF CHILD SURVIVES: - Notched teeth
- Saddle nose
- Short maxilla
- Saber shins
- CN VIII deafness
ToRCHeS?
Toxo Rubella CMV HSV-2 Syphilis
Red rashes of childhood?
- Coxsackievirus type A
- HHV-6
- Measles virus
- Parvo B19
- Rubella virus
- S.pyogenes
- VZV
Red rashes of childhood (RRC) - Coxsackie A?
Hand-foot-mouth disease
Hand-foot-mouth disease clinical presentation?
- Vesicular rash on palms
- Soles
- Vesicles and ulcers in oral mucosa
RRC - HHV-6?
Roseola = EXANTHEM SUBITUM
Roseola clinical presentation?
- ASYMPTOMATIC rose-colored MACULES over body appears after several days of high fever.
- Can present with febrile seizures.
- Usually affects infants.
Measles (rubeola) clinical presentation?
- A paramyxovirus
- Beginning at head and moving down
- Rash is PRECEDED by cough, coryza, conjunctivitis, and blue-white (Koplik) spots on buccal mucosa.
Erythema infectiosum (5th disease - B19) clinical presentation?
“Slapped cheek” rash on face - can cause hydrops fetalis in pregnant woman.
Rubella (German measles) clinical presentation?
Pink coalescing MACULES begin at head and moves down –> fine truncal rash.
==> POST-AURICULAR LYMPHADENOPATHY.
S.pyogenes - scarlet fever - clinical presentation?
Erythematous, sandpaper-like rash with fever and sore throat.
VZV - chickenpox - clinical presentation?
- Vesicular rash begins on TRUNK.
2. Spreads to FACE + EXTREMITIES with lesions of DIFFERENT ages.
Mention the major sexually transmitted diseases?
- AIDS
- Chancroid
- Chlamydia
- Condylomata acuminata
- Genital herpes
- Gonorrhea
- Hep B
- Lymphogranuloma venereum
- Syphilis
- Trichomoniasis
Chancroid - clinical features?
- Painful genital ulcer
2. Inguinal adenopathy
Chancroid - organism?
H.ducreyi
Chlamydia - clinical features?
- Urethritis
- Cervicitis
- Conunctivitis
- Reactive arthritis
- PID
- EPIDIDYMITIS.
Chlamydia - organisms (types)?
Chlamydia trachomatis D-K
Condylomata acuminata - features?
- Genital warts
2. Koilocytes
Condylomata acuminata - organism?
HPV-6 and -11.
Genital herpes - features?
- Painful penile, vulvar, or cervical vesicles and ulcers.
2. Systemic symptoms such as fever, headache, myalgia.
Genital herpes - organisms?
- HSV-2
2. HSV-1 less commonly
Gonorrhea - features?
- Urethritis
- Cervicitis
- PID
- Prostatitis
- Epididymitis
- Arthritis
- Creamy purulent discharge
Lymphogranuloma venereum - features?
- Infection of lymphatics
- Painless, genital ulcers
- Painful lymphadenopathy (buboes)
Lymphogranuloma venereum - C.trachomatis subtypes?
L1-L3.
1o syphilis - features?
PainLESS chancre
2o syphilis - features?
- Fever
- Lymphadenopathy
- Skin rashes
- Condylomata lata
3o syphilis - features?
- Gummas
- Tabes dorsalis
- General paresis
- Aortitis
- Argyll-Robertson pupil
Trichomoniasis - features?
- Vaginitis
- Strawberry cervix
- Motile in wet prep
PID - Top bugs?
- Chlamydia trachomatis ==> Subacute + Often UNDIAGNOSED.
2. N.gonorrhoeae ==> ACUTE.
PID features?
- Chandelier sign = cervical motion tenderness.
2. Purulent cervical discharge
PID may include which conditions?
- Salpingitis
- Endometritis
- Hydrosalpinx
- Tubo-ovarian abscess
C.trachomatis + N.gonorrhoeae –> which syndrome?
Fitz-Hugh-Curtis syndrome –> Infection of the liver CAPSULE and “violin string” adhesions of PERITONEUM to liver.
Salpingitis - risk factor for?
- Ectopic pregnancy
- Infertility
- Chronic pelvic pain
- Adhesions
Major nosocomial infections?
- C.albicans
- CMV, RSV
- E.coli
- P.mirabilis
- HBV
- Legionella
- P.aeruginosa
Nosocomial infection (NI) - C.albicans - risk factor?
Hyperalimentation
NI - CMV, RSV - Risk factors?
Newborn surgery
NI - E.coli, P.mirabilis - Risk factors?
Urinary catheterization.
2 MCC of NI are?
- E.coli (UTI)
2. S.aureus (wound infection)
NI - HBV - Risk factor?
Work in renal dialysis unit.
Bugs affecting unimmunized children - dermatologic - pathogens?
- Rubella virus
2. Measles virus
Asplenic patient
Encapsulated microbes - SHiN
S.pneumoniae»_space; H.influenza B > N.meningitidis
Branching rods in oral infection
Sulfur granules
Actinomyces israelii
Chronic granulomatous disease
Cat (+) microbes - esp. S.aureus
“Currant jelly” sputum
Klebsiella
Dog or cat bite
P.multocida
Facial nerve palsy
Borrelia burgdorferi (Lyme disease)
Fungal infection in diabetic or immunocompromised
Mucor or Rhizopus spp.
Health care provider
HBV - from needle stick.
Neutropenic patients
C.albicans (systemic)
Aspergillus
Organ transplant recipient
CMV
PAS (+)
Tropheryma whipplei
Pediatric infection
Haemophilus influenza (including epiglottitis).
Pneumonia in CF
Burn infection
P.aeruginosa
Pus
Empyema
Abscess
S.aureus
Rash on hands and feet
Coxsackie A
Treponema pallidum
Rickettsia rickettsii
Sepsis/meningitis in newborn
Group B strep
Surgical wound
S.aureus
Traumatic open wound
C.perfringens