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GRAM NEGATIVE Flashcards

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1
Q

Virulence factor of N. gonorrhoeae that has anti phagocytic effect.

A

Pili
In N. meningitidis incorporation of human sialic acid derivatives into the capsule prevents recognition by the host immune system. “Molecular Mimicry”

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2
Q

Appearance of N. gonorrhea on gram stain?

A

Gram negative intracellular diplococci with polymorphonuclear cells.

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3
Q

Appearance of N. gonorrhea and N. meningitidis on agar.

A

Convex , glistening , elevated, mucoid colonies that are transparent or opaque, non-pigmented and non-hemolytic.

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4
Q

Gold standard in the diagnosis of N. gonorrhea.

A

Nucleic Acid Amplification Test

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5
Q

Preferred regimen used in the treatment of uncomplicated genital infection caused by N. gonorrhea

A

Ceftriaxone 250mg IM single dose + Azithromycin 1g PO single dose.

The Azithromycin can also address the frequent co-infection with Chlamydia.
Doxycycline may be used as a substitute for Azithromycin, however it is not preferred due to higher rates of resistance to tetracyclines in N. gonorrhea.

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6
Q

Stain used to visualize Legionella pneumophilia.

A

Silver stain

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7
Q

Drug of choice for the most common cause of community acquired UTI in children.

A

Ampicillin or Sulfonamides

(most common cause is e.coli)

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8
Q

Mechanism of enterotoxin of Vibrio cholerae.

A

Increase levels of cAMP , this results to prolonged hypersecretion of water and electrolytes

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9
Q

Culture medium used to grow Camphylobacter jejuni.

A

Skirrow’s medium

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10
Q

Organisms that are cultured in Xylose-Lysine-Deoxycholate agar.

A

Shigella & Salmonella

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11
Q

Agents most commonly associated with diarrhea. (3)

A
  1. E coli
  2. V. cholera
  3. E. fecalis
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12
Q

Most helpful lab test to confirm gonococcal arthritis.

A

Culture of the aspirate.
Suspect this infection in reproductive age patients with unilateral joint swelling and pain.

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13
Q

Most appropriate initial investigation for smokers cough.

A

Chest X-ray

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14
Q

Natural habitat of Enterobacteriaceae?

A

GI tracts of humans and animals.

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15
Q

Gram-negative enteric rods that are rapid lactose fermenters?

A
  1. Klebsiella pneumoniae
  2. Enterobacter spp.
  3. E. coli
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16
Q

Natural habitat of enterobacteriaceae.

A

GI tracts of humans and animals.

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17
Q

Gram-negative enteric rods that are slow lactose fermenters.

A
  1. Serratia
  2. Citrobacter
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18
Q

Does E. coli ferment lactose?

A

Yes ( Rapid fermenter)

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19
Q

Antigen of e. coli found on its capsule?

A

H antigen

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20
Q

Appearance of e. coli in EMB Agar.

A

Metallic green with an “iridescent sheen”

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21
Q

Most common cause of UTI?

A

E. coli

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22
Q

Important strain of E. coli causing travelers diarrhea?

A

ETEC (Enterotoxigenic E.coli)

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23
Q

Important strain of E.coli causing diarrhea in infants in developing countries?

A

EPEC ( Enteropathogenic E.coli)

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24
Q

The heat-labile enterotoxin of ETEC increases _________ intracellularly.

A

cAMP

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25
Q

The heat stable enterotoxin of ETEC increases __________ intracellularly.

A

cGMP

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26
Q

The heat labile enterotoxin of ETEC closely resembles the enterotoxin of what organism?

A

Vibrio cholerae

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27
Q

Important strain of e. coli causing hemorrhagic colitis.

A

STEC ( Shiga toxin producing E. coli)

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28
Q

Most common serotype of STEC?

A

O157:H7

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29
Q

Differentiating feature of serotype O157:H7 from other E.coli?

A

Does not ferment sorbitol

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30
Q

What systemic pathology is associated most commonly with the O157:H7 serotype of E.coli?

A

HUS : Hemolytic Uremic Syndrome

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31
Q

Important strain of E.coli causing persistent diarrhea that is very similar to Shigellosis?

A

EIEC ( Enteroinvasive E.coli)

shigellosis

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32
Q

Important strain of E.coli causing diarrhea in HIV (+) patients?

A

EAEC (Enteroaggregative E.coli)

(HIV aggregative )

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33
Q

Triad of hemolytic uremic syndrome?

A
  1. Hemolytic Anemia
  2. Thrombocytopenia
  3. Uremia

Triad of Hemolytic Uremic Syndrome
T for Thrombocytopenia
Hemolytic Anemia
Uremia

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34
Q

What bacteria can cause necrotizing pneumonia with currant jelly sputum?

A

Klebsiella pneumonia

K Kurrant Jelly

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35
Q

What lobes are more commonly affected in Klebsiella pneumonia?

A

Upper lobes

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36
Q

What population is at very high risk for Klebsiella pneumonia?

A

Alcoholics

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37
Q

Wha bacteria can cause a genital ulcer with Donovan bodies on biopsy?

A

Klebsiella granulomatis

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38
Q

What STI can Klebsiella granulomatis cause?

A

Granuloma inguinale ( Donovanosis)

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39
Q

Is the ulcer in donovanosis painful or painless?

A

Painless

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40
Q

Pigment responsible for the red appearance of Serratia?

A

Prodigiosin

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41
Q

Most common site of infection of Serratia species?

A

Urinary Tract

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42
Q

What bacteria can cause staghorn caliculi?

A

Proteus mirabilis

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43
Q

What type of renal stones does proteus mirabilis cause?

A

Struvite Stones ( Ammonium Magnesium Phosphate)

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44
Q

Proteus mirabilis expresses _____________ allowing it to form alkaline environment.

A

Proteus mirabilis

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45
Q

Classic motility of Proteus mirabilis?

A

Swarming motility

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46
Q

Spot-indole test in Proteus mirabilis?

A

Positive

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47
Q

Spot-indole test in Proteus vulgaris?

A

Negative

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48
Q

Is Shigella encapsulated?

A

No

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49
Q

Is Salmonella encapsulated?

A

Yes

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50
Q

Is Shigella motile?

A

No

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51
Q

Is Salmonella motile?

A

Yes

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52
Q

Does Shigella ferment lactose?

A

No, except Shigella sonnei

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53
Q

Invasion of _________ cells is essential in pathogenesis of Shigella Infections.

A

M cells in the mucosal epithelium

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54
Q

Shigella sonnei is aka as ?

A

Duval’s bacillus

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55
Q

The only lactose fermenting Shigella?

A

Shigella sonnei

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56
Q

Which agar detects the production of H2S?

A

Hektoen Agar

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57
Q

Most common causative agent of enteric fever?

A

Salmonella paratyphi

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58
Q

Lymphoid tissue in intestinal cells for Salmonella infection.

A

Peyer’s Patches

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59
Q

Lymphoid tissue in intestinal cells for Salmonella infection?

A

Peyer’s patches

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60
Q

Classic cutaneous manifestation of enteric fever?

A

Rose spots

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61
Q

Most common manifestation of Salmonella infection?

A

Enterocolotis (not typhoid fever)

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62
Q

Preferred specimen for diagnosis of non-typhoidal salmonella?

A

Freshly passed stool

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63
Q

Definitive diagnosis of enteric fever?

A

Culture of blood , bone marrow, urine, or intestinal secretions.

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64
Q

Highest sensitivity for diagnosis of enteric fever?

A

Bone marrow culture

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65
Q

What colonies does Salmonella form on bismuth sulfite medium?

A

Black cultures due to H2S production

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66
Q

Where does Salmonella colonize in chronic state carrier?

A

Gallbladder

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67
Q

Which strain of Salmonella can be acquired from turtles?

A

Salmonella enteritidis

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68
Q

What secretion system helps with the infectivity of Salmonella?

A

Type III secretion system

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69
Q

What is the common cause of osteomyelitis in sickle cell disease?

A

Salmonella

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70
Q

Which pigment gives Pseudomonas culture bluish pigment?

A

Pyocyanin

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71
Q

Which pigment gives Pseudomonas cultures a greenish pigment?

A

Pyoverdin

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72
Q

Which pigment gives Pseudomonas cultures a dark red pigment?

A

Pyorubin

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73
Q

Which pigment gives Pseudomonas cultures a brown-black pigment?

A

Pyomelanin

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74
Q

What virulence factors of Pseudomonas generates reactive oxygen species?

A

Pyocyanin

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75
Q

What virulence factor of Pseudomonas acts as a siderophore?

A

Pyoverdin

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76
Q

How is Pseudomonas aeruginosa differentiated from other Pseudomonas species?

A

Growth 42 c

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77
Q

Is P. aeruginosa oxidase positive?

A

Yes

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78
Q

What virulence factor of P. aeruginosa is responsible for the mucoid colonies on culture?

A

Alginate

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79
Q

Hemorrhagic necrosis of the skin in Pseudomonas infection!

A

Ecthyma gangrenosum

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80
Q

What Pseudomonas toxin has a similar MOA of diphtheria toxin?

A

Exotoxin A

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81
Q

Pseudomonas is a significant cause of mortality & morbidity in these patients?

A
  1. Cystic fibrosis patients
  2. Burn patients
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82
Q

What is the MOA of exotoxin A in Pseudomonas?

A

Inactivates EF-2 via ADP-ribosylation

83
Q

Characteristic odor of Pseudomonas infection?

A

Grape like odor

84
Q

Which of the comma-shaped gram negative bacteria grows best at 42 c ?

A

Campylobacter jejuni

85
Q

Which of the comma shaped gram negative bacteria is urease positive?

A

Helicobacter pylori

86
Q

Which of the comma shaped gram negative bacteria grows best in an alkaline media?

A

Vibrio Cholera

87
Q

All species of Vibrio require this for growth?

A

NaCl

Hence, the term halophilic or salt-loving for vibrio

88
Q

Selective agar for vibrio species?

A

TCBS Agar (Thiosulfate -Citrate-Bile salts - Sucrose)

89
Q

Is V. cholera sucrose fermenting?

A

Yes

90
Q

Is V. vulnificus sucrose fermenting?

A

No

91
Q

Is V. parahemolyticus sucrose fermenting?

A

No

92
Q

What pH is best for Vibrio growth?

A

Basic / Alkaline

93
Q

What antigen is seen in V. cholerae?

A

H Antigen

94
Q

What medication can increase susceptibility to cholera?

A

Proton Pump Inhibitor ( Since cholera grows in a basic environment)

95
Q

Characteristic motility of V. cholerae?

A

Shooting star motility

96
Q

What bacteria can cause necrotizing skin infections in shellfish handlers?

A

V. vulnificus

97
Q

What halophilic bacteria can cause acute gastroenteritis after ingestion of raw shellfish?

A

V. parahemolyticus

98
Q

What is the characteristic description of diarrhea in cholera?

A

Voluminous rice water stools

99
Q

What is the MOA of cholera enterotoxin in producing diarrhea?

A

Causes increase in intracellular cAMP causing prolonged hyper-secretion of water from enteric cells.

100
Q

What gram negative rod is described as having “sea gull wing” shape?

A

Camphylobacter jejuni

101
Q

Selective media for C. jejuni?

A

Campy-blood agar and Skirrow’s media

102
Q

Campylobacter grows best at this temperature.

A

42 c

103
Q

Is C. jejuni oxidase positive ?

A

Yes

104
Q

Is C. jejuni catalase positive?

A

Yes

105
Q

Is C. jejuni catalase positive?

A

Yes

106
Q

Is C. jejuni urease positive?

A

No

107
Q

What Cancer can H. pylori cause and is associated with resolution once infection is cleared?

A

Gastric MALT ( mucosa-associated lymphoid tissue) Lymphoma

108
Q

What type of ulcer is H. pylori most associated with?
(gastric vs doudenal )

A

Duodenal 90%

109
Q

What are the noninvasive test for diagnosis of H. pylori infection?

A

1.Serology
2.Urea breath test
3.Stool antigen test

110
Q

Triple therapy for H. pylori infection?

A

OCA
1. Omeprazole
2. Clarithromycin
3. Amoxicillin

111
Q

Alternative quadruple therapy for H. pylori infection?

A
  1. PPI
  2. Metronidazole
  3. Tetracycline
  4. Bismuth
112
Q

Which area of the stomach is initially affected by H. pylori gastritis?

A

Antrum

113
Q

What mainly allows H. pylori to survive in the acidic environment of the stomach?

A

Urease production

114
Q

What is the causative agent of chancroid?

A

Haemophilus ducreyi

115
Q

Is chancroid painful or painless?

A

Painful
(Chancre is painless)

116
Q

What factor does H. ducreyi require for growth?

A

X factor (hematin) only

117
Q

What component of H. influenza is used for typing?

A

The capsule antigen

118
Q

What phenomenon does H. influenza exhibit when growing in blood agar?

A

Satellite phenomenon (grows in close proximity to staph aureus)

119
Q

What factors are necessary for H. Influenzae to grow on medium?

A
  1. Factor V (NAD+)
  2. Factor X (hematin)
120
Q

What bacteria will H. influenza grow in proximity with on blood agar.

A

Staph aureus ( because it produce factor V)

121
Q

The majority of invasive H. influenzae is of what type?

A

Type B

122
Q

Most common cause of acute epiglottitis in an unvaccinated population?

A

Hib

123
Q

Most common radiographic sign seen in epiglottitis?

A

Thumb sign

124
Q

Most common bacterial cause of exacerbations of COPD?

A

Non-typeable H. influenzae
(Not Hib)

125
Q

What is conjugated to the Hib vaccine?

A

Diphtheria toxoid

126
Q

What type of capsule does H. influenzae type B possesses?

A

Ribosyl-Ribitol Phosphate Capsule

127
Q

Most serious manifestation of Hib infection ?

A

Bacterial meningitis

128
Q

Three most common bacterial causes of childhood otitis media?

A
  1. Strep pneumonia
  2. H. influenza
  3. Moraxella catarrhalis
129
Q

Chemoprophylaxis for household contacts exposed to Hib?

A

Oral Rifampin

130
Q

Preferred medium for B. pertussis?

A

Regan-Lowe ( Preferred over Bordet-Gengou)

131
Q

What virulence factor of Bordetella pertussis mediates adhesion to ciliated epithelium?

A

Filamentous hemagglutinin

132
Q

What toxin of Bordetella pertussis mediates adhesions to ciliated epithelium?

A

Filamentous hemagglutinin

133
Q

What toxin of Bordetella pertussis causes necrosis of respiratory epithelium?

A

Tracheal Cytotoxin

134
Q

What toxin of Bordetella pertussis inhibits phagocytosis?

A

Adenylate cyclase toxin (act)

135
Q

What are the 3 stages of pertussis?

A
  1. Catarrhal stage
  2. Paroxysmal stage
  3. Convalescent stage
136
Q

What is the classic description of cough in pertussis?

A

Whooping cough

137
Q

Characteristic CBC finding of pertussis?

A

Absolute lymphocytosis (even if its bacterial)

138
Q

What disease caused by Legionella presents with high fever and pneumonia?

A

Legionnaire’s Disease

139
Q

What disease caused by Legionella presents with high fever but no pneumonia?

A

Pontiac fever

140
Q

Electrolyte abnormality most associated with Legionnaires disease?

A

Hyponatremia

141
Q

Growth of Legionella requires the presence of ? (2)

A

Iron & Cysteine

142
Q

What stain can be used to best visualize Legionella?

A

Silver Stain

143
Q

What should be elicited in travel history of patients with Legionella?

A

Staying in hotels, cruise ships.

144
Q

Mode of transmission of Legionella pneumonia?

A

Via aerosols of environmental water
(Eg. Aircon, cooling tower)

145
Q

Which specie of Neisseria is encapsulated?
(Gonococci vs Meningococci)

A

Meningococci

146
Q

Which specie of Neisseria have plasmids?
( Gonococci vs Meningococci)

A

Gonococci

147
Q

Species of Neisseria that metabolize both glucose & maltose?

A

N. meningitides

148
Q

Species of Neisseria that metabolize glucose but not maltose?

A

N. gonorrhea

149
Q

Shape of Neiserria cocci?

A

Kidney bean shaped

150
Q

What virulence factor of gonococci prevent phagolysosome fusion?

A

Por protein

151
Q

What virulence factor of gonococci is mainly responsible for antigenic variation?

A

Pili ( Fimbriae)

152
Q

What virulence factor of honococci promotes adhesion to host cells?

A

Opa proteins

153
Q

What endotoxin does gonococci possess?

A

Lipooligosaccharide (LOS)

154
Q

What STI can cause the arthritis-dermatitis syndrome?

A

Gonorrhea

155
Q

Test of choice for diagnosing gonorrhea in women?

A

NAAT ( Nucleic Acid Amplification Test)

156
Q

Portal of entry of Meningococci?

A

Nasopharynx

157
Q

Drug of choice for meningococcal disease?

A

Penicillin G

158
Q

What specific immunodeficiency predisposes one to meningococcal infections?

A

Late complement deficiency ( Inability to perform membrane attack complex)

159
Q

What species of Neisseria has a polysaccharide capsule!

A

Neisseria meningitides

160
Q

Complication of PID that involves liver capsule inflammation.

A

Fitz Hugh Curtis Syndrome

161
Q

Adrenal Hemorrhage from N. meningitides infection.

A

Waterhouse - Friderichsen Syndrome

162
Q

Virulence factor of Neisseria that cleaves IgA?

A

IgA protease

163
Q

What Bordetella pertussis toxin disables Gi receptors?

A

Pertussis toxin

164
Q

At what stage of pertussis are antibiotics effective?

A

Catarrhal stage

165
Q

Brucella Spp are mostly found within _____________.

A

Macrophages ( Facultative Intracellular)

166
Q

What zoonotic bacteria presents with undulating fevers?

A

Brucella Species

167
Q

Mode of transmission of brucellosis?

A

Direct contact with farm animals or ingestion of contaminated dairy

168
Q

What is the vector of tularemia?

A

Dermacentor ticks

169
Q

Reservoir of tularemia? (2)

A

Rabbit & Deer

170
Q

Shape of F. tularensis?

A

Coccobacillus

171
Q

Drug of choice for tularemia?

A

Streptomycin or Gentamycin

172
Q

What pathology is seen in lymphadenopathy found in tularemia?

A

Caseating granulomas

173
Q

Staining pattern of Yersinia pestis?

A

Safety pin staining (bipolar staining)

174
Q

Vector of Yersinia pestis?

A

Flea ( Xenopsylla cheopis)

175
Q

What species of Yersinia can mimic appendicitis?

A

Yersinia enterocolitica

176
Q

Characteristic lymphadenopathy in Yersinia pestis?

A

Buboes ( swollen, tender lymph nodes)

177
Q

Three forms of disease produced by Yersinia pestis?

A
  1. Bubonic plague
  2. Pneumonic plague
  3. Septicemic plague
178
Q

Drug of choice in Y. pestis infection?

A

Streptomycin

179
Q

Most common clinical manifestation of Yersinia pestis infection?

A

Bubonic plague

180
Q

How do you increase yield of Y. enterocolitica in culture?

A

Through cold enrichment

181
Q

Shape of Pasteurella multocida?

A

Coccobacillus

182
Q

Staining pattern of Pasteurella multocida ?

A

Bipolar appearance

183
Q

Drug of choice in P. multocida infection?

A

Penicillin G

184
Q

How is P. multocida usually transmitted to humans?

A

Cat or dog bite

185
Q

Vibrio vulnificus natural history.

A

Eating seafood, especially shellfish , then getting bullous eruptions on skin , may produce necrotizing fasciitis and septic shock.

186
Q

Most common cause of UTI.

A

E. coli

187
Q

Incubation period of salmonella infection?

A

1-3 days

188
Q

Most common symptom of uti in children under 2 years of age.

A

Abdominal pain

189
Q

Characteristic of carrier state of N. meningitides. (3)

A
  1. Can exhibit URTI symptoms
  2. Penicillin is effective in eradicating carrier states
  3. Nasopharyngeal swab cultures can be used for surveys
190
Q

Bacteria with the lowest infective dose.

A

Shigella

191
Q

Multiple episodes of disseminated gonococcal infection.

A
  1. Complement deficiency
    2.Unable to control Neisseria infections
192
Q

Bacteria that has the lowest infective dose.

A

Shigella

193
Q

Female sex worker had purulent vaginal discharge now with papules and pustules on her arms, forearm, and legs and painful swelling wrists. What’s the diagnosis?

A

Gonococcal arthritis

194
Q

Most commonly involved in PID.

A

N. gonorrhoeae

195
Q

Most commonly involved in PID.

A

N. gonorrhea

196
Q

How is PID confirmed?

A

Laparoscopic visualization

197
Q

Major complication of PID if not treated adequately.

A

Infertility

198
Q

Reproductive age female consulted because of lower abdominal pain accompanied by frequent urination, dysuria, tenderness on palpation of suprapubic area. What’s your clinical impression?

A

UTI

199
Q

Most common causative agent of UTI.

A

E. Coli

200
Q

Profuse diarrhea, vomiting, rice watery stool , rapid dehydration, electrolyte imbalance. What’s the causative agent?

A

Vibrio cholerae

201
Q

Round smooth, fluorescent, greenish-colored colonies, hemolytic and oxidase positive

A

Pseudomonas

202
Q

What is the term used in Pseudomonas infection with necrosis of the skin involved in burn?

A

Ecthyma gangrenosum

203
Q

Describe Typhoid fever. (7)

A
  1. Profuse diarrhea, nausea, vomiting
  2. Stool exam : gram negative bacilli
  3. Non-lactose fermenter
  4. Culture negative
  5. Antimicrobial therapy is essential
  6. Important carriers are humans working as food handlers
  7. Multiplies in lymphoid tissue
204
Q

Most common complication of gonococcal PID?

A

Infertility / Sterility

Microbiology (9 decks)

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