Gram Negative Bacteria Flashcards
1
Q
Describe neisseria
A
Diplococci, gram negative
2
Q
What are the virulence factors for neisseria meningitidis
A
- Capsule
- Endotoxin (LPS)
- IgA1 protease
- Extract iron from human cells
- Pili
3
Q
High risk groups for neisseria meningitidis
A
- Infants aged 6 months to 2 years
- Army recruits
- College freshmen
4
Q
Illness that causes petechial rash
A
Neisseria meningitidis
5
Q
What are the 3 microorganisms that cause meningitis in babies under 3 months?
A
Listeria monocytogenes, e coli, group B strep
6
Q
What are the organisms that cause meningitis in people older than 3 months
A
Neisseria meningitidis, haemophilus influenzae
7
Q
What agar is used to grow Neisseria meningitis
A
Thayer Martin VCN- chocolate agar
8
Q
Treatment for neisseria meningitis patient? Close contacts?
A
Penicillin G or ceftriaxone
Close contacts- rifampin or ciprofloxacin
9
Q
Who should have the meningitis vaccine?
A
Certain high risk groups and during epidemics, serogroup B ages 10-25
10
Q
Slow growing gram negative pathogens that cause endocarditis
A
HACEK group
Haemophilus influenzae
Actinobacillus species
Cardiobacterium species
Eikenella species
Kingella species
11
Q
Describe moraxella catarrhalis
A
Gram negative diplococcis, Part of normal resp flora, causes otitis media in children, can cause respiratory infections and pneumo, exacerbates COPD, resistant to penicillin
12
Q
What enterics ferment lactose
A
E. Coli, most enterobactericeae
13
Q
What enterics do not ferment lactose
A
Salmonella, shigella, pseudomonas aeruginosa
14
Q
Is e coli found outside of the intestine normally?
A
No
15
Q
Describe Eosine methylene blue agar
A
Inhibits gram positive and lactose fermenters turn black, e coli turns metallic green
16
Q
Describe macconkey agar
A
Inhibits gram positive bacteria and lactose fermenters turn pink/ purple
17
Q
Antigens used to classify enterics
A
O antigen- outer layer LPS in membrane
K antigen- capsule (covers O antigen)
H antigen- flagella for mobile bacteria
18
Q
Enterics that don’t invade cell but release exotoxins that causes watery diarrhea
A
Enterotoxogenic e coli and vibrio cholera
19
Q
Enteroinvasive organisms
A
EHEC, shigella, salmonella enteritidis
20
Q
What enterics can invade the lymph nodes and bloodstream?
A
Salmonella typhi, yersinia enterocolitica, campylobacter jejuni
21
Q
What are examples of hospital acquired gram negative how can they be acquired?
A
E Coli
klebsiella pneumoniae
Proteus mirabilos
Enterobacte
serratia
pseudomonas aeruginosa
Invade Foley catheters, aspirate vomit, etc.
22
Q
What are the main groups of enterics?
A
Enterobactericeae
Vibrionaceae
Bacteroidaceae
Psuedomonadacea
23
Q
Example of bacteria that can ferment lactose
A
Escherichia coli
24
Q
Examples of bacteria that cannot ferment lactose
A
Salmonella, shigella, pseudomonas aeruginosa
25
What are the biochemical classification methods for gram negative bacilli
Ability to ferment lactose and production of H2S
26
What agars are used to help classify enterics?
1. EMB agar (Eosine methylene blue) - inhibit gram + growth and lactose fermenters become deep purple / black and e coli gets green sheen.
2. Mackonkey agar - inhibit gram + a s lactose fermenters become pink purple color
27
Is E coli usually endogenous or exogenous?
Endogenous in the colon
28
3 surface antigens of enterics
1) o antigen
2) k antigen
3) H antigen
29
Describe the o atnigen
Part of enterics bacteria- outer most component of LPS, differs between the dif gram - bacteria
30
Describe K antigen
Capsule antigen (covers O antigen)
31
Describe H antigen
Makes up subunits of bacterial flagella. Only motile bacteria have this antigen.
32
Example of bacteria without h antigen
Shigella
33
Example of bacteria with h antigen
Salmonella- changes and protects from our antibodies
34
Describe non invasive enteric diarrhea
Bacteria bind to intestinal epithelial cells, but do not enter cell. Release exotoxins that cause watery diarrhea without systemic symptoms.
35
Examples of organisms that cause noninvasive enteric diarrhea
ETEC
Vibrio cholera
36
Describe pathogenesis of invasive enteric diarrhea
Bacteria with virulence factors that allow for binding and invasion of cell. Toxins released that kill cell. Leukocytes in stool and systemic symptoms + diarrhea.
37
Examples of enteroinvasive organisms
EIEC
Shigella
Salmonella enteritidis
38
Examples of enteric organisms that cause bacteriema
Salmonella typhi
Yersinia enterocolitica
Campylobacter jejuni
39
Two example situations when enterics normally part of our gut flora cause disease (hospital acquired gram negatives)
1) Foley catheter
2) patient aspirates vomit colonized with enterics
40
Examples hospital acquired gram negative organisms
E Coli
Klebsiella pneumoniae
Proteus mirabilis
Enterobacter
Serratia
Pseudomonas aeruginosa
41
What bacteria are in the family enterobactericeae?
E coli
Proteus mirabilis
Klebsiella pneumoniae
Enterobacter
Serratia
Shigella
Salmonella
Yersinia enterocolitica
42
What bacteria are in the family vibrionaceae?
Vibrio cholera
Vibrio parahaemolyticus
Campylobacter jejuni
Helicobacter pylori
43
What bacteria are in the family bacteroidaceae?
Bacteroides fragilis
Bacteroides melaninogenicus
Fusobacterium
44
How can normal gut flora e
Coli cause disease?
Obtain virulence factors through plasmid exchange, transduction, etc.
45
Virulence factors E coli can obtain
1) mucousal adherence and invasion factors
2) exotoxin production (heat liable and stable toxins, or shiga like toxin)
3) endotoxin : lipid A
4) iron binding ability
46
What diseases can E coli cause when virulence factors are present
1) diarrhea
2) UTI
3) neonatal meningitis
4) gram-negative sepsis
47
What diseases does enterotoxogenic E coli cause?
Traveler's diarrhea
48
What virulence factors does ETEC have?
Colonization factor (pili to bind)
Exotoxins- heat liable toxin (LT) and heat stable toxin (ST) - causes water loss and stool to look like rice water (like cholera)
49
What virulence factors does Enterohemorrhagic E coli have?
-Colonization factor (pili to bind to cells)
-Shiga-like toxin (aka verotoxin) - causes intestinal epithelial cell death. Causes bloody diarrhea
50
Name for disease caused by EHEC
Hemorrhagic colitis
51
Disease and symptoms cause by E Coli O157:H7
Hemolytic uremic syndrome (HUS)
-anemia
-thrombocytopenia (decrease in platelets)
-renal failure
52
Describe the pathogenesis of enteroinvasive E coli
- virulence factors shared on plasmid with shigella
- invades epithelial cells and releases shiga- like toxin
-inflammatory response with fever and bloody diarrhea
53
Bladder infection
Cystitis
54
Kidney infection
Pylenophritis
55
Most common organism for utis
E coli
56
Symptoms of uti
Dysuria (burn)
Frequency
Feeling fullness of bladder
57
Number of colonies needed to dx uti
100,000
58
Most common organism for gram - sepsis for hospitalized patients
E coli, sepsis due to lipid A toxin
59
Enteric common cause of neonatal meningitis
E coli
60
Most common disease causing Proteus species
Proteus mirabilis
61
Describe Proteus mirabilis
1) motile
2) splits urea
62
Cross reactivity for proteus
Rickettsia
63
Infections that Proteus spp cause
UTI
HAI
64
Dx for proteus UTI
Alkaline pH since it splits urea
65
Describe klebsiella pneumonia
-encapsulated (k antigen), non motile
66
Second most common cause of gram negative sepsis
Klebsiella (first e coli)
67
Organism commonly associated with UTIs in hospitalized patients with Foley catheters
Klebsiella pneumoniae
68
Risk factors for klebsiella pneumoniae pneumonia
Hospitalization
Alcoholics
69
Describe clinical outcomes of klebsiella pneumoniae pneumonia
Bloody sputum (red currant jelly), destroys lung tissue, produces cavities, high mortality rate
70
Characteristic trait of pneumonia causes by klebsiella pneumoniae
Sputum that looks like red currant jelly
71
Describe enterobacter
Part of normal intestinal flora, highly motile
72
Concern for enterobacter
Antibiotic resistance due to ampC (beta lactamase). Resistant to ampicillin and early generation cephalosporin, increasingly later generation cephalosporin.
If unsure use carbepenem
73
What color are serratia colonies in culture?
Bright red
74
What diseases can serratia cause?
UTI
Wound infections
Pneumonia
75
What are the 4 species of shigella?
Shigella dysenteriae
Shigella flexneri
Shigella boydii
Shigella sonnei
76
Describe basics of shigella
Non-motile
Does not ferment lactose
Does not produce H2S
77
Hosts for shigella
Humans
78
Population at risk for dysentery
Pre school age
Nursing homes
79
Is shigella part of the normal intestinal flora?
No
80
How is shigella transmitted?
Water, hands
81
Pathogenesis of shigella
Invades intestinal epithelial cells, releases shiga toxin which kills cells, inflammatory response, systemic infection and colon ulcers
82
Diarrhea presentation from shigella
Bright red flecks of blood and pus
83
Describe basics of salmonella
Motile
Non lactose fermenter
84
Distinguishing virulence factor salmonella
Vi antigen- polysaccharide capsule- protects from antibodies
85
Two main groups of salmonella
Typhoidal - typhi and paratypho
Non-typhoidal- salmonella enteritidis...
86
How does salmonella differ from other enterics in terms of reservoirs?
Lives in GI tract of animals, transmitted through animal feces
87
What type of salmonella only can be found in humans?
Salmonella typhi
88
Is salmonella part of the normal intestinal flora?
No, salmonella like shigella is always pathogenic
89
What are the 4 disease states of salmonella?
Typhoid fever
Carrier state
Sepsis
Gastroenteritis
90
Salmonella typhi can only survive intracellularly, so it is a ...
Facultative intracellular parasite
91
Pathogenesis of typhoid fever
Salmonella typhi invades intestinal cells, then invades regional lymph nodes and seeds in organ systems. Evades phagocytosis
92
Incubation period salmonella typhi
1-3 weeks
93
Characteristic symptoms Salmonella typhi
Fever
Rose spots on belly
Pain in lower right quadrant
Enlarged spleen
94
Empiric therapy when salmonella typhi suspected
Ciprofloxacin or ceftriaxone
95
When people become salmonella typhi carriers, where does the salmonella live?
Gallbladder
96
What species of salmonella can cause systemic infection and does not involve GI tract
Salmonella choleraesuis
97
Populations more susceptible to salmonella infections
Sickle cell anemia and no speen
Reason: neutrophils in the spleen opsonize and phagositize encapsulated bacteria
98
What population is prone to salmonella osteomyelitis?
Sickle cell anemia
99
Clinical symptoms of diarrheal, non-typhoidal salmonella
Abdominal pain
Watery diarrhea (typically no blood)
Fever in half
100
What causes diarrhea from non-typhoidal salmonella?
Cholera-like toxin and/ or ileal inflammation
101
Basic description yersinia enterocolitica
Motile
Gram negative ros
102
Major source of yersinia enterocolitica infections
Animals - fecal oral food contamination
103
Clinical symptoms yersinia enterocolitica
Fever
Diarrhea
Abdominal pain in right lower abdomen
Mucousal ulceration
104
Pathogenesis of yersinia enterocolitica
1) invasion of intestinal epithelial cells, lymph nodes, and bloodstream (like salmonella)
2) secrete enterotoxin
105
General concern about survival of yersinia in food
Can live and reproduce in cold temps (concern for refrigeration)
106
Basic description vibrio cholera
Gram negative rod
Stains red
Single flagella
107
Does vibrion cholera invade epithelial cells?
No, releases cholera toxin (choleragen)
108
Population at greatest risk for vibrio cholera
Children in endemic areas
Us adult travelers
109
Clinical manifestations cholera
Watery diarrhea, loss of 1 liter of fluid per day
110
Pathogenicity of choleragen
Causes production of cAMP, throws off NaCl balance
111
Microscopic exam of vibrio reveals...
No leukocytes but fast darting rods
112
Leading cause of diarrhea in Japan from sushi
Vibrio parahaemolyticus
113
Basic description campylobacter jejuni
Gram negative rod
Single polar flagellum
One of the most common causes of diarrhea in the world
114
What are the reservoirs for campylobacter?
Wild and domestic animals
Poultry
115
Mode of transmission vibrio cholera
Fecal contaminated water
116
Common modes of transmission for campylobacter
Fecal contaminated water, unpasteurized milk
117
Population at highest risk campylobacter
Children
118
Clinical illness campylobacter jejuni
- prodrome of fever and headache
- abdominal cramps
- bloody, loose diarrhea
119
Pathogenesis of campylobacter jejuni
Similar to salmonella typhi and yersinia enterocolitica - invades gi epithelial cells and spreads systemically.
Secrete LT toxin (similar to e coli) - destroys colon mucosal cells
120
Most common cause of duodenal ulcers and chronic gastritis
Helicobacter pylori
121
Treatment for helicobacter pylori
Bismuth salts (pepto-bismol) inhibit helicobacter pylori growth + antibiotics
122
Describe basics of the family bacteriodaceae
- obligate anaerobes
- gram negative rods
- make up 99 percent of intestinal flora (mouth and vagina also have bacteroides)
123
Species of not bacteroidaceae
Bacteroides fragilis
Bacteroides melaninogenicus
Fusobacterium
124
basic description bacteroides fragilis
- does not contain lipid A endotoxin like most gram negatives
- capsule
125
Bacteroides fragilis are a normal part of intestinal flora, but can cause infection when...
There are tears, laceration, penetration. Of the intetine
126
This bacteria forms abcssses in the peritoneal cavity
Bacteroides fragilis
127
Bacteria associated with abdominal surgery
Bacteroides fragilis
128
What are the prophylaxis recommendations to prevent bacteroides fragilis after abdominal surgery?
Antibiotics for anaerobes
- metronidazole (flagyl)
- piperacillin/tazobactsm
- meropenem
129
Action if abscess forms in abdominal cavity?
Surgically drain
130
Disease caused by bacteroides melaninogenicus
Necrotizing anaerobic pneumonias from aspiration if sputum from the mouth
Periodontal disease
131
What bacteroides melaninogenicus looks like in culture
Black pigmented colonies
132
Where does bacteroides melaninogenicus normally live?
Mouth vagina, intestines
133
Diseases caused by fusobacterium
Periodontal disease
Aspiration pneumonia
Abdominal and pelvic abscesses
Otitis media
134
Strep that are often isolated from abdominal abscesses with other gram negative bacteria
Strep viridans group
(Strep anginosus and strep milleri)
135
Common general types of HAIs a s what they are associated with
- pneumonia (endotracheal intubation and mechanical ventilation)
- UTI (Foley catheters)
- wound infections (recent surgery and implanted devices)
- bloodstream infections ( IV and central lines)
136
Most common group of gram negative bacteria that cause HAIs
Enterobacteriaceae (E coli, klebsiella, enterobacter)
137
Types of gram negative bacteria with increases in MDR
Pseudomonads-
(Pseudomonas aeruginosa
Stentrophomonas maltophilia
Burkholderia cepacia)
Acinetobacter
138
Describe pseudomonas aeruginosa
-Obligate aerobe
-Non lactose fermenter
-Gram negative rod
-Gives colonies and wound dressings a green blue color
-grape smell
139
Pathogenicity of pseudomonas aeruginosa
Doesn't infect healthy people ( not very virulent)
Weakened patient :
- excretes exotoxon A (stops protein synthesis) and some have capsule to add in adhesion
- highly drug resistant
140
Important pseudomonas aeruginosa infecitons
1. Pneumonia
2. Osteomyelitis
3. Burn wounds infections
4. Sepsis
5. Urinary tract infections and pyelonephritis
6. Endocarditis
7. Malignant external otitis
8. Corneal infections
141
Patients with this disease are commonly colonized with pseudomonas aeruginosa. It progressively destroys their lungs.
Cystic fibrosis
142
What patients are at highest risk for pneumonia from pseudomonas aeruginosa?
Cystic fibrosis
Immunocompromised patients
143
Highest risk for osteomyelitis from pseudomonas aeruginosa
- diabetic patients (from foot ulcers)
- IV drug users
- children with puncture wounds to foot
144
Describe sepsis from pseudomonas aeruginosa
- can occur in burn wounds patients
- can come from infected lines, catheters, or secondary from other sites
- high mortality
145
Group at highest risk for UTI pseudomonas aeruginosa
Debilitated patients in nursing homes and hospitals
Foley catheters
146
Two bacteria that are frequent causes of right heart valve endocarditis in IV drug users
Staphylococcus aureus
Pseudomonas aeruginosa
147
Who is at risk for malignant external otitis from pseudomonas aeruginosa?
Elderly diabetic patients
148
Who is at risk from corneal infections from pseudomonas aeruginosa
Contact lens wearers
149
Basic description burkholderia cepacia
Oxidase positive
Aerobic
Gram negative brod
Grows in water, soil, plants, and animals
Highly drug resistant
150
Burkholderia cepacia is most likely to cause infections in...
Burn and ventilated patients
Patients with cystic fibrosis (greatest risk)
151
Disease burkholderia causes
- Asymptomatic carriage
- Bronchiectasis (dilated airways)
- Rapidly progressing pneumonia with bacteremia
152
Organism that is part of normal resp flora, but can cause pneumonia in hospitalized and immunocompromised persons
Stenotrophomonas maltophilia
153
What is a risk factor for stenotrophomonas maltophilia pneumo?
Previous antibiotics
154
Describe acinetobacter
Aerobic
Gram negative
Found in soil and water
155
Most common acinetobacter isolated
Acinetobacter baumannii
156
What infections does acinetobacter baumannii typically cause?
Hospital acquired pneumonia, line related bacteremia, burn infections, and Foley catheter associated UTIs
157
What makes it difficult to dx acinetobacter baumannii under the microscope?
Take one different shapes and can look coccus, coco-bacillus, or like diplo cocci gram negative and get mixed with meningitis
158
Acinetobacter baumannii treatment
Very difficult and may have some level of resistance to all antibiotics.
May be susceptible to aminoglycosides, carbepenems, poly ixins, tigecycline, and sulbactam
159
Examples amonoglycosides
Gentamicin
Tobramycin
Amikacin
160
Examples polymixins
Colistin
Polymyxin E
Polymyxin B
161
Primary methods of prevention for gram negative HAIs
1) hand hygiene
2) limiting invasive devices
3) antimicrobial stewardship
162
What does haemophilus influenza require for growth?
Blood
163
Haemophilus influenzae typically co-infects with what disease?
Flu
164
Does haemophilus have reservoirs besides humans?
No, obligate human parasite
165
What makes haemophilus influenzae virulent?
Capsule
166
What are the 6 types of capsules for H influenza. Which one is typically associated with invasive disease?
A, b, c, d, e, f. Type b
167
Describe non-encapsulated strains of Haemophilus influenzae
Non-typeable, colonize upper respiratory tract, only cause local infection
168
What diseases do nontypeable haemophilus influenzae cause?
- Otitis media in children
- Resp disease in adults with preexisting lung disease (chronic bronchitis or recent flu)
169
What diseases can HIB cause?
Meningitis
Epiglottis
Septic arthritis
170
Who is at highest risk for nontypeable haemophilus influenzae disease?
Adults with COPD
171
When are kids at highest risk for HIB?
6 months to 3-5 years old (no longer have moms antibodies but don't have antibodies of their own yet)
172
Long term effects of meningitis from HIB
Mental retardation, seizures, language delay, or deafness
173
Concern for antibiotic use to treat meningitis from HIB
HIB releases LPS lipid A endotoxin, when bacteria killed causes inflammatory response that then kills neurons. Admin steroids before antibiotics
174
3 bacteria that cause most meningitis cases in babies < 3 months
1) listeria monocytogenes
2) E coli
3) Group B strep
175
Bacteria the cause meningitis > 6 months
1) neisseria meningitidis
2) haemophilus influenzae
176
Describe the clinical symptoms of acute epiglottitis from HIB
Sore throat, fever, rapid swelling of epiglottis that obstructs airway and causes stridor (wheezing), child cannot swallow
177
What is the most common cause of septic arthritis in infants?
Haemophilus influenzae type b
178
Describe basics of Haemophilus influenzae
Pleomorphic rods
Gram negative
179
What conditions put child at highest risk for sepsis from haemophilus influenzae?
No spleen
Sickle cell
Why? Encapsulated bacteria- opsonization happens in spleen
180
What conditions put child at highest risk for sepsis from haemophilus influenzae?
No spleen
Sickle cell
Why? Encapsulated bacteria- opsonization happens in spleen
181
What is the antibiotic of choice for less serious infections of Haemophilus influenzae?
Ampicillin or amoxicillin
182
Treatment of choice for more serious haemophilus influenzae infections?
Third generation cephalosporin
183
Severe manifestations of Haemophilus influenzae type b
1) meningitis
2) acute epiglottitis
3) septic arthritis
4) sepsis
184
haemophilus influenzae vax recommendations
2, 4, 6, 15 months (given at same time as DPT and polio)
Eighth month of preganncy
185
Describe haemophilus ducreyi
Gram negative cocobacilli
STI- chancroid, not systemic
Swollen lymph nodes that can rupture
Create break in skin that increase HIV risk
186
Treatment for haemophilus ducreyi
Ceftriaxone or azithromycin
187
Slow growing bacteria that cause endocarditis
HACEK
1. Haemophilus spp (parainfluenzae, aphrophilus, paraphrophilus)
2. Actinobacillus spp
3. Cardiobacterium spp
4. Eikenella spp.
5. Kingella spp.
188
What are the virulence factors for bordetella pertussis?
1) pertussis toxin
2) extra cytoplasmic adenylate cyclase
3) filamentous hemagglutinin (FHA)
4) tracheal cytotoxin
189
Describe pertussis toxin
Exotoxin
Causes increase in cAMP
190
What are the effects of pertussis toxin?
1) histamine sensitization
2) increase in insulin synthesis
3) promotion of lymphocytes production and inhibition of phagocytosis
191
What is the role of the bordetella pertussis virulence factor extra cytoplasmic adenylate cyclase?
Weakens host's ability to phagocytose and clear the bacteria
192
What is the role of the bordetella pertussis virulence factor filamentous hemagglutinin (FHA)?
Pili to attach to epithelial cells if bronchi (doesn't invade, adheres and release exotoxins)
193
What is the role of bordetella pertussis virulence factor tracheal cytotoxin?
Responsible for violent cough, kills ciliated epithelial cells which disrupts body's clearance mechanism
194
Incubation period for whooping cough
Typically 1 week
195
What are the 3 stages of bordetella pertussis
Catarrhal stage
Paroxysmal stag
Convalescent stage
196
How long does the catarrhal stage last?
1-2 weeks
197
Describe catarrhal stage of bordetella pertussis
1-2 weeks
Low grade fever, runny nose, sneezing, mild cough
Most contagious during this stage
198
Describe the paroxysmal stage of bordetella pertussis
- Bursts of no productive coughing (15-25 attacks per day)
- Violent coughing followed by inspiratory gasp
- patient may not be able to breathe during attack
- posttussive commiting
199
How do partially immunized/ immunized/ adults typically present?
Cough > 1 week
200
Method to determine pertussis from non-infectious cough
Increase in lymphocytes
201
Describe convalescent stage of bordetella pettussis
Cought less frequent over a month and patient no longer cotnageous
202
What culture medium is used for bordetella pertussis?
Bordet gengou medium
203
Treatment for bordetella pertussis
Erythromycin
204
Considerations for bordetella pertussis prophylaxis
Erythromycin for household members
205
When should the pertussis vax be given?
-2, 4, 6, 15-18 months, 4-6 years
-booster for adults
206
Basic description legionella pneumophilla
Aerobic
Gram negative rod
Found in water
Facultative intracellular parasite
207
Transmission of legionella
Inhalation
208
Examples facultative intracellular parasites
Legionella pneumophilla
Mycobacterium tuberculosis
209
Two ways that legionella pneumophilla protects itself
1) biofilm
2) parasite of free living amoebas, and gets encysted in tough conditions
210
What are the two major illnesses that legionella pneumophilla can cause?
1) Pontiac fever
2) legionnaire's disease
211
Describe Pontiac fever
-Similar to flu
Headache, muscle aches, fatigue, fever, chills
- resolves quickly (less than 1 week)
212
Describe legionnaire disease
Very high fever + severe pneumonia
213
Common cause of community acquired pneumonia (estimated 2%)
Legionella pneumophilla
214
Treatment legionella pneumophilla
Need to concentrate on macrophages
- macrolides
- tetracyclines
- quinolines
215
These antibiotics do NOT concentrate inside macrophages well
Aminoglycosides
Beta-lactams
216
These antibiotics concentrate well in macrophages
Macrolides
Quinolines
Tetracyclines
217
Examples of macrolides
Erythromycin
Azithromycin
Clarithromycin
218
Example of tatracyclines
Doxycycline
219
Examples of quinolones
Ciprofloxacin
Leviflaxacin
Moxifloxacin
220
What organisms cause atypical pneumonia?
Mycoplasma
Legionella
Chlamydia
221
What antibiotics work for atypical pneumonia?
Macrolides, tetracyclines, quinolones
222
Basic description yersinia
Gram negative rod
Poles of rod stain darker
Zoonotic
Virulent and can penetrate and tissue
Facultative intracellular organism that can survive in macrophages
223
Basic description brucella
Gram negative rod
Zoonotic
Virulent and can penetrate and tissue
Facultative intracellular organism that can survive in macrophages
224
Basic description pasteurella
Gram negative rod
Zoonotic
225
Treatment for yersinia
Aminoglycosides and
Doxycycline for prolonged period
226
Treatment for brucella
Aminoglycosides and
Doxycycline for prolonged period
227
Virulence factors for yersinia pestis
1) Fraction 1 (capsule antigen with antiphagocytic properties
2) V and W antigens (unknown but unique to yersinia pestis)
228
Pathogenesis of yersinia pestis
Flea bites, invade skin, reproduce intracellularly in macrophages, move to lymph nodes, extremely swollen lymph nodes, fever, headache, bloodstream infection, other organ invasion and failure, hemorrhaged under skin (black skin)
229
Two types of yersinia pestis (diseases)
Bubonic plague - fleas, skin and lymph nodes, systemic
Pneumonic plague- person to person transmission by aerosolized bacteria, pneuminia
230
High risk groups yersinia pestis
Camping, hiking, hunting southwest
231
Mortality rate of yersinia pestis if untrested
75%
232
What spreads tuleremia?
Rabbits, ticks, deerflies but many animals (even cold blooded) carry tuleremia
233
Where is tuleremia found?
All over the U.S.
234
Diseases caused by francisella tularensis
Ulceroglandular tularemia
Pneumonic tularemia
235
Describe clinical pathology of ulceroglandular tularemia
Bitten by tick or deerfly or contact with wild rabbit, demarcated hole in skin with black base, fever + systemic symptoms, local lymph nodes swollen, red, painful, bacteria spreads to blood and other organs
236
Mortality rate ulceroglandular tularemia
5 percent
237
What disease does ulceroglandular tularemia resemble? How does it differ?
Bubonic plague. No skin ulcer in plague and mortality rate much lower
238
Describe pneumonic tularemia
Starts at ulceroglandular and spreads to lungs
239
How do people get pneumonic tuleremia?
1) ulceroglandular tularemia spreads to lungs
2) aerosolized bacteria during skinning / tanning
240
Describe the infective dose for tularemia
Very low, only need 10 bacteria to cause disease
241
What body systems can tularemia invade?
Skin
Lungs
Eyes
GI tract
242
How to dx
No culture - dangerous.
Ppd ski test, clinical symptoms, antibodies
243
How to dx
No culture - dangerous.
Ppd ski test, clinical symptoms, antibodies
244
What animals can brucella infect?
Goats, cows, pigs, dogs
245
How brucella is transmitted
Direct contact infected meat or placenta, ingestion of infected mil (pasteurization kills)
246
Who is at risk for brucellosis?
-Meat packing industry (beef)
- Vet
- Farmer
- Traveler who drinks cow or goat milk in Mexico
247
What organ systems does brucellosis effect?
Skin
Lungs
GI
Eyes
248
Clinical pathologenesis of brucellosis
Starts with skin (but no ulcers), gi, eyes, or lungs. Spreads to macrophages and reproduces. Spreads systemically. Chronic but not fatal
249
Symptoms of brucellosis
Fever (night)
Chills
Sweats
Loss of appetite
Backache
Headache
Lymphadenopathy
250
Dx of brucellosis
Culture or serology
PPD test does not indicate active brucellosis, just shows exposure
251
Basic description francella
Gram negative rod
Zoonotic
Virulent and can penetrate and tissue
Facultative intracellular organism that can survive in macrophages
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Organism that colonized the mouths of cats
Pasteurella multocida
253
Bacteria that most commonly causes wound infections following a cat or dog bite
Pasteurella multocida
254
Treatment for pasteurella multocida
Don't close wound with sutures, treat with doxy or penicillin
255
What makes Chlamydia and rickettsia different from other bacteria?
They cannot make their own energy and are obligated intracellular parasites
256
Basic description of chlamydia
Gram negative
No peptidoglycan layer
No muramic acid (like other gram negative)
257
Important chlamydia species
Chlamydia trachomatis
Chlamydophila psittaci
Chlamydophila pneumonia
258
How to treat chlamydia
Doxycycline
Macrolides
Fluoroquinolones
259
Lifecycle chlamydia
Elementary bodies enters cells that line mucous membranes, prevent phagocytosis, turn into initial body and reproduce
260
What organs does chlamydia trachomatis impact?
Eyes and genitals
261
Chronic conjunctivitis from chlamydia
Trachoma
262
How trachoma spreads
Children reservoir, spread by hand to hand transmission of infected eye secretions or sharing contaminated clothing or towels
263
Leading cause of preventable blindness in the world, disease of poverty
Chlamydia trachomatis
264
Clinical pathogenesis of trachoma
Folds eyelid inward, inflammation, infection, and scarring of conjunctiva and cornea. Blindness in 10-15 years
265
Treatment for trachoma
Oral azithromycin
266
Conjunctival inflammation in 5-14 days of birth to mother with chlamydia trachomatis
Inclusion conjunctivitis
267
Type of eye drops given at birth to prevent inclusion conjunctivitis
Erythromycin eye drops
268
Diseases caused by chlamydia trachomatis
-Trachoma
-Inclusion conjunctivitis
-Infant pneumonia
-Urethritis
-Cervicitis and pelvic inflammatory disease
-Epididymitis
- reiters syndrome
- fitz-hough Curtis syndrome
- lymphogranuloma venereum
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STIs that typically cause urethritis
Neisseria Gonorrhea
Chlamydia trachomatis
Ureaplasma urealyticum
270
Test for chlamydia
PCR preferred (cannot be cultures on non living media)
271
How PID/ Cervicitis/ urethritis are treated
Likely gonorrhea or chlamydia or confection, so empiric therapy with shot of ceftriaxone followed by oral course doxy
272
Inflammatory arthritis of large joints in men between ages 20-40
Reiters syndrome (associated with chlamydia)
273
Infection of liver capsule. What organisms is the illness associated with?
Fitz high Curtis syndrome, chlamydia and gonorrhea
274
How is chlamydia psittaci transmitted?
Inhaling chlamydia in dust from bird feathers or dried feces
275
What disease does chlamydia psittaci caus
Psittacosis
276
Who is at highest risk for psittacosis
Bird breeders vets, pet shop employees, poultry slaughterhouses
277
Incubation period of psittacosis
1-3 weeks
278
What is the clinical manifestation of psittacosis?
Atypical pneumonia
279
What species of Chlamydia is spread person to person via the respiratory route
Chlamydia pneumoniae - TWAR (Tawain acute respiratory disease).
280
Basic description rickettsia
Small
Gram negative
Non-motile
Rod to coccoid shape
Obligate intracellular parasite
281
Tests for rickettsial infections
- Weil-Felix agglutination (low specificity and sensitivity, uses proteus bacteria)
- standard: Four fold titer increase via IFA, ELISA, complement fixation (CF)
282
Antigens on rickettsia
OX-2, OX-9, OX-k
283
What vectors spread rocky mountain spotted fever
Wood tick - dermacentor andersoni
Dog tick- dermacentor variabilis
284
Causative agent of rocky mountain spotted fever
Rickettsia ricketsii
285
Clinical symptoms rocky mountain spotted fever
Fever, conjunctival redness, severe headache, rash that spreads from wrists, ankles, soles, and palms to trunk
286
Where is rocky mountain spotted fever most common
Southeast U.S.
287
Time needed for tick to feed to transmit rocky mountain spotted fever
6-10 hours
288
Preferred cells rickettsia rickettsii
Endothelial lining small blood vessels
289
What is the causative agent for rickettsialpox?
Rickettsia akari
290
Vector for ricketssialpox
Mites in house mice
291
Clinical symptoms rickettsial pox
Mild, self-limited, papule at site of mite bite which later turns into blister, then later fever and headache and other vesicles appear on body
292
Antibiotic for ricketsiallpox
Doxy
293
What is the causative organism for epidemic typhus?
Rickettsia prowazekii
294
What causative agent is responsible for endemic types?
Rickettsial typhi
295
What vector is responsible for epidemic typhus (rickettsia prowazekii)? Reservoir in U.S?
Lice
Reservoir- flying squirrel in Southern US
296
Clinical symptoms epidemic typhus
Abrupt onset fever, headache, small pink macules on 5th day around upper trunk and spreads to body
297
Incubation period epidemic typhus
2 weeks
298
Treatment for epidemic typhis
Doxy and improved sanitation
299
What is brill zinser disease
If not fully treated, epidemic typhus (ricketssia prowazekii) can become a latent infection, and when it becomes active less severe version of epidemic typhus
300
What vector carries endemic typhus? Reservoir?
Flea, rodents
301
Clinical symptoms endemic typhus and incubation period
10 days, headache, fever, maculopapular rash
302
How to treat rickettsia typhi
Doxy, kill fleas and rats
303
Diseases caused by rickettsia
Rocket mountain spotted fever
Rickettsialpox
Epidemic typhus
Endemic typhus
Scrub typhus
Trench fever (Bartonella)
Cat scratch fever (Bartonella)
Q fever
Ehrlichiosis
304
What agent causes q fever
Rickettsia coxiella burnetii
305
What organism causes q fever
Rickettsia coxiella burnetti
306
What organism causes q fever
Rickettsia coxiella burnetti
307
What is unique about coxiella burnetii compared to other rickettsia and gram negative bacteria?
Can form an endospore
-differs from rickettsia because passed to humans via inhaltion
308
How is q fever transmitted?
Spores aerosolized from cow hiders or placentas and transmitted via inhalation
309
Incubation and Clinical symptoms Q fever
Incubation 2-3 weeks, fever, soaking sweats, pneumonia
Only rickettsial disease that causes pneumonia and no rash
310
Basic description spirochetes
Gram negative
Corkscrew shape
Second outer membrane
Periplasmic flagella
311
3 genera of spirochetes
1. Treponema
2. borrelia
3. Leptospira
312
Agent responsible for syphilis
Treponema pallidum
313
How can syphilis be spread between doctor and patient?
Skin contact with an ulcer
314
What two organisms cause some acute meningitis with a predominance of lymphocytes?
Treponema pallidum
Mycobacterium tuberculosis
315
Rule of 6s for syphilis
6 axial filaments
6 week incubation (3-6)
6 weeks for ulcer to heal
6 weeks after the ulcer heals secondary syphilis develops
6 weeks for secondary syphilis to resolve
66% of latent stage patients have resolution
6 years to develop tertiary syphilis
316
Stages of syphilis
Primary syphilis
Secondary syphilis
Latent
Tertiary syphilis
317
What are the manifestations of tertiary syphilis?
Gummas of the skin and bone
Cardiovascular syphilis
Neurosyphilis
318
Pregnant mom is infected with syphilis
....
Passed through placental barrier, if untreated, high mortality rate. If baby lives will get early or late onset congenital syphilis
319
Age for early congenital syphilis, symptoms
Under 2 years, rash, snuffles, lymph, liver and spleen enlargement,
320
Complications late congenital syphilis
- Neurosyphilis (deafness common)
- Bone and teeth impacts (saddle nose, saber shins, Hutchinson's teeth, mulberry molars)
- eye disease
321
How to prevent congenital syphilis
Test and treat mom before 4th month pregnancy
322
Testing for syphillis
1) active - direct examination microscopy
2) not active - RPR (false positives so need to follow up with confirmatory test like FTA-ABS)
3) PCR
323
Treatment for syphilis
Pennicillin
324
What is jarisch-herxheimer phenomen
Patients that undergo treatment for spirochetes feel worse before they feel better
325
What is unique about treponema
Does not release toxin, symptoms solely from body's immune response
326
What diseases do borrelia cause?
Lyme disease and relapsing fever
327
Basic description of borrelia
Gram negative
Spirochete
328
What tick spreads Lyme disease? How long does it need to be attached?
Ixodes
24 hours
329
Regions with Lyme disease
Northeast, Midwest, northwest
330
Reservoirs for Lyme disease
White footed mouse and whit tail deer
331
What are the stages of Lyme disease?
1) early localized stage
2) early disseminated stage
3) late stage
332
Incubation period Lyme diseases
10 days
333
Describe early localized stage Lyme disease
Lasts 4 weeks, skin lesion at site of bite, erythema migrans, flu like illness, regional lymphadenopathy
334
Describe the early disseminated phase of Lyme disease
Borrelia burgeorferi disseminates to the skin (lesions), nervous system (meningitis, bells palsy), heart (heart block), and joints (migratory arthritis)
335
Describe latent Lyme disease
10% untreated patients develop chronic arthritis
Can develop neurological symptoms like memory impairment, irritability, etc.
336
Describe relapsing fever
Caused by 18 species of borella
Gram negative
Spirochete
Used antigenic variation to evade immune system
Causes a relapsing fever, need to culture while febrile
337
Basic description leotospira
- Gram negative
- Aerobic
- Spirochetes wound in tight coil
- Lives in urine if dogs, rats livestock, wild animals
338
What species of leptospira causes dksease
Leptospira interrogans
339
Transmission of letospirisis
Swimming through urine contaminated waters or direct contact with urine
340
First phase of leptospira
Letpspiremic phase
Bacteria invade blood and CSF
Abrupt onset high fever
Headache
Malaise
Severe muscle aches
Red conjunctiva
Photophobia
Lasts 1 week
341
What is the second phase of letospirisis?
Immune phase
IgM antibodies appear
Meningismus
Elevated WBC in CSF
342
What is weils disease
Infectious jaundice cause by leptospira
Renal failure
Hepatitis
Hemorrhage
343
Dx and treatment of leptosporisis
PCR most immediate, or culture when febrile.
Treat with doxy or penicillin
