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Infectious Disease > Gram Negative Bugs > Flashcards

Gram Negative Bugs Flashcards

1
Q

Basics of Gram - bacteria:

what color do they stain, wall structure, habitat?

A

Don’t retain crystal violet stain used in the gram staining method -> red

  • have thin peptidoglycan layer of the cell wall (Gram + has a much thicker one) is sandwiched between an inner cytoplasmic cell membrane and the bacterial outer wall membrane
  • All have a lipopolysaccharide outer membrane of cell wall - endotoxin
  • Most, with few exceptions, don’t form spores
  • live in a wide range of habitats -> large intestines (enteric), zoonotic, respiratory, soil, water
  • some are true pathogens and some are opportunists.
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2
Q

Medically relevant gram - cocci include 3 species responsible for?

A
  • gonorrhea
  • meningitis
  • pneumonia
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3
Q

Medically relevant gram - bacilli include species responsible for?

A
  • respiratory illness
  • urinary infections
  • GI problems
  • and many other ailments
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4
Q

Importance of the lipopolysaccharide (LPS)?

A

outer leaflet of outer membrane -> acts as an endotoxin

  • if gm - bacteria enter blood stream, LPS can cause a toxic reaction which results in fever, increased RR, low BP
  • this may lead to life threatening endotoxic sepsis and shock
  • the presence of LPS also triggers an innate immune response and prod. of cytokines, which in turn, leads to inflammation, which can also produce host toxicity.
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5
Q

2 genera of gram - cocci

A
  • Neisseria

- Moraxella cararrhalis: resides in the resp. tract and causes tracheobronchitis and pneumonia

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6
Q

Neisseria meningitidis & N. gonorrheae features

A

non-motile, gm -
usually diplococci
aerobic

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7
Q

Neisseria gonorrheae

A

Gonorrhea may be most prevalent bacterial STI

  • 2nd most commonly reported notifiable STI in US
  • may be over 1 million infected
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8
Q

Where does gonorrhea present?

A

infection of cervix

-infection of urethra (men, inflammatory response -> purulent discharge)

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9
Q

How does gonorrhea present and how can it progress?

A
  • urethral infections
  • dysuria and fever
  • male infection may extend to prostate and epididymis, causing sterility, infection of urethra -> discharge
  • It can progress to systemic disease: arthritis, endocarditis, meningitis
  • Gonorrhea neonatorum (ophthalmia neonatorum) is an eye infection during passage through birth canal, can lead to blindness.
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10
Q

Neisseria meningitidis

A
  • causes meningitis, septicemia
  • only natural reservoir is the human nasopharyngeal mucosa
  • 10% nasal carrier rate
  • transferred: direct contact or droplets
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11
Q

subclinical/minimal disease of N. meningitides

A

transient meningococcemia, short febrile flu-like episode, cleared spontaneously

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12
Q

overt disease of fulminant meningeal sepsis

A
  • massive and rapid proliferation in the bloodstream
  • blood culture: +, usually also involves meninges
  • rapid clinical deterioration
  • fever, severe HA, vomiting, neck/back pain, stiffness, petechial rash, altered mental status, shock, organ failure.
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13
Q

Overt disease of meningitis

A
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14
Q

Why does shock and DIC occur in FMS/meningitis?

A

shock: endotoxin causes capillary leakage, poor vascular tone, intravascular micro thrombi, myocardial dysfunction
- C3a, C5a, inflam. mediators cause vasodilation, capillary leakage
- hypoperfusion -> shock

DIC: endothelial damage -> hemorrhages, micro thrombi (See in hands)
- endotoxin and cytokines create more of an inflammatory response -> deadly cycle

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15
Q

Dx of FMS or meningitis?

A

early dx is difficult but crucial!

  • later stages: FMS- skin lesions appear 6-12 hours after, easier to recognize disease
  • meningitis: skin lesions 12-18 h after onset, no lesions in 20% of pts

bacteriologic dx: FMS - gm stain of skin lesion biopsy specimen
- meningitis: only CSF +

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16
Q

Therapy for FMS/meningitis

A

survival little improved during last few decades
Most impt principles:
- therapy should never be delayed by dx procedures
-abx are most imp part of tx
- Cefotaxime or ceftriaxone + vanco
-pts in contact: prophylatic abx rochephin

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17
Q

Outcome of meningitis:

mortality and sequelae

A
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18
Q

Moraxella catarrhalis

A

gm - cocci that causes infections of:

  • upper and lower resp (part imp cause of bronchopulm. infection in elderly, pts with chronic lung disease)
  • middle ear
  • eye
  • CNS
  • joints

Resistant to PCNs, SMX/TMP, tetracyclines
- SO tx with fluoroquinolones, most 2nd and 3rd cep, macrolides, and augmentin

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19
Q

Aerobic gm - nonenteric bacilli

A
  • pseudomonas & burkholderia: opportunistic pathogen
  • Brucella & Francisella: zoonotic pathogens
  • Bordetella & Legionella: mainly human pathogens
  • Alcaligenes: opportunistic pathogen
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20
Q

Pseudomonas

A

small gm - rods w/ single polar flagellum

  • free living: mainly in soil, sea water, fresh water, also colonize plants and animals
  • impt decomposers and bioremediators
  • freq contaminants in homes and clinical settings
  • use aerobic respiration, don’t ferment carbohydrates
  • produce oxidase and catalase
  • many produce water soluble pigments
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21
Q

Pseudomonas aeruginosa

A
  • common inhabitant of soil and water
  • intestinal resident in 10% people
  • resistant to soaps, dyes, quaternary ammonium disinfectants, drugs, drying
  • Freq. contaminant of ventilators, IV solns, anesthesia equipment
  • opp. pathogen
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22
Q

Pseudomonas aeruginosa common cause of what infections, complications, presentation, tx

A
  • common cause of nosocomial infections in hosts w/ burns, neoplastic disease, cystic fibrosis
  • complications: pneumonia, UTI, abscesses, otitis(see blue green gunk in ear), and corneal disease
  • endocarditis, meningitis, bronchopneumonia
  • grape like odor
  • greenish-blue pigment (pyocyanin)
  • multidrug resistant
  • tx w/ cephaloporins, aminoglycosides, polymixin, quinolones (oflaxacin: good for otitis), & monobactams
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23
Q

Brucella -> Brucellosis

A
  • tiny gm - coccobacilli
  • 2 species: brucella abortus (cattle), brucella suis (pigs)
  • aka: brucellosis, malta fever, undulant fever, band disease -> zoonosis transmitted to humans from infected animals
  • fluctuating pattern of fever (weeks to a year)
  • tx w/ combo of tetracycline and rifampin or streptomycin
  • animal vaccine available
  • potential bioweapon
  • *the bacteria can spread to humans w/ contact of infected meat or placenta of infected animals, or unpasteurized milk and cheese
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24
Q

Brucellosis infection

A
  • brucellosis: in humans usually assoc. w/ consumption of unpasteurized milk and soft cheeses made from milk of infected animals
  • affects all age groups and both sexes
  • can be insidious & may present in many atypical forms
  • sxs are mild but may present as acute febrile illness which may persist & progress to a chronically incapacitating disease w/ severe complications
  • carefully monitored in Mt but is present, still persists in elk and bison in greater yellowstone region
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25
Q

Francisella tularensis & Tularemia

A
  • facultative intracellular coccobacillus
  • causes tularemia: zoonotic disease of mammals, endemic to northern hemisphere, particularly rabbits (rabbit fever)
  • transmitted by contact w/ infected animals, water and dust or bites by vectors
  • HA, backache, fever, chills, malaise, and weakness
  • 10% death rate in systemic and pulmonic forms
  • intracellular persistence can lead to relapse
  • tx: gentamicin or tetracycline
  • attenuated vaccine
  • potential bioterrorism agent
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26
Q

Bordetella pertussis

A
  • minute, encapsulated coccobacillus
  • causes pertussis or whooping cough
  • acute respiratory syndrome
  • 100 day cough
  • often severe, life-threatening complications in babies
  • reservoir: healthy carriers
  • transmission by direct contact or inhalation of aerosols
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27
Q

Virulence factors of Bordetella pertussis

A
  • receptors that recognize and bind to ciliated resp. epithelial cells
  • toxins that destroy and dislodge ciliated cells: loss of ciliary mechanism leads to buildup of mucus and blockage of the airways.
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28
Q

Vaccine and tx for Bordetella pertussis

A

Tdap: acellular vaccine contains tetanus toxoid and protection against diphtheria and pertussis.
tx: macrolides -> azithromycin

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29
Q

Legionella pneumophila and Legionellosis

A

-widely distributed in water
- organisms inhaled in aerosolized mist
- live in close assoc. w/ amoebas
- 1976 epidemic of pneumonia afflicted 200 American Legion members in Philly and killed 29 hence the name legionellosis
AKA: legionnaires dises and pontiac fever

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30
Q

Presentation of legionellosis and treatment

A

Most prevalent in males over 50, nosocomial disease in elderly.
- fever, cough, diarrhea, abdominal pain, pneumonia fatality rate: 3-30%

Tx: azithro

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31
Q

The most common aerobic and non-fastidious bacterium in the gut?

A

Escherichia coli -> most prevalent enteric bacillus

  • 150 strains
  • some have developed virulence through plasma transfer, others are opportunists
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32
Q

Pathogenic strains of E. coli -> Enterotoxigenic E. coli

A

enterotoxigenic E. coli: causes severe diarrhea due to heat-labile toxin and heat-stable toxin - stimulate secretion and fluid lost alsi has fimbriae (spikes -> attachment pili)

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33
Q

Pathogenic strains of E. coli -> Enteroinvasive

A

causes inflammatory disease of the large intestine

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34
Q

Pathogenic strains of E. coli -> enteropathogenic

A

linked to wasting form infantile diarrhea

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35
Q

Pathogenic strains of E. coli -> enterohemorrhagic

A

O157:H7 strain, causes hemorrhagic syndrome and kidney damage

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36
Q

How does E. coli present?

A

pathogenic strains frequent agents of infantile diarrhea of many forms is the greatest cause of mortality among babies

  • causes 70% of traveler’s diarrhea
  • causes 50-80% UTI in women
  • colifrom count: ind. of fecal contamination in water
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37
Q

Tx of E. coli

A

Most will respond to SMX/TMP, nitrofurantoin, fluroquinolones (cipro)

38
Q

Other Coliforms: Klebsiella pneumoniae

A

normal inhabitant of respiratory tract, has large capsule, cause of nosocomial pneumonia, meningitis, bacteremia, wound infections and UTIs

39
Q

Other coliforms: Enterobacter sp.

A

UTIs, surgical wounds

40
Q

other coliforms: Serratia marcescens

A

produces a red pigment; causes pneumonia, burn and wound infections, septicemia and meningitis, UTIs

41
Q

Other coliforms: Citrobacter sp

A

opportunistic UTIs and bacteremia

42
Q

Yersenia Pestis (Plague) background and history

A

Black death killed 75-200 million people, peaked in Europe in 1346-53

  • world pop. didn’t recover to pre-plague levels until the 17th century.
  • the black death isn’t a thing of the past. In the last 20 years, there have been as many as 5,000 cases of the plague resulting in 100-200 reported deaths a year.
43
Q

How is the plague spread?

A

spread by fleas

  • is on CDC’s list of reemerging diseases
  • percolating in rodent communities -> campgrounds, Eastern African nations are hardest hit
44
Q

Description of Yersinia pestis and virulence factors

A

nonenteric

  • tiny, gram - rod, unusual bipolar staining and capsules
  • virulence factors: capsular and envelope proteins protect against phagocytosis and foster intracellular growth: coagulase, endotoxin, murine toxin
45
Q

How do humans develop the plague?

A

through contact with wild animals (sylvatic plague) or domestic or semi domestic animals (urban plague) or infected humans

  • found in 200 species of mammals -> rodents, w/o causing disease
  • flea vectors: bacteria replicates in the gut, coagulase causes blood clotting that blocks the esophagus, flea becomes ravenous
46
Q

Pathology of the plague

A

ID 3-50 bacilli
Bubonic: bacillus mult. in flea bites, enters lymph, causes necrosis and swelling called a bubo in groin or axilla

Septicemic: progression to massive bact. growth, virulence factors cause intravascular coag. subcutaneous hemorrhage and purport - black plague

Pneumonic: infection localized to lungs, highly contagious; fatal w/o tx

47
Q

Dx and Tx of the plague

A

dx depends on hx, symptoms, and lab finding from aspiration of buboes.

  • tx: streptomycin, tetracycline, or chloramphenicol
  • killed or attenuated vaccine available
  • prevention: by quarantine and control of rodent population in human habitats
48
Q

Yersinia enterocolitica (Enteric Yersinia pathogen)

A

found in domestic and wild animals, fish, fruits, veggies, and water

  • bacteria enter small intestinal mucosa, some enter lymphatics and survive in phagocytes; inflammation of ileum can mimic appendicitis
  • more lymph node inflammation seen in this compared to Y. pseudotuberculosis
49
Q

Y. pseudotuberculosis (enteric Yersinia pathogen)

A

TB like sxs, localized tissue necrosis and granulomas in the spleen, liver and lymph nodes. Plague probably evolved from this organism 1500-20,000 years ago.

50
Q

Pasteruella multocida

A

zoonotic genus: normal flora in animals, causes wide range of diseases in wild and domesticated animals -> significant disease in poultry flocks world wide -> avian cholera follows bird migration routes (esp. snow geese)

  • result in opportunistic infections in humans
  • animal bites or scratches cause local abscesses that can spread to joints, bones, and lymph nodes
  • immunocompromised are at risk for septicemia and complications
51
Q

Tx of Pasteruella multocida

A

penicillin and tetracycline

52
Q

Haemophilus basics

A

genus of tiny gm - pleomorphic rods

  • fastidious (complex nutritional requirements), sensitive to drying, temperature extremes, and disinfectants
  • none can grow on blood agar w/o special techniques -> chocolate agar
  • require hemin, NAD, or NADP
  • some species are normal colonists of upper respiratory tract or vagina (H. aegyptius, H. parainfluenza, H ducreyi)
  • others are virulent species responsible for conjunctivitis, childhood meningitis, and chancroid
53
Q

H. influenzae

A

acute bacterial meningitis, epiglottitis, otitis media, sinusitis, pneumonia, and bronchitis

  • vaccine: Hib
54
Q

H. aegyptius

A

conjunctivitis, pink eye

55
Q

H. ducreyi

A

chancroid STD

56
Q

H. parainfluenzae and H. aphrophilus

A

normal oral and nasopharyngeal flora,infective endocarditis

57
Q

How do you tx Haemophilus infections

A

amoxicillin, azithro, cephalosporins, fluorquinolones, and clarithro

58
Q

Characteristics of anaerobic infections

A

most pathogenic anaerobes are usually commensals -> originate from our own flora

59
Q

Predisposing conditions (RFs) of anaerobic infections

A
  • breeches in mucocutaneous barrier (displace normal flora)
  • compromised vascular supply
  • trauma w/ tissue destruction
  • antecedent infection
60
Q

Complex flora of anaerobic infections

A

multiple species -> abdominal infection: avg of 5 species -> 3 anaerobic and 2 aerobic

  • less complex then normal flora
  • fecal flora: 400 diff species
  • those predominant in stool are not infecting species: veillonella, bifidoabacterium -> rarely pathogenic
  • species uniquely suited to cause infection predominate
61
Q

synergistic mix of aerobes and anaerobes

A

e.coli -> consume O2 so this allows growth of anaerobes

anaerobes -> promotes growth of other bacteria by being antiphagocytic and producing B-lactamases

62
Q

What are the clues to an anaerobic infections?

A
  1. infections in continuity to mucosal surfaces
  2. infections w/ tissue necrosis and abscess formation
  3. putrid odor
  4. gas in tissues
  5. polymicrobial flora
  6. Failure to grow in the lab
    in the lab: use analytical profile index, and gas chromatography
63
Q

Bacteroides fragilis

A

Major disease causing strict anaerobic after abdominal surgery, none-spore former

  • prominent capsule: anti-phagocytic, abscess formation
  • endotoxin: low toxicity, structure different than other lipopolysaccharide
64
Q

Campylobacter jejuni

- leading cause of what?

A

leading cause of bacterial diarrheal illness

  • transmission is oral/ fecal route, ingestion of cont. food & water, uncooked meat
  • assoc. w/ feed lots, chicken houses, raw milk
  • most raw chicken is probably contaminated (don’t wash!!)
65
Q

How is campylobacter jejune tx?

A

azithro, b/c increasing resistance to fluroquinolones

66
Q

Lyme disease (Borrellia burgdorferi)

A
  • Most common tick borne disease in the northern hemisphere
  • early sxs may include fever, HA, and fatigue
  • Rash occurs in 70-80% of infected persons but may or may not appear as the bull’s eye
  • left untreated later sxs involve joints, heart, and CNS (mimic other diseases)
  • In most cases: disease is eliminated by abx especially if tx early
67
Q

Dx of lyme disease

A
  • unique bull’s eye raise
  • Elisa: measures levels of abs against lyme bacteria
  • Western blot: ID’s abs directed against a panel of proteins found on lyme bacteria. This test is ordered when the ELISA result is either positive or uncertain
68
Q

Tx of lyme disease

A

sooner treated -> more complete recovery

- doxy or amoxicillin taken orally for 2-4 weeks

69
Q

Prevention of lyme disease

A
  • avoidance of deer ticks
  • wear long sleeves and tightly woven clothing light in color
  • wear shirt tucked into pants
  • pants tucked into socks or boots
  • walk in center of trails
  • Apply tick repellents with DEET or permethrin to clothing
  • check yourself, family and pets for ticks after trips outdoors
70
Q

Chlamydia trachomatis

A
  • obligate intracellular human pathogen
  • clinical signs and sxs often indistinguishable from gonorrhea
  • female pts may not have sxs
  • common STI in US, 1 million cases, 2nd to HPV
  • possible to have chlamydia and one or more other STIs at same time
  • at one time was single most important infectious agent assoc with blindness, spread from eye to finger to eye, shared towels, coughing, eye-seeking flies or during childbirth
71
Q

Tx of chlamydia trachomatis

A
  • tx both partners with azithro, doxy, or ofloxocin
72
Q

Lymphogranuloma venereum (LGV)

A
  • uncommon STI caused by 3 invasive servers of Chlamydia trachoma’s
  • chronic long term infection of lymphatic system
  • Most common in men in central and south america
  • Rare in developed nations before 2003, recent outbreak among gay men in the Netherlands has led to increase of LGV in Europe and U.S. -> majority HIV co-infected
73
Q

symptoms of LGV

A
  • swollen inguinal nodes
  • drainage through the skin from buboes or abscesses in inguinal nodes
  • painful BMs (tenesmus)
  • small painless sore on genitals
  • swelling of the labia
  • blood or pus from rectum
74
Q

Dx and Tx of LGV

- what happens if left untreated?

A

dx usually made serologically and by exclusion of other causes of inguinal adenopathy or genital ulcers

TX: abx -> doxy, erythro, azithro

  • buboes may require I&D
  • prognosis more favorable w/ early tx
  • untreated chronic condition may cause fistulas of penis, urethra, vagina, uterus, rectum
75
Q

Psittacosis

A

Parrot fever

  • zoonotic disease caused by chlamydia pssitaci, contracted from parrots, pigeons, ducks, chickens, gulls
  • sxs in humans range from unapparent to systemic illness with severe pneumonia
  • may mimic typhoid in early stages: high fever, arthralgia, diarrhea, conjunctivitis, epistaxis, and neutropenia, splenomegaly
  • severe HA can mimic meningitis
  • mimics bacterial pneumonia as it progresses: dyspnea, high fever, cough, patchy infiltrates or whiteout on CXR
  • DD for these sxs lengthy!!
76
Q

Dx and Tx of Psittacosis

A

dx: exposure hx!!!!
microbiological cultures from respiratory secretions or serology from blood cultures
tx: doxy and chloramphenicol

77
Q

Relapsing fever: 2 types

and cause

A 
tick borne (TBRF)
louse borne (LBRF)
cause: Borellia spirochetes
78
Q

Where does TBRF occur

A

in Western US, linked to sleeping in rustic, rodent infested cabins in mountainous areas

79
Q

Where does LBRF occur

A

transmitted by human body louse and is generally restricted to refugee settings in 3rd world. Occurs in epidemics, more severe in TBRF

80
Q

Sxs of relapsing fever

A

flu-like sxs: sudden fever, chills, HAs, arthralgias, nausea, may develop a rash

81
Q

Dx and Tx of relapsing fever

A

dx: blood smear -> spirochetes
tx: doxy, may cause Jarisch-Herxheimer run in over 1/2 tx
b/c acts like endotoxin when spirochetes die off -> produces rash and fatigue

82
Q

Salmonella sp

A

motile, flagellated gram neg.

  • 1800 known servers
  • responsible for common salmonella gastroenteritis (diarrhea, abdominal cramps, fever) to enteric fevers (including typhoid fever) which can be life threatening
  • asymptomatic carrier state can occur (typhoid mary)
  • most common form of “food poisoning” presents with uncomplicated gastroenteritis, usually self limited disease
  • Non-typhoid fever salmonellosis is worldwide disease of humans and animals -> animals being the main reservoir, usually food borne illness can spread from person to person
83
Q

What kind of sxs will salmonella cause?

A
  • enteric typhoid fever- severe systemic disease, any species of salmonella may cause, but S. type most studied:
  • N/V/D
  • septicemia
  • fever, anorexia, HA, myalgias
84
Q

Dx and Tx of enteric typhoid fever-severe systemic disease (salmonella)

A

Dx: stool and/or blood cultures, serology for abx
- often fatal if not tx
- replace fluids by oral or IV
- pain control and tx nausea and vomiting
- Abx: cipro
most patients will recover w/ approp. tx

85
Q

Shigella

A

intestinal disease

  • bloody diarrhea, may have abdominal pain or cramps, fever
  • usually seen in children 2-4
  • passed through direct contact w/ stool: child care setting, staff not washing hands after changing diapers, or while toilet training toddlers, drinking or swimming in contaminated water
86
Q

Dx and tx of shigella

A
  • dx: stool studies
    tx: replace lost fluids,water or pedialyte, may need IV fluids
  • usually self limiting w/in a week
  • increasing resistance to abx: cipro or cefixime (3rd gen) should be used if abx indicated
87
Q

Vibrio species: 2 groups

A

cholera infections

non-cholera

88
Q

Non-cholera vibrio infections

A

associated with improperly cooked contaminated food or eating raw shellfish
- combo of increased water temp and salinity where shellfish are harvested may contribute to increased contamination rates of shellfish.

89
Q

Non-cholera vibrio gastroenterits tx

A

Usually self-limited w/ fluid replacement, abx usually not indicated

  • non-cholera wound infection or septicemia will need doxy or a quinolone, aggressive fluid replacement, vasopressors for hypotension, fasciotomy, debridement of infected wound
  • several deaths in florida every year (septicemia: have cut, swimming -> get infected)
90
Q

Vibrio cholerae

A

secretes cholera toxin that causes profuse watery diarrhea, in endemic areas 75% of cases are asymptomatic, 20% mild to moderate and 5% are severe

  • sxs: watery diarrhea, occasional vomiting, cramps
  • rapid dehydration ensues.. death due to dehydration can occur in a few hours to days in untx children
  • 60% mortality in untx cases,
91
Q

Acinetobacter baumanni

A
  • commonly isolated from the hospital enviro and hospitalized pts
  • often cultured from sputum, respiratory secretions, wounds, urine
  • may colonize irrigating solns and IV solns
  • low virulence but is capable of causing infection in organ transplants and febrile neutropenia
  • infections conc. in ICU
  • may cause respiratory and UTIs -> ventilator assoc nosocomial pneumonia
  • mortality and morbidity more likely as a result of underlying severe illness rather than superimposed acineobacter
  • mult- drug resistance: including carbapenems

Infectious Disease (27 decks)

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