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Microbiology > Gram Positive Bacilli Part 2 > Flashcards

Gram Positive Bacilli Part 2 Flashcards

1
Q

Most common location of spore in Clostridium species

A

Subterminal

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2
Q

Terminal spores can be seen in which Clostridium species

A

C. Tetani
C. Tertium

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3
Q

Central Spore can be seen in which Clostridium species

A

C. Bifermentans

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4
Q

Shape of spores in C. Tetani and C. Tertium

A

C Tetani - Drum stick appearance (Round)
C Tertium - Tennis racket appearance (Oval)

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5
Q

Mostly Clostridium species are uncapsulated except

A

C. Perfringes
C. Butyricum

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6
Q

All Clostridium species are motile except

A

C Perfringes
C Tetani

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7
Q

Clostridium perfringes Features

A

Non motile
Capsulated
Gram positive Bacilli
Subterminal spores

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8
Q

Virulence factors of Clostridium perfringes

A

4 major toxin - alpha (lecithinase, phospholipase C), beta, epsilon, eeta
8 minor Toxin

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9
Q

Clostridium perfringes associated with which infection

A

Wound infection - Simple wound Contamination, Anaerobic cellulitis, Anaerobic Myositis (Gas gangrene)

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10
Q

Clostridium perfringes requires

A

Anaerobic environment
Contamination of wound
Rarely spontaneous

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11
Q

Clostridium perfringes mechanism of action for gas gangrene

A

Lecithinase damage cell membranes - Capillary permeability increases - Tension in muscles - Further anoxia(Anaerobic environment)

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12
Q

Clinical features of Gas gangrene

A

Pain
Discharge
Gas bubbles (Crepitus)
Shock

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13
Q

Gas gangrene can be caused by

A

PSN
P - C. Perfringes (10-48 hours)
S - C. Septicum (2-3 days)
N - C. Novyi (5-6 days)

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14
Q

Treatment of Gas gangrene

A

Surgical debridement
Iv penicillin + Clindamycin for 10-14 days
Hyperbaric Oxygen
Passive immunisation - Anti-gangrene serum

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15
Q

Clinical features of Clostridium perfringes other than gas gangrene

A

Food poisioning (due to cold/warm up meat)
Gangrenous appendicitis
Necrotizing enteritis

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16
Q

Specimen taken for C. Perfringes

A

Necrotic tissues
Muscle fragments

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17
Q

Microscopic Findings for C. Perfringes

A

Subterminal spores

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18
Q

Microscopic Finding for C. Septicum

A

Citron body

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19
Q

Media used for C. Perfringes

A

Robertson Cooked meat broth (Red/Saccharolytic)

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20
Q

C Perfringes other Diagnostic findings

A

Senior NTR
Senior - Stormy clot formation on litmus milk
N - Naegles Reaction - Nagler plate(Egg yolk medium) - Opaque area
T - Target hemolysis : Double zone of Hemolysis
R - Reverse CAMP Test +ve

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21
Q

Spore seen in Clostridium Tetani

A

Terminal spore - Drum stick appearance

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22
Q

Virulence factors of Clostridium Tetani

A

2 Exotoxins -
Tetanolysin(Hemolysin) - O2 Labile
Tetanospasmin - O2 labile

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23
Q

Pathogenesis of C. Tetani

A

Spores in muscle - Release Tetanospasmin - Acts presynaptically at inhibitory neurons terminal - cleave VAMP-Synaptobrevin - inhibits release of GABA and Glycine - no relaxation of muscles - Muscle spasm

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24
Q

Transmission of C. Tetani occurs by

A

Injury
Unsterile RTA

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25
Q

Incubation period of C Tetani

A

6-10 days

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26
Q

First symptom of C. Tetani

A

8th day disease
Increased tone of Masseter (Jaw lock/Trismus)
Risus Sardonicus (Sarcastic smile)
Opisthotonos
Limb spasm
Descending Spastic paralysis
Exaggerated DTR
Autonomic disturbances
M/C cause of death - Respiratory Failure

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27
Q

Specimen taken for C.Tetani

A

Necrotic tissue

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28
Q

Microscopic examination findings of C. Tetani

A

Gram +ve bacilli, Terminal spores (Drumstick appearance)

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29
Q

Blood agar finding for C. Tetani

A

Swarming on blood agar

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30
Q

Gelatin stab finding for C. Tetani

A

Fir tree appearance

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31
Q

C. Tetani finding on Robertson Cooked meat broth

A

Black color - Proteolytic reaction

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32
Q

Which technique used to obtain pure colonies of C. Tetani

A

Fildes Technique

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33
Q

Prevention after injury in Category A patient’s

A

Category A - TT/Booster in last 5 years
Simple wound(Clean;<8hr) - Nothing
Other wound(Dirty;>8hr) - Nothing

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34
Q

Prevention after injury in Category B patients

A

Category B - 5-10 years
Simple wound : Toxoid 1 dose
Other wound - Toxoid 1 dose

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35
Q

Prevention after injury in Category C patients in C. Tetani

A

Category C - Beyond 10 years
Simple wound - Toxoid 1 dose
Other wound - Toxoid 1 dose + HTIg

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36
Q

Prevention after injury in Category D patients in C. Tetani

A

Category D - Unknown status
Simple wound - Complete Toxoid dose
Other wound - Complete Toxoid dose+ HTIg

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37
Q

Which infection is associated with Bottle and Canned food

A

Clostridium Botulinum

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38
Q

Virulence factors of C Botulinum

A

Botulinum toxin - Serotype A,B,E (A most severe) - all chromosomal mediated except C1,C2,D - phage coded

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39
Q

All Botulinum toxin are neurotoxin Except

A

C2 - Enterotoxin

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40
Q

Pathogenesis of C. Botulinum

A

Affects excitatory nerve terminals - toxin inhibits the Snare proteins - there is no fusion leading to inhibition of Ach release - No contraction - Floppy/Flaccidity

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41
Q

Types of Botulism

A

Foodborne Botulism
Wound Botulism
Infant Botulism
Iatrogenic Botulism

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42
Q

Incubation Period of Foodborne Botulism

A

12-36 hours

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43
Q

Clinical features of Foodborne Botulism

A

D’s
Diplopia
Dysphagia
Dysarthria
Descending Flaccid paralysis
Dilated pupils
+ GI Symptoms

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44
Q

Incubation period of Wound Botulism

A

7-10 days

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45
Q

Infant Botulism Incubation period

A

1-2 days

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46
Q

Clinical features of Infant Botulism

A

First symptom - Constipation
Floppy baby Syndrome (Flaccid muscles)

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47
Q

Microscopic Diagnostic features of Infant Botulism

A

Gram Positive Bacillus
Spores - Subterminal, Oval, Bulging

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48
Q

Treatment of Infant Botulism

A

Toxoid antiserum

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49
Q

Clostridium defficille is known to cause

A

Pseudomembranous Enterocolitis

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50
Q

Virulence factor of C. Difficile

A

Toxin A - Enterotoxin (Attachment to gut)
Toxin B - Cytotoxin

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51
Q

Mechanism of action of Clostridium difficile

A

Toxin A and B - binds to Glucosylate GTP binding protiens - damage to actin. Cytoskeleton - Cell death

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52
Q

Colonoscopic findings in case of Pseudomembranous Enterocolitis

A

Dirty yellow Necrotic tissue towards mucosa

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53
Q

Microscopic Findings of C. Difficile

A

Volcano eruption

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54
Q

Most common risk factor of C. Difficile infection

A

Long term use of Antibiotics (3rd gen Cephalosporins)

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55
Q

Clinical features of Pseudomembranous Enterocolitis

A

Acute colitis with watery diarrhea, sometimes bloody

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56
Q

Media used for C. Difficile diagnosis

A

CCFA (Cefoxitin Cycloserine Fructose agar)
CCYA (Cefoxitin Cysteine yeast extract agar)

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57
Q

Treatment of Pseudomembranous Enterocolitis caused by C. Difficile

A

Earlier Oral Vancomycin - Now Fidoxamycin
For Fulminant CDI - Oral Vancomycin+ Iv Metronidazole and Rectal Vancomycin in enemas

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58
Q

Mycobacteria family includes

A

M. Tuberculosis
Non tuberculous Mycobacteria
M. Leprae

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59
Q

Mode of Transmission of M. Tb

A

Droplet (<5micron)
Ingestion

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60
Q

Antigenic properties of M. Tuberculosis

A

Mycolic acid - acid fastness
Cord factor - responsible for virulence
LAM (LipoArabinomannan)

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61
Q

Classification of Pulmonary TB

A

Primary Tb
Secondary Tb (reactivation)
Disseminated Tb

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62
Q

Primary Tb

A

Subpleural involvement
Lower part of upper lobe
Upper part of Lower lobe

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63
Q

Secondary Tb

A

Occurs at apex
Cavity present

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64
Q

Lung cavities are seen in which conditions

A

Secondary Tb
Histoplasmosis
Bronchiectasis
Squamous cell carcinoma

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65
Q

Pre existing lung cavity is seen in

A

Aspergillosis

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66
Q

Disseminated Tb

A

Due to hematogenous spread
Miliary Tb - Millet seeds

67
Q

Foci seen when only lungs are involved

68
Q

Foci when there is involvement of Lungs + Hilar lymph nodes

A

Ghon complex

69
Q

Ghon complex + calcification is called

A

Ranke Complex

70
Q

Focus called when Apex of lung is involved

A

Simon focus

71
Q

Focus called when infraclavicular and supraclavicular parts are involved

A

SPA
Supraclavicular - Puhls Focus
Infraclavicular - Assman Focus

72
Q

Tb Focus called when liver is also involved

A

Simmond Focus

73
Q

Tb Focus called when Blood vessels are involved

A

Weigharts Focus

74
Q

Tb Focus called when brain is involved

A

Rich’s Focus

75
Q

Most common Extrapulmonary Tb manifestation

A

Lymph node Tuberculosis

76
Q

Extrapulmonary Tb findings

A

Kidney - Putty kidney
Urinary bladder - Thimble bladder
Skeletal - Spine - Pott’s spine
Skin - Lupus vulgaris, Scrofuloderma

77
Q

Specimen used for Tb diagnosis

A

Sputum - 2 sample - Spot sample and early morning sample

78
Q

If sputum unavailable which specimens can be taken for diagnosis of Tb

A

Laryngeal aspirates
Bronchial secretions
Bronchoalveolar lavage
In children - Gastric lavage

79
Q

For Diagnosis of Lymph node Tuberculosis

A

FNAC (Fine needle aspirate Cytology) - Pus

80
Q

For diagnosis of Tb Meningitis

A

Cobweb reaction

81
Q

In case of Pulmonary TB, Sputum is concentrated by which method

A

Petroff method (Sputum + 4% NaOH)

82
Q

Stain used for diagnosis of M. Tb

A

ZN stain
Organism - Red
Background - Blue

83
Q

Differentiation of Typical Mycobacteria with Atypical

A

M. Tb is both acid and alcohol fast
Atypical Tb is only Acid fast

84
Q

Grading Of Tb

A

None - Negative - Negative
1-9/100field - Positive - Scanty
10-99/100field - Positive - 1+
1-10/field - Positive - 2+
>10field - Positive - 3+

85
Q

Florescent stain used for M. Tb

A

Auramine, Rhodamine
Rapid and more sensitive
Recommended screening method

86
Q

Egg based culture media used for diagnosis of M. Tb

A

Lawstein-Jensen media

87
Q

Lawstein-Jensen media includes

A

Coagulated hen’s egg
Mineral salt solution
Asparagine
Malachite green

88
Q

Finding of M. TB on Lawstein-Jensen media

A

Rough Buff Tough colonies (takes 6-8 weeks to grow)

89
Q

Blood based media used for M. Tb

A

Tharshi medium

90
Q

Serum based media used for diagnosis of M Tb

A

Loeffler’s medium

91
Q

Potato based media used for diagnosis of M Tb

A

Pawlowsky medium

92
Q

Liquid media used for diagnosis of M Tb

A

Middlebrooks
Sula and Sautons
Prausker and Becks

93
Q

Finding on Liquid media for Tb

A

Long serpentine cords

94
Q

Newer automated methods takes how much time to give result

95
Q

Bactec MGIT uses

A

Middlebrooks 7H9 broth
Fluorometric technique
MGIT - Mycobacterial growth indicator tube

96
Q

BacT test is based on

A

Calorimetry based

97
Q

Versatrek method detects

A

Pressure changes in media due to gas production

98
Q

How many fields need to see atleast before giving diagnosis of Tb negative

A

Atleast 100 field over 10 minutes before giving negative
10min/100fields/10000sensitvity

99
Q

Typing Methods used for Diagnosis of Tb

A

RFLP (Restriction fragment length polymorphism)
Gene Xpert - Type of CBNAAT
Line probe assay

100
Q

RFLP And it’s disadvantage

A

Target sequence/strain
Can’t differentiate active and latent Tb

101
Q

Gene Xpert

A

Type of CBNAAT
Use - Diagnosis+ Rifampicin resistance
Turn around time - 2hrs
Sensitivity and specificity: 88% and 99% respectively

102
Q

Methods used to diagnose Latent tb

A

Tuberculin/Mantoux test
IGRA (Interferon gamma release assay)

103
Q

Antigen used for tuberculin Mantoux test

A

PPD (Purified protein derivative)

104
Q

Site and method of administration in tuberculin Mantoux test

A

Intradermally injected in flexor aspect of Forearm

105
Q

Reading of tuberculin Mantoux test is usually done after

106
Q

Positive tuberculin Mantoux test means

A

Width of induration should me 10mm or more

107
Q

Tuberculin test will be negative if

A

Width of induration is less than 5mm

108
Q

False positive tuberculin Mantoux test can be seen in cases of

A

BCG vaccination
No tuberculous bacteria

109
Q

False negative tuberculin Mantoux test can be seen in

110
Q

Advantage and disadvantages of IGRA

A

Negative in BCG vaccinated
But cannot differentiate between latent and active infection

111
Q

MPT64 Test

A

Transdermal patch test
Only positive in case of Active Tb
100% specificity

112
Q

Which method is good for Tb patients with HIV

A

LAM Assay (LipoArabinomannan)
Urine sample
Immunochromatographic testing

113
Q

Prophylaxis of Tb, Vaccine dose and site of administration

A

BCG vaccine - Dose 0.1mL and injected above insertion of Left deltoid

114
Q

Intravesical BCG can be used in treatment of

A

Superior Urinary bladder cancer

115
Q

BCG vaccine provides immunity for how long

A

15-20 years

116
Q

Features of Non tuberculosis Mycobacterium

A

All are Catalase +ve
Reservoir - Soil, H20
No human to human
Acid fast
But not alcohol fast

117
Q

Non tuberculosis Mycobacterium also known as

A

Environmental bacteria or Tuberculoid Mycobacteria

118
Q

Which classification is done to classify Non tuberculosis Mycobacterium

A

Runyon’s classification

119
Q

Types of Non tuberculosis Mycobacterium according to Runyon’s classification

A

Photochromogens
Scotochromogens
Non - photochromogens
Rapid growers

120
Q

Photochromogens

A

Pigment production only in Light
MASK
M. marineum
M. Asiaticum
M. Sinniae
M. kansassi

121
Q

Scotochromogens

A

Pigment production in light+ dark
God Save us from Dark
M. Szulgai
M. Scrofulaceum
M. Gordonae

122
Q

M marineum causes

A

Swimming pool/Fish tank granuloma - Warty skin lesions

123
Q

M. Kansassi is known to cause

A

Upper lobe scarring/cavity formation

124
Q

Tap water scotochromogens is

A

M. Gordonae

125
Q

Non photochromogens

A

M. Avium
M. Interacellulare
M ulcerans
M xenopi

126
Q

Most common cause of Granulomatous disease

127
Q

Mycobacteria avium complex is formed by

A

M. Avium + M. Interacellulare - MA

128
Q

Mycobacteria Avium Complex is associated with which syndrome

A

Lady Windermere’s Syndrome

129
Q

M. Interacellulare also known as

A

Battery bacillus

130
Q

M. Ulcerans is known to cause

A

Brucelli ulcer

131
Q

Mycobacteria Indicus Pranii

A

It is an immunomodulator
Vaccine for leprosy (MW vaccine)

132
Q

Rapid growers includes

A

M fortuitum
M. Smagmatis
M. Chelonae - result of post surgery abscess
M.phlei

133
Q

Mycobacteria Leprae is also known as

A

Hansen’s Bacillus

134
Q

Mycobacteria leprae Features and Mode of transmission

A

Obligate intracellular
Obligate aerobe
Mode of transmission - Nasal droplet > Contact > breast milk

135
Q

Classification used to classify Mycobacterium leprae

A

Ridley Jopling Classification

136
Q

Ridley Jopling Classification of Mycobacteria Leprae

A

LL - Lepromatous leprosy
BL - Borderline Lepromatous
BB - Borderline Leprosy
BT - Borderline Tuberculoid
TT - Tuberculoid leprosy

137
Q

Bacillary load in Lepromatous leprosy and Tuberculoid leprosy

A

LL - Multibacillary
TT - Paucibacillary

138
Q

Skin lesions seen in Lepromatous leprosy and Tuberculoid leprosy

A

LL - Leonine facies with alopecia
TT - few lesions

139
Q

Nerve lesions in TT AND LL

A

LL - late nerve lesions
TT - Early nerve lesions

140
Q

Lepromin test in LL AND TT

A

LL - negative
TT - positive

141
Q

Humoral immunity is increased in LL OR TL

A

Lepromatous leprosy

142
Q

Macrophages and giant cells are seen in which leprosy

A

Tuberculoid leprosy

143
Q

How many Samples taken for diagnosis of Leprosy

A

6 smear samples - 4 Skin (Forehead, cheek, chin, buttock)
Ear lobe
Nasal mucosa

144
Q

Stain used for diagnosis of Leprosy

A

ZN stain 5% H2SO4 - Fite Forocco stain

145
Q

Microscopic Findings of Leprosy

A

Virchow cells (Macrophage) - seen in Lepromatous leprosy

146
Q

Grading of M. Leprae

A

1-10 bacilli/100 fields - 1+
1-10 bacilli/10 fields - 2+
1-10 bacilli/field - 3+
10-100 bacilli/field - 4+
100-1000 bacilli/field - 5+
>1000 bacilli/clumps/Globi in every field - 6+

147
Q

Culture of M. Leprae

A

Non cultivable (Obligate intracellular)

148
Q

Serological finding of M. Leprae

A

Antibody against PGL-1 (phenolic glycolipid)

149
Q

Lepromin test

A

0.1 ml Lepromin antigen - given intradermally in forearm

150
Q

Interpretation of Lepromin test

A

Fernandez reaction (Early) - >10mm induration after 48hrs
Mitsuda reaction (late) - >5mm nodule at 21 days or 3 weeks

151
Q

Treatment of Leprosy

A

DCR
Dapsone
Clofazimine
Rifampicin
For 6-12 months

152
Q

Lepromin test is based on which hypersensitivity reaction

153
Q

Lepra reaction is classified into

A

Type 1
Type 2

154
Q

Type 1 and Type 2 Leprae reaction shows which hypersensitivity reactions

A

Type 1 - Type 4 HS
Type 2 - Type 3 HS.

155
Q

Type 1 Leprae reaction is usually seen in

A

Borderline Leprosy
Downgrading - LL
Reversal /upgrading - TT
can be seen before or after treatment

156
Q

Erythema nodosum leprosum seen in which Leprae reaction

A

Type 2 - TYPE 3 HS

157
Q

Type 2 lepra reaction is seen in

A

Borderline Lepromatous and Lepromatous leprosy
Seen after treatment

158
Q

Clinical features of Type 1 leprae reaction

A

Edema
Ulnar nerve involvement

159
Q

Type 2 Leprae reaction clinical features

A

Crops of tender inflamed nodules (due to interferon alpha) - Erythema nodosum leprosum

160
Q

Which helper cells associated with Type 1 and Type 2 leprae reaction

A

Type 1 - Th1 response
Type 2 - Th2 response

161
Q

Which sign is positive in Type 1 leprae reaction

A

Tinel sign - pressure exerted on nerve causes tingling sensation

162
Q

Treatment of Type 1 and Type 2 Leprae reaction

A

Type 1 - Glucocorticoids
Type 2 - Thalidomide

163
Q

Type 2 leprae reaction mnemonic

A

TTTTTT
Type 2
Treatment associated
Tender nodules (ENL)
TNF alpha
TH2
Thalidomide

164
Q

How Mycobacteria tuberculosis is differentiated from other Mycobacteria

A

Niacin +
Nitrate reduction+
Catalase +
Colonies - Rough buff Tough colonies

Microbiology (37 decks)

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