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PHAR152 > Infectious Disease Intro > Flashcards

Infectious Disease Intro Flashcards

1
Q

What are some characteristics of the immune system?

A

can be specific
has memory
mobile and fast acting
flexible

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2
Q

What are non-specific lines of defense?

A

physical barriers (such as skin)
chemical barriers (such as stomach acid)
mucus and cilia protect the resp tract
urine flushes bacteria out of the urinary tract
enzymes in tears and saliva

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3
Q

Which cells of the innate immune system can act as macrophages?

A

macrophages
neutrophils
monocytes
natural killer cells
eosinophils

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4
Q

Which cells of the innate immune system will phagocytize and release inflammatory mediators?

A

mast cells
basophils

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5
Q

List off some specifics of the cells of the innate immune system.

A

macrophages and monocytes: APCs and surveillance
neutrophils: defense against bacteria and fungus
eosinophils: defense against parasites and respond to allergies
basophils: respond to allergies

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6
Q

Which cells make up the adaptive immune system?

A

B and T lymphocytes

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7
Q

How is the adaptive immune system divided?

A

humoral mediated: within the serum
cellular mediated: within the cells

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8
Q

How are T cells activated? What happens when T cells are activated?

A

activated by antigen presenting cells
activated T cells secrete IL-2 which activates more T cells

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9
Q

What are the three forms that an activated T cell can take?

A

CD4 (helper cells): secretes ILs and interferon, stimulates CD8,
production of antibodies
CD8 (cytotoxic cells): kills cells recognized as foreign
regulating cell: regulates T cell response

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10
Q

How are B cells activated?

A

after they recognize antigens

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11
Q

What forms can B cells take?

A

plasma cells: secrete antibodies
memory cells: important in future attacks

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12
Q

What are cytokines?

A

soluble factors secreted by cells
can activate cells, call for back up, etc
ex: ILs, TNF, IFN

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13
Q

What are inflammatory mediators?

A

any soluble factor that causes inflammation
secreted by various cells
ex: histamine, PGs, etc

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14
Q

What happens when antibodies bind to antigens?

A

trap the antigen or clump them together
increase attack of immune cells

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15
Q

What is an infection?

A

gets a response of host immune system and person gets ill

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16
Q

What is a sub-clinical infection?

A

specific response in the body is evoked (antibody production) but the person is not ill

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17
Q

What is colonization?

A

presence of organism at a body site without production of disease

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18
Q

What is the normal microbiota of the skin?

A

diphtheroids (corynebacterium)
propionibacteria (p.acnes)
staphylococci (especially coagulase -)
streptococci

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19
Q

What is the normal microbiota of the GI tract?

A

bacteroides
clostridium
diptheroids
enterobacteriaceae
fusobacterium
streptococci (anaerobic)

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20
Q

What is the normal microbiota of the upper respiratory tract?

A

bacteroides
haemophilus
neisseria
streptococci

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21
Q

What is the normal microbiota of the genital tract?

A

corynebacterium
enterobacteriaceae
lactobacillus
mycoplasma
staphylococci
streptococci

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22
Q

What is the most important aspect of curing infection?

A

the host defense which is composed of the innate and adaptive systems

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23
Q

True or false: antibiotics always cure an infection

A

false

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24
Q

What might be required if antibiotics do not cure an infection?

A

drainage of abscess
removal of dead tissue
removal of foreign bodies or prosthetic device
decrease in immune suppression

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25
Q

What are the factors that affect host defenses?

A

malnutrition
age
immunoglobulin deficiencies
deficiencies in cellular immunity
alcoholism
diabetes
immunosuppressive therapy
invasive procedures

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26
Q

What are the non-specific symptoms of infection?

A

malaise
listlessness
loss of appetite
headache
myalgia
arthalgia

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27
Q

True or false: fever is due to an infection unless proven otherwise

A

true

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28
Q

Aside from infection, what else can induce a fever?

A

autoimmune diseases
malignancy

29
Q

What is a fever for 6am, 4pm, rectally, and armpit?

A

6am: 37.2
4pm: 37.7
rectally: 38.2
armpit: 37.2

30
Q

What is the normal range of white blood cells?

A

5-10 x10 to the 9/L
-anything greater may be infection

31
Q

Aside from infection, what are other situations where WBC count can be elevated?

A

leukemia
rheumatoid arthritis
taking lithium or corticosteroids

32
Q

What are the normal percentages of WBCs?

A

total neutrophils: 50-70%
segmented neutrophils: 50-70%
bands: 3-5%
lymphocytes: 20-40%
monocytes: 0-7%
eosinophils: 0-5%
basophils: 0-1%

33
Q

What is the difference between a segmented neutrophil and a band?

A

segmented neutrophils are mature neutrophils
bands are immature neutrophils

34
Q

What might be present with chronic infection?

A

anemia

35
Q

What are the symptoms of septic shock?

A

decreased BP, then decreased CO
decrease in renal function
hepatic dysfunction (increased bilirubin)
decreased oxygenation
disseminated intravascular coagulation

36
Q

How can history help with the diagnosis of infection?

A

severity of signs and symptoms
source of infection (contact, trauma, etc)
try and determine which organism is causative

37
Q

How can physical examination help with the diagnosis of infection?

A

localize the infection
ex: characteristic rash of measles, neck stiffness of meningitis

38
Q

What can be done in the lab to help with the diagnosis of infection?

A

WBC and differential
ESR and CRP
renal and hepatic function
electrolytes
microbiology

39
Q

What are the microbiology techniques used to determine invading pathogens?

A

gram stain
culture
sensitivity testing

40
Q

What kind of information can you determine from a gram stain?

A

gram + or -
cocci vs bacillus
presence of WBC
is it actually bacteria

41
Q

True or false: all organisms stain great under a gram stain

A

false
ex: tuberculosis, viruses

42
Q

What is the best method for revealing an organism?

A

culture
-organism is grown and the biochemical profile is determined
-not all organisms grow well
-possible contamination issues

43
Q

What is MALDI-TOF MS?

A

matrix-assisted laser desorption/ionization time of flight mass spectrometry
-gets a fingerprint via ionization to identify microorganism

44
Q

What is sensitivity testing?

A

determines which antibiotics the organism is susceptible to
based on minimal inhibitory concentration

45
Q

How does disk diffusion help in assessing susceptibility?

A

you can measure the zones of inhibition as zone size correlates with sensitivity of the organism
-larger the zone=more sensitive to the antibiotic

46
Q

When is immunologic testing (serology) useful?

A

when organism cannot be cultured or treatment has already begun

47
Q

What is antibody testing?

A

detects presence of antibodies directed against the pathogen

48
Q

What is antigen testing?

A

detects presence of antigen in the urine, serum, CSF, etc

49
Q

What is PCR?

A

polymerase chain reaction detects very low amounts of specific DNA in clinical specimens

50
Q

What is prophylaxis and why are antibiotics used for it?

A

prophylaxis is the process of trying to prevent infection
antibiotics are used in certain cases like Rheumatic fever but its not always a great idea (drives resistance)

51
Q

What is the difference between empiric therapy and direct/specific therapy?

A

empiric therapy is essentially making an educated guess on what the organism is and then logically choosing an antibiotic
direct therapy you know the organism, specificity, etc

52
Q

If a probable infection is presented, what are some things to keep in mind when considering if an antibiotic is indicated?

A

age, other illnesses, travel history, etc
examine chance that symptoms could be due to other things
consider likelihood of viral infection
consider urgency of the situaiton

53
Q

What are the eight steps in the logical stepwise approach to the selection of a specific antibiotic?

A
  1. is an antibiotic indicated?
  2. have appropriate lab specimens been obtained?
  3. what organisms are most likely?
  4. which drug is best?
  5. is combination therapy appropriate?
  6. what are the important host factors?
  7. best route of administration?
  8. what is the right dose and duration?
54
Q

Why do lab specimens need to be obtained before antibiotics are given?

A

antibiotics can sterilize blood and tissues quickly
follow-up cultures are less reliable

55
Q

What is a tool that can help you take into account regional data when trying to determine which organism is the most likely cause of infection?

A

antibiogram
-reports susceptibility
-gives you some direction
-more number tested=more faith

56
Q

What are some things to keep in mind when trying to determine which organism is most likely the cause of infection?

A

regional data
setting (hospital acquired vs community acquired vs nursing home acquired)
site of infection and circumstances
age of patient
immunosuppressed patients may present irregular bacteria

57
Q

What should be kept in mind when determining which drug is the best for an infection?

A

is there a drug of choice and can it be used?
patient allergies (real or not?)
penetration issues
location of infection
side effects
bactericidal or bacteriostatic
cost
dosage regimen
narrow or broad-spectrum

58
Q

What are situations where bactericidal antibiotics would be preferred?

A

severe or life-threatening infection
immunosuppressed patients

59
Q

What should you ask yourself when trying to decide if combination therapy is appropriate?

A

are multiple organisms likely?

60
Q

Why is combination therapy used for infection?

A

to limit resistance
for synergism (one antibiotic enhances activity of another)

61
Q

What are the risks of combination therapy?

A

increased risk of toxicities
increased risk of colonization with resistant organisms
higher costs
false sense of security

62
Q

What are important host factors?

A

pregnancy
renal or hepatic function (affects choice of antibiotic and dose)
immunosuppressed (may need bactericidal antibiotics)
prosthetic devices
age
drug-drug interactions
drug-disease interactions
patient preference
adherence

63
Q

Which drugs are safe, cautioned, and to be avoided in pregnancy?

A

safe: penicillins, cephalosporins, erythromycin base
caution: AMG, vancomycin, clindamycin, trimethoprim,
nitrofurantoin
avoid: tetracycline, FQ, TMP-SMX, erythromycin estolate,
sulfonamides

64
Q

What are some things to keep in mind when trying to determine best route of administration?

A

more of a question in hospital setting
in the outpatient setting almost always oral
serious infections require parenteral use

65
Q

What are some things to keep in mind when determining the right dose and duration?

A

the infection in question
individualized depending on patient factors

66
Q

What are some reasons for antibiotic failure?

A

noncompliance
under dosing
inaccessible site
prosthetic material
resistance
superinfection

67
Q

What is superinfection?

A

antibiotics drives secondary infection
some consider a resistant organism to be superinfection

68
Q

What are the five clinical manifestations of infection?

A

non-specific symptoms
fever
white blood cell count
other non-specific symptoms (anemia, increased ESR and CRP)
septic shock

69
Q

What is the process of diagnosing infection?

A
  1. history (signs/symptoms, source)
  2. physical examination (localize)
  3. lab (gram stain, C & S)

PHAR152 (21 decks)

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