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Pharmacy I > Infectious Disease Introduction > Flashcards

Infectious Disease Introduction Flashcards

1
Q

What cells make up a WBC differential? What might be observed when using a differential for a patient has an infection?

A

Neutrophils > Lymphocytes > Monocytes > Eosinophils > Basophils

Bacterial infection might cause a left shift (increase in number of immature leukocytes especially neutrophil band cells, since body is working hard to rapidly mount a defense)

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2
Q

Define Minimum Inhibitory Concentration (MIC), and what are the 3 breakpoints?

A

MIC: lowest concentration of antibiotic that inhibits visible growth of the bacteria

  1. Susceptible = can treat with appropriate recommended doses
  2. Intermediate = can appropriately treat in body sites where drug is physiologically concentrated or if high dose is used
  3. Resistant = inhibition not achievable by concentration from normal dose
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3
Q

List the (aerobic) gram positive cocci

A

Coagulase positive: Staphylcoccus aureus - MSSA or MRSA

Coagulase negative: Staph. epidemidis and Staph. saprophyticus

Enterococcus faecalis, enterococcus faecium, enterococcus durans

Streptococcus pneumoniae (pneumococcus)

Beta-hemolytic: Streptococcus pyogenes (GrpA), streptococcus agalactiae (GrpB), streptococcus bovis (nonenterococci GrpD)

Alpha-hemolytic/Viridians: Streptococcus sangius, streptococcus salivarius, streptococcus mitis, streptococcus mutans

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4
Q

Where do staphylococci colonize? What infections do they cause?

A

Colonize skin and nose

Major role in post-surgical infection and can adhere to foreign materials and catheter
Infections: cellulitis/wounds/trauma, bacteremia/endocarditis, pneumonia, osteomyelitis, UTI

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5
Q

What has staphylococci developed resistance to? Any solutions?

A

Penicillin resistance by producing beta-lactamase (90% of all are PCN resistant)

Methicillin resistance by MecA gene for novel PBP2a (50% S. aureus resistant, 70% CoNS resistant)
*Methicillin-susceptible isolates are also susceptible to cephalosporins and carbapenems

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6
Q

Where do Streptococci colonize and what infections do they cause?

A

Colonizes skin (GrpA S. pyogenes), mouth (anaerobes, viridans strep), nasopharynx (GrpA S pyogenes), lower GI (GrpD S bovis, viridans strep), and female genital tract (GrpB S agalactiae)

Infections: cellulitis (GrpA S pyogenes may cause necrotizing fasciitis), dental carries (viridans strep), pharyngitis (strep throat i.e. Group A S pyogenes), bacteremia/endocarditis (viridans strep), neonatal meningitis (GrpB S agalactiae)

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7
Q

What is the general treatment for streptococci? Which specific types of streptococci show more resistance?

A

Use penicillin

More resistance with Alpha-hemolytic strep (specifically S. mitis)

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8
Q

Where do pneumococci colonize and what infections do they cause?

A

Colonizes oropharyx and nasopharynx

Infections: otitis media, sinusitis, bronchitis, pneumonia (CAP), meningitis

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9
Q

What is the concern for asplenia with pneumococci infection?

A

At risk for fulminant sepsis syndrome since there is a lack of filtration mechanism of spleen macrophages

Can not clear encapsulated organisms: S. pneumoniae, H. influenzae, N. menigitidis

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10
Q

What is the general treatment for pneumococci?

A

Due to PBP alterations, there are penicillin-resistant strains

Can use 3rd generation cephalosporins ) i.e. ceftriaxone)

May de-escalate with cultures and sensitivities
*De-escalate = start with broad spectrum until culture results return, then reassess therapy

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11
Q

Where do enterococci colonize and what infections do they cause?

A

Colonizes GI and female genital tract

Infections: opportunistic, UTI, bacteremia/endocarditis, intra-abdominal infections (but less significant for these in comparison to gram negatives and anaerobes)

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12
Q

Give examples of (aerobic) gram negative bacteria

*this flashcard only includes the bolded ones from lecture, there are many more gram negative bacteria not listed here

A

Rods:
Enterobacteraciea (i.e. Enterobacter spp, E. coli, Klebsiella pneumoniae, Proteus vulgaris, Proteus mirabilis, Serratia marcenena)

Pseudomonas aeruginosa

Cocci/coccobaccili (i.e. Haemophilis influenzae, Neisseria menigitidis)

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13
Q

Where do enterobacteraciae colonize and what infections do they cause?

*gram negative

A 
Colonizes GI (source usually from soil, water, vegetation)
*since gram negative... has LPS, cell wall component and endotoxin

Infections: UTI (70% of them), intra-abdominal, bacteremia, nosocomial pneumonia, diabetic foot infections

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14
Q

How is treatment guided for enterobacteraciae?

A

Resistance is prevalent and is more common in hospital-acquired infections

Treatment guided by in vitro susceptibility

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15
Q

Where can pseudomonas colonize and what infections do they cause? Name a specific example.

A

i.e. Pseudamonas aeruginosa = can colonize upper respiratory tract of immunocompromised patients (i.e. COPD, CF)
Not considered normal flora since found in soil/water/vegetation
Also is OPPORTUNISTIC so will attack immunocompromised, after broad spectrum antibiotics, and those on ventilation equipment

Pseudomonas infections: nosocomial infections i.e. HAP
Also febrile neutropenia, skin and soft tissue (burns, trauma, post-surgery), and UTI

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16
Q

Name the SPACE organisms, why is “double covering” needed to treat these?

A

SPACE = Serratia, Pseudomonas, Acinetobacter, Citrobacter, Enterobacter

Double covering means using two antibiotics to cover the same organism (the nasty ones)

Based on empiric treatment and may provide synergistic/additive effects especially for potentially resistant bacteria that may otherwise survive (but will cause more adverse effects)

17
Q

Give specific examples of cocci/coccobacilli (gram negative) and whether they are encapsulated or not

A

Haemophilus influenzae: if it is encapsulated it is not a regular colonizer but is more virulent and causes meningitis… if it has no capsule then it colonizes the upper respiratory tract and can cause otitis media, sinusitis and CAP

Neisseria menigitidis: it is encapsulated and colonizes the oro/nasopharynx, can cause meningitis and less commonly pneumonia
*humans are its only natural host

18
Q

Why does a polysaccharide capsule make it difficult to treat the bacteria that has it?

A

Capsule helps the bacteria elude the immune system and requires the spleen to be eliminated

Polysaccharide is the target for Haemophilis influenza type B (Hib) and Meningococcal vaccine

19
Q

Give 3 examples each of anaerobes found above and below the diaphragm

A

Above diaphragm: Peptostreptococcus spp (gram positive cocci), Actinomyces spp (gram positive rod), Fusobacterium (gram negative rod)

Below diaphragm: Bacteriodes fragilis (gram negative rod), Lactobacillus (gram positive rod), Clostridium spp (gram positive rod)

20
Q

Which isolates are usually penicillinase producers?

A

Gram-negative isolates

21
Q

Anaerobes are a diverse group and are found above and below diaphragm, where do they colonize and what infections do they cause?

A

Colonizes upper and lower GI tract as well as vagina

Infections: intra-abdominal, aspiration pneumonia, endometritis, PID, diabetic LE infections, dental carries, head and neck infections

22
Q

What are considered atypicals (bacteria)? Give 3 examples

A

Not normal colonizers and not able to gram stain
Multiply intracellularly

i. e. Mycoplasma pneumonia, Legionella pneumophilia, Chlamydophila pneumoniae
* Result in CAP

23
Q

Give an example of a bacteria that causes HAP

A

Viridans streptococcus

24
Q

Give 3 examples of bacteria that can cause CAP

A

S. pneumoniae
Atypicals
H. influenzae

25
Q

Give examples of encapsulated bacteria

Even Some Super Killers Have Pretty Nice Capsules

A 
Escherichia Coli (E.coli)
Streptococcus Pneumoniae
Salmonella
Klebsiella pneumoniae
Haemophilus influenzae
Pseudomonas aeruginosa
Neisseria meningitidis
Cryptococcus neoformans (actually a yeast)
26
Q

Which of the (staph) bacteria produces the enzyme coagulase?

A

Staphylococcus aureus

Staphylococcus epidemidis and Staphylococcus saprophyticus both do NOT produce coagulase

27
Q

In summary, name the 9 important “classes” of bacterial pathogens (with examples)

A

Streptococci i.e. Group A strep, Viridans strep

Streptococcus Pneumoniae

Enterococcus (usually faecalis)

Staphylococcus i.e. S. aureus and coagulase-negative ones

Atypicals i.e. Mycoplasma, Chlamydia, Legionella

Haemophilus Influenzae

Gram-negative rods i.e. E.coli, Klebsiella, Proteus etc.

Pseudomonas Aeruginosa

Anaerobes i,e, Bacteroides, Clostridia, Prevotella

Pharmacy I (13 decks)

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