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Clinical Foundations > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

Selective Toxicity

A

An Ideal antibiotic agent targets a biological mechanism specific top the pathogen.
Easier to achieve with prokaryotes and viruses.

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2
Q

Minimum inhibitory concentration (MIC)

A

The lowest concentration of a compound that inhibits growth of the microorganism in vitro.

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3
Q

Minimum Bactericidal Concentration (MBC)

A

The lowest concentration of a compound needed to kill 99.99% of microorganisms in a colony count in vitro.

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4
Q

Other important pharmacokinetic factors with antibiotics

A

Ability to reach site of infection

Difficult areas to reach include bone, CNS, adipose.

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5
Q

Toxicities of Antibiotics

A

Allergic reactions
Idiosyncratic reactions
Pharmacogenomic reaction
Normal flora changes —> can lead to C. Diff

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6
Q

Bactericidal

A

Kills the microorganisms

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7
Q

Bacteriostatic

A

halts growth of an infection, innate immune system can then remove the pathogens

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8
Q

Broad Spectrum

A

Effective against a wide range of organisms

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9
Q

Extended spectrum

A

Agents with an intermediate range of effectiveness

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10
Q

Narrow spectrum

A

Effective against only a few organisms

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11
Q

Antibiotics that interfere with Cell Wall synthesis

A

Beta Lactams
Vancomycin
Bacitracin
Polymyxins

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12
Q

Antibiotics that interfere with Nucleic acid synthesis

A

Sulfonamides
Trimethoprim
Quinolones
Rifampin

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13
Q

Antibiotics that interfere with Protein synthesis

A 
Macrolides (-mycins)
Linezolid
Chloramphenicol
Streptogramins
Tetracyclines
Aminoglycosides
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14
Q

Cell Wall synthesis inhibitors are ____

A

Bactericidal

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15
Q

Protein and Nucleic acid synthesis inhibitors are _____

A

Bacteriostatic

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16
Q

Cell wall synthesis inhibitors prevent ________

A

Peptidoglycan crosslinking. This requres transpeptidase to link together D-alanine residues on murein monomers

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17
Q

Beta-Lactam drugs work by ____

A

Targeting transpeptidase. The beta-lactam ring binds transpeptidase.

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18
Q

Examples of Beta-lactams

A

Penicillins- Natural effective against Gram+ Syphillis, Extended good for Gram +/-
Cephalosporins- 5 gens, each different
Carbapenems- potent, broad spectrum
Monobactams- narrow spec, Gram - only, safe for those with allergy to Beta-lactam ring.

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19
Q

Beta-lactamases are a ______ that work by _____

A

Bacterial resistance

Opening the Beta-lactam ring

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20
Q

Beta-lactamase can be over come with ___

A

Combination therapy of strong and weak Beta-lactam.
Ex. Amoxicillin/Clavulanate
Or
Modification of antibiotic so access to ring is restricted.
Ex. Methicillin.

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21
Q

Glycopeptides

A

Cell wall inhibitors that bind to D-alanine residues on monomers.
Ex. Vancomycin
Last line treatment for MRSA

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22
Q

Lipopeptides

A

Ex. Daptomycin

Cell wall inhibitors, insert into the plasma membrane to disrupt the cell wall.

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23
Q

Bacitracin

A

Cell wall inhibitor that prevents peptidoglycan subunits from being transferred to cell surface.
Only approved for external use.

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24
Q

Polymyxins

A

Cell membrane inhibitor.
Small, positively charged peptides that disrupt structure.
Gram - only
Cannot be absorbed in GI tract due to charge.

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25
Q

DNA/RNA inhibitors

A

Broad spectrum
Direct inhibitors are Bactericidal
Indirect inhibitors are Bacteriostatic

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26
Q

RNA polymerase inhibitor

A

Rifampin

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27
Q

Topoisomerase inhibitor

A

Quinolones

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28
Q

DNA structure stability inhibitor

A

Metronidazole

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29
Q

Inhibitors of folic acid synthesis

A

Sulfonamides
Trimethoprim
Used synergistically

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30
Q

Protein synthesis inhibitors

A

Generally bacteriostatic

Either inhibit 50S or 30S ribosome

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31
Q

50S inhibitors

A

Chloramphenicol
Macrolides: Erythromycin, Clindamycin, Lincomycin
Lenzolide

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32
Q

30S inhibitors

A

Tetracyclines

Aminoglycans

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33
Q

Additive Combination therapy

A

Drugs add to each other’s efficacy in a summative manner

Ex. Beta-lactamase inhibitor + beta-lactam

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34
Q

Synergistic combination therapy

A

Drugs enhance each others efficacy greater than summative effect
Ex. Sulfonamides and trimethoprim

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35
Q

Antagonistic COmbination therapy

A

One drug impairs the efficacy of the other

Ex. Tetracyclines + Penicillins

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36
Q

Categories of infectious agents

A 
Bacteria
Viruses
Parasites
Fungi
Prions
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37
Q

Transmission routes of infectious disease

A 
Direct contact
Fluid exchange
Contamination
Airborne
Vector
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38
Q

Portals of entry

A

Mucosal membranes
Skin
Parenteral route (puncture)

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39
Q

Localized infection

A

Localized replication and spread of pathogen

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40
Q

Systemic infection

A

Replication and spread to blood and neurons potentially

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41
Q

Normal Host defenses

A 
Skin
Mucous membranes
Resp tract
GI tract
UG tract
Eyes
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42
Q

Host factors

A 
Influence the course of infection:
Non-specific immune response
Immune status
Genetics
Age
Nutritional status
Hormones
Personal Habits
Fever
Microbiome
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43
Q

Anti-viral effect of IFN

A

Virus infects cell and produces viral DNA, induces interferon synthesis, interferon is secreted.
Antiviral state is induced by binding of interferon to receptor on cell surface.

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44
Q

INTERFERON INDUCTION

A

EIF-2alpha Protein Kinase: inhibits initiation of mRNA translation
Oligo-adenylate synthase: activates RNSase L, leading to degradation of mRNA and tRNA.

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45
Q

Common types of vaccines

A

Inactivated pathogen
Live, attenuated
Subunit, purified antigen
Toxoid

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46
Q

What test delineates Staph and Strep?

A

Catalase test

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47
Q

Characteristics of a Gram-positive infection

A 
Bullous impetigo
Draining sinus tracts
Erythema
Fever
Murmur if endocarditis
Petechiae is TSS present
Superficial abscesses
Warmth
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48
Q

Streptococci

A

Gram positive cocci
Forms chains of cocci
Catalase negative
Ex. S. Pneumoniae, pyogenes, agalactaie, viridans

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49
Q

Staphylococci

A

Gram positive cocci
Catalase positive
S. Aureus and others
S. Aureus is Coagulase positive

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50
Q

Staph. Aureus diseases

A 
Wound infection
food poisoning
Scalded skin syndrome
TSS
Endocarditis, osteomyelitis, pneumonia, brain abscesses, meningitis, and bacteremia
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51
Q

MRSA

A

Methicillin resistant staph aureus

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52
Q

Staph aureus virulence factors

A 
Adhesins
exotoxins- enterotoxins, TSS toxin, Exfoliative toxins
Superantigens
Biofilms
Beta-lactamase
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53
Q

Conjugation

A

One bacteria uses a sex pili to inject part of a resistance plasmid into another

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54
Q

Transformation

A

DNA from one bacteria is lysed and incorporated into the genome of another bacteria that picks it up

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55
Q

Transduction

A

Bacteria forms bacteriophage, which injects resistance genes into new bacteria cells.

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56
Q

Biofilms

A

Aggregates of bacteria
Extremely resistance to antibiotics
Resistant to phagocytosis

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57
Q

Gram positive bacilli

A 
Clostridia
Bacillus
Listeria
Erysipelothrix
Corynebacterium
Mycobacteria

Can be differentiated by catalase, fermentation, urease/gelatinase, and hemolysis

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58
Q

Spore forming Gram + Baccilli

A

Clostridia

Bacillus

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59
Q

Anaerobic Gram + baccilli

A

Clostridia
Can cause abscesses and life threatening infections
Ex. C. Diff, C. Perfringens (gas gangrene)

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60
Q

Gram negative cocci

A

Neisseria

Moraxella

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61
Q

Appropriate culture medium for GNC

A

Blood agar
Chocolate agar
Thayer-Martin agar(selective for neisseria)

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62
Q

Neisseria

A

Oxidase positive
Catalase positive (except, elongata)
N. Gonorrhea
N. Meningitidis

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63
Q

Gram negative bacilli

A 
Haemophillus
Aggregatibacter
Actinobacillus
Pasturella
Enterobacteriaceae
Pseudomonas
Burkholderia
Stenotrophomonas
Acinetobacter
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64
Q

Enterobacteriaceae

A 
Escherichia
Salmonella
Shigella
Yersinia
Klebsiella
Proteus
Citrobacter
Enterobacter
Serratia
65
Q

Type of Haemophillus

A

Inflenzae
Aegyptius
Ducreyi

66
Q

Most common Gram negative infections

A 
E. Coli
Pseudomonas aeruginosa
Klebsiella
Acinetobacter baumannii
Enterobacteriaceae
67
Q

Risk factors for Gram - infection

A 
Hospitalization
Recent surgery
Urinary catheter
War wounds
Dialysis
Mechanical ventilator
Weak immune system
68
Q

Gram - Spiral shaped bacteria

A

Campylobacteraceae

Helicobacteraceae

69
Q

Other Gram - bacilli

A 
Bordetella pertusis
Brucella
Francisella tularensis
Legionella pneumophila
Bartonella
Vibrio
70
Q

Moraxella catarrhalis

A

3rd leading cause of bacterial ear infections in children
URI in adults
Cause of COPD exacerbation

71
Q

Serratia marcescens

A

Hospital settings/ medical exposure
Immunosuppresion, previous antibiotics, catherterization
Infecctive endocarditis in drug users
Enterobacteria family

72
Q

Haemophilus influenzae

A

Hib is primary causative agent of acute epiglottis

73
Q

Characteristics of bacteria

A 
Prokaryotes
Cell wall
Nucleoids and plasmids
Flagella, pili
Capsules
Virulence factors
74
Q

Bacterial cell wall is composed of

A

peptidoglycan branched together by Amino acids

75
Q

Cell wall in Gram Positive bacteria

A

Thick peptidoglycan layer outside plasma membrane

76
Q

Cell wall of Gram negative bacteria

A

Thin peptidoglycan layer between two lipid bilayers, outside layer contains imbedded endotoxins

77
Q

Objects of Antibiotic activity

A 
Nucleic acid synthesis
RNA polymerase
Ribosome protein synthesis
Folate synthesis
Cell membrane
Cell Wall
LPS and/or TLR4
78
Q

Differential media

A

Allows closely related bacteria to grow, in a unique way that allows their differentiation when compared to each other
Ex. Blood agar

79
Q

Selective media

A

Used to isolate a particular kind of bacteria, allowing only the selected type of bacteria to grow.

80
Q

Blood Agar

A

Differential media, can be used to distinguish between bacterial species that are alpha hemolytic, beta hemolytic, and non-hemolytic

81
Q

Chocolate Medium

A

Non-Selective growth medium

Thayer-Martin Medium is has been treated with antibiotics so that it IS SELECTIVE ONLY to Neisseria.

82
Q

MacConkey Agar

A

Selective and differential medium
It is SELECTIVE for Gram (-) and Enteric bacilli because of its crystal violet and bile salts, and DIFFERENTIATES based on amount of lactose fermentation by turning pink in the presence of fermentation.

83
Q

Bacterial virulence factors

A

Capsule
Cell surface structures
Secreted toxins and enzymes

84
Q

Indirect virulence factors

A

Siderophores
Secretion machinery
Catalase
Regulatory factors

85
Q

Mycoplasma

A

Simplest bacteria, no cell wall, very small genome
Complex nutritional requirements
Triple later cell membrane
Generally infects upper respiratory tract
Attached to sialoglycoproteins
Can secrete oxidants— damage tissues
Mycoplasma pneumoniae
Ureaplasma urealyticum
Spread through droplets
IgM, IgG and IgA in that order respond
Immunity is not long lasting, can relapse.

86
Q

Mycoplasma pneumoniae clinical manifestations

A 
Dry cough
Wet cough after 3-4 days
Tracheobronchitis
Scattered rhonchi and expiratory wheeze
Atypical pneumonia may develop
Can exacerbate asthma
87
Q

Mycoplasma pneumoniae Diagnosis

A

Mild leukocytosis
WBC up to 15,000 microliter
Non-viscous sputum
non-specific radiological images

88
Q

Mycobacteria

A

Aerobic, immobile, bacilli, gram positive
Slow growing. Mycolic acid in cell wall—> only stain with Acid Fast
Some species may be pigmented yellow or orange
Lipid rich cell wall
tuberculosis, NTM, leprae

89
Q

Mycobacterium tuberculosis

A

Can be caused by many species of Mycobacterium
One of the world’s deadliest diseases
Leading killer of HIV infected patients
Lowenstein-Jensen culture media
Infectious pulmonary TB, easy to transmit

90
Q

Nontuberculosis mycobacteria (NTM)

A

Over 150 found in nature
M. Avium is most pathogenic
Difficult to diagnose

91
Q

Mycobacterium lepra

A

Causes Leprosy
Slow proliferation, incubation for months to years
Only 5% of people can actually develop leprosy
Close contact transmission
Can be tuberculoid or lepromatous

92
Q

Legionella

A

Found in freshwater and human made building water systems
Spread through droplets
Elderly/immunocompromised most at risk
Grows in Buffered charcoal yeast Extract agar

93
Q

Chlamydia

A

Biphasic developmental cycle
Environmentally stable infectious particle (EB)
EB stain purple with Giemsa, non-infectious RBs stain blue
Elementary bodies enter host cell, form reticulate bodies which multiply and differentiate into elementary bodies. Forms inclusion in cell.
Cell lysis spreads EBs.
Obligate parasites
Can only be cultured in Eukaryotic cell lines.

94
Q

Ricketsiaceae

A 
Obligate intracellular parasite
Transmitted via arthropod
Fever, rashes, vasculitis
Coccobacilli
Multiply in endothelial cells of small blood vessels
Infected cells swell, necrose
95
Q

E. Coli

A

Food poisoning, UTI, gastroenteritis, newborn meningitis

96
Q

Pseudomonas aeruginosa

A

Lung and UTI

97
Q

Klebsiella

A

Meningitis, lung, UTI and blood stream infections

98
Q

Acinetobacter baumannii

A

Several infections in war wounds

99
Q

Enterobacteriaseae

A

UTI, lung and bloodstream infections, food poisoning

100
Q

What is a virus?

A

A virus is a pathogen that is not alive. The basic structure of a virus is a genome composed of RNA or DNA, a capsid, and an optional envelope.

101
Q

Viral Genomes

A

Can be ssDNA or dsDNA, linear or circular
Can be ssRNA, plus or minus sense, or dsRNA
Genome can be complete or fragmented.

102
Q

Plus sense RNA

A

the genome is ready to be translated into proteins

103
Q

Minus sense RNA

A

The genome must first be transcribed to a plus sense RNA in order to be translated into protein

104
Q

Naked virus

A

Lacks an envelope

105
Q

Basic steps of viral life cycle

A
  1. Attachment to host
  2. Entry to host cell- Endocytosis or membrane fusion (doesn’t need step 3)
  3. Uncoating
  4. Viral gene expression
  5. Viral genome replication
  6. Assembly of capsids
  7. Maturation
  8. Egress- budding or cytolysis
106
Q

Cytopathic effects of viral replication

A

Lytic infection
Syncytium formation
Hyperplasia
Transformation

107
Q

Lytic infection

A

Virus can only replicate via cell lysis, so it produces characteristic lysed cells, visible on stain by the lack of cytoplasm and shriveled nucleus remaining.

108
Q

Syncytia formation

A

Enveloped viruses can cause fusion between cell membranes of infected cells, forming giant cells. HIV does this.

109
Q

Hyperplasia

A

Cells multiply in order to absorb stimulus. Ex. Epstein Barr Virus, Papilloma virus

110
Q

Transformation

A

Changing of normal cell function to abnormal, usually cancerous growth. Ex. HTLV (leukemia), HPV (cervical cancer)

111
Q

Common viral causes of latent infection

A

Measles
Herpes simplex
Herpes zoster

112
Q

Immunopathological reaction example

A

Dengue virus causing plasma leakage in eye

113
Q

Example of viral cause of altered development

A

Zika virus— microcephaly

Rubella virus, cytomegalovirus can also cause birth defects

114
Q

Acute viral infections

A

Acute followed by clearing

Ex. Rhinovirus, rotavirus, Influenza virus

115
Q

Chronic infection

A

Virus does not clear after acute infection

Ex. Hepatitis B, C

116
Q

Latent infection

A

Reactivates at certain periods of time.

Ex. Herpes simplex and zoster

117
Q

Slow virus infection

A

Acute infection followed by persistent infection and virus overproduction.
Ex. Measles virus SSPE, HIV

118
Q

Viral factors influencing outcome of infection

A

Virus host range
Viral virulence
$ of viral particles present in inoculum

119
Q

RNA viruses encode their own ____

A

RNA polymerase

120
Q

Picornavirus features

A

Rhinoviruses and Enteroviruses
Naked
Plus-sense ssRNA, linear
Cytolytic

121
Q

Enteroviruses

A

PH range 3-10
Small intestine major site
Prefer 37 degrees C

122
Q

Rhinoviruses

A

pH 6-8
Primary at nasal mucosa
Prefer 33 degrees C

123
Q

Picornavirus syndromes

A 
Aseptic meningitis
Encephalitis
Common cold
Febrile rash illnesses (HFM disease)
Conjunctivitis
Herpangina
Myositis and myocarditis
Hepatitis
124
Q

Paramyxovirus Features

A

Negative sense ssRNA, linear
Enveloped, fusion proteins, HNs
Mumps, measles, respiratory tract infections (resp syncytial virus, parainfluenza virus, metapneumoviruses)
Budding to spread

125
Q

Orthomyxovirus Features

A 
Influenza viruses
Negative sense, ssRNA, segmented
Enveloped, Surface glycoproteins Hemagglutinin and Neuraminidase (HN)
Very antigenically variant
Transfer via budding
126
Q

Orthomyxovirus antivirals

A

Target unique replication features, attachment and polymerase

127
Q

Orthomyxovirus syndromes

A

Respiratory tract infections, mild to severe

Vaccination can decrease severity

128
Q

Reovirus Features

A

8-11 segments of dsRNA
Naked
Rotavirus
Cytolytic

129
Q

Rotavirus

A

Leading cause of severe, dehydrating gastroenteritis in children under 5. Infects enterocytes, destroying them, decreasing GI absorption, causing diarrhea

130
Q

Retrovirus features

A

Plus sense, ssRNA with reverse transcriptase
RNA is transcribed into DNA and inserted into cellular genome
Enveloped.
Transfers via budding
HIV, feline leukemia virus

131
Q

Parvoviridae Features

A

Very small
Naked
linear, ssDNA with hairpins
Only replicates in actively dividing cells

132
Q

Human Parvovirus B19

A

Replicates in immature erythroid cells
Aplastic crisis
Fifth disease
Fetal death

133
Q

Polyomaviridae

A

Small
Naked
heat-stable, solute resistant
Circular dsDNA
Slow replication cycle, in cell nucleus, uses cellular enzymes
JC virus, BK virus, Merkel cell virus
Usually only in immunocompromised patients

134
Q

JC virus

A

Causes progressive multifocal leukoencephalopathy

135
Q

BK virus

A

Associated with nephropathy in transplant recipients

136
Q

Merkel cell virus

A

Associated with the majority of Merkel cell skin carcinomas

137
Q

Papillomaviridae

A

Small
Circular, dsDNA
Naked
Causes warty lesions, many types, can cause genital cancers

138
Q

Adenoviridae

A

Medium sized, naked
Capsisd contains spike-like attachment protein
Linear, dsDNA with repeats
Cytolytic
“pan-handle” replication
Causes acute respiratory disease, conjunctivitis, gastroenteritis

139
Q

Hepadnaviridae

A

Small, enveloped
Circular, partially dsDNA
Envelope contains lipid and viral surface antigens
Hepatitis B, persistent infection associated with liver cancer

140
Q

Herpesviridae

A

Large, enveloped with glycoprotein spikes (peplomers)
Linear, dsDNA
Can establish latent infections
Encodes its own DNA polymerase
HSV, Zoster, Epstein-Barr, HHV 6, 7, 8, Cytomegalovirus

141
Q

Causes of mononucleosis

A

Epstein-Barr virus

Cytomegalovirus

142
Q

Poxviridae

A 
Very large virus
Lipid contraining envelope. 
Linear, covalently closed, dsDNA genome
Replicate in cell cytoplasm
Small pox, vaccinina, molluscum contagiosum, monkey pox
143
Q

Fungi

A

Yeast
Molds
Dimorphic
Opportunistic

144
Q

Fungal branching

145
Q

True pathogenic fungi

A

Asperillus
Candida
Histoplasma

146
Q

Opportunistic fungi

A

Cryptococcus

Pneumocystis

147
Q

Mycotoxicoses

A

amanitin and phalloidin- Magic mushrooms
Aflatoxin- grows on peanuts
ergotism- grows on grains

148
Q

Fungal cell wall

A

Composed of chitin
Contains ergosterol
Ergosterol is the main target of most antifungals

149
Q

Pathogenesis of Fungal infections

A

Granuloma formation

Acute suppuration

150
Q

Medium for culturing fungal infection

A

Sabouraud’s agar

151
Q

Types of parasites

A

Protozoa: amoebas, sprozoans, flagellates, cilliates

Metazoa/Helminths: Roundworms, flatworms (flukes and tapeworms)

152
Q

Protozoan parasites

A 
Entamoeba
Giardia, Leishmania
Trichomonads, trypanosoma
Plasmodium (Malaria), Cryptosporidium
Toxoplasma
153
Q

Helminths

A

Multicellular organisms
Large parasitic worms
Flukes, Tapeworms, and round worms (nematodes)

154
Q

Pathogenesis of helminths

A

Toxic byproducts
Mechanical tissue damage
Immunopathology

155
Q

Helminth evasion of immune system

A

Molecule mimicry
Antigenic variation
Intracellular location
Immunosuppression

156
Q

Antiparasitic drugs

A

Heavy metals
Quinolone derivatives
Folic acid antagonists

157
Q

Prions

A

Infectious, misfolded proteins
Scrapies protein
Fatal neurodegenerative diseases

158
Q

Prion diseases

A 
CJD
Variant CJD
Gerstmann-Straussler-Scheinker Syndrom
Fatal Familial insomnia
Kuru
Mad Cow disease (bovine)
Chronic wasting disase (deer)

Clinical Foundations (17 decks)

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