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Infectious Disease Epi > Investigating an Outbreak and Bacterial Resistance > Flashcards

Investigating an Outbreak and Bacterial Resistance Flashcards

1
Q

Where was the outbreak with children with unknown, fatal, disease?

A

Sao Paulo Brazil

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2
Q

What are the purposes and objectives of an Outbreak Investigation?

A

-Identify the responsible infectious agent
-Identify the source and risk factors for the infection
-Control the outbreak

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3
Q

What was the illness in Brazil identified as?

A

Brazilian purpuric fever

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4
Q

What were some of the symptoms seen with this illness?

A

Acute illness in child 3 months to 10 years
- fever 101.3 F or higher
History of conjunctivitis within 15 days before fever
Negative test for Neisseria meningitidis

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5
Q

What was the hypothesis for this?

A
  1. BPF is a bacterial infection
  2. Preceding conjunctivitis (pink eye) puts children at risk for BPF
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6
Q

Who was able to collaborate to reduce the spread of Brazilian Purpuric Fever?

A

CDC

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7
Q

What was the first Hypothesis for BPF?

A

BPF is a bacterial infection

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8
Q

What was hypothesis #2 for BPF?

A

Preceding conjunctivitis (pink eye puts children at risk for BPF
- what was used to help confirm this value?
- odds ratio

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9
Q

What else is important besides a hypothesis?

A

implementing control and prevention activities

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10
Q

What was BPF caused by?

A

a new clone of Haemophilus influenzae biogroup aegyptius: AccI digests of purified plasmid preparations

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11
Q

What did the spanning tree analysis of the multi-locus sequence types show?

A

ST65 was a BPF clone

other STs = conjunctivitis isolates from Brazil

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12
Q

Along with investigating the findings what else is important?

A

communicating the findings

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13
Q

What did the Epidemic Intelligence Service at CDC do?

A

They established a training program in 1951
- early warning against biological warfare
- EIS officers played pivotal roles in combating the root causes of major epidemics
- many of nationals’s public health leaders are EIS alumni

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14
Q

What are Outbreaks as Epidemic Intelligence Service Officer

A
  • outbreak of foodborne illness among Peruvian marines in the Amazon
  • Anthrax in El Chaco, Paraguay
  • Epidemic meningococcal meningitis among pilgrims in Saudi Arabia
  • Moraxella conjunctivitis in New mexico
  • Meningitis in Virigna
  • BFP in Sau Paulo, Brazil
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15
Q

What is Drug Resistant Bacteria?

A

Vancomycin-resistant Enterococcus
Streptococcus pneumoniae
Methicillin- resistant Staphylococus auereus

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16
Q

Old, now drug resistant diseases?

A

S. Pneumoniae, TB

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17
Q

Emergence of Vancomycin-Resistant Enterococci in the US

A
  • cause of difficult to treat hospital acquired infections
  • UTIs, bacteremia, endocarditis, meningitisis
  • first reported in 1987
  • subsequent reports during the late 1980s in the northeast
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18
Q

Factors for Enterococci Resistance

A

increased use of oral vancomycin to treat Cdif infection and for surgical prophylaxis and treatment of MRSA
- use of broad- spectrum antibiotics
- agricultrual use of avoparcin, a glycopeptide related to vancomycin banned in 1997

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19
Q

What is the bactericidal effect of Vancomycin on Gram-Positive bacteria?

A

non-covalent binding of vancomycin via 5 H bonds to D-Ala-D-Ala terminus of peptidoglycan pentapeptide linker.

20
Q

What is transglycosylation?

A

stops growth of peptidoglycan chain by blocking addition of N-acetylmuramic acid and N-acetylglucosamine

21
Q

What is transpeptidation?

A

inhibits cross-linking, decreasing strength of cell wall

22
Q

What is the difference between the normal cell wall determinant and resistant phenotypes?

A

D- Ala -D Ala vs. D- Ala-D-Lact

23
Q

What is Van A transpon?

A

has 7 genes, 3 key genes for vancomycin resistance: VanH, vanA and van X
- changes peptidoglycan terminus from D-Ala to D-Lact

24
Q

VanH encodes _______ that converts D-isomer of Lactate

A

an alpha keto acid redcutase

25
Q

VanA encodes a D-Ala-D-Ala ______

A

that generates D-Ala D-Lact

26
Q

VanX encodes a _______ that cleaves D-Ala but not D-Lact

A

dipeptidase

27
Q

What are the sites of resistance of S. Pneumoniae to antibiotics?

A

Inhibition of protein synthesis is at erythromycin

Inhibition of peptidoglycan synthesis at penicillin

Inhibition of DNA synthesis and replication at fluroquiniquone

28
Q

T/F The amount of antibiotics are given from 2011-2016 increased/were around the same

A

true they stayed tobe around the same

29
Q

What were Antimicrobial prophylaxis and carriage or penicillin-resistant pathogens?

A

Flu increases with resistant strain

30
Q

What are the key messages of a common cold?

A
  1. Antimicrobial agents should not be given for the common cold
  2. Purulent rhinitis frequently accompanies the common cold and is not a separate indication for antimicrobial treatment
31
Q

Out of Otitis media, sore throat, bronchitis, sinusitis, and common cold, which one had the most reduction potential in potential antimicrobial uses?

A

Bronchitis

32
Q

What did the changes in incidence of invasive pneumococcal disease show?

A

There were slight changes in incidence of IPD from PCV7 to PCV13.

33
Q

What is an SNP?

A

genomes of most bacterial species consists of 2-7 million nucleotides
-rapid bacterial evolution results in a single nucleotide polymoprhisms (SNPs)

34
Q

What is Staphylococcus aureus?

A

-major cause of community-acquired infections
- skin infections
- bacteremia and endocarditis (high mortality)
-osteomyelitis

-major cause of healthcare-associated infection

-methicillian-resistant S. aureus (MRSA_

35
Q

MRSA’s resistance to methicillin is mediated by presence of the mecA gene, which encodes for _____

A

an abnormal low-affinity pencillin binding protein, PBP-2a

36
Q

MRSA permits the bacterium to grow and divide in the presence of _______

A

beta-lactam antibiotics

37
Q

mecA gene is located on a mobile genetic element called ______

A

SCCmec

38
Q

When was the rapid increase of MRSA in US hospitals?

A

in 2006, 46 of every 1000 impatients were infected or colonized with MRSA

39
Q

In 2011, what was the overall trend of Hospital onset, community associated and health care-associated community onset?

A

all three of them decreased

40
Q

Summary of Antibiotic Gram-Positive Bacteria
1. Antibiotics resistance is a _______

A

serious health problem

41
Q

Summary of Antibiotic Gram-Positive Bacteria
2. Bacteria have developed ____ for antibiotic resistance

A

multiple genetic mechanisms

42
Q

Summary of Antibiotic Gram-Positive Bacteria
3. Inappropriate _______ fuels the problem

A

antibiotic use

43
Q

What is VRE?

A

acquisition of vanA transposon that encodes for 7 genes

44
Q

What is Fluoroquinolone-resistance S. pneumoniae?

A

due to point mutations (SNPs) in gyrA and/or parC

45
Q

What is MRSA due to?

A

presence of mecA gene

Infectious Disease Epi (4 decks)

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