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KG - Microbiology Exam 2 > KG - Microbiology Exam 2 > Flashcards

KG - Microbiology Exam 2 Flashcards

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1
Q

viruses that cause ARD (common cold)?

A

adenovirus (30-40%)
rhinovirus (25%) - some say 50%?
coronavirus (10%)

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2
Q

viruses that cause ARD (common cold)?

A

adenovirus (30-40%)
rhinovirus (25%) - some say 50%?
coronavirus (10%)

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3
Q

diagnosis ARD?

A

clinical

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4
Q

treatment ARD?

A

symptomatic only

NO Zicam

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5
Q

treatment rhinovirus specifically?

A 
zinc gluconate (symptomatic) 
Picovir - not mass market yet
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6
Q

viruses that cause flu?

A

influenza A, B, C

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7
Q

prevention influenza?

A

vaccines - 2 type As, 1 type B

now 2 As, 2Bs - recent change?

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8
Q

diagnosis influenza?

A

rapid viral ID tests for antigen swabs

– can have false negatives early on

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9
Q

treatment influenza?

A

amantadine & ramantadine = type A (stops uncoating & penetration)

oseltamivir & zanamivir = type A & B (stops spread, release)

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10
Q

complications influenza?

A

pneumonia, Reyes, Guillain-Barre

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11
Q

antigenic drift? (flu)

A

point mutations, H or N

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12
Q

antigenic shift? (flu)

A

genome sequence recombinations - most important to pandemics

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13
Q

viruses that cause Chlamydiae?

A

C. trachomatis, C. pneumoniae

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14
Q

risk factor for C. trachomatis? prophlaxis?

A

infected mother, prophylaxis = silver nitrate eye drops

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15
Q

common infectious state/pop of C. trachomatis?

A

infants 3 wks post birth

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16
Q

C. pneumoniae also causes ___

A

bronchitis, pneumonia, sinusitis, & associated w/ atherosclerosis

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17
Q

viruses that cause Chlamydiae?

A

C. trachomatis, C. pneumoniae

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18
Q

risk factor for C. trachomatis? prophlaxis?

A

infected mother, prophylaxis = silver nitrate eye drops

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19
Q

common infectious state/pop of C. trachomatis?

A

infants 3 wks post birth

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20
Q

what syndrome is associated w/ C. trachomatis?

A

Reiter’s Syndrome

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21
Q

two forms chylamidiae?

A

elementary body = infectious agent

reticulate body = growing form

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22
Q

cause Croup?

A

PIV1 > PIV 2&raquo_space;> RSV

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23
Q

age typically of croup?

A

6-18 months old

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24
Q

diagnosis croup?

A

direct FAB test

- must have direct viral isolation from throat/nasal swabs

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25
Q

treatment croup?

A

symptomatic

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26
Q

describe P. aeruginosa

A

G- bacilli
encapsulated
pigment producer - pyocyanin, pyoverdin (these = VF)

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27
Q

signal sign on CXR croup?

A

steeple sign

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28
Q

PIV causes ____

A

croup, OM, parotitis

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29
Q

describe PIVs

A

paramyxovirus, nonsegmented neg sense ssRNA, enveloped, 4 serotypes

  • virion enveloped by protein spikes
  • hemagglutinin & neuraminidase activities on same peplumed molecule
  • NF proteins cause syncytia formation
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30
Q

most vulnerable to PIV?

A

immunocompromised

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31
Q

diagnosis PIV?

A

direct FAB test

- must have direct viral isolation from throat/nasal swabs

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32
Q

lifelong immunity to PIV?

A

NO, but usu mild later on

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33
Q

treatment PIV?

A

symptomatic

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34
Q

vaccine PIV?

A

NONE available

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35
Q

group common of winter outbreaks RSV?

A

infants < 1 yo (peak 2-3 months old)

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36
Q

most common cause LRIs?

A

RSV

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37
Q

why symptoms in RSV?

A

infection of epithelium of resp tract –> causes inflammatory response of IgE and Tcells

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38
Q

risks for RSV?

A

birth 3-4 months prior to winter, kids w/ underlying dz, premature birth, cardiac/resp abnormalities

  • also immunocompromised adults
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39
Q

diagnosis RSV?

A

rapid antigen test & immunofluorescence assay

serology not common anymore

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40
Q

treatment RSV?

A

monoclonal immune globulin for high risk pts (Palivizumab)

Ribavirin (controversial)

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41
Q

cause Otitis Externa?

A

P. aeruginosa & S. aureus

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42
Q

describe S. aureus

A

G+ cocci
encapsulated
COAG +
beta-hemolytic (+ if you can see through plate)

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43
Q

diagnosis OE?

A

exam, gram stain

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44
Q

treatment OE?

A

remove debris, topical antibiotics, oral antibiotics if fever, systemic analgesics

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45
Q

describe VOLUTIN staining for diphtheria?

A

Volutin = metachromic (volutin) granules

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46
Q

describe S. pneumoniae

A

G+ diplococci lancet
encapsulated
alpha-hemolytic (can’t see through plate)
optochin sensitive

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47
Q

describe H. influenzae

A

G- coccobacilli

non-typeable strain

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48
Q

describe M. catarrhalis

A

G- diplococci
oxidase positive
beta lactamase producer

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49
Q

diagnosis AOM?

A

clinical, tympanocentesis to aspirate fluid in severe pts, culture/stain

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50
Q

diagnosis sinusitis?

A

clinical/hx, nasal cytology, CT, allergy testing

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51
Q

treatment AOM?

A

amoxicillin, tubes for chronic

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52
Q

treatment sinusitis?

A

varies depending on cause - irrigation, analgesics, OTC decongestants, antibiotics, steroids, surgery

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53
Q

cause diphtheria?

A

Cornebacterium diphtheriae

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54
Q

describe cornebacterium diphtheriae

A

G+ pleomorphic bacilli
metachromic gracules
aerobic on blood agar
“Chinese letter appearance”

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55
Q

signs diphtheria (cutaneous)?

A

non healing ulcers

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56
Q

signs diphtheria (respiratory)?

A

sudden onset, malaise, fever, lymphadenitis, BULLNECK, PSEUDOMEMBRANE

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57
Q

diagnosis diphtheria?

A

clinical, culture & staining

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58
Q

describe culture: Loeffler’s medium?

A

for diphtheria:

supports growth and enhances formation of volutin granules

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59
Q

major complication pertussis?

A

pneumonia

- also vomiting, increased intracranial pressure, seizures, encephalopathy

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60
Q

describe GRAM staining for diphtheria?

A

Gram = club shaped, G+ bacilli

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61
Q

describe VOLUTIN staining for diphtheria?

A

Volutin = metachromic (volutin) granules

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62
Q

treatment diphtheria?

A

antitoxin, erythromycin, isolation, & vaccination once pt recovers

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63
Q

VF diphtheria?

A

AB exotoxin – B binds to receptors, is endocytosed, vesicle acidifies, A subunit released, A subunit inactivates EF-2 ADP ribosylation & halts protein synthesis

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64
Q

cause Pertussis?

A

Bordetella pertussis

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65
Q

describe bordatella pertussis

A

G- coccobacilli
aerobic
VF: 2 adhesins, 4 exotoxins

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66
Q

what do adhesions do in pertussis?

A

mediate attachment to integrins & colonization of ciliated respiratory epithelium

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67
Q

pertussis exotoxins (4)

A
  1. pertussis toxin (AB exotoxin) = lymphocytosis
  2. adenylate cyclase toxin = causes decreased chemotaxis
  3. dermonecrotic toxin = vasoconstriction, necrosis
  4. tracheal cytotoxin = kills ciliated resp epithelial cells
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68
Q

describe stage 1 pertussis

A

catarrhal stage: inflamed mucosa, contagious, 7-10 day incubation, nonspecific URI

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69
Q

describe stage 2 pertussis

A

paroxysmal stage: attacks/spasms w/ “whoop” sound that can be followed by vomiting, labored inspiration, 2-4 wks

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70
Q

describe stage 3 pertussis

A

convalescent stage: gradual recovery wks - months

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71
Q

diagnosis pertussis?

A

presumptive diagnosis = ELISA serology

definite diagnosis = culture or PCR

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72
Q

treatment pertussis?

A

erythromycin (or Bactrim)

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73
Q

what cultures are used for Pertussis?

A

Bordet-Gengon agar

Regan-Lowe agar

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74
Q

vaccine for pertussis?

A

YES - prevention is key

75
Q

major complication pertussis?

A

pneumonia

- also vomiting, increased intracranial pressure, seizures, encephalopathy

76
Q

causes CAP, typical?

A

S. pneumoniae
H. flu
Klebsiella pneumoniae
S. aureus

77
Q

causes CAP, atypical, zoonotic?

A

C. psittaci
F. tularensis
C. bunetii

78
Q

causes CAP, atypical, non-zoonotic?

A

C. pneumoniae
M. pneumoniae
L. pneumoniae

79
Q

which is most common cause of CAP?

A

strep pneumoniae = 60-70% CAP

80
Q

describe strep pneumoniae

A 
G+ diplococci lancet
encapsulated
alpha-hemolytic (greenish-grey colonies)
optochin sensitive
~90 serotypes (based on capsule)

VF: capsule, pneumolysin, autolysin, teochoic acid

81
Q

diagnosis CAP via strep pneumoniae?

A

consolidation on CXR
gram stain (G+ lancet diplococci, non staining capsule - not req for growth)
culture & sensitivity (blood agar, small, greenish colonies)
agglutination test for capsule saccharides
genetic probe

82
Q

treatment CAP via strep pneumoniae?

A

PCN G

83
Q

presumptive diagnosis CAP (strep pneumoniae)?

A

optochin sensitivity

84
Q

confirmation test CAP (strep pneumoniae)?

A

bile solubility test - bile will lyse alpha hemolytic strep pneumoniae, but have no other effect on other alpha hemolytic strep

85
Q

what is the Quellung reaction use for w/ CAP?

A

to observe capsules - mix organism isolated from pt w/ known anti-capsule serum (used when two possible capsules in sample)

86
Q

vaccine for CAP?

A

YES - 23 & 13 valent

87
Q

CAP VF strep pneum: capsule?

A

C3b prevents opsonization - inhibits phagocytosis

88
Q

CAP VF strep pneum: pneumolysin?

A

forms transmembrane pores, results in lysis & activates complement

89
Q

CAP VF strep pneum: peptidoglycan/techoic acid?

A

causes overstimulation of immune response

90
Q

CAP VF strep pneum: autolysin?

A

lysis of strep cells causing release of pneumolysin - response to antibiotics, dampen host response

91
Q

when will H. influenzae lyse RBCs?

A

requires comorbid infection to lyse RBCs

92
Q

CAP VF strep pneum: H2O2?

A

apoptosis in host cells, eliminate competing bacteria

93
Q

CAP VF strep pneum: pili?

A

contribute to colonization of URT, activate production of TNF

94
Q

CAP VF strep pneum: surface proteins?

A

choline binding proteins - adhesins that interact w/ carbohydrates on surface of plum epithelial cells

95
Q

describe Klebsiella pneumoniae (CAP & HAP)

A

G- bacilli
non-motile
thick, slimy coat
in normal flora

96
Q

CAP VF M. pneumoniae?

A

adheres to epithelium, releases H2O2 - damage

evades immune system by fusing to host cells w/ sterols

97
Q

symptoms CAP/HAP klebsiella pneumoniae?

A

lung hemorrhage - CURRENT JELLY SPUTUM

98
Q

diagnosis CAP/HAP klebsiella pneumoniae?

A

gram stain
culture = mucoid capsule
sputum culture
cavitation on CXR

99
Q

treatment CAP/HAP klebsiella pneumoniae?

A

combo therapy = 3rd gen cephalosporin + aminoglycosides + fluoroquinolone

*Need susceptibility testing

100
Q

which cause of CAP is opportunistic pathogen for pts w/ DM & alcoholics?

A

CAP/HAP klebsiella pneumoniae

101
Q

treatment CAP C. pneumoniae?

A

DOC = erythromycin, tetracycline

102
Q

describe Haemophilus influenzae

A 
G- coccobacilli
non-motile
encapsulated or non-encapsulated
NONHEMOLYTIC but requires RBCs to grow
if loses capsule = non typeable (but still causes dz)
103
Q

CAP VF H. influenzae?

A

LOS (similar to LPS)
capsule
polyribosylribitol phosphate (PRP) = resistant to phagocytosis by PMNs ***major factor
fibriae req for colonization of nasopharynx

  • also.. produce neuraminidase & IgA protease
104
Q

diagnosis CAP H. influenzae?

A

difficult to culture - culture shows SATELLITE on blood agar, usu use chocolate agar
serologic testing for type if encapsulated (best way to diagnose)
Latex Particle Agglutination test for ID - easier (need antigen only)

105
Q

vaccine for CAP via H. influenzae?

A

YES - type B

106
Q

treatment CAP via H. influenzae?

A 
beta lactams (amox, clav. acid)
if resistant, 3rd gen cephalosporin
107
Q

when will H. influenzae lyse RBCs?

A

requires comorbid infection to lyse RBCs

108
Q

describe Mycoplasma pneumoniae

A 
smallest living free bacteria
lack cell wall
FRIED EGG APPEARANCE
membrane has STEROLS
stain poorly (no cell wall)
pleomorphic shape
109
Q

symptoms w/ atypical CAP M. pneumoniae?

A

non productive cough x1-2 months w/ fever, crackles, HA, chest pain

110
Q

treatment P. aeruginosa?

A

DOC = cefipem + levofloxacin

  • MDR strains common
  • AVOID broad spectrum antibiotics
  • Must do susceptibility testing
111
Q

treatment CAP M. pneumoniae?

A

DOC = azithromycin, tetracycline

112
Q

CAP VF M. pneumoniae?

A

adheres to epithelium, releases H2O2 - damage

evades immune system by fusing to host cells w/ sterols

113
Q

which age group does CAP C. pneumoniae primarily affect?

A

age 60+

114
Q

describe C. pneumoniae

A 
tiny, non-motile
G- coccoid
obligate intracellular parasite
two forms: EB (infects), RB (replicates)
two exotoxins
115
Q

which part of lungs primarily affected by C. pneumoniae?

A

unilateral lower lobe, direct tissue destruction

116
Q

diagnosis CAP C. pneumoniae?

A

clinical
cell culture/microscopy
SEROLOGY/PCR

117
Q

treatment CAP C. pneumoniae?

A

DOC = erythromycin, tetracycline

118
Q

describe L. pneumophilia

A 
thin, pleomorphic
G- bacilli
fimbriae
polar flagellum
survives intracellularly
FACULTATIVE
produces beta-lactamase
catalase & oxidase positive
119
Q

CAP VF L. pneumophilia?

A

survives intracellularly
prompts immune system to take them in via opsonization
replicates in phagosome, kills cell via lysis when bacteria released

120
Q

diagnosis for CAP L. pneumophilia?

A

GOLD STANDARD = CULTURE, buffered charcoal yeast extract (BCYE)
rapid test for antigen in urine (serotype 1)

121
Q

treatment CAP L. pneumoniae?

A

DOC = levofloxacin

–> no tx for pontiac fever, supportive only

122
Q

describe pseudomonas aeruginosa

A

G- bacilli
pili
aerobic
motile

123
Q

CAP VF P. aeruginosa?

A

Pyocyanin = catalyses ROS production (tissue damage)
Pyoverdin
Exotoxin A = inhibits protein synthesis, ciliastasis, immunosuppresion
Elastase = breaks down lung elastin (LAS A, LAS B = synergistic)
Alginate = mucoid slime layer for adherence, inhibits ciliary escalator, antiphagocytic (inhibits complement & antibody binding)
LPS = endotoxin
pili = attach to host

124
Q

because it is not very virulent, which CAP pathogen is most often in compromised pts only?

A

Pseudomonas aeruginosa

125
Q

diagnosis P. aeruginosa?

A

needs isolation/ID - BAP & MacConkey media
water soluble blue green pigment
fruity smell
fluorescent tinged sputum

126
Q

treatment P. aeruginosa?

A

DOC = cefipem + levofloxacin

  • MDR strains common
  • AVOID broad spectrum antibiotics
  • Must do susceptibility testing
127
Q

describe M. tuberculosis

A 
slender, slightly curved
acid fast 
rod shaped bacilli
obligate aerobes
non-motile
heat sensitive (killed w/ pasteurization)
NO GLYCOCALYX
128
Q

two other agents that cause Tb

A

M. bovis (milk)

M. africanum (W. Africa)

129
Q

Tb VF?

A

Mycolic acid = resistant to dehydration, long chains fatty acid, resistant to H2O2

Cord factor = produces parallel growth of bacteria (“serpentine” cords), in virulent strains

sulfatides = glycolipid that inhibits phagolysosomes in macrophage, promote facultative intracellular growth

LAM = interferes w/ INF-gamma production, inhibits cell mediated immunity, scavenges ROI

130
Q

what types of cells make up granulomas?

A

MTB cells +

macrophages, fibroblasts, multinucleate giant cells, collagen fibers

131
Q

reservoir for MAC non-TB?

A

ubiquitous - soil, plants, water, etc

132
Q

what happens after sensitization in a TB infection?

A 
granulomas form
\+ TST
\+ IGRA
macrophages activated
sensitized t cells release lymphokines, IFN-gamma, activate macrophages
133
Q

What cultures are ONLY used for TB?

A

Middlebrooks & Lowenstein-Jensen agar

134
Q

in a broth culture, where do cells clump in TB?

A

top of test tube (fatty chains)

135
Q

What stains are done for TB?

A 
acid fast (Ziehl-Neelsen or Kinyoun stain)
fluorescent stain (Rhodamine) - preferred
136
Q

how are TB colonies described in a Lowenstein-Jensen agar culture?

A

“ruff, buff, & tuff”

137
Q

what is a lymphokine?

A

LMW protein secreted by T cells in response to stimulation by antigens, activate macrophages and lymphocytes

138
Q

what lymphokine is activated in TB?

A

IFN-gamma

139
Q

treatment MAC non TB?

A

HEART (highly effective antiretroviral therapy)
no isolation bc its not infectious
both HIV+ and HIV- get combo:
–clarithromycin &/or azithromycin + EMB + RIF (rifampin for HIV-, rifabutin for HIV+)
HIV - should continue until sputum cultures neg for 1 yr
HIV+ w/ MAC infection = without immune reconstitution treatment is lifelong OR treatment for 2 weeks then HEART/HAART/ART (DO NOT START TREATMENT & ART AT SAME TIME - can get IRIS)
HIV+ w/out MAC infection = chemoprophylaxis w/ CD4 100

140
Q

describe miliary TB?

A

results from progressive prim. infection or LTBI that spread (can spread to other organs)
millet-seed sized granulomas
organ/system function lost due to proliferation of TB

141
Q

describe Pott Disease (TB)

A

MTB in VERTEBRAL BODIES
chronic back pain
if untreated, destruction of vertebrae, permanent disability

142
Q

diagnosis of TB?

A

rapid molecular detection (Xpert, MTB/RIF system) = PCR

need 2 ml sputum sample

143
Q

pathogens for non-TB mycobacterial infections (MAC)

A

M. avium & intracellulare

144
Q

describe MAC non-TB

A

acid fast
G+
aerobic
bacilli

145
Q

colonies of MAC non-TB?

A

flat, small, translucent, smooth, pale yellow pigment, NO cording/clustering
–use Middlebrook agar

146
Q

MAC non-TB VF?

A

intracellular growth
lack granuloma formation even though intracellular growth
no overgrowth
resistant to disinfection

147
Q

reservoir for MAC non-TB?

A

ubiquitous - soil, plants, water, etc

148
Q

how is MAC non-TB spread?

A

NO person to person

INHALATION

149
Q

which pts particularly susceptible to NTM infections?

A

HIV+ pts

150
Q

describe HIV - clinical manifestations of MAC non-TB?

A

immunocompromised pts
often preexisting conditions
–fibrocavitary disease - elderly men, COPD, hx smoking/alcohol)
–fibronodulary disease - elderly women, bronchiectasis, repressed coughing
lymphadenitis kids 1-4 y.o. - involves unilateral cervical nodes

151
Q

what symptoms are different for HIV+ MAC compared to HIV - MAC?

A

DIARRHEA - initial infection = colonization of GI tract, then spreads to other organs

152
Q

describe HIV+ clinical manifestations of MAC non TB?

A

granulomas not effective
organs enlarge
large #s WBCs (macrophages, blood)
new infection
can involve any tissue - lymphohematogenous spread
can’t develop CMI, no activation macrophages/granulomas

153
Q

what are CD4 levels of HIV+ MAC non TB pt?

A

CD4 levels < 50 cells/microliter

154
Q

diagnosis MAC non TB?

A 
clinical consistent w/ NTM
exclude other etiologies
sterile site isolation MAC
CXR
PCR for 16s rRNA pathogen sequence
155
Q

treatment MAC non TB?

A

HEART (highly effective antiretroviral therapy)
no isolation bc its not infectious
both HIV+ and HIV- get combo:
–clarithromycin &/or azithromycin + EMB + RIF (rifampin for HIV-, rifabutin for HIV+)
HIV - should continue until sputum cultures neg for 1 yr
HIV+ w/ MAC infection = without immune reconstitution treatment is lifelong OR treatment for 2 weeks then HEART/HAART/ART (DO NOT START TREATMENT & ART AT SAME TIME - can get IRIS)
HIV+ w/out MAC infection = chemoprophylaxis w/ CD4 100

156
Q

cause polio?

A

Picorna virus

157
Q

what causes paralysis to nervous system w/ polio?

A

3 antigenic variations - must be resistant to all 3

158
Q

5 clinical syndromes of polio?

A
  1. inapparent infection
  2. abortive illness
  3. non-paralytic poliomyelitis
  4. paralytic poliomyelitis
  5. post polio syndrome
159
Q

describe polio: inapparent infection

A

asymptomatic to minor malaise

90-95% infections

160
Q

describe polio: abortive illness

A

fever, malaise, N/V, drowsiness, HA

4-8% infections

161
Q

describe polio: non-paralytic poliomyelitis

A

fever, malaise, N/V, drowsiness, HA, stiff neck, stiff back

1-2% infections

162
Q

describe polio: paralytic polio

A

flaccid paralysis from LMN damage

<1% infections

163
Q

describe rabies: paralytic phase

A

coma, HTN, death

164
Q

prevention polio?

A

vaccines:
IPV
eIPV (used in US)
OPV (no longer used because of VAPP, back mutation of live attenuated virus)

165
Q

treatment polio?

A

PREVENTION

166
Q

is polio still present?

A

mostly eradicated, now in Syria

167
Q

cause of Arbovirus?

A

arthropod-borne viruses (mosquitos, ticks)

–humans = dead end hosts usu

168
Q

describe Togaviridae group of Arboviruses

A

ss+RNA
small
enveloped
Alphavirus: Eastern/Western/Venezuelan Equine Encephalitis
Flavivirus: St. Louis Encephalitis, WNV, DENGUE FEVER

169
Q

describe Bunyaviridae group of Arboviruses

A

3 circular ssRNA segment genome

- California excephalitis virus

170
Q

describe symptoms Arboviruses

A

typically subclinical

abrupt onset fever, HA, vertigo, photophobia, N/V, confusion, personality changes, seizures

171
Q

diagnosis arboviruses

A

specific test for IgM antibodies

– ELISA serum or CSF (serum shows prior infection + Yellow Fever, CSF shows encephalitis cause)

172
Q

treatment arboviruses

A

symptomatic only

173
Q

how to stop arboviruses?

A

stop chain of transmission

- eradicate vectors, avoid exposure

174
Q

cause Rabies?

A

rhabdovirus

175
Q

describe rhabdovirus/Rabies

A

ssRNA
enveloped
bullet shaped

176
Q

describe course Rabies infection?

A
  1. prodrome
  2. excitatory phase
  3. paralytic
177
Q

describe rabies: prodrome

A

mild fever, pharyngitis, HA, pain, burning, increased sensory sensitivity

178
Q

describe rabies: excitatory phase

A

anxiety, apprehension, hydrophobia

179
Q

describe rabies: paralytic phase

A

como, HTN, death

180
Q

how long does rabies incubate?

A

can be 2 wks to years!

181
Q

diagnosis rabies?

A

hx of bite + symptoms in pt

182
Q

treatment/protocol for rabies?

A 
initiate post-exposure prophylaxis (RABIES VACCINE = HDCV + hyperimmune serum)
kill/examine animal - do DFA test
quarantine healthy dogs/cats
kill examine strays immediately
halt treatment if animal neg for virus
EXTRA CAUTIOUS w/ BATS

Milwaukee protocol = fails as much as succeeds

183
Q

animals w/ rabies in US?

A

domestic dogs

feral skunks, raccoons, foxes, bats

184
Q

how to get rabies?

A

animal bite - also documentation of aerosol transmission (ie: in a bat cave)
(cryptic rabies = majority of cases since 1990)

KG - Microbiology Exam 2 (1 decks)

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