Lecture 3: Infectious Disease pt 3 Flashcards
What are 3 ways we can classify bacteria?
1) Gram positive vs negative
2) Aerobic vs anerobic
3) Atypical
Differentiate between gram negative and positive organisms
1) Negative: 2 cell membranes, thin cell wall, pink
2) Positive: 1 cell membrane, thick cell wall, purple
Give some common examples of gram negative bacteria
1) E. coli
2) Pseudomonas
3) H. influenzae
4) Proteus
5) Neisseria
-N. Gonorrhea and N. Meningitides
6) Klebsiella
7) Legionella
8) Serratia
9) H. Pylori
Give some common examples of gram positive bacteria
1) Staphylococcus
-Staph aureus, staph epidermidis, staph saprophyticus
2) Streptococcus
-Group A strep (pyogenes), Group B strep (agalactiae), Strep viridans
3) Enterococcus
4) Listeria
5) Clostridium
-C. difficile, C. perfringes, C. tetani
Which are more likely to spread, gram positives or negatives?
G+ bacteria
1) Define aerobic
2) Define anaerobic
3) Define facultative anaerobe
1) Needs oxygen
2) Cannot survive with oxygen
3) Can go either way
List 4 atypical bacteria
1) Mycoplasma
2) Rickettsial species
3) Chlamydia
4) Spirochetes
What do B-lactams do? Give an example
Inhibit cell wall biosynthesis; amoxicillin, etc
True or false: Mycobacterium Tuberculosis is atypical
True
Mycobacterium Marinum:
1) Type?
2) Pathophysiology?
3) Exposure Risks?
1) Atypical
2) Causes Nodular Lymphangitis
3) Fresh and saltwater exposure
-Fish handlers, swimming in lakes and oceans
Describe Mycobacterium Marinum primary and secondary lesions
1) Primary Lesion: 2–8-week incubation
2) Secondary Lesions: Erythematous papules, nodules up lymph chain. Lesions ulcerate or form abscesses
Mycobacterium Marinum:
1) How is it diagnosed?
2) How is it treated?
1) Organisms rarely seen under microscope, so culture of biopsied tissue requires special incubation temperatures
-PPD (purified protein derivative): Usually >10mm in active cases
2) Treatment: Apply warm compresses to lesions
-Antibiotics for 2-3 months
-Clarithromycin and Rifampin
Mycobacterium Avium Complex (MAC)
1) Bacteria type?
2) Epidemiology?
3) Signs and Sx?
1) Atypical
2) Found in environment, rarely occurs if CD4 count >50
Dissemination MAC infection: 40% occurs in North American AIDS
3) Fever, fatigue, night sweats, wasting, GI upset, unilateral firm fluctuant lymphadenitis
Mycobacterium Avium Complex (MAC):
1) Labs?
2) How do you Dx? (3 things)
3) Tx?
1) Alkaline Phosphatase increased, low Hgb, blood cultures, lymph node biopsy, PPD positive only 50%
2) pulmonary symptoms+ chest xray+ Sputum
3)
1) Prophylaxis for HIV with CD4 cell count <50: Azithromycin 1200mg PO weekly
2) Management: Clarithromycin+ rifampin + ethambutol for 12 months
Rocky mountain spotted fever:
1) Etiology?
2) Epidemiology?
1) Rickettsia rickettsia
2) 6000 cases per year. Most lethal of Tick-borne illnesses. Most common April to September.
Rocky mountain spotted fever:
1) Epidemiology
2) Pathophysiology
1) 60%: North Carolina, Oklahoma, Arkansas, Tennessee, Missouri
2) Tick to human (as early as 2 hours).
-Infects endothelial cells and smooth muscle cells, Spreads through the lymphatic system.
Rocky mountain spotted fever:
1) Signs and Sx
2) What can it lead to? Do we have any immunity?
3) Rash distribution
4) How to Dx
5) Labs
1) Fever, flu-like illness, headache, erythematous, macular rash (transitions to petechiae), NV, abdominal pain.
2) Suspected life-long immunity after natural infection
Can lead to meningitis.
3) Peripheral to central spread. Can be on palms and soles. Face is spared.
4) Clinical findings. Biopsy only if needing confirmation.
5) Thrombocytopenia common
Rocky mountain spotted fever Tx
Within 5 days; Empiric Tx if Dx likely (endemic, tick bite or exposure):
-Doxycycline 100 mg PO/IV BID x 7d (ok for pregnancy)
Continue treatment x 3 days after afebrile
Lyme disease:
1) Epidemiology
2) Clinical manifestations
3) Is it reportable?
1) Spirochete Borrelia burgdorferi; spread by Ixodes scapularis “deer ticks”
-Mostly in northeast
2) Transmission via tick bite leads to early localized infection, or straight to early disseminated infection. Both can lead to late stage Lyme.
3) Yes, reportable
The “The classic “Bull’s Eye” erythema migrans (EM) rash is seen 60-80% of the time in what disease? Explain
Lyme disease
-20% of folks with Lyme won’t have this “classic rash”
Only 25% of patients with early localized disease recall a tick bite
How may Lyme manifest during the Early disseminated phase?
1) Early disseminated rash
2) Neurologic findings
-Lymphocytic meningitis, radiculopathies, cranial nerve palsies (CN7 especially). Bell’s Palsy
3) Carditis: Anything from 1st degree to 3rd degree block
List and describe a specific type of early disseminated lyme
Lyme Carditis:
-Occurs in early disseminated phase, about 1-28 weeks after infection
-About 1% of Lyme cases get Lyme Carditis
-Fairly wide range of disease, from mild to deadly
How may Lyme manifest during the “late lyme” phase?
Occurs months to years after infection:
1) Arthritis: usually 1 joint, though can be a few
-Usually the knee
-Eventually occurs in 60% of untreated patients
-Most common complication of late lyme disease
-Monoarthritis of the knee is most common
2) Chronic neurologic effects
3) Peripheral neuropathy or encephalitis
Early Localized Lyme disease:
1) How do you Dx it?
2) When will tests be positive?
1) Mostly a clinical diagnosis; Erythema migrans and exposure to an endemic area, with or without a tick exposure, is enough to make the diagnosis
2) Lyme serologies are likely to be negative this early
-About 25% of Lyme serologies will be positive at this phase
-Repeat convalescent serologies in a few weeks should be positive