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M3.2 Flashcards

1
Q

ZOONOSES

A

Bugs From Your Pets.
Brucella abortus
Francisella tularensis
Yersinia pestis
Pasteurella multocida

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2
Q

BRUCELLA ABORTUS

Aka?

• gram? capsule?
• transmission?
• disease?
• treatment?

A

Bangs bacillus
• small gram-negative rods without a capsule
• transmission: contaminated dairy or direct contact

BRUCELLOSIS (UNDULATING FEVER) Malta fever

• treatment: doxycycline plus rifampin

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3
Q

FRANCISELLA TULARENSIS

• gram?
• reservoir?
• transmission?
• disease?
• treatment?

A

TULAREMIA
• small gram-negative rods
• reservoir: rabbits, deer, and rodents
• transmission: ticks (e.g., Dermacentor), aerosols, contact, and ingestion

TULAREMIA

• treatment: streptomycin or gentamicin

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4
Q

Black Death, a pandemic that ravaged Europe between 1347 and
1351, taking a proportionately greater toll of life than any other
known epidemic or war up to that time. What is the vector of this disease?
A. BRUCELLA SPECIES
a. Yersinia spp.
b. Rats
c. Kingella
d. None of the above

A

d. None of the above

Yersinia causative agent flea

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5
Q

YERSINIA PESTIS

• gram? appearance? staining?
• reservoir?
• transmission?
• PE:
• treatment:
• vaccine?

A

• small gram-negative rods with bipolar (safety pin) staining
• reservoir: wild rodents
• transmission: oriental rat flea (Xenopsylla cheopis) bite, inhalation
• PE: buboes, cutaneous hemorrhage
• treatment: streptomycin and tetracycline
• No vaccine available

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6
Q

BRUCELLA ABORTUS

Other name?
Disease?
gram
capsule
transmission
treatment

A

Bang’s bacillus
BRUCELLOSIS (UNDULATING FEVER)/ Malta Fever
small gram-negative rods without a capsule
contaminated dairy or direct contact
doxycycline plus rifampin

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7
Q

FRANCISELLA TULARENSIS

Disease
gram
reservoir
transmission
treatment

A

TULAREMIA
• small gram-negative rods
• reservoir: rabbits, deer, and rodents
• transmission: ticks (e.g., Dermacentor), aerosols, contact, and ingestion
• treatment: streptomycin or gentamicin

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8
Q

YERSINIA PESTIS

Disease?
gram with?
reservoir
transmission
PE
treatment
vaccine

A

BUBONIC, PNEUMONIC and SEPTICEMIC PLAGUE
• most virulent bacteria
• small gram-negative rods with bipolar (safety pin) staining
• reservoir: wild rodents
• transmission: oriental rat flea (Xenopsylla cheopis) bite, inhalation
• PE: buboes, cutaneous hemorrhage
• treatment: streptomycin and tetracycline
• No vaccine available

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9
Q

YERSINIA PESTIS

Bubonic

A

sudden onset of fever, headache, chills, and
weakness

one or more swollen, tender and painful lymph
nodes (buboes); usually results from an infected flea bite

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10
Q

YERSINIA PESTIS

Septicemic

A

fever, chills, extreme weakness, abdominal pain,
shock, and possibly bleeding into the skin and other organs.

Skin and other tissues may turn black and die, especially on fingers, toes, and the nose.

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11
Q

YERSINIA PESTIS

Pneumonic

A

fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain,
cough, and sometimes bloody or watery mucous;

develop from inhaling infectious droplets or from untreated bubonic or septicemic plague that spreads to the lungs.

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12
Q

most virulent bacteria

A

YERSINIA PESTIS

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13
Q

Form of plague which has first symptoms of plague

A

Septicemic

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14
Q

This is the most serious form of plague.

A

Pneumonic

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15
Q

D. PASTEURELLA MULTOCIDA

Disease?
Gram? Character?
Colonies?
Reservoir?
Transmission?
Treatment?

A

BITES and OSTEOMYELITIS
• short, encapsulated gram-negative rod that exhibits bipolar
staining (‘closed safety pin appearance’, see figure below)
• buttery colonies with musty odor due to indole production
• reservoir: cats and dogs
• transmission: animal bites
• treatment: penicillin G

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16
Q

HACEK GROUP

A

Haemophilus aphrophilus
Actinobacillus actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella kingae

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17
Q

HACEK GROUP disease

A

cause culture-
negative subacute bacterial endocarditis in patients with pre- existing heart disease

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18
Q

Candidiasis

Symptoms
Discharge
Inflammation
Ph
Microscopy
Treatment
Management of partner

A

Vulvar itching and/or irritation

Scanty, white Clumped adherent plaques

Erythema of vagina
Vulvar dermatitis
Fissures common
“Satellite lesions”

≤4.5 acidic

Pseudohyphae

Miconazole 100mg vaginal
suppository
• Clotrimazole 100mg vaginal
tablet daily for 7 days
• Fluconazole 150mg oral
single dose

None
• Topical treatment if with
candida of penis

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19
Q

Trichomoniasis

Symptoms
Discharge
Inflammation
Ph
Microscopy
Treatment
Management of partner

A

Profuse discharge;
Vulvar itching

profuse
White/yellow

Erythema of vagina and vulva; Colpitis macularis
“Strawberry cervix”

> 5 basic

trichomonads

• Metronidazole or tinidazole
2gm oral single dose
• Metronidazole 500mg BID x
7 days

Treat with metronidazole
2gm single dose

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20
Q

Bacterial Vaginosis

Symptoms
Discharge
Inflammation
Ph
Microscopy
Treatment
Management of partner

Amine fishy odor

A

Malodorous; Slightly inc. discharge

Moderate White or gray
Homogenous

No inflam

> 4.5 basic

Clue cells

Metronidazole 500mg BID x 7 days

None

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21
Q

Human bite

A

Eikenella corrodens

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22
Q

Corroding Bacterium

A

Eikenella corrodens

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23
Q

TREPONEMA PALLIDUM

Shape?
Gram?

A

• Helically coiled, spiral, or corkscrew shaped bacilli
• not seen on Gram-stain because too thin
• cannot be cultured in vitro
o lacks Krebs cycle enzymes
• microaerophilic

24
Q

Venereal syphilis

A

T. pallidum subsp pallidum

25
Yaws
T. pallidum subsp pertenue
26
Bejel
T. pallidum subsp endemicum
27
Pinta/ Carate
T. carateum
28
most common route of transmission of Syphilis
Sexual contact
29
predominant inflammatory infiltrate in syphilis
plasma cell
30
Primary Syphilis
o Hard chancre – nontender ulcer that develops at the site of inoculation o Develops 2-10 weeks after inoculation
31
Secondary Syphilis
o 2-10 weeks after primary lesion has resolved o condyloma lata – highly infectious moist pale papules in the genital area o maculopapular rash, fever headache, malaise, anorexia, lymphadenopathy Systemic symptoms
32
Latent Syphilis
o Positive serologic test result o Absence of signs and symptoms
33
Tertiary Syphilis
§ granulomas (gummas) § neurosyphilis - tabes dorsalis - Argyll-Robertson pupil / Prostitute’s pupil - dementia paralytica § cardiovascular (aortitis) - obliterative invasion of small blood vessels and vasa vasorum, causing endarteritis
34
Argyll-Robertson pupil
Prostitutes pupil Accomodation Reflex Present Pupillary Reflex Absent
35
Congenital Syphilis
o snuffles / saddle nose o mulberry molars o Hutchinson triad: Hutchinson teeth, 8th nerve deafness, interstitial keratitis o saber shins o rhagades (angle of mouth) o Higoumenakis sign (clavicle) → unilateral enlargement of the sternoclavicular portion of the clavicle, leads to detachment o Clutton’s joints (synovitis) o pulmonary hemorrhage
36
DIAGNOSTIC TESTS FOR SYPHILIS
Microscopy – Darkfield illumination, silver impregnation, direct fluorescent antibody staining Nontreponemal - screening test, for monitoring of treatment o Can be used as test of cure o Antigen: cardiolipin, cholesterol, and purified lecithin o Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL)- only test useful for neurosyphilis o Others: Unheated serum reagin (USR) and toluidine red unheated serum test (TRUST) Treponemal antibody tests— for confirmation o measure antibodies against T pallidum antigens o unaffected by treatment o FTA-ABS (Fluorescent Treponemal antibody absorbed test), MHA-TP (microhemagglutination T. pallidum)
37
False Positive VDRL Results
V – D – R – L Viruses (EBV, Hepatitis) Drugs (marijuana) Rheumatic fever, RA Lupus, Leprosy
38
The neurologic complication of tertiary syphilis that involves the ocular system? a. Tabes dorsalis b. Argyll Robertson c. Macular degeneration d. Anisocoria
b. Argyll Robertson
39
True of Argyll Robertson Pupil: a. Secondary syphilis b. Accommodation reflex is lost c. Pupillary reflex is absent d. Presence of anisocoria
c. Pupillary reflex is absent
40
TREATMENT for Syphilis
Benzathine penicillin G 2.4 MU- treatment of choice
41
LEPTOSPIRA INTERROGANS Characteristic? Flagella? grown on?
• thin, coiled spirochetes • hook at one or both pointed ends (Shepherd’s crook) periplasmic flagella • obligate aerobe • grown on Ellinghausen-McCullough-Johnson-Harris (EMJH) medium or Fletcher medium
42
LEPTOSPIRA INTERROGANS HABITAT AND TRANSMISSION PATHOGENESIS
• habitat: wild and domestic animals • transmission via animal urine o dog, livestock, and rat urine o usual setting wading in floodwaters penetrate intact mucous membranes or skin through small cuts or abrasions • multiply rapidly and damage endothelium blood and CSF early urine during the later stages
43
LEPTOSPIRA INTERROGANS DETECTION
LeptoMAT (Microscopic agglutination test) o uses a battery of live leptospiral strains o Single titer of 1:1600 is diagnostic in endemic areas
44
Acute Leptospiremic Phase Septicemic
o fever, chills, intense headache o calf tenderness § due to rapid multiplication of leptospires in muscles with high oxygen tension o conjunctival suffusion § due to damaged and leaky conjunctival vessels § painful and itchy but with minimal tearing
45
Immune Leptospiruric Phase Icteric
o aseptic meningitis § CSF pleocytosis with or without meningeal symptoms § coincides with appearance of antibody titers o pulmonary involvement: snow-flake lesions in CXR o hepatic necrosis o glomerulonephritis § due to immune-complex deposition
46
Weil Syndrome
most severe form of leptospirosis o triad: jaundice, bleeding, uremia o orange cast skin (severe jaundice) o most common cause of death is respiratory failure due to massive pulmonary hemorrhage
47
TREATMENT • mild leptospirosis • severe leptospirosis
o doxycycline, ampicillin or amoxicillin o penicillin G, ampicillin, ceftriaxone or cefotaxime Jarisch-Herxheimer reaction may develop
48
most severe form of leptospirosis
Weil Syndrome
49
most common cause of death of Weil Syndrome is
respiratory failure due to massive pulmonary hemorrhage
50
A 31/M patient being treated with Penicillin G as a case of syphilis is on day 2 of treatment. He had fever, chills, HR 107 bpm, BP 90-100/60 and profuse sweating. What do you call this condition? a. Anaphylaxis b. Tachyphylaxis c. Stevens Johnson d. Jarisch-Herxheimer
d. Jarisch-Herxheimer
51
The occurrence of such is brought about by a. IgE-mediated reaction b. Immune complex deposition c. Lysis of treponemes d. Reactive multiplication of treponemal cells
c. Lysis of treponemes
52
BORRELIA BURGDORFERI CHARACTERISTICS HABITAT AND TRANSMISSION
• weakly staining, gram-negative spirochetes • largest medically-important spirochete • stains readily with silver impregnation and with aniline dyes (Giemsa or Wright stain) • Animal Reservoirs o white-footed mouse o white-tailed deer • Transmission o bite from deer ticks (Ixodes scapularis, Ixodes pacificus)
53
LYME DISEASE • Stage 1: • Stage 2: • Stage 3:
• Stage 1: erythema chronicum migrans (typical Bull’s eye configuration) • Stage 2: myocarditis (AV block), meningitis, Bell palsy • Stage 3: autoimmune migratory polyarthritis (onion skin lesions), acrodermatitis chronica atrophicans
54
LYME DISEASE DIAGNOSTICS TREATMENT
• Serology- mainstay for diagnosis o Enzyme immunoassay, IFA, Immunoblot • Culture o Modified Kelly’s medium, Barbour-Stoenner-Kelly medium (BSK) • early localized or disseminated Lyme disease o doxycycline (DOC), amoxicillin, cefuroxime • late manifestations o intravenous penicillin or ceftriaxone
55
Pediculus humanus humanus – transmits Borrelia recurrentis
Louse- borne relapsing fever
56
Tick – borne relapsing fever
Ornithodoros hermsi – transmits Borrelia hermsii o Ornithodoros parkeri – transmits Borrelia parkeri
57
Louse borne relapsing fever TREATMENT
Tetracyclines, erythromycin, and penicillin

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