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HuntsClinMed1B > Main powerpoint bacteria, Emerg data, all screenings, some lab testing > Flashcards

Main powerpoint bacteria, Emerg data, all screenings, some lab testing Flashcards

1
Q

Staph aureus

A

most pathogenic

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2
Q

staph epidermidis

A

common on skin, hospital acquired infections

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3
Q

Staph. Saprophyticus

A

Urinary tract infections

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4
Q

Staph. lugdunesis

A

Foreign body/prothetic devices

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5
Q

Coagulase neg staph species

A

S. epidermidis, S. saprophyticus, S. lugdunensis

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6
Q

Coagulase pos staph species

A

S. aureus

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7
Q

in general where can you find staph

A

on skin and anterior nares of healthy adults, and they are waiting to strike

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8
Q

Staph exotoxin production

A

Staphylococcal food poisoning
Toxic Shock Syndrome
Scalded Skin Syndrome

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9
Q

Staph Direct Tissue Invasion -

A

Most Common
Skin and soft tissue infections
Osteomyelitis
Septic arthritis
Pneumonia
Endocarditis

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10
Q

Can staph lead to bacteremia?

A

yes

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11
Q
A
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12
Q

Osteomyelitis is caused by-

A

Staph 60% of the time

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13
Q

How does S aureus produce exotoxins on food if it lives on human skin?

A

Non-infective carriers can pass S. aureus on to food (buffae or food not cooked)
Food improperly cooked or left at room temp = allow bacteria to reproduce and produce toxin

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14
Q

Strep pyogenes infections and complications

A

Strep throat
Peritonsillar abscess
Scarlet feverImpetigo
Erysipelas
Cellulitis
Rheumatic fever
Acute glomerulonephritis
can occur up to 2 weeks after infection

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15
Q

What does scarlet fever have to do with strep?

A

GABHS producing exotoxin may cause scarlet fever in susceptible persons

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16
Q

Cellulitis- is caused by what?

A

GABHS or S aureus

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17
Q

What causes Erysipelas

A

S. aureus or GABHS

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18
Q

What causes impetigo

A

GABHS or S. aureus

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19
Q

What causes scalded skin?

A

S. aureus TOXINS

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20
Q

What kind of infection is Necrotizing facilitis?

A

GABHS, hard to distinguish from C. perfringes

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21
Q

What causes toxic shock syndrome?

A

S aureus is the one we study in class, but there’s also one for GABHS

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22
Q

What causes arthritis?

A

GABHS

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23
Q

Risk factors for OM

A

smoking in household
family history
bottle feeding
MC kids 2-14

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23
Q

Incomplete hemolytic (alpha hemolytic)

A

strep pneumoniae

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24
Q

Acute sinusitis MC and RI

A

viral
-Secondary bacterial infections:
S. pneumoniae
S. aureus
H. influenzae
M. catarrhalis

Risk Factors:
Allergic rhinitis
Structural abnormalities
Nasal polyps

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25
Q

MC of CAP

A

S. pneumoniae

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26
Q

Curb 65

A

determine if a person with pneumonia should get inpatient treatment:

Confusion (+1)
BUN 20+ (+1)
RR. 30+ (+1)
SBP less than 90, DBP 60 or less (+1)
Age 65 or more. (+1)

3+ points mean inpatient
2 points means consider inpatient or out w/ close f/u
1 point means outpatient treatment

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27
Q

PSI/PORT Score

A

PSI/PORT Score: Pneumonia Severity Index for CAP
Estimates mortality for adult patients with community-acquired pneumonia.

MUST HAVE LABWORK FOR THIS

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28
Q

Emerging Data

A

Doxycycline associated with reduced infection in C. Diff versus Azithromycin

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29
Q

Who gets the Pneumovax vaccine?

A

Pneumovax is for all adults 65 and older, anyone ages 2-64 with (DM, LungD,HD,cirrhosis, SC), immunocompromised, anyone 19-64 who smokes, has asthma, resident of a nursing home.

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30
Q

Who gets Prevnar?

A

All kids ages 2, 4, 6, 12-15 mo.
All adults 65+ who have never gotten Prevnar 13.
Do we need to know whats on the next slide?

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31
Q

MC Meningitis kids and YA

A

Group B strep
baby

S. pneumoniae
toddler to school age

Neisseria meningitidis
teenager

S. aureus (more common with penetrating head trauma)
H. influenzae (Rare in US after HIB vaccine, still seen outside US)

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32
Q

MC Meningitis Adults and Elderly

A

Adults
S. pneumoniae
S. aureus
N. meningitidis (less common here)
Elderly
S. pneumoniae
S. aureus
Listeria monocytogenes

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33
Q

MC meningitis immunocompromised

A

Pseudomonas, Listeria, and Gram -

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34
Q

Enterococcus species

A

E. faecalis
E. faecium

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35
Q

Enterococcus - problems? and tx

A

Endocarditis
ampicillin + gentamicin

Skin/wound/UTI infections
Mild - ampicillin or vancomycin
Complicated - ampicillin or
vancomycin

Resistance
VRE - Vancomycin Resistant -Enterococcus

Recommended treatment:
linezolid
daptomycin

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36
Q

characteristics of B. anthrax

A

Encapsulated, toxin producing bacteria
Naturally transmitted via contact with infected animals or their products.
Bioterrorism agent
CDC Tier 1
Toxins (spores) can be weaponized as a fine powder

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37
Q

Bacillus Cerus characteristics

A

Produces toxins, causes diarrhea and emesis

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38
Q

Listeria Monocytogenes characteristics*

A

Most infections in neonates, the elderly, and immunocompromised persons
Great risk during pregnancy
Spontaneous abortion
Neonatal meningitis
Transmitted via ingestion of contaminated foods
Dairy / Queso Fresco cheese
Raw vegetables
Meat

(presentation is bacteremia, meningitis, dermatitis, oculoglandular)

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39
Q

Prevention of Diphtheriae?

A

Active immunization with diphtheria toxoid is part of routine childhood immunizations with appropriate booster injections
Susceptible persons exposed to diphtheria should receive a booster dose ofdiphtheria toxoidas well as a course of PCN orerythromycin
(&treat contacts of infected with erythromycin)

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40
Q

Acinetobacter Infections

A

Opportunistic infections in hospitalized, critically ill and immunocompromised

Can affect any organ system
resp MC, infect tracheostomy sites, suppurative infections, bacteremia

Can survive on dry surfaces for up to a month

41
Q

Moraxella Catarrhalis

A

Acute otitis media (AOM)
Acute and chronic sinusitis
COPD exacerbations

42
Q

Neisseria Meningitidis -

Meningococcal Meningitis

Characteristics

A

Characteristics
Human reservoir
40% of adults are carriers
Spread via person to person
Outbreaks occur in close communities
Military camps
College Dorms
Schools and Daycare
Outbreaks more common in winter and spring b/c cooped up more
More common in children, adolescents, and young adults
Previous infection or vaccination confers immunity

43
Q

Meningococcal (Neisseria) Prevention

A

Prevention
Meningococcal Vaccine (a vaccine that covers strains A,C,Y, and W, as well as a vaccine that covers strain B - CDC recommends vaccination of all children starting at age 11-12 with booster at 16

New Emerging Prevention
Penbraya - covers strains A,C,Y,W, and B
Approved by FDA

44
Q

Gonorrhoeae Emerging data &chlamyidia

A

Evidence from this analysis supports the Centers for Disease Control and Prevention’s recommendation that vaginal swabs are the optimal sample type for women being tested for chlamydia, gonorrhea, and/or trichomoniasis (over urine)

FDA grants approval for first time to a home test for chlamydia and gonorrhea

45
Q

Pseudomonas characteristics

A

Most common: Pseudomonas aeruginosa
Gram - rod
Primarily found in water and soil
Causes opportunistic infections
Healthy individuals
otitis externa, UTIs, dermatitis
Immunocompromised hosts, ex) burn patients; CF; VAP
UTIs, pneumonia, bacteremia, sepsis

46
Q

Pseudomonas Aeruginosa MC

A

1 pathogen

Most common first symptom is a fever

Otitis externa
Corneal ulcers from bacterial keratitis in contact lens wearers
ICU-related pneumonia
Osteochondritis after puncture through tennis shoe
#2 pathogen
Gram - organism in nosocomial pneumonia
#3 pathogen
Hospital-acquired UTIs

Folliculitis
“hot-tub folliculitis”
urticarial plaques, papules/pustules
pruritus
7-10 day duration

47
Q

Klebsiella infections

A

UTI and Pneumonia

48
Q

HaemophilusInfluenzae

A

Sinusitis, OM, bronchitis, Epiglottitis, Pneumonia, Cellulitis, Meningitis, Endocarditis

49
Q

H flu characteristics

A

Haemophilussp colonize the upper respiratory tract in patients with COPD and frequently cause purulent bronchitis.
Common cause of sinusitis, otitis, or respiratory tract infection.
Empiric antibiotic treatment depending on area of infection

50
Q

Legionaires characteristics

A

More common in immunocompromised persons, smokers, and those with chronic lung disease

51
Q

Klebsiella Pneumoniae characteristics

A

Normal intestinal flora
Typically, only causes disease in immunocompromised persons
Alcoholics
Diabetics
HIV
Klebsiella can also cause UTIs

52
Q

What is travelers diarrhea caused by?

A

E. coli

(tenesmus, 4-5 loose watery stools, fever)

53
Q

What is campylobacteriosis caused by?

A

Campylobacter Jejuni

54
Q

Salmonella disease facts

A

Enteric fever - the best example of which is typhoid fever,Caused by Salmonella typhi / enterica
(Typhoid Fever). Serotypes other than typhi typically do not cause invasive disease.

10/10/10 Has a prodromal stage of the flu, sore throat, abd pain, and then worsens.. rose spots and bloody pea soup. 2% mortality. Elderly do poorly. Relapses 15% of cases.

Acute enterocolitis - caused by S.typhimurium and S.enteritidis, among others

Infection transmitted by consumption of contaminated food or drink. The incubation period is 5–14 days

55
Q

Characteristics of salmonella enterocolitis - Caused by S.typhimurium and S.enteritidis, and others

A

Modes of transmission
Ingestion of infected foods
Eggs, poultry/chicken
Raw milk
Meat
Direct contact with infected animals
Pet turtles and reptiles
inflammatory diarrhea

56
Q

UTI is caused by what

A

Most caused by Escherichiacoli (E coli). Also, Klebsiella, Proteus mirabilis, Enterobacter

57
Q

Emerging Data yersinia pestis

A

its making a reoccurance in navajo, kenya, china, oregon, madagascar

58
Q

Francisella tularensis characteristics

A

Caused by Francisella tularensis
History of contact with rabbits, rodents, and ticks in endemic areas
Spreads easily by aerosol;highly virulent
CDC category A
eschar on thumb

59
Q

FUO characteristics

A

Fever >38.3 degrees C (101.9 degrees F) on several occasions taken with an oral thermometer

Failure to make diagnosis despite 1 week of inpatient investigation

> 3 weeks duration

60
Q

FUO labs

A

Lab Studies
CBC with diff
Peripheral blood smear
CMP - along w/ Hepatitis A,B,C w/ any abnormal liver studies
ESR or SED rate
UA and Cx
Blood cultures - at least 3 sets from different sites drawn several hours apart
HIV serology
TB serology
CXR

61
Q

SIRS Defintion

A

Defined as 2 or more of the following:
Fever >38C (100.4F) or less than 36C (96.8F)
Heart rate >90 bpm
Resp rate >20 bpm or arterial carbon dioxide tension (PaCO2)<32 mmHg
Abnormal WBC
>12,000 or
<4,000 or
>10% bands

62
Q

Bacteremia

A

Bacteria in the bloodstream which may multiply and produce systemic signs and symptoms
>200,000 deaths / yr.
20-35% with severe sepsis / 40-60% septic shock die w/in 30 days
Respiratory infection most common cause
Highest among those patients ≥ 65 y/o
Incidence greatest in winter months with resp infection
Gram + bacteria most prevalent, with Gram - and fungal increasing

63
Q

Sepsis Signs and Symptoms

A

Usually coincides with the infectious source
Example: cough with dyspnea = pneumonia
Hypotension
Systolic BP <90
Elevated temperature (>38 degrees Celsius) or hypothermia (<35-36 degrees Celsius)
Heart rate >90 bpm
Tachypnea, with respirations >20 breaths/min (producing resp alk with PaCO² <32)
Signs of end organ perfusion
Warm, flushed skin
↓ cap refill, cyanosis, mottling
Altered mental status
Absent bowel sounds

64
Q

SOFA score

A

Identification of early sepsis via Sequential Organ Failure Assessment score (SOFA) – must act quick after 2 or more

A qSofa score of ≥2 is associated with poor outcomes due to sepsis:
Resp rate ≥22 / min
Altered mentation
Systolic BP ≤100 mmHg
If above meets criteria, do full SOFA score

65
Q

Sepsis Lab findings

A

Leukocytosis (WBC >12,000) or leukopenia (<4,000)
Normal WBC with >10 immature forms
Hyperglycemia w/o diabetes
>140
C-reactive protein (CRP) >2 SD above normal
Arterial hypoxemia
Acute oliguria
<0.5 mL/kg/hr for at least 2 hours despite fluid resuscitation
Coagulation abnormalities
INR >1.5 or aPTT >60 sec
Thrombocytopenia
Platelets <100,000
Hyperbilirubinemia
Tot bili >4 mg/dL
Adrenal insufficiency
Hyponatremia
Hyperkalemia
Hyperlactatemia
Serum lactate >2 mmol/L
Plasma procalcitonin (PCT) >2 SD above normal
Specific to bacteria infection

66
Q

Sepsis Prognosis

A

Nosocomial pathogens - higher mortality rate than community-acquired pathogens
Early administration of appropriate antibiotics = beneficial impact
UTI - lowest mortality
Ischemic bowel - highest mortality
Mortality 50-55% when source of infection unknown (which is why we do empiric abx)

67
Q

Strep throat screening

A

Centor Criteria
History of Fever, Tonsillar exuhate, tender anterior cervical adenopathy, abscence of a cough = +1
14 and younger = +1
45 and up = -1

1 point = not at all
2-3 = cx. if pos, treat with abx
4+ = just give abx

don’t give to kids 3 yrs old and younger unless they are at risk (outbreak at a daycare, contact w strep +, clinical findings)

don’t do routine strep throat screening of asymptomatic people.

68
Q

How long does it take for a throat culture?

A

24-48 hrs

69
Q

When is sensitivity testing indicated?

A

pathogens unknown, suspected mixed pathogens
known resistance
severe infection
infection is not responding to 1st line

70
Q

When does sensitivity testing results come in?

A

1 to 2 days after cx results.

71
Q

Nitrites are produced in the urine by what

A

gram negative bacteria

72
Q

Desired insertion point of lumbar puncture

A

L3-L4 or L4-L5

73
Q

Path of LP

A

Supraspinous, Interspinous, Ligamentum Flavum “pop”, epidural space “pop”, dura mater, subarachnoid space

74
Q

How many tubes do you collect for CSF analysis

A

4 total

Cell count and differential
Glucose and protein levels
Gram stain, C&S
other (lactic acid, LDH, CRP) - only order if other tests abnormal

75
Q

pleural fluid analysis: Light’s criteria

A

Pleural effusion is exudative (*cloudy inflam from protein being high in the ECM) if ONE of these exists:

Pleural fluid protein: serum protein greater than 1:2
Pleural fluid LDF:serum LDH greater than 0.6
Pleural fluid LDH is greater than 0.6, or greater than 2/3 times the normal upper limit for serum LDH

76
Q

What is LDH

A

Lactate Dehydrogenase
elevated in bacterial infections and leukemia

77
Q

What is Lactic acid used to measure

A

elevated in bacterial or fungal infections

78
Q

What is measured in pleural fluid analysis

A

Glucose, Lactate levels, amylase, TG (triglycerides), Tumor markers

79
Q

high TG levels mean

A

lymphatic system involvement

80
Q

Amylase in pleural fluid analysis measures what

A

increases with pancreatitis, esophageal rupture, or malignancy

81
Q

Glucose goes down why

A

Infection. If down more, malignancy

82
Q

Review pericardiocentesis in slides

A
83
Q

Arthrocentesis - string like vicosity

A

normal

84
Q

Arthrocentesis - increased viscosity

A

septic arthritis

85
Q

Arthrocentesis - decreased viscosity

A

inflammation

86
Q

Arthrocentesis - red rusty brown

A

fresh or old blood

87
Q

Arthrocentesis - yellow/green

A

inflammatory, infectious

88
Q

CT vs MRI

A

CT utilizes radiation to produce images quickly, bone detail good, contrast can be added IV, PO or PR

MRI uses magnetic fields and radio freq. pulses to produce a more detailed image of soft tissue. Req long time and contrast can be added PO or IV

89
Q

How many culture CFU to be a positive urine culture

A

100,000 of a SINGLE bacteria

90
Q

What can’t you grow on a sputum culture?

A

Atypical bacteria, mycobacterium (TB), and fungal infections. TB can be diagnosed with Acid Fast Testing and culture specific for TB. this requires 3 seperate sputum samples and 12 weeks for a definitive diagnosis. Fungal infections often require serum testing or biopsy.

91
Q

MC on a heart prosthetic valve

A

Strep bovis (endocarditis)

92
Q

MC on a heart native valve

A

Strep viridans (endocarditis)

93
Q

Syphillus emerging data

A

The number of babies born with syphilis is surging
9/10 were preventable

94
Q

Things I need to know about pneumonia tx

A

If they have comorbiditis, that includes smoking. If they had abx in the last three months, that counts. If that had COPD, that counts as well. That qualifies them for Levofloxacin or either IP or OP treatment.

Rocephin + Z pack

95
Q

emerging data cap

A

If you do doxycycline for CAP it will lower risk of C diff versus zithromax

96
Q

Emerging data whooping

A

Whooping cough is rising in some countries and boosters may be needed

97
Q

Emerging topics Shigella

A

Extensively drug resistant shigelloisis is on the rise in the US

98
Q

Vibrio Cholera Emerging Data

A

Multple cases of vibrio cholera recently

99
Q

Emerging Data Vibrio Vulnifics

A

Missouri man dies after eating raw oysters from contracting this.

HuntsClinMed1B (19 decks)

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