Micro Flashcards
Antigen for gram neg and gram pos
Gram neg - LPS, the outer membrane (endotoxin)
- lipid A induces TNF and IL-1
Also have periplasmic space where B-lactamases are located
Gram pos - the cell wall
- lipoteichoic acid incudes TNF and IL-1
Normal content of capsule, and exception
Polysaccharide layer
Except Bacillus anthracis - D-glutamate
- edema factor, lethal factor, protective antigen
Sopre chemical composition
Dipicolinic acid
Encapsulated organisms
Even Some Pretty Nasty Killers Have Shiny Bodies, it’s Cool!
E coli Strep pneumo Pseudomonas aeruginosa Neisseria meningitidis Klebsilella pneumoniae Haemophilus influenzae type B Salmonella typhi group B strep Cryptococcus neoformans
SHiNE SKiS Strep pneumo H flu type B N meningitides E coli Salmonella Klebsiella group b Strep
Asplenic pts can’t opsonize as well - vaccinate against Strep pneumo, N meningitides, and H flu type B
Capsule is anti-phagocytic Capsule + protein conjugate is vaccine antigen - promotes T cell activation, subsequent class switching
Quelling reaction
test to determine if bacteria have capsule
- anti-capsular serum added to bacteria - capsule appears swollen under microscope
Ziehl-Neelsen stain
Carbol Fuchsin - analine dye - binds mycolic acid
- acid fast bacteria stain
Stains: Nocardia, Mycobacteria, and the protozoa Cryptospodium oocysts
How it works: stain with carbolfuchsin, decolorize with acid alcohol, counterstain with methylene blue - acid fast will retain stain
Bacteroides fragilis
Gram neg rob; anaerobe; below the diaphragm
Produce beta-lactamase; operons controlled by inversion
Necrotizing fasciitis, foul smelling; liver and other abscess, surgical incision infxn
Colonizes human flora
diabetic foot ulcer - diminished blood supply facilitates growth of anaerobes
Rx - imidazoles - metronidazole; lincosamides
- resistant to penicillins
CGD have what infection?
recurrent catalase positive organisms cuz NADPH oxidase deficiency - can’t form superoxide radical so can’t kill organism with catalase cuz these organism can just break down the H2O2 that is around
Ex:
- Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E coli, Staphylocci, Serratia
Biofilm producing organisms
S epidermidis - prosthetic, indwelling caths
Strep mutans, sanguinis - dental plaques
P aeruginosa - CF pneumonia, contact lenses
Viridans strep - endocarditis
H flu non-typeable - otitis media`
Corynebacterium diphtheriae
Diphtheria via exotoxin made by B-prophage that inhibits protein synthesis via ADP-ribosylation of EF2 (like exotoxin A of P aeurinosa)
- pseudomembranous pharyngitis, lymphadenopathy/bull neck, myocarditis, arryhthmias
Lab diagnosis - gram pos rod, metachromatic granules, positive Elek test for toxin, black colonies on cystine-tellurite agar
Toxin gets from pharynx to cardiac and cerebral tissues/cortical neurons
Tx: antitoxin, penicillin/erythromycin, DPT vaccine
Only gram pos with endotoxin
Listeria monocytogenes
- actin polymerization, intracellular spread from cell to cell, avoids antibodies
- tumbling motility
- ampicillin treatment
- listeriolysin O is pore forming toxin to lyse vacuolar membrane, activated within acidified phagosomes
Unpasteurized dairy, deli meats, transplacental and vaginal transmission
Nocardia vs actinomyces
Nocardia - gram pos aerobe - long, branching filaments resembling fungi - weakly acid fast - found in soil - pulmonary infxns in immunocompromised - cutaneous infxns in immunocompetent after trauma - treatment - sulfonamides Actinomyces - gram pos anaerobe - normal oral flora - oral/facial abscesses with sinus tracts - yellow sulfur granules - treat with penicillin
Tuberculosis damage is lung hypersensitivity type?
Delayed type (IV) - Th1 cells stimulate macrophages and CD8 T cells
If sarcoidosis, PPD negative
IGRA has fewer false positives
Mycobacterium tuberculosis factors
Cord factor inhibits macrophage maturation and induces release of TNF-a
Sulfatides inhibit phagolysosome fusion
Th1 cells and macrophages contain TB in granuloma
MAC prophylaxis with azithromycin when CD4 below 50
Leprosy
Lepromatous - Th2, low cell mediated immunity
Tuberculoid - Th1, high cell mediated immunity
Lactose fermenters
MacConkey agar macConKEE’s
- Citrobacter, Klebsiella, E coli, Enterobacter, Serratia
EMB agar - E coli is green
IgA protease producers
Neisseria m and g
H flu - also its capsule binds H factor which degrades C3b and inhibits phagocytosis - type b capsule polysaccharide PRP conjugated to protein for vaccine allows for complement dependent phagocytosis and opsonization
S pneumo
P aeruginosa exotoxins
Exotoxin A, elastase, phospholipase C, pyocyanin
- lead to ecthyma gangrenosum
Jarisch Herxheimer reaction
Flu like syndrome after abx started to syphillis (penicillin)
- due to killed bacteria/spirochetes releasing endotoxins
have positive romberg sign in tertiary due to posterior column damage; also Argyll Robertson pupil (accomdates, no reaction to light); gummas - granulomas; neurosyphilis - tabes dorsalis, general paresis
have saber shins in congenital - periosteal bone deposition, anterior bowing; facial abnormalities also; snuffles; teeth stuff
Palm and sole rashes
Drive Kawasaki CARS with palms and soles
- kawasaki
- Coxsacki A
- Rocky mountain spotted fever - R ricketsii; rash starts on wrists and ankles then spreads
- Syphilis 2ndary
Typhus Ricketsia
- typhii - endemic; fleas
- prowazekii - epidemic; lice
- rash starts centrally, spares palms and soles
Other bacterial stuff
Human monocytic ehrlichiosis - monocytes with morulae; tick vector
Human granulocytic anaplasmosis - granulocytes with morulae; tick vector
Gardnerella vaginalis
- clue cells
- fishy smell
- metronidazole
Reactive arthritis
Can’t see, can’t pee, can’t climb a tree - Reiter syndrome
- campylobacter, yersinia, shigella, salmonella, chlamydia
Systemic mycoses
pneumonia or disseminated; mold in cold, yeast in heat for most
Sabouraud agar
Histoplasmosis - Mississippi and Ohio River valley; bird/bat; in macrophages
Blastomycosis - east of Mississippi; broad based budding; granulomatous nodules
Coccidioidmycosis - Southwest US; spores in dust, spherule in tissue (not a yeast) filled with endospores
Paracoccidioidomycosis - Latin America; budding yeast, captain’s wheel formation
Opportunistic fungi
Candida - pseudohyphae and budding yeast at 20 - germ tubes at 37 - tricuspid endocarditis in IV drug use - azoles; nystatin; caspofungin; ampho B Asperillus - invasive - CGD and immunocompromised - ABPA - asthma, CF, bronchiectasis - type 1 hypersensitivity reaction - aflatoxins - hepatocellular carcinoma - septate hyphae, branch at acute angle Cryptococcus - meningitis - heavily encapsulated - sabouraud agar; india ink; mucicarmine; latex agglutination test for polysaccharide capsular antigen - pigeon droppings Mucormycosis - non-septate wide angle branching - DKA and neutropenic - enters brain through cribriform plate PCP - bilateral ground glass opacities - TMP-SMX prophylaxis if CD4 under 200; also for Rx
Parasites
Toxoplasma - TMP-SMX prophylaxis if CD4 under 100
Trypanosoma brucei
- African sleeping sickness
- enlarged lymph nodes, recurring fever due to antigenic variation, coma
- tsetse fly
- suramin for blood disease rx
- melarsoprol for CNS disese rx
Naegleria fowleri
- rapidly fatal meningoencephalitis
- freshwater; enters via cribriborm plates
- amoebas in spinal fluid
Babesia
- fever and hemolytic anemia
- asplenia have increased risk of disease
- ixodes tick
- ring form and maltese cross on smear
- atovaquone and macrolides for rx
Malaria
- vivax and ovale over and over due to hypnozoites in liver - add primaquine and test for G6PD deficiency; tertian (48 hr)
- falciparum worry about cerebral malaria
- chloroquine, mefloquine or atovaquone/proquanil if resistant for prophylaxis
- artemesins for severe
- lifecycle: sporozoites from anapholes female, gets into liver cells, becomes merozoite and replicates, lyse and infect RBCs and become trophozoite/ring form; RBC may become schizont with merozoites and lyse; gametocyte is only transmissible form back to mosquito
Trypansoma cruzi
- megacolon, megaesophagus, dilated cardiomyopathy
- unilateral periorbital swelling in acute disease
Leishmania donovani - visceral leishmaniasis
- spiking fevers, hepatosplenomegaly, pancytopenia
- amastagotes within macrophages
Cestodes
Taenia solium
- ingestion of eggs leads to neurocysticercosis
- ingestion of larvae encysted in undercooked pork leads to intestinal infection
Taenia saginata
- beef
Diphyllobothrium latum
- B12 deficiency
- long
- ingestion of larvae from raw freshwater fish
Echinococcus granulosum
- hydatid cysts in liver; anaphylaxis if antigens released
- inject cyst with ethanol or hypertonic saline before removal
- ingestion of eggs from dog feces; sheep intermediate host
Trematodes
Schistosoma mansoni (and japonica)
- snails are host
- cercariae penetrate skin
- lateral spine
- fibrosis, inflammation, portal HTN
- hepato splenomegaly
- jaundice
Schistosoma haematobium
- snails are host
- cercariae penetrate skin
- terminal spine
- squamous cell carcinoma of bladder with painless hematuria; pulmonary HTN
Clonorchis sinensis
- from undercooked fish
- snail intermediate
- pigmented gallstones and biliary tract inflammation
- cholangiocarcinoma
Viral vaccines
Live attenuated - smallpox - yellow fever - rotavirus - chickenpox - sabin polio - MMR - influenza intranasal Killed - rabies - influenze injected - salk polio - HAV Subunit - HBV and HPV
HIV CD4 count diseases
less than 500 - Candida - oral thrush - EBV - oral hairy leukoplakia - Bartonella henselae - HHV-8 - kaposi sarcoma - Cryptosporidium - diarrhea - HPV - squamous cell carinoma less than 200 - Toxoplasma - multiple ring enhancing lesions - brain abscesses - HIV - dementia - JC virus - PML - non-enhancing lesions - Pneumocystis pneumonia Less than 100 - Aspergillus - cavitation/infiltrates on CXR, hemoptysis Cryptococcus - meningitis Candida - esophagitis - CMV - retinitis, esophagitis, colitis, pneumonitis, encephalitis - EBV - B cell lymphomas - Burkitt, diffuse large B cell, CNS lymphomas (solitary, enhancing) - Histoplasma - yeast within macrophages - MAC
