Micro Flashcards

1
Q

Antigen for gram neg and gram pos

A

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

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2
Q

Normal content of capsule, and exception

A

Polysaccharide layer
Except Bacillus anthracis - D-glutamate
- edema factor, lethal factor, protective antigen

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3
Q

Sopre chemical composition

A

Dipicolinic acid

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4
Q

Encapsulated organisms

A

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
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5
Q

Quelling reaction

A

test to determine if bacteria have capsule

- anti-capsular serum added to bacteria - capsule appears swollen under microscope

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6
Q

Ziehl-Neelsen stain

A

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

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7
Q

Bacteroides fragilis

A

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

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8
Q

CGD have what infection?

A

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

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9
Q

Biofilm producing organisms

A

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`

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10
Q

Corynebacterium diphtheriae

A

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

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11
Q

Only gram pos with endotoxin

A

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

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12
Q

Nocardia vs actinomyces

A
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
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13
Q

Tuberculosis damage is lung hypersensitivity type?

A
Delayed type (IV)
- Th1 cells stimulate macrophages and CD8 T cells

If sarcoidosis, PPD negative

IGRA has fewer false positives

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14
Q

Mycobacterium tuberculosis factors

A

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

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15
Q

Leprosy

A

Lepromatous - Th2, low cell mediated immunity

Tuberculoid - Th1, high cell mediated immunity

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16
Q

Lactose fermenters

A

MacConkey agar macConKEE’s
- Citrobacter, Klebsiella, E coli, Enterobacter, Serratia
EMB agar - E coli is green

17
Q

IgA protease producers

A

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

18
Q

P aeruginosa exotoxins

A

Exotoxin A, elastase, phospholipase C, pyocyanin

- lead to ecthyma gangrenosum

19
Q

Jarisch Herxheimer reaction

A

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

20
Q

Palm and sole rashes

A

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
21
Q

Other bacterial stuff

A

Human monocytic ehrlichiosis - monocytes with morulae; tick vector

Human granulocytic anaplasmosis - granulocytes with morulae; tick vector

Gardnerella vaginalis

  • clue cells
  • fishy smell
  • metronidazole
22
Q

Reactive arthritis

A

Can’t see, can’t pee, can’t climb a tree - Reiter syndrome

- campylobacter, yersinia, shigella, salmonella, chlamydia

23
Q

Systemic mycoses

A

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

24
Q

Opportunistic fungi

A
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
25
Q

Parasites

A

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
26
Q

Cestodes

A

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
27
Q

Trematodes

A

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
28
Q

Viral vaccines

A
Live attenuated
- smallpox
- yellow fever
- rotavirus
- chickenpox
- sabin polio
- MMR
- influenza intranasal
Killed
- rabies
- influenze injected
- salk polio
- HAV
Subunit
- HBV and HPV
29
Q

HIV CD4 count diseases

A
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