MICRO: Actinomyces, C difficile, UTI Flashcards

1
Q

What is second line for PCP?

A

Clindamycin and primaquine with IV methylpred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What stain is used for PCP?

A

Methanamine silver

aka Grocott-Gomori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When is the viraemic peak in HIV?

A

4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which bacterial infections are common if neutrophil defects exist?

A

Staph

Pseudomonas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What infection is most common with complement defects?

A

Neisseria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are alcoholic patients at risk of?

A

Actinomyces and other slow growing organisms

Encapsulated organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What types of infection doe Actinomyces cause?

A

Lung or brain abscesses which are difficult to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the micro features of actinomyces?

A

Gram +ve rod that branches (often confused with fungi, Nocardia looks the same)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a characteristic feature of actinomyces on histopathology?

A

Basophilic granules or sulfur granules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What stain is used for actinomyces?

A

Grocott

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List the features of severe C diff according to Imperial guidelines.

A
Temperature over 38.5
HR >90
WCC >15
Cr rising 
No response to abx in 72hrs 
Severe colitis features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the management of mild C diff?

A

Metronidazole 400mg TDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the management of severe C diff?

A

Vancomycin ~200mg +/- metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the management of C diff with colonic dilatation?

A

Metronidazole IV (!) and vancomycin PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the management of C diff with ileus?

A

Intracolonic vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 3 Cs associated with C diff?

A

Clindamycin
Cephalosporin
Ciprofloxacin

17
Q

What non-Abx drugs can cause C diff?

A

PPIs (higher pH so more spores survive)

18
Q

Name 2 places where C diff toxins act to cause pseudomembranous colitis.

A

epithelial junctions –> neutrophils infiltrate

tight junctions –> fluid loss

19
Q

Is CRP high in C diff?

A

No, commonly low with high WCC

20
Q

What % of UTI are caused by several bacteria?

21
Q

What virulence factor does staph saprophyticus have to cause UTI?

A

P-fimbrae - adherence to epithelium

22
Q

Other than E coli/SS, what are other causes of UTI?

A

Proteus m
Klebsiella aerogenes
Enterococcus faecalis
Staph epidermidis

23
Q

What UTI is staph epidermidis associated with?

A

Prosthesis e.g. catheter

24
Q

What UTI is proteus associated with?

A

Kidney stones

25
When should you suspect that the UTI has been acquired by haematogenous route?
S aureus - does not have appropriate factors to cause ascending infection
26
How many CFUs are required to diagnose E coli/SS UTI?
>10^3 CFU/ml
27
How many CFUs are required to diagnose non-Ecoli UTI?
>10^5 CFU/ml
28
What WCC suggests inflammation in UTI?
>10^4/ml
29
Describe the agar used for UTI cultures.
CHROMOGENIC - turns different colours based on organism E coli --> PINK Other coliform --> BLUE Gram +ve --> LIGHT blue
30
If UTI symptoms have been present for >7 days how long is the treatment?
7 days
31
What is the management of catheter candida UTI?
Remove catheter - no benefits of antifungals
32
What enzyme forms nitrites in urine?
Nitrate reductase
33
Which part of kidney is more susceptible to infection?
Medulla > cortex
34
What is the tx for pyelonephritis?
Coamox +/- gentamycin