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micro: clinical bacteriology Flashcards

1
Q

staph identification

A

on the staph retreat, there was NO StRESs: NOvobiocin - Saprophyticus = Resistant, Epidermidis = Sensitive

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2
Q

strep identification: Optochin

A

OVRPS: Optochin: Viridans = Resistant; Pneumoniae = sensitive

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3
Q

strep identification: Bacitracin

A

B-BRAS: Bacitracin - group B = Resistant, group A = Sensitive

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4
Q

alpha-hemolytic

A

green ring around colonies on blood agar: strep pneumo and viridans

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5
Q

Strep pneumo identification

A

catalase -, optochin sensitive, alpha-hemolytic

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6
Q

Viridens streptococci identification

A

catalase -, optochin resistant, alpha-hemolytic

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7
Q

beta-hemolytic

A

clear area of hemolysis on blood agar: staph aureus, step pyogenes, step agalactiae, listeria monocytogenes

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8
Q

staph aureus identification

A

catalase and coagulase +, beta-hemolytic

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9
Q

strep pyogenes identification

A

group A strep, catalase -, bacitracin sensitive, beta-hemolytic

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10
Q

strep agalactiae identification

A

group B strep, catalase -, bacitracin resistant, beta-hemolytic. produces CAMP factor (enlarges S. aureus hemolysis). Hippurate test +.

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11
Q

listeria monocytogenes

A

tumbling motility, meningitis in newborns, unpasteurized milk, beta-hemolytic

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12
Q

staph epidermidis

A

infects prosthetic devices and IV catheters by producing biofilms. component of normal skin flora, common contaminant. novobiocin sensitive

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13
Q

staph saprophyticus

A

2nd most common cause of UTI in young women. novobiocin resistant

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14
Q

strep pneumo

A

common cause of MOPS: meningitis, Otitis media, Pneumonia, Sinusitis. MOPS are Most OPtochin Sensitive. lancet-shaped, GP diplococci. encapsulated. IgA protease

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15
Q

strep pyogenes

A

pyogenic, toxigenic, and immunologic. bacitracin sensitive, beta-hemolytic, PYR +. Abs to M protein -> inc. host defenses and rheumatic fever. ASO titer detects recent infection

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16
Q

enterococci

A

group D strep. normal colonic flora. PCN G resistant. -> UTI, biliary infxns, subacute endocarditis. variable hemolysis. include VRE.

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17
Q

strep bovis

A

Bovis in the blood = cancer in the colon: colonizes gut,can -> bacteremia and subacute endocarditis. associated w/colon CA.

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18
Q

corynebacterium diphteriae

A

club-shaped. black colonies on cystine-tellurite agar. ABCDEFG: ADP-ribosylation (inhibits protein synthesis via), Beta-prophage, Corynebacterium Diptheriae, Elongation Factor 2 (what ADP-ribosylates), Granules (metachromatic). + Elek test for toxin. toxoid vaccine.

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19
Q

bacterial spores

A

kill w/autoclave. have dipicolonic acid in their core. no metabolic activity. dzs: anthrax, food poisoning (B. cereus), botulism, abx-associated colitis, gas gangerene, tetanus, Q fever (coxiella burnetii)

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20
Q

C. tetani

A

tetanospasmin: exotoxin = protease that cleaves SNARE, blocking GABA and glycine from Renshaw cells in spinal cord. -> spastic paralysis, trismus, + risus sardonicus. Tx w/vaccine, antitoxin, and diazepam

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21
Q

C. botulinum

A

preformed, heat-labile toxin that inhibits ACh release and NMJ. toxin in adults, spores in babies. flaccid paralysis. Tx w/antitoxin

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22
Q

C. perfringens

A

Perfringens Perforates a gangrenous leg. produces alpha toxin (lecithinase, a phospholipase) that can -> myconecrosis and hemolysis

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23
Q

C. difficile

A

2 toxins: A = enterotoxin, binds bb in gut. B = cytotoxin, -> cytoskeletal disruption via actin depolymerization -> pseudomembranous colitis. Dx by stool PCR toxin detection

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24
Q

anthrax

A

caused by GP, spore-forming rod that produces toxin. only bacterium w/polypeptide capsule (contains D-glutamate)

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25
Q

cutaneous anthrax

A

painless papule surrounded by vesicles -> ulcer w/black eschar. painless, necrotic. -> bacteremia + death = uncommon

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26
Q

pulmonary anthrax

A

inhalation of spores -> flu-like Sx -> fever, pulmonary hemorrhage, mediastinitis, and shock

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27
Q

B. cereus

A

reheated rice. spores survive cooking. keeping rice warm -> germination and toxin formation. cereulide = preformed toxin -> emetic type (w/rice + pasta). diarrheal type is slower onset

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28
Q

listeria monocytogenes

A

facultative intracellular microbe. unpasteurized dairy and deli meats. forms “rocket tails” via actin polymerization that -> intracellular mvmnt and cell-to-cell spread, avoiding Ab. tumbling motility. only GP that -> endotoxin. -> amnionitis, septicemia, spontaneous abortion, granulomatosis infantiseptica, meningitis, gastroenteritis. Tx. w/amp in infants, immunocompromised, and elderly w/meningitis.

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29
Q

actinomyces and nocardia

A

both form long, branching filaments resembling fungi. Tx is a SNAP: Sulfonamides - Nocardia, Actinomyces - PCN

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30
Q

actinomyces

A

GP anaerobe, not acid fast, normal oral flora, -> oral/facial abscesses w/sinus tracts, -> yellow, sulfur granules. Tx w/PCN.

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31
Q

nocardia

A

GP aerobe, weakly acid fast, found in soil, -> pulm infxn in immunocompromised, cutaneous after trauma in healthies. Tx w/sulfonamides

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32
Q

primary TB

A

nonimmune host (often child). hilar nodes + ghon focus (usually lower-mid lung) = ghon complex. -> heals by fibrosis -> immunity + hypersensitivity -> tuberculin +. or progressive lung dz (HIV, malnutrition) -> death (rare). or severe bacteremia -> miliary TB -> death. or preallergic lymphatic or hematogenous dissemination -> dormant tubercle bacilli in several organs -> reactivation in adult life.

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33
Q

secondary TB

A

reinfection or reactivation in partially immune hypersensitized host (often adult). fibrocaseous cavitary lesion (upper lobes) extrapulmonary TB: CNS (parenchymal tuberculoma or meningitis), vertebral body (Pott dz), lymphadenitis, renal, GI, adrenals

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34
Q

+PPD

A

if current infxn or past exposure. false positives w/BCG vaccination (further w/u required)

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35
Q

-PPD

A

if no infection or anergic (steroids, malnutrition, immunocompromise) and in sarcoidosis.

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36
Q

mycobacteria

A

all are acid-fast pink rods.

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37
Q

cord factor

A

in virulent strains of mycobacteria. inhibits macrophage maturation and induces release of TNF-alpha. sulfatides (surface glycolipids) inhibit phagolysosomal fusion

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38
Q

leprosy

A

= hansen dz. caused by mycobacterium leprae. likes cool temps -> glove and stocking skin and superficial nerves. cannot be grown in vitro. armadillos. Tx w/dapsone and rifampin, adding clofazimine if lepromatous form.

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39
Q

lepromatous hansen dz

A

presents diffusely over the skin w/leonine facies. is communicable. characterized by low cell-mediated immunity w/humoral Th2 response

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40
Q

tuberculoid hansen dz

A

limited to few hypoesthetic hairless skin plaques, characterized by high cell-mediated immunity w/largely Th1 reponse

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41
Q

differentiates GN diplococci

A

maltose. fermenter = N. meningitidis. nonfermenter = N. gonorrhoeae

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42
Q

differentiates GN rods

A

1st: lactose. fermenter = fast: Klebsiella, E coli, enterobacter. slow: citrobacter, serratia

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43
Q

differentiates GN rod lactose nonfermenters

A

1st: oxodase. + = peudomonas. -: TSI agar: produces H2S = salmonella, proteus, yersinia. doesn’t produce H2S = shigella

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44
Q

GN coccoid rods

A

H flu, pasteurella, brucella, bordetella pertussis

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45
Q

GN comma-shaped

A

oxidase +. grows in 42C = campylobacter. grows in alkaline media = v. cholerae. produces urease = H pylori.

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46
Q

lactose fermenting enterics

A

lactose = key. test w/macConKEE’S agar (forms pink colonies). Citrobacter, Kelbsiella, E coli, Enterobacter, Serratia (weak). grow as purple/black on EMB agar. E coli grows w/green sheen

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47
Q

Neisseria

A

GN diplococci. both ferment glucose and produce IgA proteases. MeninGococci ferment Maltose and Glucose. Conococci ferment Glucose.

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48
Q

Gonococci

A

no polysaccharide capsule. no maltose fermentation. no vaccine (Ag variation of pilus proteins). sexually or perinatally transmitted. -> gonorrhea, septic arthritis, neonatal conjunctivitis, PID, fitz-hugh-curtis. condoms help. erythromycin eye ointment for neonates. Tx: ceftriaxone (+ azythro or doxy for possible chlamydia)

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49
Q

Meningococci

A

polysaccharide capsule. maltose fermentation. vaccine. transmitted via respiratory + oral secretions. -> meningococcemia + meningitis, waterhouse-friderichsen syndrome (hemorrhagic adrenalitis). rifampin, cipro, or ceftriaxone PPx in close contacts. Tx: ceftriaxone or PCN G

50
Q

H flu

A

small GN coccobacillus. aurosol transmittion. -> IgA protease. Cx on chocolate agar (w/factors V (NAD+) and X (hematin)) or grow w/staph aureus (-> factor V via hemolysis). haEMOPhilus -> Epiglottitis, Meningitis, Otitis media, and Pneumonia. Tx: mucosal infxns: amox +/- clav. meningitis: ceftriaxone. PPx w/rifampin (close contacts)

51
Q

H flu vaccine

A

only against type b. contains capsular polysaccharide conjugated to diphtheria toxoid. given between 2-18 months.

52
Q

legionella mnemonic

A

think of a french soldier (legionnaire) w/silver helmet, sitting around a campfire (charcoal) w/his iron dagger. he is no sitty (cysteine).

53
Q

legionella

A

GNR (poorly) so use silver stain. grow on charcoal yeast extract culture w/iron and cysteine. Dx: Ag in urine. hyponatremia. aurosol transmission from environmental water source (e.g. airconditioning). no person-person transmission. Tx: macrolide or quinolone.

54
Q

legionnaire’s dz

A

severe pna, often unilateral and lobar, fever, GI + CNS Sx

55
Q

pontiac fever

A

mild flu-like syndrome caused by legionella

56
Q

pseudomonas mnemonic

A

PSEUDDOmonas: Pneumonia, Sepsis, otitis Externa, UTIs, Drug use, Diabetics, Osteomyelitis (e.g. puncture wounds).

57
Q

pseudomonas

A

aerobic, motile, GNR. non-lactose fermenting. oxidase +. produces pyocyanin (blue-green pigment). has grape-like odor. produces endotoxin (fever, shock) and exotoxin A (inactivates EF-2). burn victims. mucoid polysaccharide capsule -> chronic pna in CF (forms biofilms). hot tub folliculitis

58
Q

pseudomonas Tx

A

extended spectrum beta-lactams: pip-tazo, ticarcillin, cefepime
carbapenems
monobactams: aztreonam
fluoroquinolones
aminoglycosides: gent, tobramycin
for multidrug resistent: colistin, polymyxin B

59
Q

ecthyma gangrenosum

A

rapidly progressive, necrotic cutaneous lesion caused by pseudomonas. typically seen in immunocompromised.

60
Q

EIEC

A

Invasive. dysentery. microbe invades intestinal mucosa -> intestinal necrosis + inflammation. similar to shigella

61
Q

ETEC

A

Traveler’s diarrhea (watery). produces heat-labile and heat-stable enteroToxins. no inflammation/invasion

62
Q

EPEC

A

Pediatrics. no toxin. adheres to apical surface, flattens villi, prevents absorption -> diarrhea

63
Q

EHEC

A

shiga toxin. O157:H7 = most common serotype in US.
-> dysentery. doesn’t germent sorbitol (unlike other E coli)
causes HUS: anemia, thrombocytopenia, acute renal failure: microthrombi form on damaged endothelium -> mechanical hemolysis (schistocytes), plt consumption, dec. renal blood flow.

64
Q

klebsiella mnemonic

A

4 As: Aspiration pna, Abscess in lungs + liver, Alcoholics, di-A-betics

65
Q

klebsiella

A

intestinal flora -> lobar pna in alcoholics and diabetics when aspirated. very mucoid colonies caused by abundant polysaccharide capsules. currant jelly sputum. also -> nosocomial UTIs

66
Q

campylobacter jejunum

A

major cause of bloody diarrhea, esp. children. fecal-oral transmission or from poultry, meat, unpasteurized dairy or contact w/infected animals. comma or S-shaped, oxidase +, grows at 42C. common cause of GBS and reactive arthritis

67
Q

salmonella typhi

A

humans only. hematogenous dissemination. produces H2S. has flagella (salmon swim). virulence factors: endotoxin + Vi capsule. high infectious dose. abx prolong duration of fecal excretion. monocyte-predominant response. -> constipation, then diarrhea. live attenuated oral vaccine. -> typhoid fever. Tx w/ceftriaxone or fluoroquinolone. carrier state w/gallbladder colonization.

68
Q

typhoid fever

A

rose spots on abdomen, constipation, abd. pain, fever

69
Q

salmonella except typhi

A

humans and animals. hematogenous dissemination. produces H2S. has flagella (salmon swim). virulence factor: endotoxin. high infectious dose. abx prolong duration of fecal excretion. PMN-predominant response (in disseminated dz). -> bloody diarrhea. no vaccine. found in poultry, eggs, pets, and turtles. more common cause of gastroenteritis

70
Q

shigella

A

humans only. cell to cell, not hematogenous spread. no H2S. no flagella. virulence factors: endotoxin, shiga toxin. low infectious dose. abx shortens duration of fecal excretion. PMN-predominant response. -> bloody diarrhea (bacillary dysentery). no vaccine. 4 Fs: Fingers, Flies, Food, Feces. Severity: dysenteriae > boydii > sonnei. invasion = key to pathogenicity in organisms that produce less toxin

71
Q

v. cholera

A

produces profuse rice-water diarrhea via enterotoxin that permanently activates Gs -> inc. cAMP. comma-shaped, oxidase +, grows in alkaline media. endemic to developing countries. requires prompt oral rehydration

72
Q

salmonella and shigella..

A

GN bacilli, non-lactose fermenting, oxidase -.

73
Q

yersinia enterocolitica

A

transmitted from pet feces (e.g. puppies), contaminated milk, pork. -> acute diarrhea or pseudoappendicitis (RLQ pain due to mesenteric adenitis and/or terminal ileitis)

74
Q

H pylori

A

-> gastritis + peptic ulcers (esp. duodenal). risk factor for peptic ulcer, gastric adenocarcinoma, + MALT lymphoma. curved GNR. catalase, oxidase, and urease +. Dx: urea breath test or fecal Ag test. creates alkaline environment. Tx: PPI + clarithromycin + amoxicillin (or flagyl if PCN allergy)

75
Q

spirochetes

A

BLT: Borrelia (big), Leptospira, Treponema. only borrelia can be seen using aniline dyes (wright or giemsa) in light microscopy due to size. treponema is seen on dark-field microscopy

76
Q

leptospira interrogans

A

found in water containing animal urine. -> leptospirosis and weil dz

77
Q

leptospirosis

A

flu-like Sx, myalgias (classically calves), jaundice, photophobia w/conjuctival suffusion (erythema w/o exudate). prevalent among surfers and in tropics

78
Q

weil dz

A

icterhemorrhagic leptospirosis = severe form w/jaundice + azotemia from liver and kidney dysfxn, fever, hemorrhage, and anemia.

79
Q

lyme mnemonic

A

key lime pie to the FACE: Facial nerve palsy (typically b/l), Arthritis, Cardiac block, Erythema chronicum migrans

80
Q

lyme dz

A

caused by borrelia burgdorferi. transmitted by Ixodes deer tick (same as babesia). mouse = natural reservoir. common in NE united states. initial Sx: erythema chrocum migrans, flu-like Sx, +/- facial nerve palsy. later Sx: monoarthritis (large joints), AAV nodal block, neurologic (meningitis, facial palsy, polyneuropathy). Tx: doxycycline, ceftriaxone.

81
Q

primary syphilis

A

painless chancre. Dx: dark-field microscopy of chancre-fluid. VDRL + in 80%

82
Q

secondary syphilis

A

disseminated dz w/constitutional Sx, maculopapular rash including palms and soles, condylomata lata. Dx: can still use dark-field microscopy

83
Q

tertiary syphilis

A

gummas, aortitis (vasa vasorum destruction), neurosyphilis (tabes doraslis ,”general paresis”), argyll robertson pupil. signs: board-based ataxia, + romberg, charcot joint, stroke w/o HTN. Dx for neurosyphilis: test CSF w/VDRL and PCR

84
Q

congenital syphilis

A

facial abnormalities: rhagades (linear scars at mouth angle), snuffles, saddle nose, notched hutchinson teeth, mulberry molars, short maxilla, saber shins, CN VIII deafness. PPx: treat mother early in pregnancy: transmission usually occurs after 1st trimester

85
Q

VDRL false positives

A

VDRL: Viral infection (mono, hepatitis), Drugs, Rheumatic fever, Lupus/Leprosy. inexpensive, widely available, quantitative. sensitive but not specific. Ab reacts w/beef cardiolipin

86
Q

jarisch-herxheimer reaction

A

flu-like Sx after Abx started due to killed bacteria (usually spirochetes) releasing endotoxins

87
Q

anaplasma

A

zoonotic bacteria -> anaplasmosis (anemia, hematuria, diarrhea, B Sx). source: ixodes ticks (live on deer + mice)

88
Q

bartonella

A

zoonotic bacteria -> cat scratch dz (tender lymphadenitis, B Sx), bacillary angiomatosis (tumor-like blood vessels), source: cat scratch

89
Q

borrelia burgdorferi

A

zoonotic bacteria -> lyme dz. source: ixodes ticks (deer + mice)

90
Q

borrelia recurrentis

A

zoonotic bacteria -> relapsing fever. source: louse. recurrent due to variable surface Ags

91
Q

brucella

A

zoonotic bacteria -> brucellosis/undulant fever (sweating, migratory arthralgia/myalgia, fever). source: unpasteurized dairy

92
Q

campylobacter

A

zoonotic bacteria -> bloody diarrhea. source: puppies, livestock (fecal-oral, ingestion of undercooked meat)

93
Q

chlamydophila psittaci

A

zoonotic bacteria -> psittacosis (atypical pna that mimics typhoid fever). source: parrots, other birds

94
Q

coxiella burnetii

A

zoonotic bacteria -> Q fever (fever, malaise, sweating, pain, dry cough, headache, confusion, GI Sx). source: aerosols of cattle/sheep amniotic fluid

95
Q

ehrlichia chaffeensis

A

zoonotic bacteria -> ehlichiosis (headache, myalgia, fatigue +/- rash. can -> opportunistic infxns). source: ambylomma (lone star tick)

96
Q

francisella tularensis

A

zoonotic bacteria -> tularemia (high fever, lethargy, dec. appetite, rash, supporative lymphadenopathy, septicemia). source: ticks, rabbits, deer fly

97
Q

leptospira

A

zoonotic bacteria -> leptospirosis (headache, myalgia, fever, hemoptisis, meningitis, jaundice, azotemia. source: animal urine

98
Q

mycobacterium leprae

A

zoonotic bacteria -> leprosy. source: humans w/lepromatous leprosy, armadillo

99
Q

pasteurella multocida

A

zoonotic bacteria -> cellulitis, osteomyelitis. source: animal bite: cats/dogs

100
Q

rickettsia prowazekii

A

zoonotic bacteria -> epidemic typhus (sustained high fever, cough, rash, severe muscle pain, chills, falling blood pressure, stupor, sensitivity to light, delirium and death). source: louse

101
Q

ricketssia rickettsii

A

zoonotic bacteria -> rocky mountain spotted fever (fever, headache, centripetal rash). source: dermacentor (dog tick).

102
Q

Rickettsia typhi

A

zoonotic bacteria -> endemic typhus. source: fleas (on rats)

103
Q

salmonella

A

zoonotic bacteria -> diarrhea (can be bloody), vomiting, fever, abd cramps. source: reptiles + poultry

104
Q

yersinia pestis

A

zoonotic bacteria -> plague (bubonic, septicemic, pneumonic). source: fleas (rats + prairie dogs = reservoirs)

105
Q

gardnerella vaginalis

A

-> BV. Tx: flagyl or clinda

106
Q

rocky mountain spotted fever

A

rickettsia rickettsii. tick vector. found in/near north carolina. Sx: classic triad = headache, fever, rash. rash starts on wrists/ankles, spreads to trunk, palms, soles. Tx: doxycycline

107
Q

palms + soles rash mnemonic

A

you drive CARS with your palms + soles: Coxsackievirus A (hand, foot, mouth), Rocky mountain spotted fever, secondary Syphilis.

108
Q

typhus

A

endemic (fleas): R. typhi. epidemic (lice): R. prowazekii. rash starts centrally and spreads out, sparing palms + soles. Tx: doxy

109
Q

centripetal/centrifugal rash mnemonic

A

Rickettsii on the wRists, Typhus on the Trunk.

110
Q

ehrlichiosis

A

vector = tick. rash is rare. monocytes w/morulae (berry-like inclusions) in cytoplasm. Tx: doxy

111
Q

anaplasmosis

A

vector = tick. granulocytes w/morulae in cytoplams. Tx: doxy

112
Q

Q fever

A

coxiella burnetii. no arthropod vector. spores inhaled from cattle-sheep amniotic fluid. presents as pna. most common cause of Cx neg endocarditis. Q fever = Queer: no rash, no vector, organism can survive outside (as endospore).

113
Q

chlamydia

A

cannot make ATP so they are obligate intracellular pathogens. chamys = cloak (intracellular). lab Dx: cytoplasmic inclusions seen on giemsa or fluorescent Ab-stained smear. cell wall lacks classic peptidoglycan (less muramic acid) so beta-lactams are less effective.

114
Q

chlamydia forms

A 
Elementary body (small, dense) = Enfectious, Enters cell via Endocytosis. transforms into retuculate body
Reticulate body Replicates in cell by fission; Reorganizes into elementary bodies
115
Q

C. trachomatic

A

-> reactive arthritis (reiter syndrome), follicular conjunctivitis, nongonococcal urethritis, PID. Tx: azythromycin (1 dose) or doxy

116
Q

C. pneumoniae/C. psittaci

A

-> atypical pna. transmitted via aerosol. Tx: azythromycin (1 dose) or doxy. psittaci has avian reservoir

117
Q

chlamydia trachomatis serotypes A, B, C

A

-> chronic infection, blindness 2/2 follicular conjunctivitis (mostly in africa). ABC: Africa, Blindness, Chronic infection

118
Q

chlamydia trachomatis serotypes D-K

A

-> everything else: urethritis/PID, ectopic pregnancy, neonatal pna (staccato cough) w/eosinophilia, neonatal conjuctivitis.

119
Q

chlamydia trachomatis serotypes L1, L2, L3

A

-> lymphogranuloma venereum: small, painless genital ulcers -> swollen, painful inguinal lymph nodes that ulcerate (buboes). Tx: doxy

120
Q

mycoplasma pneumonia

A

no cell wall. not seen on gram stain. pleomorphic. bacterial membrane contains sterols for stability. more common in young people, military recruits, prisons. -> atypical, walking pna. X-ray is worse that Sx. high titer of cold agglutinins (IgM): can agglutinate or lyse RBCs. grown on eaton agar. Tx: macrolides, doxy, or fluoroquinolones

step 1 (24 decks)

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