micro- Gram- bacteria Flashcards
1
Q
What are the virulence factors of N meningitidis
A
polysaccharide capsule that is antiphagocytic Endotoxin- LPS IgA1 protease ability to extract iron form transferrin Pili
2
Q
how many capsule serotypes are there for N meningitides? which ones causes menigitis
A
13
meningitis- A B and C
3
Q
what results from meningococcal release of endotoxin
A
hemorrhage as petechiae on the skin and sepsis
4
Q
What is IgA1 protease- N meningitidis
A
only found in pathogenic and cleaves IgA in half
5
Q
What are the high-risk groups for N meningitidis
A
infants 6 mo- 2 yr
army recruits
college freshman
6
Q
what is the clinical key to knowing that there is invasive meningococcal infection
A
petechial rash
7
Q
What is the presentation of meningococcemia
A
spiking fevers, chills, arthralgia, muscle pains and petechial rash
8
Q
What is Fulminant meningococcemia
A
Waterhouse-Friederichsen syndrome septic shock b/l hemorrhage to adrenal glands rapid hypotension and tachycardia DIC and coma may develop death 6-8 hrs
9
Q
What are the signs of meningitis in an infant
A
lethargy, fever, vomiting
sometimes a buldging open anterior fontanelle
10
Q
What bacteria are responsible for meningitis in an infant less than 3 mo
A
E coli, L monocytogenes, Group B strep
11
Q
What are the culprits for meningitis in older infants
A
H influenza
N meningitidis
12
Q
What is the agar used to grow Neisseria
A
Thayer-martin VCN chocolate agar
V- vancyomycin (kills gram +)
C- colistin that kills gram- not Neisseria
N- Nystatin kills fungi
13
Q
how do you differentiate between the neisseria species
A
meningitidis can produce acid from latose but gonorrhea cannot
14
Q
What are the two most common STDs
A
1 chlamydia
2 Gonorrhea
15
Q
What are the virulence factors of gonococcal infections
A
Pili
outer membrane protein porin
Opa proteins
16
Q
What is the role of pili on N gonorrhea
A
not only help for adhesion but able for antigenic variation to escape phagocytosis
17
Q
what is the role of outer membrane protein porin in N gornorrhea
A
promote invasion into cell
Por A and B- used to be PorI
18
Q
What is the role of Opa proteins in N gonorrhea
A
promote adherence and invasion of epithelial cells
result in opaque colonies
19
Q
Where does the gonococci multiply
A
in the endocytotic vacuoles
20
Q
What can gonorrhea cause in men
A
urethritis
epididymitis, prostatis and urethral strictures
21
Q
Describe gonorrhea in women
A
usually asymptomatic, sometimes urethritis
infects columnar epithelium of cervix
can progress to PID
22
Q
What is PID
A
infection of uterus-endometriosis, fallopian tubes- salpingitis and or ovaries- oophoritis
23
Q
What is the presentation of PID
A
fever, lower abdominal pain, abnormal menstrual bleeding and cervical motion tenderness
24
Q
What are the complications with PID
A
sterility, ectopic pregnancy, absecess, peritonitis, peri-hepatisis(fitz-hugh-curtis syndrome)
25
what is the mechanism behind sterility caused by STDs
scarring of the fallopian tubes
26
what is Fitz-hugh-curtis syndrome
from N gonorrhea
| inflames capsule around liver causing RUQ pain and tenderness
27
What is gonococcal bacteremia
invasion of blood stream
fever, joint pain, skin lesions
sometimes pericarditis, endocarditis and meningitis
28
Describe the presentation of septic arthritis in a gonorrhea infection
acute onset fever with pain and swelling in 1 or 2 joints
| progressive destruction of the joint
29
What do you order to confirm gonococcal septic arthritis
examination of synovial fluid for incWBC, gram stain and culture
30
What is the most common kind of septic arthritis in young, sexually active inidividuals
N gonorrhea
31
If a pregnant mother transmits gonorrhea to child during birth what is presentation
ophthalmia neonatorum so give erythromycin in eyes
32
What diseases does Moraxella catarrhalis cause
otitis media and URI in patients with COPD or emphysema or in elderly
33
What is otitis media and 3 top culprits
```
middle ear infection
80% children by age 3
Strep pneumoniae
H influenza
Moraxella catarrhalis
```
34
A COPD patient with worsening wheezing SOB and cough can be assoc with what
new strain H influenza or Moraxella catarrhalis
35
What can kingella kingae cause
septic arthritis and osteomyelitis in children
| endocarditis of native and prosthetic valves in children and adults
36
What are the slow growing gram - pathogens that cause endocarditis
```
Haemophilus spp
Actinobacillus spp
Cardiobacterium spp
Eikenella spp
Kingella spp
```
37
Describe morphology of Neisseria meningitidis
diplococci gram -
facultative anaerobe
high Co2 environment
ferment maltose
38
describe morphology of N gonorrhea
diplococci gram -
facultative anaerobe
high CO2
can only ferment glucose
39
What is Moraxella catarrhalis Resistant to
penicillins
40
What enteric bacteria canNOT ferment lactose
Salmonella, Shigella and Pseudomonas
41
What type of agar are used to grow enteric bacteria
EMB and MacConkey
42
describe EMD agar
methylene blue inhibits gram + and the lactose fermenters become deep purple to black
E coli become metallic green
43
Describe macconkey agar
inhibit gram + and lactose fermenters are pink/purple
44
What are the 3 major surface Ag on enteric bacteria
O Ag- outside LPS
K Ag- capsule over O Ag
H Ag- antigenic determinant making up subunits of flagella
45
What enteric does not have H Ag
shigella- because not mobile
| Klebsiella penumoniae
46
What type of diseases are caused by enteric bacteria
diarrhea and UTI, pneumonia, bacteremia and sepsis
47
What is diarrhea without invasion
enterotoxins causing electrolyte and fluid loss from intestinal epithelial cells or epithelial cell death
watery diarrhea without systemic systems
48
What are enteric bacteria that invade intestinal epithelial cells
E coli, Shigella and salmonella
49
What does is a key clinical sign to an enteric that invades intestinal epithelial cells
bloody stool
50
What are the symptoms of an enteric bacteria that invades the lymph nodes and blood
abdominal parin and diarrhea containing WBC and RBC
| deeper invasion has fever, headache and WBC
51
What are the enteric bacteria that invade lymph nodes and blood
salmonella typhi, yersinia enterocoitica and campylobacter jejuni
52
What are the common hospital acquired gram - enterics
E coli, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter, Serratia and Pseudomonas aeruginosa
53
What are the virulence factors that make E coli pathogenic
Mucosal accumulation of pili and ability to invade epithelial cells
Exotoxin production of heat labile and stable toxins, also shiva-like toxin
Endotoxin- Lipid A
iron binding siderophore which takes iron from transferrin or lactoferrin
54
What diseases can E coli cause
diarrhea, UTI, neonatal meningitis, gram - sepsis
55
Describe the presentation of Enterotoxigenic E coli
inhibit reabsorption of NaCl and stimulate secretion Cl and HCO3- leading to severe watery diarrhea
looks like rice water- cholera
56
Describe presentation of Enterohemorrhagic E coli
secrete shiga-like toxin that inhibit 60s ribosome
| bloody diarrhea with severe abdominal cramps called hemorrhagic colitis
57
Describe Hemolytic uremic syndrome from E coli
anemia, thrombocytopenia and renal failure is assoc with strain EHEC 0157:H7
cattle may be the reservoir- hamburgers
58
Describe Enteroinvasive E coli EIEC
has ability to invade epithelial cells
fever
WBC invade intestinal wall and the diarrhea is bloody with WBC
59
What allows E coli to causes UTI and cystitis possible higher up causing pyelonephritis
the pili virulence factor
60
What is the most common cause of gram - sepsis? second to most?
E coli
| Klebsiella penumoniae
61
Which type of patient is prone to klebsiella penumonia
hospital patients and alcoholics
62
What is kelbsiella pneumoniae pneumonia look like
bloody sputum
| destroys lung tissue
63
What are the cross reacting Ag of Proteus and Ricketssia
OX2 OX19 OX-K
64
What is the presentation of Proteus UTI
urine is alkaline from the ability to split urea into NH3 and CO2
65
how can you distinguish shigella from E coli and Salmonella
shigella does not ferment lactose or produce H2S
E coli ferments lactose
Salmonella: produces H2S, cannot ferment lactose
66
What population is prone to shigella
preschool and nursing homes
| contaminated water of hand to hand
67
What is presentation of shigella
fever abdominal pain, diarrhea with flecks of blood and pus
68
describe mechanism of shiga toxin
5 B subunits that bind and allow A subunit in that inactivates 60S ribosome inhibiting protein synthesis thus killing epithelial cell
69
What other virulent factor does salmonelly have instead of K Ag
the Vi factor which surrounds O Ag
70
What are the 3 gorups of Salmonella
typhi, cholerae-suis, enteritidis
71
Salmonella is most commonly acquired how in US
eating uncooked eggs and chickens
72
Which Salmonella is not zoonotic
typhi, only humans
73
What are the diseases that Salmonella causes
typhoid fever, carrier state, sepsis and gastroenteritis
74
What type of parasite is Salmonella
facultative intracellular
75
Describe presentation of typhoid fever
1-3 weeks post exposure including fever Ha and abdominal pain over RLQ
may have splenomegaly and diarrhea
rose spots on abdomen
76
How do you Dx salmonella typhi
culture of blood, urine or stool
77
what population is more prone to salmonella infections and why
asplenic like from sickle cell because Vi capsule is opsonized then taken to spleen because macrophages and neutrophils phagocytose opsonized bacteria
78
Patients with sickel cell anemia with salmonella are at high risk for what
osteomyelitis
79
what does diarrhea from salmonella look like
usually just watery
| sometime mucus or blood but rare
80
What is the presentation of yersinia enterocolitica
fever, diarrhea, abdominal pain in RLQ
| terminal ileum usually has mucosal ulceration
81
what is the shape of V cholera
curved gram - rod with single polar flagellum
82
What toxin does V cholera release
choleragen
83
What is the presentation of V cholera
watery diarrhea like rice water
Shock from isotonic fluid loss will occur if not rehydrated
diminished pulses, sunken eyes and poor skin turgor
84
Describe mech of choleragen
5 B subunits attached to GM1 ganglioside on intestinal epithelial cell allowing entry A. A will activate G protein increasing cAMP leading to active secretion Na Cl and inhibition of Na and Cl resorption
85
What will the stool look like in V cholera
no WBC but many curved rods with fast darting movements
86
What is the leading cause of diarrhea in japan
Vibrio parahaemolyticus
87
What are the most common causes of diarrhea in the world
Campylobacter jejuni, ETEC and Rotavirus
88
what is the presentation of Campylobacter jejuni
bloody loose diarrhea
89
What toxin does campylobacter jejnui release
LT toxin similar to that of E coli and a cytotoxin that kills mucosal cells
90
What is the most common cause of duodenal ulcers? second?
Helicobacter pylori
| aspirin
91
What are the 2 leading causes of stomach ulcers (gastric)
1 is aspirin
| 2 is helicobacter pylori
92
99% of our flora in GI are what
obligate anaerobes fram - rods of the family Bacteroides
93
Which gram - rod does not have lipid A
bacteroides fragilis
94
What are risk factors to bacteroides fragilis proliferation
after surgery or tears in intestine or infection the bacteria will create abscesses
95
what organism produces a black pigment on blood agar and involved in necrotizing anaerobic pneumonias caused by aspiration of lots of sputum
Bacteroides melaninogenicus
96
What can Fusobacterium cause
aspiration peneumonia
abdominal and pelvic abscesses
otitis media
97
What are the anaerobic gram + cocci that are normally in our flora of mouth, vagina and intestine
peptpstreptococcus and peptococcus
98
What are the most common hospital acquired infections
penumonia- endo-trach tubes and mechanical ventilation
UTI- foley catheters
wound infections- recent surgery and implanted devices
blood infections- intravenous and intra-arterial lines
4Ws: wind water wound wires
99
What are the most common bacteria that cause hospital-acquired infections
E coli, Klebsiella and Enterobacter
100
What 4 highly resistant bacteria are becoming popular in hospital settins
Pseudomonas
Acinetobacter
Stenotrophomonas
Burkholderia
101
what type of pathogen is pseudomonas aeruginosa
```
obligate aerobe that doesN't ferment lactose
gram - rod
produces green (pyoverdin) and blue (pyocyanin) pigments with a sweet grape-like scent
```
102
What is the exotoxin released by P aeruginosa
exotoxin A that stops protein synthesis
103
What are important infections caused by P aeruginosa
```
Pneumonia
Osteomyelitis
Burn wound
Sepsis
UTI, pyelonephritis
Endocarditis
Malignant external otitis
Corneal infections
```
104
What patients are at high risk for pseudomonas penumonia
CF patients and immunocompromised patients
105
What type of patients are at a higher risk for osteomyelitis due to pseudomonas infection
DM patients with ulcers
| IV drug abusers in their vertebrae and clavicles
106
What type of endocarditis is pseudomonas responsible for
usually right heart valve
107
where is malignant external otitis seen with pseudomonas
in the mastoid bone
| usually DM patients
108
What is the BEPSEUDO pneumonic
```
Burns
Endocarditis
Pneumonia
Sepsis
External malignant otitis media
UTI
Diabetic Osteomyelitis
```
109
What population is at greatest risk for Burkholderia cepacia infection
CF
110
What type of pathogen is Acinebacter and what does it commonly cause
aerobic gram - common cause hospital pneumonia, burn infections and foley catheter-assoc UTI
111
What are Acinebacter bacteria commonly mistaken for
Neisseria
112
What are the virulent factors of H influenza
has polysaccharide capsule of polyribitol ribose phosphate 6 types a-f
113
What capsule of H influenza is assoc with invasive influenza in children
capsule b
114
What do the non encapsulated(nontypeable) strains of H influenza cause in children and adults?
otitis media in children
| respiratory disease in adults that have weakened or pre-existing lung disease
115
What population is at higher risk for H influenza
COPD patients
| children between 6 mo and 3-5yrs
116
What is the most serious infection that type b H influenza can cause? presentation?
meningitis
fever, vomiting and altered mental status in infants
sometimes neurodefects, mental retardation and seizures
117
What are the infections that H influenza type b can cause
meningitis, acute epiglottitis
septic arthritis
sepsis
118
what does acute epiglottitis look like
follows a sore throat and fever
severe wheezing
salaiva drooling out
large red epiglottis looks like red cherry
119
what is the most common cause septic arthritis in children between 6 mo and 3 yr
H influenzae
120
what is common presentation of septic arthritis from H influenza
usually one joint
| fever, pain, swelling and decreased mobility of the joint
121
how does H influenza lead to sepsis
gets in blood from upper resp tract
122
What is in the H influenza vaccine
polyribotol ribose phostate( the capsule of H influenza) with mutatn diphtheria toxin protein and a N meningitidis outer membrane to activate T cells and Ab production
123
When is the Hib capsule vaccine given to children in the US
ages 2 4 6 and 15 mo
| with DPT and polio vaccines
124
What species is responsible for painful chancroid
Haemophilus ducreyi
125
what is the Ddx for chancroid
syphilis, herpes, lympho granuloma venerum and H ducreyi
126
what is lymphogranuloma venerum assoc with
chlamydia trachomatis
127
What is a great way to Dx a genital ulcer
PCR multiplex that detects H ducreyi, T. palladium and herpes 1/2
128
What are included in the list of slow growing bacteria that can cause endocarditis
```
Haemophilus spp
Actinobacillus spp
cardiobacterium spp
eikenella spp
kingella spp
```
129
a women with pruritis and burning of her labia
dysura and fishy odors
with a slide of discharge having the presence of clue cells she probably has what infection
gardnerella vaginalis
130
what are the virulence factors of Bordetella pertussis
pertussis toxin
extra cytoplasmic adenlyate cyclase
filamentous hemagglutinin
tracheal cytotoxin
131
what is the mech of pertussis toxin
B subunit that binds and lets A in that increases cAMP causing histamine sensitization, increase insulin synthesis and promotion of lymphocyte production and inhibition of phagocytosis
132
what is the role of B pertussis extra cytoplasmic adenylate cyclase
increase cAMP in neutrophils lymphocytes and monocytes impariing chemotaxis and impaired generation of H2O2 and superoxide
133
What is the role of B pertussis filamentous hemagglutinin FHA
pili rod extending from bacterial surface involved in its binding
134
what is the role of B pertussis tracheal ctyotoxin
destroys epithelial cells causing the violent cough
135
How long is the incubation period for whooping cough and what are the 3 stages
1 week uncubation
Catarrhal stage
paroxysmal stage
convalescent stage
136
Describe the catarrhal stage of whooping cough
1-2 weeks
low grade fevers, runny nose, sneezing and mild cough
most contagious during this stage
137
describe the presentation of the paroxysmal stage of whooping cough
no fever
bursts of nonreproductive coughs
5-20 forceful coughs followed by inspiratory gasp through narrowed glottis sounds like a whoop
lasts a month or longer
138
what will the WBC count look like in B pertussis infection
increased lymphocyte count with just a modest increase in neutrophils
139
What is the convalescent stage of whooping cough
attacks are less frequent and patient is no longer contagious
140
what type of swab and agar is used for B pertussis
calcium alginate swab
| Bordet- gengou medium
141
how do hospitals identify B pertussis
ELISA serological tests and PCR assays
142
What is the primary Tx for B pertussis
supportive
| sometimes erythromycin
143
When is TDaP given
2 4 6 15-18 mo 4-6 yrs
144
When is Tdap given
19-64 yrs booster
145
What type of organism is legionella pneuomophila
aerobic gram - rod
facultative intracellular parasite for amoebas
can survive in biofilm
146
where is legionella primarily found as the source of infection
that is ubiquitous in natural and man-made water environments
Air conditioning units!
147
What are the two manifestations of legionella
Pontiac fever
| Legionnaires disease
148
Descibe presentation of pontiac fever
HA, muscle aches, fatigue with fever and chills
| strikes suddenly and lasts a week
149
describe legionnaires disease
high fevers and severe pneumonia
150
What is the presentation of pneumonia caused by legionella
lobar consolidative pneumonia that can be hard to differentiate from pneumococcal pneumonia
has fever with pulse-temperature dissociation (high fever and low HR) severe HA, confusion, myalgia and sometimes with rhabdomyolysis detected by increased serum CPK and myoglobinuria, cough, hyponatremia, hypophosphatemia, and elevated AST ALT alkaline phosphatase, LDH
151
What is common in Yersinia, Francisella, brucella and pasteurella
they are all gram - rods
| all are zoonotic
152
What type of Dx testing would you do to confirm previous infection of yersinia, francisela or burcells
intradermal skin testing and DTH
153
What is Yersinia pestis known to cause
bubonic plague
154
What virulence factors does yersinia pestis have
F1- capsular Ag with antiphagocytic properties
| V and W Ag unknown actions
155
Describe the staining of yersinia pestis
ends take up more stain than the middle
| gram - rods
156
Where do the yersinia pestis bacteria replicate and invade
replicate in macrophages that take them up then move to nearest lymph nodes (usually inguinal)
157
What is the presentation of bubonic plague
swollen hot red painful nodes
fever and HA
hemorrhages under skin causing blackish color
158
patient has been camping in Arizona and New mexico how presents with fever what would you start to suspect
bubonic plague
159
What is tularemia
looks like bubonic plague
| from handling rabbits
160
what diseases are caused from francisella tularensis
ulceroglandular tularemia
| pneumonic tularemia
161
what is the presentation of ulceroglandular tularemia
well demarcated hole in the skin with black base
| fever local swollen lymph nodes are red and painful
162
What is usually the transmission causing pneumonic tularemia
aersolization of bacteria during skinning and evisceration of an infected rabbit
163
What are the other organs invaded by francisella tularemia
eyes oculoglandular tularemia
| GI typhoidal tularemia
164
How do you Dx francisella tularensis
clincal picture
skin test
measurement of titers
Not culture because extremely virulent
165
How do humans acquire brucella
direct contact with infected animal mear, aborted placentas, ingestion of infected milk
166
What is the presentation of brucella? including population seen in
penetrates skin, conjunctiva, lungs, or GI
fever chills, sweats, loss appetite, backache, HA and sometime lymphadenopathy
cyclical fever"undulant"
meat packin industry workers, veterinarian, farmer, traveler
167
how do you Dx brucella
culture from blood, bone marrow liver or lymph nodes
168
how do you prove active brucella infection
serologic examination with elevated anti-brucella Ab
169
why do you not close a wound if someone comes in with a cat or dog bite
perfect environment for Pasteruella multocida growth invading local joints and bones
170
What are shared characteristics of chlamydia and Rickettsia
gram neg
| obligate intracell parasites because need host ATP
171
What is different in energy metabolism between ricketssia and chlamydia
ricketssia can oxidize certain materials to create ATP though still needed from host
chlamydia has no mech for ATP production
172
where does chlamydia like to inhabit
columnar epithelial cells that line mucous membranes
173
What types of infections does chlamydia cause
conjunctivitis, cervicitis and pneumonia
174
What are the two forms of chlamydia
Elementary body that does not divide but attaches and enters columnar epithelial cells and inhibits phagolysosomal fusion in endosome then can transfrom into IB
Initial Body "reticulate" inhibits phagolysosome fusion and grows then binary fission
175
What are the 3 types of chlamydia
trachomatis, psittaci and pneumonia
176
where does C trachomatis primarily infect
eyes and genitals
177
what is the leading cause of preventable blindness
C trachomatis
178
describe the conjunctival infection from C trachomatis
inflammation and scarring
| scar tractino pulls folds of eyelids inward
179
What is inclusion conjunctivits and when is it seen
inflammation with purulent yellow discharge and swelling of eyelids
seen after birth 5-14 days
180
How do you Dx inclusion conjunctivits from C trachoma tis
basophilic intracytoplasmic inclusion bodies from scrapings of palpebral conjunctival surface
181
describe infant pneumonia from chlamydia
4-11 weeks of life
| upper respiratory symptoms followed by rapid breathing, cough and respiratory distress
182
How do you Dx infant pneumonia from chlamydia
clinically
| later confirmed by presence of anti-chlamydial IgM Ab
183
what are the primary infections causing Non gonococcal urethritis
chlaymdia and ureaplasma urealyticum
184
Why does chlamydia not respond to penicillin
has no peptigoglycan
185
What is indicative of NGU on gram stain
polymorphonuclear leukocytes but no intracell or extracell gram - diplococcie
186
What is the preferred Dx test for differntiating gnorrhea and chlamydia
nucleic acid amplification test like PCR on an endocervical swab or urine sample
187
What is super dangerous about untreated chlamydia
an lead to infertility from untreated PID
188
What is the clinical presentation of male chlamydia
epidiymitis with unilateral scrotal swelling, tenderness and pain assoc with fever
189
Wat Reiters sydnme and what is it assoc wit
inflammation arthritis of large joints in men btwn ages 20-40
inflammation eyes and urethritis
C trachomatis
190
What serotypes of C trachomatis cause lymphogranuloma venereum? presentation?
L1L2L3
painless papule or ulceration on genitals that heals spontaneously
migrate to regional lymph nodes which become tender and may break open and drain pus
191
What can be transmitted by working with pigeons, veterinarians and wooers at pet shops?
presentation
Chalmydophila psittaci
| atypical pneumonia psittacosis 1-3 weeks after exposure
192
What type of cells does Rickettsia like to invade
endothelial cells that line blood vessels
193
What Ag does Ricketssia share with Proteus Vulgaris
Ox2 OX19 OX-K
194
What is the weil-felix test
reaction to use Ag cross reacting with P vulgaris to Dx rickettsial infection
Agglutination is + test
195
Describe presentation of Ricketssia ricketsii or RM spotted feer
within a week from a tick bite
fever conjunctival redness, severe headache and a rash that is on wrists, ankles soles and palms that spreads to trunk
resolves in 3 233k but can lead to death
196
What does rickettsial akari cause
tickettsial pox
from house mice mites
febrile with localized red skin papule that turns into a vesicle
197
What is an endemic
infectious disease that exists constantly thorughout a population
198
What is an epidemic
sudden onset and rapid spread of infection that affects large proportion of population
199
What spcies of Rickettsia cause typhus
Rickettsia prowazekii causes epidemic
| Rickettsia typhi causes endemic
200
Presentation of epidemic typhus from Rickettsia prowazekii
abrubt onset fever and HA with 2 week incuvation period
small pink macules on upper trunk and cover body
not on palms and face
flying squirrels are vectors a lot. or lice
201
What is Brill Zinsser Disease
latent Rickettsia prowazekii with milder symptoms
| detect with high IgG for the bacteria
202
presentation of endemic thyphus from Rickettsia typhi
10 day incubation from rat flea
| fever, HA and flat rash
203
describe trench fever and what is the bacteria that causes it
Bartonella quintana
high fevers, rash, HA and severe back and leg pains
relapse 5 days later
204
What bacteria causes cat scratch disease
Bartonella henselae
205
What is the rickettsial disease that causes pneumonia and its presentation
```
Coxiella burnetti Q fever
abrupt fever with soaking sweats 2-3 weeks after infection
also have pneumonia
NO rash
transmitted from ticks and cattle
```
