Micro Key Associations Flashcards by O lawformonde

Staphylococci

gram positive round clusters

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Preferentially colonizes the vagina

Streptococcus agalactiae

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Anaerobic

Gram positive spore forming rod

endospores introduced through wounds

Clostridium tetani

Tetanus

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Best prevention for staph

WASH YOUR HANDS

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Think bunnies, Rabbits, and hares oh my…. or Peter Rabbit in a Tulle Skirt

Francisella tularensis

Tuleremia

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Gastroenteritis - fever, diarrhea, cramps 24-48h

Listeria

spp. (L. monocytogenes)

Ampicillin & PCN or Bactrim

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gram-negative bacilli, aerobic growh requires X factor (hemin) and V factor (NAD)

humans are only natural host, secretions or airborne droplets

Haemophilis influenzae

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Strep Throat-Presence of erythema, uvulitis, and tonsillar exudates

Streptococcus pyogenes

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most common cause of UTIs and Gram-negative sepsis, most frequent cause of Traveller’s diarrhea, important cause of neonatal meningitis

Escherichia coli

cephalosporins, 2. aminoglycosides, 3. TMP/SMX (bactrim) 4. fluoroquinones

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index organism for fecal contamination of water

Escherichia coli

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Multi-system disease following a “cytokine storm” induced by a toxin, TSST-1 (a superantigen)

Staphylococcus aureus-toxic shock syndrome

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UTI, bacteremia; systemic infections introduced via invasive intervention

Staphylococus Coagulase negative (S. saprophyitcus)

penicillin; for invasive infections: vancomycin

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Classic Triad: fever, headache, rash, hx of bite in <50%, early: HA, intense myalgia, anorexia, fever. Rash: begins on ankles/wrist and spreads centrally. maculopapular, evolves into petechial rash, palms/soles 40-80%, severe case: hemorrhage, necorsis, gangrene of digits, usually no eschar

higher risk: G6PD deficiency, elderly, alcoholism

Rickettsia rickettsii

Rocky Mountain Spotted Fever (RMSF)

tropism for vascular endothelial cells

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PCR, ELISA for toxin A and B, NOT Culture, Cdiff antigen, cytotoxicity assay, fecal leukocytes in 50%, pseudomembranes on endoscopy in 30-50%

Clostridium difficileC.diff, C,diff infection (CDI)

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(G+) Clustered cocci, facultative anaerobes

Staphylococus

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Placenta - in utero infection → immediate abortion/neonatal death → infection at parturition (meningitis 2wk post-birth or immediate sepsis after delivery)

Listeria

spp. (L. monocytogenes)

Ampicillin & PCN or Bactrim

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No cell walls- don’t stain. Pleimorphic.

Mycoplasmataceae

Mycoplasma spp. Ureaplasma spp.

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Inducible clindamycin resistance

beta-hymolytic streptococci

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mouth pain, drooling, dysphagia, respiratory distress “hot potato voice”, edema of the floor of mouth with swelling and displacement of tongue superiorly and posteriorly. woody, tender SWelling of suprahyoid region of neck

^^not to be confused with diphtheria, which can cause bull neck

predisposing factors: odontogenic infection (70-85%), trauma, mandibular fracture, foreign bodies, neoplasm

(NOT A SPECIFIC BUG) Ludwig’s Angina

mixed oral aerobes, anaerobes, occasionally S. aureus

infection of submandibular space: sublingual, submlyohyoid spaces

Antibiotics should be initiated as soon as possible, should initially be broad-spectrum and cover gram-positive, gram-negative, and anaerobic organisms. Combinations of penicillin, clindamycin, and metronidazole are typically used. Respiratoy distress - intubation

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endocarditis, dental caries

Streptococcus viridans

For all Strep: beta‐lactam; cephalosporin; macrolide;
respiratory fluorquinolone

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“Bull Neck” appearance is Airway Obstruction

^^not to be confused with Ludwig’s Angina (hot potato voice, woody, tender swelling of suprahyoid. from mixed aerobes and anaerobes)

Corynebacteria diptheriae

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veneral syphilis, yaws, endemic syphilis, pinta

Treponema pallidum

syphilis

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gram stain: reveals gram+ cocci in clusters.
Culture: beta-hemolytic, produces a golden yellow pigment,
metabolic - catalase positive, coagulase positive,
PCR of rRNA

Staphylococus aureus

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Infections of valves, catheters, shunts, prothetic devices, etc…

Coagulase negative Staphylococcus infection

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louse-borne relapsing fever

Borrelia recurrentis

Food-borne botulism - cranial nerve palsies, muscle weakness, respiratory paralysis, (also infant botulism and wound botulism)

Clostridium botulinum-Botulism Remove toxin - gastric lavage, wound debridement; respiratory support, polyvalent equine antitoxin

3 laboratory diagnostic techniques for Staphylococcus infections

1. Gram stain 2. PCR 3. Culture

localized with systemic toxin-effect (scalded-skin syndrome, toxic-shock syndrome) ## Footnote clindamycin, cephalosporins, erythromycin For MRSA – vancomycin, TMP/SMX, doxycycline, linazolid

Staphylococus aureus

RABIES:1. incubation can be from 2wks to year. 2. prodrome: fever, HA, sorethroat, parasthesias at inoculation site (50%) GI, behavioral and emotional symptoms, priapism, agitation, depression 3. Acute encephalitis: Furious (80%) painful contraction of pharyngeal muscles with swallowing liquids --\> hydrophobia and foaming at mouth, hyperactivity and agitation leading to confusion and seizures, Paralytic (20%) Brain stem encephalitis: cranial nerve dysfunction, 4: coma and death: due to respiratory center dysfunction

Lyssavirus Rabies negative sense, enveloped ssRNA one of the only disease where you can get vaccinated after exposure

after 4-6 weeks, 90% with IgG elevation, after Abx, titers fall slowly, PCR for serum, CSF, and synovial fluid. C6 antibody (ELISA)

Borrelia burgdorferi Lyme disease spirochetes oral Abx unless patient has neurologic or cardiac symptoms, oral doxycycline, amoxiciliin, IV ceftriaxone, 15% develop Jarsich-Herxheimer reaction

oxacillin resistance

MRSA

pre-existing anti-dengue Ab: previous infections, maternal Ab, higher risk in secondary infections, higher risk in locations with \>= 2 serotypes circulating Primary: develop Ab that can neutralize virus of homologous serotype. subsequent infections: **pre-existing heterologous Ab forms complex with new infecting serotype - DO NOT neutralise new virus, can get greater proportion of monoctes increasing viral replication. infected monocytes release vasoactive mediators - increased vascular permeability and hemorrhagic manifestations**

Dengue Arbovirus, 4 serotypes humans are main reservoir hosts, urban settings: Aedes aegypti and albopictus, slyvatic: non-human primates and tree-dwelling Aedes stegomyia

major shifts in HA and NA

antigenic shift:

culture - greenish metallic colonies on blood agar. can have fruity (grape) smell

Pseudomonas aeurginosa Whirlpool folliculitis multi-drug reistant; highest mortality rate of all noscomial pathogens. It's the HOST not the bug.

1. Gram stain, 2. Culture, 3. serology, 4. PCR of nasal swab, **_widening mediastinum on CXR_**

Bacillus Anthracis

Dental caries

Viridans Streptococci

infection occurs when bacteria enters peritoneal cavity abcesses in GI tract, pelvis and lungs

Bacteroides fragilis-bacteroides

sore throat, fever, lymphadenopathy, tonsillar enlargement with exudate; paltal petechiae (25-60%), cervical lymphadenopathy (80-90%), splenomegaly (50%), hepatomegaly (10-15%); can be asymptomatic

Epstein-Barr Virus (EBV) mononucleiosis gamma-herpesvirus distinguish from strep using monospot

"Honey crusted rash"

Impetigo (Streptococcus pyogenes) Impetigo (Stayphylococcus aureus)

endocarditis, sepsis, UTI, opportunistic pathogen

Streptococcus enterococcus Nitrofurantoin, may be PCN sensitive (amoxicillin); For deep infections vancomycin; linezolid if resistent

* Food-borne * Rare, occurs in source-specific outbreaks * At risk: really young and really old, immunosuppressed individuals (pregnancy, steroids, transplant Pts, HIV)

Listeria spp. (L. monocytogenes)

selective media for Staphylococcus aureus

mannitol salt agar

Latex particle agglutination for...

Streptococcus pneumoniae

incubation 2-21 days: starts with fever, severe HA, muscle pain, weakness, fatigue, GI distress - vomiting, diarrhea, abd pain. unexplaiend hemorrhage

Ebola virus Filovirus (-)ssRNA, enveloped, helical, nonsegmented, zoonotic

septic arthritis

Stayphylococcus aureus

gram-negative coccobacilli through skin abrasions, unpasteurized dairy products, livestock (zoonosis)

Brucella Brucellosis

ulcers with **_black base at site of bite_**, high fever, lymphadenopathy, pneumonia (if bacteria was inhaled)

Francisella tularensis Tuleremia 1. gentamycin or streptomycin, 2. doxycycline, 2. attenuated vax (only for high risk)

1. gram stain - gram + rods, 2. culture- can grow on temps as low as 0 deg C, **_use cold enrichment to isolate from mixed flora_**

Listeria spp. (L. monocytogenes)

gram-negative enterobacteriaceae, mucoid

Klebsiella pneumoniae

fried rice sickies Food-poisoning (enterotoxin), traumatic ocular infection

Bacillus cereus no treatment for food poisoning

UTI, **_staghorn calculi_** (kidney stones that take shape of tubules), sepsis

Proteus mirabilis; Proteus vulgaris ampicillin

chancroids - begins as tender papule on genital or perianal area; lesion can ulcerate, with suppurative lymphadenopathy

Haemophilis ducreyi Chancroid 1. azithromycin, 2. ceftriaxone (IM) 3. ciprofloxacin

Invasive (endocarditis, pneumonia, osteomyelitis)

Staphylococus aureus ## Footnote clindamycin, cephalosporins, erythromycin For MRSA – vancomycin, TMP/SMX, doxycycline, linazolid

Pneumococcal vaccine

1. PCV13 (conjugate): all infants, young children, and adults \>65 2. PCV13 followed by PPSV23 (polysaccharide) at 6-12 mo 3. Also high risk individuals: sickle cell, HIV, other immune dysfunction

1. ciprofloxacin, 2. doxycycline, 3. raxibacumab (monoclonal Ab for inhalation anthrax) 4. vaccine for high-risk individuals

Bacillus Anthracis

infects human embryonic cortical neural progenitor cells (hNPCs) which produce infectious progeny virus, increase cell death of hNPCs birth defects: microcephaly

Zika virus

gram stain and culture on blood or chocolate agar

Moraxella catarrhalis All strains produce beta-lactamases, macrolides, fluoroquinolones, amoxicillin-clavulanate colonization is dependent on age, COPD adults have higher rate, resistant to penicillin

food poisoning from enterotoxin, skin and soft tissue infection -gas gangrene or clostridial myonecrosis

Clostridium perfringens gaseous gangrene radical surgery (may require amputation) 2. penicillin, 3. hyperbaric O2

Non-selective media for Streptococcus

Sheep blood agar, chocolate agar

gram-negative rodbody lice feces

Bartonella quintana Trench Fever

Acid fast stain, fluorescent stain, MTB rapid diagnostics, Gambian pouch rat expert, .1ml PPD 5TU injected intracutaneously and induration measured 48-72 hrs. + is 5,10,15 determined by sensitivity, specificity ,and prevalence for diff groups. --\> indicated presences of viable mycobacteria

Mycobacterium tuberculosis

gram-negtative non-sporulating bacillus, obligate aerobe except with nitrate, oxidase positive typically nosocomial, colonizes damage tissues, ubiquitious

Pseudomonas aeurginosa Whirlpool folliculitis

1. if bitten by a possible rabid animal: A. capture the animal and observe for 10 days. 3. destroy animal and examine for Negri bodies, C. treat immediately if you cannot capture the animal or it has rabies

Lyssavirus Rabies negative sense, enveloped ssRNA one of the only disease where you can get vaccinated after exposure

Sporiform, facultative anaerobes

Bacillus Anthracis

Kaposi's sarcoma: vascular tumor associated with HIV, Castleman's disease: focal or multicentric lymphoma (not associated w/ HIV)

HHV8 Kaposi's sarcoma-associated herpes virus, castleman's disease Gamma- herpesvirus ds linear DNA, enveloped, icosahedral

1. flea bite, 2. contact with infected animal tissue. 3. inhaled aerosolized organisms - human to human during epidemics 1. wild rodents, city rats, squirrels and prairie dogs in southwest US

Yersinia pestis bubonic plague

Asymptomatic: 20-50% Dengue fever (DNF): 2-7 days of high ever "break bone fever" 1. painful fever with HA, muscle aches, joint aches, backache. retro-orbital pain, diffuse erythematous maculopapular rash, no plasma leak or severe hemorrhage. N/V abdominal pain may occur. 2. critical (plasma leak): last 24-36hr, usually alert and lucid. 3. convalescent phase: stabilization of vital signs, HCR, increase urine output, rash: confluent pruritic rash with small island of unaffected skin, fluid overload if don't decrease fluid resuscitation. \_\_\_ 2. dengue hemorrhagic fever: positive tourniquet test, skin hemorrhage: petechiae, purpura, ecchymoses, thrombocytopenia (=\< 100.000/mm3), plasma leakage: hemoconcentration, pleural effusion, ascites, hypoproteinemia 3.Dengue shock syndrome: DHF + circulatory failure, narrow pulse pressure, hypotension + cold/clammy skin. \>20% mortality w/o prompt tx. \<1% if early intensive support therapy

Dengue Arbovirus, 4 serotypes humans are main reservoir hosts, urban settings: Aedes aegypti and albopictus, slyvatic: non-human primates and tree-dwelling Aedes stegomyia

sandfly

Bartonella bacilliformis Oroya Fever (Carrion's Disease)

penicillin; for invasive infections: vancomycin

Staphylococus Coagulase negative (S. saprophyitcus)

Bacillus

Gram positive rods

recombination of genomic material in cell co-infected with 2 diff viruses

reassortment

Catheter related sepsis-- gram positive

enterococcus spp

Nitrofurantoin, may be PCN sensitive (amoxicillin); For deep infections vancomycin; linezolid if resistent

Streptococcus enterococcus

if given ampicillin (because you think it's strep), will present with rash

Epstein-Barr Virus (EBV)

***pneumonia with significant lung necrosis and bloody sputum common in alcoholics or those with underlying lung disease***, hospital acquired UTI and sepsis

Klebsiella pneumoniae 1. 3rd gen cephalosporin, 2. cipro

pertussis toxin, part of the TDaP vax.

Bordatella pertussis whooping cough

1. gram stain, 2. culture (urine, CSF, sputum, blood) 3. pathogenic strains from stool. 4. EMB agar

Escherichia coli

non-sporiforming, small cocci/diplo, motile

Listeria spp. (L. monocytogenes)

no treatment for food poisoning self-limiting, no treatment

Bacillus cereus

meningitis - bacteremic spread and may be associated with trauma, neurosurgery CSF leak or paranasal sinusitis, epiglottitis- emergency with celluitis and swelling pharyngitis fever drooling difficulty swallowing breahing and **_thumbprint sign_**, otitis media & sinusitis (URTI), pneumonia (LRTI), septic arthritis, sepsis Risk: HIV/AIDS • Sickle cell disease • Splenectomy • Chronic lung disease • Also smoking, malignancy, pregnancy and alcoholism

Haemophilis influenzae 1. 2nd or 3rd gen cephalosporins, Hib vax, passive immunization from mother

1. acute: fever, HA, back pain, mylagia, intense arthralgia, rash in 50%: maculopapular, diffuse hyperemia, edema of face and extremities \_\_ 2. chronic: **debilitating polyarthraglias**. can last months to \>1 year. less common in children, peripheral joints, spinal pain, associated with tenosynovitis and Raynaud's syndrom

Chikungunya

15% develop Jarsich-Herxheimer reaction

Borrelia burgdorferi Lyme disease spirochetes oral Abx unless patient has neurologic or cardiac symptoms, oral doxycycline, amoxiciliin, IV ceftriaxone, 15% develop Jarsich-Herxheimer reaction

radical surgery (may require amputation) 2. penicillin, 3. hyperbaric O2

Clostridium perfringens gaseous gangrene radical surgery (may require amputation) 2. penicillin, 3. hyperbaric O2

alpha-hemolytic strep

Streptococcus pneumoniae Streptococcus viridans

Streptococcus

gram positive dipolococci

Group B, beta-hemolytic

Streptococcus agalactiae

one of the causes of "atypical" pneumonia: mostly mild or asymptomatic infections. upper (bronchitis, pharyngitis) lower (pneumonia)

Chlamydia pnuemoniae

gram-negative diplococci transmitted by sexual contact, major reservoir in women carriers

Neisseria gonorrhea

Shingles: usually unilateral and contained in 1-3 dermatomes latency in dorsal root ganglia, prodromal pain 50% thoracic \_\_ postherpetic neuralgia - persistent pain \>1 month, incidience increases with advancing age. Herpes zoster ophthalmicus - vesicles on one side of forehead and on tip of nose may be associated with severe corneal involvement, can lead to blindness

herpes zoster shingles

Antitioxin (Europe only), Antibiotics (PCN, erythromycin, rifampin, tetracycline), respiratory isolation, supportive therapy

Corynebacteria diptheriae

regional lymphadenitis, enlarged and tender lymph nodes, fever, headache, rash, splenomegaly, culture-negative endocarditis, bacillary angiomatosis. Granuloma with central necrosis + giant cells.

Bartonella henselae Cat scratch disease 1. azithromycin, 2. doxycycline

1. gram stain: reveals gram+ cocci in clusters. 2. Culture: gamma-hemolytict, 3. metabolic - catalase positive, coagulase positive

Staphylococus Coagulase negative (S. saprophyitcus)

gram stain, anaerobic culture (produces a black pigment when grown on blood agar)

Bacteroides melaninogenicus-bacteroides

Localized infections with **_toxin mediated_** effects (scalded skin syndrome/toxic shock syndrome/food poisoning)

Stayphylococcus aureus

inducible clindamycin resistance

Staphylococcus resistance

CNS - brain & brainstem & CSF - Top 5 causes of meningitis, 20% mortality

Listeria spp. (L. monocytogenes) Ampicillin & PCN or Bactrim

pyomyocysitis

Stayphylococcus aureus

Anaerobic Gram positive spore forming bacilli 1. soil 2. canned food 3. smoked fish 4. **_honey (_**infant botulism) 5. IV drug use

Clostridium botulinum-Botulism

1. culture (easily transmited so careful 2. skin test. 3. measure rise in IgG

Francisella tularensis Tuleremia 1. gentamycin or streptomycin, 2. doxycycline, 2. attenuated vax (only for high risk)

Detect of unique DNA sequences that are able to distinguish MRSA and MSSA

Staphylococcus aureus PCR

gram-negative enterobacteriaceae

Yersinia pestis bubonic plague

1. neonates are susceptible from 6-24 mnths with IgG is low. 2. Army recruits, college dorms

Neisseria meningitidis bacterial meningitis

immunosuppression - CF, prolonged hospitalization, burn wound patients OTITIS EXTERNA, WHIRLPOOL FOLLICULITS. Cutaneous infections: paronychia, toe web infections, cellulitis, pyoderma (skin infection w/ pus); GI infections: typhilitis, Shanghai fever, diarrhea; bacteremia, bone + joint infections

Pseudomonas aeurginosa Whirlpool folliculitis multi-drug reistant; highest mortality rate of all noscomial pathogens. It's the HOST not the bug.

Men: genital infection restricted to urethra, complications: epididymitis, prostatitis, anorectal GC Women: vaginal discharge, dysuria, abdominal pain, 10-20% ascending genital infection with tubo-ovarian abscess, PID - increased risk of infertility or ectopic/tubal preganancy, bartholinitis. Neonates: ophthalamia neonatorum

Neisseria gonorrhea ceftriaxone plus azithromycin, penicillin resistance common

human to human, respiratory route, may be 3-5 days before rash

varicella zoster virus (VSV) alpha-herpesvirus, latency in neurons, has nucleocapsid, enveloped

TETANUS - muscle spasms, persistent back spasm (opisthotonos), lowjaw (trismus), respiratory muscle paralysis, neonatal tetanus (umbilical stump -90% mortality)

Clostridium tetani Tetanus wound debridement, antibiotics, passive immunization: tetanus immune globulin, active immunization: tetanus toxoid

Respiratory: tracheobronchitis, atypical or walking pneumonia Genital: PID, pyelonephritis, Urethritis

Mycoplasmataceae Mycoplasma spp. Ureaplasma spp.

skin infection; localized (cellulitis, impetigo, folliculitis, furnuncles, carbuncles)

Staphylococus aureus ## Footnote clindamycin, cephalosporins, erythromycin For MRSA – vancomycin, TMP/SMX, doxycycline, linazolid

responsible for blindness, infertility

Chlamydia trachomatis

Detection of _____ streptolysin O and DNAase B antibodies

Streptococcus pyogenes

**_Whooping Cough_**: 1. catarrhal phase: patient is highly contagious (1-2wk) - low grade fever, rhinorrhea, mild cough, abx effective 2. paroxysmal phase: (2-10wk) whooping (burse of non-productive coughs), increase # of lymphocytes in blood smear, Abx ineffective 3. convalescent phase

Bordatella pertussis whooping cough erythromycin, vaccine, treat household contacts with erythromycin

1. culture of blood, bone marrow. liver, lymph nodes 2. serologic test. 3 skin test (indicates exposure only)

Brucella Brucellosis 6 weeks of antibiotics; pasteurization of milk

ss RNA viruses, orthomyxovirus, enveloped, types A, B, C

Influenza

ELISA, PCR, Bordet-Gengou media, fluorescein-labeled Abs

Bordatella pertussis whooping cough erythromycin, vaccine, treat household contacts with erythromycin

biphasic: acute bacteremic phase = flu-like symptoms (fever, myalgia, arthalgia, headache, Oroya fever); chronic phase = cutaneous nodules develop 1-2 months after and persist for years

Bartonella bacilliformis Oroya Fever (Carrion's Disease)

Worrisome AB-Resistance: Vancomyocin, Oxacillin, Clindamycin

Staphylococus aureus

gram-negative, enterobacteriaceae, facultative anaerobe

Escherichia coli

Gram stain, PCR, Rapid Strep

Streptococcus pyogenes

Sporiform, aerobic

Bacillus cereus

1. cephalosporins, 2. aminoglycosides, 3. TMP/SMX (bactrim) 4. fluoroquinones

Escherichia coli

Gram stain and culture of ulcer exudate and pus from lymph nodes cultures are ineffective, often have no growth

Haemophilis ducreyi Chancroid

gram-negative diplococci normal flora in vagina and orophaynx

Moraxella catarrhalis

culture specimen from suspected food source

Bacillus cereus

first infection = usu. more severe symptoms; recurrent infections = usu. less severe primary genital infection: fever, anorexia, malaise, headache, regional lymphadenopathy, genital lesions primary oral infection: gingivostomatitis (vesicles with ulceration), cervical lymphadenopathy \_\_\_\_ keratitis, herpetic whitlow (vesicular infection + inflammation of the nail bed); IN IMMUNOCOMPROMISED HOSTS: chronic skin lesions (primary manifestation), esophagitis, pneumonia (rare), dissemination (rare) aseptic meningitis (from inflammation of sacral nerve roots)

HSV (HSV-1, HSV-2) alpha-herpesvirus, latency in neurons, has nucleocapsid, enveloped

Anaerobes Gram positive spore forming bacilli soil, water, sewage, part of normal flora

Clostridium perfringens gaseous gangrene

fever, rash, superficial fluied-filled vesicles, pustules, crusts/scabs Complications: Hepatitis, pneumonitis, encephalitis; infection of cutaneous lesions; Reye's syndrome (encephalopathy, liver disease) is assoc. w/ aspirin consumption; Guillain-Barre syndrome

varicella zoster virus (VSV) alpha-herpesvirus, latency in neurons, has nucleocapsid, enveloped

non-sporiform, aerobic, club-shaped

Corynebacteria diptheriae

gram-negative rod cat bite or scratch

Bartonella henselae Cat scratch disease

gram-negative diplococci (Serogroup B) humans = only reservoir

Neisseria meningitidis bacterial meningitis

obligate aerobe, **_requires cysteine_** rabbits, rodents, tics, fleas

Francisella tularensis Tuleremia

Antibiotic associated colitis (diarrhea), dehydration, electrolyte disturbances, shock, toxic megacolon, reactive arthritis

Clostridium difficile C.diff, C,diff infection (CDI) discontinue causative Abx, initiate Abx effective against Cdiff: metronidazole, oral vancomyocin, fidaxomicin, toxin-binding resins

lepromatous: high bacillary lode, diffuse, extensive skin involvement, plaques, nodules, deformity of facial structures, anergy, tuberculoid: few bacilli present, \<5 skin lesions, anasethesia present, react to M.leprae skin test, nerve involvement common, mixed

Mycobacterium leprae Leprosy (Hansen's disease)

5 lab diagnostic techniques for streptococcal infections

1. Gram stain 2. antigen detection 3. molecular diagnostics 4. aerobic and anaerboci culture 5. antibody detection

Flu like sxs, leukopenia + thrombocytopenia + elevated transaminases, Complications: spetic shock, ARDS, neuro (peripheral , facial palsy, demyelinating polyneuropathy, brachial plexopathy); **_morulae in granulocytes_**

Anaplasma phagocytophilium Anaplasmosis tropism for neutrophils, intracellular bacteria

Endocarditis

Viridans Streptococci Enterococcus spp

Gram negative rods, non spore forming, polysaccharide capsulepart of the normal flora of intestine Anaerobes

Bacteroides fragilis-bacteroides Bacteroides melaninogenicus-bacteroides

roseola infantum in 20-30% of cases, usually self-limited, mild, febrile seizures 3-13%, rare encephalitis \_\_\_ acute onset high fever with well-appearance subocciptal adenopathy, red throat, abrupt disappearance of fever with onset of macular rash, drop in WBC prior to rash, may have atypical lymphocytes, 6 days duration, mono like illness in adults

HHV6 spring/fall, spread by saliva, 6th disease, beta- herpesvirus ds linear DNA, enveloped, icosahedral

Fluoroquinolone resistance

Streptococcus pneumoniae

Neonatal sepsis/megingitis Postpartum sepsis

Streptococcus agalactiae

gram -, obligate intracellular bacteria

Chlamydia trachomatis Chlamydia psittaci Chlamydia pnuemoniae

70 antigenic variations, resistant to beta lactamses and carbapenemase

Klebsiella pneumoniae

West Nile fever (WNF) 20-30% or West nile neuroinvasive disease (WNND) \<1%: meningitis, encephalitis or myelitis, that produces flaccid paralysis \_\_\_\_\_ 1. West nile meningitis: symptoms of WN fever + meningitis. 20% have cranial nerve palsies, CSF: ~200 WBC/mm3( often neutrophils, elevated protein, normal glucose), usually recover without permanent neurological sequelae, 2. WN Encephalitis: more common in older and immunocompromised individuals, fatality rate 20% - cardiac arrythmia or respiratory failure. chronic neurologic sequelae: tremors, parkinsonism, ataxia, can last months.years, high rate of institutionalization. 3.flaccid paralysis: typically asymmetric in \>1 limb, ~50% with encephalitis, rarely occurs w/o fever or other symptoms. permanent weakness and prolonged recovery

West Nile Virus enveloped flavivirus

Penicillin/cephalosporin resistance

1. Streptococcus pneumoniae 2. viridans streptococci

Resp. Tract --\> Exudate in Pharynx/trachea --\> Airway Obstruction. Tonsillitis/pharyngitis; Neck Adenopathy. Other Presentations: MYOCARDITIS and Cranial neuropathies

Corynebacteria diptheriae Antitioxin (Europe only), Antibiotics (PCN, erythromycin, rifampin, tetracycline), respiratory isolation, supportive therapy

Sputum gram stain with gram positive diplococci

Streptococcus pneumoniae

_**Meningitis\*, Pneumonia\*,**_ bacteremia, otitis media, sinusitis

Streptococcus pneumoniae For all Strep: beta‐lactam; cephalosporin; macrolide; respiratory fluorquinolone

Gram positive opportunitistic infection, such as a UTI

enteroccocus spp

1. clinical : **tourniquet test (positive: \>20 petechiae/in2)** 2. acute: virus detection, blood CSF, tissue, RT-PCR, antigent detection (NS1 protein), 0-5 days post-onset of symptoms. 3. Serology: IgM \>5 days post onset. IgG: paired acute.convalescent - 4-fold rise in titers

Dengue Arbovirus, 4 serotypes humans are main reservoir hosts, urban settings: Aedes aegypti and albopictus, slyvatic: non-human primates and tree-dwelling Aedes stegomyia

Immunochromatography for....

1. Streptococcus pyogenes 2. Streptococcus agalactiae

subcutaneous hemorrhage results in blackish skin discoloration giving name "Black Death"

Yersinia pestis bubonic plague 1. streptomycin or gentamycin 2. doxycycline

A woman is pregnant and expecting, with regard to Streptococcus infections, what should you test her for?

GBS

spirochetes, corkscrew shaped

Treponema pallidum syphilis

Gram Stain, immunochromatography, latex, molecular diagnosis, aerobic and anaerobic, antibody detection

Streptococcus pneumoniae

Intracellular pathogenesis - binds epithelial cells, escapes intracellular killing via filopods (bacteria push against membrane and through to adjacent cells, escaping immunosurveillance), cell to cell spread

Listeria spp. (L. monocytogenes)

Trench fever: fever, headache. back pain, lasts for 5 days and occurs at 5 day intervals. 2. bacteremia, endocarditis, bacillary angiomatosis

Bartonella quintana Trench Fever 1. doxycycline 2. chloramphenicol 3. azithromycin

transmission secondary to contact with infected body fluids: contaminated medical instrumetns and close contact with sick or dead patients and their bodies. likely mechanism is skin or mucous membrane contact with virus infected fluids - blood, semen, diarrhea, vomit

Ebola virus Filovirus (-)ssRNA, enveloped, helical, nonsegmented, zoonotic

vancomycin resistance

VRSA

10-15% of otitis media, 3rd most common for bacterial sinusitis, lower RTI especially in COPD and bronchitis patients, pneumonia in elderly

osteomyelitis

Stayphylococcus aureus

For all : beta‐lactam; cephalosporin; macrolide; respiratory fluorquinolone

Streptococcus

minor shift in HA or NA with only minor changes in antigenicity.

antigenic drift

Types: 1) Bubonic, 2) Septicemia, 3) Pneumonic. Presentation: Fever, headache, chills, fatigue, leucocytosis, sepsis, pneumonic plague (epidemics).

Yersinia pestis bubonic plague 1. streptomycin or gentamycin 2. doxycycline

Scalded skin syndrome: exfoliatin-mediated detachment of the granulosum and spinosum layers within the epidermis

Staphylococcus aureus

Yellow Fever: 3-6 day incubation **conjunctival suffusion**1. hepatitis with jaundice, 2. fever. 3. backache

Yellow Fever

meningococcal meningitis with **_petechial rash_**, meningococcemia w/o meningitis, meningitis w/o meningococcemia, mild transient bacteremia, pneumonia

Neisseria meningitidis bacterial meningitis 3rd gen cephalosporins (ceftriaxone, cefepime); chloramphenicol - used in developing countries Chemoprophlyaxis should be given to close contacts only after exposure to invasive disease. Meningitis Belt = Sub-Saharan Africa

Gram stain, blood culture for possible disseminated GC, chocolate agar, commercial antigen probes, urine NAAT

Neisseria gonorrhea

Vancomycin resistance

enterococci

mixed oral aerobes, anaerobes, occasionally S. aureus infection of submandibular space: sublingual, submlyohyoid spaces

(NOT A SPECIFIC BUG) Ludwig's Angina Antibiotics should be initiated as soon as possible, should initially be broad-spectrum and cover gram-positive, gram-negative, and anaerobic organisms. Combinations of penicillin, clindamycin, and metronidazole are typically used. Respiratoy distress - intubation

non selective media for Staphylococcus

* sheep blood agar * chocolate agar

gram-negative enterobacteriaceae, **_motile_**

Proteus mirabilis; Proteus vulgaris

neonatal and postpartum sepsis, meningitis

Streptococcus agalactiae For all Strep: beta‐lactam; cephalosporin; macrolide; respiratory fluorquinolone

Wide zone beta-hemolysis: Strep

streptococcus pyogenes

eschars, necrosis in RT, oropharyngeal and abd infection 1. cutaneous (95%): painless black vesicles, can be fatal if untreated. 2. pulmonary (woolsorter's disease). 3. abd pain, vomiting, bloody diarrhea

Bacillus Anthracis 1. ciprofloxacin, 2. doxycycline, 3. raxibacumab (monoclonal Ab for inhalation anthrax) 4. vaccine for high-risk individuals

Lateral neck radiograph; Look for THUMBPRINT sign

Haemophilis influenzae 1. 2nd or 3rd gen cephalosporins, Hib vax, passive immunization from mother

Group D

Streptococcus enterococcus

aerobic, non-spore forming, nonmotile bacillus

Mycobacterium tuberculosis avium and intracellulare leprae

CNS (Meningitis) and placenta, bacteremia in immunocompromised

Listeria spp. (L. monocytogenes) Ampicillin & PCN or Bactrim

Endemic: Latin America, Sub-saharan Africa, East Asia

Bacillus Anthracis

1. gram stain for gram- rods, 2. blood cultures. culture of bubo aspirate 4. serology. 5. rapid diagnostic - antibody against F1

Yersinia pestis bubonic plague 1. streptomycin or gentamycin 2. doxycycline

high fever, sweats malaise, anorexia, abdominal pain, diarrhea, back pain, lymphadenopathy (10%), hepatosplenomegaly (40%); granulomas. Can progress into undulant/Malta fever; COMPLICATIONS: arthritis, osteomyelitis, meningitis

Brucella Brucellosis 6 weeks of antibiotics; pasteurization of milk

1. culture, 2. **_examination of urine with high pH_**

Proteus mirabilis; Proteus vulgaris

Gram stain and culture of CSF, CSF on chocolate agar, blood cultures

down-regulates cytotoxic CD8 response Immunocompetent: asymptomatic, mono, congenital CMV, immunocompromised: retinitis (50% bilateral), pneumonitis, GI- colitis, esophagitis, CNS-encephalitis, myelitis

cytomegalovirus (CMV) Also mono Beta-herpesvirus DNA virus, icosahedral, lipid envelope negative monospot

Alpha hemolysis: strep

streptococcus pneumoniae

diagnosis is made clinically - NEVER a microbiologic diagnosis, feel impending doom, usually with antecedent trauma

Clostridium perfringens gaseous gangrene radical surgery (may require amputation) 2. penicillin, 3. hyperbaric O2

ampicillin resistance

E. faecium

high risk: infants \<1 year old, adults (as immunity wears off)

Bordatella pertussis whooping cough erythromycin, vaccine, treat household contacts with erythromycin

**Respiratory Tract** [URI, pharyngitis, Scarlet fever, suppurative sequelae (tonsillar or retropharyngeal abscess), nonsuppurative sequelae (rheumatic fever, glomerularnephritis)], **Skin** [Impetigo, ecthyma (punched out ulcers into dermis, green-yellow crust), cellulitis (acute skin infection, SubQ), erysipelas (superficial cellulitis), necrotizing fasciitis (incl. deep fascia), toxic shock (systemic infection, fever, hypotension, tachycardia/pnea, desquamation)]

Streptococcus pyogenes For all Strep: beta‐lactam; cephalosporin; macrolide; respiratory fluorquinolone

toxin-mediated (food poisoning)

Staphylococus aureus ## Footnote clindamycin, cephalosporins, erythromycin For MRSA – vancomycin, TMP/SMX, doxycycline, linazolid

flu like sxs + maculopapular rash, leukopenia + thrombocytopenia + elevated transaminases, Complications: spetic shock, ARDS, coagulaopathies, neuro (meningoencephalitis, seizures, coma, peripheral, primary cranial neuritis) - more complications and fatalities; **morulae in MONOCYTES**

Ehrlichiaspp. Ehrlichiosis

cutaneous manifestations: erythema chronicum migrans -occurs at tick bite site, 3-30 days post bite, usually red outer with central clearing, fatigue, F/C, adenopathy, meningeal signs, hepatitis, splenomegaly MSK manifestations: 80% untreated patients affected, occur within 2wks-2years. from joint pain to intermittent arthritis to chronic erosive synovitis. Early disease: migratory pain in joints, tendonitis, bursae potenitally affected, frank arhtritis with marked swelling can occur in large joints with remission inbetween attacks, small % with chronic arthritis Cardiac: occurs within several weeks, 5% untreated patients, usual presentation: AV block (1st degree, Wenkebach, complete heart block) may present with EKG changes, myopericarditis, LV dysfunction, brief: 3days to 6 weeks Neuro manifestations: early- symptoms of meningeal irritation concomitant with ECM, not associated with CSF pleoctyosis or neuro defecits, late: 15% cases affected, several weeks to months after onset of diseasae, includes meningitis, encephalitis, chorea, cranial neuritis, motor/sensor radiculitis, myelitis. usual pattern: fluctuating meningitis with superimposed cranial nerve palsy or peripheral neuropathy

Borrelia burgdorferi Lyme disease spirochetes oral Abx unless patient has neurologic or cardiac symptoms, oral doxycycline, amoxiciliin, IV ceftriaxone, 15% develop Jarsich-Herxheimer reaction

pulmonary disease in elderly men with COPD, elderly non-smoking women, CF, hypersensitivity pneumonitis (hot tub lung), disseminated disease in AIDS patients, lymphadenitis in children

Mycobacterium avium and intracellulare M. avium complex (MAC) surgey may be required despite "modern therapy" Lady Windermere's Syndrome

fever, rigors, myalgia, headache; sore throat, dry cough, nasal obstruction, viral pneumonia CAN BE FOLLOWED BY: bacterial pneumonia, infection Guillain-Barre syndrome

Influenza

0.5-3% develop disseminated infection: fever, migratory arthalgias, suppurative arthritis, pustular rash on extremities, purulent conjunctivitis in newborns (ophthalmia neonatorum); pharyngitis

Neisseria gonorrhea ceftriaxone plus azithromycin, penicillin resistance common

birdsbird owners, veternarians, zoo/per shop workers, poultry industry Parrot fever, ornithosis

Chlamydia psittaci

HPS: F/C, HA, myalgia, GI distress, dizziness, x4-10days. leads to cough, severe SOB, mortality 38%

Hantavirus bunyavirus rodents via urine or feces

1. neonatal conjunctivitis, 2. infant pneumonitis, 3. genital infections in adults 4. trachoma

Chlamydia trachomatis

Anaerobic ## Footnote Gram positive spore forming bacilli spores may be in environment for monts, asymptomatically in colonic flora up to 5% of normal population

Clostridium difficile C.diff, C,diff infection (CDI)

Scarlet Fever- scarlatiniform sandpaper rash, strawberry tongue

Streptococcus pyogenes

1. encapsulated, beta-lactamase. filamentous hemagglutininhuman - highly contagious, transmitted via respiratory route

Bordatella pertussis whooping cough

Real-time PCR for detection of _____ amplified DNA

Streptococcus agalactiae

slowly replicatng mycobacteria, incubation is 5-20 yearsvia droplets from close and frequent contact to nose and mouth, armadillos in southern US

Mycobacterium leprae Leprosy (Hansen's disease)

Direct detection of ______ ribosomal RNA

Streptococcus pyogenes

1. serology 2. PCR

Bartonella henselae Cat scratch disease 1. azithromycin, 2. doxycycline Bartonella quintanaTrench Fever 1. doxycycline 2. chloramphenicol 3. azithromycin

if it's a nasty, leaky skin infection, it's probably \_\_\_\_. Honeycomb appearance think impetigo from \_\_\_\_\_

Staphylococus aureus

Vaccines: PCV13 (conjugate) + PPSV23 (polysaccharide)

Streptococcus pneumoniae

Otitis media

streptococcus pneumoniae

1. necrotizing anaerobic pneumonia (LUNG ABSCESSES), brain abscesses. peridontal disease

Bacteroides melaninogenicus-bacteroides 1. Metronidazole 2. Clindamycin

GRAM POSITIVE UTI

Enterococcus spp

(G+) Group A , cocci in chains, beta-hemolytic

Streptococcus pyogenes

Primary TB: hematogenous dissemination including apical posterior arias of lung, development of delayed type hypersensitivity and skin test conversion or IGRA (quantiferon) Granuloma - containment of TB Latent TB

Mycobacterium tuberculosis