Microbio Flashcards
Gram nonreactive bacteria
Chlamydia
Legionella
Acid fast bacteria
Mycobacteria
Nocardia
Indicates mycolic acid in cell wall
Gram stain and shock
LPS on Gram negative most likely to cause shock
But gram + can also cause through various virulence factors
Protein A
Expressed on S aureus
Binds i gg to subvert immune response
Diphtheria toxin
Interferes with protein elongation at EF 2
Shiga toxin
Inhibit proteinsynthesis by damaging ribosomes
LPS
Complementactivation via tlr4 cd14 MD2 → cytokine release and widespread immune response
DIC
LPS → clotting factors and platelet migration
Waterhouse friderichsen syndrome
Adrenal failure in setting of septicemia often +DIC
Usually neisseria meningitis
Also pseudomonas, ‘s pneum, s aureus, H flu
Organ failure
Adrenocorticalinsufficieny
Severe hypotension
Coma
Toxic shock
Associated with superantigens that cause cytokine storm
SEB, TSST1, SEC2, strep exotoxin a and c
Skin desquamation
Usually s_pyogenes or Saureus
Toxic component LPs
Lipid A
C perfringens
Gas gangrene
S aureus lab tests
Positive:
Gram
Catalase
* CoagulaSe
* DNase
* Mannitol ferment
Other:
* B-hemolytic
Novobiocin sensitive
Bile salt resistant
- unique from other staph species
Test differentiating S epi from S. Sapro
Novobiocin
Epi - sensitive
Sap - resistant
S epidermis
Norm(al skin ‘
Endogenous infections in ic., venous line, foley,
→ cellulitis osteomyelitis endocarditis UTIs -
Medical devicecontamination.
Mainly subacute endocarditiswhen history of value replacement acute more likely aureus
S saprophyticus
Vaginal flora
Gu infections in sexually active young women
Strep tests
Glram POS
* catalase Ng
* Pairs or chains
Non motile
No spores ‘
Hemolysis differentiates spectes
- differentiates staph
S. Agalactiae tests
Group B strep
B hemolytic
Bacitracin resistant
S.pyogenes tests
Group A strep
B-hemolytic
Bacitracin serisitive
Pyr rapid test
Anti-streptolysin o (aso) titers
Anti-dnase B, anti hyaluronidase,anti streptokinase,anti-m
S. Pneumonia e tests
Alpha hemolytic
Optochin sensitive
Encapsulated
Viridans strep tests
’ Opportunistic
No cap:sule
Alpha hemolytic
Optochin resistant
Group B strep infections
Normal vagina
Infection in Newborns after vag delivery
Septicemia, meningitis, pneumonia,osteomyelitis
S. Pneum infection s
Normal upper respiratory
Meningitis, otitis media, pneumonia, sepsis
Especially severe in kids, old, ic, asplenic
Group A strep infections
Aka pyogenes - fever
N normal skin and throat
Strep throat
Skin infections
Necrotizing fasciitis
Autoimmune sequelae due to m protein
M protein
- Group a strep (pyogenes)
Blocks complement
*Rheumatic fever
Post infectious glomerulonephritis
Spe-b
Superantigen
Protease precursor
S pyo → necrotizing fasciitis
Rheumatic fever
Type 2 hypersens
M protein
2-3 weeksafter strep throat. Not group A strep skin infections for some reason
2 major or 1 major 2 minor:
M: polyarthritis, carditis,nodules, erythema, chorea
m: fever, arthralgia w/o polyarthritis, high CRP or ESR, prolonged PR interval on EKG
Post strepglomerulonephritis
Type 3 Hs
Skin or pharyngeal GAS
Dx w/ elevated ASO or anti-dnase B
Viridian’S strep infections
Dental caries
Subacute endcaarditis on previously damaged valves
Opportunistic
Biofilms
CAP tx outpatient
Presumptive for S. Pneumoniae unless other risk factors
Generally a macrolide (-thromycin)
Can be fluoroquinolone (-floxacin), doxy
Pneumococcal pneumonia tx inpatient
IV 3rd gen cep + macrolide (-thromycin)
Eg. Ceftriaxone+ azithromycin
+ Vanco if complicated eg. HAP VAP
Pneumococcal meningitis tx
Vanco + cef-3
Outpatient tx uncomplicated strep
Amoxicillin
Erythromycin if allergy
B cereus
Bacillus
Gram POS
Spore forming i
Contaminated food
Reheated fried rice prototypical
B cereus tx
Supportive
Most cases dt toxins and most bacteria are abx-resistant, so ab x not generally given
Inhalation anthrax
Hemorrhagic mediastinitis - widening of mediastinum on X-ray
Necrotizing pneumoni a
Bacteremia
Meningitis
Fatal
B anthracis tx
- Combination clindamycin and linezolid for inhalation
Ciprofloxacin or doxy for localized cutaneous
Gas gangrene
C. Perfringens
Alpha toxin - perforates cells
Listeria monocytogenes
Vulnerable-neonates, pregnant, ic, old
Contaminated food e.g. Unpasteurized dairy raw veg processed meat
Vertical trans..
In healthy adults visuallyself-limited gastroenteritis
Listeria pregnancy and neonates
Early pregnant: sa, stilbirth,prematurity
After birth meningitis, septicemia
Listeria Ab x
Resistan t to most
Most notablyfluoroquindones
Ampicillin preferred
Growing resistance
Bact rim usually works
Cold enrichment
Largely unique to listeria
Accelerated growth at cooler temps
Common feature in all nocardia i infections
Abcess
Nocardia pneumonia
Ic. or preexisting lung disease
Necrosis, cavitations, abscess
Secondarydissemination causing abscesses in brain, skin
Can also cause primary abscesses elsewhere
Nocardiaappearance
Gram positive rods in chains or filaments
Similar toactinomyces but weakly acid-fast
Nocardia eco niche
Soil
Obligate O 2
Nocardia tx
Slow growing ‘’
Prolonged ab x course
No resistance yet
Poor px when disseminated
Bactrim is tx of choice
HUS
Shige-like toxin in ehec
Microthrombi shear red cellsand platelets
Anemia-thrombocytopenia - acute kidney failure following bloodydiarrhea
Shiga-like to mins
Inhibit 28 S on 60 s ribosome subunit
Also independently necrosis and inflammation
Ehec
Neonatal meningitis
Most commonly E coli
Also listeria
Pil i
- Biofilms,epithelialedherenu
Kleibsellapreumonia
. Vulnerable pts
Diabetes, etoh
Pulmonaryhemmorahgic necrosis
Red currant jelly sputum
Aspiration prenmonia
Macconkey agar
Lactose fermentation turns media pink
Eg. Ecoli lactase POS → pink
Pseudomonas aeruginosa
Ic, vulnerable - cf, burns, leukemia, age s neutropenia
Hap/ VAP
Non-respiratory e.g. Hot tub folliculitis, otitis external, osteomyelitis following penetrating injury, UTIs from catheters, necrotizingenterocolitis in leukemia
Pseudomonas tx
4th gen ceph + amino glycoside (-mycin)
Pip/tazo mosaggrssive
Salmonella tests
Motile facultative ‘ anaerobe
ferments glucose
Reduces sulfer- black t si medium
Shigella infectious dose
Very low
Resistant togastric acid
Shigella tx
Ceftriaxoneand fluoroquin clones
Salmonella tx
Supportive
Ab x prolonginfectious duration
Y ersinia enterocolitica
.galstroenteritis / food poisoning from pork products, puppies
Iron overloadpredisposes
Pain can mimic appendicitis
Y-entero tx
Supportive if uncomplicated
Otherwise aminoglycosydes (my cin) and bact rim
Tend to be fluoroquinoloneresistant
Campylobacter jejune appearance
Motile curved or corkscrew gram neg rod
Campy virulence
Direct invasion of intestinalepthelium
Corkscrew shape and flagellum
→ bloody diarrhea
Can result in reactivearthritis
Campy transmission
Under cooked chicken most common
Campy complications
Reactive arthritis
Guillan barre
Urease
Involved in H pylori, y enter o, some other enter bacterium
NeutralizesStomach acid via ammonia production to promote survival
Whooping cough toxin
Pertussis exotoxin binds ‘ G, protein receptor increasing secretions
Pili paralyze mucocilary escalator
Pertussis complications
Respiratoryexhaustion
Pertussis encephalopathy
Pertussis tx
Macrolides (-thromycin)
Prophylaxis with erythromy in for contacts
Tdap prevention
Legionella path
Enter and replicate in alveolarmacrophages
Type 4 secretion system effector proteins
Legionnaire’s sx
Neuro-headache, confusion
Diarrhea
Lobar or atypical pneumonia
Often hyponatremia
Generally all together
Legionella tx
Azithromycin or levofloxacin
Neisseriameningitidis manifestations
Meningitis
Purpuri c rash
Possible URI
Complications:
Di c
Waterhous-friderichsen syndrome
Neisseria tx
Ceftriaxone
H flu manifestations
Meningitis
Epiglottitis
Pneumonic
Otitis media
Esp in 6-18 mo between breastfeadingand vaccination
Acinetobacter
VAP
Lyme disease st
Stage 1: Erythema migran s / bull’s eye
Stage 2:
Facial nerve palsy
Arthritis
Cardiac block
Stage 3:
If untreated
Meningitis
Rocky mountair spotted fever
Dog tick
Southeastern us
Headache -fever- rash on palms and solesof feet
Leukopenia
Hyponatremja
Hepatic transaminase
Thrombocytopenia
RMSF tx
Doxycydine
Yersinia pestis
Rat fleas
Bacteria invade mq
Tender, swollen lymph nodes
Lesion at bite site
Progression to septicemic plague - DIC + necrosis
Yersiniapestis tx
Streptomycin