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Microbiology Flashcards

1
Q

What is the causative agent of Rheumatic fever?

A

S. pyogenes (GAS) pharyngitis

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2
Q

What is an important adhesin to keratinocytes?

A

M protein

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3
Q

What is the name of the structure that may allow Group A strep GAS to bind to the host HA receptor CD44 found on the surface of pharyngeal epithelial cells?

A

The hyaluronic acid (HA) capsule

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4
Q

What are the functions of the proteins produced by Group A streptococcus ?

A
  1. To degrade chemotoxins that recruit neutrophils to the site of infection
  2. inactivate or degrade antibodies
  3. block antimicrobial peptide function
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5
Q

What are the functions of M proteins?

A

M proteins prevents opsonization by complement through two mechanisms.

-1.Binds the host cell plasma protein, fibrinogen, which interferes with the alternative pathway of complement deposition by forming a dense layer on the bacterial surface.

  • Binds host complement control proteins that inhibit the formation of opsonins by the complement cascade
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6
Q

What s the best prevention method of antibiotics?

A

Correct use of antibiotic

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7
Q

What is the age range for patients to develop rheumatic fever?

A

5 and 15 years old

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8
Q

Fill in the blanks. “Group A strep pharyngeal infection precedes clinical manifestations of RF by _______.”

A

2-6 weeks

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9
Q

What are the most important antigenic proteins in external layer of cell wall?

A

M, R & T proteins

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10
Q

What are the clinical features of Rheumatic Fever?

A

Arithritis
Carditis
Sydenham’s chorea
Erythema marginatum
Subcutaneous nodules
Arthralagias
Epistaxis
Serositis

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11
Q

What is the criteria used in the diagnosis of Rheumatic Fever?

A

Jones criteria

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12
Q

What is the most common feature of Rheumatic Fever?

A

Arthritis

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13
Q

What are the joints preffered in arthritis?

A

Knees, ankles ,wrists, elbows , shoulders

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14
Q

What is the most serious manifestation of rheumatic fever?

A

Carditis

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15
Q

What are the clinical signs of Carditis?

A

High pulse rate
Murmurs
Cardiomegaly
Rhythm disturbances (prolonged PR interval)
Pericardial friction rubs
Cardiac failure

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16
Q

What are the most common lesions in Carditis?

A

Mitral and aortic valves regurgitation

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17
Q

What are the clinical features of Sydenham’s Chorea?

A

Extrapyramidal disorder
- Fast ,clonic, involuntary movements(epecially face and limbs)
- Muscular hypotonus
- Emotional lability

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18
Q

What is the normal length of subcutaneous nodules?

A

.5-2 cm long

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19
Q

Fill in the blanks. “ Subcutaneous nodules are most common along ______.”

A

Along extensor surfaces of joints
- Knees ,elbow, wrists

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20
Q

What are other locations of subcutaneously nodules?

A

On bony prominences, tendons, dorsi of feet, occiput or cervical spine

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21
Q

Where is the common location of Erythema Marginatum?

A

Trunk ,abdomen ,Inner arms or thighs

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22
Q

What are the features of the cutaneous lesions seen in Erythema Marginatum?

A
  • Reddish pink border
  • Pale centre
  • Round or irregular shape
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23
Q

What are the major criteria seen in Rheumatic Fever?

A
  • Arthritis
  • Carditis
  • Sydenham ‘s chorea
  • Erythema marginatum
  • Subcutaneous nodules
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24
Q

What are the minor criteria seen in Rheumatic Fever?

A
  • Fever
  • Arthralgia
  • Elevated c-reactive protein or
  • Elevated erthrocyte sedimentation rate
  • Prolonged PR interval on ECG
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25
Q

How is the Jones criteria used in the diagnosis of Rheumatic fever?

A
  • Evidence of previous infection with strep upper airway infection and
  • 2 major criteria or
  • I major criteria and 2 minor criteria
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26
Q

What are the antibodies present in Rheumatic fever ?

A

Antistreptolysin O antibody
Anti DNAase B titer, anti-hyaluronidase, anti –streptokinase anti-nicotinamide, streptozyme screen

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27
Q

What are the different tests that can confirm /give a documented evidence of recent GAS infection?

A
  1. Positive throat culture or specific nucleic acid based test.
  2. Detection of GAS antigen in a throat swab
  3. An elevation of anti-ASO ,anti-DNase B, anti-hyluronidase antibodies.
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28
Q

What is the best treatment for Rheumatic Fever to eradicate GAS?

A

Single dose IM benzathine penicillin G

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29
Q

Which drug should be given for treatment of RF to eradicate GAS in patients with a Penicillin allergy?

A

Oral clindamycin

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30
Q

Which drugs DO NOT eradicate Group A streptococcus?

A

SULFA-DERIVED ANTIBIOTICS

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31
Q

What is the treatment for arthritis seen in RF?

A

Salicylates or NSAIDs x 3 weeks

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32
Q

What is the treatment for carditis seen in RF?

A

Steroid use compulsary
* Prednisone 1-2 mg /kg/d (max 60 mg) x 10- 15 d
* Taper

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33
Q

What is the treatment of Sydenham’s Chorea?

A

Haloperidol .5-1 mg/kg
Alternate - sodium valproate 15-20 mg/kg/d

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34
Q

What are the clinical features of Group A strep infections?

A

Sudden-onset sore throat , pain on swallowing , malaise, high fever, abdominal pain, soft palate petechiae, vomiting, nausea

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35
Q

What is Septicaemia?

A

Systemic inflammatory response syndrome (SIRS) due to infection

36
Q

What is Septic shock?

A

Severe sepsis with hypotension

37
Q

What is Bacteremia?

A

Presence of viable bacteria in the circulation.

38
Q

True or False ? PCR can detect microbes (bacteria, viruses, fungi) without culture which might not be viable.

39
Q

What are the symptoms of severe sepsis?

A
  • Hypotension
  • Lactic acidosis
  • Oliguria
  • Confusion
  • Hepatic dysfunction
40
Q

What are the risk factors for sepsis infection?

A

Very young and very old people with
- A weakened immune system
- Chronic illness, including diabetes, kidney or liver disease,AIDS,andcancer
- A severe wound, including severe burns

Hospitalization
- Duration & type (ICU higher)

  • Operative procedure e.g. dirty surgery
  • Indwelling invasive / urinary catheter
  • Underlying chronic medical/surgical conditions
41
Q

What are the clinical signs of sepsis?

A
  • Fever(high temperature, pyrexia), and there may be chills and shivering.
  • Fast heart rate/pulse(tachycardia)
  • Rapid rate of breathing (tachypnea)
  • Unusual levels of sweating (diaphoresis)
  • Dizziness or feelings of faintness
  • Confusion or a drop in alertness, or any other unusual change in mental state, including a feeling of doom or a real fear of death
  • Slurred speech
  • Diarrhea, nausea, or vomiting
  • Low urine output (not needing to urinate for a whole day, for example)
42
Q

What are the symptoms that might indicate sepsis in a newborn?

A
  • a newborn who feels feverish (hot) or cold
  • with peri-umbilical pus , swelling or redness
  • with poor or no sucking ( abnormal feeding )
  • feeble or not crying
  • drowsy, difficult to arouse
  • with convulsion
  • with repeated vomiting
43
Q

What are important clues in the diagnosis of sepsis?

A
  • Recent travel
  • Contact with animals
  • Local infective disease outbreaks
  • Recent surgical procedures
  • Indwelling prosthetics devices
  • Prior antibiotics
  • Underlying pathology and immunosuppressive illness or medication
44
Q

What are the characteristics of Toxic shock syndrome?

A

Fever
Desquamative skin rash
Hypotension
Multisystem involvement
Frank hyperemia

45
Q

What is the causative agent in Toxic shock syndrome?

46
Q

What is the criteria of diagnosing Toxic shock syndrome?

A
  • Temp>38.9 C
  • Systolic blood pressure<90mmHg
  • Rash with subsequent desquamation, especially on palms and soles
  • Involvement of >3 of the following organ system
47
Q

What should be investigated during laboratory blood films for Sepsis?

A
  • Look for leukopenia(worst prognosis)or a neutrophil leukocytosis
  • Blood film –toxic granulation suggest infection even if normal blood count
  • Low platelet count-suggests DIC
  • If recent travel to endemic area-3 separate thick & thin films for malaria parasite required.
48
Q

What are the causes of Infective Endocarditis?

A

Long term hemodialysis
Diabetes mellitus
HIV

49
Q

What are the clinical features of Acute Infective Carditis?

A

Acute onset of high grade fever >38C
Chills
Fatigue
Rapid destruction of valves
Murmur
Rapid onset of CCF
Complications result from intracardiac disease & metastatic infection produced by emboli

50
Q

What are the clinical features of Subacute Infective Endocarditis?

A

Indolent process:
Fever
Fatigue
Anorexia
Night sweats
Weight loss
Flulike syndrome
Murmur
Extracardiac manifestations are the result of arterial embolisation of fragments of vegetation:
CVA
Blindness: retinal artery
Coronary artery emboli: MI

51
Q

Clinical features such as Roth spots( retinal haem. with pale centres), Janeway lesion, Petechiae, Osler’s nodes, Clubbing are associated with?

A

Sub-acute Infective endocarditis

52
Q

What is the criteria used to diagnose Infective endocarditis?

A

Modified-Jones criteria.

53
Q

How can Infective endocarditis give a definite diagnosis using the modified Jones criteria ?

A

Two major criteria OR
One major and Three minor criteria
OR five minor criteria

54
Q

What are the minor criteria involved in Infective Endocarditis?

A
  1. Predisposing factor
    2.Temperature > 38 degrees celsius
    3.Vascular phenomena
  2. Immunologic phenomenon (ex Olser’s nodes)
    5.Microbiologic evidence
54
Q

What are the major criteria involved in Infective Endocarditis?

A
  1. Blood culture positive for IE
    2.Evidence of endocardial involvement .
55
Q

What are measures to achieve a positive laboratory diagnosis of IE?

A
  • Culture: Blood, valvular material, embolic tissue
  • Serological tests
  • Molecular based techniques: Blood, valvular lesions, isolates from culture
    ID, resistance genes
56
Q

How many sets of blood cultures should be taken ignorer to diagnose IE?

A

3-6 sets of blood cultures (BC)

For subacute IE draw 3-5 sets over 24 hrs (detects up to 98% if no AB)

57
Q

What is the aetiology of Infective endocarditis?

A

Staphylococcus aureus
Streptococcus Groups A, B, C and G
Pseudomonas aeruginosa

58
Q

What is the aetiology for sub-acute infective endocarditis?

A
  • Streptococcus viridans group (50-60%)
  • Staphylococcus epidermidis
  • Enterococcus faecalis (Enterococcus Group D Streptococcus)
  • Streptococcus bovis (nonenterococcus Group D Streptococcus )
  • HACEK organisms (5%)
59
Q

What are the HACEK organisms?

A

Haemophilus aphrophilus
Actinobacillus actinomycetemcomitans, Cardiobacterium hominis
Eikenella corrodens
Kingella kingae

60
Q

What is the antiseptic agent that should be used to clean site of collection for infective endocarditis?

A

70 – 80% alcohol then 2% iodine in concentric fashion

61
Q

What is the cleaning agent that should be used at the top of the bottles for blood cultures?

A

Alcohol - DO NOT use iodine on the septa (top) of the BACT/Alert bottles)

62
Q

What colour blood culture bottles is used for paediatrics?

63
Q

Which colour blood culture bottles is used for anaerobics?

64
Q

Which colour blood culture bottles is used for aerobics?

A

Blue ( Blue - colour of water which has h2O so its blue lol idk)

65
Q

What is the substance used in the manual technique for testing blood cultures with suspected IE with anaerobic organisms?

A

Thioglycolate medium Thioglycolate medium for anaerobic organisms

66
Q

What is the substance used in the manual technique for testing blood cultures with suspected IE with aerobic organisms?

A

Brain Heart Infusion medium for aerobic organisms

67
Q

For how long are all blood cultures incubated before processed?

A

24 hours prior to processing

68
Q

Which organism is catalase positive , coagulase positive and novobiocin sensitive?

A

Staphylococcus Aureus

69
Q

Which organism is catalase negative and Bacitracin sensitive?

A

Group A Strep (Streptococcus pyogenes)

71
Q

Which organism is Catalase negative and optochin resistant ?

A

Streptococcus viridans

72
Q

What is the Gram reaction for Streptococcus viridians (alpha-haemolytic)?

A

Gram positive cocci in pairs and short chains

73
Q

Which organism is catalase negative and hydrolyses bile aesculin?

A

Enterococcus faecalis

74
Q

What is the Gram reaction for Enterococcus faecalis?

A

Gram positive cocci in pairs and chains

75
Q

Which organism is Catalase POSITIVE, Coagulase NEGATIVE , Novobiocin sensitive ?

A

Staphylococcus epidermidis - Gram positive cocci

76
Q

Which organism is Germ tube positive?

A

Candida albicans

77
Q

How can specimens be tested for in suspect sepsis?

A
  • Blood cultures
  • Culture of other fluids
  • Wound swabs
  • Sterile body sites
    e.g. Spinal fluid
    Joint or pleural fluid
  • Intramuscular devices
78
Q

Which agar plate will identify the members of the Enterobacteriaceae?

A

MacConkey’s Agar

79
Q

Which organism Is catalase NEGATIVE and Optochin susceptible?

A

Streptococcus pneumoniae ( Alpha - haemolytic )

80
Q

What is the Gram reaction for Streptococcus pneumonia ?

A

Gram positive cocci in lanclet pairs and short chains.

81
Q

Which organism is Indole POSITIVE, Oxidase - Negative, Urea and Citrate Negative and Lysine variable?

A

Escherichia coli - (arma negative bacilli)

82
Q

Which organism is Indole Negative, Urea and Citrate POSITIVE , Oxidase Negative and Lysine Positive?

A

Klebsiella pneumoniae

83
Q

What are causes for a culture negative Infective Endocarditis?

A
  1. Previous use of antibiotics is commonest cause
  2. Bartonella spp
    3.Coxiella burnetti spp
    4.Legionella, Chlamydia, Brucella
    5.Fungi e.g. Candida spp
  3. Staph aureus if burrowed deep within thrombus leaving surface sterile IE remains diagnostic & therapeutic challenge
84
Q

What is the Treatment for Infective Endocarditis with the causative organism being HACEK?

A

Ceftriaxone or Ampicillin + Gentomycin

Cardiovascular System (10 decks)

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