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Part 1 MRCOG > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Beta haemolytic strep on agar and examples

A

Beta-hemolysis (β-hemolysis) is associated with complete lysis of red cells surrounding the colony.

It exhibits a wide zone (2-4 mm wide). Beta hemolysis is more marked when the plate has been incubated anaerobically. They are generally commensals of throat and causes opportunistic infections.

Examples: Streptococcus pyogenes, or Group A beta-hemolytic Strep (GAS).

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2
Q

Alpha haemolytic strep on agar and examples

A

Alpha-hemolysis (α-hemolysis) is a partial or “green” hemolysis associated with reduction of red cell hemoglobin. Alpha hemolysis is caused by hydrogen peroxide produced by the bacterium, oxidizing hemoglobin to green methemoglobin.

It exhibit incomplete haemolysis with 1-2 mm wide. Persistence of some unhaemolysed RBC’s can be seen microscopically.

Examples: Streptococcus pneumoniae and a group of oral streptococci (Streptococcus viridans or viridans streptococci)

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3
Q

Prevalence of HIV in UK Obstetric population

A

2 per 1000 live births

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4
Q

Infant antiretroviral therapy

A

V Low risk (Mother been on cART for >10 weeks and 2x documented maternal HIV viral loads <50 HIV RNA copies/ ml during pregnancy at least 4 weeks apart AND maternal HIV viral load <50 at 36 weeks) –> 2 weeks zidovudine monotherapy

Low risk (maternal viral load <50 at 36 weeks or at time of delivery if premature) –> 4 weeks zidovudine mono therapy

High risk (doesn’t meet low risk criteria) –> Combination PEP

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5
Q

HIV viral load at 36 weeks and recommendation for delivery

A

<50 HIV RNA copies/ml: vaginal delivery

50-399: PCLS considered (factor in actual viral load, trajectory of viral load, length of time on treatment, adherence issues, obstetric factors & woman’s views)

> 400: PLCS

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6
Q

Infant HIV testing

A

Formula fed infants:
- During the first 48 hours and prior to hospital discharge
- If HIGH RISK, at 2 weeks of age
- 6 weeks (at least 2 weeks post cessation of infant prophylaxis)
- 12 weeks (at least 8 weeks post cessation of infant prophylaxis)
- On other occasions if additional risk
- HIV antibody testing for seroreversion should be checked at age 18-24 months

Breastfed infants as above plus the following additional tests:
- At 2 weeks of age
- Monthly for the duration of breastfeeding
- At 4 and 8 weeks after cessation of breastfeeding

Breastfeeding is advised to be avoided regardless of viral load

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7
Q

What family of viruses does rubella belong to?

A

Togavirus (single stranded RNA genome)

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8
Q

Structure of rotavirus

A

Double stranded RNA virus

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9
Q

Examples of double stranded DNA viruses

A

Hep B
CMV
VZV
HSV1 & 2
HPV
EBV

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10
Q

Structure of parvovirus B19

A

Single stranded DNA virus

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11
Q

Single stranded RNA viruses

A

Hep A/C/D/E
Rubella
HIV
Zika
Ebola

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12
Q

What is pelvic actinomyces associated with?

A

IUCDs- usually prolonged use (>2 years), symptoms of fever, vaginal discharge, pelvic or abdominal pain & weight loss.

On microscopy, may see sulphur granules

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13
Q

What are HPV 6 and 11 associated with?

A

Genital warts and low grade squamous intraepithelial lesions of the cervix (can correspond cytologically to CIN1)

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14
Q

Gardasilu vaccine

A

Quadrivalent vaccine against HPV 6, 11, 16, 18

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15
Q

Which genotypes of HPV are the most important?

A

16 and 18
They are responsible for 70% of cases of HPV related cancers

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16
Q

How does HPV induce cancer?

A

Via Onco-proteins.
The primary Onco-proteins are E6 and E7 which inactivate two tumour suppressor proteins, p53 (inactivated by E6) and pRb (inactivated by E7)

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17
Q

How quickly are HPV infections typically cleared?

A

70% within 1 year and 90% within 2 years

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18
Q

Intrapartum antibiotics for GBS

A

3g Benzylpenicillin should be administered as soon as possible after the onset of labour and 1.5g 4 hourly until delivery.

If penicillin allergic the alternative depends on severity of reaction.
Provided a woman has not had severe allergy to penicillin, a cephalosporin should be used.

If there is any evidence of severe allergy to penicillin, vancomycin should be used.

Suggested regimens are: Cefuroxime 1.5 g loading dose followed by 750 mg every 8 hours or if allergy to beta-lactams is severe then IV vancomycin 1 g every 12 hours.

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19
Q

Most common causative organism for cellulitis and other possible microorganisms

A

Streptococcus pyogenes (group A strep- also causes tonsillitis, scarlet fever and rheumatic fever)

Staph. aureus is the second most common

Staph. epidermis can form biofilms on catheters/implants

Clostridia Perfringens causes gas gangrene

Strep. Mutans causes tooth decay and dental cavities

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20
Q

Types of alpha haemolytic streptococci

A

Strep pneumoniae
Strep viridans

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21
Q

Types of beta haemolytic strep and the diseases they cause

A

A: strep pyogenes:
- Scarlet fever
- Rheumatic fever
- Tonsilitis/ pharyngitis
- Glomerulonephritis
- Toxic shock
- Nec Fasc

B: Strep agalactia
- GBS disease of newborn
- Chorioamnionitis
- Endometritis

C: Strep dysgalactiae
- Pharyngitis
- Endocarditis
- Toxic shock
- Nec fasc

D: reclassified as enterococcus
- Colitis
- Endocarditis

F: Strep anginosus
- Liver abscess

G: group G strep
- Toxic shock
- Nec fasc
- Vaginitis

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22
Q

Incubation period of chickenpox, rubella, influenza, parvovirus, strep pyogenes (scarlet fever), CMV

A

Chickenpox: 14 (10-21)
Rubella: 14 (12-23)
Influenza: 1-3
Parvovirus (Fifth disease): 4-20
Strep pyogenes (Scarlet fever): 1-7
CMV: 3-12 weeks

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23
Q

Features of congenital CMV infection

Diagnosis

A

Sensorineural Hearing Loss
Visual Impairment
Microcephaly
Low Birth weight
Seizures
Cerebral Palsy
Neurodevelopment delay
Hepatosplenomagaly with jaundice
Thrombocytopenia with petechial rash

10-15% of infected infants will be symptomatic at birth

A further 10-15% who are asymptomatic at birth will develop symptoms later in life

Diagnosis of fetal CMV infection is via amniocentesis

Amniocentesis should not be performed for at least 6 weeks after maternal infection and not until the 21st week of gestation

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24
Q

Risk of congenital CMV infection with primary/ recurrent infection during pregnancy

A

Risk of congenital infection is 30-40% with primary infection during pregnancy (vertical transmission)

Risk of congenital infection is 1-2% with recurrent CMV infection in pregnancy

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25
Q

Congenital rubella syndrome features

Risk of transmission in 1st/2nd trimester

A

Sensorneural Deafness

Ophthalmic Defects: Retinopathy, Glaucoma, Cataracts, Micropthalmia

Cardiovascular Defects:
PDA, VSD, Pulmonary stenosis

CNS:
Neurodevelopmental delay, Microcephaly, Meningoencephalitis

Others:
Thrombocytopenia (rash described as blueberry muffin), Hepatosplenomegaly
Late onset: diabetes, GH deficiency, thyroiditis

Risk of transmission:
1st: 80-90%
2nd: 25%

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26
Q

Congenital toxoplasmosis infection clinical features

Risk of placental transmission/ adverse fetal outcome

A

Hydrocephalus
Microcephaly
Intracranial calcifications
Ophthalmic Defects (chorioretinitis, strabismus, blindness)
Epilepsy
Neurodevelopmental delay
Thrombocytopenia
Anaemia

Risk of placental transmission increases with gestation (1st TM 14%, 3rd TM >50%)
Adverse fetal outcome risk dereases with gestation

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27
Q

Congenital HSV infection clinical features

A

Neonatal Herpes can lead to severe neurological impairment and death

Genital HSV infection occurring in early pregnancy is associated:
Increased risk of spontaneous abortion, IUGR, preterm labour and congenital herpes (rare 2 per 100,000 live births)

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28
Q

What type of organism is toxoplasma gondii?

Source?

A

Intracellular protozoan parasite

Source: uncooked meat, cat faeces

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29
Q

When are fetal consequences highest for toxoplasmosis infection?

Diagnosis?

Treatment?

A

First 10 weeks gestation, however maternal-fetal transmission risk increases as the pregnancy proceeds but the consequences become less severe

Diagnosis can be via PCR or Immunoglobulins (IgM,IgG and IgA). MRI/CT may show ring enhancing lesions in CNS tissues

Treatment not usually required in the immunocompetent.

In pregnancy treatment is indicated if recent infection suspected

Treatment varies depending on local protocols (Spiromycin or combination of pyrimethamine, sulfadiazine, and folinic acid)

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30
Q

Interpretation of immunoglobulins for rubella infection

A

IgM- acute infection
IgG- produced in response to infection, but produced later than IgM. Also produced in response to vaccination.

If both negative = susceptible to infection

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31
Q

Risk of congenital fetal varicella syndrome (FVS) in pregnant women who develop chickenpox

A

The risk of FVS to babies born to mothers who have chickenpox during the first 20 weeks gestation is 0.4% (1-12 weeks) - 2.0% (13-20 weeks).

If a mother has chickenpox in late pregnancy (5 days prior to delivery) then there is risk of neonatal varicella infection (25%) which may be severe.

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32
Q

Features of FVS

A

Hypoplasia of one limb
Cicatricial lesions with a dermatomal distribution
CNS abnormalities
Eye abnormalities

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33
Q

What is the causative organism of gas gangrene?

A

Clostridium perfringens

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34
Q

What is the most common causative organism in necrotizing fasciitis?

A

Group A streptococcus (strep pyogenes)

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35
Q

HPV vaccine Gardasil is what type of vaccine?

A

Recombinant vaccine of virus-like particles (VPLs)

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36
Q

Most common cause of endometritis (bacteria)

A

Polymicrobial

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37
Q

Incidence of listeriosis in pregnancy

A

1 in 10,000 or 12 per 100,000

38
Q

Listeriosis:
- Source/ type of bacteria
- Features
- Impact on pregnancy
- Fetal morality rate
- Treatment

A
  • Source/ type of bacteria: gram positive bacillus, intracellular pathogen, diagnosed by blood cultures. Source is soil, water and contaminated food (raw meats, dairy)
  • Features: typically mild illness in adults unless immunocompromised
  • Impact on pregnancy: causes chorioamnionitis, placental necrosis and granuloma formation. Miscarriage, stillbirth and meningitis
  • Fetal mortality rate: 20-30% (some sources quote up to 50%)
  • Treatment: amoxicillin for 2-3 weeks
39
Q

Surgical wound cleansing in first 48h

A

Use sterile saline for wound cleansing up to 48 hours after surgery.

Advise patients that they may shower safely 48 hours after surgery.

Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus.

40
Q

Management of 1st/2nd/3rd trimester acquisition of genital herpes (>28 weeks)

A

1st/2nd trimester:
- Initial episode treated acicolvir 400 mg TDS for 5 days
- Following 1st or 2nd trimester acquisition, daily suppressive aciclovir 400 mg TDS from 36 weeks of gestation reduces HSV lesions at term and hence the need for delivery by caesarean section

3rd trimester:
Initiate acicolvir 400 mg TDS and continue until delivery
C-section delivery is advised if 1st episode of HSV (within 6 weeks of delivery)
If opt for SVD, avoid interventions like ARM and give intrapartum IV acyclovir

41
Q

Pregnant woman non-immune to rubella- advice re: vaccination timing?

A

Post-natally, can be whilst breast feeding.

42
Q

When is the transplacental transmission from mother to foetus greatest for toxoplasma gondii?

A

26-40 weeks

Although risk of transmission is lower in earlier pregnancy, if infection does occur, particularly <10 weeks, complications are typically more severe

43
Q

How many pregnancies does CMV infection affect?

A

0.2-2.2% (1 in 50 to 1 in 500)

44
Q

What is the mortality rate associated with disseminated neonatal herpes?

A

30% (even if treated)

45
Q

What type of virus is HIV?

A

Lentivirus (retrovirus)

46
Q

Gram positive cocci

A
  • Staphylococcus
  • Streptococcus

(Both facultative anaerobes)

47
Q

Gram positive bacilli/ rods

A
  • Corynebacterium (Facultative anaerobe)
  • Listeria non-spore forming (Facultative anaerobe)
  • Bacillus spore forming (Facultative anaerobe)
  • Clostridium spore forming (Obligate anaerobe)
  • Actinomyces spore forming (Facultative anaerobe)
48
Q

Gram negative cocci

A

-Nisseria gonorrhoeae
- Neisseria meningitidis
- Moraxella catarrhalis

All obligate aerobes

49
Q

Gram negative intracellular organism

A

C. trachomatis

50
Q

Gram negative bacilli/ rods

A

(Facultative anaerobes- with or without O2)
Hemophilus influenzae
Klebsiella pneumoniae
Escherichia coli
Proteus mirabilis
Enterobacter cloacae
Helicobacter/Compylobacter (spiral rod)
Salmonella

(Obligate aerobes- need O2)
Legionella pneumophila
Bacteroides
Pseudomonas aeruginosa

51
Q

Gram negative spirochaetes (spiral shaped)

A

Treponema pallidum
Borrelia burgdorferi (considered diderm rather than gram neg or positive)

52
Q

What increases/ decreases the risk of HIV transmission?

A

Increases: presence of inflammatory STD (increased risk of acquiring HIV of 1.5 –> 2.2). Risk effect greater for men than women.

Decreases: male circumcision

53
Q

% of neonates with congenital CMB that are symptomatic at birth

A

10-15%

53
Q

Treatments for genital warts and those that shouldn’t be used in pregnancy

A
  • Trichloracetic acid
  • Liquid nitrogen cryotherapy
  • Imiquimod 5% cream
  • LASER treatment
  • Podophylline paint (teratogenic)
  • 5-fluorouracil (teratogenic)

Non-treatment also an option (one third of patients will clear warts spontaneously)

Soft non-keratinised warts respond well to podophyllotoxin and trichloroacetic acid (TCA). Keratinised lesions may be better treated with physical ablative methods such as cryotherapy, excision, TCA or electrocautery.

Imiquimod is suitable treatment for both keratinised and non-keratinised warts.

People with small numbers of low volume warts, irrespective of type, can be treated with ablative therapy or topical podophyllotoxin from the outset. Very large lesions should be considered for surgical treatment

54
Q

Treatment options for toxoplasmosis gondii in pregnancy

A

Spiramycin ASAP if fetus not infected or status of the fetus not known. This reduces risk of transplacental infection. This is continued until term, or until fetal infection is documented. Most effective if initiated within 8 weeks of seroconversion.

Pyrimethamine, sulfadiazine and folinic acid where fetal infection is known e.g. positive amniotic fluid PCR. Monitoring for haemotoxicity required.

Pyrimethamine should be avoided in the 1st trimester as teratogenic

55
Q

Which congenital infection most commonly causes congenital hearing loss?

A

CMV

56
Q

What disease does Borrelia cause?

A

Lyme disease

57
Q

What percentage of women develop antibodies to HPV following infection?

A

50-60%

58
Q

Risk of transmission of HIV for the following exposures:

Receptive anal intercourse
Insertive anal intercourse
Receptive vaginal intercourse
Insertive vaginal intercourse
Receptive oral sex (giving fellatio)
Insertive oral sex (receiving fellatio)
Blood transfusion
Needle stick injury
Sharing injecting equipment
Mucous membrane exposure

A

Receptive anal intercourse 1.11 %

Insertive anal intercourse
0.06%

Receptive vaginal intercourse
0.1%

Insertive vaginal intercourse
0.082%

Receptive oral sex (giving fellatio)
0.02%

Insertive oral sex (receiving fellatio)
0%

Blood transfusion
90-100%

Needle stick injury
0.3%

Sharing injecting equipment
0.67%

Mucous membrane exposure
0.63%

59
Q

HPV genotypes 6 and 11 are associated with what lesions of the cervix?

A

Low grade squamous intraepithelial lesions of the cervix (LSIL)

60
Q

What virus family does zika belong to?
How is it transmitted?

Management if couple planning conception

A

Flaviviridae

Transmitted by aedes mosquito

If male partner has travelled to Zika area the couple should delay trying to conceive ie avoid UPSI for 3 months after return.

If only female partner has travelled then should avoid UPSI for 2 months after return.

61
Q

Which organism is the most common cause of puerperal sepsis?

A

Group A streptococcus

62
Q

Risk of developing chlamydia when had sexual intercourse with asymptomatic chlamydia positive partner

A

65% (2/3)

63
Q

What organism causes lymphogranuloma venereum?

A

Chlamydia trachomatis L1-L3

64
Q

Which type of white cell is elevated in acute CMV infection?

In which cells can CMV lie dormant?

A

Lymphocytes/ Monocytes

Monocytes

65
Q

Chance foetus will be affected if fetal CMV infection confirmed

A

10% symptomatic at birth

66
Q

What strain of streptococcus is responsible for the majority of GBS infections?

A

Strep agalactiae (aerobic and gram positive)

67
Q

Which pathogen underlies late congenital infection during childhood and presents with eight nerve deafness, interstitial keratitis and abnormal teeth?

A

Treponema pallidum pallidum (ventral syphilis)

68
Q

Congenital infection most associated with hydrops

A

Parvovirus B19 (causes fetal anaemia)

69
Q

Causes of ophthalmia neonatorum

A

Chlamydia (most common, can also cause pneumonia)
Gonorrhoea
HSV
S. Aureus

70
Q

Rate of stillbirth in UK (2016), how does BMI > 30 affect this?

A

1 in 225/ 4.4 per 1000

1 in 100

71
Q

Tests for late IUD

A

FBC, U&Es, LFTs, Bile Acids, Clotting, CRP
(Sepsis, abruption, PET, cholestasis, DIC)

Kleihauer for all women (not just those RhD negative)
(Presence of FMH, quantify need for extra Anti-D)

Thrombophilia screen
(Most tests are not affected by pregnancy – if abnormal, repeat at 6 weeks)

HbA1c, random glucose, TFTs
(DM, thyroid dysfunction)

Microbiology: Serology (if tropical travel test for malaria)
(Toxoplasma, Rubella, CMV, HSV, Parvovirus, Syphilis; compare virology against booking serum)

Microbiology: Blood cultures, Swabs (Cx, HVS); MSU
(GBS, E. Coli, Listeria, Chlamydia spp. etc)

Parental genetics
(Aneuploidy or single gene disorders)

Fetal and Placenta Histology; written consent required
(Cord/cardiac blood; fetal and placental swabs
Fetal skin/placenta for karyotyping/single gene Post-mortem: external (e.g. Dysmorphic, SGA/IUGR), limited autopsy/X-rays; full autopsy; placenta only)

72
Q

Management of varicella exposure in pregnant woman

A

If not sensitised (VZV IgG negative) and within 10 days of exposure, give VZIG

Is symptomatic, acyclovir treatment (if present within 24h of onset of rash)

73
Q

Vertical transmission rate of Hep B/ Hep C and how this can be reduced (Hep B)?

A

Vertical transmission is 90% for hep B and 5% for hep C

Can be reduced by:
1. Hep B vaccine at birth (70% reduction)
2. Hep B vaccine and anti-hep B immune globuline (HBIG)- 90% reduction

74
Q

Congenital syphilis syndrome

A

Teeth
Snuffles
Saddle nose
Hepatosplenomegaly
Osteochondritis
Gumma
Blindness/ deafness
FTT, IUFD

75
Q

Effect of Abx in pregnancy

A

Penicillin’s, cephalosporin’s, macrocodes, clindamycin = Safe.

Sulphonamides = hyperbilirubinemia and kernicterus

Tetracyclines = Fetal/infant stunting of growth, discoloration of teeth, and hypoplasia of dental enamel

Aminoglycosides (Streptomycin) = congenital deafness ; may cause neuromuscular blockade if low calcium/Mg

Nitrofurantoin = Cause neonatal haemolysis

Quinolones (ciprofloxacin) = arthropothies

76
Q

What percentage of women with untreated bacteria develop pyelonephritis?

A

28%

77
Q

Causes of TSS (bacteria), mechanism and mortality/ treatment

A

S. Aureus (Coagulase positive)–> enterotoxin type B
Streptococcus –> strep pyogenes –> strep pyrogenic exotoxins

Mechanism is via T cell superantigen stimulation (toxins act as super antigen)

Mortality in S. Aureus is 3%, but 30-70% with strep

Treated with flucloxacillin & clindamycin (Vanc instead of fluclox if pen allergic)

78
Q

Oncogenic viruses and cancer they cause

A

EBV –> Burrito’s lymphoma, nasopharyngeal carcinoma, Hodgkin’s disease

HPV –> cervical ca, skin ca

Hep B/C –> liver ca.

HTLV1 –> T cell leukaemia

HSV2 –> Cervical ca.

79
Q

Ebola haemorrhagic fever:
1. Mortality rate if pregnant
2. Spontaneous abortion rate
3. How long can men transmit the virus in semen after recovery?

A
  1. 95.5%
  2. 66%
  3. 7 weeks
80
Q

Surgical wound classifications

A

Clean: an incision in which no inflammation is encountered in a surgical procedure, without a break in sterile technique, and during which the respiratory, alimentary or genitourinary tracts are not entered.

Clean-contaminated: an incision through which the respiratory, alimentary, or genitourinary tract is entered under controlled conditions but with no contamination encountered.

Contaminated: an incision undertaken during an operation in which there is a major break in sterile technique or gross spillage from the gastrointestinal tract, or an incision in which acute, non-purulent inflammation is encountered. Open traumatic wounds that are more than 12 to 24 hours old also fall into this category.

Dirty or infected: an incision undertaken during an operation in which the viscera are perforated or when acute inflammation with pus is encountered (for example, emergency surgery for faecal peritonitis), and for traumatic wounds if treatment is delayed, there is faecal contamination, or devitalised tissue is present

81
Q

Post op wound cleansing

A
  • Use sterile saline for wound cleansing up to 48 hours after surgery.
  • Advise patients that they may shower safely 48 hours after surgery.
  • Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus.
82
Q

How is hepatitis D transmitted? What is its structure?

A

Via blood products and sexual transmission/ vertical transmission

Requires co-infection with Hep B for propagation

RNA virus

Associated with chronic liver disease

83
Q

Structure of HSV

A

dsDNA virus

84
Q

Ebola virus binds to which cell surface protein

A

Cholesterol transporter protein

85
Q

Which virus causes molluscum contagiosum?

A

Poxvirus

86
Q

On MacConkey agar, what colour do the following organisms appear?
1. E.Coli/ Enterobacter/ Klebsiella
2. Salmonella, proteus, pseudomonas aeruginosa, shigella

A
  1. Pink (produce acid, lowering pH of agar)
  2. Undyed/ clear
87
Q

Which organisms contain ribosomes, do not have a rigid cell wall but cannot be grown on inanimate culture?

A

Chlamydia

87
Q

If MSRA is suspected when treating SUO- what Abx should be added to the regime?

A

Vancomycin or teicoplanin

88
Q

Risk of neonatal herpes is SVD at time of active infection

A

41%

Part 1 MRCOG (13 decks)

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