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NMSK-A II > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What is another name for septic arthritis?

A

infectious arthritis

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2
Q

What is the most common way to get a native joint infection (NJI)?

A

hematogenous spread

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3
Q

Who is at highest risk for a native joint infection?

A

intervenous drug users

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4
Q

What are the two major classes of septic arthritis?

A

1) nongonococcal
2) gonococcal
* *both bacterial**

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5
Q

Which type of bacterial infection is most serious?

A

nongonococcal; more inflammation

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6
Q

What is the bacterial spectrum usually associated with native joint infections?

A

Gram +

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7
Q

What is the most common specific bacterial nongonococcal infection which leads to a native joint infection?

A

Staphylococcus aureus (Gram +)

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8
Q

What is the most common specific bacterial gonococcal infection which leads to a native joint infection?

A

Neisseria gonorrhoeae

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9
Q

Which bacterium is a leading cause of septic arthritis in children less than 4 yo?

A

Kingella kingae

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10
Q

Which bacterium’s 2nd most common manifestation is Lyme Disease?

A

Borrelia burgdorferi

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11
Q

What is the leading cause of joint infections?

A

prosthetic joint infections

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12
Q

Which bacteria comprise the most number of prosthetic joint infections and why?

A

1) S. aureus
2) S. epidermidis

microbiota on skin

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13
Q

Which tests can be done to differentiate S. aureus and S. epidermiditis?

A

Coagulase (S. aureus +)

Mannitol Fermentation test (S. aureus +)

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14
Q

How do Staphylococcus present on a slide?

A

Gram + cocci in clusters

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15
Q

What is the main virulence factor of Staphylococcus?

A

slime layer (and adhesins)

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16
Q

What is the hemolysis of Staphylococcus epidermidis?

A

Gamma (non-hemolytic)

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17
Q

How do Eikenella corrodens infections typically occur?

A

1) human bite

2) clenched fist injuries

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18
Q

What are two characteristics of Eikenella corrodens on a plate?

A

1) pit agar

2) bleach-like odor

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19
Q

What are the main virulence factors of Kingella kingae?

A

1) pili

2) beta hemolysis

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20
Q

How does Kingella kingae invade the bloodstream?

A

damage to respiratory mucosa (e.g. viral) facilitates invasion

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21
Q

When is it appropriate to use Thayer-Martin culture media?

A

gonococcal cultures from mouth or rectum; chocolate + selective antibiotics

22
Q

What is a DGI?

A

Disseminated Gonococcal Infection from N. gonorrhoeae; leads to meningitis and meningococcemia

23
Q

What are the main virulence factors of Neisseria?

A

1) adhesions (pili, Opa’s, LOS; ipo-oligosaccharides)
2) IgA protease
3) facultative intracellular
4) antigenic and phase variation with Opa’s, pili, LOS
5) bind host sialic acid to their LOS to act as decoys
6) outer-membrane blebbing

24
Q

How do LOSs behave in regards to antibiotics?

A

Gram + (even though Neisseria are Gr- and Oxidase +)

25
Q

What is the most important symptom of a disseminated gonococcal infection?

A

septic arthrities

26
Q

What is the most common location of a nongonococcal arthritis NJI?

A

knee

27
Q

What is the most common location of a gonoccal arthritis NJI?

A

polyarticular; knee, wrist, ankle, elbow

28
Q

What key information comes from analyzing the synovial fluid of an NJI which help to identify the type of infection?

A

1) Gram-stained smear
2) WBC
3) culture

29
Q

Give the following laboratory findings for septic arthritis for:

1) volume
2) clarity
3) color
4) viscosity
5) WBC per mm3
6) PMNs %
7) culture

A

1) volume: >3.5 mL
2) clarity: obaque
3) color: yellow to green
4) viscosity: variable
5) WBC per mm3: 15,000-100,000
6) PMNs %: >75%
7) culture: often positive

30
Q

Why are nongonoccal infections more likely in the synovial fluid than in the blood?

A

fastidious

31
Q

What unique symptoms present with a prosthetic joint infection?

A

1) sudden local joint pain
2) mechanical joint failure
* *no fever, swelling

32
Q

What are the 2 ways to diagnose a prosthetic joint infection?

A

1) multiple joint biopsies

2) sonication of actual prosthetic, grow on all different conditions to identify

33
Q

What special infection control technique is used when working with MRSA patients who have a prosthetic joint infection?

A

patient gets a pre-wash before surgery

34
Q

Geographically, where is Lyme Disease most common?

A

Northeast, Upper Midwest

forested areas

35
Q

What is the seasonality of Lyme Disease?

A

Peak in summer months (June-July)

36
Q

Which bacterium is responsible for causing Lyme Disease?

A

Borrelia burgdorferi

37
Q

Which vector is responsible for the transmission of Lyme Disease?

A

Ixodes scapularis (tick; rodent reservoir)

38
Q

Which stage of development is the primary vector for the transmission of Lyme Disease?

A

nymph

39
Q

What is beneficial about Borrelia burgdorferi having much of its DNA on plasmids?

A

helps manifest a variety of hosts

40
Q

What is the structure, gram stain, and main virulence factor of Borrelia burgdorferi?

A

spirochete
Gram -
motility due to axial filaments

41
Q

Is Borrelia burgdorferi typically cultured in the lab for diagnostic purposes?

A

No; fastidious and slow with limited metabolic capabilities; 4 week incubation period

42
Q

How are Borrelia burgdorferi infections typically diagnosed?

A

1) titer for antibodies to the microbe

2) confirm with immunoblotting

43
Q

What is the typical clinical presentation of early localized Lyme Disease?

A 
erythema migrans (bull's eye rash)
**diagnosis made on clinical grounds alone**
44
Q

What is Lyme arthritis?

A

late Lyme Disease; chronic arthritis caused by Borrelia burgdorferi infection

45
Q

What are 2 important things to remember when diagnosing Lyme Disease in addition to clinical presentation?

A

1) travel/activity history

2) slight increase in WBC

46
Q

What are the two types of immunologic (serologic) methods of diagnosing Lyme Disease?

A

1) Direct: microbial antigen

2) Indirect: host antibody directed against the microbial antigen; titer

47
Q

What is a titer?

A

quantitative measure of antibody/antigen in the body

48
Q

How are titers expressed clinically?

A

reciprocal: last tube to give positive reaction in serial dilution (1:640) = “640”

49
Q

What is a seroconversion?

A

patient did not have antibody the first time the titer was done (acute titer) but has antibodies now (look for 4X’s increase over time)

50
Q

Is the antibody or antigen typically measured when diagnosing Lyme Disease?

A

antibody with ELISA; confirmed with a Western blot

early disseminated or late Lyme Disease

NMSK-A II (10 decks)

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