Microbiology Flashcards
Gram positive bacteria have a ? proteoglycan cell wall and stain ? with Gram stain
thick proteoglycan cell wall
purple
Gram negative bacteria have a ? proteoglycan cell wall and stain ? with Gram stain
thin proteoglycan cell wall
pink
Classification of antimicrobial agents? (6)
- inhibit cell wall synthesis
- inhibit protein synthesis
- inhibit DNA synthesis
- inhibit RNA synthesis
- cell membrane toxin
- inhibit folate metabolism
Types of antimicrobials that inhibit cell wall synthesis? (2)
- B lactams
2. Gycopeptides
How do B lactams work?
- inhibit the enzymes responsible for building the proteoglycan cell wall of the bacteria i.e. penicillin binding protein
- bacteriocidal - prevents peptide cross linking thus daughter cells are weaker and lyse when they divide
Which bacteria are B lactam effective against?
Which bacteria are B lactam ineffective against?
a) gram +, gram -, enterococci
b) mycoplasma, chlamydia
Resistance against B lactams?
production of B lactamase
Penicillin
- which organisms?
- resistance?
Gram +
Broken down by B lactamase produced by Staph aureus
Amoxicillin
- broad or narrow?
- which organisms?
- resistance?
Broad spectrum Penicillin
Gram + Gram - Enterococci
Broken down by B lactamase produced by Staph aureus
Flucloxacillin
- broad or narrow?
- which organisms?
- resistance?
- narrow spectrum penicillin
- Gram +
- stable to B lactamase produced by Staph aureus
Piperacillin
- which organisms?
- resistance?
- example with Tazobactam?
Gram + Gram - Pseudomonas
Broken down by B lactamase produced by Staph aureus
Tazocin
What are Clavulanic Acid and Tazobactam?
B-lactamase inhibitors
Protect penicillins from B lactamase produced by Staph aureus
Allows broader spectrum
Examples of B lactams? (3)
- Penicillins
- Cephalosporins
- Carbepenems
Cephalexin
- type of B lactam
First generation cephalosporin
Cefuroxime
- type of B lactam
- resistance
Second generation cephalosporin
Stable to many B lacatamases produced by Gram -
Ceftriaxone
- type of B lactam
- broad or narrow?
- which organisms?
- association
- # 1 use
Third generation cephalosporin Broad Gram + Staph & Strep C difficile Meningitis first line
Cephtazidime
- type of B lactam
- which organisms?
Third generation cephalosporin
Pseudomonas
Extended Spectrum B Lactamases?
Organisms producing these are resistant to ALL cephalosporins
Carbepenems
- resistance
- broad or narrow?
- examples (3)
Resistant to Extended Spectrum B Lactamases Broad spectrum 1. Meropenem 2. Imipenem 3. Ertapenem
Key features of B Lactams (5)
- Non-toxic
- Renally excreted (low dose is renal impairment)
- Short half life (multiple daily doses)
- Do NOT cross BBB
- Cross-allergenic (if allergic to Penicillin 10% cross reactivity with Cephallosporins and Carbepenems)
Glycopeptides
- how do they work?
- which organism
- side effect
Inhibit cell wall synthesis
Gram - only
Nephrotoxic therefore drug level must be monitored
Vancomycin
- Class of Abx?
- use?
Glycopeptide
C difficile
Aminoglycosides
- mode of action?
- binding site
- toxicity? (2)
- which organism?
- inhibit protein synthesis
- 30s ribosomal subunit
1. ototoxic
2. nephrotoxic
Gram -ve
Gentamycin
- Class of abx?
- organisms?
- use
Aminoglycoside
Gram - especially Pseudomonas
Gram - sepsis
Tetracylines
- mode of action?
- binding site
- contraindications (2)
- which organisms? (3)
- association
- inhibit protein synthesis
- 30s ribosomal subunit
1. children
2. pregnant women
- chlamydia
- rickettsiae
- mycoplasma
- light-sensitive rash
Doxycyline
- class of Abx?
- organisms?
- Tetracycline
- intracellular chlamydia
Macrolide
- mode of action?
- binding site
- which organisms?
- indication
inhibit protein synthesis
50s subunit of ribosome
Gram + (Staph, Strep)
Pen allergic
Erythromycin
- class of Abx?
- organisms? (2)
Macrolide
- Staph
- Strep
Chloramphenicol
- mode of action?
- binding site?
- broad or narrow?
- associations (2)
- uses (2)
- avoid
- inhibit protein synthesis
- peptidyl transferase of 50s ribosomal subunit
- very broad
- aplastic anemia
- grey baby syndrome
- bacterial conjunctivitis
- Genuine Pen allergy - meningitis
- systemic use due to risk of aplastic anaemia
Oxazolidinones
- mode of action?
- binding site
- which organisms?
- indication
- example
- association
- inhibit protein synthesis
- 23s of 50s ribosomal subunit
- Gram +
- MRSE VRE
- Linezolid
- thrombocytopenia after prolonged use
Quinolones
- mode of action
- binding site
- which organisms?
- broad or narrow?
- indications (3)
- examples (3)
- inhibit DNA synthesis
- a-subunit of DNA gyrase
- Gram -ve
- broad
1. UTI
2. Pneumonia
3. atypical pneumonia
- Ciprofloxacin
- Levofloxacin
- Moxifloxacin
Nitroimidazoles
- mode of action
- broad or narrow?
- which organisms? (2)
- examples (2)
- indication
- related
- inhibit DNA synthesis
- narrow
1. anaerobic
2. protozoa
- Metronidazole
- Tinidazole
Giardia
Nitrofuratoin - UTI
Rifamycins
- mode of action
- binding site
- which organisms?
- indication
- examples (2)
- inhibit protein synthesis
- RNA polymerase
- mycobacteria
- TB
1. Rifampicin
2. Rifabutin
Rifampacin
- class of Abx
- use
- drug interactions (2)
- monitoring required
- side effects
- resistance
- Rifamycin
- TB
1. OCP
2. Warfarin - LFTs
- orange bodily secretions
- rapid resistance whereby chromosomal mutation changes B-subunit so that Rifampacin can’t bind to RNA polymerase
Daptomycin
- mode of action
- organisms
- indications (2)
- cell membrane toxin
- Gram +ve
1. MRSA
2. VRE
Colistin
- mode of action
- organisms
- indications
- administered by
- toxicity
- cell membrane toxin
- Gram -ve
- multi-drug resistant organisms
- IV only
- nephrotoxic
Sulfonamides
- mode of action
- indication
- used in conjunction with
- toxicity
- example
- inhibit folate metabolism
- PCP
- Trimethroprim
- teratogenic
- Sulphamethoxazole
Diaminopyrimidines
- mode of action
- indication
- toxicity
- example
- inhibit folate metabolism
- community acquire UTI
- teratogenic
- Trimethroprim
Mechanisms of Abx resistance? (4)
BEAT
- Bypass Abx sensitive step
- Enzyme-mediated drug inactivtion e.g. B-lactamase
- Accumulation inhibition
a) impaired uptake
b) increased efflux - Target altered in microbe
Major mechanism of resistance to B Lactams?
- example organisms (2)
Enzyme-mediated inactivation
- Staph aureus
- Gram -ve bacilli
Mechanism of resistance in MRSA?
Methicillin-Resistant Staph Aureus
Altered target, PBPs now have a low affinity for B Lactams
Mechanism of resisatnce of Strep pneumonniae?
Altered target, lowered affinity for B lactams
Can be overcome by increasing dose
Common organisms with Extended Spectrum B Lactamases? (2)
- E coli
2. Klebsiella
Which ABX?
Staph aureus
Flucloxacilin (unless allergy)
Which ABX?
Strep throat
Benzylpenicillin
Which ABX?
CAP (mild)
Amoxicillin
Which ABX?
CAP (severe)
Cefuroxime + Clarithromycin
Which ABX?
HAP
Cefuroxime
Which ABX? Bacterial meningitis (Meningococcus/Strep)
Ceftriaxione
Which ABX? Bacterial meningitis (Listeria)
Amoxicillin + Ceftriaxone
Which ABX?
UTI (community)
Trimethroprim
Which ABX?
UTI (hospital)
Augmentin or Cephalexin
Which ABX?
Sepsis (severe)
Cefuroxime
Metronidazole
Gent
Which ABX?
Neutropenic sepsis
Tazocin + Gentamycin
Which ABX?
Collitis (C diff)
Metronidazole
Natural reservoir of Influenza A (H1)
ducks
Natural reservoir of Influenza A (H1N1)
pigs
Who receives trivalent flu vaccine?
- type of vaccine?
At risk populations (health workers)
Inactivated
purified HA + NA rich
Who receives quadrivalent flu vaccine?
- type of vaccine?
Children
Live attenuated vaccine
HA rich
Why does influenza cause a respiratory illness? (4)
- sialic acid is only expressed
- virus enters through the mouth
- virus is activated by proteases expressed in the mouth
- can only fuse with mucus secreting cells
Where in the lungs can influenza virus survive?
LRTI not URTI as does not replicate well at low temperatures
Surface glycoproteins of influenza virus (2)
- cause of seasonal variation?
- NA neuraminidase activity
- cleaves sialic acid to allow virus to exit host cell - HA haemogglutinin activity
- binds to sialic acid receptors allowing virus to attach to host cell and causes membrane fusion
- RNA segments of the virus are prone to mutation hence variation in influenza virus to produced new strains
Antigenic Drift
mutation in HA/NA to give new strains of the virus therefore vaccine must be updated annually
Antigenic Shift
- which strain?
- how?
complete change of HA/NA
- only happens with Influenza A
- trading of RNA segments between human and animal strains
Protease that activates influenza virus?
clara tryptase
Severe outcomes of the flu? (4)
- secondary bacterial pneumonia
- mutant virus
- co-morbidity
- cytokine storm (H5N1)
Antivirals for flu? (3)
- Amantadine
- Tamiflu
- Oseltamivir
- Zanamivir
Mechanism of Amantadine/Rimantidine?
- which strain?
M2 ion channel inihibitor
Influenza A
Mechanism of Oseltamivir/Zanamivir?
- which one is oral?
- which one is inhaled powder/IV?
- which strain?
- who is treated?
Neuraminidase inhibitors Oseltamivir - oral Zanamivir - IV/inhaled powder Influenza A & B High risk groups
Aged ≥ 65 years Immunosuppressed Chronic respiratory disease Chronic heart disease Chronic liver disease Chronic neurological disease Diabetes mellitus Pregnant women Morbid obesity (BMI ≥ 40) Children
MIC
Minimum Inhibitory Concentration
How much abx is required to inhibit growth of organism in a test tube
Bacteriuria
presence of bacteria in urine
Cystitis
inflammation of the bladder, normally caused by infection
Uncomplicated UTI
Presence of UTI in functionally/structurally normal urinary system
Complicated UTI
Presence of UTI in functionally/structurally abnormal tract
Why does obstruction increase likelihood of UTI?
inhibits flow of urine, stasis of urine, increased chance of infection
Causes of obstruction within urinary tract
a) Extrarenal (5)
b) Intrarenal (6)
Extrarenal
- Valves
- Stenosis
- Bands
- Calculi
- Ureteral compression e.g. BPH
Intrarenal
- nephorcalcinosis
- uric acid nepropathy
- analgesic nephropathy
- PKD
- hypokalaemic nephropathy
- intrarenal lesions of sickle cell trait/disease
Neurogenic causes of urinary obstruction? (4)
- poliomyelitis
- tabes dorsalis (syphilis)
- diabetic nephropathy
- spinal cord injuries
Most common bacteria causing UTI?
E coli
Other bugs causing UTI? (5)
- Proteus fimbriae
- Klebsiella
- Staph epidermis
- Staph saprophyticus
- Enterococcus faecalis
Routes of infection of UTI (2)
- contamination from rectum
2. haematogenous route
Symptom of UTI (6)
- frequency
- dysuria
- abdo pain
- flank pain
- fever
- vomiting
Investigation of UTI (4)
- urine dipstick ( nitrites, leukocytes)
- MSU MC+S
- Bloods - FBC, U+Es, CRP
- Renal USS
Which of the following cell types on microscopy suggests a poorly taken sample.
- White blood cells
- Squamous epithelial cells
- Red blood cells
Squamous epithelial cells
Treatment for uncomplicated lower urinary tract infection in women?
Trimethroprim 3/7
Treatment of UTI in women with previous history of UTIs or men?
Nitrofuratoin 7/7
Treatment of pyelonephritis?
Co-amoxiclav + Gentamycin
Pathogenesis of CNS infection (4)
- haematogenous spread
- direct infection
- PNS to CNS
- local extension
Common organisms causing bacterial meningitis (2)
- N.meningitidis (Gram -ve)
2. Step pneumoniae (Gram +ve)
Common organisms causing bacterial meningitis in neonates? (3)
- Group B Strep
- Listeria
- E coli
Common organisms causing bacterial meningitis in elderly? (3)
- Group B Strep
- Listeria
- TB
Symptoms of bacterial meningitis? (8)
- headache
- neck stiffness
- fever
- focal neurology
- rash
- photophobia
- irritability
- vomiting
Common organisms causing viral meningitis? (3)
- Coxsackie
- Mumps
- HSV 2
Organism causing fungal meningitis?
Cryptococcus neoformans
Meningococcal septicaemia
- percentage
- clinical spectrum (4)
- 40%
1. capillary leak - hypoalbuminaemia
2. coagulopathy
3. metabolic derangement
4. myocardial failure
Likely organisms causing chronic meningitis? (2)
- TB
2. Cryptococcus
Encephalitis
- transmission
inflammation of brain parenchyma
person to person or through vectors e.g. ticks
leading cause of encephalitis internationally?
Western Nile Virus
Treatent of meningoencephalitis?
Ceftriaxone + Acyclovir
Normal CSF Levels in adult
WCC
Protein
Glucose
0 - 5
- 15 - 0.4
- 2 - 3.3
CSF levels in bacterial meningitis?
WCC
Glucose
HIGH with polymorphs
LOW
CSF levels in viral meningitis?
WCC
Glucose
HIGH with mononuclear cells
Normal
CSF levels in TB/cryptococcus meningitis?
WCC
Protein
HIGH with mononuclear cells
HIGH
Pathophysiology of cerebral abscess? (5)
- otitis media
- mastoiditis
- paranasal sinuses
- endocarditis
- haematogenously
Pathophysiology of spinal infection (3)
- open spinal trauma
- infection in adjacent structures
- haematologenously
Risk factors for spinal infection (7)
- age
- IVDU
- DM
- transplantation
- long-term steroids
- malignancy
- malnutrition
Hepatitis A
- type of virus
- immunoglobulin associated with acute infection
- immunoglobulin associated with previous vaccination
- diagnosis
- transmission
- incubation
- symptoms (7)
- EMQ (3)
RNA virus IgM IgG Anti-HAV IgM fecal-oral 2-6 weeks
- fatigue
- low grade fever
- diarrhoea
- nausea
- pruritis
- jaundice
- arthralgia
- undercooked fish
- South East Asia
- Mardi Gras
Hepatitis B
- type of virus
- transmission (3)
- acute/chronic
- incubation
- lab findings
dsDNA virus
- sexual
- vertical
- blood products
Acute 6/12
2 - 6 months
increased AST, increased ALT due to liver inflammation
Hepatitis B - diagnosis HBsAg HBeAg HBcAb IgM HBcAb IgG HBsAb
HBsAg - active infection marker HBeAg - high level of viral replication HBcAb IgM - recent infection HBcAb IgG - exposure to HBV/chronic infection HBsAb - immunity HBV vaccination
Complications of HBV (3)
- Fibrosis
- Cirrhosis
- HCC
Treatment of HBV (3)
- IFN alpha - can clear virus
- Lamivudine - can suppress viral replication
- Tenofovir - can suppress viral replication
Hepatitis C
- type of virus
- transmission
- acute/chronic
- incubation
- lab findings
RNA virus blood products 80% progress to chronic 2 weeks - 6 months ALT - responds to viral load
Hepatitis C diagnosis
Anti - HCV
HCV RNA
Anti-HCV Ab
Anti - HCV - active infection
HCV RNA - acute HCV
Anti-HCV Ab - chronic HCV
Treatment of HCV (2)
- Peg IFN - allows less drug to be given and is better tollerated, sustained response
- Ribavirin
Complications of Hep C (2)
- Cirrhosis
2. HCC
Hepatitis D
- type of virus
ONLY if you already have HBV
RNA virus
Hepatitis E
- type of virus
- transmission
- incubation
- poor prognosis
RNA virus
faecal-oral
3-8weeks
pregnancy
Which organisms cause bloody diarrhoea? (5)
SECSY
- Salmonella
- E coli
- Campylobacter
- Shigella
- Yersinia enterocolitis
Two viruses commonly causing GI infection in children?
- Rotavirus
2. Adenovirus
4 lab findings for Staph aureus
- Catalase +
- Coagulase +
- Gram +
- yellow colonies of blood agar, B haemolytic
Pathophysiology of Staph aureus as GI infection?
- incubation
- duration
- transmission
- treatment
- aerobic/anaerobic?
- produces enterotoxin
- release IL-1 IL-2
- prominent vomiting & watery non-bloody diarrhoea
2-7days
B.cereus
- association
- pathophysiology (3)
- aerobic/anaerobic?
REHEATED RICE 2 spore toxins 1) heat stable - emetic causing 2) heat labile - diarrhoeal causing sudden vomiting + non-bloody diarrhoea
aerobic
Clostridium botulinum
- associations (2)
- pathophysiology (3)
- symptoms
- aerobic/anaerobic?
vaccum-packed/canned foods
1) honey - children
2) beans - students
- ingestion of preformed toxin
- blocks Ach release from peripheral nerves
- paralysis
descending paralysis
anaerobic
Clostridium perfringens
- association
- pathophysiology (2)
- incubation
- symptoms (2)
- aerobic/anaerobic?
- reheated meats
1. enterotoxin binds to TCR & MHC - massive cytokine release causing systemic toxicity
- 8-16hrs
1. watery diarrhoea
2. cramps
anaerobic
Clostridium difficile
- who
- why?
- pathology
- treatment
- aerobic/non-aerobic?
- hospitalised patients
- Abx therapy cephalosporins/fluorquinolones
- pseuomembranous colitis
- Stop Abx
Metronidazole/Vancomycin - anaerobic
Listeria monocytogenes
- susceptible cohorts? (2)
- type of bacteria (2)
- maternal concerns (3)
- source of foods (3)
- symptoms (5)
- treatment
- immunocompramised
- pregnant women
B haemolytic , tumbling mobility
- miscarriage
- stillborn
- mental retardation of fetus
- unpasteurised dairy products
- pre-packaged meals
- cured meats
- watery diarrhoea
- cramps
- fever
- headache
- vomiting
Ampicillin
Types of E.coli? (4)
ETEC
EIEC
EHEC
EPEC
ETEC E.coli
- what
- who
- 2 toxins
- source
- Toxigenic
- travellers diarrhoea
1. heat labile - stimulates adenyl cyclase & cAMP
2. heat stable - stimulates guanylate cyclase
food/water contaminated with human faeces
EIEC
- what
- source
- Invasive dysentery
- food/water contaminated with human faeces
EHEC
- what
- source
- cause
- result
- Haemorrhagic
- food/water contaminated with human faeces
- verotoxin
- HUS
EPEC
- what
- source
- who
- complication
- Pathogenic
- food/water contaminated with human faeces
- infantile diarrhoea
- HUS
Typhoid/Enteric Fever
- causative agent
- multiplies where?
- symptoms (2)
- signs (5)
- treatment
- salmonella typhi + paratyphi
- Peyers patches
1. slow onset fever
2. constipation
- bradycardia
- splenomegaly
- rose spots
- anaemia
- leukopenia
- Ceftriaxone
Salmonella enteritides
- association (3)
- symptoms
- treatment
- poultry
- eggs
- meat
bloody diarrhoea
self-limiting/ceftriaxone
Dystenery
- causative agent
- enterotoxin
- symptoms (3)
Shigella dysenteriae Shiga enterotoxin Invades mucosal cells of distal ileum and colon causing inflammtion 1. fever 2. pain 3. bloody diarrhoea
Vibriosis cholera
- source
- symptoms
- pathophysiology
- organism appearance
water contaminated with human faeces - SHELLFISH
rice water diarrhoea
cholera toxin causes cAMP to open Cl channels -> massive loss of electrolytes
comma shaped
Campylobacter jejuni
- sources (3)
- organism appearance
- duration
- symptoms (4)
- complications (3)
- treatment
food/water contaminated with animal faeces
- poultry
- meat
- unpasteurised milk
can be up to 20days
- fever
- headache
- severe abdo cramps
- foul-smelling bloody diarrhoea
- Reactive arthritis
- Reiter’s syndrome
- Guillan Barre syndrome
What is Reiter’s syndrome? (3)
- arthritis
- uvetitis
- conjunctivitis
Yersinia
- preference
- source
- associations (3)
- 4*C cold enrichment
- food contaminated with domestic animals faeces
1. arthritis
2. necrotising granulomas
3. erythema nodosum
Diarrhoea causing protozoa (3)
- Entamoeba histolytica
- Giardia lamblia
- Crystosporidium parvum
Entomoeba histolytica
- EMQ hint
- histology
- symptoms (6)
- treatment
men who have sex with men flask-shaped ulcer in colon 1. diarrhoea 2. flatulence 3. dysentery 4. tenesmus 5. weight loss 6. RUQ pain due to liver abscesses - Metronidazole
Giardia lamblia
- EMQ hints (4)
- histology
- source
- symptoms (4)
- test
- treatment
- travellers
- hikers
- MSM
- mental hospitals
faecally contaminated water containing cysts
- flatulence
- foul-smelling non-bloody diarrhoea
- cramps
- malabsorption of protein & fat
ELISA string test
Metronidazole
Cryptosporidium parvum
- who
- where
- test
- immunocompramised
- jejenum
- Kinyoun acid fast stain
Secretory Diarrhoea (2) - cause
- no fever
- no WCC in stool sample
- enterotoxin causes massive cytokine production & supression of adaptive immune response
Inflammatory diarrhoea (2)
- fever
2. WCC in stool sample - neutrophils
Enteric fever (2)
- fever
2. WCC in stool sample - mononuclear cells
Viruses causing diarrhoea (5)
- norovirus
- enteroviruses
- rotavirus
- adenovirus
- poliovirus
Rotavirus
- who
- type of virus
- symptoms
- children
- ds-DNA
- secretory diarrhoea, massive cytokine production
- low grade fever
Adenovirus
- who
- symptoms
- which strains cause bloody diarrhoea?
- children
- bloody diarrhoea
- 40 and 41
Norovirus
- who
- immunity
- outbreaks
- predominant symptom
- adults
- no lifelong immunity
- high infectivity, high resilience
- vomiting ++
Notifiable diarrhoea causing diseases (5)
- Campylobacter
- Clostridium difficile
- Listeria
- Virbrio cholera
- Yersinia
Passive immunity
Transfer of immune effectors i.e. immunoglobulins e.g. HBIG, VZIG
Types of vaccine (5)
- Immunoglobulin
- Anti-toxins
- Inactivated
- Subunit
- Live attenuated
Examples of live attenuated vaccines (6)
- contraindicated
- advantage
- MMR
- Rotavirus
- Yellow fever
- VZV
- BCG
- Polio
- in pregnancy/immunosuppressed
- act most like the real infection therefore give long-lasting immunity
Examples of inactivated vaccines (3)
- Rabies
- Hep A
- HiB
Examples of subunit vaccines (2)
- Influenza
2. Typhoid
Examples of antitoxin (2)
- Botulinum antitoxin
2. Diptheria antitoxin
When to give VZIG?
used in susceptible pregnant women neonates or immunosuppressed patients exposed to chickenpox
When to give HBIG?
Prevention of HBV infection. Used in conjunction with vaccination
When to give NHIG?
prevention of HAV, rubella and polio infection (limited efficacy)
Patients with HIV should NOT receive which virus vaccine?
a. Bacillus Calmette–Guérin (BCG)
b. Measles, mumps, rubella (MMR)
c. Hepatitis B vaccine
d. Inactivated poliovirus vaccine
e. Yellow fever vaccine
e. Yellow Fever
Whooping cough is caused by which species of bacteria?
a. Bordatella pertussis
b. Streptococcus pneumoniae
c. Corynebacterium diphtheriae
d. Corynebacterium ulcerans
e. Haemophilus influenzae
a. Bordatella pertussis
Congenital rubella syndrome (CRS)
- worst time
- manifestations (4)
first trimester
- cardiac
- auditory
- opthalmic
- neurological
Purified polysaccharide pneumococcal vaccine activates B cells to produce which sort of immunoglobulin (Ig)?
a. IgG
b. IgA
c. IgM
d. IgE
e. IgD
c. IgM
Mycobacterium tuberculosis
- description of bacteria (5)
- slow growing
- Gram + rods
- non-motile
- waxy cell wall with long-chain fatty acids
- acid alcohol fast
2 acid fast stains
- Ziehl-Neeson
2. Auramine
What colour does AFB stain with ziehl-neeson?
Red
Non-tuberculous myocobacteria
a) slow-growing (3)
b) fast-growing (3)
- source
- transmission
- association
- treatment
- M.avium
- M.marinum
- M.ulcerans
- M.fortuitum
- M.abscessus
- M.chelonae
- water & soil
- no person to person
- immunosuprression
- little response to anti-TB
M.avium
- children
- immunossuppressed
- underlying resp disease
children - pharyngitis & cervical adenitis
immunossupressed - disseminated infection
underlying bronchiectasis etc - pulmonary resembles TB
M.marinum
- who
- what
- swimming pool/aquarium owners
- single or clusters of papules/plaques over fingers/hands/elbows
M.Ulcerans
- who
- transmission
- what
- Australia
- insects
- starts as painless nodules and develops into chronic, progressive ulcer
Fast-growing non-tuberculous mycobacterium
- what
- where
- skin and soft tissue infections
- hospital-setting e.g. catheters
Leprosy “Hansen’s Disease”
- causative organisms (2)
- incubation
- transmission
- symptoms
a) skin (5)
b) nerves (2)
c) eyes (2)
d) bones (2) - treatment (3)
- types (2)
- M.leprae
- M.lepromatosis
2-10 years
nasal secretions
a) depigmentation, macules, plaques, nodules, trophic ulcers
b) thickened nerves, sensory neuropathy
c) keratitis, iridocyclitis
d) periositis, aseptic necrosis
Rifampicin, Dapsone, Clofazimine
- Paucibacillary/Tuberculoid 5 lesions
Most common opportunistic infection in HIV?
TB
Risk factors associated with TB incidence? (6)
- migrants
- IVDU
- HIV+
- homelessness
- prison
- close contacts
Which strain does BCG vaccinate against?
Efficacy?
At risk populations who receive BCG? (2)
Contraindicated?
M.bovis
80%
1. babies born in high areas of prevalence
2. unvaccinated new immigrants from high prevalence countries
HIV patients
TB Disease process (2)
- Primary TB
- infection during childhood/elderly/HIV
- asymptomatic
- granuloma present - Post-primary
- > 5 years after primary infection
- re-activation/re-infection
Risk factors for reactivation of TB? (4)
- immunosuppression
- chronic alcohol excess
- malnutrition
- ageing
Characteristic feature of TB granuloma?
Langhan’s giant cells
Progressive primary TB? (2)
- LN ulcerates into bronchus causing pneumonia
2. cavity formation causes bronchiectasis, consolidation & collapse
Miliary TB? (2)
- progressive disease
2. haematological spread
Pulmonary TB Presentation (6)
- cough
- haemoptysis
- weight loss
- fever
- night sweats
- malaise
Pulmonary TB signs (3)
- Upper lobe consolidation
- caseating granuloma
- mediastinal lymph nodes
Extrapulmonary TB
- percentage
- signs & symptoms (8)
20%
- lymphadentitis (cervical) “scrofula”
- abscesses
- pericarditis
- perotinitis
- ileitis
- skin involvement
- renal disease
- genitourinary involvement
Spinal TB
- percentage
- presentation (4)
- complications (2)
- treatment
4%
- weight loss
- fever
- sweats
- back pain
- vertebral collapse
- ileopsoas abscess
12 months anti-TB
TB Meningitis
- percentage
- presentation (8)
- investigation (2)
- treatment
2%
- headache
- weight loss
- malaise
- fevers
- sweats
- neck stiffness
- personality changes
- focal neurology
- LP - lymphocytic
- CT - tuberculomata
- 12 months anti-TB + steroids
Investigations in suspected TB
a. imaging (2)
b. cultures (3)
c. sputum stains (2)
d. histological features (4)
e. skin tests (2)
f. other (2)
a. CT, CXR
b. sputum, bronchoalveolar lavage (BAL), urine (EMU)
c. ziehl neeson, auramine
d. gram + rods, acid fast, aerobic, intracellular
e. heaf test, mantoux
f. PCR assay, IFNgamma assay
First line treatment of TB
- dosing
RIPE Rifampycin Isoniazid Pyrazinamide Ethambutol
all 4 for 2/12
Rifampycin & Isoniazid for 4/12
Side effects of Rifampycin (2)
orange secretions
hepatotoxicity
Side effects of Isoniazid (2)
peripheral neuropathy
hepatotoxicity
Side effects of Pyrazinamide (2)
hyperuricaemia
hepatotoxicity
Side effects of Ethambutol (2)
optic neuritits
visual disturbances
Treatment schedule for TB Meningitis
all 4 for 2/12
Rifampycin & Isoniazid for 8-10/12
Treatment for latent TB
6/12 Isoniazid
Second line treatment for TB? (6)
- injectables (Capreomycin, Kanamycin, Amikacin)
- Quinolones (Moxifloxacin)
- Linelozid
- PAS
- Cycloserine
- Clofazamine