Microbiology Flashcards by Ally Wilbourn

When to give tetanus immune globulin

If patient is unvaccinated, uncertain of vaccination, or <3 tetanus toxoid doses with a DIRTY wound

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Patients with asplenia are at risk for

infection due to encapsulated bacteria due to deficiency in antibody-mediated phagocytosis

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Newborn with microcephaly, ventriculomegaly, periventricular calcifications, hepatosplenomegaly, thrombocytopenia

Congential CMV (saliva)

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Pt with HIV (CD4 <100) & febrile wasting, cough, SOB, night sweats, mucocutaneous ulcer, LAD, HSM, pancytopenia

disseminated Histoplasmosis

dx with urine histoplasma antigen
tx w/ amphotericin B

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Pt with fever, muscle stiffness, trismus/lockjaw, and painful muscle spasms triggered by physical stimuli

tetanus

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cephalocaudal spread of maculopapular rash with fever and arthralgias

Rubella (German measles)

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19 year old with dry cough, sore throat, headache, maculopapular rash on extremities. Small pleural effusion and increased interstitial markings

Mycoplasma pneumonia

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elderly man with severe unilateral ear pain. Ear canal is mildly erythematous with purulent drainage and granulation tissue

necrotizing otitis externa

pseudomonas
defecits in lower cranial nerves (vii, x, xi)
tx: iv cipro with surgical drainage

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Patient with acute febrile illness and AMS. Was recently bit by a tick. Leukopenia, thrombocytopenia, and elevated LFTs

Ehrliciosis (carried by lone star tick/reservoir is white tail deer)
-tx: doxycycline empirically

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Pt on mission trip around pig farmers has a new seizure. CT show multiple cysts with surrounding edema

neurocysticercosis

Taenia solium (pork tapeworm) eggs
tx with albendazole, steroids, phenytoin

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Pt with fever, hemoptysis, and chest pain with neutropenia. Ct scan pf chest shows multiple nodular lesions with surrounding ground-glass opacities

Invasive aspergillosis

RF: immunocompromised
tx: Voriconazole + capsofungin

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Tx of food borne botulinum

horse-derived antitoxin

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Young patient with viral URI (flu) develops worsening sx with fever of 104. Xray showed multilobar cavitary infiltrates and thin walled cavities

Staph aureus (MRSA)

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HIV patient with linear ulcers with intranuclear and intracytoplasmic inclusions in distal esophagus. Was treated with oral oral fluconazole 2 weeks ago for odynophagia

CMV
tx: Ganciclovir
CD4 <50

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Infection after starting chemotherapy

organism
treatment

Pseudomonas aeruginosa

Pip-tazo, meropenem, cefepime (covers gram + and -)

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Pregnant patient that had a fever and diffuse maculopapular rash (non-pruritic) several weeks ago. U/S of infant shows enlarged ventricles and multiple intracranial calcifications. Hepatomegaly also noted.

Toxoplasma gondii

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4 year old girl with “itchy private parts” mostly at night. Perianal area is excoriated and erythematous. No vaginal discharge but erythematous vulva.

Enterobius vermicularis (pinworms) - helminth
tx: pyrantel pamoate or albendazole for pt and home contacts

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Pt recently traveled to the Caribbean now returns with fever, malaise, polyarthralgias, throbocytopenia, pymhopenia

Chikungunya fever (from Aedes mosquito)

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Pt presents with fever, double vision, painful swelling around his eyes, pain in neck and jaw muscles. Lab studies show increased eosinophils

Trichinellosis

endemic in Mexico, China, Thailand
ingestion of undercooked meat
Intestinal phase (1 week): asx, abdominal pain, N/V, diarrhea
muscle stage: myositis, fever, sugunal splinter hemorrhages, periorbital edema, esosinophilia (>20%)

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Side effect of aminoglycosides

Ototoxicity by damaging cochlear cells

Gentamicin can also damage the motion-sensitive hair cells

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complications of infectious mono

acute airway obstruction
autoimmune hemolytic anemia and thrombocytopenia
splenic rupture

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infectious endocarditis causes:
hospital acquired
community acquired
post dental procedure

Staph (hospital)
Strep (community)
Viridans/sanguinis (post dental)

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Severe watery diarrhea in an HIV patient with CD4 of 94 and a low grade fever. Started working at a horse breeding farm

Cryptosporidium parvum

- modified acid fast stain

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Infant born with diffuse intracranial calcifications, ventriculomegaly, hepatomegaly, jaundice

Congenital toxoplasmosis

infant fails hearing screen. Mom traveled out of country while she was pregnant, got sick and had arthralgias. Pt has loud murmur heard over second ICS on left.

Rubella (German measles) - congenital - sensorineural hearing loss - cataracts - PDA

Plantar hyperkeratotic papules that are painful to walk on. Pt is sexually active

HPV

Pt from Wisconsin develops fever, night sweats, weight loss. Pt has multiple skin lesions and CXR shows left upper lobe consolidation and two lytic lesions in the anterior ribs

Blastomycosis

Pt is traveling to India and wants to be protected from malaria

Mefloquine chemoprophylaxis until 4 weeks after return - can use chloroquine in sensitive areas - in non-sensitive areas, can give atovaquone-proguanil, doxycycline, mefloquine

Pneumonia, diarrhea, and hyponatremia

Legionella - urine antigen test - treat with macrolides or fluoroquinolones

Pt presents with fever, chills, dysphagia, and drooling. Has a fever, tongue is displaced posterior and superior due to swollen area on floor of mouth. B/l submandibular area is tender, indurated, nonfluctuant with palpable crepitus

Ludwig angina - rapidly progressive cellulitis of submandibular space - many cases arrive from dental infections - tx: IV abx (ampicillin-sulbactam, clindamycin)

Diarrhea in HIV patients

<180: Cryptosporidium (watery diarrhea) <100: mycrosporidium (fever rare) <50: MAC (fever >102.2 & watery diarrhea) CMV (frequent, small volume diarrhea, hematochezia)

Pt with HIV develops red/purple papules that enlarge into nodules. They are friable and bleed easily when palpated. He also has hepatosplenomegaly

Bartonella - bacilliary angiomatosis | - tx with doxy or erythromycin

Immunocompromised patient presents with bloody diarrhea, mild hepatitis, and pulmonary complaints

CMV

Pt has deep puncture wound by neighbor's cat. Vaccinations are UTD. Most recent tetanus was 3 years ago

Pasturella - tx with Augmentin

Pt has single intrahepatic cyst that is well-defined with eggshell calcifications. She has had dogs at home for 10 years

Hydatid cyst due to Echinococcus granulosus | - causes unilocular cystic lesions that can occur in any organ

Pt returned from kenya 2 weeks ago now has fevers, headache, and malaise. He developed intense chills followed by fever and diaphoresis. He experienced similar sx a few days ago

Malaria - cyclical fevers

Pt develops submandibular mass after tooth extraction. Mass expresses fluid with yellow granules. Anaerobic culture grows filamentous gram positive rods with rudimentary branching.

Actinomyces | tx = penicillin

Tx of PCP

Bactrim and corticosteroids

Pt presents with fever, right cheek pain and bloody nasal discharge. Pt has a 30 year hx of DM type 2. CT scan shows opacification and bony erosion of the right maxillary sinus

Mucormycosis (Rhizopus)

Where does E corrodens come from

periodontal infection

Polyarthralgias, tenosynovitis, and painless vesiculopustular skin lesions

disseminated gonoccocal infection

Common cause of cellulitis in burn victims and patients with uncontrolled DM

Psuedomonas - gram neg rod

Pt was bit on the leg while skinning small game in Arkansas. There is a painful ulcer with regional LAD

Francisella tularensis | - tx with aminoglycosides

Progressive abdominal discomfort and nausea. Previous farmer in Guatemala. Hepatomegaly present with 10 cm , smooth, round cyst with daughter cysts inside.

Echinococcus granulosus - dog tapeworm - tx: albendazole - hydatid cyst with internal septations

50 year old male develops abdominal pain, bloody stools, and malaise 4 months after kidney transplant. Blood smear shows atypical lymphocytes and colonoscopy shows multiple ulcerations throughout colon.

CMV colitis

Tx of H. ducrei

single PO dose of azithromycin

nasopharyngeal carcinoma is associated with reactivation of

EBV - usually in those from asia | - early spread to cervical LN is common

Patient with worsening pharyngitis develops thrombosis in IJ, sever neck swelling and tenderness. CXR shows multiple peripheral lung nodules, some with cavitation

Fusobacterium necrophorum | - Lemierre syndrome

southeast Asian man presents with a well-demarcated hypopigmented skin lesion on the left upper arm with no pinprick sensation. The ulnar nerve is thickened and tender to palpation at the elbow and he has numbness and tingling in his fingers.

Leprosy - Mycobacterium leprae - need full thickness biopsy - tx: dapsone + rifampin

clostridium septicum

highly associated with colon cancer - can cause gas gangrene and tissue necrosis (as well as strep bovis)

most common cause of nosocomial blood infections

central venous catheters - staph aureus - candida

parvovirus in adults

acute, symmetric arthralgias (looks like RA)

pneumonia in a patient with prior lung dz. CT shows dilated airways (bronchiectasis)

pseudomonas | - b-lactam + fluoroquinolone

Pts with neutropenic fever should be immediately treated for

pseudomonas | - pip/tazo, ceftazidime, meropenem, imipenem, and cefepime

candida appearance on KOH

pseudohyphae and budding yeast

aminoglycosides

can cause sensorineural hearing loss and ATN

antibiotics most likely to cause c diff

ampicillin and clindamycin

14 year old with 2-week history of a non-productive cough, low-grade fever, sore throat, and occasional chest pain that worsens with deep inspiration.

``` Atypical pneumonia (walking) tx: macrolides ```