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Microbiology And Antimicrobials Flashcards

1
Q

What type of bacteria is Streptococcus Angiosus?

A

Gram Positive Cocci

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2
Q

Give an example of a gram positive cocci bacteria:

A

Streptococcus Anginosus

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3
Q

What type of bacteria is Veillonella Species?

A

Gram Negative Cocci

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4
Q

What is an example of a gram negative cocci bacteria?

A

Veillonella Species

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5
Q

What type of bacteria is Actinomyces Israeli?

A

Gram Positive Bacilli

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6
Q

What is an example of a Gram Positive Bacilli bacteria?

A

Actinomyces Israelii

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7
Q

What is an example of a Gram Negative Bacilli bacteria?

A

Prevotella Intermedia

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8
Q

What type of bacteria is Prevotella Intermediate?

A

Gram Negative Bacilli

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9
Q

What type of bacteria is Prevotella Intermediate?

A

Gram Negative Bacilli

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10
Q

What is the meaning of an Aerobic Growth condition?

A

Growth in the presence of Oxygen

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11
Q

What is the meaning of a Capnophilic growth condition?

A

Growth in the presence of Carbon Dioxide

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12
Q

What is the meaning of a facultative growth condition?

A

With and Without oxygen

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13
Q

What is the meaning of Strictly Anaerobic growth conditions?

A

Without oxygen

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14
Q

Which growth condition for bacteria does metronidazole have effect?

A

Strictly Anaerobic

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15
Q

Which growth condition for bacteria does metronidazole have effect?

A

Strictly Anaerobic

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16
Q

What is the definition of Antimicrobial Resistance?

A

Occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective

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17
Q

What is the definition of Antimicrobial Resistance?

A

Occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective

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18
Q

What are the two types of resistance?

A

Intrinsic and Acquired

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19
Q

What are two examples of acquired resistance?

A

Mutation and Acquisition of new DNA

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20
Q

What is an example of resistance by altered target site?

A

S.mitis
Penicillin resistance due to modified penicillin binding proteins

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21
Q

What is an example of antibiotic resistance?

A

Enzymatic Inactivation

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22
Q

What two species of bacteria demonstrate resistance by enzyme inactivation?

A

Prevotella and Fusobacterium

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23
Q

Define: Endogenous Infection

A

The infectious agent is derived from the host flora

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24
Q

What is the ideal specimen for a dental abscess?

A

Pus Aspirate

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25
Q

Why is a pus aspirate the ideal sample for a dental abscess?

A

Prevents contamination with saliva

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26
Q

What are the treatment principles for a localised infection?

A

Establish a diagnosis and document it
Remove the source of infection

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27
Q

Which two bacterias are commonly associated with dental abscesses?

A

Streptococcus Anginosus
Prevotella Intermedia

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28
Q

Which two bacterias are commonly associated with Periodontal Abscesses?

A

Anaerobic Streptococci
Prevotella Intermedia

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29
Q

Which bacterias are associated with Pericoronitis?

A

Mixed oral Anaerobes (P Intermedia)
S Anginosus group

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30
Q

Which bacterias are associated with Pericoronitis?

A

Mixed oral Anaerobes (P Intermedia)
S Anginosus group

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31
Q

What is the recommended antibiotic for systemic pericoronitis?

A

Metronidazole

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32
Q

What type of bacteria is associated with localised alveolar osteitis?

A

Mixed oral flora

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33
Q

What is Osteomyelitis of the Jaws predisposed by? (5)

A

Bisphosphonate therapy
Impaired vascularity of the bone (radiotherapy, Paget’s disease)
Foreign bodies (implants)
Compound fractures
Impaired host defences (diabetes)

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34
Q

What types of bacteria are associated with Osteomyelitis of the Jaw (4)?

A

Anaerobic gram negative rods
Anaerobic streptococci
Streptococcus Anginosus
Staphylococcus Aureus

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35
Q

What bacterias are associated with M/BRONJ? (3)

A

S. Anginosus
Mixed anaerobes
Actinomyces Israelii

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36
Q

What two bacterias are associated with Salivary Gland infection?

A

S. Aureus
Mixed Anaerobes

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37
Q

What is the treatment for Salivary Gland infection?

A

Drainage
Flucloxacillin and Metronidazole

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38
Q

What are the four stages of Documentation when administering antibiotics?

A
  1. Document diagnosis
  2. Document Ab choice, dose, route and duration
  3. Document a review date
  4. Document deviation from guidance
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39
Q

What does SOI stand for?

A

Severe Odontogenic Infection

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40
Q

What is the definition of Ludwig’s Angina?

A

Bilateral infection of the submandibular space

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41
Q

Which three bacterias are commonly associated with Ludwigs Angina?

A

Anaerobic gram negative bacilli
Streptococcus Anginosus
Anaerobic Streptococci

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42
Q

What is the definition of sepsis?

A

Life threatening organ dysfunction caused by a dysregulated host response to infection

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43
Q

What are the two components of a sepsis diagnosis?

A

SIRS and suspected/confirmed infection

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44
Q

What does SIRS stand for?

A

Systemic Inflammatory Response Syndrome

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45
Q

What are the four features of SIRS?

A

Temperature <36 or >38
Pulse >90/min
Respiratory rate >20/min
White Cell Count <4 or >12

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46
Q

How many people die from sepsis per year in Scotland?

A

3,500

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47
Q

What are the treatment principles of Severe Odontogenic Infections?

A

Diagnose
Seek advice/help

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48
Q

What are the 4 factors to consider in Severe Odontogenic Infection diagnosis?

A

Patient looks unwell
Family or carer is very concerned
There is ongoing deterioration
Physiology is abnormal for this patient (check HR, Oxygen Saturation and Blood Pressure)

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49
Q

What are the eight red flags in Severe Odontogenic Infection diagnosis?

A

New deterioration in Glasgow Coma Scale/ AVPU
Systolic SP <= 90mmHg (or >=40 below normal)
Heart rate >= 130 per minute
Respiratory rate >= 25 per minute
Needs oxygen to keep SpO2 92% (88% in COPD)
Non-blanching rash or mottled/ashen/cyanotic
Not passed urine in last 18 hours
Recent chemotherapy (within 6 weeks)

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50
Q

What are the sepsis six?

A

Give high flow oxygen
Take blood cultures
Give IV antibiotics
Give a fluid challenge
Measure lactate
Measure urine output

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51
Q

What does S stand for in microbiology results?

A

Susceptible at a standard dose

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52
Q

What does I stand for in microbiology results?

A

Susceptible at increased exposure/dose

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53
Q

What does R stand for in microbiology results?

A

Resistant, even with increased exposure/dose

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54
Q

What is the definition of a breakpoint?

A

A chosen concentration (mg/L) of an antibiotic which defines whether a species of bacteria is susceptible or resistant to the antibiotic

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55
Q

What is the definition of clinical resistance?

A

When infection is highly unlikely to respond even to maximum doses of antibiotics

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56
Q

What are the laboratory confounding variables of resistance testing?

A

Inoculum size
Planktonic phase
PH
Atmosphere
Biofilm

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57
Q

What are the clinical confounding variables of resistance testing?

A

Co-morbidities
Pus collections
Foreign bodies
Site of infection
Biofilm

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58
Q

What is exposure a function of?

A

Mode of administration
Dose, dosing interval, infusion time
Distribution/excretion of the antibiotic
Interactions with bacteria at site of infection

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59
Q

What is the aim of antimicrobial stewardship?

A

To preserve antimicrobial medicines by taking measures to promote their control

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60
Q

What are the five strategic objectives of Antimicrobial Stewardship?

A

Improve awareness and understanding
Strengthen the knowledge through surveillance and research
Reduce the incidence of infection
Optimise the use of antimicrobial medicines
Ensure sustainable investment

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61
Q

What is the definition of antimicrobial stewardship?

A

A coherent set of actions which promote using antimicrobials responsibly

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62
Q

What is the role of the Scottish Antimicrobial Prescribing Group (SAPG)?

A

Coordinates the national antimicrobial stewardship programme in humans

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63
Q

What is Penicilin V most active against?

A

Oral streptococci
Anaerobes
Selected gram negative cocci

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64
Q

What is amoxicilllin most active against?

A

Oral streptococci
Anaerobes
Gram negative cocci
Members of the enterobacteriaceae family

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65
Q

What antimicrobials is anginosus streptococci invariably sensitive to?

A

Penicillin V
Amoxicillin

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66
Q

What is the first line antimicrobial for dental infection?

A

Phenoxymethylpenicillin (penicillin V)

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67
Q

What is the recommended dose of penicillin V?

A

500mg every 6 hours for 5 days

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68
Q

What are four factors that cause candidosis?

A

Poor denture hygiene
Hospitalisation
Immunocompromised
Poor oral hygiene
HIV

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69
Q

What are the 3 features of Candida albicans?

A

Hyphae
Hydrolytic enzymes
Adhesions

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70
Q

What are the 3 features of Candida albicans?

A

Hyphae
Hydrolytic enzymes
Adhesions

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71
Q

What type of fungus is candida?

A

A dimorphic fungus present both as yeast (blastosporic) and filamentous (hyphae)

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72
Q

What is the size of a yeast cell in comparison to a bacteria?

A

Yeast cells are 25-50x bacteria cells

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73
Q

What are the risk factors of candidiasis?

A

Immunocompromised patients
Advanced HIV infection
Central venous catheter
Broad spectrum antibiotics
Colonisation at a sterile site
Trauma patient
Immunosuppressive drugs
Intra-abdominal surgery
Parenteral nutrition
Dialysis
Burn unit victim
Long term corticosteroid use

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74
Q

What is the classification of oral candidiosis?

A

Pseudomembranous- thrush
Erythematous- atrophied (HIV-related), denture related
Hyperplastic- candida leukoplakia
Angular cheilitis

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75
Q

What are the three Newton’s type for denture induced stomatitis?

A

Newtons Type 1: localised inflammation
Newtons Type 2: diffuse inflammation
Newtons Type 3: granular inflammation

76
Q

What are the two main species of candida?

A

Candida albicans
Candida glabrata

77
Q

What are the 4 features of Candida albicans?

A

Adhesion and colonisation
Hyphal penetration and invasion
Vascular dissemination
Endothelial colonisation and penetration

78
Q

What do hydrolytic enzymes do?

A

Catalyse the hydrolysis of a substrate through the addition of water

79
Q

What do phospholipases do?

A

Lipids that allow host cell penetration

80
Q

What do haemolysins do?

A

RBCs
Facilitates hyphal invasion

81
Q

What do proteinases do?

A

Protein
Adhesion to epithelial cells

82
Q

What are five methods of collection for laboratory diagnosis?

A

Smear
Oral rinse
Swab
Foam pad
Biopsy

83
Q

What are the three types of antifungal?

A

Echinocandins: active against biofilms
Azoles: ineffective against biofilm
Polyenes: active against biofilms

84
Q

What are three examples of echinocandins?

A

Caspofungin
Micafungin
Aniduafungin

85
Q

What are three examples of azoles?

A

Fluconazole
Voriconazole
Pocaconazole

86
Q

What are three examples of polyenes?

A

Nystatin
Amphoteicin B
Liposomal AmB

87
Q

What antifungals are Candida albicans sensitive against?

A

Fluconazole and Metaconazole

88
Q

What antifungal is candida glabrata sensitive to?

89
Q

Which microbes are associated with periodontitis?

A

P. Gingivalis
T. Denticola
T. Forsythia

90
Q

Which microorganisms are associated with gingivitis?

A

Actinomyces
Prevotella intermedia
Bacteriodes
Fusobacterium nucleatum

91
Q

What are the influences on microflora?

A

Host factors
Diet
Saliva
Gingival crevicular fluid
Microbial interactions
Gaseous environment

92
Q

What is the preferred clinical specimen for oral biofilm infections?

A

Swab for wound/lesion taken chair side
Cultured on agar plate for incubation

93
Q

What is the preferred clinical sample for an abscess?

94
Q

What are the six features of the chain of infection?

A

Infectious agent
Reservoir
Portal of exit
Portal of entry
Mode of transmission
Susceptible host

95
Q

What microorganisms are associated with endodontic infections?

A

Bacteriodes
Streptococcus
Fusobacterium nucleatum
Prevotella
Clostridium
Lactobacillus
Porpphyomonas endodontalis

96
Q

What microbe is associated with 4-40% of endodontic infections?

A

Enterococcus faecal is

97
Q

What are examples of virulence factors?

A

Endotoxins
Adhesions
Collagenases
Hyalurnates
Immune evasion

98
Q

What are bacterial detection methods associated with microbial culture?

A

Agar medium
Isolate bacteria
Identify by characterisation of enzyme activities
Sugar fermentation tests

99
Q

What are bacterial detection methods associated with molecular biology?

A

DNA probes
PCR

100
Q

How can we identify anaerobes?

A

They have a sensitivity to metronidazole

101
Q

What are the advantages of culture methods?

A

Yields bacterial isolates for future testing and study

102
Q

What are the disadvantages of culture methods?

A

Required viable cells
Insensitive
Only a small number analysed at once
Inconclusive results
Labour intensive

103
Q

What are the 3 stages of PCR?

A

Denature (94-95C)
Annealing (50-56C)
Extension (72)

104
Q

What are the advantages of PCR?

A

Less time consuming than culturing
Very sensitive
Can directly detect bacterial DNA within clinical samples
Does not require viable cells
Can detect uncultivable species

105
Q

What are the disadvantages of PCR?

A

May detect dead cells
Detects only pre-selected species

106
Q

What are the disadvantages of PCR?

A

May detect dead cells
Detects only pre-selected species

107
Q

How does a restriction enzyme analysis work?

A

Digests whole enzyme with restriction enzymes

108
Q

What are the molecular (genetic) typing methods?

A

Restriction enzyme analysis
Gene probe typing
Ribotyping

109
Q

How does ribotyping work?

A

Use E-coli rRNA as a DNA probe following restriction enzyme analysis (REA)
rRNA operon present in multiple copies in bacterial genomes

110
Q

What is the mode of action of azole antifungals?

A

Indirectly target the ergosterol in the fungi cell wall by interrupting the activity of the enzyme that produces it: 14-alpha demethylase
Fungistatic effect

111
Q

What is an example of a polyene anti fungal?

112
Q

What is the mode of action of polyenes?

A

Directly targets the ergosterol and causes perforation and leakage of intracellular contents
Fungicidal effect

113
Q

What is an example of an echinocandin?

A

Micafungin

114
Q

What effect do echinocandins have?

A

Fungicidal

115
Q

What are the factors of chlorhexidine substantivity?

A

Adsorption to oral surfaces
Maintainacne of antimicrobial activity
Slow neutralisation of antimicrobial activity

116
Q

What is the treatment for erythematous candidiasis

A

Thorough cleaning of denture: milton soak

117
Q

What is the treatment for pseudomembranous candidiasis?

A

Nystatin
Topical MW 4x daily
Chlorhexidine adjunct

118
Q

What is the treatment for hyperplasticity candidiasis?

A

Systemic antifungals
Fluconazole 50mg or Itraconazole 10-20mg

119
Q

What is the treatment for angular chelitis?

A

Chlorhexidine and miconazole crea, (50mg 7 days)

120
Q

What type of substance is chlorhexidine?

A

Bisbiguanide

121
Q

What is the mode of action of chlorhexidine?

A

Dicationic: 1 cation is dental pellicle, 1 cation is bacterial membrane

122
Q

How does chlorhexidine perform at a low concentration?

A

Increases cell permeability

123
Q

How does chlorhexidine perform at a high concentration?

A

Causes cytoplasmic and cell death

124
Q

What is the substantivity of chlorhexidine?

125
Q

What does substantivity mean?

A

Persistence of action

126
Q

What is substantivity dependent on?

A

Absorption to oral surfaces
Maintenance of antimicrobial activity
Slow neutralisation

127
Q

What are the dosing options for chlorhexidine?

A

0.2% 10ml 2x day
0.12% 15ml 2x day

129
Q

What are the virulence factors of candida?

A

Adhesions
Hyphae
Hydrolytic enzymes

130
Q

What are the mechanisms of antimicrobial resistance?

A

Biofilm too thick for penetration
Antimicrobial inactive against non-growing organisms
Antimicrobial broken down and destroyed by enzymes

131
Q

What are the stages of biofilm development?

A

Adhesion
Colonisation
Accumulation
Complex Community
Dispersal

132
Q

What are the key organisms associated with caries?

A

Streptococcus mutans
Lactobacillus acidophilus
Actinomyces

133
Q

What are the virulence factors for microorganisms associated with caries?

A

Binding proteins
Acid tolerance
Adaption
Sugar modifying enzymes
Adhesions
Effluent pumps

134
Q

What are the features of acid tolerance?

A

Maintains pH
Alters cell membrane
Protection and repair mechanisms

135
Q

What are the side effects of chlorhexidine?

A

Anaphylaxis
Hypersensitivity
Brown staining
Tongue discolouration
Burning gums
Impairs perio healing

136
Q

What does a biofilm compose of?

A

Aggregate of micro-organisms whose cells adhere to one another and embed in a surface
The adherent cells become embedded within a self produced matrix of extracellular polymeric substances which allow adherence to a surface

137
Q

What is a niche?

A

The role a species plays in its environment and how it meets its need for food and shelter

138
Q

What is the role of fimbrillar adhesions?

A

Virulence factors
Help invade membrane vesicles of host cells by binding to cellular integrins

139
Q

What are lipopolysaccharides?

A

A distinct cell wall component of gram negative bacteria with the potential structural diversity to mediate specific adherence

140
Q

What is lipotechoic acid?

A

A cell wall component of gram-positive bacteria involved in specific or non-specific adherence

141
Q

What are protein fimbrae?

A

Filamentous proteins on the surface of bacterial cells that may act as adhesions for specific adherence

142
Q

What are lectins?

A

Any proteins that bind to a carbohydrate

143
Q

What are examples of host receptors?

A

Glycolipid
Integrins
Glycoproteins
Collagen

144
Q

What are factors that contribute to successful colonisation?

A

Adherence, substrate (energy) and a liable environment
Mucosa surface, pellicle, acid rich police proteins, minerals and lectins
Mechanical washing, bacteriocidal enzymes, buffering and secretor IgA
Adhesions, LTA, protease, virulence factors

145
Q

What bacteria is associated with NUG/NUP?

A

Anaerobic fusospirochetal bacteria

146
Q

When are antibiotics not indicated?

A

When there is no infection associated with systemic signs

147
Q

What systemic signs provide clear evidence of spreading infection?

A

Trismus
Lymphadenopathy
Difficulty swallowing
Pyrexia
Tachycardia

148
Q

What is a risk associated with spreading infections in the canine space?

A

Potential to cause intracranial bacterial infections

149
Q

What signs associated with referral indicate referral to A&E?

A

Signs of septicaemia such as grossly elevated temperature (39.5C, lethargy, tachycardia)
Spreading cellulitis
Swelling that may compromise the airway or cause difficulty in swallowing or closure of the eye
Dehydration
Significant trismus associated with a dental infection
Failure to respond to previous treatment
An uncooperative patient

150
Q

What is the virulence factor of pseudomonas aeruginosa?

A

Capsule production

151
Q

What are endogenous sources of pseudomonas aeruginosa?

A

Oral flora
Hands

152
Q

What are the exogenous sources of pseudomonas aeruginosa?

A

Water (Dental unit water lines)
Suction system
Aerosol turbines/ultrasonics
Hands
Inadequate decontamination

153
Q

What patients are susceptible to pseudomonas aeruginosa?

A

Cystic fibrosis
Post op eye infections
Septicaemia in neutropenic
Ecthyma gangrenosa
Burn/graft infections
Hospital acquired pneumonia
Catheter assosciated urine infections

154
Q

How can you break the reservoir chain of infection in regard to pseudomonas aeruginosa?

A

Avoid damp/wet conditions
Use fresh detergent/disinfectant solutions
Frequently change ultrasonic bath/denture disinfectant
Steriliser reservoir- puridied water and change frequently

155
Q

How can you break the portal of exit chain of infection in regard to pseudomonas aeruginosa?

A

Use sterile single use solutions where possible

156
Q

How can you break the mode of transmission chain of infection in regard to pseudomonas aeruginosa?

A

Hand hygiene
Use type b steriliser

157
Q

How can you break the portal of entry chain of infection in regard to pseudomonas aeruginosa?

A

Aeseptic technique

158
Q

What cells does HIV attack?

A

CD4+ T cells- allows virus to enter and infect cells

159
Q

What is low CD4+ associated with?

160
Q

What does Koch’s postulate signify?

A

Causal relationship between a microorganism and disease

161
Q

What are the four factors of Koch’s postulate?

A
  1. Micro-organism present in all cases of the disease
  2. Micro-organism must be cultured from a diseased individual
  3. Inoculation of a healthy individual with the micro-organism must cause disease
  4. The same causative agent can be isolated from the diseased inoculated individual
162
Q

What are the two types of Pattern Recognition Receptors?

A

Pattern Associated Molecular Patterns (PAMPs)
Damage Associated Molecular Patterns (DAMPs)

163
Q

What are PAMPs?

A

Conserved exogenous (non-self) factors expressed by pathogens

164
Q

What are examples of PAMPs?

A

Nucleic Acids
Lipopolysaccharides (LPS)
Peptidoglycan

165
Q

What are DAMPs?

A

Endogenous (host) factors released following cell damage

166
Q

What are examples of DAMPs?

A

Heat shock proteins
Nucleic acids

167
Q

What is the overall result of PAMPs and DAMPs?

A

Activation of inflammatory signalling pathways

168
Q

What is the role of TNF-alpha in sepsis?

A

TNF-alpha drives sepsis

169
Q

Why does TNF-alpha drive sepsis?

A

Causes systemic vasodilation
Increases vascular permeability
Decreases blood pressure
Causes systemic blood clotting of microvasculature

170
Q

How is the complement system activated?

A

PRR recognition of PAMPs and DAMPs
C3a and C5a (peptides)
Immunopathogenesis

171
Q

What are the stages of pathogenicity?

A

Enter
Attach
Colonise
Evade host immunity
Produce harmful proteins
Disseminate
Release from host

172
Q

What is the microbiome?

A

All of the micro-organisms in a particular ecosystem

173
Q

What is the human microbiome?

A

All of the micro-organisms living in the body

174
Q

Where is resident flora from?

A

Delivery; (vaginal>c section)
Feeding (breast>bottle)

175
Q

What are the effects of host microbiome symbiosis?

A

Resistance to pathogen colonisation
Cardiovascular resistance

176
Q

What are the benefits of a normal flora?

A

Vitamin synthesis and excretion
Prevention of pathogen colonisation
Anatagonise other bacteria
Stimulate tissue development
Stimulate production of cross-reactive proteins

177
Q

When does microbial biomass increase?

A

As alkalinity increases

178
Q

What are the barriers for microbes in the gastointestinal tract?

A

Low pH
Saliva and bile
Immune system

179
Q

What are the effects of antibiotics on the gut microbiome?

A

Increased infection susceptibility
Compromised immune homeostasis
Dysregulated metabolism
Accumulation of antibiotic resistances

180
Q

Why do antibiotics cause increased infection susceptibility in the gut microbiome?

A

Loss of potential competition
Lower antibacterial and IgG exposure
Reduced neutrophil activity

181
Q

Why do antibiotics cause compromised immune homeostasis in the gut microbiome?

A

Disruption of Treg/Th balance
Elevated inflammatory tone

182
Q

Why do antibiotics cause dysregulated metabolism in the gut microbiome?

A

Elevated inflammatory tone
Altered insulin sensitivity
Altered metabolism of SCFA and bile acids

183
Q

Why do antibiotics cause accumulation of antibiotic resistances in the gut microbiome?

A

Establishment of resident bacteria
Transfer of resistant genes to pathogens

184
Q

What is oral dysbiosis driven by?

A

Major ecological pressure
Increase in GCF
Increase in inflammation
Increased temp/pH
Diet/decreased pH

185
Q

What are the 9 factors associated with oral dysbiosis?

A

Disease
Diet
Smoking
Alcohol
Oral Hygiene
Antibiotics/Antimicrobials
Act of Salivary Proteins
Salivary Flow
Innate/Adaptive Immune Factors

186
Q

What is 16s RNA?

A

Biomarker for determining bugs in the mouth

Finals (20 decks)

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