Microbiology EMQs Flashcards

Question

``` A Amoxicillin B Doxycycline C Co-amoxiclav IV D Meropenam E Chloramphenicol F Cefotaxime G Vancomycin H Trimethoprim I Flucloxacillin ``` An 18-year-old woman student presents to accident and emergency with headache, neck stiffness and photophobia. CT scan reveals no raised intracranial pressure. Gram-negative diploccoci are visualized on Gram-staining of the patient’s CSF.

Answer 1

F Cefotaxime Cefotaxime (F) is a third generation cephalosporin and is the drug of choice in treating Neisseria meningitidis, which is the most common cause of meningitis in the UK. Cefotaxime is a β-lactam antibiotic and therefore inhibits cell wall synthesis. If meningitis is suspected in the community, the patient should be started on benzyl-penicillin until they are transferred to a secondary care unit. Cefotaxime is also useful in the treatment of pyelonephritis, sepsis secondary to hospital acquired pneumonia and soft tissue infections.

Answer 2

C Hepatitis B virus Hepatitis B virus (HBV; C) is a double-stranded DNA virus that is prevalent in sub-Saharan Africa. It is transmitted via sexual contact, contaminated blood products, intravenous drug use as well as vertical transfer from mother to child during child birth. The virus has an incubation period of 2–6 months with 80 per cent of infections remaining acute and 20 per cent becoming chronic with risk of cirrhosis and hepatocellular carcinoma. HBV antigens include HBsAg (surface antigen), HBcAg (core antigen) and HBeAg (soluble antigen).

Answer 3

A Human immunodeficiency virus (HIV) Human immunodeficiency virus (HIV; A) possesses single-stranded RNA as well as enzymes (reverse transcriptase, integrase and protease) in its core. HIV is transmitted via sexual intercourse, blood products, intravenous drug use and vertically from mother to child. HIV infects CD4+ T cells; within the cell the RNA undergoes reverse transcription to make DNA which is integrated into the host DNA; the virus then becomes latent or buds to infect further. AIDS (CD4+ count

Answer 4

B Epstein–Barr virus (EBV) Epstein–Barr virus (EBV; B) primarily infects B lymphocytes, binding via a complement receptor. Transmission involves person-to-person transfer through close contact. EBV is associated with glandular fever (infectious mononucleosis) which causes pharyngitis, lymphadenopathy, fever, splenomegaly and hepatomegaly. Rare sequelae include thrombocytopenia and erythema multiforme. EBV can also cause Hodgkin’s lymphoma (latent reactivation of EBV), Burkitt’s lymphoma and nasopharyngeal cancers. It is diagnosed on blood film (atypical lymphocytes), monospot test (positive heterophil antibody test) and/or EBV antibodies in the blood.

Answer 5

I Influenza virus Influenza virus (I) is part of the orthomyxoviridae group of viruses and causes epidemics of influenza annually. The influenza virus causes primary pneumonia as well as delayed secondary bacterial pneumonia and otitis media in immunocompromised patients. It is a spherical virion with haemagglutinin (HA) and neuraminidase (NA) glycoproteins on the surface. HA binds to sialic acid receptors present in the upper respiratory tract; viral RNA is subsequently inserted into the host cell and HA is cleaved by clara cell tryptase. NA cleaves neuraminic acid, a component of protective mucin; as a result the protective barrier is disrupted exposing sialic acid receptor sites beneath. NA also has a role facilitating the release of newly formed influenza virions.

Answer 6

F Varicella zoster virus Varicella zoster virus (VZV; F) is a droplet-spread herpes virus that causes chickenpox in children and shingles in adults. Chickenpox is characterized by fever, malaise and a rash (erythematous base with fluid top) that spreads over the body. Complications include secondary bacterial infection and encephalitis. VZV remains dormant in the dorsal root ganglia and may reactivate in states of immunosuppression. The most common symptom is neuralgia which occurs in a dermatomal distribution; other manifestations include encephalitis, Guillain–Barré syndrome, facial palsy and progressive outer retinal necrosis.

Answer 7

D Zidovudine Zidovudine (D) is a nucleoside reverse transcriptase inhibitor (NRTI) used in the treatment of HIV/AIDS (as well as prevention of vertical transmission from infected mothers). Treatment is commenced once the CD4 count falls below 350 copies/μL. Zidovudine works by inhibiting the action of the enzyme reverse transcriptase, preventing the conversion of HIV RNA to DNA, which consequently cannot be incorporated into the host DNA. Side effects include anaemia, neutropenia, hepatic and cardiac dysfunction as well as myopathy. The standard treatment regimen involves the use of two nucleoside reverse transcriptase inhibitors (NRTIs) and a non-nucleoside reverse transcriptase inhibitor (NNRTI; Efivarenz) or a protease inhibitor (PI; Ritonavir).

Answer 8

C Interferon-α Interferon-α (IFN-α; C) is a protein that is used in the treatment of hepatitis B; it potentiates the immune system to fight active viral infection. IFN-α acts on the JAK-STAT pathway; IFN-α binds to the IFN-α receptor, causing phosphorylation of STAT1 and STAT2, which subsequently form a complex with IRF9 (a transcription factor), leading to the synthesis of anti-viral proteins. A NRTI and IFN-α is the standard treatment for hepatitis B infection. Pegylated-IFN-α is used in the treatment of hepatitis C; similar to IFN-α, the addition of polyethylene glycol increases the half life of the drug.

Answer 9

B Oseltamivir Oseltamivir (B) is a viral neuraminidase inhibitor used in the treatment of influenza. Osteltamivir is in fact a pro-drug; once metabolized in the liver the active form GS4071 is produced. Once a newly formed influenza virion is produced, the surface viral protein haemagglutinin is bound to sialic acid receptors along the upper respiratory tract. Neuraminidase is normally responsible for cleaving the haemagglutinin–sialic acid receptor bond, hence facilitating the release of newly formed virions. Therefore, inhibiting neuraminidase activity prevents further viral replication.

Answer 10

E Gancylcovir Gancyclovir (E) is a 2´-deoxyguanosine analogue used in the treatment of cytomegalovirus (CMV) infection. It is the first line drug for the prophylaxis of CMV in bone marrow transplant patients. 2´-deoxyguanosine is phosphorylated to the triphosphate form, which prevents viral DNA polymerase from elongating viral DNA and therefore inhibits CMV replication. Gancyclovir can cause bone marrow toxicity; it may therefore be prescribed together with granulocyte-colony stimulating factor (G-CSF). Gancyclovir is also used in the treatment of human herpes virus 6 (HHV-6) and Epstein–Barr virus infection.

Answer 11

A Acyclovir Acyclovir (A) is a guanosine analogue anti-viral drug used primarily in the treatment of herpes simplex virus infections (HSV-1 and HSV-2). It is converted to acyclo-guanosine monophosphate (acyclo-GMP) by viral thymidine kinase. Acyclo-GMP is further phosphorylated to acycloguanosine triphosphate (acyclo-GTP). Acyclo-GTP is incorporated into the viral DNA strand, terminating the chain and stopping DNA polymerase from functioning. Aciclovir is also indicated for the treatment of varicella zoster, Epstein–Barr virus and cytomegalovirus infections (with decreasing efficacy).

Answer 12

I Candida albicans Candida albicans (I) can affect both immunocompetent and immunocompromised hosts. In the immunocompetent host, clinical features range from oral thrush (creamy-white patches with red base over mucous membranes of mouth; treated with nystatin) to vaginitis (vaginal inflammation, pruritis and discharge; speculum examination reveals patches of cottage cheese-like clumps fixed to vaginal wall). In immunocompromised patients, C. albicans infection leads to oesophagitis, characterized by odynophagia. Candidaemia can lead to severe flu-like symptoms and can be diagnosed by testing for blood β-D-glucan (a component of fungal cell walls).

Answer 13

A Cryptoccus neoformans Cryptococcus neoformans (A) is an encapsulated yeast that is transmitted via inhaled spores from pigeon droppings. It is usually asymptomatic in most cases. Seventy-five per cent of cases occur in immunocompromised patients, characterized by the development of sub-acute or chronic meningitis. Cryptococcal meningitis is fatal without treatment due to the associated cerebral oedema and brainstem compression. Diagnosis is made by CSF analysis with India ink stain which reveals yeast cells surrounded by a halo (polysaccharide capsule). A cryptococcal antigen test can also be used which offers higher sensitivity.

Answer 14

B Pityriasis versicolour Pityriasis versicolor (B) is a chronic fungal infection caused by Malassezia furfur, characterized by hypopigmentation (in patients with dark skin tones) and hyperpigmentation (in patients with pale skin tones). Spots affect the back, underarm, arms, legs, chest, neck and rarely the face. Microscopic investigation of the M. furfur with potassium hydroxide reveals a ‘spaghetti with meatballs’ appearance. Wood’s light may also reveal an orange fluorescence in some cases.

Answer 15

C Aspergillus flavus Aspergillus flavus (C) is a fungus that commonly grows on stored grains and can cause a spectrum of disease. Allergic reaction in the airways may cause allergic broncho-pulmonary aspergillosis (ABPA) which occurs due to an IgE mediated type I hypersensitivity reaction leading to bronchospasm and eosinophilia. Infection in pre-formed lung cavities (for example in TB patients) may lead to a fungal ball visible on chest X-ray (aspergilloma). Invasive aspergillosis is a chronic necrotizing infection that may occur in neutropenic patients (chemotherapy) or patients with end stage AIDS (CD4 count

Answer 16

G Sporothrix schenckii Sporothrix schenckii (Rose garderner’s disease; G) is a fungus found in soil and plants that causes sporotrichosis. A prick by thorns causes nodular lesions to appear on the surface of the skin. Initially the lesions will be small and painless; left untreated they become ulcerated. Infection may also spread to joints, bone and muscle by this route. Inhalation of spores may lead to pulmonary disease and systemic infection may lead to central nervous system involvement. Treatment options include itraconazole, fluconazole and oral potassium iodide.

Answer 17

C Brucellosis Brucellosis (C) is a Gram-negative rod-shaped bacterium that is harboured by cattle (Brucella abortus), goats (B. melitensis), pigs (B. suis) and dogs (B. canis). Brucella spp. are transmitted by inhalation, unpasteurized dairy produce and direct contact with animals. Symptoms include fever, myalgia, arthralgia, tiredness and in chronic cases may be associated with depression. Diagnosis is made by blood culture on Castaneda medium. Complications include granulomatous hepatitis (histology of liver biopsy demonstrates granulomata), endocarditis, oseteomyelitis and thrombocytopenia.

Answer 18

G Lyme disease Lyme disease (G) is caused by the spirochaete Borrelia burgdorferi which is transmitted by the Ixodes ticks harboured by certain species of mice and deer. Initial symptoms include erythema migrans (a spreading annular skin lesion with a characteristic target-shaped appearance), malaise, fever and musculoskeletal pain. Several weeks after the primary infection, the patient may experience neurological (headache, meningitis and Bell’s palsy) and cardiac (arrhythmias, myocarditis and pericarditis) effects. Late features include arthralgia and arthritis.

Answer 19

E Leptospirosis Leptospirosis (Weil’s disease; E) is a zoonotic disease caused by Leptospira interrogans which is harboured by both wild and domestic animals. It is transmitted via drinking water that has become contaminated with the urine of infected animals; as a result those involved in water-sports and sewage workers are at particular risk. Lyme disease is characterized by an influenza-like disease with/without gastrointestinal symptoms. Diagnosis can be made by ELISA, PCR or microscopic agglutination test (MAT). Long-term complications include hepatitis and renal failure.

Answer 20

I Rocky mountain spotted fever Rocky Mountain spotted fever (I) is caused by Rickettsia spp. infection, a Gram-negative genus of bacteria, most prevalent in North and South America. It is harboured in small wild rodents and domestic animals (transmitted to humans by ticks). Rickettsia bacteria invade the endothelial lining of capillaries causing a vasculitis. Clinical features include headache, fever, myalgia, vomiting and confusion. Late signs include a rash that is maculopapular and/or petechial on the distal parts of the limbs which then spreads to the trunk and face. Rocky Mountain spotted fever may lead to thrombocytopenia, hyponatraemia and/or elevated liver enzymes.

Answer 21

A Psittacosis Psittacosis (A) is a zoonotic infectious disease caused by Chlamydia psittaci which is contracted from a wide variety of birds (parrots, pigeons and cockatiels to name a few). Human symptoms mainly involve a severe pneumonia (with or without hepatitis). Although the patient may report mild symptoms, the X-ray will generally appear to show severe pathology. Diagnosis is made by visualizing cytoplasmic inclusions on Giemsa or fluorescent antibody stained sputum or biopsy sample.

Answer 22

E Mumps Mumps (E) is spread by droplets in the air which travel via the lungs to parotid tissue and subsequently to distant sites. Clinical features of infection consist of fever, malaise and transient hearing loss. Parotitis is characteristic of mumps infection with unilateral or bilateral swelling and pain on chewing. Plasma amylase levels may be elevated as a result of inflammation of the salivary glands. Complications such as viral meningitis, orchitis/oophoritis, mastitis and arthritis may result from long-standing infection. The MMR vaccine given at 12–18 months has drastically reduced the incidence of mumps.

Answer 23

F Listeria monocytogenes Listeria monocytogenes (F) is a β-haemolytic anaerobic Gram-positive rod that can cause meningitis in the neonate to 3 months age group. Listeria monocytogenes may be transmitted vertically from mother to baby in utero (due to the ingestion of infected food by the mother) or during birth (transvaginal transfer). Early signs of meningitis are nonspecific in the age group affected (fever, poor feeding, vomiting, seizures and reduced consciousness) whereas late signs include a bulging fontanelle, neck stiffness, opisthotonos (arched back), Brudzinski and Kernig signs positive as well as meningococcaemia.

Answer 24

C Measles Measles (C) is a viral respiratory system infection caused by the genus Morbillivirus. Infection presents with cough, coryza, conjunctivitis and/ or a discrete maculopapular rash. White spots on the buccal mucosa (Koplik spots) are pathognomonic for measles. Complications of measles infection may involve the respiratory (pneumonia and tracheitis) and neurological (febrile convulsions and encephalitis) systems. Subacute sclerosing panencephalitis (SSPE) may occur several years after the primary infection; infection persists in the central nervous system leading to loss of neurological function, dementia and eventually death.

Answer 25

H Haemophilus influenzae Haemophilus influenzae (H) is a Gram-negative rod shaped bacterium that causes meningitis in children older than 3 months who have not been vaccinated. Other organisms that cause meningitis in older children include Streptococcus pneumoniae and Neisseria meningitidis. Diagnosis involves culture of the bacteria using chocolate agar, with subsequent Gram-stain and microscopy. Latex particle agglutination and PCR are more sensitive and specific investigative tests. The Haemophilus influenzae type B (Hib) vaccine has dramatically reduced Hib-related meningitis; the first dose is given when the child is 8 weeks old.

Answer 26

A Rubella Rubella (German measles; A) is a viral infection which can be congenital or acquired. Congenital rubella syndrome (CRS) occurs in a developing fetus if the mother has contracted rubella in her first trimester. CRS is characterized by sensorineural deafness, eye abnormalities (cataracts, glaucoma, retinopathy) and congenital heart disease (patent ductus arteriosus). Other associations include microcephaly and developmental delay. Acquired rubella is transmitted via the respiratory route. Characteristically, a rash appears on the face which spreads to the trunk and disappears after a few days.