Microbiology - general and antibiotics Flashcards
Gram + cell membrane component
Lipoteichoic acid
2 unique features of Gram - bac cell wall
- Periplasm
2. Outer membrane
3 components of outer cell membrane of Gram - bacteria
Polysaccharide
Lipid A
O antigen
2 components of peptidoglycan sheets of bacterial cell wall
Which one connects peptides?
NAG
NAM (connects peptides)
Make up of capsule
Which bacteria is the exception?
Polysaccharide
Exception - Bacillus anthracis - poly D glutamate peptide capsule (major virulence factor)
3 conjugated vaccines with capsule polysaccharide
Strep pneumonia
H influenzae b
N meningitidis
Bacteria using glycocalyx
Staph epidermidis - forms biofilm
2 key bacteria using pili/fimbria
E. Coil Neisseria gonorrhoea (antigenic variation —> risk subsequent infection
3 components of bacteria spores
Keratin-like outer coating
Dipicolinic acid
Peptidoglycan cortex/core wall
2 main spore-forming groups of bacteria
Bacillus
Clostridium
Name the microbes that poorly Gram stain.
‘These Little Microbes May Unfortunately Lack Real Colour But Are Everywhere’ Treponema (too thin to visualise) Leptospirosis (too thin to visualise) Mycobacterium (high lipid content) Mycoplasma (lack cell wall) Ureaplasma (lack cell wall) Legionella (primarily intracellular) Rickettsia (primarily intracellular) Chlamydia (primarily intracellular; lacks muramic acid) Bartonella (primarily intracellular) Anaplasma (primarily intracellular) Ehrlichia (primarily intracellular)
Giemsa staining microbes (4)
‘Ricky got Chlamydia as he tried to Please the Bored Geisha’ Rickettsia Chlamydia Plasmodium Borrelia
Staining for Cryptococcus (2)
India ink
Mucicarmine (stains capsule red)
Chocolate agar
H influenzae
Thayer Martin agar
Neisseria gonorrhoea
Neisseria meningitidis
Bordet Gengou agar
Bordatella pertussis
Tellurite agar
C diphtheria
Loffler medium
C diphtheria
Lowenstein Jensen agar
M TB
Eaton agar
Mycoplasma
MacConkey agar
Lactose-fermenting enteric
Eosin-methylene blue (EMB) agar
E. Coil
Charcoal yeast extract agar buffered with cysteine and iron
Legionella
Sabouraud agar
Fungi
Silver stain (3)
PCP (fungi)
Legionella
H pylori
Most cocci are Gram +
Name 2 cocci that are Gram -
Neisseria meningitidis/gonorrhoea
Moraxella
Most rods are Gram -ve
Name the G+ rods (4)
Corynebacterium
Clostridium
Listeria
Bacillus
Branching/filamentous
Nocardia
Actinomyces
Sorbitol culture
Used to detect E.coli 0157 (colourless colonies instead of pink)
Facultative aerobes (3)
Staph
Strep
Enteric gram -
Obligate aerobes (3)
Pseudomonas
M TB
Nocardia
Key obligate intracellular organisms (2)
Rickettsia
Chlamydia
Facultative intracellular (8)
‘Some Nasty Bugs May Live FacultativeLY’ Salmonella Neisseria Brucella Mycobacterium Listeria Francisella Legionella Yersinia
Urease +ve organisms
‘Pee CHUNKSS’ Proteus Cryptococcus H pylori Ureaplasma Nocardia Klebsiella S epidermidis S saprophyticus
Predisposes to struvite stones
Catalase +ve organisms
‘Cats Need PLACESS to Belch their Hairballs’
E.g.s Nocardia Pseudomonas Listeria Aspergillus Candida E. coli Staph Serratia B cepacia H pylori
Name 3 key virulence factors.
Protein A
IgA protease
M protein
MOA protein A virulence factor.
Which bacteria?
Binds FC portion of IgG —> prevents opsonisation and phagocytosis
Staph aureus
MOA IgA protease.
Which bacteria?
Cleaves IgA —> adhere and colonise mucous membranes
SHiN bacteria
- S pneumonia
- H influenzae type b
- Neisseria
MOA M protein virulence factor
Expressed by which bacteria?
Helps prevent phagocytosis (binds factor H, break down of C3 convertase)
Gp A Strep
MOA diphtheria toxin
ADP ribosylation of EF-2 —> prevents protein synthesis
MOA exotoxin A of Pseudomonas
ADP ribosylation of EF-2 —> prevents protein synthesis
MOA Shiga toxin
Inactivated 60S ribosome by removing adenine residue from rRNA
MOA EHEC toxin
Inactivated 60S ribosome by removing adenine residue from rRNA
What causes the HUS with enterohaemorrhagic E. coli?
Shiga-like toxin enhances cytokines release.
MOA ETEC heat labile toxin
Overactivation adenyulate cyclise —> increases cAMP —> increased chloride secretion into gut
MOA EHEC heat stable toxin
Overactivates cGMP —> increased cGMP —> reduced resorption of NaCl and water in gut
MOA oedema toxin of Bacillus anthracis
Mimics adenylate cyclase —> increased cAMP
MOA Vibrio cholera’s toxin
Activates Gs —> increased cAMP —> increased chloride secretion into gut
Voluminous ‘rice water’ diarrhoea
MOA Pertussis toxin
Disables Gi —> increased cAMP —> impaired phagocytosis
MOA tetanospasmin
Cleaves SNARE (soluble NSF attachment protein receptor; required for neurotransmitter release via vesicular fusion) —> prevent release of inhibitory GABA and glycine from Renshaw cells —> spastic paralysis
MOA Boutlinum toxin
Cleaves SNARE (soluble NSF attachment protein receptor; required for neurotransmitter release via vesicular fusion) —> prevents release stimulators (ACh) signals at NMJ —> flaccid paralysis
MOA of alpha toxin (Clostridium perfringens)
Phospholipase (lecithinase) —> degrades tissue and cell membranes
Myonecrosis and double zone haemolysis on blood agar
MOA Strep pyogenes Streptolysin O
Degradation cell membrane
RBC lysis, contribute to beta haemolysis
MOA TSST-1 of Staph aureus and erythrogenic exotoxin A of Strep pyogenes
Cross-links beta region TCR to MHCII outside of antigen binding site —> overwhelming release IL-1, IL-2, IFN-gamma, TNF-alpha
3 main effects LPS of outer membrane of Gram -
- Macrophage activation (TLR4/CD14)
- Complement activation
- Tissue factor activation
Bacterial transformation
Uptake of DNA from surrounding environment
What prevents bacterial transformation?
Add deoxyribonuclease (degrades naked DNA)
Bacteria using bacterial transformation (3)
‘SHiN’
S pneumonia
H influenza type b
Neisseria
Bacterial conjugation
DNA t/f of plasmids via sex pili
High frequency strains in bacterial conjugation
Allow gene mapping
Bacterial transduction
Transfer of DNA via bacteriophage
What are the two types of bacterial transduction?
- Generalised (lytic phage)
- virus infects bacteria and multiplies randomly picking up host DNA —> transfer to another bacteria - Specialised (lysogenic phage)
- virus DNA inserts into host DNA, some host DNA then excised with phage DNA
Name the bacteria whose toxins are formed from lysogenic phages.
‘ABCDS’
Group A erythrogenic toxin Botulinum toxin Cholera toxin Diphtheria toxin Shiga toxin
What is the term given to phages only replicating in the lytic cycle?
Virulent
What is the term given to phages replicating in both the lytic and lysogenic forms?
Temperate
Bacterial transposition
Give an example.
Transposons excised and re-integrated in new locations
Mechanism of abx resistance
E.g. Tal456 with vanA gene from VRE —> Staph aureus
What do penicillin binding proteins do?
Cross link alanine residues in bacterial cell wall
MOA penicillins
Mimic alanine residues (D-ala-D-ala) —> breakdown >creation of cell wall —> autolysis —> cell death
Therefore bacteriocidal
Name 2 natural penicillins
Penicillin G
Penicillin VK
Which drug increases the concentration of pen G/VK when co-administered?
Probenecid (usually used in gout)
Name 3 mechanisms by which bacteria develop resistance to penicillins.
- Modify PBPs e.g. Strep pneumonia
- Reduced bacterial cell penetration (G- outer cell membrane has poor penetration; reduced porins)
- Beta lactamase enzymes
Which bacteria produce beta-lactamase enzymes? (2)
- Gram negative (present in periplasm)
2. Staph aureus (no periplasm therefore secretes)
Name 3 inhibitors of beta lactamase.
- Clavaulanic acid
- Sulbactam
- Tazobactam
How many hours after administration of penicillin does the Jarisch-Herxheimer reaction occur?
2 hours
Name examples for each hypersensitivity reaction in penicillin.
(Similar for cephalosporins)
Type 1 - acute (IgE) anaphylaxis
Type 2 - haemolysis (IgG)
Type 3 - serum sickness (IgG)
Type 4 - skin reaction, interstitial nephritis
What type of T cell mediates the SJS and TEN reactions that you see with penicillin use?
CD8
With which abx can you see SJS/TEN?
Aminopenicillins
TMP-SMX
Cephalosporins
Name 3 anti-staph penicillins. Why are they anti-staph?
Oxacillin
Naficillin
Dicloxacillin
Side chain protects from Staph penicillinase.
Name 3 uses of anti-staph penicillins.
Community-acquired cellulitis
Impetigo
Staph endocarditis (once sensitivities confirmed)
Name 2 aminopenicillins
Amoxicillin (po)
Ampicillin (iv - poor bioavailability)
MOA resistance to penicillin G & V
Beta lactamase cleaves beta lactam ring
Name the 8 bacteria where aminopenicillins are used.
‘HHELPSS kill Enterococci’
H influenzae (G-) H pylori (G-) E coli (G-) Listeria monocytogenes (G+) Proteus mirabilis (G-) Salmonella (G-) Shigella (G-) Enterococci (G+)
Mechanism of resistance to aminopenicillins.
Penicillinase (type of beta lactamase) - cleaves beta lactam ring
Why is MRSA resistant to penicillinase-resistant penicillins (anti-staph penicillins)?
Altered PBP target site
Name 2 antipseudomonal penicillins.
Piperacillin
Ticarcillin
MOA of antipseudomonal penicillins (ticarcillin, pipercillin).
Increase porin channel penetration
Which 3 abx groups are ESBL resistant to?
Penicillins
Cephalosporins
Aztreonam
In which type of bacteria do you find ESBL?
Gram -
MOA of cephalosporins
Beta lactam drugs that inhibit cell wall synthesis (less susceptible to penicillinases)
Cephalosporins - bacteriostatic or bactericidal?
Bactericidal
Which organisms are not covered by 1-4th generation cephalosporins?
‘LAME’
Listeria
Atypicals (Chlamydia, Mycoplasma)
MRSA
Enterococci
Name the 2 1st generation cephalosporins
Cefazolin
Cephalexin
Name the 4 2nd generation cephalosporins
Cefaclor
Cefoxitin
Cefuroxime
Cefotetan
Name the 8 bacteria in which 2nd generation cephalosporins are effective
‘HENS PEcK’
Gram + cocci H influenzae Enterobacter aerogenes Neisseria spp. Serratia marcesens Proteus mirabilis E coli Klebsiella
Name the 4 organisms which can be treated with 1st generation cephalosporins
‘PEcK’
Gram +
Proteus mirabilis
E coli
Klebsiella
Which cephalosporin might you use prophylactically prior to surgery to prevent S aureus wound infections?
Cefazolin (1st generation)
Name 4 3rd generation cephalosporins
Ceftriaxone
Cefotaxime
Cefpodoxime
Ceftazidime
Name 3 conditions in which you would use ceftriaxone
Meningitis
Gonorrhoea
Disseminated Lyme disease
When might you use ceftazidime
Pseudomonas
Name a 4th generation cephalosporin
Cefepime
Coverage of cefepime
Gram - with increased activity against Pseudomonas and G+
List the following according to beta lactamase sensitivity from most sensitive to most resistant
1-4th generation cephalosporins
Carbapenems
Aztreonam
Penicillins
- Penicillins (anti-staph penicillins resistant to staph penicillinases)
- 1st gen ceph
- 2nd gen ceph
- 3rd gen ceph
- 4th gen ceph
- Aztreonam
- Carbapenems
Name a 5th generation cephalosporin
Ceftaroline
Which two microbes is ceftaroline (5th gen cephalosporin) particularly effective against?
MRSA
VRSA
Name 5 adverse reactions seen with cephalosporins and their mechanisms
HS reactions
Vitamin K deficiency - reduced K2 (reduced GI bacteria)
Hypoprothrombinaemia - NMTT side chains inhibit epoxide reductase; mainly seen in malnourished patients
Nephrotoxicity with aminoglycosides
Disulfiram reaction - inhibits acetaldehyde dehydrogenase
What are the 3 mechanisms of resistance to cephalosporins?
- Modified PBPs
- Altered cell permeability
- Inactivation by cephalosporinases (type of beta lactamase)
What is the name of the drug co-administered with impenem and what is its purpose?
Cilastatin - reduce inactivation of drug in renal tubules
What is the MOA of cilastatin?
Inhibits dehydropeptidase I
Where do carbapenems act?
Bacterial cell wall - affect peptidoglycan cross-linking
Name a monobactam and state its MOA
Aztreonam - affects peptidoglycan cross-linking
Name the 3 main SEs of carbapenems
Rash
GI distress
Neurotoxicity (seizures)
What is the mechanism of neurotoxicity of carbapenems?
Inhibit GABA
When are you more likely to get the neurotoxicity effects of carbapenems? (2)
High doses
Renal failure
What is the MOA of aztreonam?
Binds PBP 3 (found in G-)
Is there any cross reactivity of aztreonam with penicillin allergies?
No
Which type of bacteria is aztreonam effective against?
G-
What is the MOA of sulphonamides?
Inhibit dihydropterate synthase
3 mechanisms of resistance to sulphonamides
Increased PABA synthesis
Reduced uptake
Altered dihydropterate synthase
What is the MOA of trimethoprim and pyrimethamine?
Inhibition of DHF reductase
What is the main toxic effect of TMP/pyrimethamine and how can this be prevented?
BM suppression; leucovorin (avoids need of DHF reductase to convert to THF)
Name the main SEs of sulphonamides and their mechanisms where applicable. (6)
Hypersensitivity - due to NH2 group at N4 and N ring at N1
SJS/TEN
Photosensitivity - drug interaction with UV light
Haemolysis in G6PD deficiency
Kernicterus - displaces other albumin bound substances; increased unconjugated bilirubin
Raised INR if taking warfarin - displaces other albumin bound substances
What is the MOA of dapsone?
Inhibition of DHF reductase
Is dapsone bactericidal or bacteriostatic?
Bacteriostatic
Name 2 uses of dapsone
- Leprosy
2. PCP prophylaxis
Name 2 adverse effects of dapsone
Haemolysis if G6PD deficient
Methaemoglobinaemia
MOA of sulfonamide abx
Mimic PABA —> competitive inhibition of dihydropterate synthase (PABA —> dihydropteric acid)
Mechanisms of resistance to sulfonamides (3)
- Increased PABA production
- Altered dihydropterate synthase
- Reduced uptake
Which microbes does TMP-SMX not cover?
PsA
B fragilis
Most anaerobes
What are the main problems with the use of TMP-SMX in pregnancy? (2)
Sulfonamides —> kernicterus
TMP —> NTDs
Name the 3 stages of protein synthesis that protein inhibitors affect and name the abx acting in each one.
- Initiation - aminoglycosides, linezolid
- Add tRNA - tetracyclines
- Add peptides - chloramphenicol, macro lives, clindamycin
MOA of aminoglycosides
Block initiation by binding 30S subunit of ribosomes
Are aminoglycosides effective against anaerobes?
No - require transport into cells
Are aminoglycosides effective against intracellular bacteria?
No
Mechanisms of resistance to aminoglycosides (2)
Phosphorylation aminoglycoside kinases
Adenylation/acetylation of transferases
Main SEs with aminoglycosides (3)
Ototoxicity
Nephrotoxicity
Neuromuscular blockade (blocks ACh release at NMJ) - mainly occurs with pre-existing neuromuscular disease/high levels
MOA macrolides
Blocks tRNA translocation (from A site, where peptide bond catalysed to P site) by binding to P site of 50S subunit
Cover of macrolides
G+ cocci
Some G-
Intracellular pathogens - Chlamydia (obligate), Legionella (facultative)
Why is erythromycin used in gastroparesis?
Binds to motilin rec in GIT —> smooth muscle contraction
Mechanism of resistance of macrolides
Alter 23S rRNA (component of 50S) by methylation
3 main SEs of macrolides
Increased motility Increased QT (blocks K+, especially erythromycin) Cholestatic hepatitis
Why do macrolides —> raised theophylline/warfarin levels?
P450 inhibitor
MOA tetracyclines
Binds 30S ribosome —> prevent attachment tRNA
Are tetracyclines transported into the cell?
Yes
What type of drugs impair the absorption of tetracyclines?
Minerals and antacids (Ca, Mg, Fe, dairy) - chelate drug
Mechanisms of developing resistance to tetracyclines (1)
Reduced influx/increased efflux from cells via plasmid-encoded transport pumps
Main SEs tetracyclines (4)
GI
Photosensitivity
Teeth discolouration (in under 8 year olds)
Inhibit bone growth in children
Chelates calcium
MOA chloramphenicol
Inhibition peptidyl transferase
Main SEs of chloramphenicol (3)
Anaemia (BM suppression)
Aplastic anaemia (irreversible and often fatal)
Grey baby syndrome (babies lack UDP glucoryltransferase that is required for excretion) - grey skin, hypotension, fatal
MOA clindamycin
Similar MOA to macrolides - bind to 23S rRNA of 50S ribosomes —> prevent translocation
Mechanism resistance to macrolides
Methylation of 23S rRNA binding site
Why use metronidazole over clindamycin for ‘below the diaphragm’?
B fragilis - high resistance
Main SE of clindamycin
Diarrhoea (C. Difficile, abx-associated)
MOA linezolid
Binds to 50S ribosome, blocking initiation
Main use of linezolid
VRE
MOA streptogramins
Act at 50S ribosome
Uses of streptogramins (quinipristin, dalfopristin)
VRE
VRSA
Aminoglycosides - bactericidal/bacteriostatic?
Bacteriocidal
Macrolides - bactericidal/bacteriostatic?
Bacteriostatic
Tetracyclines - bactericidal/bacteriostatic?
Bacteriostatic
Chloramphenicol - bactericidal/bacteriostatic?
Bacteriostatic
Clindamycin - bactericidal/bacteriostatic?
Bacteriostatic
Linezolid - bactericidal/bacteriostatic?
Bacteriostatic (mostly)
MOA quinolones
Inhibit DNA synthesis - DNA grasses, topoisomerase IV
Quinolones - bactericidal/bacteriostatic?
Bactericidal
Mechanism of resistance to quinolones (3)
Altered DNA gyrase and topoisomerase IV
Altered cell permeability
Efflux of drug
3 main uses of quinolones (3)
UTI
Pneumonia
Abdo infection (enteric G-)
Order of PsA cover for cipro, levo and moxi
Cipro>levo>moxi
Levofloxacin use
Strep pneumonia
MSSA
Therefore use in pneumonia
MOA vancomycin
Inhibits peptidoglycan (cell wall) formation by binding D-ala-D-ala peptides and preventing cross-linking (vs beta lactams, which inhibit transpeptidases)
Mechanism of resistance to vanc
Terminal acid change
E.g. D-ala-D-ala —> D-ala-D-lactate in VRSA
Cover of vancomycin
G+ (too large to enter cell)
2 main uses of vanc
MRSA
C diff
3 main SEs of vanc
Nephrotoxicity
Ototoxicity
Red man syndrome
What is red man syndrome?
Seen with vanc infusion (if given too fast)
Histamine release from mast cells
Prevent with slow infusion
NOT a hypersensitivity reaction
MOA metronidazole
Reduced form = activated —> free radicals —> interact with DNA —> DNA breakage/destabilisation —> cell death
Main SEs metronidazole (3)
Metallic taste
Non-specific GI/neuro (e.g. neuropathy)
Disulfiram-like reaction ?MOA
Nitrofurantoin - bactericidal/bacteriostatic?
Bactericidal
In which condition might nitrofurantoin cause haemolysis?
G6PD deficiency
4 bacteria resistant to cephalosporins and reason for resistance
Resistant PBP
- Listeria
- MRSA
- Enterococci
No cell wall
- atypicals e.g. Mycoplasma, Chlamydia
Name 10 granulomatous infections.
Mycobacterium - TB and leprosy
Fungal pneumonias - Histo, Blasto, Coccidio
Zoonotic - Bartonella, Brucella
Listeria in infants (granulomatosis infantiseptica)
Shistosomiasis
Syphilis
3 infections causing a rash involving palms and soles
- Secondary syphilis
- Rocky Mountain Spotted Fever (Rickettsia)
- Coxsackie
All DNA viral genomes are double-stranded except for?
Parvovirus
All DNA viral genomes are linear except for? (3)
‘PPH’
Papilloma
Polyoma
Hepadnavirus
Name the 4 groups of naked DNA viruses.
Parvo
Adeno
Papilloma
Polyoma
Name the 3 groups of enveloped DNA viruses.
Hepadna
Herpes
Pox
DNA viruses - icosahedral or helical? Which virus is the exception?
Icosahedral
Pox virus does not have icosahedral capsid
Where do DNA viruses replicate? Which virus is the exception?
Nucleus
Pox virus - replicates in cytoplasm
All RNA viruses are single stranded except for _____?
Reovirus (dsRNA)
All RNA viruses are linear except for? (3)
‘BAD’
Bunyavirus
Arenavirus
Delta virus
All RNA viruses replicate in the cytoplasm except for? (2)
Influenza
Reovirus
Name the 4 viruses that have segmented genomes.
‘BOAR’ Bunyavirus Orthomyxovirus Arenavirus Reovirus
Name the 4 + sense naked viruses.
CHRP Calci Hepe Reo Picorna
Name the 4 +ve sense enveloped viruses.
CFTR Corona Flavi Retro Toga
Name the 5 -ve sense enveloped virus families.
BROAD FP Bunya Rhabdo Orthomyxo Arena Delta Filo Paramyxo