Microbiology - Gram Negative & Spirochetes Flashcards
Penicillin and gram negative bugs
- Most are resistant to Penicillin G
- but can be susceptible to penicillin derivatives (e.g. amoxicillin and ampicillin)
- Gram negative outer membrane layer inhibits entry of penicillin G
Neisseria
Gram - diplocci
Both ferment glucose
Produce IgA proteases
N. MeningoCocci - ferments Maltose and Glucose
N. Gonorrohae - ferments only Glucose
N. Gonorroeae
- no polysaccharide capsule
- no maltose fermentation
- no vaccine (due to rapid antigenic variation of pilus proteins)
- sexually transmitted
- causes gonorrhoae, septic arthritis, neo natal conjunctivis, PD, and Fitz-Hugh-Curtis syndrome (infecting liver capsule_
Treatment of N. Gonorrhoeae
- Ceftriaxone + (Azithromycin or Doxycycline) for possible chlamydiae coinfection
N. Meningiditis
- Polysaccharide capsule
- Maltose and Glucose fermentation
- Vaccine (none for type B)
- Transmitted via respiratory and oral secretions
- Causes meningococcemia, meningitis, and Waterhouse-Friedrichsen syndrome
- Associated with dorms or military
Treatment for Meningiditis
- Ceftriazone or Peniillin G
Prophylaxis: Rifampin, Ciprofloxacin, or Ceftriaxone in close contacts
H. influenzae
Gram - bacilli
- causes Epiglottis (“cherry red” in children)
- MOPS (Menigitis, Otitis Media, Pneumonia)
- Aerosol transmission
- produces IgA protease
- most invasive disease caused by capsular type B
- DOES NOT CAUSE FLU
Vaccine for H. influenzae
- contains type B capsular polysaccharide (polyribosylribitol phosphate) conjugated to diptheria toxoid or protein
- Given between 2 and 18 months of age
Treatment for H. influenzae
Ceftriaxone, Rifampin prophylaxis in close contacts
Most common cause of septic arthritis in sexually active young people
N. gonorrhoeae
Routes of infection: H. influenzae
Pharynx –> lymphatics –> Meninges
Culture for H. influenzae
Chocolate with factors V (NAD+) and X (hematin)
Legionella pneumophila
Aerobic gram - rod
- poor Gram stain, use silver stain
intracellular pathogen that grows in macrophages
-requres charcoal yeast extract with iron and cysteine
- common cause of pneumonaie in elderly
Legionnaire’s disease
- caused by Legionella pneumoniae
- severe ATYPICAL pneumoniae, fever, GI, and CNS symptoms
Pontiac fever
- caused by Legionella pneumoniae
- mild - flu like sunrome
Labs for Legionella pneumoniae
- Detected clinically by presence of antigen in urine
- Patients present with HYPOnatremia
Pseudomonas aeruginosa
Aerobic gram - rod
associated with wound and burn infections
Non-lactose fermenting, oxidase positive
Produces pyocyanin (blue green) pigment
has grape-like odor
Produces endotoxin (fever, shock) and exotoxin A (inactivates EF-2)
Transmission of L. pneumoniae
Aerosol transmission
Usually from environmental water source habitat (e.g. air conditioning)
NO PERSON to PERSON TRANSMISSION
Clinical findings of P. aeruginosa
PSEUDOS Pneumonia (esp. in cystic fibrosis) Sepsis (black lesions in skin) External otitis media UTI Drug Use and Diabetic Osteomyelitis
Treatment of P. aeriuginiosa
Aminoglycoside plus
extended-spectrum penicillin (e.g. piperacillin, ticarcillin)
E. coli
Gram - Bacilli, Lactose fermenter Virulence factors: Fimbriae - cystitis and pyelonephritis K capsule - pneumonia, neonatal meningitis LPS endotoxin - septic shock
EIEC: Mechanism
Microbe invades intestinal mucosa and causes necrosis and inflammation.
Clinical manifestations: similar to Shigella
EIEC: Presentation
INVASIVE; dystentary
ETEC
Mechanism: Labile toxin/stabile toxin.
No inflammation or invasion
Presentation: Traveler’s diarrhea (watery)
EPEC
Mechanism: No toxin produced. Adheres to apical surface, flattens villi absorption
Presentation: Diarrhea usually in children (Pediatrics)
EHEC: Mechanism:
O157:H7 is most common serotype. Produces Shiga-like toxin and Hemolytic-uremic syndrome (triad of anemia, thrombocyteopenia, and ARF)
Endothelium swells and narrows lumen, leading to mechanical hemolysis and reduced renal blood flow; damaged endothelium consumes platelets
EHEC: Presentation
Dysentery (toxin alone causes necrosis and inflammation)
Does not ferment sorbitol (distinguishes it from other E. coli)
Klebsiella
Gram - bacilli
Lactose fermenter
Intestinal flora causing lobar pneumonia in alcoholics and diabetics when aspirated
Very mucoid colonies caused by abundant polysaccharide capsule.
Red “currant jelly” sputum
- Causes nosocomial UTIs
Klebsiella (4 A’s)
Aspiration pneumonia
Abscess in lungs and liver
Alcoholics
di-Abetics
Salmonella
- Gram negative bacilli, Lactose non-fermenter
- Large inoculum
- Have flagella
- Can disseminate hematogenously
- Produces H2S
- Abx may prolong symptoms
Invades intestinal mucosa and causes MONOCYTIC response - Cause bloody diarrhea
Shigella
Gram - bacilli, Lactose non-fermenter
Cell to cell transmission; no hematogenous
Only reservoirs are humans and primates
Doesn’t produce hydrogen sulfide
Abx shorten excretion of organism in feces
Invades intestinal mucosa and causes PMN infiltration
Salmonella typhi
- caues typhoid fever
- found only in humans
- characterized by rose spots on the abdomen, fever, diarrhea, headache
- Can remain in remain gall bladder and cause a carrier
Tx: ceftriaxone
Campylobacter jejuni
Gram - bacillil, S or comma shaped
major cause of bloody diarrhea, especially in children.
Fecal-oral transmission in poultry, meat, unpasteurized milk
- common antecedent of Guillain-Barre syndrome and reactive arthritis
Vibrio cholerae
Gram - bacilli, Oxidase + Comma shaped, oxidase positive Grows in alkaline media Ferments glucose Produces produce rice-water diarrhea via toxin that permanently activates Gs thus increases cGMP Tx: Prompt oral rehydration
Yersinia enterocolitica
Gram negative bacilli (Anaerobe)
- usually transmitted through pet feces (e.g. puppies), contaminated milk or pork
Causes mesenteric adenitis that can mimic Crohn’s or appendicits
H. pylori
Curved gram negative rod, Urease +
causes gastritis and up to 90% of duodenal ulcers
- Increases risk of peptic ulcer, gastric adenocarcinoma, and lymphoma.
- Creates alkaline environment.
- Most common initial treatment is “triple therapy” (PPI, clarithromycin, amoxicillin)
Treatment for H. pylori
TRIPLE THERAPY
PPI. Clarithromycin, Amoxicillin, and/04 Metronidazole
Spirochetes
spiral shaped bacteria with axial filaments and include BLT (Boriella, Leptospira, Treponemia)
Visualizing Borellae
Use aniline dyes (Wright’s or Giemsa) stain in light microscopy
Visualizing Treponema
Visualized by dark field microscopy
Leptospira interrogans
found in waer contaminated with animal urine
- causes leptospirosis: flu-like symptoms, jaundice, photophobia with conjunctiviis
- common among surfers and in tropics (e.g. Hawaii)
Weil’s disease
ictohemorrhagic leptospirosis
- severe form with jaundice and azotemia from liver and kidney dysfunction
- fever, hemorrhage, and anemia
Lyme disease
- caused by Borrelia burgdoferi, transmitted by tick Ixodes .(also vector for Babesia)
- natural reservoir is mouse
- common in Northeastern United States
Treatment of Lyme disease
Doxycycline, Ceftriaxone
3 stages of Lyme disease
Stage1 - erythema chornicum migrans (expanding “bulls-eye” red rash with central clearing, flu-like symptoms
Stage 2 - neurological (facial nerve palsy) and cardiac (AV nodal block) manifestations
Stage 3 - musculoskeletal (chronic monoarthritis and migratory polyarthritis), neurological (encephalopathy and polyneuropathy), and cutaneous manifestations
Syphillis
- caused by Treponema pallidum (spirochete)
Primary Syphillis
Localized disease presenting with painless chancre
- Screen with VDRL and confirm diagnosis with FTA-ABS
Secondary syphillis
Disseminated disease with constitutional symptoms, maculopapular rash (palms and soles), condylomata lata
Treponema present in chancres of primary and condylomata of secondary syphillis and may be visualized by dark field microscopy
Tertiary syphillis
Gummas (chronic granulomas, painless indurated lesion)
Aortitis (vasa vasorum destruction)
Neurosyphillis (tabes dorsalis) - may find pleocytosis (WBC) in lumbar puncture
Argyll Robertson pupil
Signs of Tertiary syphillis
Broad-based ataxia Positive Romberg test Charcot joint (loss of sensation in joint) Stroke without hypertension **Test spinal fluid with VDRL**
Congenital syphillis
Saber shins
Saddle nose
CN VIII deafness
Hutchinson’s teeth, mulberry molars
Early prevention is key, as placental transmission typically occurs after trimester
VDRL false positive
VRDL detects nonspecific antibody that react with beef cardiolipin
- False positives seen in mononucleosis, hepatitis, some drugs, rheumatic fever, SLE, and leprosy
Jarisch-Herxheimer reaction
Flu-like symptoms immediately after antibiotics are started - due to killed bacteria release pyrogens
VDRL false positive mneumonic
("VDRL")
V-iruses (mono, hepatitis)
D-rugs
R-heumatic fever
L-upus and leprosy
