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MBBS - Year 1 > Microbiology - Infection and Immunity > Flashcards

Microbiology - Infection and Immunity Flashcards

1
Q

Prophylaxis

A

Treatment given, or action taken to prevent disease

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2
Q

HCAI

A 
Healthcare-associated Infections
MRSA 
C. difficile 
ESBL 
Surgal site infections
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3
Q

MRSA as a HCAI

A 
Indwelling catheters (urinary, PEG’s etc)
Poor hygiene (handwashing, etc)
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4
Q

C. difficile as a HCAI

A

Antibiotics
Proton pump inhibitors
Poor hygiene

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5
Q

ESBL as a HCAI

A

Urinary catheters

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6
Q

Surgical site infections

A

Gram -ve bacteria
MRSA
Group A streptococcus
Anaerobes

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7
Q

How do we prevent HCAI

A 
Operating theatre air quality 
Vaccination
Post exposure prophylaxis 
Surveillance - outbreak investigation 
Standardisation 
ANTT
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8
Q

ANTT

A

Aseptic no touch technique

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9
Q

Why do we need to prevent HCAI

A

To reduce morbidity and mortality which may result from sepsis
To reduce the length of stay in hosp
To reduce the economic burden
To reduce the risk of surgical procedure
Patients w/ HCAI’s are 7x more likely to die as inpatients

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10
Q

Factors associated w/ infection

A

The micro-organisms
The host
The environment
Treatment: previous and current

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11
Q

Preventing airborne transmission

A

Place the infected patients in source isolation

Protect the vulnerable patients by use of filtered air, negative pressure (TB)

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12
Q

Preventing direct contact

A

Patients w/ microorganisms that pose a risk for others (e.g. MRSA, Vancomycin-resistant enterococci, Clostridium difficile, Norovirus) are placed in source-isolation
Aseptic technique, hand hygiene etc

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13
Q

Environmental hygiene

A

Decontamination of contaminated equipment or medical devices
Safe disposal of hosp waste
Screening of suspects carriage (patient) and immunisation (staff)

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14
Q

Enhancing resistance to infection

A

Vaccination
Optimising nutrition
Other factors e.g. body temp

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15
Q

Infection transmission route (HCAI)

A 
Person to person spread 
Direct contact (skin to skin)
Faecal-oral 
Airborne/ droplet 
Blood to blood 
Environment or person spread - indirect
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16
Q

Factors to consider for surgical antibiotic prophylaxis

A

Type of wound
Most likely pathogens
Antimicrobial factors

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17
Q

Type of wound - Abx prophylaxis

A

Clean
Clean/ contaminated, has opportunity to become contaminated as is in close proximity to a contaminated area
Dirty – contaminated, purulent (filled w/ pus)

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18
Q

Colonisation vs infection

A

Microorganisms existing in the body but don’t invade tissue or cause detectable (clinical) damage vs when microorganisms begin to invade the body tissues and cause detectable (clinical) damage

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19
Q

Examples of clean surgeries

A 
Cardiac/ vascular 
Breast 
Orthapaedic 
Dialysis access 
Neurologic
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20
Q

Most likely pathogen in clean surgeries

A

Staphylococcus aureus,

S. aureus, Cogaulase -ve

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21
Q

Examples of clean/contaminated surgeries

A

Burn
Head and neck
GI
GU

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22
Q

Most likely pathogen in clean/contaminated surgeries

A

Coagulase -ve staphylococci

Psuedomonas aeruginosa

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23
Q

Example of dirty surgeries

A

Ruptured viscera

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24
Q

Most likely pathogen in a dirty surgery

A

Streptococci
S. aureus
Anareobes
Enterococci

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25
Q

Routes of delivery for Abx

A 
Oral - time for conc to peak 
IV - injection or infusion 
Intramuscular 
Local 
PK/PD characteristics
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26
Q

Patient related factors to HCAI

A

4 hr mark is very critical

Host resistance 
Age 
Malnutrition 
Hypovolemia 
Obesity 
Diabetes 
Steroids 
Other immunosuppressants
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27
Q

Host resistance in patient related factors

A

Healing response
Local wound characteristics
Operative characteristics

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28
Q

Hypovolemia

A

Poor tissue perfusion

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29
Q

Procedure related factors

A

Some procedures are riskier than others depending on entry of tract
Pre-existent sepsis (local or distant)
Poor skin preparation, incl shaving
Nonviable tissue in wound
Hematoma
Foreign material, incl drains and sutures
Dead space

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30
Q

Golden standard sample to send to microbiology

A

Bone sequestrae

Pus is better than swabs

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31
Q

Most septic part of body

A

Bone

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32
Q

Main presentation of infections

A 
Fever 
Chills and sweats 
Change in cough or a new cough 
Sore throat or mouth sore 
Shortness of breath 
Nasal congestion 
Stiff neck 
Dysuria 
Unusual vaginal discharge 
Increased urination 
D + V 
Pain in the abdomen or rectum 
Redness, soreness or swelling 
New onset of pain
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33
Q

Localised signs of infection

A

Rubor (redness)
Tumor (swelling)
Calor (heat)
Dolor (pain)

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34
Q

Classification of skin and soft tissue infections

A

Superficial
Moderate
Deep

35
Q

Respiratory infections

A

Sore throat, about 70% of acute sore throats are caused by viruses
A lab diagnosis is not generally necessary for pharyngitis or tonsilitis

36
Q

Cause of pneumonia or LRTI

A

Viruses in winter, and bacteria in summer (70%)

37
Q

LRTI vs URTI

A

Usually more severe than infections of the URT and choice of appropriate antimicrobial therapy is important and be life saving

38
Q

Symptoms of pneumonia and LRTI

A 
Fever, sweating and/or chills 
Cough, often severe, that produces phlegm 
Shortness of breath 
Difficulty breathing 
Nausea and vomiting 
Muscle aches
39
Q

Rash

A

Manifestation of infection that’s generalised in the skin

40
Q

UTI

A

Bacterial infection usually acquired by ascending route from the urethra to the bladder
May proceed to kidney or bloodstream —> septicaemia

41
Q

Most common cause of ascending UTI

A

Gram -ve rod E. coli

42
Q

Bacteria causing infections of GI tract

A

E. coli
Salmonella
Campylobacter

43
Q

Viruses causing infections of GI tract

A

Rotavirus

Norovirus

44
Q

Abdominal infections

A

Usually polymicrobial

Usually result in an intra-abdominal abscess or secondary peritonitis, may be generalised or localised (phlgemon)

45
Q

Symptoms of abdominal infections

A 
Abdominal pain or tenderness 
Bloating or distention 
Fever 
Nausea + vomiting 
Loss of appetite 
Thirst 
Inability to pass stool or gas 
Fatigue
46
Q

Viral hepatitis

A

Viruses directly targets the liver from A-E
Diff aetiologies e.g. non-infectious multisystemic conditions, infectious agents (hepatotropic viruses) and drug toxicity

47
Q

Obstetrics and neonatal infections

A

Congenital
Perinatal
Postnatal

48
Q

Congenital infections

A

Maternal —> microorganisms enter the blood, establish infection in placental —-> foetal infection

49
Q

Intrauterine infections in pregnant women

A

May result in death of the foetus or congenital malformations

50
Q

When will a foetus survive despite a congenital infection

A

In relatively non-cytopathic virus or when controlled by mother’s IgG response but may still be born w/ malformations or other pathological changes

51
Q

Perinatal infections

A

Maternal blood: passage down infected birth canal e.g. herpes simplex

52
Q

How do postnatal infections

A 
Milk 
Blood 
Saliva contact 
Infected umbilical stump 
Meconium ----> sepsis
53
Q

CNS infections

A

Usually blood -borne or infectious agents invading via peripheral nerves

54
Q

Clinical feature of meningitis - bacterial

A

Clinical features incl a haemorrhagic skin rash w/ petechiae

55
Q

Incubation period of bacterial meningitis

A

1-3 days

Sudden onset of sore throat, fever, irritability, neck stiffness

56
Q

Pathogens causing bacterial meningitis

A

Haemophilus influenzae
Streptococuus Pneumoniae
Neisseria meningitides

57
Q

Treatment for bacterial meningitis

A

Ceftriaxone - cephalosporin

2-4g daily by IV infusion or IV injection or deep intramuscular injection

58
Q

Viral meningitis

A

Most common type of meningitis
Milder disease than bacterial meningitis, w/ headache, fever and photophobia but less neck stiffness
CSF is clear

59
Q

Tetanus

A

Cl. tetani toxin is carried to CNS in peripheral nerve axons

60
Q

Spores carrying tetanus

A

Widespread in soil and originate from fences of domestic animals
Spores enter wound and if necrotic tissue or the presence of a foreign body permits local and anaerobic growth —> tetanospasmin is produced

61
Q

FUO

A

Fever of Unknown Origin

62
Q

Common causes of FUO

A 
Bacterial infections 
Viral infections 
Malignancy 
Automimmue 
Miscellaneous
63
Q

Bacterial infections causing FUO

A

OM, abscess, infective endocarditis, typhoid fever

64
Q

Viral infections causing FUO

A

EBV
Enterovirus
Adenovirus

65
Q

Malignancy causing FUO

A

Leukaemia
Lymphoma
Neuroblastoma

66
Q

Autoimmune conditions causing FUO

A

SLE

IBD

67
Q

Miscellaneous conditions causing FUO

A

Kawasaki disease
Drug fever
Periodic fever

68
Q

Causes of infective endocarditis

A

Native valves are usually infected by oral streptococci and staphylococci

69
Q

Bacterial endocarditis signs

A

FROM JANE

Fever 
Roth spot 
Oster nodes 
Murmur 
Janeway lesions 
Anaemia 
Nail bed haemorrhage 
Emboli
70
Q

When should sepsis be treated

A

Within 1 hr w/ Abx

71
Q

Blood clotting

A

Disseminated intravascular coagulation

72
Q

Sepsis 3

A

Low systolic pressure (<100 mmHg)
Increased respiratory rate (>22 breaths/ min)
Altered mental state

73
Q

Body sites that are usually sterile

A 
Blood and bone marrow
Cerebrospinal fluid
Serous fluids
Tissues
Lower respiratory tract 
Bladder
74
Q

Body sites that have normal commensal organisms

A 
Mouth, nose and upper respiratory tract
Skin
Gastrointestinal tract
Female genital tract
Urethra
75
Q

Main 3 factors leading to infection

A

Host
Environment
Pathogen factors

76
Q

Koch’s postulates

A

The microbe must be present in every case of the disease.
The microbe must be isolated from the diseased host and grown in pure culture.
The disease must be reproduced when a pure culture is introduced into a non-diseased-susceptible host.
The microbe must be recoverable from an experimentally infected host.

77
Q

Functions of toxins

A

Promote bacterial survival by killing cells of the defence system
Killing other cells
Disabling tissue function,

78
Q

Exotoxins

A

Substances produced by bacteria with a variety of functions

79
Q

Nerve stimulating toxins

A

Staphylococcal enterotoxins act on gut nerves, which signal to the brain to cause vomiting

80
Q

Toxins as super antigens

A

Activating many T lymphocytes, with the release of many cytokines, especially tumour necrosis factor (TNF), causing shock

81
Q

Endotoxins

A

Produced by Gram -ve bacteria

Stimulate macrophages to release cytokines, TNF and IL1

82
Q

How can HCAI be acquired

A 
Exogenous source (e.g. from another patient – cross-infection)
Endogenous source (i.e. another site within the patient – self- or auto-infection).
83
Q

Reducing risks of post-operative infections

A

Preoperative stay minimised
Any infections treated before
Operations kept to minimum w/ good air flow - laminar air flow
Adequate debridement

84
Q

Reducing the risk of infection in surgery

A 
Abx and prophylaxis 
Foot flow – minimising coming in and out 
People in theatre 
Air flow directed away from pt 
Scrubbing and hand washing 
Reduce contamination n 
Sterile environment

MBBS - Year 1 (93 decks)

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