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Pathology > Microbiology- Part 3 (p59-70- Endocarditis, viruses, wound, bone + joint, UTIs, anti-microbials, paeds, CNS + vaccines) > Flashcards

Microbiology- Part 3 (p59-70- Endocarditis, viruses, wound, bone + joint, UTIs, anti-microbials, paeds, CNS + vaccines) Flashcards

1
Q

Key features of infective endocarditis history?

A

Fever
Non-specific- anorexia, weight loss, malaise, fatigue, rigors, night sweats
Acute- SOB, chest tightness, embolic complications
Dental Hx- Route of infection
PMH for RF- RhF, congenital heart disease, valve replacementi

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2
Q

Which criteria is used for diagnosing infective endocarditis?

A

Dukes

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3
Q

Signs of infective endocarditis?

A

Heart murmurs that change

Subacute- clubbing, splinter haemorrhages, Osler’s nodes, Janeway lesions, Roth spots, splenomegaly, haematuria

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4
Q

Infective agents in infective endocarditis?

A

Subacute bacterial endocarditis- low virulence strep (viridians)
Acute- s.aureus (metastatic infection)- most cases of prosthetic valve endocarditis

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5
Q

Treatment of infective endocarditis?

A

Blood cultures vital for guiding treatment

Prosthetic valve- van + gent + Rifampicin

Native valve:
acute- flucloxacillin
Indolent- Pen + gent

Strep viridians- benzylpenicillin + gent
MRSA- vancomycin

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6
Q

What are the different flus that affect humans throughout the year?

A 
Influenza A (H1)- beginning of Jan
Influenza A (H1N1)- (end of Dec)
Influenza B- peaks March
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7
Q

Which animal is the natural reservoir of influenza A?

A

Ducks

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8
Q

What RNA segments are influential in flu transmission and what do they do?

A

Neuraminidase- cleaves sialic acid residues exposing receptors on host cells and disrupts the mucin barrier
Haemogglutinin- binds sialic acid receptors and allows viral entry

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9
Q

What are flu virus strains e.g. H5N1 named after?

A

Structure of haemoglobin and neuraminidase

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10
Q

What antivirals are used for influenza?

A

Amantadine (Influenza A only)- targets M2 ion channel but single mutation leads to resistance
Neuraminidase inhibitors- Oseltamivir (Tamiflu), zanamivir (Relenza), sialic acid- effective only <48h

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11
Q

How does aciclovir work against HSV?

A

Guanosine analogue which blocks viral DNA extension through activation by viral thymidine kinase (TK)

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12
Q

Why does aciclovir not work against CMV?

A

CMV doesn’t have viral thymidine kinase

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13
Q

What treatment is used for CMV?

A

Ganciclovir- nucleoside analogue

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14
Q

What is the main side effect of ganciclovir?

A

BM suppression

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15
Q

What does CMV lead to?

A 
RCHEP
Retinitis 
Colitis
Hepatitis
Encephalitis
Pneumonia
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16
Q

What is the key feature of CMV cells?

A

Owls eye inclusions

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17
Q

What do you use in CMV if ganciclovir doesn’t work or severe SE?

A

Foscarnet

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18
Q

How does foscarnet work?

A

Pyrophosphate analogue- inhibits nucleic acid synthesis without requiring activation

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19
Q

What is especially used to treat CMV retinitis?

A

Cidofovir- nucleoside phosphonate (also used in opportunistic post-transplant viral treatment)

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20
Q

What is a good way to remember how to treat herpes?

A

If you get herpes, you need to Act Very Fast- Aciclovir, Valaciclovir, Famciclovir

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21
Q

How do you treat resistant Herpes?

A

Foscarnet/cidofovir

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22
Q

How is CMV treated in BMT?

A
  1. Preemptive therapy- monitor CMV viral load in blood
  2. Acute therapy- reduce immunosuppression
    a. 1st line- ganciclovir
    b. 2nd line- foscarnet
    c. 3rd line- cidofovir
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23
Q

Important side effect of foscarnet and cidofovir?

A

Nephrotoxicity

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24
Q

How do you decide when to treat HBV?

A
  1. Serum HBV DNA levels (>2000IU/ml)
  2. Serum aminotransferase levels (>normal UL)
  3. Liver biopsy histological grade + stage: Moderate-severe active necroinflammation and/or fibrosis
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25
Q

What is the treatment goal of HBV?

A

Prevent progression to cirrhosis + HCC

Maintain serum HBV DNA level as low as possible

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26
Q

Treatment options for HBV?

A

Pegylated interferon alpha 2a- Direct antiviral effect + upregulates expression of MHC on cell surfaces
Nucleos/tide analogues-
a. Inhibitors of viral polymerase- lamivudine, adefovir dipivoxil, entecavir, telbivudine
b. Inhibitor of reverse transcriptase- tenofovir

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27
Q

1st line treatment for HBV?

A

Entecavir, PegINF alpha 2a and tenofovir

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28
Q

Treatment goal for HCV?

A

Sustained virologic response- persistent absence of HCV RNA in serum >6/12 after completing antiviral treatment
Prevent progression to cirrhosis, HCC or decompensated liver disease

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29
Q

Treatment for HCV?

A

PegINFa 2b/2a
Ribavirin (RNA nucleoside analogue)
New options such as sofosbuvir or ledipasavir
- can cure but v expensive

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30
Q

How are respiratory viruses diagnosed?

A

PCR of BAL/throat swab or NPA

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31
Q

Who do opportunistic infections affect?

A

Immunodeficient pts- innate (primary) or acquired (malignancy, HIV, steroids, chemotherapy)

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32
Q

What are the three stages of PCR?

A

Denature
Primer annealing
Chain elongation (with Taq polymerase)

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33
Q

Name three origins of opportunistic viral infections post-transplant?

A

Reactivation of latent infection- Herpes
Graft brought infection with it- Hep B
Exogenous opportunistic infection post-transplant e.g. measles

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34
Q

Varicella has a high risk of which complications in immunocompromised?

A

Pneumonitis

Hepatitis

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35
Q

What does EBV cause in HIV pts?

A

Oral hairy leukoplakia

Lymphomas

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36
Q

Which virus is responsible for KS in AIDS patients?

A

HHV8

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37
Q

What is seen on biopsy of KS?

A

Presence of spindle cells

KSHV proteins

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38
Q

Which bugs are commonly responsible for surgical site infections?

A

STAPH AUREUS
E. coli
Pseudomonas
Haemolytic strep

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39
Q

Treatment for wound infection with staph aureus?

A

Flucloxacillin

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40
Q

Aetiology of septic arthritis?

A

Abnormal joint (RA) or immunosuppression + bacteraemia (diabetes or IVDU)

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41
Q

Which bugs cause septic arthritis?

A

STAPH AUREUS, STREP, some gram negatives

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42
Q

How does septic arthritis present?

A

Unwell febrile pt with red hot swollen joint (50% knee)

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43
Q

How is septic arthritis diagnosed?

A

Blood culture before Abx, joint aspirate (>50k cells/mm^3), inflammatory markers

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44
Q

Treatment of septic arthritis?

A

IV antibiotics (cephalosporin or flucloxacillin) + drain joint

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45
Q

What is the aetiology of osteomyelitis?

A

Local or haematogenous spread- brodie abscess -> frank osteomyelitis

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46
Q

What bug causes osteomyelitis?

A

Staph aureus

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47
Q

Presentation of osteomyelitis?

A

Pain, fever, local swelling

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48
Q

How is osteomyelitis diagnosed?

A

MRI best imaging, bone biopsy for culture/histology

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49
Q

Treatment of osteomyelitis?

A

Abx treat most cases- if not, debridement

50
Q

Why are UTIs more common in women?

A

Short urethras

51
Q

What bugs commonly cause UTIs?

A

E. COLI, proteus, klebsiella, staph saprophyticus

52
Q

How do UTIs present?

A

Frequency, dysuria, abdo/flank pain

53
Q

How are UTIs diagnosed?

A

Clinical, dipstick (nitrite, leucocytes +ve, MSU M,C+S

54
Q

How are UTIs treated?

A

Trimethoprim or nitrofurantoin

55
Q

Which antimicrobials inhibit cell wall synthesis?

A

Beta-lactams (penicillins, cephalosporins and carbapenems)

Glycopeptides (e.g. vancomycin)

56
Q

Which antimicrobials inhibit protein synthesis?

A

Aminoglycosides (gentamicin), tetracyclines (doxycline), macrolides (erythromycin)

57
Q

Which antimicrobials inhibit DNA synthesis?

A

Fluoroquinolones (cipro)

Nitroimidazoles (metronidazole)

58
Q

Which antimicrobials inhibit RNA synthesis?

A

Rifamycin (rifampicin)

59
Q

Which antimicrobials use a cell membrane toxin?

A 
Polymyxin (colistin)
Cyclic lipopeptide (daptomycin)
60
Q

Which antimicrobials inhibit folate metabolism?

A

Sulfonamides

Diaminopyrimidines (Trimethoprim)

61
Q

What are penicillins used to treat?

A

Gram-positive bacteria

62
Q

What is vancomycin used to treat?

63
Q

What is gentamicin used to treat?

A

Gram negative sepsis

64
Q

What is doxycycline used to treat?

65
Q

What is erythromycin used to treat?

A

Gram +ve (Penicillin allergy)

66
Q

What is chloramphenicol used to treat?

A

Bacterial conjunctivitis

67
Q

What is ciprofloxacin used to treat?

68
Q

What is rifampicin used to treat?

69
Q

What is trimethoprim used to treat?

70
Q

Give examples of antibiotics which are considered broad spectrum?

A

Co-amoxiclav, tazocin, ciprofloxacin, meropenem

71
Q

What are the four ‘BEAT’ mechanisms of antibiotic resistance?

A
  1. Bypass antibiotic-sensitive step in pathway e.g. MRSA
  2. Enzyme-mediated drug inactivation e.g. beta-lactamases
  3. Impairment of Accumulation of drug e.g. tetracycline resistance
  4. Modification of drug’s Target in the microbe e.g. quinolone resistance
72
Q

What antibiotic is used to combat staph skin infection?

A

Topical flucloxacillin

73
Q

Which antibiotic is used to treat pharyngitis caused by beta-haemolytic strep?

A

Benzylpenicillin

74
Q

Which antibiotic is used to treat a mild CAP?

A

Amoxicillin

75
Q

Which antibiotics are used to treat severe CAP?

A

Co-amoxiclav + clarithromycin (covers atypicals)

76
Q

Which antibiotics are used to treat HAP?

A

Amoxi+Gent or Tazocin

77
Q

Which antibiotic is used to treat bacterial meningitis?

A

Ceftriaxone

78
Q

Which antibiotics are used to treat community UTIs?

A

Trimethoprim or nitrofurantoin

79
Q

Which antibiotics are used to treat nosocomial UTIs?

A

Co-amoxiclav or cephalexin

80
Q

Which antibiotics are used to treat severe sepsis?

A

Tazocin/ceftriaxone

Metronidazole +/- Gent

81
Q

Which antibiotic is used to treat c diff?

A

Metronidazole

82
Q

Common congenital infections that are screened for?

A 
TORCH:
Toxoplasmosis
Other (HIV, HBV)
Rubella
CMV
HSV
83
Q

How do congenital infections present?

A 
TORCH:
Thrombocytopenia
Other (ears, eyes)
Rash
Cerebral abnormality e.g. microcephaly
Hepatosplenomegaly
84
Q

Which organisms can cause early onset sepsis?

A

GROUP B STREP, E. coli, listeria

85
Q

How is neonatal sepsis diagnosed?

A

Septic screen- FBC, CRP, blood culture, deep ear swab, CSF, surface swab, CXR

86
Q

How is neonatal sepsis treated?

A

ABC approach
Supportive
Nutrition
Abx- BenPen + Gent

87
Q

What sort of rash is seen in neisseria meningitidis?

A

Non blanching petechial

88
Q

Which type of meningitis commonly presents acutely?

89
Q

Which type of meningitis presents in chronic fashion- headaches for months?

A

TB or cryptococcus

90
Q

Which type of meningitis commonly presents aseptically?

91
Q

Which bacteria commonly cause meningitis?

A

Neisseria meningitidis

Strep pneumoniae

92
Q

What RFs are there for bacterial meningitis?

A

Complement deficiency, hyposplenism, hypogammaglobulinaemia, immune defect (alcoholic), infection (pneumonia), entry fracture

93
Q

How does bacterial meningitis present?

A

Headache, vomiting, photophobia, irritable, fever, focal neuro signs, rash

94
Q

How is bacterial meningitis diagnosed?

A

Clinical + blood cultures, serum-Ag, EDTA-PCR, throat swab, CSF- WCC (polymorphs) and protein raised, glucose decreased

95
Q

How is bacterial meningitis treated?

A

Resuscitate! Ceftriaxone and corticosteroids (cover listeria with ampicillin)
If consciousness affected, consider IV acyclovir to cover encephalitis

96
Q

What would you suspect if the CSF had low glucose, high WCC with polymorphs?

A

Bacterial infection

If glucose normal but still polymorphs, could be partially treated

97
Q

What would you suspect if the CSF had normal glucose, high WCC with mononuclear cells?

A

Viral meningitis/encephalitis

98
Q

What would you suspect if the CSF had high protein, high WCC with mononuclear cells?

A

Mycobacterium TB or cryptococcus

99
Q

How is Hep A transmitted?

A

Faecal-oral

100
Q

How is Hep A diagnosed?

A

Acute- Anti-HAV IgM

101
Q

Which one of Hep A, B and C isn’t an RNA virus?

A

Hep B- dsDNA virus

102
Q

How is Hep B transmitted?

A

Sexual
Vertical
Horizontal
Blood products

103
Q

How is Hep B diagnosed?

A

Raised ALT and AST
HBsAg (Infection or vaccine)
HBeAg (Infectivity)
HBcAb (Acute IgM chronic IgG)

104
Q

How is Hep B treated?

A

PegIFNalpha 2a
Lamivudine
Tenofovir

105
Q

Which condition is associated with polyarteritis nodosa?

106
Q

How is Hep C transmitted?

A

Blood products

107
Q

How is Hep C diagnosed?

A

ALT

Anti-HCV

108
Q

How is Hep C treated?

A

PegIFNa2b

Ribavirin

109
Q

Who can Hep D infect?

110
Q

How is Hep E transmitted?

A

Faeco-oral

111
Q

How is Parvovirus B19 transmitted?

A

Resp/Blood-borne

112
Q

What are the symptoms of parvovirus B19?

A

Fever, malaise, erythema infectiosum, ‘slapped cheek’, transient aplastic crisis

113
Q

How does Rubella present?

A

Flu like symptoms followed by pinpoint maculopapular rash and lymphadenopathy (adults)

114
Q

How is Rubella diagnosed?

A

Serology of saliva swabs

115
Q

Which vaccines do you not give during pregnancy?

A

Live attenuated- MMR, VZV, Yellow fever

116
Q

Which bacteria is gram positive cocci clusters + coagulase positive?

A

Staph aureus

117
Q

Which bacteria is gram positive cocci clusters + coagulase negative?

A

Staph epidermis

118
Q

Which bacteria are gram positive rods?

A 
ABCDL
Actinomyces
Bacillus (cereus/anthracis)
Clostridium 
Diptheria
Listeria
119
Q

Which bacteria are gram negative cocci?

A

Neisseria meningitidis/gonnorhoeae

Moraxella

120
Q

Which bacteria are gram negative rods?

A 
EESY
Enterobacteriaceae
E. Coli, Salmonella
Shigella, Klebsiella
Yersinia

Pathology (13 decks)

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