Nocardio, Flashcards by Jeff Lin

what are the 3 types of acyclovir-resistant viruses?

thymidine kinase negative
thymidine kinase altered substrate
DNA polymerase mutations

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what ages do you start the HPV vaccine and dose schedule? (2018)

age 11 or 12 until age 26 for females, and age 21 for males not previously vaccinated.

MSM and immunocompromised until age 26

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what’s the difference between PCV13 and PPSV23?

PPSV23 – contains polysaccharide antigens
• PCV13 – contains immunogenic proteins conjugated to pneumococcal polysaccharides

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what is the two zoster vaccines that you can give?

Lived attenuated vaccine (VZL) and the recombinant subunit vaccine (RZV)

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what is the dose schedule and when do you give zoster vaccine?

• RZV is preferred over ZVL
• Healthy adults > 50 years
– Regardless of prior h/o HZ
– No need to wait any specific period of time after HZ to give RZV
(just not during acute episode)
• 2 doses, 2‐6 months apart
• Wait a minimum of 8 weeks after giving ZVL to give RZV

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what are the meningococcal quadrivalent vaccines? types and approval ages

Meanctra (MCV4) - conjugate vaccine, 9 months to 55 years

Menveo (MCV4) - conjugate vaccine 2 months to 55 years

Menomune (MPSV4) - polysaccharide vaccine >2 years old

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what serogroups are covered in the meningococcal quadrivalent vaccines?

A,C,Y,W-135

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what serogroup is not covered in the meningococcal quadrivalent vaccine? What can you use?

Meningococcal B vaccine

MenB-4C (Bexsero) ages 10-25, 2 dose series>1 month apart
MenB-fHbp (Trumenba) - 10-25;
Healthy - 2 dose series (0,6 months)
Risk for MC - 3 doses 0,1-2, and 6 months

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who needs the Meng B vaccine ?

meng b risk patients

asplenia

complement deficiencies

On ecluizumab (solaris)

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what are the CDC recommendations before starting a patient on soliris?

Immunize with both quadrivalent and B vaccines at least 2 weeks prior to giving eculizumab if possible
– Repeat immunization every 5 years while on eculizumab

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who should get hep A vaccination?

Travelers
MSM
IVU
chronic liver disease
post-exposure prophylaxis for healthy humans
persons who anticipate close contact with an international adoptee
person who work with nonhuman primates

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what are the basic microbiology characteristics of nocardia?

beaded & branching gram-positive rods
partially acid-fast
aerobic (unlike actinomyces)

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what is the pathogenesis of Nocardia?

inhalation (most common)
Direct inoculation through the skin

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what is the clinical presentation of nocardia?

90%: slowly progressive pneumonia with cough, dyspnea, & fever
Aspergillus similar; co-infections occur
Similar to cryptococcal disease & actinomycosis
Can disseminate to any organ (brain in particular: get MRI)

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who is at risk for getting nocardia disease?

Transplant, steroids, alcoholism, diabetes, CGD, anti-TNF therapy, AIDS
Occurs month to years after transplantation

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what are the norcardia skin lesions and who gets them?

 Immunocompetent host in tropical region (N. brasiliensis)
 Immunocompromised patient who gardens or walks barefoot
 Sporotrichoid lesions
 Mycetomas: chronic, progressive, lower limbs, draining sinuses
(similar to Actinomycetes)

what radiology findings suggest nocardiosis?

Chest imaging: nodules, cavities, infiltrates with consolidation,effusions, ground-glass opacities
 MRI brain: single or multiple abscesses

what are the nocardia buzzwords?

Beaded
branching
brain (+ lung)
Bactrim

what is the empiric combination therapy for nocardia?

Amikacin + imipenem/meropenem + TMP/SMX
 Ceftriaxone & linezolid as alternate agents
If skin only, bactrim monotherapy

what is the clinicla findings and radiological findings for rhodococcus?

 Indolent pneumonia (80%) in immunocompromised host
 Fever, cough, hemoptysis, fatigue, subacute, pleuritic CP
 Nodules, thick-walled cavities, infiltrates, effusions possible
 Extrapulmonary dissemination possible (skin & brain)
 Mimic of TB, NTM, Aspergillus, Nocardia

what does the typical patient transmission risk factors and pathogenesis for Rhodococcus?

 T cell immunosuppressed

 HIV+ & CD4<200; organ txp

 Inhalation or ingestion

 Farm/soil/manure or horse exposure in some patients

what is the common microbiology for Rhodococcus?

Microbiology: R. equi is the most common
 Gram positive, aerobe, coccobacillary
 Colonies can be salmon pink
 Weakly acid fast: can be mistaken for Nocardia but no branching

what is the treatment for Rhodococcus?

 Combination therapy
 2 or 3 drug regimens: vanc + imipenem/meropenem + fluoroquinolone
or rifampin 2-3 wks then oral FQ + azithro/clari or rifampin
 Linezolid an alternative

how is the diagnosis of rhodococus made?

 Culture followed by 16S rRNA, MALDI
 Tissue: gram stain, necrotizing granulomatous reaction; microabscess
 Blood cultures may be positive (>25%)

Rhodococcus buzzwords?

* Short Gram positive rod (coccobacillus) * Cavitary pneumonia (hemoptysis) * Salmon pink colonies * Advanced HIV * Horse / manure exposure

bacteria with a "safety pin" appearance?

* Yersinia pestis * Vibrio parahemolyticus * Burkholderia mallei & pseudomallei * Haemophilus ducreyi * Klebsiella granulomatis * Melioidosis

what does Meliosis look like in the microbiology lab?

* Facultative intracellular gram-negative rod, Burkholderia pseudomallei *  Oxidase positive *  Characteristic bipolar staining with a "safety pin" * appearance

typical patient location for Meliodosis?

 Southeast Asia, northern Australia, South Asia (+ India), & China;  Esp. Northeastern Thailand & northern Australia

Meliodosis take-aways?

SE Asia (Thailand)/Australia Soil/water exposure (inhalation/inoculation/rainy season) Pneumonia + severe sepsis/shock or multiple abscesses Can be years after exposure (not usually) Safety pins on Gram stain; Gram negative rods

Meliodosis treatment?

* Treatment: Treat all cases *  Mild disease: initial intensive IV therapy for two weeks followed by eradication therapy orally for 3-6 months *  B. pseudomallei resistant to penicillin, ampicillin, 1st/2nd generation cephalosporins, polymyxin, aminoglycosides *  Ceftazidime or carbapenem first then tmp/smx (+/- doxycycline) for 3-6 months

Glanders cause, transmission, location?

*  Caused by Burkholderia mallei & is rare in humans *  Requires close contact w/ infected animals (horses, donkeys,mules) *  Bacteria enter through the eyes, nose, mouth, or skin wounds *  B. mallei is an obligate mammalian pathogen & must cause the disease to be transmitted between hosts *  Africa, Asia, Middle East, Central America, South America

Glanders symptoms and treatment?

*  Incubation period usually 1 to 21 days but can be months or years *  1st symptom usually fever, followed by pneumonia, pustules & abscesses *  The acute form is highly lethal without treatment *  Treatment = imipenem + doxycycline for 2 weeks, then azithromycin + doxycycline for 6 months

Actinomyces microbiology lab?

*  Gram-positive, anaerobic, non–spore-forming bacteria *  Part of the normal mucosal flora of the oral, gastrointestinal, respiratory, & genital tracts *  Actinomyces israelii most common species *  Produce sulfur granules

typical patient that would be at risk for actinomyces?

* Recent dental procedures * aspiration (thoracic) * IUD (pelvic)

Clinical findings, Dx, DDX, treatment of Actinomyces?

*  Clinical findings: Oral-cervicofacial disease most common, followed by abdominal & thoracic infection; Lumpy jaw *  Slow growing mass, ignores tissue planes, can necessitate/form sinuses/fistulas *  DDx: Cancer, TB, Nocardia *  Diagnosis:  Culture, histopathology (sulfur granules) *  Treatment:  Penicillins (PCN, ampicillin) x weeks to months

what are the actinomyces buzzwords?

* Sulfur granules *  Dental work *  IUD *  Erosive mass *  Filamentous anaerobe

what are the 4 causes of sporotrichoid lesions?

* Sporothrix schenckii - gardening, soil, splinters, animal bites/scratches * Nocardia brasilensis - gardening, soil, splinters * Mycobacterium marinum - Aquarium, fish handling, water exposure * Leishmania brasilensis - endemic reigon