Nocardio, Flashcards
what are the 3 types of acyclovir-resistant viruses?
- thymidine kinase negative
- thymidine kinase altered substrate
- DNA polymerase mutations
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
what’s the difference between PCV13 and PPSV23?
- PPSV23 – contains polysaccharide antigens
- • PCV13 – contains immunogenic proteins conjugated to pneumococcal polysaccharides
what is the two zoster vaccines that you can give?
Lived attenuated vaccine (VZL) and the recombinant subunit vaccine (RZV)
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
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
what serogroups are covered in the meningococcal quadrivalent vaccines?
A,C,Y,W-135
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
who needs the Meng B vaccine ?
meng b risk patients
asplenia
complement deficiencies
On ecluizumab (solaris)
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
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
what are the basic microbiology characteristics of nocardia?
- beaded & branching gram-positive rods
- partially acid-fast
- aerobic (unlike actinomyces)
what is the pathogenesis of Nocardia?
- inhalation (most common)
- Direct inoculation through the skin
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)
who is at risk for getting nocardia disease?
- Transplant, steroids, alcoholism, diabetes, CGD, anti-TNF therapy, AIDS
- Occurs month to years after transplantation
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
