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Non-Enteric Gram Negatives Flashcards

1
Q

Neisseria meningitidis (meningococcus)

A

G- diplococcus (free and inside PMN’s)
Normal nasopharynx asymptomatic carriage
meningitis (leading cause of acute in adolescents)
NOT IN INFANTS b/c of protected abs from ma
fulminant bacteremia and sepsis –> CNS
aerosol transmission: dorms, schools, prisons, bases, planes, pilgrimages (HAJJ)
Epidemics in Africa and Asia

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2
Q

H. influenzae morphology

A

G- coccobacillus

Nasopharynx

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3
Q

Sepsis, meningitis, pneumonia, cellulitis, mastoiditis, epiglottitis

A

Serotype B encapsulted H. influenzae diseases

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4
Q

Unencapsulated nontypable H. flu diseases

A

Mucosal infections: sinusitis, conjunctivitis, OM, bronchitis, pneumonia

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5
Q

Moraxella catarrhalis morph and diseases

A

G- diplococcus
nosocomial, sinusitis, OM, bronchitis & pneumonia in lung diseased, rarely sepsis/meningitis
Nasopharynx

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6
Q

Bordatella pertussis morph and disease

A

G- coccobacillus

Tracheobronchitis syndrome whooping cough

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7
Q

Pseudomonas aeuginosa morph and diseases

A

G- rod BACILLUS
Chronic lung infection in CF pts
Acute pneumonia in the immunocompromised
Lung, skin, eye, burn/wound, blood

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8
Q

DIC with petechial rash progressing to purpura

A

Meningococcemia

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9
Q

Waterhouse-Friderichsen syndrome

A

Adrenal infarction/insufficiency

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10
Q

Sequelae in meningitis survivors

A 
cranial nerve damage (CN II, VIII)
cognitive dysfunction (seizures, learning/speech)
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11
Q

Vaccine for meningococcus doesn’t cover?

A

Does not cover serogroup B –> sialic acid (~K1 e. coli)

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12
Q

Spleen helps with clearance of?

A

Encapsulated bugs
Lots of B cells and macrophages
Also C5-9 needed for MAC formation

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13
Q

Risk for meningococcal infection

A

Asplenia

Sickle cell disease

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14
Q

N. meningococcal pathogenesis

A

Capsule: serogroup A (Africa, Hajj, China)
B&C (Europe, North America)
Pili bind to nonciliated nasopharyngeal cells
LPS/endotoxin cause damage –> bloodstream invasion
“LOS” lipo-oligosaccharide
Pilin, Opa (attachment), capsule, LOS show variation, interfering with host response and enables repeat infections
IgA protease
Readily releases and takes up DNA from environment
No siderophores, rather surface proteins that bind TF/LF

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15
Q

Which bug readily releases/takes up DNA?

A

Neisseria

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16
Q

Binding proteins or siderophores for Neisseria

A

Binding proteins

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17
Q

MCV4 vaccination for whom?

A

2mo-10y at increased risk
>9mo if traveling/residing in endemic areas
Routine for ALL at 11-12 years
Booster ALL at 16
DOES NOT provide resistance against naso colonization

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18
Q

Tx of N. meningitidis? (3 options)

A

Penicillin (or cephalosporin)
Start broad
Chloramphenicol (low cost) avoided in the US due to marrow suppression and aplastic anemia

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19
Q

Prophylaxis for contacts of meningococcal index case (3)

A

Rifampicin or Fluoroquinolone or Cephalosporin

Achieves good levels in secretions

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20
Q

Acute meningococcal meningitis/meningococcemia tx

A

Antibiotics
Supportive
Glucocorticoid replacement
Anticoagulants

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21
Q

Meningococcus v. Gonococcus: similarities

A

Humans only host
Mucosal colonization
Virulence factors
Severe sequelae

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22
Q

Sequelae of gonococcus

A 
PID
fallopian tube scarring
infertility
ectopic preg
neonatal ocular infection
rare disseminated infection --> septic arthritis
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23
Q

NM v GC: Host niche

A

NM: nasopharynx
GC: urogenital tract (unlike NM, GC cause disease at their colonization site)

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24
Q

NM v GC: transmission

A

NM: aerosol
GC: sexual

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25
NM v GC: disease
NM: rare GC: common
26
NM v GC: capsule
NM: yes GC: no
27
NM v GC: vaccine
NM: some GC: NO
28
2nd most common STI behind chlamydia
Gonorrhea | Generally symptomatic in MALES, not in F
29
Haemophilus culture (2 RBC components)
Chocolate agar (will have lysed erythrocytes) Hemin (factor X) NAD (factor V)
30
H. flu type b encapsulated
``` G- coccobacillus (rod) Responsible for all invasive disease Droplet Entry via nasopharynx --> blood --> CNS Sepsis and meningitis Capsule (type b polyribosyl ribitol phosphate) Humoral immunity of utmost importance Ages: 2mo-5y (maternal ab's until can produce own) ```
31
Other type b H. flu infections
Direct extension: | Pneumonia, cellulitis (buccal, orbital), mastoiditis, epiglottitis
32
Nontypable unencapsulated H. flu
``` rarely sepsis/meningitis nasopharyngeal colonization (80%) also vagina sinusitis, conj, OM (most common under S. pneumo), bronchitis, pneumonia (2nd CAP after S. pneuma) Premature birth and neonatal infections ```
33
Moraxella catarrhalis
droplets nasopharynx in kids, reduced in adults usually mixed in culture with H. flu and S. pneu URI: sinusitis, OM (#3 behind above 2) LRI: bronchitis, pneumonia in viral URI kids and COPD adults immunocomp (CF, neutropenia, lupus, leukemia) --> sepsis, meningitis, disseminated infections nosocomial infections (pulmonary, pediatric ICU's)
34
Bordetella pertussis
G- coccobacillus singly or in pairs Fastidious, slow-grow on blood w NICOTINAMIDE Obligate human, no environment Aerosol Adults have less severe disease but are MAIN reservoirs Mucosal URI infection, rarely invasion or spread to lungs/blood
35
Hib invasive disease still a problem for
Areas Hib vaccine not available Pts who don't complete vaccination schedule Pts who don't respond to vaccine Rare invasive disease in those who get vaccine but don't produce Ab's
36
H. influenzae type B in adults?
Not usually, even pre-vaccination due to low grade exposures and development of antibodies
37
Thumb sign
"cherry red" epiglottitis HiB give Abx and dexamethasone
38
Catarrhal stage
fever, coughing, malaise (1-2 wks) organism replication and CAN BE CULTURED, PCR Gram stain sputum / pharyngeal swab Now is when bacterial products damage epithelium
39
Antibiotics for which stage of pertussis?
Catarrhal - may lessen severity and decrease transmission
40
Spasmodic/paroxysmal/toxemic/whooping stage
vomiting may follow cannot recover organism now (may be present/cleared) Abx do not help disease or prevent transmission toxin-mediated stage: ciliary paralysis signs continue until escalator restored
41
Pt w/3 wk hx of cough, started as a cold w/low fever, discharge/cough worsened, now cough comes in spasms and followed by vomiting sometimes
Whooping stage
42
Pathogenesis of Bordatella p: adherence
Adherence: filamentous hemagglutinin (FHA) binds gal residues on ciliated respiratory epithelial cells as well as CR3 molecules on phagocytes Also pertactin, fimbrae, pili
43
Pathogenesis of Bordatella p: Toxin production
- Tracheal cytotoxin (TCT) - peptidogly fragment that damages epithelium via IL-1 and NO production --> ciliary stasis and cell death - Pertussis toxin (PTx) - secreted and on cell surface; adhesion and A/B exotoxin that disrupts cAMP regulation --> compromise of host phagocytes and lymphocytes --> dec bact clearance and secondary infections --> -LYMPHOCYTOSIS due to decreased entry into nodes - Adenylate cyclase - disrupts cell signaling - Lethal toxin
44
Convalescent stage
gradual fading of cough | regeneration of respiratory cilia
45
Pertussis complications in kids
``` Respiratory compromise 2ndary infections Dehydration Seizures, encephalopathy Malnutrition, weight loss ```
46
Treatment of pertussis
Erythromycin/azith/clarith/or TMP/sulfa ONLY IN Sx Pt with cough duration < 3 WEEKS Prophylaxis for close contacts if w/in 3 wks
47
Pertussis prevention
Whole cell vaccine (DPT/DTP) --> SE's (convulsion, brain damage) Newer acellular vaccine --> fewer SE's but less protection Recently, pertussis isolates are lacking PERTACTIN (key component of acellular vaccine)
48
Pertussis vaccine recommendations
DTaP series in infants/kids Tdap at 11-12y Single booster in all adults regardless Tdap for all women during EACH pregnancy
49
Pseudomonas aeruginosa basic facts
``` facultative anaerobe flagella, oxidase + does NOT ferment lactose likes aerobic infection sites BIOFILMS Ammonia as nitrogen source Resistant to harsh conditions hot tubs (folliculitis, OE), antiseptic solutions, eyedrops, humidifiers, hospital equipment, CONTACT LENSES ```
50
P. aeruginosa in the lab
``` G- baccilus BLUE PYOCYANIN and fluoresces GREEN FLUORESCEIN Wood's light for burns/wounds SWEET GRAPE-LIKE ODOR ```
51
Psuedomonas pathogenesis
Exotoxin A --> EF2 --> inhibits protein synthesis (~diptheria toxin) Hydrolytic enzyme tissue destruction pili, capsule ALGINATE SLIME (mucoid strains from CF pts) May overgrow other pathogens during abx tx
52
Antibiotics for pseudomonas
quinolones (cipro) beta-lactams (ceftazidime, imipenem, cefepime, meropenem, piperacillin) Aminoglycosides (tobramycin)
53
Common aerobic infection sites of pseudomonas
``` nails, SSTI's, OE burn/wounds, ocular (KERATITIS), bacteremia infective endocarditis HAP/VAP leading COD IN CF PTs ```
54
Ecthyma gangrenosum
deep ulcers via pseudomonas neutropenic hosts MOST COMMON hematog dissem via bacteremia, NOT A SKIN INFECTION
55
Psuedomonas in CF pts | Tx
CFTR may be attachment site Viscous mucus --> less PMN/abx access Diminished phagocyte fxn BIOFILM chest percussion, NEBULIZED AG's for prophylaxis
56
Pseudomonas paradox
No problem most of the time for pts w/intact defenses | BUT rapidly progressive infection, tissue damage, and resistance
57
N. meningitidis in infants?
no - abs from ma
58
dorms, schools, prisons, bases, planes, HAJJ, africa/asia
N. mening (meningococcus)
59
moraxella on sepsis ddx?
not really; rare
60
chronic lung infection in CF pts bug
pseudomonas
61
opa
attachment virulence factor for N. meningitidis
62
What factor shows variation leading to repeat N. mening. infections?
LOS
63
what nutrient will grow bordatella on culture?
nicotinamide
64
B. pertussis | Peptidogly fragment that damages epithelium via IL-1 and NO production --> ciliary stasis and cell death
Tracheal cytotoxin (TCT)
65
B. pertussis toxin: Secreted and on cell surface; adhesion and A/B exotoxin that disrupts cAMP regulation --> compromise of host phagocytes and lymphocytes --> dec bact clearance and secondary infections --> -LYMPHOCYTOSIS due to decreased entry into nodes
Pertussis toxin (PTx)
66
B. pertussis toxin: | disrupts cell signaling
Adenylate cyclase
67
contact lens infection
pseudomonas
68
Leading COD in CF pts
pseudomonas

Bugs & Drugs (15 decks)

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