Pneumonia, TB, URTI Flashcards
1
Q
Streptococcus pneumoniae
A
MOST COMMON CAP Gram + lancet diplococci optochin sensitive alpha hemolytic Quellung rxn: capsule swell IgA protease, lipoteichoic acid disease: pneumonia, meningitis, otitis, sinusitis CXR: LOBAR Dx: Gram stain and culture; rapid urinary antigen test SUDDEN onset, RUSTY sputum POST VIRAL resp. infection Tx: ceftriaxone or penicillin if susceptible, flouroquinolones, azithromycin SEVERE: vancomycin empirically
2
Q
S. pneumoniae risk factors
A
alcohol/drugs: aspiration abnormality of respiratory tract or circulatory dynamics splenectomy sickle cell HIV
3
Q
Pneumovax or polyvalent (23-type) polysaccharide vaccine (PPSV23)
A
S. pneumo vaccine
65 and older
high risk adults
4
Q
Prevnar or PCV13
A
S. Pneumo vaccine
children and infants
high risk adults
5
Q
mycoplasma pneumoniae
A
NO cell wall
MOST COMMON atypical pneumonia
CXR: looks worse than patient
military, prison, CHILDREN
ADHESIN binds to ciliated epithelial cells and causes reduced ciliary clearance
Dx: serology, PCR, COLD AGGLUTININS (IgM against O RBC), Eaton agar
NOT gram stain: NO cell wall
Tx: macrolide, flouroquinolone, doxycycline
disease: pneumonia, HEMOLYSIS, rash, CNS, cardiac
6
Q
Klebsiella pneumoniae
A
Gram - bacillus ferments lactose incapable of growth at 10 degrees C ALCOHOLICS and MALNOURISHED RED CURRANT JELLY sputum capsule complications: abscess and necrotizing pneumonia Tx: need sus.
7
Q
pseudomonas aeruginosa
A
aerobic Gram - bacilli
pyocyanin: blue-green; grape odor
oxidase positive
motile
endotoxin, exotoxin A, elastase, leucocidin, hemolysins, proteases
extensive vasculitis with thrombosis and hemorrhage with necrosis
HCAP/HAP/VAP; CYSTIC FIBROSIS
CXR: diffuse bilateral infiltrates
ventilators (water loving)
Tx: get antibiotic susceptibilities; then cefepime, meropenem or imipenem, ciprofloxacin, pipericillin/tazobactam (best), gentamicin
diseases: pneumonia, wound infection (burn victim), sepsis, external otitis (DM), UTI, hot tub folliculitis
8
Q
chlamydia pneumoniae
A
atypical pneumonia
middle age adults (if think it is mycoplasma but older)
Dx: no good test
Tx: doxycycline
9
Q
Staphylococcus aureus
A
Gram + cocci in clusters coagulase + catalase + POST VIRAL infection CXR: patchy involving more than one lobe Tx: need susceptibilities complications: necrotizing PNA, lung abscess CAP, HOSPITAL
10
Q
Haemophilus influenzae
A
small Gram - coccobacillary rod, pleomorphic, facultative anaerobe
6 serotypes
capsule: type B
culture on chocolate agar requires factors V (NAD+) and X (HEMATIN)
Tx: amoxicillin (mild), ceftriaxone (serious)
disease: pneumonia, EPIGLOTTITIS, otitis media, meningitis, exacerbation of COPD
11
Q
Acinetobacter baumanii
A
Gram - coccobacillary rod OPPORTUNISTIC water, soil Hospital, associated with respiratory equipment VAP/HAP, sepsis, line infection, UTI HIGHLY resistant to many antibiotics
12
Q
legoinella pneumonphila
A
Gram - rod
ENDOTOXIN, avoid PHAGOLYSOSOME fusion: replicate in macrophages
Dx: urine antigen, CANNOT use gram stain: intracellular (need SILVER stain), charcoal yeast extract with iron and cysteine
hyponatremia, HYPONATREMIA
ventilators: water loving (hotel: air conditioning, showers, sauna)
CXR: consolidation, diffuse interstitial infiltrates, pleural effusion
disease: Legoinnaire’s or Pontiac fever
older and have COMORBIDITIES
Tx: macrolide or flouroquinolone
13
Q
exotoxin A
A
PSEUDOMONAS: blocks protein synthesis by inactivating elongation factor EF-2 by ADP ribosylation
14
Q
Legionnaire’s disease
A
severe pneumonia with dry cough, fever, diarrhea, confusion
15
Q
Pontiac fever
A
mild flu-like symptoms
16
Q
moraxella catarrhalis
A
Gram - coccobacillary rods
acute exacerbations of COPD
elderly
disease: pneumonia, sinusitis, otitis media
17
Q
hospital acquired pneumonia (HAP)
A
48+ hours after hospital admission
can’t be incubating when you come in
IV catheters, ventilator (highest), immunosuppression, prolonged antibiotic therapy, underlying illness
STAPH and PSEUDOMONAS
18
Q
healthcare associated pneumonia (HCAP)
A
- hospitalization of at least 2 days within the prior 90 days
- IV therapy, chemo, wound care in last 30 days
- nursing home resident
- attends hemodialysis clinic or hospital
STAPH and PSEUDOMONAS
19
Q
influenza virus
A
Helical, enveloped SS linear -RNA (8 segments)
hemagglutinin, neurominidase, M2
degrades resp. epithelium; necrosis of superficial layers of resp. epithelium
cytokines: myalgia
SUDDEN: fever, sore throat, dry cough, headache, V/D (in children)
Dx: RT-PCR, clinical, direct fluorescent Ab, rapid viral Ag test, viral culture
Tx: oseltamivir, zamanivir
can get SUPERIMPOSED bacterial pneumonia (S. aureus and S. pneumoniae)
prophylaxis: oseltamivir
vaccine: tri or quadvalent (6 mo or older; lasts 6 mo); H3N2
complication: Reye’s
20
Q
Influenza A
A
epidemics and pandemics
animals too
subtypes
21
Q
Influenza B
A
sporadic outbreaks
no subtypes
humans only
22
Q
antigenic drift
A
causes epidemics
spontaneous mutations in the viral genome as it replicates
results in new viral strains different enough to (partially) elude Ab from a previous exposure
23
Q
antigenic shift
A
causes pandemics
HA and NA genes are replaced through reassortment with animal influenza viruses
all individuals are susceptible
24
Q
respiratory syncytial virus (RSV)
A
pleomorphic, enveloped, ss linear -RNA
S protein (surface spikes)
disease: penumonia, bronchiolitis in INFANTS: cough, wheeze, fever, tachypnea, hypoxemia; URT in adults
outbreaks every winter
Dx: RT PCR on nasal swab, rapid antigen test
CXR: bilateral diffuse infiltrates
Tx: supportive, albuterol, hydration, oxygen; inhaled Ribavirin (stem cell transplant patients)
Prevention: Palvizumab
complication: APNEA, RESP. FAILURE
sequelae: ASTHMA
low mortality
less than 12 weeks, premature, immunosuppressed don’t do well
25
adenovirus
non-enveloped, ds linear DNA
lethargy, diarrhea, vomiting
disease: pneumonia, conjunctivitis, hemorrhagic cystitis, URTI, febrile pharyngitis, gastroenteritis, disseminated infection in immunocompromised
CXR: typical bilateral diffuse infiltrates
sequelae: BRONCHIECTASIS or BRONCHIOLITIS OBLITERANS
vaccine: for military for serotypes 4 and 7
Tx: supportive
transmission: fecal-oral, direct inoculation, aerosol
26
Parainfluenza
```
enveloped ss linear RNA
F (fusion protein) and HN (hemagglutinin/ neurominidase)
4 PIVs
CROUP:seal-like barking cough
STRIDOR: vibration
Dx: clinical
Tx: supportive
STEEPLE SIGN
REINFECTION common
good prognosis
```
27
human metapneumovirus
URTI and pneumonia
serious LRTI
Hard to distinguish from: RSV and influenza and HPIV-3
28
Severe acute respiratory syndrome (SARS)
ASIA
2002
Coronavirus
fever/chills, RIGORS, headache, malaise, nonproductive cough, dyspnea, HYPOXEMIA
LEUKOPENIA, THROMBOCYTOPENIA
reservoirs: masked palm civet, horseshoe bat
29
Middle Eastern Respiratory Syndrome (MERS)
MIDDLE EAST, Southeast Asia, Europe, US (after going to middle east)
2012
Coronavirus
SEVERE, pneumonia, ARDS, AKI, hemoptysis, fever, chills, rigors, cough, SOB, sore throat, myalgia, n/v/d, abdominal pain
animal transmission; human to human
30
RSV pneumonia risk
1. immunocompromised
2. institutionalized elderly
3. infants with chronic lung disease
4. infants born during RSV season who are less than 6 months of age, particularly who attend daycare
5. infants born before before 35 weeks gestation
31
Palivizumab
IM
chimeric mAb against F protein
prevent: RSV
32
Ribavirin
inhaled
Tx: RSV in stem cell transplant adults
NOT infants
33
people that get complications of influenza virus
1. young children and elderly
2. chronic diseases
3. immunosuppressed
4. pregnant or 2 weeks post part
5. morbidly obese
6. nursing home residents
7. Native Americans and Alaskan natives
34
hemagglutinin
influenza and parainfluenza
attaches virus to its cellular target and promotes viral entry
(H1-H3)
35
neuraminidase
influenza and parainfluenza
facilitates the release of newly formed virions from infected cell
degrades protective layer of mucus in respiratory tract
(N1, N2)
36
F protein
needed for infectivity
| RSV, parainfluenza
37
spike (S) protein
RSV
| fusion proteins which cause respiratory epithelium cells to fuse forming multinucleate giant cells (syncytia)
38
M2 protein
influenza
| ion channel essential for virus infectivity
39
urine antigen test
legionella
S. pneumoniae
Histo
40
Croup
```
seal like barking cough
inflammation around larynx, trachea, bronchi
fever, rhinorrhea, sore throat, stridor
STEEPLE sign
parainfluenza: hPIV1-3
also: RSV, HMPV, influenza
```
41
hPIV3
parainfluenza
pneumonia
bronchitis
croup
42
hPIV4
parainfluenza
| common cold
43
Reye's
influenza and aspirin
| encephalopathy and liver disease
44
mycobacterium tuberculosis (TB)
acid fast, obligate aerobe, bacillus
CARBOLFUCHSIN stain
cell wall (defense): MYCOLIC ACID, CORD factor, SULFATIDES
INTRACELLULAR in macrophages
Dx: ACID FAST on sputum, Lowenstein-Jensen, PCR (fast), nucleic acid amplification, liquid media (medium), solid agar (slow)
does NOT grow on blood agar
erythema nodosum
45
Cord factor
virulent TB
| inhibits macrophage maturation and induces TNFa release
46
PknG
TB
| protein that inhibits phagolysosome fusion
47
sulfatides
TB surface glycolipids
| inhibit phagolysosome fusion
48
IFN-y
secreted by TH1
activates macrophage to contain infection
GRANULOMA
49
IL-12
secreted by macrophage
activate TH1
GRANULOMA
50
TNFa
increased risk for TB
| used in RA
51
TB risk factors
1. prison
2. immigrant
3. malnourished
4. alcoholism
5. poverty
6. debilitating illness
7. AIDS
8. elderly
9. DM, Hodgkin, CKD, immunosuppression, RA on TNF-a
52
secondary/reactivated TB
insidious onset
APEX of lung: CAVITATION
malaise, anorexia, SOB, hemoptysis, purulent sputum, fever, night sweats, pleuritic pain
53
progressive primary TB
tubercle can erode into bronchus and spread to other parts of lung
looks like bacterial pneumonia
CXR: infiltrates or lobar consolidation, hilar LAD, pleural effusion
difficult to DX
54
miliary/disseminated TB
HIV high risk
Sx: dyspnea, cough
CXR: bunch of seeds (also spleen)
liver (RUQ pain), bone marrow, spleen involved
meningitis, POTT'S disease, GI (NVD), urinary tract (STERILE PYURIA, hematuria, proteinuria)
adrenal insufficiency, epididymitis, prostatitis
55
overt TB Tx
```
RIPE
Isoniazid (latent) (6-9 mo)
Rifampin (6-9 mo)
Pyrazinimide (2 mo)
Ethambutol (if susceptible can stop)
can go to RIP if susceptible
in 2 months stop PZA
total: 6-9 months
Miliary: 9-12 months all 4
```
56
How does TB in HIV differ from other patients?
HIV: hard to diagnose
doesn't cause as severe damage to bronchi and less cavitation and fewer granulomas
meaning less likely to have organism in sputum because low immune response (low CD4)
can be negative: PPD, IFN-y, PCR,
sputum smear
57
PPD (purified protein derivative)
intradermal
delayed type reaction: T cells
BCG and other mycobacteria can make false positive
greater than 15: all positive
10-15: homeless, IVDU, nursing home, immigrant, less than 4 years old
5-10: HIV, recent contact with TB, fibrotic changes on CXR consistent with prior TB, transplants, immunosuppressed
58
IGRA (Quantiferon gold, Quan-TB, T-spot)
BETTER TEST: more sensitive
Blood cells exposed to antigens from MTB and IFN-y measured
no false positives with BCG and other mycobacteria
still can't pick up some HIV
59
Histoplasma capsulatum
dimorphic
Mississippi Ohio Tennessee Valley
fever, chills, cough, chest pain: takes a lot of exposure
AIDS: disseminated: pancytopenia, mouth/GI ULCERS, rash, erythema nodosum, mortality at 10%
GRANULOMA: macrophage
Dx: biopsy, serology, urinary antigen, CXR
CXR: infiltrates, mediastinal LAD, cavitary lesions
Tx: amphotericin (severe), itraconazole
60
Blastomyces dermatitidis
dimorphic
Ohio/Mississippi River Vally, Missouri and Arkansas River basins
moist soil
cough, chest pain, sputum, fever, night sweats
disseminated: GRANULOMATOUS lesions of SKIN, bone, GU, CNS
Dx: CXR (LOBAR, multilobar infiltrates, MULTIPLE NODULES), biopsy (SINGLE BROAD BASED BUD), serology
Tx: itraconazole, amphotericin (severe)
61
coccidioides immitis
dimorphic
Southwestern US, Latin America
large SPHERULES filled with ENDOSPORES
VALLEY FEVER: erythema nodosm
dissemination: 3rd trimester, AA, Fillipinos
BONE, MENINGES, SKIN
Dx: serology, spherules (micro), EOSINOphilia, skin test
Tx: amphotericin (lung, disseminated), fluconazole (meningitis)
62
Paracoccidioides brasiliensis
```
dimporphic
rural Latin America: BRAZIL
ULCERS: oral, nasal, facial
submandibular lymphadenopathy
Dx: biopsy YEAST CELLS with MULTIPLE BUDS, serology
Tx: amphotercin (severe), itraconazole
PILOT WHEEL
```
63
Aspergillus fumigatus
DECAYING VEGGIES
Dx: biopsy ACUTE ANGLE branching SEPTAE HYPHE, Galactomannan antigen test
FUNGUS BALL in lungs: hemoptysis, allergic infection with asthmatic infection, BROWNISH BRONCHIAL PLUGS expectorated
HEMATOLOGIC MALIGNANCIES: PNA with hemorrhage and infarction, neutropenia
IgE
HALO sign
Tx: remove fungus balls, VORICONAZOLE (FA is wrong); alternatives are amphotericin, echinocandins
for ABPA: steroids too
64
Mucormycosis
OPPORTUNISTIC: DM, neutropenia, iron overload, burn/surgery, corticosteroids
bread mold
rhinocerebral sinusitis, frontal lobe (BRAIN) abscesses, spreads to ORBIT, hard palate and brain, pneumonia, cutaneous
HIGH MORTALITY
Dx: biopsy with NONSEPTATE broad HYPHAE with RIGHT ANGLE branching, spores in sporangium
Tx: underlying disorder; amphotericin, surgical removal of necrotic tissue, posaconazole
65
Pneumocystis jiroveci (carinii)
YEAST
AIDS: CD4 les than 200 main risk: need CD4 to recruit monocytes and macrophages
cysts in alveoli: inflammation with frothy exudate that blocks O2 exchange
Sx: dry cough, dyspnea, fever, tachypnea, HYPOXEMIA, pneumothorax
Dx: cysts by biopsy or bronchoscopy
HELMET: stains: METHENAMINE SILVER, GIEMSA; fluorescent Ab, PCR
Tx: Trimethoprim-sulfamethoxazole; other: clindamycin/primaquine, atovaquone, pentamidine
PROPHYLAXIS for AIDS: bactrim, dapsone, atovaquone
66
Cryptococcus neoformans
yeast: capsule, NARROW based buds
most common life threatening disease in AIDS
PIGEONS
MENINGITIS, PNA
Sx: none, fever, chest pain, dyspnea cough, hemoptysis
67
Cytomeagalovirus
```
DNA enveloped virus
OPPORTUNISTIC:
renal and bone marrow transplants: pneumonitis
AIDS: colitis and retinitis
latent in MONOCYTES
```
68
Nocardia asteroides
Gram + aerobe, thin branching filaments, weakly acid fast
occurs in people with reduced cell-mediated immunity
BRAIN ABCESS and PNA
LUNG ABSCESS, empyema
Tx: Trimethoprim-sulfamethoxazole; often RESISTANT
Dx: gram stain, acid fast stain, culture
69
dimorphic fungi
inhaled spores from soil
yeast in human
mold at room temp.
lung infection usually self limited and even asymptomatic
ALL can cause pneumonia and disseminate
BLASTOMYCES dermatitidis, HISTOPLASMA capsulatum, COCCIDIOIDES immitis, PARACOCCIDIOIDES brasiliensis
70
giemsa stain
fungi (pneumocystis jiroveci)
71
bacillus calmette-guerin (BCG)
vaccine for TB
NOT used in the US unless military and young children exposed to active TB
mostly only in places with high incidence of TB (variable effectiveness and not cost effective)
Tx: bladder cancer
CI: immunocompromised
72
erythema nodosum
TB, coccidiodes, histoplasmosis
good prognosis
means cell mediated response is working
73
Why is TB treatment so long?
1. grow slowly
2. metabolically inactive in the lesion
3. intracellular
4. caseous material blocks penetration by drugs
74
Latent TB Tx
isoniazid: 9 months
| isoniazid and rifapentine: 3 months
75
What needs to be taken with isoniazid?
B6 to prevent peripheral neuropathy
76
rifampin
orange urine and tears
77
ethambutol
ocular probs
78
rhinovirus
```
URTI
icosahedral, non enveloped, ss +RNA, lots of serotypes
MOST COMMON cause of COLD
ACID LABILE
resp. droplets and indirect droplets
binds ICAM-1
bradykinin, PGs: vasodilation, mucous, sneeze, cough
Dx: clinical
Tx: supporitive
Prevent: hand wash
NO VACCINE
No LRTI: likes 33 C temp.
```
79
coronavirus
URTI
helical, enveloped ss +RNA
no LRTI (except SARS and MERS)
Sx: cold, GI ILLNESS
80
bordetella pertussis
GRAM- coccobacillary, capsule
AB toxin: inhibit G protein leading to overactive cAMP WHOOPING COUGH
URTI
CONTAGIOUS
Dx: PCR or DFA swab, culture, CBC with LYMPHOCYTOSIS
Tx: azithromycin (have to give early to help with Sx)
vaccine: DTaP (2, 4, 6, 15-18 mo, 4-6 yr; booster 11, 19-64 yr)
81
corynebacterium diphtheriae
Gram + bacillus, pleomorphic, CLUB shaped, BEADED, PALISADES
AB toxin: inactivate EF-2
URTI
Sx: sore throat, BULL NECK (cervical lymphadenopathy), CARDIAC, NEURO, mechanical obstruction: PSEUDOMEMBRANE
Dx: throat swab (LOEFFLER's or TELLURITE (gray black color) or blood agar), Ab inoculation/based gel diffusion, PCR, gram stain, METHYLENE BLUE
Tx: ANTITOXIN and penicillin or erythromycin; treat immediately
Vaccine: DTaP
82
AB toxin
PERTUSSIS: stimulates AC by catalyzing addition of ADP-ribosylation to inhibitory subunit of G protein complex: overactive cAMP and PKA
impairs phagocytosis and cilia
DIPTHERIAE: blocks protein synthesis by inactivating EF2 protein by ADP ribosylation
83
Stages of B. pertussis
1. catarrhal: 2 weeks of mild URT sym.
2. paroxysmal: 2-3 mo. severe cough (WHOOPING)
3. convalescent: 1-2 wk reduction in coughing
84
acute otitis media
Kids
most common reason for antibiotics
S. PNEUMONIAE, H. INFLUENZAE, moraxella catarrhalis
Tx: Amoxicillin; Augmentin for those with resistant or recent antibiotics
85
acute sinusitis
complication of viral URI
facial pressure
Tx: augmentin
86
epiglottitis
```
MOST H. INFLUENZAE
H. paraflu, S. pneumoniae, Group A strep
urban male in 40s
Sx: muffled voice, dysphagia, sore throat
good prog.
Not recognized: death
Xray: THUMB SIGN
Tx: ceftriaxone
```
87
typical pneumonia signs/Sx
```
crackles/rales
bronchial breath sounds
dullness to percussion
increased tactile fremitus
fever, shaking, chills, cough with sputum, SOB, pleuritic pain
```
88
Dx of pneumonia
CXR
gram stain/culture
other organism specific tests
89
complications of pneumonia
necrosis that can lead to an abscess
spread of infection to pleural cavity: empyema
bacterial dissemination
90
IgA protease
enhances ability to colonize URT
| S. PNEUMONIAE
91
lipoteichoic acid
activates complement/induces cytokine production
| S. PNEUMONIAE
92
capsule
interferes with phagocytosis and promotes invasiveness
| S. pneumoniae
93
atypical pneumonia signs and symptoms
mild URT symptoms, minimal sputum and fever, dry cough, headache, sore throat
mod. elevation of WCC, absence of physical finding of consolidation
CXR: diffuse interstitial infiltrates
94
lobar pneumonia
consolidation of an entire lobe of lung
bacterial
Streptococcus pneumoniae
Klebsiella pneumoniae
95
bronchopneumonia
scattered patchy consolidation centered around bronchioles, often multifocal and bilateral
bacterial organisms: S. aureus, H. influenzae, P. aeruginosa, moraxella catarrhalis, legionella pneumonophilia
96
interstitial pneumonia
diffuse interstitial infiltrates
atypical pneumonia: viral or bacterial: Mycoplasma pneumoniae, chlamydia pneumoniae, RSV, CMV, influenza virus, coxiella burnetti
97
pandemic
spread through human populations across a large region (global)
98
epidemic
widespread occurrence of infectious disease in a community
99
stridor
harsh vibrating noise when breathing caused by obstruction/inflammation of larynx
100
primary TB infection
ASYMPTOMATIC in 90%: usually latent
only sign is: GOHN complex
can develop into active infection at anytime
101
Gohn complex
TB
| subpleural fibrocalcific nodule
102
TB pathogenesis
1. MTB enters macrophages by phagocytosis
2. MTB inhibits phagolysosome formation
3. IL-12 is produced to stimulate TH1
4. TH1 produce IFN-y
5. IFN-y enables granuloma formation to contain infection
6. leads to caseous necrosis
macrophages: secrete TNF and cytokines that recruit more monocytes
103
What is the most important determinant of whether overt disease occurs TB infection?
host's cell mediated immune response
104
MDR TB
resistance to INH and RIF most common
| AIDS patients
105
XDR TB
resistance to INH, RIF, fluoroquinolone and at least one additional drug
106
Why is directly observed therapy used?
noncompliance is a risk factor for resistance
107
Name 4 types of fungal infections
1. superficial/cutaneous: hair, skin, nails
2. subcutaneous: skin, subQ, lymph
3. endemic: dimorphic fungi; serious in healthy and immunocompromised
4. opportunistic: life-threading disease in immunocompromised
108
Valley fever
coccidioides
mild illness with fever and cough
ERYTHEMA NODOSUM
109
methenamine silver stain
pneumocystis jiroveci
110
ICAM-1
intracellular adhesion molecule on respiratory epithelial cells
RHINOVIRUS
111
methylene blue stain
diphtheria
112
bacillus anthracis
```
BOXCAR, G + in chains
Plasmids: D-GLUTAMATE capsule, toxins
SPORE: in macrophage of weeks
pneumonia: aerosol: DEATH
LF, EF, PA
WIDE MEDIASTINUM
HIGH MORTALITY: edema, septic shock
Tx: ciprofloxacin
BIOWEAPON
```
113
brucellosis spp.
```
G -, intracellular
MALTA fever
GRANULOMA
Not US really
skin contact with farm animals, UNPASTEURIZED DAIRY (from other places)
Dx: agglutination test with antiserum
Tx: tetracycline with rifampin
BIOWEAPON
```
114
burkhoderia pseuomallei
```
G -, intracellular
capsule
spread: host cell lysis, use host actin to move from cell to cell
Asia, Thailand, N. Australia
SOIL; MUD
livestock
DORMANT
GRANULOMAS
Tx: ceftazidime
RESISTANCE to many antibiotics helps identify it
BIOWEAPON
```
115
coxiella brunetti
```
G -, intracellular
TICK, contaminated viscera, raw milk
spore
if get ENDOCARDITIS, GRANULOMATOUS HEPATITS: fatal
Q FEVER
Tx: resolve on own, doxycycline
BIOWEAPON
```
116
francisella tularensis
```
G -
type A: US, type B, Europe
atypical LPS not rec. by TLR-4
TICK, blood to blood contact with animal, ingestion
states: AR, MO, MA (Marth's vineyard)
skin: ULCERGLANDULAR, oculoglandular
inhaled: high mortality, can get from skin lesion
Dx: agglutination, fluor. Ab
vaccine; military
Tx: streptomycin
BIOWEAPON
```
117
hantavirus
```
ss -RNA, envelop, segmented
bunyaviridae
RODENT URINE
hemorrhagic fever: middle east, asia
Tx: supportive
```
118
yersinia pestis
```
G -, capsule
SAFETY PIN
PLAGUE
FLEAS
WESTERN US, SE ASIA
virulence: capsule, LPS, Yops (inhibit phagocytosis and cytokine production), F-1
endotoxin-related symptoms: DIC, cutaneous hemorrhage
LARGE NODES
Tx: streptomycin, tetracycline
BIOWEAPON
```
