Renal Exam 2 Flashcards by Daniel Carriger

Escherichia coli

lab tests

E. Cola’s soda fountain

gram (-) bacillus

Facultative Anaerobe

oxidase (-)

catalase (+)

Green metallic** sheen on **EMB agar

Ferments Lactose (+) → pink on MacConkey’s agar

Encapsulated

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Escherichia coli

E. Cola’s soda fountain

Main VF are Capsular K antigen and Flagellar H antigens.

* causes neonatal meningitis only if has the K antigen

E. coli is leading cause of gram (-) sepsis by LPS endotoxin in outer cell membrane
Fimbriae lead to UTI’s (#1 cause of UTI’s)

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Escherichia coli

Major pathotypes of E. coli

E. Cola’s soda fountain

* Enterohemorrhagic E. coli (EHEC)

* Enterotoxigenic E. coli (ETEC)

Enteropathogenic E. coli (EPEC)

Enteroinvasive E. coli (EIEC)

Enteroaggregative E. coli (EAEC)

Adherent-Invasive E. coli (AIEC)

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Escherichia coli

Enterohemorrhagic E. coli (EHEC)

E. Cola’s soda fountain

Severe Hemorrhagic Colitis caused by strain 0157:H7.

Common cause is undercooked meat.

Causes bloody diarrhea with little to no fever but mucosal inflammation or invasion..

EHEC is the only E. Coli that does not ferment sorbital.

Shiga-like Toxin inhibits ribosomes at the 60s position → can cause hemolytic uretic syndrome (HUS)

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Escherichia coli

Shiga-like Toxin

E. Cola’s soda fountain

Shiga-like Toxin is from the Enterohemorrhagic (EHEC) strain of E. coli

Shiga-like Toxin inhibits ribosomes at the 60s position → can cause hemolytic uretic syndrome (HUS)

Shiga-like Toxin damages endothelial cells of capillaries in the glomerulus → platlets adhere to damaged endothelial cells → ⬇ platelet count → causing thrombocytopenia → platelet clumps hemolysis RBC’s

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Escherichia coli

Enterotoxigenic E. coli (ETEC)

E. Cola’s soda fountain

“Traveler’s Diarrhea”

Heat Labile toxin → produces cAMP (symp effects)

Heat Stable toxin → produces cGMP (p.s. effects)

Watery DIarrhea

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Escherichia coli

Treatment

E. Cola’s soda fountain

TMP/SMX or fluoroquinolones

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Klebsiella, Enterobacter, Serratia

lab tests

(common to all three)

Hospital room scene

gram (-) bacilli

Ferments Lactose → turns pink on MacConkeys

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Klebsiella, Enterobacter, Serratia

Enterobacter ddx

Shared traits

gram (-) bacilli

Ferments Lactose → turns pink on MacConkeys

Hospital room scene

Very motile

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Klebsiella, Enterobacter, Serratia

Serratia ddx

Shared traits

gram (-) bacilli

Ferments Lactose → turns pink on MacConkeys

Hospital room scene

Very motile

Red pigment when cultured

(like a pink ring around shower or bright red)

Catalase (+)

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Klebsiella, Enterobacter, Serratia

Klebsiella ddx

Shared traits

gram (-) bacilli

Ferments Lactose → turns pink on MacConkeys

Hospital room scene

* 3 A’s!!! (Alcoholics, Abscesses, Aspiration)

* sputum that is red color

Klebsiella is Immotile

Urease (+)

Polysaccharide capsule

Cavatary “TB like” lesions

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Klebsiella, Enterobacter, Serratia

Treatment

Hospital room scene

Multi Drug Resistant Carbopenam

Clindamycin

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Proteus mirabilis

lab tests

The god of the public restroom

gram (-) bacillus

Facultative Anaerobe

Swarming motillity when plated

urease (+)

H₂S (+)

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Proteus mirabilis

signs and symptoms

The god of the public restroom

Stag horn calculi, kidney stones

(urease → ⬆ pH → kidney struvite stones → stag horn calculi on imaging)

Pain

UTI’s

FIshy Odor

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Proteus mirabilis

Treatment

The god of the public restroom

Sulfonamides

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Pseudomonas

lab tests

The suiters of pseudo Mona

gram (-) bacillus

obligate Aerobe

oxidase (+)

catalase (+)

Blue green pigment when plated (from Pyocyanin and pyoverdin, may even turn wounds blue)

Encapsulated

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Pseudomonas

signs and symptoms

The suiters of pseudo Mona

* Thrives in aquatic environments (HOT TUB FOLLICULITIS)

⬆ risk if pt has Chronic Granulomatous Disease
Fruity grape like odor
May turn wounds blue (from Pyocyanin and pyoverdin)
Most common gram (-) Nosocomial Pneumonia
Osteomyelitis in IV drug users and diabetics
UTI’s (catheters!)
Burn patients are especially susceptile
Ecthyma gangrenosum
Otitis Externa (Swimmers ear)

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Pseudomonas

Respiratory failure in who?

The suiters of pseudo Mona

Respiratory failure in CF patients.

Most common gram (-) Nosocomial Pneumonia.

(CL- channels dysfunctional in CF)

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Pseudomonas

MOA

The suiters of pseudo Mona

Exotoxin A

Ribosolation of EF2** → inhibition of protein synthesis and cell death

Pseudomonas

Treatment

The suiters of pseudo Mona

Piperacillin (penicillin)

amingoglycosides

and Fluoroquinolones

Staphylococcus saprophyticus

lab tests

Beauty and the Plumber

gram (+) cocci

catalase (+)

coagulase (-)

urease (+)

S. Saprophyticus = Novobiocin resistance

Staphylococcus saprophyticus

signs and symptoms

Beauty and the Plumber

UTI’s

Sexually Active Females

Neisseria species overview

lab tests

Noir Series

gram (-) Diplococci

Oxidase (+)

Grows on Chocolate agar

Inhibited on Blood agar

Thayer martin (AKA VPN) is selective agar enriched with vancomycin, polymixin, and nystatin

*Carbohydrate fermentation (+) ddx with Moraxella catarrhalis which is also gram (-) diplococci but is carb ferm (-)

Neisseria species overview

MOA

Noir Series

MAC defiency

Unable to form the MAC complex due to complex c5-c9 being inhibited, leads to increased Neisseria infections.

**_Neisseria species overview_** VF

**_Noir Series_** **_Pilli_** allow the **attachment** to surfaces and **display** **antigenic variation** **_IgA protease_** will **cleave IgA** at its hinge point, facilitating **survival** along **mucosal surfaces**.

**_Neisseria gonorrhea_** Treatment

**_The Violinists last Clap_** **3rd** generation **cephalosporin** -**_ceftriaxone_** Treat for **_chlamydia_** **_coinfection_** **_-macrolide Zpack_**

**_Neisseria gonorrhea_** MOA

**_The Violinists last Clap_** **STI** **_NOT_ encapsulated** Facultative ****_intra_**cellular** **Invade _PMN_'s** (**_P_**oly**_m_**orpho**_n_**uclear leukocytes; Neutrophils, eosinophils, and basophils)

**_Neisseria gonorrhea_** Signs and symptoms

**_The Violinists last Clap_** Effects **genitalia** first May cause **Polyarthritis**, often in **knee** and is **asymmetric** **_Males_:** causes **urethritis**, **prostatis**, and **orchiditis** **_Females_:** **_PID_** (Pelvic Inflammatory DIsease) → **_purulent white_** **discharge** **_Fitz Hugh Curtiss_ syndrome** → **_Violin string_ like lesions** in **liver** from spread into peritoneum

**_Neisseria gonorrhea_** Delivery / Birth

**_The Violinists last Clap_** Can be passed on to the baby during delivery **_N. gonorrhea_** causes **_conjunctivitis_** **_within 5 days_** of birth **\*** vs **chlamydia** which is **usually \> 7 days** after birth

**_Chlamydia Trachomatis, Pneumonia, and Psittaci_** lab tests

**_The pirates of Calam Island_** gram **indeterminate** (_does not_ gram stain) use **_Giemsa_ stain** or **_NAAT_ test** (aka PCR) obligate **_intra_**cellular (**cannot create** its own **_ATP_**, like ricketsia) **Lacks muramic acid** in the cell wall. **Elementary** and **Reticulate** bodies.

**_Chlamydia Trachomatis, Pneumonia, and Psittaci_** **Elementary** vs. **Reticulate** bodies.

**_The pirates of Calam Island_** **_Elementary_** bodies: 1st stage of life cycle **outside of cell**. The **_infectious_ form!** **_Elementary enters_** the eukaryotic cell and is taken up by phagosomes. **_Reticulate_** bodies: **_Dividing_ form! _Reticular replicates_** to form **inclusion bodies** seen under microscope **in cells** when infected. \*After bacteria replicate with its host cells, they leave the cell and become elementary stage again

**_Chlamydia Trachomatis_** **_3_ main groups** of _C. Trachomatis_

**_The pirates of Calam Island_** **_3_ main groups** of _C. Trachomatis_ 1. **A-C** → Blindness 2. **D-K** → STI 3. **L1-L3** → LGV **\* "Can't see, Can't pee, Can't climb a tree" (Reiter's syndrome)**

**_Chlamydia Trachomatis_** **_Blindness_ group** of _C. Trachomatis_

**_The pirates of Calam Island_** C. trachomatis **_A-C_** → **Blindness** Trachoma is the **leading cause** of **blindness in** the **world!** **Transmission** is usually from **_hand to eye_** **contact**, but can also be from **fomites** (objects like clothes or phones) **\*** mnemonic "A-_C (see) with your eyes_"

**_Chlamydia Trachomatis_** **_STI_ group** of _C. Trachomatis_

**_The pirates of Calam Island_** C. trachomatis **_D-K_** → **STI** * **Most common** bacterial **STI** in the **U.S.** * **_Watery_ discharge** (vs. Gonorrhea with mucoprulent). * Can lead to **PID** w/o symptoms or **ectopic pregnancies**. * If mother has it during **delivery** can lead to **_neonatal_ _conjunctivitis_ and _pneumonia_**. Presents **in _1-2 weeks_** (vs. Gonorrhea in 2-4 days) as possible **staccato cough** (short sudden bursts with breath inbetween) or **conjunctivitis**.

**_Chlamydia Trachomatis_** **_LGV_ group** of _C. Trachomatis_

**_The pirates of Calam Island_** C. trachomatis **_L1-L3_** → **LGV** (**_L_**ympho**_g_**ranuloma **_V_**enerum) (also is **an STI**) * Starts with **painless** genetial **ulcer** (similar to syphilis) * Presents as **_tender_** **lymphadenopathy** with **_draining_** lymph nodes.

**_Chlamydia Trachomatis_** **_Reiter's_ syndrome**

**_The pirates of Calam Island_** _Reiter's_ syndrome **Triad** 1. Cant **see** (_Conjunctivitis_) 2. Can't **pee** (_Urethritis_) 3. Can't **climb a tree** (_Arthritis_) **\*** **_Reactive arthritis_** due to **cross reaction** of **antibodies** fighting chlamydia hitting the **_knee_** or **_sacroiliac joint_**.

**_Chlamydia Trachomatis, Pneumonia, and Psittaci_** treatment

**_The pirates of Calam Island_** Macrolides - **Azithromycin** Tetracycline - **Doxycycline** \* also **_tx for Co-infection_** of **Chlamydia** and **Gonorrhea** with **_cephtriaxone_**

**_Chlamydia Pneumonia_** signs and symptoms

**_The pirates of Calam Island_** **Walking** (_atypical_) pneumonia. More commoin in the **elderly.**

**_Chlamydia Psittaci_** signs and symptoms

**_The pirates of Calam Island_** **Transmitted** by **_birds_** and **_bird droppings_**. Causes **pneumonia!**

**_Schistosoma mansoni, japonicum, haematobium_** **_Trematodes_** **(flukes / flat worms)** source / infection cycle

**_San Fran-schisto ocean park_** (Schistosomiasis) * Free living **aquatic** organisms → gain **entrance through** the **_skin_** → **enter blood** stream → carried to **liver** → **_mature_** into adults **_in the liver!_** → humans **poop and pee** into **water** → **_snails_** become **_intermediate_ hosts** → adult then **migrate _AGAINST**_ the _**portal_ flow** in the **venus** system to reach their destination. * **S. mansoni** and **S. japonicum** like to **reside** **in** **mesenteric** veins. * **S. haematobium** likes to **reside** in veins of **bladder.**

**_Schistosoma mansoni, japonicum, haematobium_** **_Trematodes_** **(flukes / flat worms)** signs and symptoms

**_San Fran-schisto ocean park_** (Schistosomiasis) * **_Swimmers itch_** where **larvae** penetrate the skin. _**S. mansoni** and **S. japonicum**_: * **_Portal_ HTN** → (chronically) GI distension and abdominal pain. * **_Liver_ cirrhosis** and **jaundice**. **_S. haematobium_**: * **_Hematuria_** in **bladder** and **risk** of bladder **_cancer_**.

**_Schistosoma mansoni, japonicum, haematobium_** **_Trematodes_** **(flukes / flat worms)** lab tests / tx

**_San Fran-schisto ocean park_** (Schistosomiasis) _**Tx** for **all** Trematodes (**flukes**)_: ****_Pr_**a_z_iquanta**_l_**** _On stool **O&P** you will see_: * **_S. mansoni_**: **large lateral spine** on the **side** of the body of the egg * **_S. japonicum_**: **small spine** (or absent) on eggs. Mostly **round**. * **_S. haematobium_**: **Large terminal** **spine**

**_Enterococcus_** lab tests

**_Protest at the Caucus_** gram (**+**) cocci catalase (**-**) **_6.5% NaCl_** **Resistant (**grows in 6.5% NaCl**)** **Bile resistant** (grows in bile) **_NOT_** **encapsulated** (ddx from S. Pneumonia)

**_Enterococcus_** signs and symptoms

**_Protest at the Caucus_** **UTI's** **Endocarditis** **Infection** of **biliary tree**

**_Enterococcus_** Treatment

**_Protest at the Caucus_** **Nosocomial infection** resisant to almost every antibiotic we have. _Vancomycin_ **_resistant_** **_Linezolid_** **_Tigacycline_**