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Block 7 Week 2 Colt > Soft Tissue Infections II: Bacterial and Fungi - Kozel > Flashcards

Soft Tissue Infections II: Bacterial and Fungi - Kozel Flashcards

1
Q

Bacillus is aerobic or anaerobic?

A

aerobic and a facultative anaerobe

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2
Q

The bacillus capsule has a poly-gamma-D-(blank) chain

A

glutamic

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3
Q

the bacillus capsules aids in (blank)

A

antiphagocytic properties

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4
Q

T/F: the bacillus capsule induces protective immunity

A

true

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5
Q

The bacillus anthracis toxin is similar to the (blank) toxin of cholera

A

AB

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6
Q

What are the three toxins of anthracis

A

Protective ag
Lethal factor
Edema factor

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7
Q

What is the role of protective ag?

A

binds cellular receptors to aid in the uptake of LF or EF.

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8
Q

What is the function of lethal factor?

A

it is a protease that induces cell death

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9
Q

what is the function of edema factor?

A

works on adenylate cyclase and produces edeam

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10
Q

What type of anthrax follows innoculation with spores?

A

cutaneous anthrax

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11
Q

what type of anthrax begins as a painless papule that forms a black eschar formation?

A

cutaneous

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12
Q

What type of anthrax follows ingestion of spores and may spread to systemic disease?

A

GI anthrax

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13
Q

Describe the spread of inhalation anthrax?

A

lungs to lymph nodes to systemic

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14
Q

Hypotension, pulmonary edema, massive bacteremia, and acute fatal toxic shock are symptoms of what type of anthrax?

A

inhalational anthrax

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15
Q

T/F: inhalational anthrax has a short incubational period

A

false; may be prolonged

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16
Q

T/F: inhalational anthrax is fatal if untreated

A

true

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17
Q

What are the two sample sources for anthrax?

A

blood or material from the eschar

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18
Q

The gram stain of anthrax blood is often (pos/neg)

A

positive

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19
Q

What kind of stain do you need to do to see the anthrax capsule?

A

negative stain

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20
Q

What is the role of the laboratory response network?

A

Federal national organization of labs across the country that can employ BSL-3 techniques if necessary to rule out bioterrorist agents; usually do PCR of the samples.

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21
Q

antrhax is a disease of (carnivores/herbivores)

A

herbivores

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22
Q

T/F: anthrax is communicable

A

FALSE

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23
Q

What bug causes woolsorter’s disease?

A

anthrax

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24
Q

What type of vaccine is the human vaccine for anthrax?

A

AVA: acellular vaccine adsorbed

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25
Q

What type of anthrax vaccine is given to animals?

A

live vaccine

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26
Q

T/F: there is a point of no return during anthrax exposure due to massive toxin production

A

true

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27
Q

What is the abx of choice to treat anthrax?

A

ciprofloxacin

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28
Q

What is the prophylaxis given to people exposed to anthrax?

A

AVA vaccine and ciprofloxacin or doxycycline for 40 days

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29
Q

What is the gram stain on clostridium?

A

gram pos

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30
Q

is clostridium aerobic or anaerobic?

A

anaerobic

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31
Q

T/F: clostridium can form spores

A

true

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32
Q

Where do you find clostridium?

A

ubiquitous in soil, water, and sewage

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33
Q

T/F: clostridium is part of the normal flora of the gI tract of man and some animals

A

true

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34
Q

T/F: clostridium doesn’t produce toxins

A

false; makes many

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35
Q

What is the major lethal toxin of gas gangrene?

A

alpha toxin

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36
Q

clostridium alpha toxin has (blank)ase activity and can lyse many cells leading to massive hemolysis

A

lecithinase

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37
Q

(blank) toxin is released by clostridium when the cells undergo sporulation

A

enterotoxin

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38
Q

What is the function of clostridium enterotoxin?

A

altered membrane permeability leading to loss of fluid and ions

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39
Q

T/F: clostridium enterotoxin is a Superag

A

true

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40
Q

How do you get myonecrosis?

A

introduction of spores or vegetative cells by trauma or surgery

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41
Q

Clostridium food poisoning follows eating contaminated what?

A

meat

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42
Q

necrotizing enteritis is caused by the combo of what two foods?

A

clostridium contaminated pork and sweet potatoes

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43
Q

What causes death in necrotizing enteritis?

A

necrotizing destruction of jejunum

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44
Q

What toxin causes necrotizing enteritis?

A

beta toxin

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45
Q

When dealing with clostridium food poisoning, what two things must you distinguish?

A

colonization from infection

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46
Q

How do you test for clostridium in food poisoning?

A

enterotoxin immunoassay from stool

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47
Q

What is the mortality in soft tissue infections with clostridium?

A

40-100%

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48
Q

What are all of the tx for clostridium soft tissue infection?

A

Surgical debridement
High does PCN and clindamycin
Wound care

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49
Q

T/F: abx are not effective in clostridium food poisoning

A

true

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50
Q

what shape is borrelia?

A

spirochete

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51
Q

T/F: borrelia can be grown in culture

A

true

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52
Q

What is the incubation period of borrelia?

A

3-30 days

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53
Q

80% of pts show what type of rash after getting borrelia?

A

erythema migrans

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54
Q

How long is it until initial lyme disease goes to early disseminated disease?

A

days to weeks after onset of the rash

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55
Q

the early disseminated stage of lyme disease is noted by multiple (blank) skin lesions

A

annular

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56
Q

What are the complications of early disseminated lyme disease?

A

fatigue, arthritis, myalgia, cardiac dysfunction, and neurologic symptoms

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57
Q

How long does it take to progress to a late infection of lyme disease?

A

months after initial presentation

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58
Q

Where in the world do we see more chronic skin involvement in late lyme disease?

A

europe

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59
Q

Post-lyme disease syndrome has symptoms similar to (blank)

A

chronic fatigue syndrome and fibromyalgia

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60
Q

T/F: most patients with chronic lyme disease actually don’t remember having bulls eye skin lesions

A

TRUE

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61
Q

What is Acrodermatitis chronica atrophicans?

A

chronic blueish red skin lesions seen in late disseminated Lyme disease, seen commonly in Europe

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62
Q

what are the two ways to Dx lyme disease?

A

erythema migrans or one late manifestation (MSK, CNS, or cardio) plus lab confirmation

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63
Q

T/F: gram staining is the first step in lab Dx of lyme disease

A

FALSE; direct microscopy not useful

64
Q

Can you culture lyme disease in agar?

A

nooooope

65
Q

What is the preferred lab test to dx lyme disease?

A

Ab testing

66
Q

Describe the tree of Ab testing for lyme disease?

A
  1. low levels of Ab early in infection
  2. ELISA followed by a western
  3. IgM peaks after 6-8 weeks
  4. IgG peaks 4-6 months and persists
67
Q

What type of hard tick is the vector for lyme disease?

A

Ixodes

68
Q

What life cycle stage of the hard shelled tick causes lyme disease?

A

nymph stage in greater than 90 percent of the cases

69
Q

What is the reservoir host for the larval form of lyme disease?

A

white footed mouse

70
Q

what is the reservoir host for the adult form of lyme disease?

A

white tailed deer

71
Q

When in the year is the lyme disease most common?

A

may-september when the ticks are in nymph stage

72
Q

What are the regional foci for lyme disase within the US?

A

Northease and mid-atlantic, upper midwest and pacific midwest

73
Q

What is the drug of choice in early lyme disease?

A

doxycycline; amoxicillin, cefuroxime, or erythromycin are alternatives

74
Q

Recurrent arthritis or central or peripheral nervous system disease in lyme disease is treated with what?

A

IV cetriaxone; alternatives include cefotaxime or doxy

75
Q

Can you use abx to treat post-lyme disease syndrome?

A

nope, just Tx symptomatically

76
Q

Rickettsia are intracellular parasites that only grow in the cytoplasm of (blank) cells

A

eurkaryotic

77
Q

T/F: ricekttsia is maintained and transmitted by arthropods

A

true

78
Q

T/F: humans are accidental hosts of rickettsia

A

true

79
Q

Where in the cell does rickettsia replicate?

A

cytosol and nucleus

80
Q

RMSF results in (blank) caused by endothelial cell damage and leakage of the blood vessels

A

vasculitis

81
Q

What is the incubation period for RMSF?

A

7 days

82
Q

If you hear of a centripetal rash that turns spotted, what do you think?

A

RMSF

83
Q

T/F: death may occur within a week of symptom onset of RMSF

A

true

84
Q

What are the complications of RMSF?

A

CNS, renal, or cardiac problems

85
Q

Can you diagnose RMSF in the in house lab?

A

nope, need to send it out to a reference lab

86
Q

What is the method used to Dx RMSF?

A

immunofluorescence staining

87
Q

How is RMSF cultured?

A

in tissue or embryonated eggs

88
Q

The Weil-Felix test is used to detect Abs that cross react with the (blank) ag, but is no longer recommended for RMSF for a lack of sensitivity and specificity

A

Proteus Ag

89
Q

Indirect immunofluorescence of RMSF detects (blank) shed across rickettsial species

A

LPS

90
Q

What is the principal reservoir and vector of RMSF?

A

ticks

91
Q

When in the year do most RMSF infections happen?

A

April - September

92
Q

What is the drug of choice for RMSF? Alternatives?

A

Doxy is choice, no alternatives

93
Q

T/F: empiric doxycycline should be started if RMSF is suspsected

A

true; need early treatment for survival

94
Q

which rickettsia is transmitted by mites/chiggers and has a resrvoir in wild rodents? where is this one found?

A

Orientia tsutsugamushi; found in Japan, eastern Asia, N. Australia; aka scrub typhus

95
Q

what is epidemic typhus?

A

Rickettsia prowazekii

96
Q

What is the geographic distribution of rickettsia prowazekii?

A

worldwide

97
Q

What is the reservoir for epidemic typhus? the vector?

A

reservoir: human
vector: human body louse

98
Q

What causes murine endemic typhus?

A

rickettsia typhi

99
Q

What is the geographic distribution of endemic typhus?

A

worldwide

100
Q

What type of rickettsia has a GRADUAL onset?

A

endemic typhus

101
Q

What is unique about Y pestis staining?

A

BIPOLAR staining

102
Q

Y pestis is gram what?

A

negative

103
Q

T/F; Y pestis is an enterobacteriae

A

true

104
Q

What type of plague follows flea bites?

A

bubonic plague

105
Q

what is a bubo?

A

painful, swollen lymph node

106
Q

what is the mortality of bubonic plague if untreated?

A

75%

107
Q

from what symptom does “black death” get its name?

A

black plague gangrene

108
Q

What type of plague is this?
Initially, headache, malaise and pulmonary signs
Highly infectious; rapidly fatal if untreated

A

pneumonic plague

109
Q

T/F: Y pestis readily diagnosed by automated systems because of its danger as a biothreat

A

false; often misdiagnosed by machine

110
Q

What are the natural hosts of plague?

A

rats, squirrels, rabbits

111
Q

What form of plague is spread from person to person?

A

pneumonic

112
Q

What is the firstline drug and the alternative treatment for plague?

A
  1. streptomycin

2. doxy

113
Q

(blank) are molds that invade stratum corneum of skin or other keratinized tissues

A

dermatophytes

114
Q

Trichophyton, Microsporum, and Epidermophyton are the major genera of (blank)

A

dermatophytes

115
Q

What is athlete’s foot?

A

tinea pedis

116
Q

What organisms often cause athelte’s foot?

A

T. rubrum, T. interdigitale, sometimes E. floccosum

117
Q

what is jock itch?

A

tinea cruris

118
Q

what is the most common jock itch infection?

A

T. rubrum

119
Q

The differential diagnosis of Tinea corporis includes:

A

eczema and psoriasis

120
Q

what are the most common causes of tinea corporis?

A

T. rubrum, M. canis, M. gypseum

121
Q

The fuck is scalp ringworm?

A

Tinea capitis; causes scaling of scalp, itching, and hair loss

122
Q

T/F: there is only one organism that causes scalp ringworm

A

FALSE, many species of trichophyton and microsporum

123
Q

What is Onchomycosis?

A

infx of the nails

124
Q

What speceis causes onhcomycosis?

A

many from trychophyton and microsporum

125
Q

Anthropophilic, zoophilic, and geophilic species belong to the class of (blank)

A

dermatophytes

126
Q

(Anthropophilic/Zoophilic) infx are chronic and relatively noninflammatory but are hard to cure while (Anthropophilic/Zoophilic) produce a profound host reaction and highly inflammatory lesions but are easily treatable

A

Anthropophilic: nbd

Zoophilic: holy shit that’s bad

127
Q

How do you diagnose dermatophytes?

A

Direct exam of scrapings or clipppings; set in KOH for microscopy

128
Q

How long does it take and what type of medium is needed to culture dermatophytes?

A

mycologic culture, need 7-28 days

129
Q

What are the two drugs of choice for dermatophytes?

A

azoles or terbinafine

130
Q

When do you use oral agents for dermatophyte infx?

A

for more extensive infections of hair and nails; use itraconazole, fluconazole, terbinafine, griseofulvin
GIFT

131
Q

Pityriasis is aka

A

tinea versicolor

132
Q

What does tinea versicolor do?

A

makes you white if you are dark and makes you dark if you are white

133
Q

If you take a look under the scope of a sample of tinea versicolor, what do you see?

A

budding yeast like cells

134
Q

“Spaghetti and meatballs” KOH appearance is indicative of what?

A

tinea versicolor

135
Q

T/F: tinea versicolor is found worldwide

A

true

136
Q

Where is tinea versicolor the most prevalent?

A

tropical or subtropical, up to 60%; makes sense; you get it at the beach normally

137
Q

T/F: tinea versicolor can be spread from person to person

A

treu

138
Q

WHat are the two treatments for tinea versicolor?

A

topical azoles or selenium sulfide shampoo or oral azoles for systemic issues

139
Q

what causes Lymphocutaneous sporotrichosis?

A

Sporothrix schenckii

140
Q

Sporothrix schenckii has what appearance?

A

dimorphic fungus

141
Q

How do you get Lymphocutaneous sporotrichosis?

A

traumatic innoculuation of soil or vegetable matter

142
Q

What is the common name for Lymphocutaneous sporotrichosis?

A

rose gardener’s disease

143
Q

t/F: the site of innoculation of Lymphocutaneous sporotrichosis may ulcerate

A

ture

144
Q

Where do secondary nodules appear in Lymphocutaneous sporotrichosis?

A

along the same lymphatic chain that drains the first nodule

145
Q

T/F: Lymphocutaneous sporotrichosis is only found in eastern europe

A

false; world wide

146
Q

If you see budding yeast at 35C and mold at 25C when culturing from the pus of a nodule, what do you have?

A

Lymphocutaneous sporotrichosis; DIMORPHIC fungus

147
Q

what is the Tx for Lymphocutaneous sporotrichosis?

A

itraconazole

148
Q

What disease is this>?
Localized, chronic, granulomatous process involving cutaneous and subcutaneous tissues
Multiple granulomas and abscesses containing masses of hyphae
Abscesses drain through skin; may extrude granules of hyphae
May destroy muscle and bone locally

A

Mycetoma, caused by Curvularia, Fusarium, Exophiala

149
Q

What specific thing must you see under the scope to Dx mycetoma?

A

grains or granules in the exudate

150
Q

Where is mycetoma most common?

A

tropical areas with LITTLE rainfall

151
Q

What is the only definitive Tx for mycetoma?

A

amputation!!

152
Q

What type of sample must you collect to Dx bacillus anthracis?

A

blood or material from eschar; do direct exam with scope and gram stain

153
Q

What type of sample must you collect to Dx clostridium perfringens?

A

fluids from the site of lesions; direct exam with scope and gram stain; culture and look for rapid anaerobic growth on blood agar

154
Q

What type of sample must you collect to Dx borrelia burgdorferi?

A

either erythema migrans ~5cm or at least one systemic symtptom PLUS lab Dx:
IgM in 6-8 weeks or
IgG 4-6 months

155
Q

What type of sample must you collect to Dx RMSF?

A

send out to a reference lab!! Detects LPS

156
Q

What type of sample must you collect to Dx Y pestis?

A

Blood, bubo aspirate, or sputum, use std. micro techniques by hand to see what it is.

Block 7 Week 2 Colt (4 decks)

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