Steve Martin's Manic Micro Material Flashcards
Peptidoglycan
Gives rigid support, protects against osmotic pressure
sugar backbone with peptide side chains cross lnked by transpeptidase.
Cell wall/Cell membrane of gram positive bacteria
Major surface antigen
peptidoglycan for support
lipoteichoic acid induces TNF and IL-1
Outer membrane of gram negatives
Site of endotoxin (lipopolysaccharide (LPS))
major surface antigen
Lipid A induces TNF and IL-1
O polysaccharide is the atnigen
Ribosome subunits of bacteria
Have 30s and 50s subunits
Giemsa Stains
Chlamydia, Borrelia, Rickettsiae, Trypanosomes, Plasmodium
clams, ticks, worms, and mosquitos
PAS periodic acid-Schiff
Stains glycogen, mucopolysaccharides: used to diagnose Whipple disease
PAS the Sugar
Ziehl-Neelsen (Carbol Fuchsin)
Acid fast organisms Nocardia and mycobacterium
India Ink
Cryptococcus neformans (mucicarmine can also be used to stain thick polysaccharide capsule red)
Silver Stain
Fungi luke pneyocystis
Legionella
Helicobacter pylori
Culture for H. Influenza
Chocolate agar with factors V (NAD+) and X (hematin)
When you have the flu, you go to the five (V) and dime (X) to buy chocolate
Culture for N. Gonorrhoeae and N meningitidis
Thayer Martin, AKA VPN media
Vanco to inhibit gram +
Polymixin to inhibit gram negative except neisseria
Nystatin inhibits fungi
to connect to neisseria, please use your VPN client
Culture for B pertussis
Bordet-Gengou agar
also Regan-lowe
Culture for C Diptheria
Tellurite agar loffler medium
country tom has a DIP in and he says “I’ll tell you right!”
Culture for M tuberculosis
Lowenstein-Jensen agar
tuberculowenstein-jensen
Culture for M pneumoniae
Eaton agar, requires cholesterol
mycoplasma pneumonia eats away your lungs
Culture for Lactose-fermenting enterics
Pink colonies on MacConkey agar (fermentation produces acid, turning colony pink)
E Coli is grown on eosin-methylene blue (EMB) agar as colonies with green metallic sheen
Citrobacter, Klebsiella,
E. coli, Enterobacter, and Serratia
Culture for Legionaella
Charcoal yeast extract agar buffered with cysteine and iron
A french legionnaire wears a silver helmet, an iron dagger, has a charcoal bonfire and is not a sissy (cysteine)
Culture for fungi
Sabouraud agar
Sab is a fun guy!
Sab is also cryptic when he goes to india……. (india ink used for cryptococcus neoformans)
Obligate Aerobes
Use O2 dependent system to generate ATp
Nocardia, Pseudomonas, MycoBacterium tuberculosis
Know Pseudomonas Must Breath
Obligate anaerobes
Actinomyces, Fusobacterium, Bacteroides, and Clostridium
“Can’t Breath or Act if you are Fused to the Back of the Closet”
Lack catalase and or superoxide dismutase therefore they are susceptible to oxidative damage
Generally foul smelling due to short fatty acids
are difficult to culture
produce gas in tissue (CO2 and H+)
Obligate intracellular bugs
Rickettsia, Chlamydia, Coxiella
Can’t make own ATP
“Rick is Clammy and Cocky inside”
the rick from rick and morty
Facultative intracellular
Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella, Yersinia pestis
“Some Nasty Bugs May Live FacultiveLY”
Encapsulated Bacteria
“SHiNE SKiS”
Strep pneumoniae
Haemophilus influenzae type B, Neisseria meningitidis, Escherichia coli, Salmonella, Klebsiella pneumoniae, and group B Strep
Capsules have antiphagocytic virulence factors
Capsule + protein conjugate serves as an atigen in vaccines
Bugs are opsonized, cleared by spleen
No spleen, big risk of infection
Catalase-Positive Bugs
Catalase degrades H202 before it can be converted to microbicidal products by the enzyme myeloperozidase
People with chronic granulomatous disease (NADPH ozidase deficiency) have recurrent infections with catalase organisms
Pseudomonas, Listeria, Aspergillus, Candida, E. coli, S. Aureus, Serratia
“you need PLACESS for your CATs”
cats can serrate your face
Encapsulated Bacteria Vaccines
Some vaccines have polysaccharide capsule antigens that are conjugated to a carrier protein, enhancing immunogenicity by promoting T-cell activation and subsequent class switching A polysaccharide antigen alone cannot be present to T-Cells so you won't get class switching
Urease-positive bugs
CHuck norris hates PUNKSS
Cryptococcus, H pylori, Proteus, Ureaplasma, Norcardia, Klebsiella, S. epidermidis, S saprophyticus
Pigment producing bacteria
Actinomyces isrelii makes yellow sulfur granules which are composed of filaments of bacteria (israel has yellow sand)
S. aureus makes yellow pigment (aureus latin for gold)
Pseudomonas aeruginosa makes blue green pigment (aerugula is green)
Serrratia marcescens makes a red pigment - after a cat serrates your face you bleed red
Protein A bacterial virulence factor
binds Fc region of IgG
prevents opsonization and phagocytosis
Expressed on S aureus
IgA protease bacterial virulence factor
Enzyme that cleaves IgA
secreted by S. pneumoniae, H. influenza type B, Neisseria in order to colonize respiratory mucosa
SHiN
M protein bacterial virulence factor
Helps prevent phagocytosis
Expressed by group A streptococci
meromysin in heart
Characteristics of Exotoxins
Secreted from cell Polypeptide Highly toxic induces high antitoxin antibody response toxoids used as vaccines destroyed rapidly at 60 degrees C examples: tetanus, botulism, diphtheria
Characteristics of Endotoxin
secreted from cell membrane of gram negative cells is a lipopolysaccharide low level of toxicity, poorly antigenic fever, shock (hypotension), DIC Induces TNF, IL-1, IL-6 Stable at 100 degrees C No antitoxin vaccines Example: meningococcoemia, sepsis by gram negative rods
Corynebacterium diphtheriae: toxins
releases diphtheria toxin, inactivating elongation factor EF-2
Causes pharyngitis with pseudomembranes (fibrinous) in throat and severe lymphadenopathy
positive ELEK test
LICK test for blue and red corn chips
Pseudomonas aeruginoase: toxins
realeases Exotoxin A, inactivating elongation factor EF-2
Causes host cell death
Shigella spp: toxins
releases shiga toxin causing inactivation of 60s ribosome by removing adenine from rRNA
causes GI mucosal damage leading to dysentery, also enhances cytokine release causing hemolytic-uremic syndrome
Enterohemorrhagic E coli: toxin
releases Shiga like Toxin causing inactivation of 60s ribosome by removing adenine from rRNA
SLT enhances cytokine release causing hemolytic-uremic syndrome, but does not invade host cells
Enterotoxigenic E. coli: toxin
Heat labile toxin: overactivates cAMP causing increase Cl secretion in gut and efflux
Heat stabile toxin: overactivates cGMP causing decreased reaborption of NaCl and H2O in gut
Both cause watery diarrhea
“Liable in the Air, Stable on the Ground”
Bacillus anthracis: toxin
Edema factor toxin
mimics the cAMP enzyme
likely responsible for characteristic edematous borders of black eschar in cutaneous anthrax
vibrio cholerae: toxin
cholerae toxin
overactivates cAMP by permanently activating Gs leading to increase Cl secretion with H2O following
Voluminous “rice-water” diarrhea
Vibrate the G-Spot
Vibrio Gs
Bordetella pertussis: toxin
Pertussis toxin
overactivates cAMP by disabling Gi, impairing phagocytosis to permit survival of microbe
Whooping cough: child coughs on expiration and whoops on inspiration
Clostridium tetani: toxin
tetanospasmin toxin
protease that cleave SNARE proteins required for neurotransmitter release
Symptoms: spasticity, rusis sardonicus, lockjaw, prevents release of inhibitory neurotransmitters (GABA, glycine) from Renshaw cells in spinal cord
get tetanus from a rusty wrench-saw (Renshaw)
Clostridium botulinum: toxin
Botulinum toxin
Proteases that cleave SNARE proteins required for neurotransmitter release
Flaccid paralysis, floppy baby
toxin prevents release of stimulatory ACh signals at neuromuscular junctions leading to flaccid paralysis
Clostridium perfringens: toxin
Alpha toxin
phospholipase (lecithinase) that degrades tissue and cell membranes
degradation of phospholipids leading to myonecrosis (gas gangrene) and hemolysis (double zone of hemolysis on blood agar)
Streptococcus pyogenes: toxin
streptolysin O
Protein that degrades cell membrane
Lyses RBCs, contributes to Beta-hemolysis, host antibodies against toxin (ASO) used to diagnose rheumatic fever (do not confuse with immune complexes of poststreptococcal glomerulonephritis)
Exotoxin A
bring MHC II and TCR in proximity to outside of antigen binding site to cause overwhelming release of IFN-gamma and IL-2 leading to shock
Toxic shock syndrome: fever, rash, shock
Staphococcus aureus: toxin
Toxic shock syndrome toxin (TSST-1)
bring MHC II and TCR in proximity to outside of antigen binding site to cause overqhelming release of IFN-gamma and IL-2 leading to shock
also protein A binds Fc portion of IgG
Bacterial Transformation
Ability to take up naked DNA (i.e. from cell lysis) from environment (aka competence)
a feature of many bacteria
any DNA can be used
Bacterial transformation: Hfr x F-
High frequency recombination (Hfr)
replication of incorporated plasmid DNA may include flanking chromosomal genes
transfer of plasmid and chromosomal genes
Transposition
segment of DNA (e.g. transposon) that can “jump” from one location to another, can transfer genes from plasmid to chromosome and vice versa
when excision occurs, may include some flanking chromosomal DNA which can be incorporated into a plasmid and transferred to another bacterium
examples include antibiotic resistance genes on R plasmid
Transduction: Generalized
A packaging event
lytic phage infects bacterium, leading to cleavage of bacterial DNA
Parts of bacterial chromosomal DNA may become packaged in viral capsid
phage infects another bacterium, transferring these genes
Transduction: specialized
an excision event lysogenic phage infects bacterium
viral DNA incorporates into bacterial chromosome
when phage DNA is excised, flanking bacterial genes may be excised with it
DNA is packaged into phage viral capsid
phage infects another bacterium, transferring these genes
alpha hemolytic bacteria
Form green ring around colonies on blood agar
Streptococcus pneumoniae
viridans streptococci
Streptococcus pneumoniae: Classification
Capsule Optochin sensitive Bile soluble Catalase negative alpha hemolytic gram positive Cocci diplococci lancet shaped IgA protease natural transformer
Viridans Streptococci: Classification
No capsule optochin resistant bile insoluble alpha hemolytic Gram positive cocci Catalase negative
Strep pyogenes: classification
Group A Bacitracin sensitive Beta hemolytic catalase negative gram positive cocci
Strep agalactiae: classification
Group B Bacitracin resistant gram positive cocci in chains Beta hemolytic catalase negative CAMP test positive
Enterococcus: classification
Group D gram positive cocci Catalase negative gamma hemolytic Growth in bile and NaCl
Staph saprophyticus: classification
novobiocin resistant
Gram positive cocci
catalase positive
coagulase negative
Staph epidermidis: classification
Novobiocin sensitive Gram positive cocci catalase negative coagulase negative Makes biofilm(which is why it can adhere to medical implants and cause infections)
Staph aureus: classification
gram positive cocci
catalase positive
coagulase positive
beta-hemolytic
Gram positive rods: classification
Clostridium corynebacterium listeria bacillus mycobacterium
actinomyces: classification
Gram positive branching filaments
anaerobe
not acid fast
nocardia classification
Gram positive
branching filaments
aerobe
mildly acid fast
Staphylococcus aureus: Virulence factor, what does the infection cause
Protein A- binds Fc-IgG
Inflammatory disease
Toxin-mediated disease- toxic shock syndrome (TSST-1), scalded skin syndrome (exfoliative toxin), rapid onset food poisoning (enterotoxins)
MRSA- altered penicillin-binding protein makes it resistant
Streptococcus pneumoniae: causes what
MOPS meningitis Otitis media in kids Pneumonia Sinusitis Rusty sputum (alpha hemolytic) causes sepsis in sickle cell anemia and splenectomy
S. pneumoniae MOPS are Most OPtochin
Sensitive.
What bacteria is likely to be the cause of dental carries
Streptococci mutans
What bacteria is likely to cause infection of damaged heart valves
Streptococci sanguinis
sanguis=blood
makes dextrans which bind to fibrin-platelet aggregates on damaged heart valves
Streptococcus pyognenes (group a strep): causes what
release pyrogenic exotoxin in scarlet fever rheumatic fever (antibodies against M protein, type II hypersensitivity) acute glomerulonephritis (type III hypersensitivity)
Strep agalactiae: causes, prevention
B is for babies (group B), shortly after birth babies get symptoms
causes pneumonia, meningitis, and sepsis
Colonizes vagina
Produces CAMP factor which enlarges area of hemolysis cause by strep aureus)
Hippurate test positive
screen pregnant women and give positive ones intrapartum penicillin prophylaxis
Enterococci: causes, facts
normal colonic flora that are penicillin G resistant
cause UTI, biliary infections, subacute endocarditis following GI/GU procedures
VRE= Vanco resistant enterococci
Streptococcus bovis: causes
Colonizes the gut
can cause bacteremia and subacute endocarditis in COLON CANCER
Corynebacterium diphtheriae: causes
causes diphtheria via exotoxin encoded by beta prophage
Potent exotoxin inhibits protein synthesis via ADP-ribosylation of EF-2
lab diagnosed
Bacterial Spores
Spores are highly resistant to heat and chemicals
Need to autoclave to kill
Have dipicolinic acid in their core
If you DIP your COLON in
ACID, only the spores will be left (like clostridium)
Clostridia botulinum
preformed heat labile toxin that inhibits ACh release at the neuromuscular junction causing botuism
Adults ingest the toxin
babies ingest the spores in honey causing floppy baby syndrome
Clostridia perfringens
produce alpha toxin
lecithinase which is a phospholipase
can cause myonecrosis (gas gangrene) and hemolysis
Clostridia difficle
Produces 2 toxins
Toxin A, enterotoxin, binds brush border of gut
Toxin B, cytotoxin, cases cytoskeletal disruption via actin depolymerization causing pseudomembranous colitis leading to diarrhea
usually secondary to antibiotic use. especially clindmycin or ampicillin
diagnose by detecting one of the toxins in stool
Anthrax
caused by bacillus anthracis
gram positive spore forming rod
only bacterium with a polypeptide capsule
(contains D-glutamate)
Cutaneous anthrax
boil-like lesion
ulcer with black eschar (painless and necrotic)
uncommon for it to progress to bacteremia and death
Pulmonary anthrax
inhalation of spores
flu-like symptoms that progress to fever, pulmonary hemorrhage, mediastinitis and shock
Woolsorters’ disease
inhalation of anthrax spores from contaminated wool……weird
Bacillus cereus
causes food poisoning
spores survive cooking rice, keeping rice warm results in germination and enterotoxin formation
emetic type usually seen with rice and pasta (nausea and vomiting within 1 to 5 hrs, caused by cerculide, a preformed toxin)
Diarrheal type causes watery, nonbloody diarrhea and GI pain within 8 to 18 hrs
Cereus - cereal
Rice - warm rice krispies cereal
Listeria monocytogenes
Facultative intracellular microbe
ingestion of unpasteurized dairy products, deli meats, transplacental transmission, or vaginal during birth
form “rocket tails” from actin polymerization, help it move, tumbling motility
Only gram positive to produce LPS
can cause amnionitis, septicemia, spontaneous abortion, neonatal meningitis
goes away in adults usually
ampicillin in kids, immunocompromised, elderly
Actinomyces
gram positive anaerobe
long, branching filaments resembling fungi
not acid fast
normal oral flora
causes oral/facial abscesses that drain through sinus tracts, forms yellow sulfur granules
treat with penicillin
Nocardia
Gram positive aerobe
weakly acid fast
long, branching filaments resembling fungi
found in soil
causes pulmonary infections in immune compromised and cutaneous infections after trauma in normal patients
treat with sulfonamides
Primary TB infection
Ghon complex
usually in mid zone of lung
Secondary TB infection
what is it called when it invades the vertebral body
fibrocaseous cavitary lesion usually in upper lobe
pott disease when in the vertibrae
Mycobacteria
acid fast
M. tuberculosis
M. kansasii (pulmonary TB-like symptoms)
M. avium (intracellular, causes disseminated non-TB disease in AIDS patients), prophylactic treatment with azithromycin
TB symptoms, and virulence
fever, night sweats, weight loss, hemoptysis
cord factor in virulent strains inhibits macrophage maturation and induces release of TNF-alpha. sulfatides inhibit phagolysosomal fusion
Leprosy
Caused by mycobacterium leprae
2 forms
lepromatous and tuberculoid
mycobacterium leprae
causes leprosy
acid fast bacillus
likes cool temperatures (infects skin, superficial nerves)
can’t be grown in vitro
reservoir in US is in armadillos
dapsone, rifampin and clofazimine for 2 to 5 years
Lepromatous leprosy
presents diffusely over skin with leonine facies, no granulomas,
communicable
low cell-mediated immunity with humor Th2 response
Tuberculoid leprosy
limited to a few hypoesthetic, hairless skin plaques, go after superficial surface and nerves, slow growth
high cell-mediated immunity with Th1 type immune response, will see granulomas on biopsy
dapsone and rifampin treats in 6 months
M. Tuberculosis
Acid fast bacillus
produces niacin
mycolic acids make it resistant to gram staining
Auramine- rhodamine stain of sputum will be positive
Campylobacter jejuni: classification
Gram negative oxidase positive comma shaped grows at 42 degrees polar flagella microaerophilic
Vibrio cholerae: classification
Gram negative
oxidase positive
comma shaped
grows in alkaline media
Helicobacter pylori: classification
Gram negative
oxidase positive
comma shaped
produces urease
Haemophilus influenzae: classification
gram negative
coccoid rod
require factors V and X
Pasteurella
gram negative rod
coccoid rods
from animal bites
Brucella
Gram negative
coccoid rod
causes brucellosis
Bordetella pertussis: classification
gram negative
coccoid rod
N. meningitidis: classification
gram negative
diplococci
maltose fermenter
N. gonorrhoeae
gram negative diplococci maltose nonfermenter Can be grown on chocolate agar, but not on blood agar Pili are its pathogenic feature
Klebsiella: classification
gram negative rod
fast lactose fermenter
E. coli: classification
gram negative rod
fast lactose fermenter
produces beta galactosidase which breaks down lactose into glucose and galactose
Enterobacter: classification
gram negative rod
fast lactose fermenter
Citrobacter: classification
gram negative rod
slow lactose fermenter
Serratia: classification
gram negative rod
slow lactose fermenter
Shigella: classification
Gram negative rod
lactose non fermenter
oxidase negative
Salmonella: classification
Gram negative rod
lactose non fermenter
oxidase negative
Proteus: classification
Gram negative rod
lactose non fermenter
oxidase negative
Yersinia: classification
Gram negative rod
lactose non fermenter
oxidase negative
Pseudomonas: classification
Gram negative rod
non fermenter
Oxidase positive
Lactose fermenting enteric bacteria
Lactose is KEE
Test with macConKEE’S agar, turns pink from acid
Citrobacter, Klebsiella, E. coli, Enterobacter, and Serratia
EMB agar- lactose fermenters grow as purple/black colonies
E. coli grows purple with green sheen
Penicillin and gram negative bugs
gram negative bacilli are resistant to penicillin G but may be susceptible to penicillin derivatives such as ampicillin or amoxicillin
gram negative outer membrane blocks penicillin and vanco entry
Neisseria Gonococci
Gram negative diplococci (only circular gram negative)
ferments glucose
Produces IgA proteases
Has pili
Mostly found intracellularly in neutrophils but not an intracellular organism
No capsule
No maltose fermentation
No vaccine due to rapid antigenic variation of pilus proteins
Sexually transmitted
Causes gonorrhea, septic arthritis, neonatal conjunctivitis, pelvic inflammatory disease, Fitz-hugh curtis syndrome
Condoms prevent transmission
treat with ceftriaxone (add azithromycin or doxy for possible chlamydia co infection)
Capsule is immunogenic
Neisseria Meningococci
Gram negative diplococci ferments glucose Produces IgA proteases Polysaccharide capsule maltose fermentation Vaccine but not for type B Transmitted by respiratory and oral secretions Causes meningiococcemia and meningitis, waterhouse-Friderichsen syndrome prophylaxis with rifampin, ciprofloxacin, or ceftriaxone Treat with ceftriaxone or penicillin G Type B capsule is not immunogenic GIVE AWAY MENINGITIS IS PETECHIAL RASH!
Haemophilus influenzae
Small gram negative coccobacillary rod
aerosol transmission
Produces IgA proteases
culture on chocolate agar with Nad (V) and hematin (X) or with staph aureus which provides factor X
haEMOPhilus causes: Epiglottitis, Meningitis, Otitis media, Pneumonia
Treat mucosal with amoxicillin +/- clavulanate
treat meningitis with ceftriaxone
rifampin for prophylaxis
X-ray of H. influenzae epiglottitis
thumbprint sign- thickening of epiglottis on lateral neck radiograph
Legionella pneumophila
Gram negative rod, stains poorly-use silver stain Grow on charcoal yeast extract with iron and cysteine clinically detected by antigen in urine aerosol transmission from water no person to person transmission treat with macrolide or quinolone labs show hyponatremia pontiac fever= mild flu like symptoms
Legionnaires disease
severe pneumonia
fever
GI
CNS symptoms
Pseudomonas aeruginosa
Aerobic gram negative rod
non lactose fermenting oxidase positive
produces pyocyanin (blue green pigment)
grape like odor
from a water source
produces endotoxin (fever, shock) and exotoxin A (inactivates EF-2)
PSEUDOmonas is associated with burn infections, Pneumonia (especially cystic fibrosis), Sepsis, External otitis, UTI, Drug use, and Diabetic Osteomyelitis, and hot tub folliculitis
treat with aminoglycosides plus extended spectrum penicillin (piperacillin, ticarcillin, cefepime, imipenen, meropenum)
Ecthyma gangrenosum
rapidly progressive necrotic cutaneous lesions caused by pseudomonas bacteremia
usually in immune compromised patients
treat with aminoglycosides plus extended spectrum penicillin (piperacillin, ticarcillin, cefepime, imipenen, meropenum)
E coli
Gram negativem oxidase negative lactose fermenting rod
grows pink on MacConkey agar
virulence factors: fimbriae- cystitis and pyelonephritis, K capsule- pneumonia, neonatal meningitis, LPS endotoxin- septic shock
Strain EIEC of E coli
Microbe invades intestinal mucosa and causes necrosis and inflammation
clinically similar to shigella
Invasive; dysentery
Strain ETEC of E coli
produces heat-labile and heat-stabile enterToxins. no inflammation or invasion
Travelers’ diarrhea (watery)
Strain EPEC of E coli
no toxin produced
adheres to apical surface,
flattens villi, prevents absorption
Diarrhea usually in Peds patients
strain EHEC of E coli
O157:H7 is the most common serotype
produces Shiga-like toxin causing hemolytic-uremic syndorme (triad of anemia, thrombocyopenia, acute renal failure)
also called STEC (shiga toxin producing E coli)
Microthrombi form on endothelium damaged by toxin leading to mechanical hemolysis (schistocytes) and decreased renal blood flow; microthrombi consume platelets leading to thrombocytopenia
Dysentery (toxin alone causes necrosis and inflammation)
Does not ferment sorbitol (which other E coli do)
Klebsiella
Gram negative, oxidase negative, bacillus,
fast lactose fermenting, urease positive
MacConkeys agar
an intestinal flora that causes lobar pneumonia in alcoholics and diabetics when aspirated
very mucoid, abundant polysaccharide capsules
red currant jelly sputum, x ray shows lobar cavitation
nosocomial UTIs
4 A’s
Aspiration pneumonia, Abscess in lungs and liver, Alcoholics, di-A-betics
treat with 3rd gen cephalosporin +/- aminoglycoside
Salmonella
has flagella can disseminate hematogenously have animal reservoirs produces hydrogen sulfide antibiotics may prolong fecal excretion of organism invades intestinal mucosa and causes a monocytic response can cause blood diarrhea does not ferment lactose
Shigella
no flagella
cell to cell transmission no hematogenous spread
only reservoirs are humans and primates
does not produce hydrogen sulfide
antibiotics shorten duration of fecal excretion of organism
invades intestinal mucosa and causes PMN infiltration
often causes blood diarrhea
does not ferment lactose
Salmonella typhi
Causes typhoid fever
found only in humans
characterized by rose spots on the abdomen, fever, headache, and diarrhea
can remain in gallbladder and cause a carrier state
Neonates with meningitis: what bugs are you thinking
Group B strep (agalactae)
E coli
Listeria monocytogenes
Campylobacter jejuni
major cause of bloody diarrhea, especially in kids
fecal oral transmission through foods (pork, meat, unpasteurized milk)
Comma or S shaped
oxidase positive, grows at 42 Celcius
Look for RBCs and WBCs in stool (invasive bug causing immune response and bleeding)
common antecedent to Guillain-Barre syndrome and reactive arthritis
Vibrio cholerae
produces profuse rice-water diarrhea via enterotoxin that permanently activates Gs, increasing cAMP
comma shaped, oxidase positive, grown in alkaline media
endemic to developing countries
oral rehydration necessary
Yersinia enterocoliticia
Usually transmitted from pet feces, contaminated milk, or pork
causes mesenteric adenitis that can MIMIC Crohns disease or appendicitis (find micro abscesses in lymph nodes when they think they have appendicitis
Helicobacter pylori
Causes gastritis and peptic ulcers (especially duodenal)
risk factor or peptic ulcer, gastric adenocarcinoma, lymphoma
curved gram negative rod
catalase positive, oxidase positive, urease positive
Use urea breath test or urine antigen test to diagnose
creates alkaline environment
most common initial treatment is triple therapy: proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole
Spirochetes
spiral shaped bacteria with axial filaments
includes Borrelia (big size), Leptospira, Treponema
only borrelia can be visualized using aniline dyes (wright or Giemsa stain) in light microscopy
Treponema is visualized by dark-field microscopy
Leptospira interrogans
Found in water contaminated with animal urine, causes leptospirosis: fly like symptoms, jaundice, photophobia with conjuctival suffusion (erythema w/o exudate)
prevalent among surfers and in tropics (i.e. Hawaii)
Weil Disease
Icterohemorrhagic leptospirosis
severe form of leptospirosis
jaundice, azotemia from liver and kidney dysfunction, fever, hemorrhage, anemia
Lyme Disease
Cause by Borrelia burgdorferi, from tick Ixodes
Natural reservoir is mice
Common in Northeastern US
Initial symptoms- erythema chromicum migrans, flu like, +/- facial palsy (bell palsy)
Later symptoms- monoarthritis (knee, hips) due to type III hypersensitivity, migratory polyarthritis, AV nodal block, encephalopathy, facial nerve palsy, polyneuropathy
treat: doxy, ceftriaxone
Ixodes tick transmits
Lymes, Babesia, Anaplasmosis
Syphilis: caused by, treatment
spirochete Treponema pallidum
treat: penicillin G
Primary syphilis
Localized disease with painless chancre
use dark field microscopy to visualize treponemes in fluid from chancre
Secondary syphilis
secondary=systemic
bronze colored maculopapular rash (palms and soles);
condylomata lata: gray to white flat wart like lesions of the mouth and perineal area;
constitutional symptoms
serologic testing: VDRL/RPR (nonspecific), confirm diagnosis with FTA-ABS (fluorescent treponenal antibody absorption test)
latent syphilis follows (no symptoms, but still positive tests)
Tertiary syphilis
gumma (chronic granulomas), aortitis (vasa vasorum destruction), neurosyphilis (tabes dorsalis), argyll robertson pupils
broad-based ataxia, romberg, charcot joint, stroke without hypertension
for neurosyphilis test spinal fluid with VDRL or RPR
Congenital syphilis
saber shins, saddle nose, CN VIII deafness, Hutchinson teeth, mulberry molars
to prevent, treat mom early, placental transmission usually occurs after first trimester
Argyll Robertson pupil
Pupil constricts with accommodation but is not reactive to light
associated with tertiary syphilis
“prostitute pupil” accommodates but does not react
VDRL false positives
VDRL detects nonspecific antibody that reacts with beef cardiolipin
inexpensive, widely available test for syphilis
sensitive, not specific
many false positives due to VDRL: Viruses, Drugs Rheumatic Fever, Lupus/Leprosy
Jarisch-Herxheimer reaction
Flu-like symptoms after antibiotics are started
due to killed bacteria releasing pyrogens
Anaplamsa spp.
causes Anaplasmosis,
transmitted via Ixodes ticks (live on deer and mice)
Bartonella spp.
causes Cat scratch disease, bacillary angiomatosis
get from cat scratches
Borrelia burgdorferi
causes lyme disease
Transmitted via ixodes tick (live on deer and mice)
Borrelia recurrentis
causes relapsing fever
transmitted via Louse
recurrent due to variable surface antigens
Brucella spp.
causes Brucellosis/undulant fever
from unpasteurized dairy
faculative intracellular
Campylobacter
causes bloody diarrhea
from puppies, livestock (fecal oral, or uncooked meat)
Chlamydophila psittaci
cause psittacosis
from parrots, other birds
Coxiella burnetii
causes Q fever
from Aerosols of cattle/sheep amniotic fluid
BURN the cattle and sheep on the bbQ
Ehrlichia chaffeensis
causes Ehrlichiosis
from lone star ticks
you get ehrlich from the lone star tick
Francisella tularensis
gram negative coccobacillus, slow growing, aerobic, require cystine to grow
involvement of regional lymph nodes
rupture of pustules causes ulcers
causes Tularemia
from ticks, rabbits, deer fly, dermacentor tick, (think mid western hunter)
Leptospira spp.
causes leptospirosis
get it from animal urine
surfers in the leper colony in hawaii surf on a spiral of urine
Mycobacterium leprae
causes leprosy
from humans with lepromatous leprosy or armadillos which are the reservoir in the US
(lepromaTWOs is a Th2 response) (tubercuLLOYD christmas - all that ONE in a million talk is Th1)
Pasteurella multocida
causes cellulitis and osteomyelitis
get it form animal bites, cats, dogs
animals in a pasture chewing on skin and bones
Rickettsia prowazekii
causes epidemic typhus
get it from Louse
epidemic typhus is on the PROWL
Rickettsia rickettsii
causes rocky mountain spotted fever
from dermacentor ticks
obligate intracellular (endothelial cells) organisms that need CoA and NAD because they cannot synthesize ATP
Rickettsia typhi
causes Endemic typhus
from fleas
Yersinia pestis
causes plague from fleas (rats and prairie dogs are reservoirs)
Babesia microti
causes babesiosis from the ixodes tick protozoan parasite, intraerythrocytic fever headache and chills splenectomy patients get severe hemolytic anemia
Gardnerella vaginalis
pleomorphic gram variable rod
causes vaginosis
Presents as a gray vaginal discharge with a fishy smell, nonpainful (vs. vaginitis)
associated with sexual activity, but not sexually transmitted
Clue cells or vaginal epithelial cells covered with Gardnerella bacteria are visible under the microscope
Treat with metronidazole or clindamycin if anaerobic vaginosis (other gram negative bacteria can cause vaginosis)
I don’t have a clue why I smell fish in the vagina
garden!
Rocky Mountain spotted fever
Rickettsia rickettsii (lives in endothelial cells), vector is Dermacentor ticks
Rash usually at wrists and ankles, spreads to trunk, palm, and soles
Classic triad are headache, fever, rash (vasculitis)
Typhus
Endemic (fleas)- R. typhi
Epidemic (human body Louse) R. prowazekii
rash starts centrally and spreads out, sparing palms and soles
Rickettsii on the wRists, Typhys on the Trunk
Ehrlichiosis
Ehrlichia: vector is tick
monocytes with morulae (berry like inclusions) in cytoplasm
ehrlich is from the lone star tick
Anaplasmosis
Anaplasma, vector is tick, granulocytes with morulae (berry like clusters) in cytoplasm (intracellular):
Leukopenia, thrombocytopenia, increased transaminases.
Q fever
Coxiella burnetti
no arthropod vector
tick feces and cattle placenta release spores that are inhaled as aerosols. presents as pneumonia
Q fever is Queer: no rash, no vector, causative organism can survive outside in its endospore form
Chlamydiae
Chlamydie in obligate intracellular organism that causes mucosal infections; non gram staining
Elementary body (small, dense) is infectious and enters cell via endocytosis; transforms into reticulate body (what you would culture)
Reticulate body replicates in cell by fission; reorganizes into elementary body
Diagnose in lab: cytoplasmic inclusions seen on Giemsa iodine, or fluorescent antibody- stained smear
cell wall lacks muramic acid
treat with azithromycin (one time treatment) or doxy
reiter’s = arthreitis
Chlamydia trachomatis causes
reactive arthritis (reiter syndrome) follicular conjuctivitis, nongonococcal urethritis and PID treat with azithromycin (one time treatment) or doxy
Chlamydia pneumoniae and C. psittaci cause
cause atypical pneumonia; transmitted via aerosol
treat with azithromycin (one time treatment) or doxy
Chlamydia trachomatis serotypes: A, B, C
Chronic infection, causes blindness due to follicular conjunctivitis in africa
ABC= Africa/Blindness/Chronic infection
Chlamydia trachomatis serotypes: D-K
Urethritis/PID, ectopic pregnancy, neonatal pneumonia (staccate cough, neonatal infection
D-K=everything else
neonatal disease can be acquired passing through infected birth canal: why we give erythromycin eye drops
Chlamydia trachomatis serotypes: L1, L2, L3
Lymphogranuloma Venereum: small painful ulcers on genitals leading to swollen, painful inguinal lymph nodes that ulcerate (“buboes”) and drain through the skin. treat with doxy
Mycoplasma pneumoniae
not seen on gram stain, no cell wall
membrane has sterols for stability
young people in close quarters
Causes atypical “walking” pneumonia
insidious onset, headache, nonproductive cough, patchy or diffuse interstitial infiltrate
X ray looks worse than patient
higher titer of cold agglutinins (IgM)
grown on Eaton agar
treatment: macrolide, doxy, or fluoroquinolone
penicillin does not work because it has no cell wall
Cold agglutinins
IgM: IgM isohemagglutinins that agglutinate autologous erythrocytes at 4 degrees C
Strep MG agglutinins: agglutinates streptococcus salivaries termed MG
Treatment of mycoses
local infection: fluconazole or intraconazole
systemic infection: amphotericin B
Histoplasmosis
Looked for a macrophage filled with histoplasms (the histoplasma is smaller than RBC, 2-5 micrometers) thin capsule, no true cell wall Mississippi and ohio river valleys causes pneumonia *Birds or bat droppings*
Blastomycosis
States east of Mississippi river and central US
Causes inflammatory lung disease
can disseminate to bones and skin, joints, and genitourinary
forms granulomatous nodules
Broad based budding (same size as RBCs)
Blasto Buds Broadly
a dog rolling around in a rotting wood pile
Coccidiomycosis
Southwestern US, California, Desert areas
Causes pneumonia and meningitis
can disseminate to bone and skin
increased cases after earthquakes (spores go into air, become spherules in lungs)
Spherule is much larger than an RBC, filled with endospores
Valley fever, desert humps (erythema nodosum), Desert rheumatism (arthralgias)
Paracoccidioidomycosis
Latin America
Budding yeast with captians wheel formation
way bigger than RBC
Paracoccidio parasails with the captian’s wheel all the way to latin america
paraguay is in south america, and you can sail there with your captain wheel
Tinea Versicolor
caused by malassezia furfur
degradation of lipids produces acids that damage melanocytes and cause hypopigmented and or hyperpigmented patches
occurs in hot humid weather
treat: topical miconazole, selenium sulfide,
spaghetti and meatball appearance
Furry meatballs look green under a woods lamp
Trichophytan rubrum
KOH the skin scraping, detects arthroconida and hyphae
Candida albicans
alba=white
systemic or superficial infections
Oral and esophageal in immunocompromised or steroid asthma user who doesn’t wash out mouth
Vulvovaginits, diaper rash, endocarditis in IV drug user, disseminates to any organ, chronic mucocutaneous candidiasis
treat: topical azole for vagina, fluconazole or caspofungin for oral/esophageal; systemic is fluconazole, amphotericin B, or caspofungin
Diagnosed by gram tube test, budding yeast with short true hyphae
catalase positive
Aspergillis fumigatus
Invasive aspergillosis, especially in immunocompromised or chronic granulomatous disease
Allergic bronchopulmonary aspergillosis (ABPA): associated with asthma and cystic fibrosis, may cause bronchiectasis and eosinophilia
Aspergillomas in lung cavities, especially after TB infection
Some species produce aflatoxins which are associated with hepatocellular carcinoma
think A’s for Acute Angles in Aspergillus. not dimorphic
the aflac duck eats liver and asparagus (aflatoxin of aspergillus causes hepatocellular carcinoma)
fumigatus = fumes = lungs
Catalase positive
Cryptococcus Neoformans
Cryptococcal meningitis, cryptococcus
Heavily encapsulated yeast
not dimorphic
found in soil, pigeon droppings
get it from inhalation with hematogenous spread to meninges
culture on Sabouraud agar, stain with india ink and mucicarmine
latex agglutination test detects polysaccharide capsular antigen and is most specific
“Soap Bubble” legions in brain
Most common cause of meningitis in AIDS patients in US
Sab is a cryptic guy when he visits india because he has a latex soap bubble fetish fetish, he also raises pigeons
Mucor and Rhizopus spp.
Mucormycosis
Disease mostly in ketoacidotic diabetic and leukemic patients
fungi proliferate in blood vessel walls when there is excess ketone and glucose
penetrate cribriform plate and enter brain
rhinocerebral, frontal lobe abscesses
Symptoms: headache, facial pain, black necrotic eschar on face, may have CN involvement
treat: amphotericin B
Ribbon form hypae branching at 90 degrees
Pneumocystic jirovecii
Causes Pneumocystis pneumonia, diffuse interstitial pneumonia (increased surfactant due to activation of type II pneumocytes leading to death by asphyxiation)
Yeast
Inhaled
Get this if immunosuppressed (AIDS, newborn)
X ray shows diffuse bilateral CXR appearance
Lung biopsy or lavage confirms
Disc shaped yeast forms on methenamine silver stain
TMP-SMX to treat
atovaquone, dapsone to prevent when CD4 count less than 200
pneumodiscus
Sporothrix schenckii
Sporotrichosis
Dimorphic cigar shaped budding yeast that lives on vegetation
thorn prick introduces yeast to skin
causes local pustule or ulcer with nodules along draining lymphatics
little systemic illness
treat with itraconazole or potassium iodide
ITRy to plant a Rose in a Pot, pot=potassium
ITRaconazome
Giardia lamblia
Giardiasis: blotting, flatulence, foul-smelling, fatty diarrhea
often seen in campers/hikers and may be in water supply
think fat-rich Ghirardelli chocolates for fatty stools of Giardia, may be asymptomatic
comes from cysts in water
Look for trophozoites or cysts in stool to diagnose
Treat with metronidazole
Entamoeba histolytica
Amebiasis: bloody diarrhea (dysentery), liver abscess (anchovy paste exudate), abdominal abscesses before liver affected RUQ pain (histology shows flask like ulcer if submucosal abscess of colon ruptures comes from cysts in water diagnose by doing serology and or trophozoites (with RBCs in cytoplams) or cysts in stool treat with metronidazole or iodoquinol for asymptomatic cyst passers
Cryptosporidium
Causes severe diarrhea in AIDS
Mild disease with watery diarrhea in healthy people
get it from Oocysts in water
Diagnose by seeing oocysts on acid fast stain
treat by prevention (city water filters), nitazoxanide in healthy people
Diarrhea caused by bug lysing brush boarder cells (bug replicates in brush border cells)
Nita is Sabs cryptic sister who has oocytes and does so much butt stuff that she has severe diarrhea with her AIDS
Toxoplasma gondii
brain abscess in HIV (ring enhancing lesions on CT/MRI)
Congenital Toxoplasmosis= triad of chorioretinitis, hydrocephalus, and intracranial calcifications
“bright periphery and dark core” due to necrosis
Transmitted as cysts in meat, uncooked pork, or oocytes in cat feces, cross placenta (pregnant stay away form cats)
diagnose by serology
treat with sulfadiazine and pyrimethamine
15-20% of population is infected but immune system makes it go dormant until immune compromised then they get the infection
Most common brain infection in HIV patients causing seizures, altered mental status, focal neurologic defects
Naegleria fowleri
Rapidly fatal meningoencephalitis
flagellated trophozoite
Get it from swimming in freshwater lakes (Naegleria-Nalgene)
enters body via cribiform plate forming necrotic lesions spreading from olfactory lobes
Diagnose by amoebas in spinal fluid
Treat: amphotericin B, but most still die
Trypanosoma brucei
African sleeping sickness: enlarged lymph nodes, recurring fever ( due to antigenic variation), somnolence, coma
two subtypes: rhodesiense and gambiense
get it from Tsetse fly that has a painful bite
diagnose by blood smear
Suramin for blood borne disease or melarsoprol for CNS penetration
(“it sure is nice to go to sleep”; melatonin helps with sleep)
Plasmodium
Causes malaria: headache, fever, anemia, splenomegaly
vivax and ovale-get 48 hour cycle (tertian; fever on first and third day, thus fevers are 48 hours apart)
dormant in liver
Falciparum-sever; irregular fever pattern; parasites in RBCs occlude capillaries in brain (cerebral malaria), kidney, lungs
malariae- 72 hour cycle (quartan)
transmitted via misquito (anopheles)
diagnosed by blood smear showing trophoziote ring from within RBC, schizont containing merozoites
Treatment of plasmodium
AKA treatment of malaria
Begin with chlorquine, which blocks plasmodium heme polymerase; if resistant use mefloquine or atovaquone/proguanil
If life threatening use IV quinidine (test for G6PD deficiency)
if Vivax/ovale add primaquine for hypnozoite (test for G6PD deficiency)
Babesia
Babesiosis: fever and hemolytic anemia; predominantly in Northeastern US,
if asplenic you get increase risk of severe disease
Transmitted via ixodes tick (same as borrelia burgdorferi of Lymes, so many are co infected)
Diagnose via blood smear, see ring form “maltese cross’ or PCR
Treat with atovaquone + azithromycin
Trypanosoma cruzi
causes chagas’ disease: dilated cardiomyopathy, megacolon, megaesophagus, predominantly in south america
Transmitted via Reduciid bug (kissing bug) feces, deposited in a painless bite (much like a kiss)
diagnose via blood smear
treat with benznidazole or nifurtimox
romana sign - unilateral periorbital edema
a MEGA-BENZ-MOX-Cruz ship takes you to the other hemisphere (unilateral edema)
Leishmania donovani
Visceral leishmaniasis: spiking fevers, hepatosplenomegaly, pancytopenia
transmitted via sandfly (beachmaniasis)
Diagnose via macrophages containing amastigotes
Treat with amphotericin B, sodium stibogluconate
DONOVANI, the world famous SAND volleyball player SPIKES the volleyball so hard that it goes down your throat and gives you a huge belly (HEPATOSPLENOMEGALY)
the mascot goats are there (amastigotes)
Trichomonas vagainalis
Vaginitis: foul-smelling, yellow-greenish discharge; foul smelling and burning; do not confuse with Gardnerella vaginalis (gram variable bacterium associated with baterial vaginosis)
transmitted via sex (cannot exist outside humans, has no cysts)
diagnose with trophozoites (motile) on wet mount; see a strawberry cervix
Treat with metronidazole for patient and partner (prophylaxis)
Enterobius vermicularis
roundworm/nematode
Transmitted fecal ora
causes intestinal infection causing anal pruritus (diagnosed via scotch tape test)
treat: bendazoles (BENDy worms) or pyrantel pamoate
WA had the scotch tape test done. He is a vermin (vermicularis)
Ascaris lumbricoides
roundworm/nematode
AKA giant roundworm, it is HUGE! 8 inches
human fecal-oral; eggs visible in feces under microscope
get intestinal infection and some lung, can cause bowel obstruction
treat: bendazoles (BENDy worms) or pyrantel pamoate
Ancylostoma
roundworm/nematode
hookworms
larvae penetrate skin
get intestinal infection causing anemia by sucking blood from intestinal walls
Strongyloides stercoralis
nematode/roundworm
Larvae in soil pentrate the skin
get intestinal infection causing vomiting, diarrhea, epigastic pain (like a peptic ulcer)
treat with ivermectin or albendazole
Onchocerca volvulus
nematode/roundworm
transmitted via the female blackfly that bites you
get hyperpigmented skin and river blindness (blackflies, black skin nodules, “black sight”, allergic reaction to microfilaria is possible
Treat with ivermectin (ivermectin for iver blindness)
Loa loa
roundworm/tapeworm
transmitted via Deer fly, horse fly, mango fly
get swelling in skin, worm in conjunctiva
treat with Diethylcarbamazine
Wuchereria bancrofti
roundworm/nematode
get it from female misquito
it blocks lympatic vessels: elephantaisis; takes 9 months to a year after bite to get symptoms
treat with diethylcarbamazine
Toxocara canis
nematode/roundworm
get it from fecal oral transmission
causes visceral larva migrans (go to a ton of organs and cause inflammation and damage)
treat with Albendazole or mebendazole
nematode routes of infection
ingestion is Enterobius, Ascaris, Toxocara
Cutaneous is Strongyloides, Ancylostoma, Necator
Bites is Loa loa, Onchocerca volvulus, Wuchereria bancrofti
“you’ll get sick if you EAT these! these get into your ffet from the SANd. lay LOW to avoid getting bitten.”
Taenia solium
Tapeworm
transmission: ingestion of larvae encysted in undercooked port, ingestion of eggs
Intestinal infection, cysticerosis, neurocystericerosis (focal calcifying brain lesions w/ seizures)
Treat: praziquantel (Add albendazole for neurocystericerosis)
Diphyllobothrium latum
Tapeworm
transmission: ingestion of larvae form raw freshwater fish
Causes B12 deficiency (tapeworm competes for B12), get anemia
treat with praziquantel
Echinoccus granulosus
Tapeworm
Get it from ingestion of eggs from dog feces
Causes hydatid (containing tape worm) cysts in liver, causing anaphylaxis if antigens released, surgeons pre-inject w/ ethanol to kill cysts before removal
Treat w/ albendazole
Schistosoma
Trematode (flukes)
get it from snails, cercariae (larval stage) penetrate skin of human
causes: liver and spleen granulomas, fibrosis and inflammation: if chronic infection w/ S. haematobium can lead to squamous cell carcinoma of the bladder (painless hematuria)
Treat w/ praziquantel
Clonorchis sinensis
treamatode (flukes)
get it from undercooked fish
causes biliary tract infection causing pogmented gallstons. Associated with cholangiocarcinoma
treat w/ praziquantel
Viral recombination
exchange of genes between 2 chromosomes by crossing over within regions of significant base sequence homology
Viral reassortment
When viruses with segmented genomes exchange segments. High frequency recombination. Cause of world wide influenza pandemics
Viral complementation
When 1 of 2 viruses that infect the cell has a mutation that results in a nonfunctional protein
the nonmutated virus “complements” the mutated one by making a functional protein that serves both viruses
Viral Phenotypic mixing
occurs w/ simultaneous infection of a cell with 2 viruses. genome of virus A can be partially or completely coated (forming pseudovirion) with the surface proteins of virus B. Type B protein coat determines the tropism (infectivity) of the hybrid virus. However, the progeny from this infection have a type A coat that is encoded by its type A genetic material.
Live attenuated viruses
induce humoral and cell-mediated immunity but have reverted to virulence on rare occasions
killed/inactivated vaccines induce only humoral immunity but are stable
no boosters needed
Dangerous to give live viruses to immunocompromised patients or those w/ close contacts
Examples of live attenuated viruses
smallpox, yellow fever, chickenpox, sabian polio virus, MMR, influenza
Killed virus vaccines
Rabies, influenza, Salk polio, and HAV vaccines
Recombinant viral Vaccines
HBV (antigen=recombinant HBsAg), HPV (types 6, 11, 16, 18)
DNA viral genomes
All DNA viruses except parvoviridae are dsDNA
all are linear except papilloma, polyoma, and hepadnaviruses (circular)
RNA viral genomes
All RNA viruses except reovirdae are ssRNA
Naked viral genome infectivity
purified nucleic acids of most dnDNA (except poxviruses and HBV) and positive strand ssRNA viruses are infectious.
Naked nucleic acids of negative strand of ssRNA and dsRNA are not infectious, they require polymerases contained in the complete virion.
DNA viruses all replicate in the
nucleus (Except poxvirus)
RNA viruses all replicate in the
cytoplasm
except influenza and retrovirus
What are the naked enveloped viruses
DNA- (PAPP)Papillomavirus, Adenovirus, Parvovirus, Polyomavrius
RNA- (CPR-H) Calicivirus, picornavirus, Reovirus, and Hepevirus
enveloped viruses acquire their envelopes from
the plasma membrane of the cell
except for herpesvirus which gets it from the nuclear membrane
Herpesviruses
Enveloped
dsDNA and linear genome
HSV-1: oral lesions, temporal lobe encephalitis, keratoconjunctivitis
HSV-2: genital lesions
VZV(HHV-3): chickenpox, shingles
EBV (HHV-4): mononucleosis, Burkitt lymphoma, Hodgkin lymphoma
CMV(HHV5): infection in immunocompromised patients (AIDS retinitis), especially transplant patients, congenital defects (sightomegalovirus)
HHV-6 roseola (exanthem subitum)
HHV-7: less common cause of roseola
HHV-8 causes kaposi sarcoma
Hepadnavirus
Enveloped
Partially dsDNA and circular
HBV: acute or chronic hepatitis, vaccine has HBV surface antigens
not a retrovirus but has reverse transcriptase
Adenovirus
not enveloped dsDNA and linear Febrile pharyngitis, sore throat acute hemorrhagic cystitis pneumonia conjunctivitis "pink eye" Contaminated swimming pools can transmit it to many people
Parvovirus
not enveloped
ssDNA (-) and linear: smallest DNA virus
B19 virus: aplastic crises in sickle cell disease, slapped cheeks rash in kids-erythema infectiosum (fifths disease), RBC destruction in fetus leads to non-immune hydrops fetalis and death (aplastic anemia), pure RBC aplasia and rheumatoid arthritis-like symptoms in adults
Papillomavirus
not enveloped dsDNA and circular HPV-warts from 1, 2, 6, 11 CIN, cervical cancer from 16 and 18 vaccine available
Polyomavirus
Not enveloped
dsDNA and circular
JC virus: progressive multifocal leukoencephalopathy (PML) in HIV (JC=Junky Cerebrum)
BK virus: transplant patients, commonly targets kidney (BK=bad kidney)
Poxvirus
“brick shaped” (only DNA not icosahedral)
enveloped
does not use nucleus to make DNA (only DNA virus to do that)
dsDNA and linear (largest DNA virus)
smallpox
Cowpox (milkmaid blisters)
molluscum contagiosum: flesh colored dome lesions with central umbilicated dimple
HSV-1
Herpes encephalitis: hypodensity of temporal and frontal lobes on CT, increase lymphocytes in csf
cowdry type A inclusion in neurons and glia in encephalitis
gingivostomatitis, keratoconjunctivits, herpes labialis
latent in trigeminal ganglia
transmitted by respiratory secretions and saliva
HSV-2
herpes genitalis, neonatal herpes; small tender nodules with inguinal lymph node involvement
latent in sacral ganglia
transmitted by sexual contact, perinatally
VZV
varicella-zoster, encephalitis, pneumonia
latent in dorsal roots or trigeminal ganglia
most common complication of shingles is post-herpetic neuralgia.
transmitted by respiratory droplets
EBV
Mononucleosis: fever, hepatosplenomegaly, pharyngitis, and lymphadenopathy (posterior cervical lymph nodes)
Transmitted by secretions and saliva
infects B cells: atypical lymphocytes seen on peripheral blood smear are not infected B cells but rather reactive cytotoxic T cells
Detect by monospot test: heterophile antibodies detected by agglutination of sheep or horse RBCs
Associated w/ hodgkin lymphoma, endemic burkitts lymphoma, and nasopharyngeal carcinoma (cytokeratin positive)
CMV
Congenital infection, mononucleosis (negative monospot though), pneumonia, retinitis. infected cells have Owl eye inclusions
latent in mononuclear cells
transmitted congenitally and by transfusion, sexual contact, saliva, urine, transplant
HHV-6
Roseola: high fevers for several days that can cause seizures, followed by a diffuse macular rash
transmitted by saliva
HHV-8
Kaposi sarcoma: neoplasm of endothelial cells, seen in HIV/AIDS and transplant patients
Dark/violaceous flat and nodular skin lesions representing endothelial growths. can also affect GI tract and lungs
transmitted by sexual contact
Viruses that can cause neonatal encephalitis
- HSV1
- HSV2
- CMV
How to identify HSV
viral culture for skin/genitalia
CSF PCR for herpes encephalitis
Tzanck test (genital herpes)- a smear of an open skin vesicle to detect multinucleated giant cells
Infected cells also have Cowdry A inclusions
Reoviruses
not enveloped dsRNA linear 10-12 segments iscosahedral coltivurs- colorado tick fever rotalvirus- #1 cause of fatal diarrhea in children
Picornaviruses
no envelope ssRNA positive, linear icosahedral PERCH viruses Poliovirus: polio-Salk/Sabin-IPV/OPV Echovirus- aseptic meningitis Rhinovirus: common cold Coxsackievirus: aseptic meningitis; herpangina, hand, foot and mouth disease; myocarditis; pericarditis HAV- acute viral hepatitis Fecal oral spread except rhinovirus
Hepevirus
No envelope
ssRNA positive linear
icosahedral
causes HEV
Caliciviruses
not enveloped
ssRNA positive linear
icosahedral
norovirus: viral gastroenteritis
Flaviviruses
enveloped
ssRNA positive, linear
Icosahedral
HCV, yellow fever, Dengue, St. Louis encephalitis, West nile virus
Togaviruses
Enveloped
ssRNA positive, linear
icosahedral
Rubella, eastern and western equine encephalitis
Retroviruses
Enveloped ssRNA positive linear icosahedral have reverse transcriptase HTLV- T-cell leukemia HIV-AIDS
Coronaviruses
enveloped
ssRNA positive and linear
helical
coronavirus- common cold and SARS
Orthomyxoviruses
enveloped ssRNA negative and linear 8 segments helical influenza replicates in nucleus only (only RNA virus that needs nucleus)
Paramyxoviruses
enveloped ssRNA linear Helical PaRaMyxovirus: Parainfluenza: croup Rsv: bronchiolitis in babes (treat with ribavirin) Measles, Mumps
Rhabdoviruses
enveloped
ssRNA negative linear
helical
Rabies
Filoviruses
enveloped
ssRNA negative linear
helical
ebola/marburg hemorrhagic fever- often fatal
Arenaviruses
Enveloped ssRNA negative circular 2 segments helical LCMV: lymphocytic choriomeningitis virus Lassa fever encephalitis: spread by mice
Bunyaviruses
enveloped ssRNA negative 3 segments helical California encephalitis Sandfly/Rift valley fever Crimean-COngo hemorrhagic fever Hantavirus- hemorrhagic fever, pneumonia
Delta Virus
enveloped
SS negative circular
unknown capsid
HDV is a defective virus that requires HBV co-infection
negative strand RNA viruses
must transcribe negative strand to positive. viron brings its own RNA-dependent RNA polymerase
Always Bring Polymerase Or Fail Replication
Arenavirus, Bunyavirus, Paramyxovirus, Orthomyxovirus, Filovirus, Rhabdovirus
Segmented viruses
all RNA, no segmented DNA viruses
Bunyavirus, Orthomyxovirus, Arenavirus, Reovirus
BOAR!
Rhinovirus
a picornavirus nonenveloped RNA virus causes of common cold (rhino runny nose) over 100 serologic types acid labile- destroyed by stomach acid- so it does not infect GI tract (all other picornaviruses do)
Yellow Fever Virus
a flavivirus (and an arbovirus) transmitted by Aedes mosquitoes Virus has a monkey or human reservoir High fever, black vomitus, and jaundice Flavi=yellow
Rotavirus
the most important cause of global infantile gastroenteritis
segmented dsRNA virus (reovirus)
major cause of acute diarrhea in the US during winter, especially in day care settings, kindergartens
villous destruction with atrophy leads to decreased absorption of Na and loss of K
ROTAvirus=Right Out The Anus
CDC recommend vaccine for all infants
Influenza virus
Orthomyxovirus
enveloped, negative ssRNA, 8 segments
contain hemagglutinin (promotes viral entry) and neuraminidase (promotes progeny virion release) antigens.
patients at high risk for fatal bacterial superinfection
rapid genetic changes
Genetic shift/antigenic shift
causes pandemics
reassortment of viral genome; segments undergo high-frequency recombination such as when human flu A virus recombines with swine flu A virus
Genetic drift
causes epidemics
minor changes based on random mutation
Rubella virus
Togavirus
AKA german measles
fever, postauricular and other lymphadenopathy, arthralgias, fine rash
causes mild disease in children but serious congenital disease (ToRCHes)
Congenital rubella findings include blueberry muffin appearance, indicative of extramedullary hematopoiesis, cataracts, deafness, PDA
Paramyxovirus diseases
parainfluenza (croup), mumps, measles, as well as RSV, which causes respiratory tract infection (bronchiolitis, pneumonia) in infants (fever, labored breathing, expiratory wheezes, tachypnea, tachycardia)
all contain surface F (fusion) protein which causes respiratory epithelia cells to fuse and form multinucleated cells
Palivizumab is treatment
Palivizumab
monoclonal antibody against F protein
prevents pneumonia caused by RSV infection in premature infants
Measles Virus
a paramyxovirus
koplik spots and descending maculopapular rash are characteristic
SSPE (subacute sclerosing panencephalitis)
giant cell pneumonia (rare, in immune suppressed)
3 C’s of measles: Cough Coryza (swelling of mucous membranes in nose) Conjunctivitis
Vitamin A used to prevent severe exfoliative dermatitis in malnourished children
SSPE
subacute sclerosing panencephalitis
occurs 6 or more years after measles virus (Get measles before 2 years of age)
spasticity, ataxia, coma, behavior changes, increased immunoglobulins in CSF
Mumps virus
Paramyxovirus
Parotitis, Orchitis, aspectic Meningitis
Can cause sterility
Mumps makes your parotid glands and tests as big as POM-poms.
syncytia
giant multi nucleated cells
will show up from viruses of paramyxovirus and herpesvirdae viruses
is a mechanism of immune system
Rabies virus
bullet shaped virus
get negri bodies in purkinje cells of cerebellum and in hippocampal neurons
weeks to months incubation period
Give rabies immune globulin
travels to CNS by migrating retrograde fashion up axons
Progression of disease: fever, malaise, agitation, photophobia, hydrophobia, paralysis, coma, then death
SKUNKS, raccoon, bat
HAV
hep A RNA picornavirus fecal oral transmission no carrier weeks of incubation usually asymptomatic
HBV
Hep B
DNA hepadnavirus
parenteral, sexual, maternal-fetal spread
there are carriers
months of incubation
increased risk of HCC (hepatocellular carcinoma), integrates into host DNA and acts as oncogene
HCV
Hep C (Chronic, Cirrhosis, Carcinoma, Carrier)
RNA flavivirus
Primarily blood transmission
There are carriers
long incubation
increased HCC risk from chronic inflammation
HDV
Hep D (Defective, Dependent on HBV)
RNA delta virus
Parenteral, sexual, maternal-fetal spread
there are carriers
co infected (long incubation) or super infected (short incubation, bad prognosis)
increased HCC risk
HEV
RNA hepevirus (Enteric, Expectant mothers, Epidemic)
spread Fecal-oral, especially with waterborne epidemics
there are no carriers
short incubation
no increased HCC risk
High mortality in pregnant women
Anti-HAV IgM
IgM antibody to HAV; best test to detect active Hep A
anti-HAV IgG
IgG antibody to detect prior HAV infection and/or prior vaccination; protects against reinfection
HBsAg
antigen found on surface of HBV; indicates hep B infection
Anti-HBs
antibody to HBsAg; indicates immunity to hep B
HBcAg
antigen associated with core of HBV
Anti-HBc
antibody to HBcAg; IgM=acute/recurrent infection; IgG= prior exposure or chronic infection. positive during window period
HBeAg
A second, different antigenic determinant in the HBV core. HBeAg indicates active viral replication and therefore high transmissibility
Anti-HBe
antibody to HBeAg; indicates low transmissibility
Chlamydia infection causes inflammatory pelvic disease. This predisposes females to:
ectopic pregnancy with tubular rupture. The infection caused inflammation and scarring due to type 4 hypersensitivity and all that damage can lead to ectopic pregnancy. Eventually ectopic pregnancy leads to rupture
HIV: all of its major proteins and genes that give it virulence
Diploid genome (2 RNA molecules) env gene (codes for gp120 and pg41): formed from the cleavage of gp160 to form envelope glycoproteins, gp120 is for attachment to the host CD4+ t cell, gp41 is for fusion and entry gag gene (codes for p24): for capsid protein pol gene (reverse transcriptase, asparate protease, integrase): RT synthesizes dsDNA from RNA; dsDNA integrates into host genome. Virus binds CCR5 (early) or CXCR4 (late) co receptor and CD4 on T cells; binds CCR5 and CD4 on macrophages. U
How to diagnose HIV
Presumptive diagnosis made with ELISA (sensitive, high false positive rate and low threshold, rule out test); + results are confirmed with western blot assay (specific, high false negative rate and high threshold, rule in test).
Viral PCR load will give you prognosis
AIDS is confirmed HIV with
Prion diseases
are caused by conversion of a normal (usually alpha helix) protein termed prion protein (PrPc) to a beta pleated form (PrPsc), which is transmissible. PrPsc resists protease degradation and facilitates the conversion of still more PrPc to PrPsc. Accumulation of PrPsc results in spongiform encephalopathy and dementia, ataxia, and death. It can be sporadic (creutzfeldt-jakob disease) or inherited (Gerstmann-Straussler-Scheinker syndrome), or acquired, (kuru).
What is the normal flora of the skin
S epidermidis
What is the normal flora of the nose
S epidermidis and S. aureus
What is the normal flora of the oropharynx
Viridans strep
What is the normal flora of dental plaque
S. mutans
What is the normal flora of colon
B fragilis > e coli
What is the normal flora of Vagina
Lactobacillus, colonized by E coli and group B strep
Bugs causing food poisoning, what do you get it from: B. cereus
Reheated rice. “Yes, and B. serious about it, it sucks.”
Bugs causing food poisoning, what do you get it from: C. botulium
Improperly canned foods (bulging cans is a sign…haha…bulging cans…..haha…C her BODulium…haha)
Also alkaline canned foods like veggies
Bugs causing food poisoning, what do you get it from: C. perfringens
reheated meat dishes
Bugs causing food poisoning, what do you get it from: E coli 0157:H7
Undercooked meat
Bugs causing food poisoning, what do you get it from: Salmonella
Poultry, meat and eggs
Bugs causing food poisoning, what do you get it from: S. aureus
Meats, mayonnaise, custard; preformed toxin
Bugs causing food poisoning, what do you get it from: V parahaemolyticus and V. vulnificus
contaminated seafood
vulnificus can also cause wound infections just by touching contaminated food with open cut
What bugs cause bloody diarrhea
campylobacter, E. histolytica, Enterohemorrhagic E coli, enteroinvasice E. coli, salmonella, shigella, Y enterocolitica
What bugs cause bloody diarrhea
C diff, C perfringens, Enterotoxigenic e coli, protozoa, v cholerae, some viruses.
Most common cause of pneumonia in neonates less than 4 weeks old
Group B strep (S. agalactiae)
E. coli
Most common cause of pneumonia in children 4 weeks to 18 years old
Virus (RSV), Mycoplasma, C. trachomatis (infants to 3 years old), C. pneumoniae (school age), S. pneumoniae, (Runts May Cough Chunky Sputum)
Most common cause of pneumonia in Adults (18 to 40)
Mycoplasma, C. pneumoniae, S. pneumoniae
Most common cause of pneumonia in Adults (40-65
S. pneumoniae, H. influenzae, Anaerobes, Viruses, Mycoplasma
Most common cause of pneumonia in Elderly 65+
S. pneumoniae, Influenza virus, Anaerobes, H. influenzae, Gram-negative rods
Most common cause of pneumonia in Alcoholic/IV drug users
S. pneumoniae, Klebsiella, Staphylococcus
Most common cause of pneumonia in Aspiration
Anaerobes (bacteriodes, peptococcus, fusobacterium), will be foul smelling sputum that is rust colored (these are the normal flora being thrown up and getting into the lung. Look for patient who goes unconscious.
Most common cause of pneumonia in atypical pneumonia
Mycoplasma, Legionella, Chlamydia
Most common cause of pneumonia in Cystic Fibrosis
Pseudomonas, S. aureus, S. pneumoniae
Most common cause of pneumonia in Immunocompromised
Staphylococcus, enteric gram negative rods, gungi, virsuses, P jirovecii (HIV)
Most common cause of pneumonia in nosocomial infections
staph, pseudomonas, other enteric gram negative rods
Most common cause of pneumonia in Post-viral pneumonia infections
Staph, H. influenzae, S. pneumoniae
Common causes of meningitis for New born (0-6 months)
Group B strep, E coli, Listeria
Common causes of meningitis for Children (6 months to 6 years)
S pneumoniae, N meningitids, H influenzae type B, Enteroviruses
Common causes of meningitis for 6 to 60 year olds
S. Pneumoniae, N meningitidis (#1 in teens), Enteroviruses, HSV
Common causes of meningitis for 60+ year olds
S. pneumoniae, gram negative rods, listeria
Medication you give empirically for meningitis
Give ceftriaxone, vancomycin, and add ampicillin if listeria is suspected
Viral causes of meningitis
enterociruses, HSV-2, HIV, West nile virus, VZV,
What are the common causes of meningitis in HIV patients
Cryptococcus, CMV, toxoplasmosis (brain abscess), JC virus (PML)
CSF fundings in bacterial meningitis
Increase opening pressure
Increase PMNs
increased protein
decreased sugar
CSF findings in fungal or TB meningitis
Increased opening pressure
increased lymphocytes
increased protein
decreased sugar
CSF findings in viral meningitis
normal to increased opening pressure
increased lymphocytes
Normal to increased proteins
normal sugar
Most likely cause of Osteomyelitis if patient has: no risk factors
assume S. aureus
Most likely cause of Osteomyelitis if patient is sexually active
Neisseria gonorrhoeae (rare), septic arthritis more common
Most likely cause of Osteomyelitis if patient has: diabetes
Pseudomonas aeruginosa, Serratia
Most likely cause of Osteomyelitis if patient has: IV drug users
Pseudomonas aeruginosa, Serratia
Most likely cause of Osteomyelitis if patient has: Sickle cell
Salmonella
Most likely cause of Osteomyelitis if patient has: Prosthetic joint replacement
S. aureus and S epidermidis
Most likely cause of Osteomyelitis if patient has: Vertebral involvement
Mycobacterium tuberculosis (Pott disease)
Most likely cause of Osteomyelitis if patient has: Cat and dog bites
Pasteurella multocida
UTI presentation
dysuria, frequency, urgency, suprapubic pain, and WBCs (but not WBC casts) in urine.
UTI diagnosis
Leukocyte esterase test + means bacterial UTI; nitrite test + means gram negative bacterial UTI
UTi urease test positive means most likely what bugs
proteus or klebsiella
UTI bugs: E coli
Leading cause of UTI, colonies show green metallic sheen on EMB agar, negative urease test, positive nitrite test
UTI bugs: Staphylococcus saprophyticus
2nd leading cause of UTI, in sexually active women, urease test negative, nitrite test negative
UTI bugs: Klebsiella pneumoniae
3rd leading cause of UTI, large mucoid capsule and viscous colonies
Urease test +
UTI bugs: Serratia marcescens
some strains produce a red pigment; often nosocomial and drug resistant
UTI bugs: Enterobacter cloacae
often nosocomial and drug resistant
UTI bugs: Proteus mirabilis
motility causes “swarming” on agar; produces urease; associated with struvite stones.
UTI bugs: pseudomonas aeruginosa
blue-green pigment and fruity odor; usually nosocomial and drug resistant.
Bacterial Vaginosis
No inflammation, thin, white discharge with fishy odor
See clud cells and a pH > 4.5
Treat: metronidazole
Trichomoniasis vaginal infection
Inflammation, frothy, grey-green foul smelling discharge
Motile trichomonads with a pH > 4.5
treat: metronidazole and make sure you treat sexual partner
Candida vulvovaginitis:
Inflammation, thick, white, “cottage cheese” discharge
Pseudohyphae
pH is normal (4 to 4.5)
treat with -azoles
Factors that increase chance of getting this infection: diabetes (Increase sugar in secretions), antibiotic use, increase estrogen levels, immune compromised
ToRCHeS infections: what is it, how do you get it, symptoms
microbes that may pass from mother to fetus. Transmission is tranplacental in most cases, or via delivery (especially HSV-2). nonspecific signs common to many ToRCHeS infections include hepatosplenomegaly, jaundice, thrombocytopenia, and growth retardation. Other agents: Strep Agalactiae, E coli, Listeria monocytogenes, all cause meningitis in neonates. Parvovirus B19 causes hydrops fetalis.
ToRCHeS infection: Toxoplasma gondii
get it from Cat feces or ingestion of undercooked meat
Mom’s manifestions: usually none, rarely lymphadenopathy
Neonatal manifestions: Classic triad: chorioretinitis, hydrocephalus, and intracranial calcifications
ToRCHeS infection: Rubella
Transmission: respiratory droplets
mom symptoms: rash, lymphadenopathy, arthritis
Neonatal symptoms: Classic triad: PDA (or pulmonary artery hypoplasia), cataracts, and deafness +/- blueberry muffin rash
ToRCHeS infection: CMV
Transmitted via sexual contact or organ transplant
Mom symptoms: Rash, lymphadenopathy, arthritis
Neonatal symptoms: Hearing loss, seizures, petechial rash, blueberry muffin rash (lots of cutaneous hemorrhages), calcifications in periventricular calcifications
ToRCHeS infection: HIV
Transmitted via sexual contact or needle stick
Maternal symptoms: Cariable presentation depending on CD4+ count
Neonatal manifestions: recurrent infections, chronic diarrhea
ToRCHeS infection: Herpes simplex virus 2
transmitted via skin or mucous membrane contact
mom symptoms: usually asymptomatic; herpetic vesicular lesions
Neonatal symptoms: encephalitis, herpetic vesicular rash
ToRCHeS infection: Syphilis
transmitted via sexual contact
Maternal manifestations: chancre (primary) and disseminated rash (secondary) are the two stages likely to result in fetal infection
Neonatal manifestations: often results in stillbirth, hydrops fetalis; if child survives, presents with facial abnormalities (notched teeth, saddle nose, short maxilla), saber shins, CN VIII deafness
V. vulnificus
gram negative, comma, oxidase positive, rod, sensitive to acid
Causes: gastroenteritis, cellulitis
treat: tetracycline, 3rd generation cephalasporin
Red rashes of childhood: Coxsackievirus type A
Hand foot mouth disease
Vesicular rash on palms and soles; vesicles and ulcers in oral mucosa
Red rashes of childhood: HHV-6
Roseola
A macular rash over body appears after several days of high fever; can present with febrile seizures; usually affects infants
Red rashes of childhood: Measles
Measles (Rubeola)
A paramyxovirus; beginning at head and moving down; rash is preceded by cough, coryza, conjunctivitis, and blue-white Koplik spots on buccal mucosa
Red rashes of childhood: Parvovirus B19
Erythema infectiosum (fifths disease) Slapped cheek rash on face; can cause hydrops fetalis in pregnant women; adults get swollen joints mostly in hands and wrists
Red rashes of childhood: Rubella virus
Rubella
Rash begins at head and moves down; leads to fine truncal rash; postauricular lymphadenopathy
Red rashes of childhood: Streptococcus pyogens
Scarlet fever
Erythematous, sandpaper like rash with fever and sore throat
Red rashes of childhood: VZV
Chickenpox
Vesicular rash begins on trunk; spreads to face and extremities with lesions of different ages
Sexually transmitted diseases: AIDS
spread by HIV
leads to opportunistic infections, Kaposi sarcoma, lymphoma
Sexually transmitted diseases: Chancroid
from Haemophilus ducreyi (so painful you do cry)
Painful genital ulcer, inguinal adenopathy, starts as papule then painful genital ulcer;
Sexually transmitted diseases: Chlamydia
From chlamydia trachomatis (D-K)
causes urethritis, cervicitis, conjunctivitis, reactive arthritis, Pelvic inflammatory disease
Sexually transmitted diseases: Condylomata acuminata
From HPV-6 and 11
Causes genital warts and koilocytes
Sexually transmitted diseases: Genital herpes
from HSV-2, less commonly HSV-1
Painful penile, vulvar, or cervical vesicles and ulcers; can cause systemic symptoms such as fever, headache, myalgia
Sexually transmitted diseases: Gonorrhea
from neisseria gonorrhoeae
Causes Urethritis, cervicitis, PID, prostatitis, edidiymitis, arthritis, creamy purulent discharge
Sexually transmitted diseases: Hepatitis B
from HBV
causes jaundice
Sexually transmitted diseases: Lymphogranuloma venereum
Caused by C. trachomatis (l1-l3)
infectino of lymphatics; painless genital ulcers, painful lymphadenopathy (i.e. buboes)
Sexually transmitted diseases: primary syphilis
From Treponema pallidum
Painless chancre
Sexually transmitted diseases: secondary syphilis
From Treponema pallidum
fever, lymphadenopathy, skin rashes, condylomata lata
Sexually transmitted diseases: tertiary syphilis
From Treponema pallidum
Gummas, tabes dorsalis, general paresis, aortitis, Argyll Robertson pupils
Sexually transmitted diseases: Trichomoniasis
From Trichomonas vaginalis
Causes vaginitis, strawberry cervix, motile in wet prep
Pelvic inflammatory disease: Top causative bugs
Chlamydia trachomatis (subacute, often undiagnosed, the most common bacterial STD in the US), Neisseria gonorrhoeae (acute),
Pelvic inflammatory disease
Cervical motion tenderness (chandelier sign), purulent cervical discharge. PID may include salpingitis, endometritis, hydrosalpinx, and tubo-ovarian abscess. Can lead to Fitz-High-Curtis syndrome- infection of the liver capsule and violin string adhesions of peritoneum to liver
Salpingitis is a risk factor for ectopic pregnancy infertility, chronic pelvic pain and adhesions.
Nosocomial infections: Candida albicans, risk factors
hyperalimentation
Nosocomial infections you are at risk for in a Newborn nursery
CMV and RSV
Nosocomial infections you are at risk for urinary catheterizations
E. coli, Proteus mirabilis, the second most common causes of nosocomial infections are E coli and S aureus
Nosocomial infections you are at risk for if you work in renal dialysis unit
HBV
Nosocomial infections you are at risk for if there are water aerosols being used
Legionella
Nosocomial infections you are at risk for if your use respiratory therapy equipment
Pseudomonas aeruginosa, presume pseudomonas “airuginosa” when air or burns are involved
What bugs do you think of when you hear: asplenic patients (due to splenectomy or autosplenectomy, e.g.,, chronic sickle cell anemia)
Encapsulated microbes, especially SHiN (S. pneumoniae»_space; H. influenzae type B > N. Meningitidis)
What bugs do you think of when you hear: Branching rods in oral infection, sulfur granules
actinomyces israelii
What bugs do you think of when you hear: Chronic Granulomatous disease
Catalase positive mucrobies, especially S. aureus
What bugs do you think of when you hear: Currant Jelly sputum
Klebsiella, see lobar cavitation on x ray
What bugs do you think of when you hear: Dog or cat bite
Pasteurella multocida
What bugs do you think of when you hear: Facial nerve palsy
Borrelia burgdorferi (lymes disease)
What bugs do you think of when you hear: Fungal infection in diabetic or immunocompromised patient
Mucor or Rhizopus spp.
What bugs do you think of when you hear: health care provider that is sick
HBV from needlestick (I guess you just assume the stuck themselves……)
What bugs do you think of when you hear: Neutropenic patients
Candida albicnas (Systemic), Aspergillus
What bugs do you think of when you hear: Organ transplant recipient
CMV
What bugs do you think of when you hear: PAS positive
Tropheryma whippleu (whipple disease)
What bugs do you think of when you hear: Pediatric infection
Haemophilus influenzae (including epiglottitis)
What bugs do you think of when you hear: Pus, empyema, abscess
S. aureus
What bugs do you think of when you hear: Rash on hands and feet
Coxsackie A virus, Treponema pallidum, Rickettsia rickettsii
What bugs do you think of when you hear: sepsis/meningitis in newborn
Group B strep
What bugs do you think of when you hear: Surgical wound
S aureus
What bugs do you think of when you hear: Traumatic open wound
Clostridium perfringens
Penicillin G, V
G is IV and IM, V is oral
Binds penicillin-binding proteins (transpeptidases). Block transpeptidase cross-linking of peptidoglycan. Activate autolytic enzymes
Used: mostly used for gram positive bugs (S. pneumoniae, S. pyogenes, Actinomyces), N. Meningitids, T. pallidum. Bactericidal for gram + cocci, gram + rods, gram - cocci, and spiorchetes.
Toxicity: hypersensitivity reactions, hemolytic anemia
Resistance: penicillinase in bacteria cleaves beta lactam ring
Aminopenicillins
Ampicillin , amoxicillin
Mechanism: same as penicillin, wider spectrum
Use: H. influenzae, E coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci
Toxicity: hypersensitivity reactions; rash; pseudomembranous colitis (C. diff)
Resistance: penicillinase
Penicillinase-resistant penicillins
Oxacillin, nafcillin, dicloxacillin
Mechanism: same as penicillin, narrow spectrum, resistant because due to bulky R group
Clinical use: S. aureus (except MRSA; resistant because o faltered penicillin-binding protein target site)
Toxicity: hypersensitivity reactions, interstitial nephritis
Antipseudomonals
Ticarcillin, piperacillin
Mechanism: same as penicillin.
Clinical: Pseudomonas spp. and gram negative rods, susceptible to penicillinases
Beta lactamase inhibitors
Clavulanic Acid, Sublactam, Taxobactam
Added to penicillin antibiotics to prevent destruction from penicillinase.
Polymyxin B
Used for serious infections, given IV
For gram - bacilli, Pseudomonas aeruginosa, klebsiella
Binds LPS on membrane, acts as catatonic detergent, alters osmotic barrier
Nephrotoxicity
Cephalosporins: Mechanism
Beta-lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases. Bactericidal
Organisms NOT covered by cephalosporins are LAME: Listeria, Atypicals (chlamydia, mycoplasma), Mrsa, and Enterococci
Cephalosporins: 1st generation
Cefazolin, cephalexin
gram + cocci
for PEcK: Proteus mirabilis, E coli, Klebsiella pneumoniae
Cefazolin used prior to surgery to prevent S. aureeus wound infections
Cephalosporins: 2nd generation
Cefoxitin, cefaclor cefuroxime
for gram + cocci (HEN PEcKS)
Haemophilus influenza, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. coli, Klebsiella pneumoniae, Serratia marcescens
Cephalosporins: 3rd generation
ceftriaxone, cefotaxime, ceftazidime
serious gram - infections resistant to other beta lactams
Ceftriaxone- for meningitis and gonorrhea
Ceftazidime- for Pseudomonas
Cephalosporins: 4th generation
cefepime
increases activity against Pseudomonas and gram + organisms
Cephalosporins: 5th generation
Ceftaroline
Broad gram + and gram - organism coverage
including MRSA; does not cover pseudomonas
Cephalosporins: toxicity
Hypersensitivity reactions, vitamin K deficiency, low cross-reactivity with penicillins. Increase nephrotoxicity of aminoglycosides
Aztreonam
Monobactum penicillin
Resistant beta lactamases. Prevent peptidoglycan cross-linking by binding to penicillin-binding protein 3. Synergistic with aminoglycosides. No cross-allergenicity with peniciliins
Uses: gram - rods, no activity against gram + or anaerobes. For penicillin allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides
Toxicity: usually nontoxic; occasional GI upset
Daptomycin
Works on gram +
treat skin/skin structure infectinos
given IV
no toxicity usually
rapid cell death, binds to membrane causes rapid depolarization
Gram postive only (MRSA and Vanco resistant)
REsistance is from positive charged lysines repelling drup
Carbapenems
Imipenem, meropenem, ertapenem, doripenem
imipenem is broad spectrum, beta lactamase resistant carbapenem. Always administered with cilastin (inhibitor of renal dehydropeptidase I) to decrease inactivation of drug in renal tubules
Uses: Gram + cocci, gram - rods, and anaerobes. wide spectrum but significant side effects so use when patient is about to die. Meropenem has a decreased risk of seizures and is stable to dehydropeptidase I.
Toxicity: GI distress, skin rash, and CNS toxicity (seizures) at a high plasma levels)
Vancomycin
Inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors. Bactericidal.
Clinical use: gram + only, serious, multi-drug resistant organisms, including MRSA, enterococci, and C diff
Toxicity: well tolerated in general but NOT trouble free. Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing- red man syndrome (can largely prevent by pretreatment with antihistamines and slow infusion rate)
Resistance: D-ala D-ala switches to D-ala D-lac
Bacitracin
Topical or IM Pain at IM, nephrotoxicity Cell wall inhibitor, prevent incorporation of peptidoglycans and lipopolysaccharides Used for gram + and gram - Not beta lactam
Food poisoning with S. aureus
Ham, potato salad, and pastries
has exotoxin A which produces nausea and vomiting in a few hours (3-6), with little to no diarrhea
aminoglycosides
gentamicin neomycin, amikacin, tobramycon, streptomycin
Mechanism: bactericidal; binds 30s, inhibits formation of initiation complex and cause misreading of mRNA. Also block translocation. Require 02 for uptake; therefore ineffective against anaerobes.
Uses: severe gram - rod infections. synergistic with beta lactam antibiotics
Toxicity: Nephrotoxicity (especially when used with cephalosporins), Neuromuscular blockade, Ototoxicity (especially when used with loop diuretics), Teratogen, ototoxic to fetus
Tetracyclines
Tetracycline, doxycycline, minocycline
Bacteriostatic: binds 30s, prevetns attachment of aminoacyl-tRNA’ limited CNS penetration, doxy is fecally excreted and can be used during renal failure. Do not take with Ca or Mg, or iron because divalent cations block absorption.
Uses:Borrelia burgdorferi, M pneumoniae, drugs ability to accumulate intracellularly makes it very effective against Rickettsia and Chlamydia, also used to treat acne.
Toxicity: Gi distress, discoloration of teeth and inhibition of bone growth in children, photosensitivity, contraindicated in pregnancy
Macrolides
Azithromycin, clarithromycin, erythromycin
Mechanism: inhibits protein synthesis by blocking translocation; binds to the 23s subunit of the 50s ribosomal subunit: bacteriostatic
Uses: atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STDs (Chlamydia), gram + cocci (Strep infections in penicillin allergic patients)
Toxicity: MACRO: gastrointestinal Motility issues, Arrhythmia caused by prolonged QT, acute Cholestatic hepatitis, Rash, eOsinophilia, increases serum concentrations of theophyllines-oral anticoagulants,
Clarithromycin is embryotoxic
Chloramphenicol
Blocks peptidyltransferase at 50s subunit: bacteriostatic
Uses: meningitis (H. flu, N. meningitidis, S. pneumoniae) and rocky mountain spotted fever (rickettsia rickettsii)
Limited use owing to toxicities but often still used in developing countries cause it’s cheap.
Toxicity: anemia (dose dependent), aplastic anemia (dose independent), gray baby syndrome (premature infants because they lack liver UDP-glucuronyl transferase)
Resistance arises from: plasmid encoded acetyltransferase inactivates the drug
Clindamycin
Blocks peptide transfer at 50s: bacteriostatic
Uses: anaerobic infections (e.g. bacteroides spp. Clostridium perfringens) in aspiration pneumonia, lung abscesses, and oral infections. also effective against invasive group A strep infections.
Toxicity: Pseudomembranous colitis (C diff overgrowth), fever, diarrhea
Clindamycin vs metronidazole
Clindamycin: treats anaerobes above the diaphragm vs metronidazole which treats below diaphragm
Sulfonamides
Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine
Mechanism: inhibit folate synthesis, para-aminobenzoic acid antimetabolites inhibit dihydripteroate synthase. bacteriostatic
Uses: gram +, gram -, Nocardia, chlamydia, triple sulfas or SMX for simple UTI
Toxicity: hypersensitivity, if G6PD then hemolysis, nephrotoxic (tubulointerstitial nephritis), photosensitivity, kernicterus in infants, displaces other drugs from albumin
Resistance arises from: altered enzyme (bacterial dihydropteroate synthase), decrease uptake, or increase PABA synthesis.
Trimethoprim
inhibits bacterial dihydrofolate reductase, bacteriostatic
Used in wombo combo with SMX, causing sequential blocking of folate synthesis. combination used for UTIs, Shigella, salmonella, pneumocystis jirovecii pneumonia treatment and prophylaxis, toxoplasmosis prophylaxis.
Toxicity: megaloblastic anemia, leukopenia, granulocytopenia, (may alleviate with supplemental folinic acid)
fluoroquinolones
-floxacin (like ciprofloxacin, moxifloxacin), and enoxacin, nalidixic acid
Inhibts DNA gyrase (topo 2) and topo 4, bactericidal.
Do not take with antacids cause the bind and prevent absorption
Uses: gram - rods in urinary and GI tracts, pseudomonas, Neisseria, some gram +
Toxicity: GI upset, superinfections, skin rashes, headache, dizziness, less commonly: tendonitis and rupture, leg cramps, myalgia. Can’t use in pregnant or breast feeding women due to potential cartilage damage. can prolong QT, tendon rupture mostly in old people on prednisone
Metronidazole
Forms free radical toxic metabolites in the bacterial cell that damage DNA, bactericidal, antiprotozoal
uses: treats GET GAP: Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (bacteriodes, c diff). part of triple therapy for h pylori.
toxicity: disulfiram-like reactions(severe flushing, tachycardia, hypotension) w/ alcohol; headache, metallic taste
Treatment and prophylaxis for: M tuberculosis
Prophylaxis: Isoniazid
Treatment: RIPE (rifampin, Isoniazid, Pyrazinamide, Ethambutol)
Treatment and prophylaxis for: M. avium and M. intracellulare
Prophylaxis: azithromycin or rifabutin
Treatment: Azithromycin or clarithromycin + ethambutol, can add rifabutin or ciprofloxacin
More drug resistant than M tuberculosis
Treatment and prophylaxis for: M leprae
No prophylaxis
Treatment: Jesus daps you on the head or Dapsone and rifampin for tuberculoid form but add clofazimine for lepromatous form
Isoniazid
Mechanism: decreased synthesis of mycolic acids, bacterial catalase-peroxide (encoded by KatG) need to convert INH to active metabolite
Uses: M. tuberculosis, and the only agent used in prophylaxis for TB
Toxicity: Neurotoxicity, Hepatotoxicity, Pyridoxine (B6) can prevent neurotoxicity, lupus
Rifamycins
Rifampin, rifabutin
Inhibits DNA-dependent RNA polymerase
uses: M tuberculosis, delays resistance to dapsone in leprosy, meningococcal prophylaxis and chmoprophylaxis in contacts of children with H influenzae type B
Toxicity: minor hepatotoxicity and increase p450, orange body fluids, Rifabutin used over rifampin in patients with HIV infection due to less cytochrome p450 stimulation.
Pyrazinamide
mechanism: uncertain, thought to acidify intracellular environment via conversion to prazinoic acid. effective in acidic pH of phagolysosomes, where TB engulfed macrophages is found
Clinical use: mycobacterium tuberculosis
Toxicity: Hyperuricemia, hepatotoxicity
Ethambutol
Mechanism: decrease polymerization of mycobacterium cell wall by blocking arabinosyltransferase
Uses: mycobacterium tuberculosis
Toxicity: optic neuropathy (red-green color blindness)
Antimicrobial prophylaxis for: endocarditis w/ surgical or dental procedures
penicillins
Antimicrobial prophylaxis for: Gonorrhea
Ceftriaxone
Antimicrobial prophylaxis for: History of recurrent UTIs
TMP-SMX
Antimicrobial prophylaxis for: Meningococcal infections
Ciprofloxacin is choice drug, rifampin for kids
Antimicrobial prophylaxis for: pregnant women carrying group b strep
Ampicillin
Antimicrobial prophylaxis for: prevention of gonococcal or chlamydial conjunctivitis in newborn
Erythromycin ointment
Antimicrobial prophylaxis for: Prevention of post-surgical infection due to S. aureus
Cefazolin
Antimicrobial prophylaxis for: Prophylaxis of strep pharyngitis in child with prior rheumatic fever
oral penicillin
Antimicrobial prophylaxis for: Syphilis
Benzathine penicillin G
Antimicrobial prophylaxis for: HIV patient with
TMP-SMX to prevent pneumocystis pneumonia
Antimicrobial prophylaxis for: HIV patient with CD4+ t cells
TMP-SMX to prevent pneumocystis pneumonia and toxoplasmosis
Antimicrobial prophylaxis for: HIV patient with CD4+ t cells
Azithromycin to prevent mycobacterium avium complex
Treatment for MRSA infection
Vancomycin, daptomycin, linezolid, tigecycline, ceftaroline
what side effect can linezolid cause
serotonin syndrome
treatment for VRE
Linezolid and streptogramins (quinupristin/dalfopristin)
Amphotericin B
Mechanism: binds ergosterol (unique to fungi) and form membrane pores that allow leakage of electrolytes
Uses: serious systemic mycoses, cryptococcus, blastomyces, coccidioides, histoplasma, candida, mucor. Intrathecally for fungal meningitis. Give with K+ and Mg2+ because of altered renal tubule permeability
Toxicity: fever, chills, hypotension, nephrotoxicity, arrhythmias, anemia, IV phlebitis. Hydration decreases nephrotoxicity, liposomal amphotericin decreases toxicity.
Nystatin
Mechanism: same as amphotericin B. Topical for because it is too toxic for systemic use
Use: swish and swallow for oral candidiasis; topical for diaper rash or vaginal candidiasis
Azoles
-azoles (fluconazole, ketoconazole, itraconazole…..)
Mechanism: inhibit fungal sterol (ergosterol) synthesis by inhibiting p-450 that converts lanosterol to ergosterol
UsesL local and serious systemic mycoses, fluconazole for chronic suprresion of cryptococcal meningitis in AIDS patients and candidal infections of all types. Itraconazole for blastomyces, Coccidioides, Histoplasma. Clotrimazole and miconazole for topical fungal infections. Voriconazole for aspergillus in immunocompromised.
Toxicity: testosterone synthesis inhibitor (gynecomastia, esp. w/ ketoconazole, liver dysfunction (inhibits p450)
Flucytosine
Mechanism: inhibits DNA and RNA biosynthesis by conversion to 5-fluorouracil by cytosine deaminase
Use: systemic fungal infections (esp. meningitis caused by cryptococcus) in combination with amphotericin B
Toxicity: bone marrow suppression
Echinocandins
-fungin (Caspofungin, micafungin, anidulafungin)
Mechanism: inhibits cell wall synthesis by inhibiting synthesis of beta-glucan.
Uses: invasive aspergilloisis, candida
Toxicity: GI upset, flushing (by histamine release)
Terbinafine
Mechanism: inhibits the fungal enzyme squalene epoxidase
Use: Dermatophytoses (especially onychomycosis- finger and toe nails)
Toxicity: GI upset, headaches, hepatotoxicity, taste disturbance
Griseofulvin
Mechanism: interferes with microtubule function; disrupts mitosis/ Deposits in keratin-containing tissues (e.g. nails)
Uses: oral treatment of superficial infections; inhibits growth of dermatophytes (tinea, ringworm), Teratogenic
Antiprotozoan therapy for toxoplasmosis
Pyrimethamine
Antiprotozoan therapy for trypanosoma brucei
Suramin and melarsoprol
Antiprotozoan therapy for t. cruzi
nifurtimox
Antiprotozoan therapy for leishmaniasis
sodium stibogluconate
Chloroquine
Mechanism: blocks detoxification of heme into hemozoin. Heme accumulates and is toxic to plasmodia.
Uses: treatment of plasmodial species other than P. falciparum. For life threatening malaria, use quinidine in US or artesunate
Toxicity: Retinopathy; prurititus (Especially in dark-skinned individuals)
Treatment for P falciparum
do not use chloroquine (frequency of resistance in P falciparum is too high). resistance due to membrane pump. Treat falciparum with artemether/lumefantrine or atovaquone/proguanil.
Antihelminith therapy
Mebendazole, pyrantel pamoate, ivermectin, diethylcarbamazine, prazinquantel
Works to immobilize helminths. Use praziquantel against flukes (trematodes) such as Schistosoma
Zanamivir, oseltamivir (-mivir)
antiviral
Mechanism: inhibit influenza neuraminidae leading to decreases in the release of progeny virus
Uses: treatment and prevention of influenza A and B
Ribavirin
antiviral
Inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase
toxicity: hemolytic anemia, severe teratogen
Acyclovir, Famciclovir, valacyclovir
Mechanism: monophosphorylated by HSV/VZV thymidine kinase and not phosphorylated in uninfected cells (so less side effects). Guanosine analog. Triphosphate formed by cellular enzymes. Preferentially inhibits viral DNA polymerase by chain termination
Toxicity: Obstructive crystalline nephropathy and acute renal failure if not hydrated
Ganciclovir
Mechanism: 5’ monophosphate formed by a CMV viral kinase. Guanosine analog. Triphosphate formed by cellular kinases. Preferentially inhibits viral DNA polymerase
Uses: CMV, especially in immunocompromised patients. Valganciclovir, a prodrug of ganciclovir, has better oral bioavailability
Toxicity: leukopenia, neutropenia, thrombocytopenia, renal toxicity. more toxic to host enzymes than acyclovir
Resistance comes from mutated CMV DNA polymerase or lack of viral kinase
Foscarnet
Mechanism: viral DNA polymerase inhibitor that binds the pyrophosphate-binding site of the enzyme. Does not require activation by viral kinase
Uses: CMV retinitis in immunocompromised patients when ganciclovir fails; acyclovir resistant HSV
Toxicity: nephrotoxicity
Resistance comes from mutated DNA polymerase
Cidofovir
Mechanism: preferentially inhibits viral DNA polymerase. Does not require phosphorylation by viral kinase.
Uses: CMV retinitis in immunocompromised patients; acyclovir resistant HSV. long half life
Toxicity: nephrotoxic (given with probenecid and IV saline to decrease toxicity)
HIV therapy overview
HAART: highly active antiretroviral therapy: given when patient presents with AIDS-defining illness, low CD4 count(
Protease inhibitors
-Navir tease a protease
Mechanism: assembly of virions depends on HIV-1 protease (pol gene), which cleaves the polypeptide products of HIV and mRNA into their functional parts. Thus, protease inhibitors prevent maturation of new viruses. Ritonavir can boost other drugs concentrations because it blocks p450
Toxicity: hyperglycemia, GI intolerance, lipodystrophy, Nephropathy, hematuria (indinavir)
NRTIs: name them
Abacavir, emtricitabine, lamivudine, stavudine, tenofovir, Zidovudine, and Didanosine
The magician did all the tricks and voodoo for the ten people
NRTIs: mechanism
Competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain (lack a 3’ OH). Tenofovir is a NucleoTide and all the others are nucleosides and need to be phosphorylated. Zidovudine is used for general prophylaxis and during pregnancy to decrease risk of fetal transmission
NRTIs: Toxicity
Bone marrow suppression (reversed w/ granulocyte colony stimulating factor and erythropoietin), peripheral neuropathy, lactic acidosis (nucleosides), rash (nucleosides), anemia (zido), pancreatitis (didanosine)
NNRTIs: Names
Efavirenz, Nevirapone, Delavirdine
Do a nerdy a favor and travel to Nevada and Delaware.
NNRTIs: Mechanism
bind reverse transcriptase at site different from NRTIs. Do not require phosphorylation to be active or compete with nucleotides.
NNRTIs: Toxicity
Rash and hepatotoxicity. Vivid dreams and CNS symptoms are common with efavirenz. Delaviridein and efavirenz are contraindicated in pregnancy.
Integrase inhibitor
Raltegravir (tegra)
Inhibits HIV genoma integration into host cell chromosome by reversibly inhibiting HIV integrase
Toxicity is hypercholesterolemia
Fusion inhibitors
Enfuvirtide (ENFUsion inhibitor), Maraviroc (CCR is a rock band)
Mechanism: enfuvirtide binds gp41 inhibiting entry, maraviroc is a CCR-5 binder on the surface of t cells/monocytes, inhibiting interaction with gp120
Toxicity: skin reaction at injection site
Interferons (the drug, not the natural form)
Mechanism: glycoproteins normally synthesized by virus-infected cells, exhibiting a wide range of antiviral and antitumoral properties
Uses: IFN-alpha-chronic hepatitis B and C, Kaposi sarcoma, hairy cell leukemia, condyloma acuminatum, renal cell carcinoma, malignant melanoma.
IFN-beta: Multiple sclerosis
IFN-gama: chronic granulomatous disease
Toxicity: Neutropenia, myopathy
Name the antibiotics to avoid in pregnancy
SAFe Children Take Really Good Care
Sulfonamides, Aminoglycosides, Fluoroquinolones, Clarithromycin, Tetracycline, ribavirin, Griseofulvin, Chloramphenicol
Traveler’s diarrhea
E coli, shigella, campylobacter are the most common cause
treat with fluoroquinolone (most ciprofloxacin)
Bartonella henselae
Cat scratch fever; Only affects immune compromised and pregnant; regional lymphadenopathy with stellate granulomas on biopsy of lymph nodes; fever alternating with chills is commona
All DNA viruses are icosahedral except
Poxvirus family
All DNA viruses replicate in the nucleus except
Poxvirus family
Lipid A
is part of the LPS of gram negative bacteria. It is the most toxic portion of LPS. Causes release of IL-1 and 6, TNF.
Burn patients with necrotic lesions. What bug.
pseudomonas aeruginosa (gram negative rod, oxidase positive, has exotoxin A that inhibits EF-2 like diphtheria)
Lysogenic conversion
lysogenic conversion makes it so exotoxins of bacteria can cause their symptoms. Only certain bacteria need to do this. COBEDS is the way to remember: Cholera toxin, O antigen of Salmonella, botulinum toxin, Strep pyogenes toxin, Diphtheria toxin, Shiga toxin
Brucella abortus
Get undulant fever (spiking high fevers with sweats that come and go); chronic infection in nature; think unpasteurized milk and cheese or people who work with cattle.
In a female patient with a IUD placed and an infection think….
Actinomyces israelli; gram positive rod anaerobic rod, makes yellow sulfur granules, causes cerviocfacial, female reproductive and GI infections.
Hantavirus
think SW USA, exposure to rodent poop, and has acute respiratory distress
Causes of impetigo
Strep Pyogenes (honey crusted lesions) or Staph aureus (blister like lesions)
Dermacentor tick trasmitts what
Rickettsia (RMSF) and tularemia
Schuffner dots tell you what
Plasmodium Vivax or Ovale malaria; they are round bodies inside of infected erythrocytes.
Tonsillar abscess, how should you treat?
Likely a gram negative rod so give them some clindamycin (50s inhibitor)
Needle stick injury in the US is most likely to give you what disease
Hep C
