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Bacteria > Streptococcus and Enterococcus > Flashcards

Streptococcus and Enterococcus Flashcards

1
Q

What are the 4 important Streptococcus?

A 
Strep pyogenes (Strep A)
Strep agalactiae (Strep B)
Strep anginosus
Strep mitis (includes S. pneumoniae)
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2
Q

B-hemolytic strepococci

A

Group A- S. pyrogenes
Group B- S. agalactiae
Group D- Enterococcus
Group F- S. anginosus or S milleri

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3
Q

Strep A types of infections

A

Suppurative: Pharyngitis, skin infections

Non-suppurative- rheumatic fever, RF disease, acute glomerulonephritis

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4
Q

Strep A virulence factors

A

Protein M
Capsule
Surface Adhesions: LTA, protein M, protein F

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5
Q

Strep A toxins

A

Hemolysins (Streptolysin O and S)
Hemolysin O- form antibodies to this toxin
Streptococcal Pyogenic Extotocins (SpeA, B,C)

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6
Q

Strep A enzymes

A

DNases, Hyaluronidases
Streptokinase - degrades fibrin, used as a medication
C5a peptidase
specB- cleaves IgG

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7
Q

Pharyngitis:
clinical features
diagnosis

A

Strep A- S. pyrogenes
clinical features: fever, NO cough, purulent exudate, cervical lymphadenopathy
diagnosis: Rapid antigen test, Culture
negative Rapid antigen test, must get culture

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8
Q

Pharyngitis treatment

complication if not treated

A

1st line: penicillin
2nd line: clindamycin or Macrolide (azithromycin, etc)
complication- scarlet fever

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9
Q

uncommon complication of Strep A infection (pharyngitis)?

clinical manifestations?

A

Scarlet Fever
usually due to GAS pharyngitis
due to Spec A and C exotoxins
trunk rash, strawberry tongue**, capillary fragility, desquamation of skin

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10
Q

Impetigo:
what 2 bacteria cause this
clinical manifestation
treatment options

A

S.aureus or S.pyogens
honesty colored crusting
topically: Bacitracin or Mupirocin
extensive disease: PO- amoxicillin-clavulanic acid or cephalexin

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11
Q

characteristic of B-hemolytic strepococcal infection?

A

Erysipelas: erythema, raised, sharp border

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12
Q

skin infections caused by GAS

A

Impetigo
Erysipelas
Cellulitis with lymphangitis
Necrotizing fascitis**

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13
Q

Complication of GAS skin infections?

A

Streptococcal toxic shock syndrome

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14
Q

GAS non-suppurative infections?

A

Rheumatic fever, Rheumatic heart disease

Acute glomerulonephritis

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15
Q

Acute Rheumatic fever: associated with what, incubation period?

A

10-30 days after GAS pharyngitits (not associated with skin infections)

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16
Q

Acute Rheumatic fever: clinical syndrome:

A

2 major OR 1 major +2 minor
major criteria: carditis, chorea, subcutaneous nodules, polyarthritis, erythema marginatum

Minor criteria: fever, 1st degree heart block, arthralgia, elevated CRP/ESR

AND evidence of recent infection with Strep

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17
Q

Rheumatic fever treatment: Symptoms, primary and secondary treatment

A

Symptoms: aspirin or corticosteroids

primary: treatment of pharyngitis (penicillins OR marcrolids/clindamycin)
secondary: penicillin G monthly or oral penicillin daily

18
Q

Post-streptococcal glomerulonephtritis?
incubation period?
associated with what infection?

A

1-2 weeks after pharyngitis
2-3 weeks after skin infection
associated with deposition of immune complex

19
Q

Strep B species?
most common infection in which age group?
colonizer of what?
onset?

A 
Streptococcal agalactiae
neonates
GI tract, female genital tract
early onset; in utero, at birth
late onset
20
Q

Strep B infection causes what?

A

sepsis, meningitis, or pneumonia

21
Q

Strep B diagnosis?

Strep B treatment?

A

culture or nucleic acid amplification test
1st line: penicillin
2nd line: vancomyocin or clindamycin

22
Q

S. anginosus
belongs to which group?
causes what?
what type of hemolysis?

A

belongs to bigger group S. milleri
Abscesses: liver, brain, peridontal
alpha, beta, or gamma hemolysis

23
Q 
Viridans Streptococci:
what hemolysis?
colonize what?
S. bovis?
treatment?
A

alpha and gamma hemolysis
mucosal surfaces NOT skin
S. bovis/S.gallolyticus = increase risk of colon cancer, do colonoscopy
treatment: penicillin or vancomycin (no penicillin for mitis group)

24
Q

Streptococci pneumoniae general characteristics

A

Viridans group, mitis group
Gram positive, catalase negative
Alpha-hemolysis

25
Q

Streptococci pneumoniae laboratory idendification

A

Alpha hemolysis
catalase negative
suseptible to optochin
solubility in bile salts

26
Q

S. pneumoniae virulence factors

A

Evasion of host immunity: capsule, Pneumolysin (lysis of phagocytic cells)

Adherence: phosphocholine, surface adhesion proteins

FEW toxins

27
Q

S. pneumoniae resistance

A

some resistance to penicillin (not anywhere near rates of other bacteria) mechanism: alteration of PBP
some resistance to macrolides, TMP/SMX
no resistance to fluoroquinolones

28
Q

S. pneumoniae pathogenesis?
where does S. pneumoniae cause infections?
What is a predisposing factor?

A

disease presents when S. pneumoniae moves from the oropharynx to normally sterile sites
lower airways= pneumonia or bronchitis
paranasal sinuses= sinusitis
ears= otitis
meninges= meningitis
viral infection precedes S. pneumoniae infection, trapping bacteria
bacteremia usually associated with pneumonia or meningitis

29
Q

Where does S. pneumoniae colonize?

A

Nasopharyx

30
Q

Otitis media cause and treatment

A

S.pneumoniae is most common cause
treatment: no treatment over 2 yrs with mild symptoms
more severe symptoms, amoxicillin

31
Q

Meningitis cause, treatment, diagnosis

A

S. pneumonia most common cause (2nd cause Neisseria gonorrhea)
Treatment: both Ceftriaxone and vancomycin (good CNS penetration)
Diagnosis: lumbar puncture

32
Q

Risk factors for S. pneumoniae infection?

A

lack of pneumococcal vaccine
splenectomy
immunodeficiencies (inability to form antibodies, PMN deficiency)
inflammatory condition- COPD, asthma, smoking

33
Q

Pneumonia treatment:

A

Ceftriaxone (to cover S. pneumoniae)

Macrolid (to cover atypicals)

34
Q

2 types of pneumococcal vaccinations

A

Prevnar- children

pneumovax- over 65yo

35
Q

Enterococcus general features

A

Gram positive in pairs and chains
Facultative anaerobes
E. faecium, E. faecalis

36
Q

Laboratory identification of Enterococci

A

Catalase negative
PYR positive
LAP positive

37
Q

Enterococci colonization

A

GI track

38
Q

Enterococci virulence factors

A

Antibiotic resistance**
inherent resistance: cephalosporins, semi-synthetic penicillins
acquired resistance: vancomycin, aminoglycosides, fluoroquinolones

other: surface proteins, cytolysins, proteases, Gis protein

39
Q

Treatment of E. faecalis

A

treatment of choice: ampicillin or penicillin

Endocarditis: ampicillin + aminoglycoside

40
Q

Treatment of E. Faecium

A

Treatment of choice: vancomycin
Endocarditis: vancomycin + aminoglycoside
if VRE: use Linezolid or daptomycin instead (both Gram positive, VRE)

41
Q

what infections do Enterococci cause?

A

Intra-abdominal and pelvic infections
UTIs
bacteremia
Endocarditis (along with S. aureus, psuedomonas)

42
Q

Enterococci UTI

A

Common in males

common in hospitalized patients with urinary catheter

Bacteria (16 decks)

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