Test 2 Flashcards by Julia Gumirov

What are enterobacteriaceae?

-enteric
-gram neg
-non-spore forming rods
-natural habitat is the intestinal tract of humans and animals

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What are the 2 types of enterobacteriaceae?

1) coliforms
2) non-coliforms

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What are coliform bacteria?

-type of enterobacteriaceae
-can be normal flora or pathogenic
-ferment lactose
-ex: E. Coli or K. Pneumoniae

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What is non-coliform bacteria?

-type of enterobacteriaceae
-can be normal flora or pathogenic
-non-lactose fermenters

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Is E.coli an enterobacteriaceae? If so, what type?

Yes, it’s a coliform bacteria

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What diseases are caused by E.coli?

-UTIs
-epidemic diarrhea of newborns
-opportunistic infections

All of these can happen when E.coli leaves the GI

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Is E. coli gram neg or pos? What shape is it? What is its significance?

-gram neg
-motile rod
-competitively discourages growth of possible pathogenic organisms in the colon

coli= colon

human colon contains E.coli as part of its normal flora, however other serotypes can be pathogenic and certain enteropathogenic strains are troublesome to newborns

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What is the #1 cause for UTIs in women?

e. coli

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What is enteroinvasive E. coli (EIEC)?

identical to shigellosis with profuse diarrhea and high fever

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What is enterotoxigenic E. coli (ETEC)?

E. coli penetrates the intestinal epithelium and produces 2 enterotoxins that causes gastroenteritis

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What is the most common bacterial form of “traveler’s diarrhea”?

enterotoxigenic E. coli (ETEC)

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What is enteropathogenic E. coli (EPEC)?

-infection occurring during birth
-important cause of diarrhea in infants especially when sanitation is poor

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What is enterohemorrhagic E.coli (EHEC, also called E. coli O157:H7)? What are its symptoms?

test q

-the most dangerous of pathogenic strains
-food-borne illness
-exists in the intestines of healthy cattle and causes no disease in these animals, but slaughtering them brings the pathogen to beef products
-major source of transmission is undercooked ground beef
-causes severe blood diarrhea
-uncomplicated cases resolve within 5-10 days

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What is hemolytic uremic syndrome?

caused by enterohemorrhagic E.coli (EHEC, also called E. coli O157:H7)

its in older adults, young children, or the immunocompromised that may develop complications involving the kidneys and leading to kidney failure

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What is the treatment for E. coli bacterial infections?

antibiotics

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What samples can be collected for E.coli diagnostics?

-urine sample will show its a gram neg bacteria
-stool sample

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How can you prevent E. coli infections?

-care in choosing food and water
-avoiding unpasteurized products
-thorough cooking of ground beef

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Proteus sp. are enterobacteriaceae. Are they coliform or non-coliform bacteria?

all 4 species are non-coliform

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What diseases are caused by Proteus sp.?

-UTIs
-bacteremia
-pneumonia
-focal lesions in debilitated patients

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Are the Proteus sp. gram neg or pos? What shape is it? Where are they considered normal flora?

-gram neg
-pleomorphic rods (pleomorphic= different forms, this bacteria was named after Greek God Proteus who took shape of many forms)
-found in intestinal tract
-produce infections only when bacteria leave the intestinal tract

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What is the pathogenicity of Proteus sp.?

-encountered most frequently in UTIs and wound infections
-seen usually in immunocompromised patients
-normal Proteus sp. are present in very small numbers in the intestinal tract
-at times it may be present in large numbers and cause disease which may be associated with excess oral antibiotic therapy
-proteus produces urease which makes the pH of urine more alkaline promoting stone formation (kidney stones)

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What is the treatment for Proteus sp.?

antibiotics

can first do blood work or urine sample to confirm

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Salmonella is comprised of 2 species. What are they?

1) salmonella enterica (human pathogen, subdivided into 6 subspecies and serotypes with unique virulence properties based on O antigen which is lipid A associated, H antigen which is a flagellar protein or Vi antigen which is a capsular polysaccharide bacteria)
2) salmonella bongori (animal pathogen)

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Are the salmonella species an enterobacteria?

yes

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Salmonella typhi is a subspecies for salmonella enterica. What disease does it cause and is it pathogenic?

-pathogenic
-causes typhoid fever (enteric fever)

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Salmonella typhi is a subspecies for salmonella enterica. Is S. typhi a gram neg or pos bacteria? What shape is it?

-gram neg bacteria
-rod shaped

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Salmonella typhi is a subspecies for salmonella enterica. S. typhi is motile with ______________ flagella

peritrichous

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Salmonella typhi is a subspecies for salmonella enterica. How is S. typhi transmitted?

via fecal oral route through contaminated food or water

typhoid Mary worked as a cook and was the first person in US identified as an asymptomaic carrier of this pathogen

the ingested organisms reach the small intestine, enter the lymphatics and then enters the blood stream to many organs

the organisms multiply in the intestinal lymphoid tissue and are excreted in stools

incubation period is 10-14 days

bacteria will enter lymphatic tissue in GI and multiply here which can penetrate bowel and cause digestive absorption problems and cause leaky bowel

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Salmonella typhi is a subspecies for salmonella enterica. Is S. typhi common in US?

no not anymore, due to good sanitation practices

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Salmonella typhi is a subspecies for salmonella enterica. What are the S&S of S. typhi?

-fever
-malaise
-headache
-constipation
-myalgia
-nausea
-abdominal pain
-rash called rose spots found on chest and abdomen

principle lesions are hyperplasia and necrosis of lymphoid tissue (peyer’s patches), hepatitis, necrosis of the liver, and inflammation of the gallbladder and other organs

following an infection, 5% continue to harbor and excrete organisms for a year or more without symptoms

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Salmonella typhi is a subspecies for salmonella enterica. Is S. typhi severe?

it can be

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Salmonella typhi is a subspecies for salmonella enterica. How is S. typhi diagnosed?

-primarily clinical
-blood and stool cultures within first week of onset (positive in 85-90% of cases)
-PCR test
-salmonella shigella (SS) agar favors growth of these organisms over other coliforms
-bismuth sulfite medium permits rapid detection of S. typhi, which forms black colonies from production of H2S
-widal test is an Ab aggulation test that will build clumps if serum has the bacteria in it
-serological testing is not definitive and is used only in poor areas of the world where blood cultures are not readily available

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What is the tx and prevention for S. typhi?

tx: antibiotics

prevention: vax for travelers

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Salmonella enterica ssp. Paratyphi A and B causes what disease?

paratyphoid fever (enteric fever)

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Is Salmonella enterica ssp. Paratyphi A and B gram neg or pos? What shape is it?

both are gram neg rods

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Salmonella enterica ssp. Paratyphi A and B both cause paratyphoid fever (enteric fever). What is it and how is it transmitted?

-causes enteric fever but the disease is milder and shorter duration than typhoid fever from S. typhi
-transmitted by means of contaminated water and food

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What disease does Salmonella enterica ssp. typhimurium cause?

septicemic enteric fever

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Is Salmonella enterica ssp. typhimurium gram neg or pos? What shape is it?

gram neg rod

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Who does Salmonella enterica ssp. typhimurium infect with septicemic enteric fever? How is it transmitted?

-cattle
-poultry
-pigs
-pets (turtles, parrots, etc)

the organisms almost always enters via the oral route, usually with contaminated food or drink

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What are the S&S for septicemic enteric fever caused from Salmonella enterica ssp. typhimurium? How is it treated?

-nausea
-diarrhea
-abdominal cramping
-septicemia

tx: antibiotics

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What disease is caused by salmonella enteritidis (salmonella enterica serotype enteritidis)?

salmonella gastroenteritis

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Is salmonella enteritidis (salmonella enterica serotype enteritidis) gram neg or pos? What shape is it?

gram neg rod

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What is the mode of transmission for salmonella enteritidis (salmonella enterica serotype enteritidis)?

-anal oral route
-from contaminated foods that have not been properly cooked or pasteurized like meat, eggs, milk, water, ice cream
-most often from poultry
-contaminated water can also be a problem
-animals are the main reservoir and it affects many animals like poultry, cattle, swine, sheep, rats, dogs, cats, mice, turtles, and birds

note: this is an animal disease with humans being secondarily infected

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What is salmonella gastroenteritis caused by salmonella enteritidis (salmonella enterica serotype enteritidis)? What are the S&S?

-FBI
-bacteria is ingested (its an infection) with limited multiplication and no invasion of host tissue (DOES NOT CAUSE SEPTICEMIA)
-bacteria remains in GI
-this is unusual for bacteria and overtime can start to produce endotoxins from the cell wall (lipopolysaccharide with lipid A irritates the GI tract and can cause fever) within 6-48 hours of infection

S&S:
-fever
-abdominal pain
-diarrhea
-nausea
-vomiting

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What is the 2nd major cause of FBI in US?

salmonella enteritidis (salmonella enterica serotype enteritidis) causes salmonella gastroenteritis

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What is the treatment and prevention for salmonella gastroenteritis caused by salmonella enteritidis (salmonella enterica serotype enteritidis)?

tx:
-replacement of electrolytes is usually enough
-antibiotics may be needed if severe case

prevention:
-adequate cooking of meat and boiling water can eliminate the problem

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Shigella sp. has 4 subspecies but we only have to know one. What is this one subspecies and what disease does it cause?

S. dysenteriae causes shigellosis (bacillary dysentery)

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Is S. dysenteriae (shigella sp.) gram neg or pos? What shape is it?

gram neg non-motile rod/bacillus

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What is the source of infection for S. dysenteriae (shigella sp.)? What is the mode of transmission?

-human intestine is the source
-upon recovery a few people may remain as chronic intestinal carriers and may have recurrent bouts of the disease
-mode of transmission is fecal oral route via contaminated food or water

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S. dysenteriae (shigella sp.) causes shigellosis (bacillary dysentery). What are the characteristics of this disease?

-S. dysenteriae is the most severe of the shigella sp. and produces an enterotoxin AND a neurotoxin
-inflammation and necrosis of large intestine, but invasion into bloodstream is rare
-toxic products of bacterial cell wall (lipid A) irritates causing ulceration with some epithelial cell penetration
-disease ranges from mild transient diarrhea to full blown dysentery
-inflammation of large intestine is accompanied by gripping pain, constant desire to evacuate the bowels (tenesmus, which means constant need to be on toilet), diarrhea containing blood/mucus/pus
-fever, water loss and electrolytes imbalance with weight loss
-patients may die 1-2 days after symptoms appear
-more commonly, symptoms last about a week, and slowly abate, many cases are self-limiting
-the young and old are the most frequent victims

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How is shigellosis (bacillary dysentery) caused by S. dysenteriae (shigella sp.) diagnosed?

culture organism from feces

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What is the treatment for shigellosis (bacillary dysentery) caused by S. dysenteriae (shigella sp.)?

-antibiotics
-fluid replacement bc of electrolyte imbalance

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What disease is caused by vibrio cholera?

cholera

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Is V. cholera gram neg or pos? What shape is it?

-gram neg
-motile comma shaped rod

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How is V. cholera transmitted?

-fecal oral route
-water borne disease
-better sanitation= less frequent cases of cholera
-humans are the only host, V. cholera does not affect animals

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What are the characteristics of cholera caused by V. cholera?

-not an invasive infection
-bacteria does not reach bloodstream, will remain in GI
-50% of infections are asymptomatic
-for those with symptoms, there is sudden onset of nausea and vomiting and profuse diarrhea with abdominal cramps
-the cell wall of V. cholera has an endotoxin which is an enterotoxin that is secreted and results in enormous our-pouring of diarrhea, fluids, and electrolytes
-the diarrhea is referred to as RICE STOOLS
-this rapid loss of fluid and electrolytes leads to severe dehydration, circulatory collapse (blood volume decreases and heart has to pump faster/harder), and anuria (no urine production)
-mortality rate w/o treatment is 25-50%

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What is the treatment for cholera caused by V. cholera?

-water and electrolytes!!!!!!
-antibiotics are secondary

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generally speaking, what is the difference between bacterial infections and toxins?

infections take longer, whereas toxins can hit within a couple hours

and bc the onset is faster, toxins usually are more vomit prone, whereas infections are more diarrhea prone

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What disease is caused from vibrio parahaemolyticus?

gastroenteritis (FBI, usually acute)

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Is vibrio parahaemolyticus gram neg or pos? What shape is it?

-gram neg
-comma shaped rod

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vibrio parahaemolyticus is a marine organism requireing a high salt conc. What is this called?

halophile organism

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How is gastroenteritis transmitted caused by vibrio parahaemolyticus?

ingestion of contaminated seafood such as raw fish or shellfish, most commonly shellfish

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What are the characteristics of gastroenteritis caused by vibrio parahaemolyticus?

-incubation period of 12-24 hours
-N/V, abdominal cramps, fever, and water to blood diarrhea
-fecal leukocytes are present
-the gastroenteritis tends to subside in 1-4 days w/ no treatment other than restoration of water/electrolyte balance
-most common in Asia and other places people eat raw seafood

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What is the treatment and prevention for gastroenteritis caused by vibrio parahaemolyticus?

prevention: adequate cooking of seafood

tx: restoration of electrolyte balance

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What diseases are caused by vibrio vulnificus?

-severe wound infections
-bacteremia
-gastroenteritis

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Is vibrio vulnificus gram neg or pos? What shape is it? How is it transmitted?

-gram neg
-comma shaped rod
-found in oysters/shellfish especially in warm months
-commonly infects fishermen

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What are the pathogenicity characteristics of vibrio vulnificus?

severe wound infections
-seen in both normal people and immunocompromised pts who are in contact with infected water
-can be mild but progress rapidly with cellulitis, myositis, and necrosis

bacteremia
-occurs in pts who eat infected oysters
-seen in alcoholics or pts with liver disease
-about 50% die

gastroenteritis
-FBI

infection often proceeds rapidly with development of severe disease

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What is the treatment for severe wound infections, bacteremia, and gastroenteritis caused by vibrio vulnificus?

antibiotics

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What type of enteric bacteria is K. pneumonia?

test q

coliform bacteria

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What diseases are caused by K. pneumonia?

test q

pneumonia and UTIs

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Is K. pneumonia gram neg or pos? What shape is it? What other bacterial characteristics does it have?

-gram neg rod
-has prominent capsule which is virulent
-bacterial strains w/o capsule do not cause disease
-opportunist present in respiratory tract and feces in about 5% of normal people

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What are the pathogenicity characteristics of pneumonia caused by K. pneumonia?

test q

-acquired by droplets
-may cause primary or secondary disease in alcoholics or people with COPD
-characterized by rapid onset and gelatinous reddish-brown sputum called red currant jelly

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What is treatment for K. pneumonia?

antibiotics

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Which bacteria is the #1 cause of most classic opportunistic infections?

pseudomonas aeruginosa (blue pus organism)

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Which infections is pseudomonas aeruginosa associated with?

wound and burn infections

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Is pseudomonas aeruginosa gram neg or pos? What shape is it?

-gram neg
-motile rod

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Pseudomonas aeruginosa is considered normal flora. Where? Where else is it found

-normal flora in GI
-seen in moist environments like nature and in hospitals (nosocomial infection)

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What pigment is produced by pseudomonas aeruginosa?

-blue pigment called pyocyanin
-wound, environment around it, etc will appear blue
-literally called “blue pus’

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What are the pathogenicity characteristics of pseudomonas aeruginosa?

-pili extend from cell membrane to promote attachment
-lipopolysaccharide layer exists in many phenotypes and is responsible for many of the endotoxin properties of organism
-most isolates produce exotoxins which may be related to pathogenicity
-pathogenic only when introduced into areas devoid of normal defenses like tissue damage, use of IV, urinary caths, or neutropenia is present from chemotherapy
-infection is most prevalent in severe burn victims
-also implicated in wounds, UTIs and pneumonia particularly in the immunocompromised

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What is hot tub folliculitis?

-caused by pseudomonas aeruginosa
-skin infection of the hair follicles
-happens when in contact with contaminated water
-can happen in also whirlpools and waterslides, not just hot tubs

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What is the diagnosis and treatment regimen for wound and burn infections of pseudomonas aeruginosa?

diagnosis: culture of specimens

tx: combo of antibiotics

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What diseases are caused by Y. pestis?

-bubonic plague (black death)
-septicemic plague
-pneumonic plague

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Is Y. pestis gram neg or pos? What shape is it? What other microbio/epi characteristics does it have?

-gram neg
-rod
-zoonotic organism
-can be used in bioterrorism
-primarily a disease of rodents (reservoirs) like rats and squirrels
-flea vector, flea will bite on human and cause infection

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What are the other names for the black death?

-pestilence
-great plague
-the plague
-black plague

note: one of the most devastating pandemics in history

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Which plague caused by Y. pestis is the most common? What is it?

bubonic plague
-bite of flea initiates infection
-bacteria infects lymphatic system and the lymph nodes become inflamed forming buboes (enlarged enflamed lymph nodes)
-hemorrhages result in giving skin a black splotchy appearance

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What is the septicemic plague caused by Y. pestis?

-bacteria enters bloodstream rather than lymphatic system
-occasionally will start as bubonic plague and then transition into septicemic plague
-almost always fatal w/o treatment of antibiotics

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What is the pneumonic plague caused by Y. pestis?

-can be caused by primary or secondary infection
-primary is inhaling the plague bacteria
-secondary is septicemic plague spreading into lung tissue
-pneumonic plague is very aggressive
-antibiotics are needed within 24hours of onset to prevent death

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How is bubonic plague caused by Y. pestis spread?

buboes > thoracic duct > blood > spleen > additional lymph nodes

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How are the plagues caused from Y. pestis diagnosed?

cultures of blood, lymph nodes, or sputum

if culture is neg, then serological testing can be done to confirm diagnosis

What is the treatment and prevention for Y. pestis?

prevention: reduce rodents and wear flea repellent

tx: antibiotics ASAP

Is legionella pneumophila an enterobacteria?

What disease is caused by legionella pneumophila?

legionnaire’s disease (a type of pneumonia)

Is legionella pneumophila a gram neg or pos bacteria? What shape was it? Where is it found?

-gram neg
-rod or coccoid shaped
-found in warm moist water environments like lakes, streams, etc

What are the pathogenicity characteristics of legionnaire’s disease caused by legionella pneumophila?

-common in immunocompromised
-bacteria is inhaled from contaminated AC units, cooling towers, shower heads, residual water systems, etc.
-asymptomatic infection is common in all age groups
-may result in febrile illness of short duration or in a severe rapidly progressive illness with high fever, malaise, nonproductive cough, and hypoxia
-pneumonia may occur
-many patients appear disoriented

How is legionnaire’s disease caused by legionella pneumophila diagnosed?

-can be isolated from bronchial washings and blood
-can be cultured on special media at 90% humidity
-can use direct fluorescent antibody tests
-sometimes antigens will appear in urine

What is the prevention and treatment for legionnaire’s disease caused by legionella pneumophila?

tx: antibiotics

prevention: hyper chlorination and superheating of water can help

Is C. jejuni enteric?

What disease is caused by C. jejuni?

gastroenteritis and occasionally systemic infection

Is C. jejuni gram neg or pos? What shape is it? What are the other microbio/epi chracteristics?

-gram neg
-rod shaped comma or S shaped “gull wing”
-microaerophilic (5% O2, 10% CO2)
-incubation of plates should be at 42 degrees celcius to discourage growth of most other bacteria present in feces
-found in GI

What is the #1 cause of FBI in US?

C. jejuni

What are the pathogenicity characteristics of gastroenteritis caused by C. jejuni?

-bacterial infection is acquired by fecal oral route from food, drinks, or contact with infected animals/animal products especially poultry
-C. jejuni is susceptible to gastric acid and ingestion of about 10k cells is necessary to produce infection
-C. jejuni multiply in the small intestine, invade the epithelium and produce inflammation that results in the disappearance of red/white blood cells in the stools
-has acute onset of cramps/abdominal pain, profuse diarrhea that may be bloody, headache, malaise, and fever
-usually lasts 5-8 days
-certain serotypes of C. jejuni has been associated with Gullain Barre syndrome (many years after infection), which is a form of an ascending paralytic disease

What is prevention, diagnosis, and treatment like for gastroenteritis caused by c. jejuni?

diagnosis: gram stained stool smears and cultures on selective media

tx: antibiotics shortens duration of fecal shedding

prevention: fully cook meat

Which bacteria is similar to C. jejuni?

H. pylori

What diseases are caused by H. pylori?

-gastritis
-duodenal peptic ulcers
-gastric ulcers
-stomach carcinoma (epithelial tissue cancer)
-stomach lymphoma (lymph tissue cancer)

Is H. pylori gram neg or pos? What shape is it? What other microbio/epi characteristics does it have?

-gram neg
-motile spiral shaped
-microaerophilic (5% O2, 10% CO2)
-found deep in the mucosal layer near the epithelial surface where pH is approx 7.4
-produces urease which further buffers the acidic pH in stomach (increases pH of itself to fight off acidic GI pH)

What are the pathogenicity characteristics of H. pylori for gastritis, duodenal peptic ulcers, gastric ulcers, stomach carcinoma (epithelial tissue cancer), and stomach lymphoma (lymph tissue cancer)?

-nausea, pain, vomiting, and fever
-acute symptoms may last for approx 1-2 weeks
-after colonization, the H. pylori infections persist for years or decades
-about 90% of pts with duodenal ulcers and 50-80% of those with gastric ulcers have H. pylori
-H. pylori is also a major risk factor for cancers

What is the diagnosis for H. pylori stomach issues?

-gastric biopsy
-gastric culture
-antibody assay
-breathe test

What is the treatment for H.pylori stomach problems?

-antibiotics, treat ulcers
-ulcers are treated with anti-acids and antibiotics

What infection is caused by the bacteroides fragilis group (20 ish species)?

abscesses

Is the bacteroides fragilis group (20 ish species) gram neg or pos? What shape are they? Where are they found?

-gram neg (this is unusual bc usually anaerobic bacteria is gram pos, in fact this is the ONLY gram neg anaerobic bacteria we have to know)
-anaerobic
-rods
-normal inhabitants of the bowel

What are the abscesses like that are caused by the bacteroides fragilis group (20 ish species)?

-implicated in intra-abdominal infections (disruptions of intestinal wall)
-also seen in intra-pelvic infections for pts with PID (pelvic inflammatory disorder) and ovarian abscesses

What is the treatment regimen for abscesses caused by the bacteroides fragilis group (20 ish species)?

surgical drainage and antimicrobial therapy

What diseases are caused by H. influenza?

-pneumonia
-meningitis (in children)
-upper/lower respiratory tract infection (both adults + kids)

note: H. influenza is a misname, does not actually cause influenza, but when it was discovered it was thought the pneumonia was influenza

Is H. influenza gram neg or pos? What shape is it? What are the other microbio/epi characteristics?

-gran neg
-small and encapsulated (which increases virulence)
-coccobacillus
-non-encapsulated type is found in normal flora of respiratory tract of humans
-H. influenza type b (Hib) is an important human pathogen (carrier rate is <1%)
-the carrier rate for nontype H. influenza is 50-80% higher

What are the pathogenicity characteristics of H. influenza?

-H. influenza type b (Hib) causes meningitis, pneumonia, and epiglottitis
-nontype H. influenza tends to cause chronic bronchitis, otitis media, sinusitis, and conjunctivitis
-H. influenza type b (Hib) enters through respiratory tract and may reach bloodstream and is carried to meninges -> causes bacteremia + meningitis

How is H. influenza diagnosed?

-specimens of sputum or CSF
-bacteria cultured on chocolate medium (heated blood)
-gram stain of CSF shows neg intracellular coccobacillus
-H. influenza requires heated blood for growth to obtain the X factor heme and the V factor NAD
»H. influenza exhibits satellitism on blood agar plates when grown in presence of S. aureus and other organisms
»aka, H. influenza grows next to S. aureus and S. aureus will stimulate growth of V factor

What is the treatment and prevention for H. influenza infections?

antibiotics

hib vax for younger population + military

What infection is caused by H. influenza biotype aegyptius?

conjunctivitis (pink eye)

Is the H. influenza biotype aegyptius gram neg or pos? What shape is it? What are its other microbio characteristics?

-gram neg
-small encapsulated coccobacillus
-closely resembles H. influenza

What is the conjunctivitis like caused H. influenza biotype aegyptius?

-associated with highly communicable form of conjunctivitis in children
-may be mild or serve
-infected eye gives sensation of having sand in the eye
-mucus or mucopurulent discharge is present (eye boogers)

What is the diagnosis and treatment like for conjunctivitis caused by H. influenza biotype aegyptius?

diagnosis: examination of smears shows gram neg coccobacillus

tx: antibiotic eye drops

What disease is caused by H. ducreyi?

chancroid STD (resembles syphilis but ulcer is soft and painful whereas syphilis is hard and painless)

memory cue: Dr. Lou said H. ducreyi = do cry bc STD is so painful

Is H. ducreyi gram neg or pos? What shape is it?

-gram neg
-small encapsulated coccobacillus

What is chancroid?

STD caused by H. ducreyi
-typically grows in male genitals and causes painful shallow hard ulcer at the site of infection (women can also get it)
-starts off as a small bump that becomes an ulcer and grows within a day of its appearance
-ulcer will have irregular/ragged borders and the base of it is covered with grayish/yellowish material and can easily bleed

What is the diagnosis and treatment for chancroid STD caused by H. ducreyi?

-case history and clinical appearance helps with diagnosis
-culture of bacteria from ulcer region is the gold standard, but the media is only 80% sensitive
-antibiotic therapy
-there is no permanent immunity, meaning its recurring with continual infection
-immune system will not remember infection

What disease is caused by Bordetella pertussis?

whooping cough, also known as pertussis

is Bordetella pertussis a gram neg or pos bacteria? What shape is it? How is it spread? Who does it affect?

-gram neg
-small encapsulated coccobacillus
-spreads via respiratory droplets, or carriers
-only host is human, has short lifespan outside of host
-causes worldwide incidence, but most common in young people

What is whooping cough caused by Bordetella pertussis?

-highly communicable and important pathogen of humans
-Bordetella pertussis produces the pertussis toxin which is a secreted exotoxin that increases virulence

What are the 3 stages of whooping cough caused by Bordetella pertussis?

1) catarrhal stage
-after an incubation of 2 weeks, pt will develop cough and sneezing
-bacteria spreads and pt will become highly infectious but not very ill

2) paroxysmal stage
-cough develops an explosive character “whoop” upon inhalation
-leads to rapid exhaustion, vomiting, cyanosis, and convulsions
-secondary invaders like staph and haemophilus may complicate this even more

3) convalescent stage
-slow progress of recovery
-coughing and whooping may recur for up to a year

How is whooping cough that is caused by Bordetella pertussis diagnosed?

-culture using enriched medium
» use cough aerosols on Bordet-Gengou (potato blood glycerol)
» or can use Regan Lowe medium (preferred, due to longer shelf life)
-rapid PCR test (excellent sensitivity)
-serological assay (more useful for late stages of disease)

What is the treatment and prevention for whooping cough caused by Bordetella pertussis?

-antimicrobial therapy ASAP
-DTaP vaccine

What are the 4 species of Brucella?

1) B. abortus (cattle)
2) B. suis (swine)
3) B. melitensis (goats and sheep)
4) B. canis (canine)

What disease is caused by the brucella sp.?

brucellosis, also known as undulant fever or malta fever

Are the brucella sp. gram neg or pos? What shape are they? What are the other microbio/epi characteristics?

-gram neg
-rods
-aerobic
-zoonotic (animals harbor it asymptomatically and transmit to humans)
-most common route of infection is unpasteurized cheese from goat milk

What are the 3 transmission routes for the brucella sp.? What is brucellosis, also known as undulant fever or malta fever?

routes:
1) intestinal tract (ingestion of infected milk or milk products)
2) mucous membranes (droplets)
3) skin (contact with infected tissues of animals

-infection proceeds via lymphatic channels and regional lymph nodes to the thoracic duct, blood stream, and RES (reticuloendothelial system, which includes the liver, spleen, lymph nodes, and BM)
-may result in granulomatous nodules
-fever, weakness, aches, and sweats
-fever appears in waves (usually rises in afternoon (undulant fever) and falls at night), accompanied with night sweats
-symptoms can last weeks to months
-after initial infection, a chronic stage may develop
»characterized by weakness, aches and pains, and low-grade fever

What is a part of the reticuloendothelial system (RES)?

-liver
-spleen
-lymph nodes
-BM

How is brucellosis that is caused by the burcella sp. diagnosed?

-blood and biopsy from lymph nodes or BM for culture
-serological testing, specifically agglutination test or ELISA test

What is the treatment and prevention for brucellosis that is caused by the burcella sp.?

treatment: prolonged antimicrobial therapy

prevention: proper pasteurization of milk and milk products and reduction of occupational hazards with animals

What disease is caused by Francisella tularensis?

tularemia “rabbit fever”

Is Francisella tularensis gram neg or pos? What shape is it? What other microbio/epi characteristics are there?

-gram neg
-small coccobacillus
-zoonotic (transmitted by arthropods biting humans, flies, direct contact with infected animal tissue, inhalation, or ingestion of contaminated food/water)
-hunters are especially at risk
-wild animals cannot be controlled

What is tularemia caused by Francisella tularensis? What are the 3 types?

-highly infectious bacteria
-routes of infection can be through penetration of skin and mucus membranes or inhalation of 50+ cells
-fever, malaise, headache, and pain in the involved region/regional lymph nodes

types:
1) ulceroglandular tularemia
-bacteria enters through skin abrasions/ulcers
-regional lymph nodes enlarge and may become necrotic, sometimes draining for weeks
2) pneumonic tularemia
-often lethal w/o treatment
-most dangerous type
-inhalation of infective aerosols results in bronchial inflammation and localized pneumonitis
3) oculoglandular tularemia
-eye infection
-can develop when an infected finger or droplet touched the conjunctiva

other forms that are less common:
-glandular tularemia (lymphadenopathy but no ulcers)
-oropharyngeal tularemia (ingested)
-typhoidal tularemia (septicemia)

How is tularemia caused by Francisella tularensis diagnosed? What is the treatment?

clinical specimens, but mostly serological tests/blood tests

tx: antimicrobial therapy

What organisms are controlled by US government in fears of bioterrorism?

-Francisella tularensis
-Yersinia pestis
-Bacillus anthracis
-Ebola VIRUS, not bacteria

What disease is caused by B. anthracis?

anthrax, also known as wool sorters disease (occupational hazard) or black eschar (bc of black pustules from necrosis)

Is B. anthracis gram neg or pos? What shape is it? What are the other microbio/epi characteristics?

-gram pos
-large rod
-aerobic
-spore-forming bacteria
-has capsule made of proteins (polymer of glutamic acid)
-portal of entry is the mouth and GI
-primarily disease of herbivores and occupational disease (farmers, vets, butchers, people who work with wool or goat hair or leather)

What is anthrax caused by B. anthracis? What are the 3 routes of transmission?

-infection happens when in contact w/ infected animals or animal products
-humans acquire it by entry of spores through injured skin, rarely through GI mucous membranes or by inhalation of spores
-B. anthracis produces several toxins

routes:
1) cutaneous anthrax
-relatively mild, most common type (95% of anthrax infections, 20% will result in death)
-skin abrasions w/ spore containing animal products can lead to infections
-begins as papule and within 1/2 days it develops into pustule or black necrotic tissue that crusts over
-lymph glands in area may be invaded and swell
2) intestinal anthrax
-consumption of contaminated and undercooked meat
-acute inflammation of GI
-results in death in 25-60% of cases
3) inhalation anthrax
-most dangerous type, can be used for bioterrorism
-usually fatal w/o tx
-inhaling spores
-workers on tan hides, hear sheep, or process wool may inhale spores
-may contract a pneumonia called wool sorters disease
-initially resembles common cold, but after a couple days can progress to severe breathing and shock

How is anthrax caused by B. anthracis diagnosed?

-fluid or pus specimens from local lesion
-blood, pleural fluid, CSF, or stool samples
-direct smears with immunofluorescence stain
-cultures on blood agar medium
-ELISA test for late stages

What is the tx for anthrax? What are the control measures?

tx: antimicrobial therapy

control measures
-disposal of animal carcasses by burning or deep burial in lime pits
-decontamination of animal products
-protective clothing and gloves for handling potentially infected animals
-active immunization for domestic animals with live attenuated vaccine
-vaccine is also available to military or other people at risk for repeated exposure

What disease is caused by C. diphtheria?

respiratory or cutaneous dipitheria

Is C. diphtheria gram neg or pos? What shape is it? What are the other microbio characteristics?

-gram pos
-rod (irregular swellings at one end gives it a club shaped appearance)
-aerobic
-non-spore forming bacteria
-metachromatic granules (nutrient granules stain red w/ blue dye) gives rod a beaded appearance
-individual bacteria cell in slides tend to lie parallel or at an acute angle to each other
-spread by droplets (respiratory) or direct contact with wounds

What are the pathogenicity characteristics of respiratory diphtheria?

-most dangerous type
-diphtheria toxin (EXOTOXIN) is absorbed into mucous membranes and causes destruction of epithelium
-necrotic epithelium becomes grayish pseudomembrane (most commonly seen over tonsils, pharynx, or larynx)
-bacteria continues to grow and will produce more toxins, which will be absorbed into the organs- heart muscle, liver, kidneys, adrenal glands, and sometimes acute hemorrhages
-the toxin will also produce nerve damage resulting in paralysis of the soft palate, eye muscles and extremities
-begins w/ low grade fever and sore throat
-followed by prostration and dyspnea caused by obstruction of the membranes, which will later cause suffocation

What are the pathogenicity characteristics of cutaneous diphtheria?

-seen on hands, feet, and legs
-occurs chiefly in the tropics with humidity
-most commonly seen on wounded areas and is usually localized to that area
-less severe than the respiratory diphtheria

How are C. diphtheria infections diagnosed?

-cultures from nose, throat, and suspected lesions
-PCR test for detection of the toxin

What is the treatment and prevention for C. diphtheria infections?

tx:
-administration of specific antitoxin to kill the exotoxin
-antibiotics

prevention: DTaP vaccine (Toxoid vaccine) given to children and young adults

What are the 3 bacteria/infections that can be prevented with DTaP vaccine?

diphtheria, tetanus, whooping cough

What disease is caused by C. tetani?

tetanus (also known as lockjaw or trismus)

Is C. tetani gran neg or pos? What shape is it? What other microbio characteristics are there?

-gram pos
-large rod
-anaerobic
-spore forming (endospores are found in the soil and feces of horses or other animals)

How does tetanus infection occur?

via punctures
-nail, needle, wound, etc
-infection of umbilical stump in primitive cultures

What are the pathogenicity characteristics of C. tetani?

-incubation period may range from 4/5 days to 4/5 weeks
-the vegetative cells produce the toxin tetanospasmin
-C. tetani also produces an exotoxin called neurotoxin which fixes to inhibitory neurons
-the effect of the neurotoxin is to block the release of inhibitory neurotransmitter GABA and glycine across the synaptic cleft which is required for nerve impulses
-the neurotoxin produces a generalized muscular spasm characteristic of tetanus, which is the contraction of voluntary muscles
-usually the area of injury or infection is affected first and then the muscles of the jaw, which contract so that the mouth cannot be opened
-gradually overtime, other muscles will become involved and result in a tonic spasm
-pt will be fully conscious and in pain
-death results once respiratory muscles are affected
-death rate is relatively high

How is tetanus caused by C. tetani diagnosed?

clinical picture and history of injury

How is tetanus caused by C. tetani treated? What is the prevention?

tx:
-large doses of antitoxin (tetanus immune globulin) through IV
-muscle relaxants
-sedation
-assisted ventilation

prevention:
-immunization of tetanus toxoid vaccine (DPT, also known as DTaP)
-boosters every 10 years

Which bacteria is a part of botox?

test q

C. botulinum

What disease is caused by C. botulinum?

botulism (2 types: one is an FBI (infants only) and the other is a toxin)

Is C. botulinum gran neg or pos? What shape is it? What other microbio characteristics does it have?

test q

-gram pos
-large rod
-anaerobic
-spore forming
-C. botulinum is a saprobe that is found in soil
-botulism is a toxemia (adults only), but also can be a true food poisoning (FBI for infants)

What are the pathogenicity characteristics of C. botulinum?

-C. botulinum secretes an exotoxin called neurotoxin under anaerobic conditions
-commonly found in home canned foods
-the toxin is absorbed by the upper portion of GI tract and in the duodenum and jejunum
-the neurotoxin passes into bloodstream and reaches the peripheral NMJ/synapse and binds to the presynaptic terminals
-the toxin blocks the release of the neurotransmitter ACh which is required to stimulate the muscles
-this causes flaccid paralysis of the involuntary muscles

What are the symptoms of C. botulinum?

test q

-flaccid paralysis of the involuntary muscles
-prior to paralysis pt will have double vision bc the eyes muscles are the smallest and have least amount of ACh, so when it gets inhibited eyes go first
-blurred vision
-drooping eyelids
-slurred speech
-difficulty swallowing
-dry mouth
-muscle weakness
-death occurs from respiratory paralysis or cardiac arrest

note: all these symptoms are related to decreased muscle function because ACh is inhibited

What is infant botulism?

-most frequent cause of infection is spores in honey
-spores germinate in GI after ingestion
-not a toxemia like in adults, but rather a true food poisoning FBI

What is the treatment and prevention of C. botulinum?

prevention:
-canned foods need to be boiled for at least 20 min before consumption bc C. botulinum is a heat liable toxin, meaning it can be destroyed

tx:
-trivalent antitoxin ASAP through IV
-mechanical ventilation

What diseases are caused by C. perfringens?

-gas gangrene
-FBI

Is C. perfringens gram neg or pos? What shape is it? What other microbio/epi characteristics does it have?

-gram pos
-large rod
-anaerobic
-spore forming
-C. perfringens and related clostridia can produce invasive infections including myonecrosis and gas gangrene

How is C. perfringens transmitted? Where is it found?

-C. perfringens infects deep wounds that are contaminated by soil or feces
-found in soil
-some strains produce a powerful exotoxin especially when grown in meat dishes

What are the pathogenicity characteristics of gas gangrene and FBI caused by C. perfringens?

-C. perfringens produces several powerful exotoxins that can diffuse out of the contaminated wound into the host and may cause death
-the spores germinated, vegetative cells multiply, and ferment carbs present in tissues and produce gas
-the distention of tissue and interference of blood supply, together with the toxins favors the spread of infection
-tissue necrosis extends outwards and provides opportunity to increase even more bacterial growth
-will cause hemolytic anemia, severe toxemia, and death
-incubation period is 8-48 hours
-C. perfringens FBI usually follows the ingestion of large numbers of clostrida in warm meat dishes
-the toxin forms in the gut, resulting in vomiting and diarrhea for 1-2 days

How is C. perfringens diagnosed? What is the treatment?

diagnosis
-clinical picture and isolation of the organisms from wounds, pus, tissue

tx:
-surgical debridement of the area and removal of all devitalized tissue
-antimicrobial therapy
-hyperbaric oxygen

What disease is caused by C. difficile?

pseudomembranous colitis

Is C. diff gram pos or neg? What shape is it? What other microbio/epi characteristics are there?

-gram pos
-large rod
-anaerobic
-spore forming
-most commonly affects older adults in hospitals or long term care facilities
-typically occurs after long term use of antibiotics (2+ weeks, this is bc normal flora is all gone now so theres plenty of room for C. diff to grow)
-can be an opportunistic infection

What are the pathogenicity charcteristics of pseudomembranous colitis caused by C. diff? What are the symptoms?

-C. diff produces 2 toxins
-one of the toxins is called enterotoxin, which cause fluid loss
-the other toxin is a cytotoxin which causes further mucosal damage
-symptoms can be mild-moderate
-watery diarrhea 3+ times a day for 2+ days, mild abdominal cramping and tenderness
-symptoms can also be more severe
-watery diarrhea 10-15x a day, severe abdominal pain and cramping, fever, blood or pus in stool, nausea, dehydration, kidney failure

Which antibiotics with long term use puts you at high risk for contracting pseudomembranous colitis caused by C. diff?

-ampicillin
-clindamycin
-any fluoroquinolones

How is pseudomembranous colitis caused by C. diff diagnosed?

-detection of either toxins in stool
-endoscopic observation of pseudomembranous colitis
-clinical evidence of micro-abscesses

What is the treatment for pseudomembranous colitis caused by C. diff?

-discontinue use of antibiotics
-start metronidazole or vancomycin (antimicrobials)
-fecal microbiota transplantation (FMT, also known as fecal transplant)

What is the difference between broad spectrum and narrow spectrum antibiotics?

broad spectrum
-kills widespread of bacteria and many different types
-also kills all the normal flora

narrow spectrum
-kills a specific bacteria or only a few types

What disease is caused by M. tuberculosis?

tuberculosis (TB)

Is M. tuberculosis gram neg or pos? What shape is it?

-trick question- its an acid fact bacilli
-resists decolorization by acids or alcohol

Who is high risk for M. tuberculosis?

-minorities
-immigrants from countries with high endemicity
-HIV pts
-homeless people
-young and old people

What is the most frequent source of infection in humans for TB? How is M. tuberculosis transmitted?

-humans who excrete large amounts of tubercle bacilli from respiratory tract
-close contacts in family or massive exposure like medial personnel make transmission by droplet nuclei most likely
-disease only occurs in a small population of infected individuals

What are the pathogenicity characteristics of TB? What are the 2 types of lesions and 2 types of infection?

this is freakishly long

-virulent strains contain cord factor (mycolic acid) around cell
-M. tuberculosis is emitted in droplets when infected person coughs, sneezes, or speaks
-droplets evaporate and make it into alveoli
-M. tuberculosis replicates within macrophages
-1-2 months after exposure, pathogenic lesions are associated with infection and appear in the lungs
-tubercle bacilli spread in the host through the lymphatic channels and bloodstream and via the bronchi and GI tract
-chronic disease that advances slowly

types of lesions:
1) exudative lesions
2) productive lesions

types of infections:
1) primary infection type of TB
-host has first contact with tubercle bacilli
-a lesion develops and spreads to the lymphatics and regional lymph nodes
-lesion in tissue often heals quickly
-lesion calcifies and tuberculin test becomes positive
2) reactive type of TB
-had TB in past
-usually caused by bacilli that have survuved in the primary lesion
-characterized by chronic tissue lesions, formation of tubercles, and fibrosis

symptoms
-fatigue
-weakness
-weight less
-fever/ night sweats (fever in afternoon, night sweats in evening)
-chronic cough with blood in sputum

atypical manifestations
-lupus vulgaris = cutaneous TB
-miliary TB = disseminated throughout the body, lesions resemble millet seeds
-TB in bone

How is TB diagnosed caused by M. tuberculosis?

-staining os sputum specimen using Ziehl-Neelsen (acid fast stain)
-X-ray
-Tuberculin skin tests
»mantoux, PPD (more specific), or tine skin tests
» can detect past or present TB
-TB blood tests are called interferon gamma release assays (IGRAs), pos test= infected with TB
-blood tests are preferred for people who have gotten skin test in past

What is the treatment and prevention for TB caused by M. tuberculosis?

-specific chemotherapy with INH (isoniazid) and usually RMP (rifampin) but can be something else paired with INH
-bacille calmette-guerin (BCG) vaccine protects against meningitis and TB in children from recurring, but this is not commonly used in US

NOTE: if vaccinated with BCG, then mantoux skin test will appear positive

What disease is caused by M. bovis?

TB in humans and cattle

M. bovis is an _______________ bacteria

acid fast

BCG vaccine is prepared from a strain of the attenuated live __________ TB bacillus

bovine

What are the pathogenicity characteristics of TB caused by M. bovis?

-milder form of TB than the one caused by M. tuberculosis
-less than 2% of TB cases in US
-human infection normally through consuming unpasteurized milk or its products
-if inhaled, M. bovis has the ability to produce pulmonary disease indistinguishable from M. tuberculosis TB (only can tell difference through blood work)

What is the treatment and prevention for TB caused by M. bovis?

-antibiotics and chemotherapy
-elimination of diseased cattle
-pasteurization of milk products

note: mantoux skin test can distinguish between past or present infection, BUT if you’re vaccinated with BCG then mantoux skin test will be positive

What disease is caused by M. leprae?

leprosy, also known as Hansen’s disease

M. leprae is an __________ bacteria. M. leprae is related to ____________________

acid fast, M. tuberculosis

M. leprae is not able to be cultivated on ____________ agar

nonliving

What are the pathogenicity characteristics of leprosy caused by M. leprae?

-naturally infected armadilos can transmit to humans, but is rare
-nasal secretions spread through family is the more common route of transmission
-affects small children the most, who have been exposed for prolonged periods to heavy shedders of bacilli
-incubation period is 2-10 years
-lesions involve cooler tissues
-neurological disturbances are manifested by nerve infiltration and thickening with resultant anesthesia and shortening of the digits
-disfigurement caused by nerve involvement if left untreated may be severe
-2 major types: lepromatous and tuberculoid (lepromatous can be seen and isolated on skin scrapings, but tuberculoid cannot)

How do you diagnose leprosy caused by M. leprae? What is the treatment and prevention?

diagnosis: lepromin skin test

prevention
-thorough disinfection of contaminated articles
-avoid contact with body fluids and rashes of people with leprosy
-genetic testing- several genes have been associated with susceptibility to leprosy

tx
-sulfones drugs like dapspme is the first line of therapy
-may need to take meds for years

What disease is caused by M. pneumonia?

primary atypical pneumonia (walking pneumonia- called this bc it will not make you tired/sleepy like typical pneumonia)

What is the smallest organism that can live outside of cells and is about the size of a large virus?

M. pneumonia

What organism is the smallest free-living self-replicating organism (capable of independent existence)?

M. pneumonia

What is different about M. pneumonia cell wall compared to typical bacteria?

lacks a rigid cell wall

What are the pathogenicity characteristics of M. pneumonia? How is it transmitted?

-pathology does not match clinical symptoms
-most common in children and young adults
-transmitted person to person by means of respiratory secretions
-generally a mild disease
-can be asymptomatic, moderate symptoms, or have serious pneumonitis
-incubation period is 1-3 weeks
-onset is insidious with malaise, fever, headache, sore throat, cough
-lasts 2-3 weeks usually and recovery is gradual

What is the diagnosis and treatment for M. pneumonia?

-usually self limiting
-most antibiotics are not helpful
-cold hemogglutinins (cold agglutinins) appear in about 50% of patients, which are Abs that agglutinate with RBCs at 2 degrees C

What are the general characteristics of rickettsiae?

-pleomorphic coccobacilli
-small obligate intracellular bacteria (needs host to survive, usually bacteria is extracellular)
-transmitted to humans by arthropod vectors
-typically manifested by fever, rashes, and vasculitis (can also lead to hemorrhages)
-all illnesses can be treated with doxycycline or chloramphenicol

Within the spotted fever group is Rickettsia rickettsia. What disease does Rickettsia rickettsia cause?

rocky mountain spotted fever

Who is most commonly infected with rocky mountain spotted fever? How is it transmitted?

-caused by Rickettsia rickettsia
-children are the primary victims
-contracted via a tick bite (tick is infected)
-tick is attached for 4+ hours and is able to transmit Rickettsia rickettsia
-commonly seen in wild mammal and bird popluations

What are the pathogenicity characteristics of rocky mountain spotted fever caused by Rickettsia rickettsia?

-symptoms present within a week of tick bite
-rocky mountain spotty fever is only when pt has febrile illness, hx of potential tick exposure, travel to endemic area, presentation in spring or fall
-the classic triad is= fever, headache, and rash
-rash is on the palms of hands and soles of feet
-The rash is a maculopapular rash that appears 2-6 days after onset of fever and progresses through stages
-the absence of delayed appearance of rash increases difficulty of diagnosis
-organism proliferates in the endothelium of small blood vessels and capillaries causing small hemorrhages and occasionally small areas of necrosis

How is rocky mountain spotted fever caused by Rickettsia rickettsia diagnosed?

-no tests are rapid or sensitive to be fully effective
-medical history and clinical exam
-serological assays are mostly used to confirm diagnosis after treatment has already been initiated
-direct fluorescence Ab assay of Rickettsia rickettsia in tissue is done
-can also do PCR
-Weil Felix agglutination reaction test uses pats serum and prosteus strain OX19

What is the treatment for rocky mountain spotted fever caused by Rickettsia rickettsia?

tetracyclines, like doxycycline

There are 2 major diseases in the typhus group: _________ and _________ typhus. They can be differentiated serologically and on the basis of epidemiology of respective diseases

epidemic, endemic

What disease is caused by R. prowazekii?

epidemic typhus (louse borne, louse is singular for lice)

How is epidemic typhus caused by R. prowazekii spread? Where is it found?

-a disease of substandard living conditions and poor sanitation
-occurs in colder mountainous regions
-occurs with overcrowding and poor hygiene
-transmitted through louse vector to humans
-can also be found in flying squirrels

What are the pathogenicity characteristics of epidemic typhus caused by R. prowazekii?

-longer duration than the typhus caused by R. typhi
-overwhelming bacteremia with growth in blood vessel endothelium (vasculitis), high fever
-systemic infection and prostration are severe and fever lasts for about 2 weeks
-fatality rate is up to 30%
-Brill-Zinsser disease is a recrudescence of an old typhus infection and bacteria can persist for years in lymph nodes without any symptoms

How is epidemic typhus caused by R. prowazekii diagnosed? What is the treatment?

-serological tests such as indirect immunofluorescence and enzyme assays
-antimicrobial treatment

What disease is caused by R. typhi?

endemic typhus (murine typhus)

What is endemic typhus caused by R. typhi? Where is it found/ how is it transmitted? What is the treatment and prevention?

-shorter duration/milder form than the typhus caused by R. prowazekii
-rat flea reservoir
-common in high rat infested areas
-antibiotics can be used, and rats need to be controlled

What are the 3 species a part of the Vibrio genus?

1) Vibrio cholera
2) Vibrio parahemolyticus
3) Vibrio vulnificus

What are the 3 species a part of the Haemophilus genus?

1) Haemophilus influenza
2) Haemophilus aegyptius
3) Haemophilus ducreyi

What are the 4 species a part of the clostridium genus?

1) clostridium tetanus
2) clostridium botulinum
3) clostridium perfringins
4) clostridium difficile

What are the 3 species a part of the mycobacterium?

1) mycobacterium tuberculosis
2) mycobacterium bovis
3) mycobacterium leprae

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