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Disease & Defense > Unit 2 > Flashcards

Unit 2 Flashcards

1
Q

What are the components of the innate immune system?

A 
Natural killer cells
Mast cells
Eosinophils
Basophils
Phagocytic cells: macrophages, neutrophils, and dendritic cells
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2
Q

What are the functions of the innate immune system?

A

(1) Recruit immune cells (cytokines) = inflammation
(2) Activate complement cascade
(3) Phagocytosis by macrophages/neutrophils
(4) Antigen presentation
(5) Physical barrier (skin, mucus, gut flora)

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3
Q

What are the Gram-positive bacteria?

A

Staphylococcus
Entercoccus
Streptococcus

Bacillus
Clostridium

Corynebacterium
Listeria

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4
Q

What is the Gram stain appearance of Staphylococcus aureus?

A

Gram-pos cocci in clusters

catalase-positive

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5
Q

What is the typical disease association of Staph. aureus?

A 
Cutaneous infections (boils, folliculitis, wounds)
Toxinogenic infections (TSS, food poisoning)
Pneumonia (particularly w/ impaired immune system) 
Foreign body (sutures, etc.)
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6
Q

What are the virulence traits of Staph. aureus?

A

Fibronectin binding protein (adherence)
α-toxin (pore-forming)
Coagulase, fibronectin-binding protein
Protein A

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7
Q

Scalded Skin Syndrome

A

Systemic circulation of epidermolytic toxins
(localized in adults, widespread in infants)

Serine proteases highly specific for a protein binding together epidermal & dermal layers

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8
Q

Toxic Shock Syndrome

A

Local infection and toxin production (superantigen)

Toxin expression requires oxygen, neutral pH, and high protein levels

Leads to high fever, shock, vomiting, muscle pain, and organ failures (hepatic, renal)

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9
Q

Staphylococcus epidermidis

A

Normal skin flora

Primary virulence factor: slime! ==> biofilm formation
Adheres to foreign bodies (catheters, shunts, artificial/damaged heart valves)

Difficult to treat - often requires removal of the device. Highly resistant to antibiotics! (including methicillin)

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10
Q

What is endocarditis?

A

Bacteria growing on heart valves

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11
Q

What is the Gram stain appearance of Streptococcus?

A

Gram-positive cocci often in chains or pairs

catalase-negative

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12
Q

Streptococcus pyogenes (Group A Strep) - description? What does it cause?

A

β-hemolytic

Cause strep throat, scarlet fever, rheumatic fever, & post-strep glomerulonephritis

Normal flora!

Skin & wound infections - spreading

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13
Q

What is the virulence factor in Group A Strep (Strep. pyogenes)?

A

M-protein (80+ types –> adherence, antigenic, antiphagocytic!!)

M-protein binds Factor H to surface of bacterial cells, which reduces C3b on surface –> anti-phagocytic mechanism

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14
Q

What is one of the possible consequences of streptococcal pharyngitis?

A

Rheumatic fever
Some M-proteins of Group A Strep are rheumatogenic
Some M-types share antigenic similarities with protein components in heart & valve tissues ==> antibody-mediated damage to heart valves

==> heart damage :(

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15
Q

What diseases can be caused by Streptococcus pneumoniae?

A

Pneumonia, sinusitis, otitis media, bronchitis (non-invasive)
Meningitis, bacteremia/septicemia (invasive)

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16
Q

How do Strep. pneumoniae evade host defenses?

A

Antiphagocytic polysaccharide capsule (90+ different types)

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17
Q

Describe the pneumonia vaccine for adults

A

Pneumovax; 23-valence
Approved for 65+
Protects against invasive pneuococci (meningitis, septicemia, etc.) but not against pneumonia = misnomer

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18
Q

Describe the pneumonia vaccine for kids

A

Prevnar
Conjugate vaccine (w/ diphtheria)
==> Herd immunity (may also be protective in adults against pneumonia)

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19
Q

Enterococcus (faecalis & faecium) - common sites of infection?

A

Common sites of infection = urinary tract, surgical sites, biliary tract

Frequent cause of nosocomial infections

Often causes MIXED INFECTIONS

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20
Q

What is scary about enterococcus + antibiotics?

A

Becoming resistant to most of them! Including vancomycin!!!!!! ==> VRE :((((

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21
Q

What does nosocomial mean?

A

Originating in a hospital

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22
Q

Clostridium - characteristics?

A

Gram-pos rods

STRICT ANAEROBES & SPORE FORMERS

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23
Q

Clostridium difficile

A

Relatively resistant to most antibiotics

Associated with, or follows, antibiotic use. Normal GI flora is suppressed, C. dif proliferates

Common cause of nosocomial diarrhea and, in more severe cases, pseudomembranous colitis

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24
Q

Clostridium tetani

A

Present in soil & animals (spores!)

Toxin is transported to CNS ==> blocks inhibitory interneurons ==> spastic paralysis, lockjaw

Vaccine targets TOXIN, not bacteria

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25
Q

Clostridium botulinum

A

Soil & animals (spores!)

Preformed toxin in food ==> circulation

Toxin blocks acetylcholine at neuromuscular junctions ==> flaccid paralysis

Especially common in home-canned foods (cluster cases)

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26
Q

Clostridium perfringens

A 
Wound infections (cellulitis, fasciitis, myonecrosis [gas gangrene])
^^Alpha-toxin!!! Kills phagocytic cells as well as muscle!
Food poisoning (enterotoxin)
==> contaminated food, toxin produced in vivo, site of action = small intestine
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27
Q

E. coli - what is their shape? What diseases do they cause?

A

Gram-neg rod
Normal flora in large intestine

ETEC - typical traveler’s diarrhea from contaminated food/water
Self-limiting; managed by fluid replacement

UTIs - typically endogenous from GI tract getting into the “wrong” place

Abdominal infections - release of contents of colon to peritoneal cavity

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28
Q

Pseudomonas aeruginosa

A

Gram-neg rod

Infections of traumatic injuries, surgical wounds, and especially BURNS

Chronic lung infections of pts with CF

29
Q

What are the causes of lung infections in pts with CF per age?

A

IN CHILDREN - Staph aureus - usually controlled with antimicrobials

IN YA - Pseudomonas aeruginosa pathogen of paramount importance

30
Q

Neisseria gonorrhoeae

A

Gram-neg (diplo)cocci

Causative agent of gonorrhea and conjunctivitis leading to blindness in infants born to infected mothers

Key to infectivity is PILI –> adherence, interferes with neutrophil killing

31
Q

Anaerobes (other than clostridia) - locations? Diseases?

A

Normal flora in colon, mouth, female genital tract, skin

Usually cause disease as a mixed infection (aspiration –> lung abscess, leakage from colon –> abdominal abscess, etc.)

32
Q

Bacteroides fragilis

A

Common colon flora; rather aerotolerant

Occurs in anaerobic abscesses below the diaphragm

Virulence factors: tissue-destructive enzymes, capsule, superoxide dismutase (enzyme that degrades superoxide = toxic byproduct of oxygen)

33
Q

What is one example of a bacteria that is an obligate intracellular?

A

Chlamydia trachomatis

34
Q

What is a bacteria without a cell wall?

A

Mycoplasma pneumoniae

35
Q

What are some of the diseases of Chlamydia trachomatis?

A

Trachoma = chronic infection of conjunctiva, leading to scarring and blindness. Endemic in Asia, Africa

Genital infections = STD, neonatal conjunctivitis, neonatal pneumonia

==> the most common bacterial STD in humans
==> the leading cause of infectious blindness worldwide

36
Q

What disease does mycoplasma pneumoniae cause?

A

Atypical pneumonia (common; 10%). “Walking pneumonia”
Predilection for younger persons (5-20 yo)
Occurs in any season
Bacteria adheres to respiratory epithelial cells –> growth remains extracellular –> produces hydrogen peroxide and superoxide radicals, which damage tissue

37
Q

What is the difference in the pneumonia caused by Mycoplasma pneumoniae vs. Streptococcus pneumoniae?

A

Strep. pneumoniae = bacteria grow within alveoli (air sacs themselves), fill them with phagocytic cells & fluid

Mycoplasma pneumoniae = inflammation & thickening of interstitium, the tissue around the air sacs. Alveoli are clear.

38
Q

What is metronidazole good against?

A

Anaerobes! (like C. dif & Bacteroides)

Protozoa (trich, giardia, etc.)

39
Q

What is an adverse reaction of metronidazole?

A

Antabuse-like reaction (GI upset, vomiting, headache) if alcohol consumed within 3 days of drug

40
Q

What is nitrofurantoin good for?

A

Treating UTIs, b/c of rapid excretion via kidneys

Treats E. coli (and TEM-1)

41
Q

What is the mechanism of aminoglycosides?

A

Protein synthesis inhibition (30s)

BACTERICIDAL (bind irreversibly)

42
Q

What are the adverse effects of aminoglycosides?

A

Ototoxicity, nephrotoxicity

43
Q

What is the spectrum of aminoglycosides?

A

NARROW SPECTRUM: only gram(-) aerobes

E. coli, Klebsiella, Pseudomonas

44
Q

Which drugs are IV only & require routine monitoring of Cp levels?

A

Vancomycin & aminoglycosides

45
Q

Which drugs are renally excreted?

A

Pencillins, cephalosporins, vancomycin, carbapenems, aminoglycosides, nitrofurantoin, fluoroquinolones

46
Q

Are aminoglycosides effective against entercocci?

A

No, not on their own. They must be given together with penicillin or vanco.

47
Q

What are the different fluoroquinolones good against?

A

EXTENDED SPECTRUM
Cipro: pseudomonas, chlamydia, mycoplasma
Levo: S. pneumoniae, pseudomonas, chlamydia, mycoplasma
Moxi: S. pneumoniae, chlamydia, mycoplasma

48
Q

Which antibiotics are bacteriostatic?

A

TMC = tetracyclines, macrolides, and clindamycin

49
Q

What are the DDIs with fluoroquinolones?

A

theophylline + caffeine (↓ metabolism)

antacids (↓ FQ absorp)

50
Q

What is penicillin good against?

A

Pen G:
Gram + (Staph/Strep)
ENTEROCOCCUS!

Pen V:
Gram - (N. gonorrhoeae)

51
Q

What is Dicloxacillin good against?

A

MSSA

this is a penicillinase-resistant drug

52
Q

What are amoxi/ampicillin good against?

A

Enterococcus, E. coli

53
Q

What is the name of the β-lactamase inhibitor?

A

Amoxicillin-clavulanate

“Mocks the cleave”

54
Q

What are Pip/Tazo good against?

A 
MSSA
E. coli
Klebsiella
Pseudomonas
Bacteroides fragilis

MEKPB

55
Q

What are all of the cephalosporins good against?

A

MSSA

56
Q

What is (only) ceftriaxone good against (among the cephs)?

A

N. gonorrhoeae

57
Q

What are ceftazidime (3rd) and cefepime (4th) good against?

A

Pseudomonas

58
Q

What are the generations of cephalosporins?

A 
1st = cephalexin, cefazolin 
2nd = cefaclor, cefuroxime
3rd = ceftriaxone, ceftazidime
4th = cefepime
59
Q

What are carbapenems generally good for?

A

They are wide spectrum - reserved for MDR organisms

60
Q

What is Ertapenem (a carbapenem) good against? What are Imip, Dora, & Mero good against?

A

Ertapenem:
MSSA
Bacteroides

Imip/Dora/Mero:
MSSA
Bacteroides
AND Pseudomonas

61
Q

What is vancomycin good against?

A

MSSA, MRSA, Enterococcus

C. diff (oral only)

62
Q

What are the macrolides good against? What are their names?

A

Erythro/azithro/clarithromycin

S. pneumoniae & pyogenes
N. gonorrhoeae & Chlamydia
Mycoplasma

63
Q

Where do the macrolides concentrate?

A

The lungs

64
Q

What are the DD interactions of macrolides?

A

Clar/ery inhibit CYP450

NOT AZI ==> “A-okay”

65
Q

What are the tetracyclines good against?

A

S. pneumoniae, N. gonorrhoeae (+/-), chlamydia, and mycoplasma

Basically everything from the macrolides except S. pyogenes

66
Q

What are some of the adverse reactions of tetracyclines?

A

Affects bone/tooth development - not for pregnant women or kids <8 yo

DD interactions with metal cations (antacids, diary, iron) in stomach

67
Q

What does clindamycin do well, that other drugs don’t?

A

Penetrates into bone

68
Q

What is clindamycin good against?

A

NARROW SPECTRUM
Gram + cocci (Staph, Strep)
Bacteroides
Choice in CA-MRSA

69
Q

What are some of the adverse reactions of clindamycin?

A

Severe diarrhea

Pseudomembranous colitis

Disease & Defense (3 decks)

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