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BACTE FINALS > WEEK 11: AEROBIC GRAM-POSITIVE BACILLI > Flashcards

WEEK 11: AEROBIC GRAM-POSITIVE BACILLI Flashcards

1
Q

Non-spore formers can be divided into two, smaller groups
as:

A

non-branching catalase-positive bacilli and non
branching catalase-negative bacilli

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2
Q

frequently isolated from urogenital specimens from women
and are incubated aerobically but they are aerotolerant
anaerobes

A

Lactobacillus

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3
Q

Frequently isolated in clinical laboratory but are typically
considered contaminants or commensals:

A

Bacillus and
Corynebacterium

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4
Q

A large diverse group of bacteria that includes animal and
human pathogens as well as saprophytes and plant
pathogens

A

CORYNEBACTERIUM

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5
Q

closely related to
mycobacteria and nocardiae On the basis of 16S ribosomal ribonucleic acid (rRNA)
sequencing,

A

corynebacteria

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6
Q

CORYNEBACTERIUM CAN BE DIVIDED INTO

A
  • Can be divided into nonlipophilic and lipophilic species
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7
Q
  • Lipophilic corynebacterial:
A

o Considered fastidious and grow slowly on
standard culture media
o incubated for at least 48 hours
o Growth is enhanced if lipids are included in the
culture medium

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8
Q

Slightly curved, gram-positive rods with
nonparallel sides and slightly wider ends, producing the
described “club shape”

A

CORYNEBACTERIUM

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9
Q

The term diphtheroid, meaning “diphtheria-like,” is
sometimes used in reference to this Gram staining
morphology

A

CORYNEBACTERIUM

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10
Q

The classification of corynebacteria is not well
characterized. It is not possible to identify 30% to 50% of
coryneform-like isolates to the species level without

A

16S
rRNA gene sequencing.

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11
Q

Most significant pathogen of the group CORYNEBACTERIUM

A

C. diphtheriae

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12
Q

CORYNEBACTERIUM DIPTHERIAE
IS CLASSIFIED INTO

A

Classified into biotypes (mitis, intermedius, and gravis)
according to colony morphology, as well as into lysotypes
based upon corynebacteriophage sensitivity

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13
Q

WHAT IS NEEDED FOR OPTIMAL GROWTH OF C. DITHERIAE??

A
  • Most strains require nicotinic and pantothenic acids for growth; some also require thiamine, biotin, or pimelic acid
  • For optimal production of diphtheria toxin, the medium should be supplemented with amino acids and must be deferrated
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14
Q

Virulence factor of c diptheriae

A
  • diptheria toxin
  • fragment a and b
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15
Q

he major virulence factor and a protein
of 62,000 daltons (Da)

A

Diphtheria toxin

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16
Q

__________and _______ which belong to the
“C. diphtheriae group,” can also produce the toxin when
they become infected with the tox-carrying β-phage____

A

C. ulcerans and C. pseudotuberculosis

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17
Q

when is diptheria toxin toxic?

A

Toxin is exceedingly potent and is lethal for humans in
amounts of 130 ng/kg body weight

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18
Q

is responsible for the cytotoxicity

A

fragment a

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19
Q

binds to receptors on human cells
and mediates the entry of fragment A into the
cytoplasm

A

Fragment B

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20
Q

diptheria toxin is caused by and secreted by

A
  • The toxicity is caused by the ability of diphtheria toxin to
    block protein synthesis in eukaryotic cells.
  • The toxin is secreted by the bacterial cell and is nontoxic
    until exposed to trypsin.
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21
Q

cleaves the diptheria toxin into the two fragments,
which are held together by a disulfide bridge

A

Trypsinization

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22
Q

splits nicotinamide adenosine dinucleotide to form nicotinamide and adenosine diphosphoribose
(ADPR).

A

Fragment A

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23
Q

binds to and inactivates elongation factor 2 (EF-2),
an enzyme required for elongation of polypeptide chains on
ribosomes.

A

ADPR

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24
Q

Production of the diptheria toxin in vitro depends on numerous
environmental conditions:

A

o Alkaline pH (7.8 to 8.0)
o Oxygen
o Iron concentration in the environment (most
important)

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25
Q

diseases cause dby c diptheria

A

2 different form of disease in humans
Respiratory diptheria
Cutaneous diphtheria = nonhealing ulcer and dirty gray membrane

Begins gradually and is characterized by low-grade fever, malaise, and a mild sore throat

Most common site of infection is the tonsils or the pharynx

The symptoms of diphtheria include pharyngitis, fever, swelling of the neck or area surrounding the skin lesion

Combination of cell necrosis and exudate forms a tough gray-to-white pseudomembrane, which attaches to the tissues.

diphtheritic lesion

diphtheritic lesion

Cardiac failure

Asymptomatic nasopharyngeal carriage

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26
Q

how to diagnose c diptheria

A

Toxigenicity is identified by a variety of in vitro (e.g., gel
immunodiffusion, tissue culture) or in vivo (e.g., rabbit skin test, guinea pig challenge) methods

In vivo toxin testing is rarely done because the in vitro
methods are reliable, less expensive, and free from animal
use.

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27
Q

appearance of c diptheria

A
  • pleomorphic
  • palisades, sharp angles with v and L formation
  • club shaped swelling and beads
  • babes ernst granules
  • irregular stain esp with meth blue
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28
Q

accumulation of polymerized polyphosphates.

A

Babès-Ernst granules

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29
Q

accumulation of
nutrient reserves and differs with the type of medium and the metabolic state of the individual cells.

A

Babès-Ernst granules

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30
Q

temp for c diptheriae

A

FA
Grows best under aerobic conditions and has an optimal growth temperature of 37° C, although multiplication occurs within the range of 15° to 40° C.

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31
Q

WHAT AGAR MEDIUM IS BEST FOR C DIPTHEIRA

A

Grows on nutrient agar, better growth is usually obtained on a medium containing blood or serum, such as Loeffler serum or Pai agars

LOEFFLER = KITANG KITA
SBA = SMALL ZONE OF B HEMOLYSIS
CTBA - BLACK/BROWN COLONY DUE TO REDUCED TELLURITE

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32
Q

is useful for differentiating corynebacteria because
only C. diphtheriae, C. ulcerans, and C. pseudotuberculosis
form a brown halo as a result of cystinase activity

A

CTBA

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33
Q

CTBA is useful for differentiating corynebacteria because only____________________ form a brown halo as a result of cystinase activity

A

CTBA is useful for differentiating corynebacteria because
only C. diphtheriae, C. ulcerans, and C. pseudotuberculosis
form a brown halo as a result of cystinase activity

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34
Q

1distinguishes C. diphtheriae
from c. ULCERANCE AND C PSEUDOTUBERCULSOSIS

A

Lack of urease production

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35
Q

Identification of an isolate as C. diphtheriae does not mean that the patient has diphtheria

t or f

A

trueeeeeee

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36
Q

elek test what bacteria and explain procedure

A

c. diptheria

o Requires reagents and antisera be carefully
controlled and titrated

o Organisms (controls and unknowns) are streaked
on medium of low iron content.

o Each organism is streaked in a single straight line
parallel to each other and 10 mm apart.

o A filter paper strip impregnated with diphtheria
antitoxin is laid along the center of the plate on a
line at right angles to the inoculum lines of control
and unknown organisms

o The plate is incubated at 35° C and examined after
18, 24, and 48 hours.

o Lines of precipitation are best seen by transmitted
light against a dark background.

o The white precipitin lines start about 4 to 5 mm
from the filter paper strip and are at an angle of
about 45 degrees to the line of growth.
If an isolate is positive for toxin production and it is
placed next to the positive control, the toxin line of
the positive control should join the toxin line of the
positive unknown to form an arch of identity

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37
Q

what else can be used to diagnose c diptheria

A

Rapid enzyme-linked immunosorbent assays and
immunochromatographic strip assays: Available for the
detection of diphtheria toxin.
* PCR - for tox gene

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38
Q

Toxoid vaccine-formalin-treated diphtheria toxin is part of

A

trivalent diphtheria, tetanus, and pertussis vaccine

preventing disease but not infection

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39
Q

Antimicrobial agents have no effect on the toxin that is
already circulating, but they do eliminate the focus of
infection and prevent the spread of the organism.

A

c diptheria

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40
Q

treatment of diptheria

A
  • Drug of choice is penicillin
  • Erythromycin is used for penicillin-sensitive individuals.
  • Most patients do not develop immunity after infection;
    therefore, vaccination should be administered after
    recovery
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41
Q

C. Amycolatum

A
  • normal skin microbiota
  • prosthetic joint infection and has been
    reported to cause bloodstream infection and endocarditis
  • flat and dry, have a matte or
    waxy appearance, and are nonlipophilic.
  • MDR:β-lactams, fluoroquinolines, macrolides, clindamycin, and
    aminoglycosides
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42
Q

C. jeikeium

A
  • NORMAL SKIN MICROBIOTA
  • LIMITED TO IMMUNOCOMPOROMISED, HAD INVASIVE PROCEDURE OR THOSE WITH CENTRAL LINE CATHETER OR PROSTHETIC DEVICE
  • Most common cause of Corynebacterium-associated
    prosthetic valve endocarditis in adults.
  • Causes septicemia, meningitis, prosthetic joint infections,
    and skin complications, such as rash and subcutaneous
    nodules.
  • Lipophilic
  • MDR: Cephalosporins, aminoglycosides.
  • SUS: VANCOMYCIN
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43
Q

C. pseudodiptheriticum

A
  • Part of the normal biota of the human nasopharynx, is an infrequent cause of infection.
  • Associated with respiratory tract infections in
    immunocompromised or patients with other
    underlying diseases, such as chronic obstructive pulmonary disease or diabetes mellitus
  • Respiratory tract infection can mimic respiratory diphtheria.
  • Cause endocarditis, urinary tract infections (UTIs), and
    cutaneous wound infections in immunocompromised
    patients.
  • NOT PLEOMORPHIC
  • EVEN STAIN
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44
Q

C. pseudotuberculosis

A
  • Veterinary pathogen
  • Human infections typically have been associated with
    contact with sheep and are rare
  • Causes a granulomatous lymphadenitis in humans.
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45
Q

C. striatum

A
  • Part of the human skin and the nasopharynx
  • commensal, contaminant, nosocomial
  • device-related infection and has been reported in cases of endocarditis, septic arthritis, meningitis, and pneumonia.
  • Nonlipophilic
  • Pleomorphic
  • Produces small, shiny, convex colonies in about 24 hours.
  • Resistant: Penicillins and other β-lactams, macrolides,
    fluoroquinolones, daptomycin (reported recently)
  • Susceptible: Vancomycin. Resistance to daptomycin has been reported recently.
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46
Q

C. ulcerans

A
  • Isolated from humans with diphtheria-like illness, and a significant number of isolates produce the diphtheria toxin.
  • veterinary pathogen, causing mastitis in cattle and
    other domestic and wild animals
  • Isolated from skin ulcers and exudative pharyngitis.
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47
Q

C. urealyticum

A
  • Most commonly associated with UTIs.
  • Presumptive identification can be made for urine isolates with pinpoint, nonhemolytic, white colonies
  • Christensen urea slant
  • Resistant: β-lactams, trimethoprimsulfamethoxazol,
    macrolides, and tetracycline.
  • Drug of choice: Vancomycin
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48
Q

Linked to bacteremia, endocarditis, pneumonia, and other
infections.

A

R. MUCILAGINOSA

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49
Q

R. DENTOCARIOSA

A
  • Normal human oropharyngeal microbiota
  • Found in saliva and supragingival plaque.
  • Isolated from patients with endocarditis.
  • Resembles coryneform bacilli
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50
Q

o Branching filaments that resemble filaments of
facultative actinomycetes.
o However, when placed in broth, the species
produces
coccoid cells, a characteristic
differentiating it from actinomycetes.

A

R. DENTOCARIOSA

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51
Q

is widespread in the environment and has been recovered from:
o Soil
o Water
o Vegetation
o Animal products: Raw milk, cheese, poultry, and
processed meats

A

LISTERIA MONOCYTOGENES

  • can also be in git
  • Isolated from crustaceans, flies, and ticks.
  • Known to cause illness in many species of wild and
    domestic animals, including sheep, cattle, swine, horses,
    dogs, cats, rodents, birds, and fishes
  • Can be isolated from both human and animal asymptomatic carriers.
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52
Q

Has the highest mortality rate secondary to its unique
virulence factors

A

L. monocytogenes

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53
Q

is recognized as an uncommon but serious
infection primarily of neonates, pregnant women, older
adults, and immunocompromised hosts. Infection may also
occur in healthy individuals

A

Listeriosis

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54
Q

Virulence Factors of listeria monocytogenes

A
  • Hemolysin (Listeriolysin O (LLO))
  • catalsew=
  • superoxide dismutase

-Phosphatidylinositol-specific phospholipase C (PI-PLC)

  • Intracellular mobility via actin polymerization (ActA)
  • Surface protein (p60)
  • hemolysis
  • Intracellular mobility via actin polymerization (ActA)
  • Ability to replicate at refrigerator temperatures
  • Internalins (InlA and InlB)
  • cadherin
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55
Q

o Damages the phagosome membrane, effectively
preventing killing of the organism by macrophages
o Helps bacteria escape from host cell vacuole

A

Hemolysin (Listeriolysin O (LLO))

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56
Q

Helps the bacteria escape host cell vacuole and
cause membrane disruption

A
  • Phosphatidylinositol-specific phospholipase C (PI-PLC)
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57
Q

Induces phagocytosis through increased adhesion
and penetration into mammalian cells.

A
  • Surface protein (p60).
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58
Q

Nonhemolytic isolates are found to be avirulent and
demonstrate no intracellular spread of the organism

A

L monocytogenes

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59
Q

forms “rocket tails” via actin
polymerization that allows the bacteria to move rapidly between cells, avoid antibody detection,
and spread hematogenously

A

L. monocytogenes

  • Intracellular mobility via actin polymerization (ActA)
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60
Q

Low temperatures induce enzymes such as RNA
helicase which improves ???
activity and replication at low temperatures

A

Low temperatures induce enzymes such as RNA
helicase which improves L. monocytogenes’
activity and replication at low temperatures

enables the ability to propel itself
and latch onto enterocytes early in infection, but
eventually losing the flagella the longer the
bacteria is exposed to higher temperatures

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61
Q

Bacterial surface proteins for host cell attachment

A
  • Internalins (InlA and InlB)
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62
Q

An epithelial attachment protein that is found in
abundance in the blood-brain barrier as well as the
placental-fetus barrier which may explain why the
bacteria can infect neonates and cause meningitis.

A

Cadherin

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63
Q

disease caused by l monocytogenes

A

Known to cause illness in many species of wild and domestic animals, including sheep, cattle, swine, horses, dogs, cats, rodents, birds, and fishes

  • meningitis
  • Sepsis, meningitis, encephalitis, spontaneous abortion, or fever and self-limiting gastroenteritis in a healthy adult
  • a tropism for the central nervous system (CNS)
  • Infections of newborns and immunocompromised adults are the most common
  • Early and late-onset listeriosis in newborn
  • Most common manifestations: CNS infection and endocarditis.
  • Outbreaks have occurred as a result of eating contaminated cheese, coleslaw, and chicken.
  • Contaminated ice cream, hot dogs, and luncheon meats have served as vehicles for this foodborne disease.
  • intestinal tract infection
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64
Q

Responsible for spontaneous abortion and stillborn
neonates

Signs and symptoms: flulike illness with fever, headache,
and myalgia

result in premature labor or septic
abortion within 3 to 7 days.

source of infection eliminated at birth so self limiting siya

A

l monocytogenes disease in preggy

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65
Q

disease in newborn l monocytogenes

A
  • Extremely serious
  • 50% fatality for babies born alive
  • Similar to Streptococcus agalactiae neonatal disease, there
    are two forms of neonatal listeriosis: early onset and late
    onset.
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66
Q

o Early-onset listeriosis:

A

From an intrauterine infection that can
cause illness at or shortly after birth.
▪ The result is most often sepsis.
▪ Associated with aspiration of infected
amniotic fluid.

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67
Q

o Late-onset disease
listeriosis

A

▪ Occurs several days to weeks after birth.
▪ Affected infants generally are full-term
infants and healthy at birth.
▪ Most likely to manifest itself as meningitis.
▪ Fatality rate is lower than in early-onset
infection

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68
Q
  • Outbreaks have occurred as a result of eating contaminated
    cheese, coleslaw, and chicken.
  • Contaminated ice cream, hot dogs, and luncheon meats
    have served as vehicles for this foodborne disease.
A

l monocytoegenes

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69
Q

Most common manifestations: CNS infection and
endocarditis.

A

l monocytogenes

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70
Q

appearance of l monocytogenes

A
  • Gram-positive coccobacillus.
  • Subculturing, cells become coccoidal
  • Older cultures often appear gram variable.
  • Singly, in short chains, or in palisades.
  • L. monocytogenes can resemble Streptococcus when
    found in the coccoid form
  • L. monocytogenes can resemble Corynebacterium when
    the bacillus forms prevail.
  • Not usually seen on the CSF smear
  • Colonies and hemolysis resemble those seen with S.
    agalactiae
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71
Q

how to grow l monocytogenes

A
  • Grows on a special type of agar called Mueller-Hinton agar.
  • Grows well on SBA and chocolate agar
  • Grows well on nutrient agars and in broths, such as brain heart infusion medium and thioglycolate broth.
  • Prefers a slightly increased carbon dioxide (CO2) tension for isolation.
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72
Q

temp for l monocytogenes

A

Optimal growth temperature: 30° to 35° C, but growth
occurs over a wide range (0.5° to 45° C).
* Cold Enrichment: Can grow at 4° C and used to isolate the
organism from polymicrobial clinical specimens

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73
Q

wet mount prep in l mono cytogenes

A

▪ Exhibits tumbling motility (end-over-end
motility) when viewed microscopically
▪ Umbrella pattern is seen when the
organism is incubated at room temperature (22° to 25° C) but not at 35°

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74
Q

l monocytogenes camp reaction

A

▪ More pronounced CAMP reaction is seen
when Rhodococcus equi is used in place
of Staphylococcus aureus. L.
▪ Produces a “block”-type hemolysis
▪ distinguishes L. monocytogenes (+) from
other Listeria spp (-)

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75
Q
  • Presumptive identification and confrimatory findings of l monocytogewnes
A
  • Presumptive identification:
    o Gram staining
    o Tumbling motility
    o Positive catalase
    o Esculin hydrolysis.
  • Confirmatory findings:
    o Acid production from glucose and positive
    o Voges-Proskauer
    o Methyl red reactions.
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76
Q

HOW TO TREAT L MONOCYTOGENES

A
  • Preferred Drug: Ampicillin
  • Penicillin, aminoglycosides, and macrolides is effective to
    treat Listeriosis
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77
Q
  • There are three species in the genus Erysipelothrix:
A

o Erysipelothrix rhusiopathiae
o Erysipelothrix tonsillarum
o Erysipelothrix inopinata

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78
Q
  • Only species known to cause disease in humans.
    genus Erysipelothrix
A

ERYSIPELOTHRIX RHUSIOPATHIAE

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79
Q

Commensal and present in vertebrates and invertebrates,
including domestic swine, birds, and fishes.

A

ERYSIPELOTHRIX RHUSIOPATHIAE

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80
Q

ROute of infection: ERYSIPELOTHRIX RHUSIOPATHIAE

A

Cuts or scratches on skin
* Human cases typically result from occupational exposure.
Work involves handling fish and animal
products are most at risk.

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81
Q

LOC OF ERYSIPELOTHRIX RHUSIOPATHIO

A

Survives well in environmental sources: Water, soil, and
plant.

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82
Q

DISEASE CAUSED BY ERYSIPELOTHRIX RUSOPATHIAE

A

Linked to bacteremia, endocarditis, pneumonia, and other infections.

Produces three types of disease in humans:
ERYSPELOID
SEPTICIMEIA
DIFFUSE CUTANEOUS INFECTION AND SYSTEMIC DISEASE

pneumonia, abscesses, meningitis, endophthalmitis, osteomyelitis, and septic arthritis

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83
Q

A localized skin infection that resembles
streptococcal erysipelas.

A

Erysipeloid

  • Lesions usually are seen on the hands or fingers
    because they are inoculated through work
    activities.
  • Signs and symptoms: Low-grade fever,
    arthralgia, lymphangitis, and lymphadenopathy
    may occur.
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84
Q

ERYSIPELOTHRIX RHISIOPATHIAE IS RESISTANT AND SUSCEPTIBLE TO

A

o Resistant: Aminoglycosides and Vancomycin
o Susceptible:
Cephalosporins
Fluoroquinolones

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85
Q

APPEARANCE OF ARYSIPELOTHRIX RHUSOPATHIAE

A
  • Thin, rod-shaped, grampositive organism that can form long
    filaments
  • Arranged singly, in short chains, or in a “V” shape.
  • V shape arrangement is similar to corynebacterial
  • E. rhusiopathiae decolorizes easily, so it may appear gram
    variable.
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86
Q

Inoculated in a nutrient broth with 1% glucose and
incubated in 5% CO2 at 35° C.

A

ERSYPELOTHRIX RHUSOPATHIAE

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87
Q

Gelatin stab culture yields a highly characteristic “test tube
brush–like” pattern at 22° C.

A

ERYSIPELOTHRIX RHUSOPATHIAE

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88
Q
  • Stain gram variable or gram negative.
  • Gram-positive type of cell wall
    o Peptidoglycan layer is thinner
A

GARDNERELLA VAGINALIS

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89
Q

Characterized by a malodorous discharge and
vaginal pH greater than 4.5.

A

bacterial vaginosis (BV)

90
Q

BV

A

o Results from a reduction in the Lactobacillus
population in the vagina
o Increase in vaginal pH

91
Q

GARDNERELLA VAGINALIS

A
  • BV
  • Also play a role in UTIs in men and women
  • BV is associated with preterm birth and increased risk for acquisition of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs)
92
Q

GARDNERELLA VAGINALIS
VF

A

VAGINOLYSIN
PROTEASE AND SIALIDASE ENZYME

93
Q

cholesterol-dependent cytolysin that
initiates complex signaling cascades that induce target cell lysis and allow for Gardnerella’s virulence

A

Vaginolysin

94
Q

Diagnosis of BV:

A

o Presence of “clue cells,” large squamous epithelial
cells

o Gram-positive ,gram-variable bacilli and coccobacilli clustered on the edges

o Lactobacillus rods are absent in the wet mount.

95
Q

Amsel’s clinical criteria

A

used to diagnosis BV
if three of four criteria are found:
1. Homogeneous, thin, white discharge that
smoothly coats the vaginal walls
2. Clue cells
3. pH of vaginal fluid greater than 4.5
4. Fishy odor of vaginal discharge before or after
addition of 10% potassium hydroxide, the whiff
test (positive).

96
Q

detect vaginal fluid sialidase activity

A

o Affirm VP III (Becton Dickinson, Sparks, MD)
o DNA hybridization probe test
o OSOM BV Blue test (Sekisui Diagnostics,
Framingham, MA

97
Q

for definitive
identification of G. vaginalis

A

16S rRNA gene sequencing

98
Q

Gram staining of the vaginal fluid to
examine the predominant strain of bacteria to make a
microbiological diagnosis of BV

A

Nugent CriteriaQ

99
Q

GARDNERELLA VAGINALIS
GROWS BEST IN

A
  • It takes more than 24 hours to develop visible colonies
  • Grows best in 5% to 7% CO2 at a temperature of 35° to 37° C.
    Medium of choice: Human blood bilayer Tween (HBT)
    agar.
    Also produces β-hemolytic colonies on media made with
    rabbit or human blood, but not sheep blood
    (NONHEMOLYTIC ON SBA AND PIN POINT)
100
Q

Differential Diagnosis
OF BV

A

PROPER PELVIC EXAM, = exclude other similarly presenting diseases such as herpes simplex virus
SPECULUM EXAM, = can look for cervicitis and a wet mount of the vaginal discharge can determine if there is candidiasis or trichomoniasis
CERVICAL SWAB = can be sent for chlamydia and gonorrhea

101
Q

GARDNERELLA VAGINALIS
Treatment

A
  • Drug of choice: Clindamycin and Metronidazole
102
Q

are a primary clue that a
clinical sample contains Nocardia spp.

A

Finely beaded, branching rods

103
Q

Colony, microscopic morphology and types of infections
caused, sometimes resemble those of fungi, but these
organisms are true bacteria.

A

NOCARDIA

104
Q

isolation of __________ from patients should be carefully evaluated for the presence of disseminated disease,
immunocompromised hosts

A

Nocardia

105
Q

was considered the most prominent
Nocardia human pathogen

A

Nocardia asteroides

106
Q

more virulent than the other
members of the N. asteroides complex, since infection with this species is more likely to result in disseminated disease

A

N. farcinica

107
Q

different susceptibility pattern, showing
consistent susceptibility to erythromycin and ampicillin

NOCARDIOA

A

N. NOVA

108
Q

VF OF NOCARDIA

A

Superoxide dismutase and catalase

nocobactin = ironchelating compound

109
Q

occurs from the inhalation of the
organism present in dust or soil and is the most common manifestation of disease.

NOCARDIA

A

PULMONARY INFECTION

110
Q

DISEASE CAUSED BY NOCARDIA

A
  • Infection occurs by two routes: pulmonary and cutaneous.
  • Serious infection
  • brain abscess infection
  • 40% of the diagnoses are made at autopsy.

Pulmonary infections
- Confluent bronchopneumonia
- thick and purulent sputum
- no sulfur granules

Cutaneous infections
- acetinmycotic mycetomas
- Direct inoculation of Nocardia species by transcutaneous routes results in three forms of infection: cellulitis, lymphocutaneous disease, or actinomycetoma
- Primary cutaneous nocardiosis
- Lymphocutaneous nocardiosis/sporotrichoidtype
- Actinomycetoma

111
Q

No sulfur granules (masses of filamentous organisms bound
together by calcium phosphate) develop, and no sinus tract
formation occurs.

A

Confluent bronchopneumonia

112
Q

Cutaneous Infection IN NOCARDIA
IS OFTEN caused by what species

A

N. brasiliensis is the most frequent cause of this form of
nocardiosis

113
Q

most common cause of actinomycotic
mycetoma.

A

N. brasiliensis

114
Q

are
characterized by swelling, draining sinuses, and granules

A

mycetomas

115
Q

MYCETOMAS

A
  • As the infection progresses, burrowing sinuses open to the
    skin surface and drain pus.
  • The pus may be pigmented and contain “sulfur granules”
  • Sulfur granules appear yellow or orange and have a distinct
    granular appearanc
116
Q

Direct inoculation of Nocardia species by transcutaneous
routes results in three forms of infection:

A

cellulitis,
lymphocutaneous disease, or actinomycetoma

117
Q

This Nocardia
infection is marked by the presence of a primary
pyodermatous lesion frequently associated with areas of
chronic drainage and crusting. progresses to the
formation of lymphatic abscesses

A

Lymphocutaneous nocardiosis/Sporotrichoidtype

118
Q

te-stage infection,
characterized by a chronic, localized, slowly progressive,
and subcutaneous and bone disease, usually involving the
foot and often painless

A

Actinomycetoma

119
Q

Chalky, matte, velvety, or powdery appearance
and may be white, yellow, pink, orange, peach, tan,
or gray pigmented.

A

NOCARDIA

120
Q

beaded appearance may be confused as chains of
gram-positive cocci

A

NOCARDIA

121
Q

Can have a dry, crumbly appearance similar to
breadcrumbs

A

NOCARDIA

122
Q

Examination of colonies with a dissecting
microscope may reveal the presence of aerial
hyphae (production of spores)

A

NOCARDIA

123
Q

Branching isolate that is partially acid fast on
staining with carbolfuchsin and decolorizing with a
weak acid (0.5% to 1% sulfuric acid) compared
with 3% hydrogen chloride in the stain for
mycobacteria.

A

NOCARDIA

124
Q

Direct examination specimen: Tissue and pus from draining
sinuses

A

NOCARDIA

125
Q

Broad, interwoven, septate hyphae that are wider
(2 to 5 µm) compared to actinomycotic mycetoma

A

Eumycotic mycetoma

126
Q

HOW TO GROW NOCARDIA

A
  • Grow well on most common nonselective laboratory media
  • Incubated at temperatures between 22° and 37° C,
  • 3 to 6 days or more may pass before growth is seen.
  • Recovered on simple media containing a single organic
    molecule as a source of carbon.
  • Media containing antimicrobial agents used for isolating
    fungi should not be used because they susceptible to many
    of the agents used in these media.
  • SBA: some isolates are β-hemolytic
  • Thayer-Martin agar may enhance recovery by inhibiting
    the growth of contaminating organisms.
  • They also grow on nonselective buffered charcoal–yeast
    extract agar
127
Q

Phenotypic tests are used to identify relevant Nocardia spp.

A

o Substrate hydrolysis (casein, tyrosine, xanthine,
and hypoxanthine)
o Other substrate and carbohydrate use,
arylsulfatase, and gelatin liquefaction
o Antimicrobial susceptibility profile
o Fatty acid analysis by high-performance liquid
chromatography

128
Q

most reliable identification
method for nocardia

A

16S rRNA gene sequencing

129
Q

nocardia is susceptible to

A

trimethoprim sulfamethoxazole
(mild to tolerate diseases)

combination therapy with TMP SMX plus amikacin (life threatening heart, disseminated disease, infection of immunocomporomised, cns disease)

Cetrafioxone (cns disease)

TMP SMX and/or minocycline and/or amoxicillin-clavulanate
(Improves on iv and no cns disease)

Sulfonamide

130
Q

nocardia is resistant to

A

Penicillin

Antifungal agents

131
Q

actinomyces is found in

A

Actinomyces species are members of the endogenous flora of mucous membranes and are frequently cultured from the gastrointestinal tract, bronchi, and female genital tract

  • The major sites of actinomycoses are cervicofacial, abdominopelvic, and thoracic
132
Q

most common cause of human disease among the
Actinomyces species is

A

A. israelii

133
Q

never been cultured from nature, and
no person-to-person spread has been documente

A

actinomyces

134
Q

Infections are associated with the breakdown of normal
physical barriers, such as disruption of mucosal membranes
in the mouth and gastrointestinal tract

A

Actinomyces

135
Q

Certain conditions may predispose to infection, including
erupting secondary teeth, dental extractions and caries,
gingivitis, and gingival trauma

A

Actinomyces

136
Q

diagnosis of ______ in children should alert the
astute physician to consider an underlying immunodeficiency such as chronic granulomatous disease.

A

actinomyces

137
Q

The major sites of actinomycoses are

A

cervicofacial,
abdominopelvic, and thoracic

138
Q

disease caused by actinomyces

A

Infections are associated with the breakdown of normal physical barriers, such as disruption of mucosal membranes in the mouth and gastrointestinal tract

  • Certain conditions may predispose to infection, including erupting secondary teeth, dental extractions and caries, gingivitis, and gingival trauma
  • in children should alert the astute physician to consider an underlying immunodeficiency such as chronic granulomatous disease. Virtually all infections are polymicrobial
  • Certvicofacial actinomycosis
  • thoracic disease
    -acute pneumonitis
  • abdominal and pelvic actinomycosis
    -acute inflammatory lesions
    -osteomyelitis
    -stimulates ptb
    -chronic inflammation, fibrosis, and
    cavitation that result in the invasion and destruction of
    surrounding structures
139
Q

actinomyces is susceptible to

A

Thoracic, abdominal, or soft tissue abscesses may require a medico-surgical approach with drainage and extensive resection of affected tissues and excision of sinus tracts combined with prolonged antibiotic therapy

Penicillins and extended spectrum penicillins, cephalosporins, carbapenems, and tetracycline

Amoxicillin

or penicillin-allergic patients, doxycycline, erythromycins, and clindamycins have proven to be suitable alternatives

140
Q

actinomyces israelii is resistant to

A

A. israelii have developed resistance to penicillin

141
Q

most challenging aspect of diagnosis of infection by
members of the Actinomycetes is the

A

inclusion of these
organisms in the differential diagnosis of patients with
chronic cavitary pulmonary disease, especially the
immunocompromised patient

142
Q

Both species present as masqueraders in many clinical
presentation

A

actinomycosis and nocardiosis

143
Q

presence of beaded, branching, gram-positive bacilli
in any clinical specimen should alert the clinician to
consider both

A

aerobic Nocardia and anaerobic
Actinomyces

144
Q

transportation of actinomyces

A

Actinomyces are microaerophilic or
facultative, specimens should be transported in
anaerobic transport media and cultured under strict
anaerobic conditions

145
Q

Nocardia species will grow on standard blood culture
media, but the use of selective media such as _________________________________may be useful

A

Thayer
Martin with antibiotics

146
Q

Cause mycetomas, which are identical to those caused by
Nocardia.

A

Actinomadura

147
Q

Actinomaduraudes

A

Actinomadura madurae and Actinomadura
pelletieri.

148
Q

is cellobiose and xylose positive

A

A. madurae

149
Q
  • Gram Stain Morphology: Moderate, fine, intertwining,
    branching with short chains or spores, fragmentation
  • Colony Appearance on Routine Agar: White-to-pink
    pigment, mucoid, molar tooth appearance after 2 weeks’
    incubation; sparse aerial hyphae
A

Actinomadura

150
Q
  • Primarily saprophytes found as soil inhabitants
A

Streptomyces

151
Q

specimens has been increasingly isolated from many
clinical specimens, including sputum, wound, blood, and
brain

A

Streptomyces anulatus

152
Q
  • Gram Stain Morphology: Extensive branching with chains
    and spores; does not fragment easily
  • Colony Appearance on Routine Agar: Glabrous or waxy
    heaped colonies; variable morphology; wide range of
    pigmentation from cream to brown-black; white aerial
    hyphae
A

Streptomyces

153
Q

Distinguished by simple biochemical tests.

A

Gordonia

154
Q

Absence of arylsulfatase and mycelia

A

gordonia

155
Q

Infections are postsurgical sternal wounds, coronary artery
infection, and infection from central venous catheters.

A

gordonia

156
Q

gordonia is susceptible to

A

Susceptible: β-lactams, quinolones, aminoglycosides,
macrolides, and other agents active against gram-positive
organisms.

157
Q

Colony appearance on Routine Agar: Somewhat
pigmented; G. sputi smooth, mucoid, and adherent; G.
bronchialis dry and raised

A

gordonia

158
Q
  • Contact with farm animals and feces is an important risk
    factor.
  • Lung infections account for about 80% of human disease
A

phodococcus

159
Q

Rhodococcus - Most common human isolate

A

Rhodococcus equi

160
Q

SBA: Colonies resemble Klebsiella and can form a salmon
pink pigment on prolonged incubation, especially at room
temperature

A

rhodococcus

161
Q

Filaments w/ some branching,
diphtheroid-like with minimal branching or coccobacillary;
colony growth appears as coccobacilli in “zigzag”
configuration

A

rhodococcus

162
Q

Colony Appearance on Routine Agar: Nonhemolytic;
round; often mucoid with orange-to-red, salmon-pink
pigment developing within 4–7 days; pigment may vary
widely

A

rhodococcus

163
Q
  • Causative agent of Whipple disease.
A

Tropheryma whipplei

164
Q

Facultative intracellular pathogen first identified in 1991 by
using PCR from a duodenal biopsy specimen

A

Tropheryma whipplei

165
Q

Trypheryma whipplei loc

A
  • Found in human feces, saliva, and gastric secretions
  • Ubiquitous in the environment
166
Q

Symptoms: diarrhea, weight loss, malabsorption, arthralgia,
and abdominal pain.

A

tropheryma whipplei -

167
Q

T. whipplei can be identified with

A

PCR or 16S rRNA gene
sequencing

168
Q

how to treat tropheryma whipplei

A

Drug of Choice:
Initially w/ Doxycycline and Hydroxychloroquine for 1 year followed by Doxycycline for life

169
Q

diagnosis for tropheryma whipplei specimen

A

Diagnosis is best made by microscopic examination of
endoscopic biopsy specimens.

170
Q

Presence of characteristic periodic acid–Schiff staining is
strongly suggestive of

A

Whipple disease

171
Q

disease caused by tropheryma whipplei

A
  • Symptoms: diarrhea, weight loss, malabsorption, arthralgia,
    and abdominal pain.
  • Neurologic and sensory changes often occur
  • Associated with culture-negative endocarditis
  • Rare but is seen more commonly in middle-aged men
  • Asymptomatic carriage or a mild self-limiting gastroenteritis
    occurs in children after ingestion of the organism.
172
Q

Aerobic or facultative anaerobic bacilli that form
endospores

A

bacillus

173
Q

Do not grow on Columbia colistinnaladixic acid agar.

A

bacillus

174
Q

bacillus

A
  • nonpigmented
  • confused with aerotolerant strains of the
    other primary endospore-forming genus, Clostridium
  • Survival is aided by the formation of spores, which are
    resistant to conditions to which vegetative cells are
    intolerant
  • Grow well on SBA and other commonly used enriched
    media
  • lab contaminant
    -insect and plant pathogen
    -human infections (anthracis and cereus)
175
Q

bacillus vs clostridium

A

form endospores aerobically and
anaerobically, whereas Clostridium spp. form endospores
anaerobically only.

176
Q

Known to cause an anthrax-like disease in gorillas,
chimpanzees, and other animals in Africa.

A

B. cereus biovar anthracis

177
Q

Depends on a glutamic acid capsule and a three
component protein exotoxin.

A

B. ANTHRACIS

178
Q

vf of b antharcis

A

-capsule
-3 proteins:rotective antigen (PA), EF, and LF,

179
Q
  • PA with EF,
A

Edema

180
Q

PA and LF combine

A

death

181
Q

denylate cyclase that increases the concentration
of cyclic adenosine monophosphate (cAMP) in host cel

A

ef

182
Q

protease that kills host cells by disrupting the
transduction of extracellular regulatory signals

A

lf

183
Q

Spread by animals feeding on plants contaminated with the
spores or from contaminated soil.

A

anthrax

184
Q

Cases mostly occurred among postal workers as a result of
exposure to sporetainted material (powder in or on
envelopes) sent through the mail, although the actual
source remains unknown for some cases.

A

anthrax

185
Q

4 anthracis found in humans

A

cutaneous, inhalation or pulmonary, and gastrointestinal and injectional

186
Q

hen wounds are
contaminated with anthrax spores acquired through skin
cuts, abrasions, or insect bites

A

cutaneous anthrax

187
Q

Cutaneous Anthrax

A
  • A small pimple or papule appears at the site of inoculation
    2 to 3 days after exposure.
  • A ring of vesicles develops, and the vesicles coalesce to
    form an erythematous ring
  • A small dark area appears in the center of the ring and
    eventually ulcerates and dries, forming a depressed black
    necrotic central area known as an eschar or black eschar
  • Lesion is sometimes referred to as a malignant pustule,
    even though it is not a pustule and is not malignant. It is
    painless and does not produce pus, unless it becomes
    secondarily infected with a pyogenic organism
188
Q
  • Usually, the infection remains localized, but regional
    lymphangitis and lymphadenopathy appear
  • If septicemia occurs, symptoms of fever, malaise, and
    headache are seen
A

cutaneous anthrax

189
Q
  • Also called woolsorter’s disease
A

Inhalation Anthrax

190
Q

It resembles an upper respiratory tract infection, such as
that seen with colds and flu.

A

Inhalation Anthrax

191
Q

initial and severe phase of inhalation anthrax

A
  • The initial, mild form of the disease lasts 2 to 3 days. It is
    followed by a sudden severe phase in which respiratory
    distress is common.
  • The severe phase of the disease has a high mortality rate.
    The respiratory problems (dyspnea, cyanosis, pleural
    effusion) are followed by disorientation, coma, and death.
  • The severe phase (onset of respiratory symptoms to death)
    may last only 24 hours
192
Q

Occurs when the spores are inoculated into a lesion on
the intestinal mucosa after ingestion of the spores

A

Gastrointestinal Anthrax

193
Q
  • Symptoms: abdominal pain, nausea, anorexia, and
    vomiting.
  • Bloody diarrhea can also occur
  • This form of the disease is difficult to diagnose, the fatality
    rate is higher than in the cutaneous form
A

gastrointestinal anthrac

194
Q

Injectional Anthrax

A
  • Characterized by soft tissue infection associated with
    “skin popping” or other forms of injection drug use and
    results from the direct injection of the spores into tissue.
  • Can be associated with necrotizing fasciitis, organ failure,
    shock, coma, and meningitis, and it has a much higher rate
    of mortality.
  • Soft tissue infections have not been associated with black
    eschar formation. Lack of eschar, severity of disease, and
    increased mortality rate make this form clinically distinct
195
Q

Approximately 5% of patients with anthrax (cutaneous,
inhalation,
gastrointestinal,
or
injectional)
develop
meningitis, with a greater proportion of cases occurring in
the i

A

nhalation and injectional forms.

196
Q

when does Unconsciousness and death, happen after initial exposure to b anthrax

A

Unconsciousness and death, if they occur, follow 1 to 6 days
after initial exposure.

197
Q

Young cultures stain gram positive; as the cells age, or if
they are under nutritional stress, they become gram
variable.

A

b atnhrax

198
Q

encapsulated gram-positive rods in blood
is strongly presumptive for

A

B. anthracis identification.

199
Q

spore stain

A

Spores can be observed with a spore stain. With this
technique, vegetative cells stain red, and the spores stain
green Spores can be observed with a spore stain. With this
technique, vegetative cells stain red, and the spores stain
green

200
Q

Medusa head

A

B. anthracis.

201
Q

Colonies have a tenacious consistency, holding tightly to the
agar surface, and when the edges are lifted with a loop, they
stand upright without support.

A

b anthracis

202
Q

be isolated from normally sterile sites, such as
blood, lung tissue, and CSF, selective media are not usually
needed for recovery.

A

b anthracis

203
Q

Grows in high-salt (7% sodium chloride) and low pH (<6)
conditions.

A

b anthracis

204
Q

Capsule production by B. anthracis can be detected by

A

India ink

205
Q

Presence of both antigens (polysaccharide and capsule) is

A

confirmation for B. anthracis

206
Q

treatment of b anthracis

A

The initial therapy should be a multidrug regimen, including a fluoroquinolone and one or more additional agents with good CNS penetration.

Vaccne

Penicillin, tetracycline, fluoroquinolones, and chloramphenicol

ciprofloxacin or doxycycline be used for initial intravenous therapy until antimicrobial susceptibility results are known

Initial therapy of inhalation anthrax: Ciprofloxacin or doxycycline plus one or two additional antimicrobial agents, depending on disease severity.

clindamycin = inhibit exotoxin production. *

metronidazole= injectional anthrax

ciprofloxacin or doxycycline =postexposure prophylaxis for pulmonary anthrax

207
Q

B. cereus is similar to B. anthracis in many ways—

A

morphologically and metabolically

208
Q

o β-hemolytic frosted glass–appearing colony
o Spore-forming

A

b cereus

209
Q

o insect pathogen
o produces parasporal crystals that can be observed
by using phase contrast microscopy or spore
staining.

A

B. thuringiensis

210
Q

Common cause of food poisoning and opportunistic
infections in susceptible hosts.

A

b cereus

211
Q

diseases caused by b cereus

A

Common cause of food poisoning and opportunistic infections in susceptible hosts.

food poison: diarrheal or emetic

eye infection,endophthalmitis, panophthalmitis, and keratitis with abscess formation
(occur more frequently in intravenous drug abusers, neonates, and immunosuppressed and postsurgical
patients. )

few reports of B. cereus strains carrying the B.
anthracis toxin genes that caused severe pneumonia
similar to pulmonary anthrax

212
Q

diarrheal form of b cereus

A

Associated with ingestion of meat or
poultry, vegetables and pastas
* Incubation period of 8 to 16 hours.
* Signs and symptoms:
o Abdominal pain and diarrhea.
o About 25% of individuals have vomiting
o Fever is uncommon.
* The average duration of the illness is 24 hours.
* Diarrheal form is clinically indistinguishable from diarrhea
caused by Clostridium perfringens.

213
Q

emetic form

A
  • Signs and symptoms:
    o Predominant symptoms of nausea and vomiting 1
    to 5 hours after ingestion of contaminated food.
    o Diarrhea is present in about one third of affected
    individuals.
214
Q

eported in nonsterile alcohol pads used as an
antiseptic measure before injections.

A

b cereus

215
Q

treatment of b cereus

A

Treatment with vancomycin or clindamycin with or without an aminoglycosid

SELF LIMITNG

216
Q

b cereus is resistant to

A

resistant to penicillin
and all of the other β-lactam antibiotics except the
carbapenems

217
Q
  • These organisms have been reported to cause food
    poisoning, bacteremia, meningitis, pneumonia, and other
    infections.
  • They are more commonly seen as contaminants
A

other bacillus species

218
Q

other bacillus species

A

These include, but are not limited to:
o Bacillus subtilis
o Bacillus licheniformis
o Bacillus circulans
o Bacillus pumilus
o Bacillus sphaericus q

219
Q

are two well-known
antibiotics obtained from Bacillus species. Several
species are used as standards in medical and
pharmaceutical assays

A

Bacitracin and polymyxin

220
Q

The spores of the___________ are used to test heat sterilization
procedures, and B. subtilis subsp. globigii, which is
resistant to heat, chemicals, and radiation, is widely used
to validate alternative sterilization and fumigation
procedures

A

obligate thermophile B.
stearothermophilus

221
Q

Rarely encountered but cause disease:

A

Listeria,
Erysipelothrix, Corynebacterium diphtheriae, and Bacillus
anthracis

BACTE FINALS (3 decks)

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