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Micro > Week 3- Strep, CSF, Blood > Flashcards

Week 3- Strep, CSF, Blood Flashcards

1
Q

Strepcoccus/Enterococcus species are:

A

gram-positive cocci in pairs and/or chains

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2
Q

Strep pyogens: what are the natural reservoirs?

A

skin and mucous membranes (always consider as a potential pathogen)

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3
Q

What is the most common infection from strep pyogens?

A

phayrngitis (can also give you impetigo, erysipelas, scarlet fever, and peurperal fever)

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4
Q

What should be the first step in diagnosis if you suspect strep pyogens?

A

rapid strep test, which is 70-90% sensitive (this test detects antigens). If its negative, then you culture.

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5
Q

Will you perform a suscebitibility for strep pyogens? What is the treatment?

A

No. The treatment has not changed. It is PCN

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6
Q

What are the two post-streptococcal sequelae? Will you culture, and give antibiotics?

A

NON-SUPPRATIVE rhuematic fever and acute glomerulonephritis. NO! dont culture, dont give antibiotics. Be aware that antibody tests can provide SEROLOGICAL evidence of a prior infection (ASO and anti-Dnase-B)

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7
Q

Where is strep agalactiae (Group B) considered normal floral?

A

upper respiratory tract and genitourinary tract. (it is an opportunistic pathogen)

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8
Q

What is Group B strep primarily responsible for?

A

neonatal meningitis, pneumonia, sepsis (neonate/maternal)

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9
Q

Group B: You suspect a pregnant woman might have group B, what DIAGNOSTIC testing might you do?

A

direct speciman and culture

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10
Q

Group B: For a positive Group B prego, what will you do prior to her giving birth?

A

IV PCN q4h before birth.

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11
Q

Group B: How might an early onset neonatal exposure present?

A

pneumonia, septicemia, or meningitis

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12
Q

Group B: How might a late onset of neonatal exposure might present?

A

septicemia with meningitis, NO PNEUMONIA! diagnose this with A CULTURE!

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13
Q

Will you perform susceptibility testing for Group B?

A

No. (unrelated side note: organism is beta hemolytic)

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14
Q

Strep sp. viridans is normal flora in…

A

mucous membranes of oropharnx, GI/GU tracts and skin

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15
Q

What is strep sp viridans number 1 clinical significance?

A 
#1 cause of subacute bacterial endocarditis!!
diagnose with a culture
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16
Q

What kind of hemolysis does strep sp. viridans have?

A

alpha

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17
Q

What is the best way to treat strep sp viridans? What is an additional treatment you could use?

A

Treat with PCN and ceftriaxone. Sometimes a synergistic combo of PCN and gentamicin is used!

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18
Q

Is susceptibility testing needed for Strep sp viridans?

A

susceptibility testing and full ID performed for life-threating infections!

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19
Q

strep bovis: if it is isolated from blood, what is there a high correlation with?

A

colon cancer

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20
Q

strep bovis is susceptible to what? What should the treatment be?

A

PCN. Treat with PCN and ceftriaxone. Sometimes a synergistic combo of PCN and gentamicin is used!

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21
Q

where is strep pneumonia normal flora

A

the upper respiratory tract

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22
Q

what is strep pneumonia major virulence factor?

A

polysaccharide capsule which protects it from phagocytosis

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23
Q

Strep pneumoniae is the #1 cause of what? (hint: there are two disease states)

A

Community acquired bacterial pnuemonia and meningitis in people > than 1 mo. old (note: septicemia CAN occur too, but it is more likely to occur if someone already has meningitis).

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24
Q

What is the diagnositc testing for strep pneumonia?

A

sputum, blood, csf

25
Do you perform susceptibility testing with strep pneumonia?
Yes. if PCN is "s", then treat appropriatley. If PCN is "r", then refer to susceptibility results (usually you end up treating with vanco, levo, or ceftriaxone). NOTE: a vaccine is available
26
Where is Enterococcus sp normal flora?
the GI tract. It is an opportunistic pathogen of the blood, abdomen.
27
What is enterococcus sp. clinical signfigance?
usually the cause of disease in debilitated or immunosuppressed individuals. Disease states include: UTI, peritonitis, endocarditis, septicemia, abdominal infections
28
What are enterococcus sp. intrinsically resistant to?
cephalosporins.
29
How should enterococcus sp be treated?
treated with a cell well active antibiotic (ex PCN, ampicillin) and aminoglycoside ( ex. gentamicin, streptomycin). (synergistic approach).
30
What is a nosociomial problem associated with enterococcus sp.?
VRE.
31
What are they key factors for CSF infection
age of patient, nutritional/immunological status, presence of underlying disease
32
What is the primary route of infection for CSF?
nasopharyngeal colonization--> crosses mucosal barrier--> blood stream --> meninges --> replicate in subarachnoid space
33
Is the CSF normally sterile?
yes
34
What is the normal transport and handling of CSF fluid?
transport immediatley!! Process STAT! If process is delayed, keep speciman at ROOM TEMP...DONT REFRIGERATE!!
35
How do you typically collect CSF fluid? How many bottles should you collect?
lumbar puncture (needle into subarachnoid space), collect 3-4 (1-2mls each) bottles.
36
Describe what each CSF specimen tube is used for
tube 1= chemistry studies (glucose and protein) tube 2 or 3 = bacterial culture and gram stain tube 3 or 4= hemotology (cell counts)
37
CSF speciman: QNS testing
PCP must prioritize
38
Describe Bacterial CSF infections
1. increased WBCs (and neutrophils REMAIN increased--> contrast to viral meningits) 2. increased protein 3. increased opening pressure 4. decreased glucose
39
describe viral CSF infections
1. initial increase in neutrophils, then lymphocytes 2. slightly increased protein 3. normal opening pressure 4. normal glucose
40
Most common bacterial agents for CSF infection
``` HIB Neisseria meningitidis Strep pneumonia Listeria monocytogenes Strep group B aerobic gram neg bacilli ```
41
Describe HIB in regards to meningitis
gram-neg coccobacilli Hib vaccine exists capsular B strain causes most cases
42
Describe strep pneumoniae in regards to meningitis
GPC in pairs, often encapsulated. Most common cause of meningitis > 1month to adult vaccine available
43
Describe N. meningitidis in regards to meningitis
asymptomatic nasopharyngeal carrier spread disease. vaccine recommended.
44
Describe Listeria monocytogenes in regards to meningitis
GPR--> commonly seen in neonates, older adults, alcoholics, and immunocompromised. Can cause still birth in prego females
45
Describe Strep Group B in regards to meningitis
common cause of meningitis in neonates and infants (0-1 months). Vertical transmission. Nosocomial transmission
46
Describe aerobic gram neg bacilli in regards to meningitis
Neonates: E. Coli during birht from mother's normal flora Older Adults Patients with head trauma Neurological procedures
47
What should you do if you get a positive CSF culture?
verbally called ordering physician
48
How long do you hold negative CSF cultures for?
7 days
49
What is the clinical presentation of septicemia?
fever, chills, tachycardia, hyperventilation, and toxicity which result when bacteria multiply at a rate that EXCEEDS removal
50
What is bacteremia?
presence of bacteria in the bloodstream.
51
Differentiate between the different classification of bacteremia
1) transient: organisms comprising normal flora are introduced into the blood stream. patient is asymptomatic/not treated. 2) Intermittment: bacteria from infection is released into bloodstream, aprox. 45 min prior to temperature spike. 3) Continuous: bacteria have direct access to the bloodstream
52
Bloodstream Infections: Intravascular vs Extravascular?
intra: originates within the cardiovascular system extra: results from bac entering blood circulation
53
How are blood cultures drawn?
In sets. 2bottles in ONE set. One bottles supports aerobic growth and one bottle supports anaerobic growth. Blood draw should be from a sterile skin site. Draw cultures from diff site OR 1 hr apart.
54
Should you collect more than 3 blood culture sets in 24 hours?
NO!
55
How should blood culture be transported?
Keep at room temperature prior to, and during transport to lab. Incubated at 37 degrees C.
56
What should you do with positive blood cultures?
Positive cultures are called to PCP. | Give them: # of positive cultures with specific gram stain results
57
What does a low positive culture count indicate?
That the positive blood culture results are NOT signficant and DO NOT need treatment. (in other words, you may grow a very small amount but it doesnt matter). This results from 1) transient bactermia, 2) contamination
58
What are the 3 most common blood culture contaminants?
1) Staph sp coagulase neg, 2) Strep sp viridans (#1 cause of subacute endocarditis) 3) Corynebacterium sp.
59
What is the most common cause of endocarditis with PROSTHETIC devices?
staph. epidermis

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