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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
Q

Do you perform susceptibility testing with strep pneumonia?

A

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
Q

Where is Enterococcus sp normal flora?

A

the GI tract. It is an opportunistic pathogen of the blood, abdomen.

27
Q

What is enterococcus sp. clinical signfigance?

A

usually the cause of disease in debilitated or immunosuppressed individuals. Disease states include: UTI, peritonitis, endocarditis, septicemia, abdominal infections

28
Q

What are enterococcus sp. intrinsically resistant to?

A

cephalosporins.

29
Q

How should enterococcus sp be treated?

A

treated with a cell well active antibiotic (ex PCN, ampicillin) and aminoglycoside ( ex. gentamicin, streptomycin). (synergistic approach).

30
Q

What is a nosociomial problem associated with enterococcus sp.?

A

VRE.

31
Q

What are they key factors for CSF infection

A

age of patient, nutritional/immunological status, presence of underlying disease

32
Q

What is the primary route of infection for CSF?

A

nasopharyngeal colonization–> crosses mucosal barrier–> blood stream –> meninges –> replicate in subarachnoid space

33
Q

Is the CSF normally sterile?

A

yes

34
Q

What is the normal transport and handling of CSF fluid?

A

transport immediatley!! Process STAT! If process is delayed, keep speciman at ROOM TEMP…DONT REFRIGERATE!!

35
Q

How do you typically collect CSF fluid? How many bottles should you collect?

A

lumbar puncture (needle into subarachnoid space), collect 3-4 (1-2mls each) bottles.

36
Q

Describe what each CSF specimen tube is used for

A

tube 1= chemistry studies (glucose and protein)
tube 2 or 3 = bacterial culture and gram stain
tube 3 or 4= hemotology (cell counts)

37
Q

CSF speciman: QNS testing

A

PCP must prioritize

38
Q

Describe Bacterial CSF infections

A
  1. increased WBCs (and neutrophils REMAIN increased–> contrast to viral meningits)
  2. increased protein
  3. increased opening pressure
  4. decreased glucose
39
Q

describe viral CSF infections

A
  1. initial increase in neutrophils, then lymphocytes
  2. slightly increased protein
  3. normal opening pressure
  4. normal glucose
40
Q

Most common bacterial agents for CSF infection

A 
HIB
Neisseria meningitidis
Strep pneumonia
Listeria monocytogenes
Strep group B 
aerobic gram neg bacilli
41
Q

Describe HIB in regards to meningitis

A

gram-neg coccobacilli
Hib vaccine exists
capsular B strain causes most cases

42
Q

Describe strep pneumoniae in regards to meningitis

A

GPC in pairs, often encapsulated. Most common cause of meningitis > 1month to adult
vaccine available

43
Q

Describe N. meningitidis in regards to meningitis

A

asymptomatic nasopharyngeal carrier spread disease. vaccine recommended.

44
Q

Describe Listeria monocytogenes in regards to meningitis

A

GPR–> commonly seen in neonates, older adults, alcoholics, and immunocompromised. Can cause still birth in prego females

45
Q

Describe Strep Group B in regards to meningitis

A

common cause of meningitis in neonates and infants (0-1 months). Vertical transmission. Nosocomial transmission

46
Q

Describe aerobic gram neg bacilli in regards to meningitis

A

Neonates: E. Coli during birht from mother’s normal flora
Older Adults
Patients with head trauma
Neurological procedures

47
Q

What should you do if you get a positive CSF culture?

A

verbally called ordering physician

48
Q

How long do you hold negative CSF cultures for?

A

7 days

49
Q

What is the clinical presentation of septicemia?

A

fever, chills, tachycardia, hyperventilation, and toxicity which result when bacteria multiply at a rate that EXCEEDS removal

50
Q

What is bacteremia?

A

presence of bacteria in the bloodstream.

51
Q

Differentiate between the different classification of bacteremia

A

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
Q

Bloodstream Infections: Intravascular vs Extravascular?

A

intra: originates within the cardiovascular system
extra: results from bac entering blood circulation

53
Q

How are blood cultures drawn?

A

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
Q

Should you collect more than 3 blood culture sets in 24 hours?

A

NO!

55
Q

How should blood culture be transported?

A

Keep at room temperature prior to, and during transport to lab. Incubated at 37 degrees C.

56
Q

What should you do with positive blood cultures?

A

Positive cultures are called to PCP.

Give them: # of positive cultures with specific gram stain results

57
Q

What does a low positive culture count indicate?

A

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
Q

What are the 3 most common blood culture contaminants?

A

1) Staph sp coagulase neg, 2) Strep sp viridans (#1 cause of subacute endocarditis) 3) Corynebacterium sp.

59
Q

What is the most common cause of endocarditis with PROSTHETIC devices?

A

staph. epidermis

Micro (3 decks)

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