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Infection control > Week 4 Part 2 > Flashcards

Week 4 Part 2 Flashcards

1
Q

What is an antimicrobial?

A

A substance that inhibits or kills microbes (viruses, bacteria, fungi, parasites)

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2
Q

How are more antimicrobials administered?

A

by intravenous (IV) or oral routes

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3
Q

what are examples of antimicrobial-coated devices?

A

endotracheal tubes or urinary catheters

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4
Q

Antimicrobials that activity kill organisms are known as what?

A

bactericial or fungicial

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5
Q

antimicrobials that arrest the growth of organisms and assist the host’s immune system in clearing infection are known as what?

A

bacteriostatic or fungistatic

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6
Q

What are the major sites of action by antimicrobial classes?

A

-cell wall
-cell membrane
-ribosome
-nucleid acid synthesis
-metabolic pathway

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7
Q

What is an antibiogram?

A

a summary of the cumulative susceptibility of bacterial isolates to formulary antibiotics in a given institution or region

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8
Q

describe the microtier broth dilution systems (a type of antimicrobial susceptibility test)

A

it uses trays of small-volume wells consisting of various concentrations of antibiotic that are read via an automated, commercial instrument

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9
Q

what are three antimicrobial susceptibility tests

A

-microtiter broth dilution systems
-kirby bauer
-E-test of D-test

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10
Q

Agar disk diffusion, the antimicrobial susceptibility test, is known as what

A

Kirby-bauer

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11
Q

Describe the antimicrobial gradient diffusion method (E-test or D-test)

A

a reagent strip consisting of a gradient of antimicrobial is placed on an agar plate to produce a gradient of concentrations in the medium

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12
Q

True or false. Antimicrobial resistance is a natural phenomenon?

A

True

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13
Q

what are somethings that have helped antimicrobial resistance develop?

A

-overuse, misuse, and inappropriate use of antibiotics
-the delivery of more complex healthcare that may require longer antibiotic use
-prolonged hospitalisation
-surgical procedures overseas

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14
Q

Describe the general mechanisms of antibiotic resistance

A

-intrinsic to bacteria
-acquired by bacteria

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15
Q

what are the 4 mechanisms of antibiotic resistance?

A

-drug inactivation/modification
-change in target site of the drug
-change in metabolic pathway
-decrease in drug accumulation

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16
Q

What can modification of the target site involve?

A

-binding protein
-ribosomes
-chromosomes
-cell physiology

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17
Q

what can modification of the antibiotic involve?

A

enzyme production

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18
Q

how the the antibiotic be prevented from reaching the target?

A

-decrease of cell permeability
-active transport out of the cell

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19
Q

describe how decrease in drug accumulation is a mechanism of antibiotic resistance

A

-through decreased permeability
-increased efflux

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20
Q

what are the 3 mechanisms of horizontal gene transfer?

A

-transformation
-transduction
-conjugation

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21
Q

Germ’s may change the antibiotics target so…

A

the drug can no longer fit and do its job

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22
Q

Germs get rid of antibiotics using what?

A

pumps

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23
Q

germs restrict access by changing what?

A

the entryways or limiting the number of entryways

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24
Q

germs develop new cell processes that do what?

A

avoid using the antibiotics target

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25
Q

germs change or destroy the antibiotics with what?

A

enzymes (proteins that break down the drug)

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26
Q

what is an example of a bacteria that uses a pump to get rid of antibiotics?

A

pseudomonas aeurginosa

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27
Q

what is an example of a bacteria that breaks down antibiotics?

A

K. pneumoniae produces carbapenemaes which break down carbapenem drugs and most other beta-lactam drugs

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28
Q

describe how/who overused/misused antibiotics

A

-clinical practice in humans
-agriculture
-veterinary medicine
-contamination of our water systems and food chain

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29
Q

when was the first case of penicillin-resistant S. aureus?

A

1947

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30
Q

when was the first case of MRSA?

A

1961

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31
Q

what percentage of S. aureus isolates in Canada are MRSA?

A

14%

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32
Q

MRSA has developed resistance to which class of antibiotics?

A

B-lactam

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33
Q

True or false. MRSA is associated with higher case fatality rates than MSSA?

A

True

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34
Q

VRE are strains of Enterococcus ___ and Enterococcus ___ that have become resistant to high levels of vancomycin

A

faecium and faecalis

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35
Q

Rates of VRE positive blood cultures have ___ in Ontario between January 2009 and July 2015

A

Doubled

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36
Q

True or false. VRE bacteremia mortality burden os greater than that of VSE bacteremia, even following the availability of effective anti-VRE treatments

A

True

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37
Q

What is the name of the enzyme that is produced by some bacteria that inactivates the B-lactam class of antibiotics

A

Beta-lactamase (B-lactamase)

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38
Q

what are examples of antibitoics in the B-lactam class?

A

peniccilin, cephalosporins

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39
Q

ESBL acts on all what?

A

cephalosporins

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40
Q

What are carbapenems?

A

a class of antibiotics that includes ertapenem, imipenem, and meropenem

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41
Q

What is CPE?

A

an anterobacteriaceae that produces enzyes (carbapenemases) that inactivate carbapenems and a few other classes of antibiotics

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42
Q

mortality of CPE is up to __ of severely infected patients

A

50%

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43
Q

what are rates for antimicrobial stewardship expressed as?

A

per 100 admissions or 1,000 patient days

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44
Q

What are some priority antimicrobial-resistant organisms in Canada?

A

-MRSA
-VRE
-CPE
-C. diff
-Gonorrhea
-TB
-Streptococcus pneumoniae
-streptococcus pyogenes
-Typhoidal and non-typhoidal salmonella enterica
-acinetobacter species
-campylobacter species
-E. coli

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45
Q

Between 2014-2018, the proportion of multidrug-resistant gonorrhea infections has___

A

doubled

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46
Q

the rate of HAI VRE BRI _ _ _

A

more than doubled

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47
Q

the rate of community-assocaited MRSA BSI increased by _%

A

140%

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48
Q

Approximately 20% of patients diagnosed with VRE an MRSA BRI died with _ days of diagnosis

A

30

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49
Q

The effectiveness of carbapenems is threatened by a _-fold increase in the number of patients testing positive for CPE without signs of infection

A

9-fold

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50
Q

In Typhoid fever, ceftriaxone resistance increased from nearly undetectable levels to _%

A

3%

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51
Q

the rapid emergence of E. faecium sequence type _ is associated with rising levels of resistance to important antimicrobials

A

1478

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52
Q

HA-CPE cases are often associated with what?

A

international travel and international healthcare exposure, although domestic nosocomial transmission appears to be increasing

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53
Q

True or false. HA C. diff cases have decreased by 15% between 2015-2018

A

True

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54
Q

what are viruses classified according to?

A

-type of genetic material
-presence or absence of envelope
-shape of the protein capsid

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55
Q

what type of genetic material can a virus have?

A

-DNA or RNA
-Double-stranded vs. single-stranded
-if single-stranded, positive sense vs. negative sense

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56
Q

what are the smallest viruses?

A

parvoviruses (B19) (18-25mm)

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57
Q

How do bacteria replicate?

A

by binary fission

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58
Q

What is the surface of a virus?

A

protein shell/lipid envelope

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59
Q

True or false. Viruses are acellular therefore they are neither eukaryotes or prokaryotes?

A

True

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60
Q

Viruses are an _ intracellular parasite

A

obligate

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61
Q

viruses are classified in families and genera based on _

A

genome type

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62
Q

viruses contain _ _ (either RNA or DNA) surrounded by _, and in some cases, other components such as a - _

A

nucelic acid; protein; membrane-like envelope

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63
Q

What are the 3 possible geometric shapes of a virus?

A

-cosahedral (spherical)
-helical (rod-shaped)
-complex

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64
Q

Does a virus have metabolic genes?

A

No, they use the hosts metabolic resources

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65
Q

what is the purpose of the capsid of a virus?

A
  1. protective outer shell surrounding viral nucleic acid
  2. protects the nucelic acid from the environment
  3. contains capsid spikes (built of capsid protein subunits used for binding to cell surface proteins)
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66
Q

Outside the host cell, the virus particle is known as a?

A

virion

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67
Q

what is a virion?

A

a virion is metabolically inert and does not grow or multiply until it enters a living cell

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68
Q

what are the 5 steps of viral replication?

A
  1. attachment
  2. penetration
  3. replication
  4. maturation
  5. release
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69
Q

describe the attachment step of viral reproduction

A

the virion attaches to a complementary receptor site on the host cell. Virus attachment is specific (i.e., Epstein-Barr virus attaches to receptors on B lymphocytes)

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70
Q

describe the penetration stage of virus replication

A

the virion enters the host cell through a process called endocytosis, meaning the host cell engulfs the virus

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71
Q

describe the replication stage of viral reproduction

A

viral DNA or RNA directs the host cell to begin synthesis of viral components. Viral replication use host cell ribosomes, energy sources, and amino acids to produce these components.

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72
Q

describe the maturation stage of viral reproduction

A

the viral components essentially assemble into viral particles spontaneously forming daughter virions

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73
Q

describe the release stage of viral replication

A

the host cell lyses or the virus buds through the cell wall and the daughter virions are released.

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74
Q

True or false. Some viruses lie dormant in the host cell for months or years and after the latent period, new virions form and cause damage to host cell

A

True

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75
Q

What is a susceptible cell?

A

-has receptors for the virus (usually glycoproteins)
-capable of supporting viral replication

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76
Q

What are the three methods of viral entry?

A
  1. endocytosis
  2. direct fusion
  3. nucleus acid translocation
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77
Q

describe endocytosis

A

the entire virus is engulfed by the cell and enclosed in a vacuole

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78
Q

describe direct fusion

A

the virus fuses with the cell membrane of the host cell. the enveloped viruses take some of the host membrane with them

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79
Q

describe nucleic acid translocation

A

the capsid adheres to the host cell membrane. There is partial rearrangement of the virion. the nucleic acid passes directly into the host

80
Q

Non-enveloped viruses will often gain viral entry via

A

nucleic acid translocation

81
Q

What are some examples of DNA viruses

A

-Herpes
-Chickenpox
-Hep B virus
-Epstein-Barr Virus (mononucleosis)

82
Q

Describe non-enveloped viral assembly and release

A

assembly in the cytoplasm. release through lysis of host cell

83
Q

what would be the host for virus assembly and release of an enveloped virus?

A

lipid and carbohydrate

84
Q

During DNA virus replication, DNA becomes integrated with the nucleus. This can lead to what?

A

latent infection

85
Q

what can trigger a latent infection to start replicating?

A

-stress, UV lite (cold sores)
-immune suppression
-unknown triggers

86
Q

what is an example of a retrovirus (an RNA virus)

A

HIV

87
Q

what are examples of RNA viruses?

A

-SARS
-Influenza
-Common cold
-Hep C
-Ebola
-COVID-19
-West Nike
-Dengue
-Mers
-Polio
-Rabies
-Hep E

88
Q

What are examples of DNA viruses?

A

-Parvovirus
-Cowpox
-Monkeypox
-Herpes
-Chicken pox
-Epistein-Barr
-Smallpox
-Cytomegalovirus

89
Q

What are the 3 types of antiviral drugs?

A
  1. drugs interfering with viral replication (polymerases, translation)
  2. Protease inhibitors (protein processing)
  3. Virus release
90
Q

What are the 3 types of Influenza?

A

A, B, and C

91
Q

Which influenza types are responsible for epidemics?

A

A and B

92
Q

what is the influenza incubation period?

A

1-4 days

93
Q

what is the reservoir for influenza?

A

humans, mammals, and birds

94
Q

Retrovirus replicates via what?

A

reverse transcriptase

95
Q

True or False. Noroviruses are Enveloped, single-straned RNA viruses

A

False. Noroviruses are non-eveloped, single-stranded RNA viruses

96
Q

how big are noroviruses?

A

27-40nm

97
Q

what family does norovirus belong to?

A

Caliciviridae

98
Q

what is the incubation period for norovirus?

A

12 to 48 hours

99
Q

When does shedding begin with norovirus?

A

before onset of symptoms, and may persist for 4 weeks or more

100
Q

how is norovirus transmitted?

A

oral fecal route

101
Q

how long should droplet contact precautions be maintained for norovirus?

A

48 hours after symptom resolution

102
Q

Is meales enveloped or nonenveloped? Is measles RNA or DNA?

A

enveloped; RNA

103
Q

Measles belongs to what genus and what family?

A

Morbillivirus; paramyxoviridae family

104
Q

what are some measles symptoms?

A

fever, cough, coryza, conjunctivities, maculopapular rash beginning on the face, koplik spots

105
Q

how is measles transmitted?

A

Airborne

106
Q

what is the incubation period for measles?

A

8-12 days

107
Q

Those exposed to measles should be placed on airborne precautions from day _ after first exposure until day _ after last exposure

A

5; 21

108
Q

chicken pox is also known as what?

A

human herpesvirus 3

109
Q

Chickenpox is a member of what family, subfamily, and genus?

A

herpesviridae family; subfamily alphaherpesvirinae; genus varicellovirus

110
Q

what is the chickenpox incubation period?

A

14-21 days

111
Q

how is chickenpox transmitted?

A

Airborne

112
Q

how long should chickenpox precautions be maintained?

A

Until all vesicles have crusted over

113
Q

What disease is herpes zoster?

A

shingles

114
Q

What is shingles characterized by?

A

grouped vesicular skin lesions in the distribution of 1 to 3 sensory dermatomes

115
Q

Localized shingles requires _ precautions; disseminated requires _ precautions

A

no additional precautions; airborne

116
Q

what is the reservoir for Ebola?

A

Bats

117
Q

True or false. Ebola can only be spread when a patient is symptomatic?

A

True

118
Q

What is the incubation period for Ebola?

A

2-21 days

119
Q

How is Ebola spread?

A

through direct contact with blood or body fluids of an infected person or through contact with objects that have been contaminated with the blood or body fluids of an infected person

120
Q

What is Creutzfeldt-Jakob disease?

A

Transmissible spongiform encephalopathies (TSEs or prion diseases) constitute a group of rare, rapidly progressive, universally fatal neurodegenrative diseases of humans and animals

121
Q

What body system does CJD affect?

A

the central nervous system

122
Q

how many cases of CJD are there annually?

A

1 to 1.5 cases per million people

123
Q

what is the CJD incubation period?

A

15-120 months

124
Q

the onset of disease for CJD peaks in what age group?

A

60-74 years

125
Q

what is the diagnostic test for CJD?

A

usually autopsy

126
Q

Is there treatment for CJD?

A

No

127
Q

What type of virus is rabies?

A

single stranded RNA virus

128
Q

what family and genus does rabies belong to?

A

Rhabdoviridae family; Lyssavirus genus

129
Q

What is the reservoir for rabies?

A

mammals

130
Q

what is the incubation period for rabies?

A

3 to 8 weeks

131
Q

What is the diagnostic test for rabies?

A

direct fluorescent antibody (DFA)

132
Q

What does a direct fluorescent antibody test detect?

A

the presence of rabies virus antigen in brain tissue

133
Q

What is the treatment for rabies?

A

There is no specific treatment

134
Q

Describe post exposure prophalaxis for rabies

A

immune globulin and vaccine on day 0, 3, 7, and 14 and for unimmunized immunocomprimised patients a fifth dose on day 28

135
Q

What are two examples of fungi?

A
  1. Yeasts
  2. Moulds
136
Q

Where are fungi found?

A

Soil and moist areas

137
Q

what is the shape of the nucleus of a fungi and how big is it?

A

spherical or ovoid; 6 um in diameter

138
Q

diagnosis of fungal infections is based on information from who?

A

-clinicians
-radiologists
-pathologists
-*microbiologists

139
Q

what is the primary sterol in the cytoplasmic membrane of fungi?

A

ergosterol

140
Q

What do antifungals do?

A

either stop the product or incorportion of ergosterol into membrane

141
Q

is the cel wall of fungi made of peptidoglycan?

A

No

142
Q

what is the major structure of the cell wall of fungi?

A

Chitin

143
Q

describe the cellular makeup of yeasts

A

single-celled, single nucleus with a nuclear membrane, contain organelles

144
Q

in culture, describe the colony yeasts form

A

smooth and creamy

145
Q

how do yeasts reproduce?

A

Budding or fission

146
Q

What are two common pathogenic yeasts?

A
  1. Candida spp.
  2. Cryptococcus neoformans
147
Q

Molds consist of long, branching filaments of cells called?

A

hyphae

148
Q

a tangled mass of hyphae visible to the naked eye is called a what?

A

mycelium

149
Q

what are 2 opportunistic pathogenic molds?

A

-Aspergillus spp (invasive pulmonary aspergillosis)
-Rhizopus and Mucor mucromycosis

150
Q

how do molds reproduce?

A

-Some reproduce asexually by fragmentation of their hyphae
-molds may reproduce sexually and asexually by the formation of spores as a result from fusion of nuclei from two opposite mating

151
Q

describe fungi dimorphism?

A

can grow as either a yeast or a mould

152
Q

Moldlike forms of dimorphic fungi produce what?

A

vegetative and aerial hyphae 25 degrees C

153
Q

yeastlike dimorphic fungi forms reproduce by what?

A

budding at 37 degrees C

154
Q

What are 3 common pathogenic dimorphic fungi?

A
  1. histoplasma capsulatum
  2. Blastomyces dermatitidis (chronic skin infections)
  3. Coccidiodes immities(respiratory)
155
Q

True or false. Some fungi can be identified directly from a clinical specimen (i.e., skin scraping)

A

True. These specimens would be incubated at room temperature for several weeks first

156
Q

What are some clinical presentations of fungi?

A

-respiratory (localized pneumonia, fungus ball)
-cutaneous (scaling, itching, thickening, crusting)
-CNS (headaches, meningitis, brain abscess)
-ocular (keratitis on cornea or inside the eye)
-sinusitis
-urinary tract (kidney infection)
-endocarditis

157
Q

what is systemic mycoses caused by?

A

dimorphic fungi

158
Q

what is the route of exposure for systemic mycoses?

A

aerosol/inhalation

159
Q

what does systemic mycoses cause?

A

respiratory diseases that may spread to blood and other tissues.

160
Q

what are the 3 systemic mycoses and where are they found?

A

histoplasma: great lakes region
coccidiodes: Arizona
Blastomyces: beaver dams, campers

161
Q

dermatophytes can only infect what?

A

hair nails and skin

162
Q

what is the name of the dermatophytes family?

A

Tinea

163
Q

what is Tinea capitis?

A

ringworm of the scalp

164
Q

What are the target sites of antifungal therapy? (hint: there are 3)

A
  1. cell wall
  2. cell membrane
  3. mitosis
165
Q

are parasites eukaryotic or prokaryotic?

A

eurkaryotic

166
Q

how many parasite species affect humans?

A

About 90

167
Q

what are 3 common parasite groups?

A

-ectoparasite
-endoparasite
-helminths

168
Q

what are 3 ectoparasites?

A

-scabies
-bed bugs
-lice

169
Q

is an endoparesite?

A

a protozoa (in blood or intestines)

170
Q

what are 3 types of helminths?

A

-nematode
-cestode
-trematode

171
Q

scabies is caused by what mite and what subspecies?

A

sarciotes scabiei; subspecies hominis

172
Q

how long does it take scabies larvae to emerge?

A

2 to 4 days

173
Q

describe scabies

A

the adult feamle burrows into skin and lays eggs. larvae emerge from eggs in 2 to 4 days and develop to nymphs then adults which mate and produce new eggs

174
Q

what is the treatment for scabies?

A

Lindane cream applied from chin to fingertips for 8-12 hours (head for shorter time). repeat

175
Q

what is the treatment for scabies in pregnant women or infants?

A

Permethrine 5% (same dwell time but one application is enough)

176
Q

what is the scientific name for bed bugs?

A

Cimex lectularius

177
Q

How long can bed bugs live without a blood meal?

A

several months

178
Q

what are the 3 types of lice?

A
  1. pedculus humanus (head)
  2. pthirus pubic (pubic or crab lice)
  3. pediculus humanus corporis (body)
179
Q

Enterobus vermicularis is more commonly known as what?

A

pinworm or roundworm

180
Q

where are prevalence rates of pinworm common?

A

-preschool/school-aged children
-caregivers of infected children
-institutionalized people

181
Q

what is the characteristic of pinworm?

A

anal itching

182
Q

how is pinworm autotransmitted?

A

from scratching and ingesting eggs

183
Q

what is pinworms mode of transmission?

A

oral fecal

184
Q

what is the diagnostic method for pin worm?

A

cellulose tape (clear adhesive cellophane tape)

185
Q

What is the incubation period for pinworm?

A

from ingestion of an egg until an adult female migrates to the perianal region is 1 to 2 months or longer

186
Q

Which micoorganism is endemic in the tropics and subtropics?

A

strongyloides stercoralis

187
Q

Humans may remain infected for decades due to self infection with what microorganism?

A

strongyloides stercorali

188
Q

what microorganism has the reservoir humans, dogs, and cats?

A

strongyloides stercoralis

189
Q

Infection with what parasite is often asymptomatic?

A

tapeworm

190
Q

what is the scientific name for tapeworm?

A

taeniasis

191
Q

How is tapeworm diagnosed?

A

by demonstration of the proglottids or ova in feces or the perianal region

192
Q

prevalence of tapeworm is high in what areas?

A

those with poor sanitation

193
Q

What are tapeworm symptoms?

A

mild GI symptoms such as nausea or diarrhea

194
Q

what 3 meat products contain different types of tapeworm?

A

-beef
-pork
-fish

195
Q

What genus does malaria belong to?

A

Plasmodium

196
Q

what is the malaria incubation period?

A

7-30 days after bite

197
Q

how is malaria primarily acquired?

A

from the bite of the female Anopheles genus of mosquito

Infection control (7 decks)

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