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Microbiology
FA complete review part 2 Gram Positive and Gram Negative organism
| Question | Answer |
|---|---|
| Partial reduction of hemoglobin causes greenish or brownish color without clearing around growth on blood agar. | Alpha-hemolytic anemia |
| Which bacterial is included in Alpha-hemolytic bacteria? | 1. Streptococcus pneumoniae 2. Viridans streptococci |
| Which a-hemolytic bacteria is Optochin resistant? | Viridans streptococci |
| Complete lysis of RBCs --> clear area surrounding colony on blood agar. | Beta-hemolytic bacteria |
| What are the 3 most common bacterial denomited Beta-hemolytic? | 1. Staphylococcus aureus 2. Streptococcus pyogenes 3. Streptococcus agalactiae |
| Catalase (-), bacitracin sensitive, gram + | Strept pyogenes |
| Which beta-hemolytic bacteria is bacitracin resistant? | Streptococcus agalatiae |
| Group A streptococcus = | Strep pyogenes |
| Complete bacterial description of S. aureus | Gram (+), B-hemolytic, catalase (+), coagulase (_) cocci in clusters |
| What virulence factor is seen in S. Aureus? | Protein A |
| Where are the common locations for S. aureus colonization? | Nares, ears, axilla, and groin |
| What are common complications of an S. aureus infection? | 1. Inflammatory disease 2. Toxin-mediated disease 3. MRSA |
| What is the clinical manifestation of description of S. aureus - induced inflammatory disease? | Skin infections, organ abscesses, pneumonia, endocarditis, septic arthritis, and osteomyelitis |
| What are Toxin-mediated diseases by S. aureus? | TSST-1, scalded skin syndrome, rapid-onset food poisoning |
| What is MRSA? | Methicillin-resistant S. aureus |
| What are common complications of MRSA infection? | Serious nosocomial and community-acquired infects |
| Why is MRSA resistant to methicillin and nafcillin? | Altered penicillin-binding protein |
| Where does the TSST-1 superantigen bind to? | MHC II and T cell receptors --> polyclonal T cell activation |
| Main signs and symptoms of Staphylococcal toxic shock syndrome (TSS)? | Fever, vomiting, rash, desquamation, shock, and endo-organ failure |
| What are common causative association of Staphylococcus TSS? | Prolonged use of vaginal tampons or nasal packaging |
| Streptococcus TSS is associated with an __________________, unlike Staphylococcal TSS. | Painful skin infection |
| Staph epidermidis description | Gram (+), catalase (+), coagulase (-), urease (+) cocci in clusters |
| S. epidermidis is Novobiocin ______________________ and it does not ferment ______________. | Sensitive; Mannitol |
| Which staph specie ferments Mannitol? | Aureus |
| What is commonly infected by S. epidermidis? | Prosthetic devices (hip implant, heart valve), and IV catheters by proeicudn adherent biofilms |
| What aids in the infections of S. epidermidis? | Biofilm production |
| Novobiocin resistant. | Staph saprophyticus |
| Which staphylococcal specie is found in normal flora of female genital tract and perineum? | Staph saprophyticus |
| S. saprophyticus is: | The 2nd MCC of uncomplicated UTI in young women |
| Gram (_), lancet-shaped diplococci | Streptococcus pneumoniae |
| S. pneumoniae is ____________________ and ______________________. | Encapsulated and Optochin sensitive |
| What mnemonic is often used to summarize some clinical manifestations of S. pneumoniae? | MOPS |
| What does MOPS stand for? | M. meningitis O. Otitis media (in children) P. Pneumonia S. Sinusitis |
| Pneumococcus is associated with _____________ sputum. | "rusty" |
| What kind of patients have increased risk of sepsis by S. pneumoniae? | Sickle cell disease patients and those asplenic patients |
| A S. pneumoniae losses it capsule. It means? | NO virulence |
| Which alpha-hemolytic gram (+) bacteria is Optochin resistant? | Viridans group streptococci |
| Which species of Viridans cause dental caries? | S. mutans and S. mitis |
| What viridian streptococci specifically creates dextrans? | S. sanguinis |
| S. sanguinis creation of Dextrans causes: | Dextrans to bind to fibrin-platelet aggregates on damaged heart valves causing Subacute bacterial endocarditis |
| What type of endocarditis is associated with S. sanguinis? | Subacute Bacterial endocarditis |
| A Group A strep infection causes: | 1. Pyogenic manifestations 2. Toxigenic conditions 3. Immunologic diseases |
| What are the clinical manifestation of Pyogenic Group A infection? | Pharyngitis, cellulitis, impetigo ("honey-crusted" lesion), and erysipelas |
| Scarlet fever, toxic shock-like syndrome, and necrotizing fasciitis, are: | S. pyogenes toxigenic manifestations |
| What thow Immunologic conditions are associated with S. pyogenes infection? | Rheumatic fever and PSGN |
| S. pyogene-induced pharyngitis can cause __________________ if left untreated. | Rheumatic fever |
| Rheumatic fever is often preceded by: | Pyogenic Pharyngitis |
| What is the most common preceding S. pyogenes manifestation leading to PSGN? | Impetigo |
| What is Scarlet Fever? | Blanching, sandpaper-like body rash, strawberry tongue, and circumoral pallor i the setting of group A streptococcal pharyngitis (erythrogenic toxin (+). |
| Gram (+) cocci, bacitracin resistant, B-hemolytic, colonizes vagina. | Streptococcus agalactiae (group B streptococci) |
| What are the possible results of a S. agalactiae infection in a baby? | Pneumonia, Meningitis, and sepsis |
| Which factor is produced by Group B streptococcus? | CAMP |
| What is the role of CAMP? | Enlarges the area of hemolysis form by S. aureus |
| Hippurate test (+). PYR (-) | Streptococcus agalactiae (group B streptococci) |
| Woman intrapartum, (+) S. agalactiae should be given? | Intrapartum penicillin prophylaxis |
| Which weeks are usual times for screening pregnant mother for S. agalactiae infection? | 35-37 weeks |
| S. gallolyticus is a subspecies of: | Streptococcus bovis |
| What conditions or diseases are associated to S. gallolyticus? | Bacteremia and Subacute endocarditis |
| What cancer type is associated with S. gallolyticus? | Colon cancer |
| What area is colonized by Strep bovis? | Gut |
| What are the 2 most common species of Enterococci? | E. faecalis and E. faecium |
| What are some features of Enterococci? | - Resistant to penicillin G - Cause: UTI, biliary tract infections, and subacute endocarditis |
| Catalase (-), PYR (+), and variable hemolysis. | Enterococci |
| What does VRE stand for? | Vancomycin-resistant enterococci |
| VRE are a imporntac cause of: | Nosocomial infections |
| Entero = | intestine |
| Which are more resilient, Streptococci or Enterococci? | Enterococci |
| Strepto = | Twisted (chains) |
| What organism is gram (+), spore-forming rod that produces anthrax toxin? | Bacillus anthracis |
| What is caracheirstic of B. anthracis' capsule? | Only one with a polypeptide capouse that contains D-glutamate |
| The description of colonies as "Medusa head" refers to: | Bacillus anthracis |
| What are the tow types of B. anthracis? | 1. Cutaneous anthrax 2. Pulmonary anthrax |
| What is th clinical presentation of Cutaneous anthrax? | Painless papules surrounded by vesicles --> ulcer with black eschar --> not common to progress to bacteria and death |
| What is another name given to Pulmonary anthrax? | Woolsorter's disease |
| CXR may show a widened mediastinum. Dx? | Pulmonary anthrax |
| Pathogenesis of Pulmonary anthrax: | Inhalation of spores --> flu-like symptoms that rapidly progress to fever, pulmonary hemorrhage, mediastinitis, and shock |
| Common gram positive rod that causes food poisoning? | Bacillus cereus |
| Spores of which organism are often seen in Cooking rice? | Bacillus cereus |
| What causes reheated rice syndrome? | Spore infection by B. cereus |
| What is the preformed toxin of B. cereus? | Cereulide |
| What is the clinical presentation of the B. cereus infection of diarrheal type? | Waterry, nonbloody diarrhea and GI pain within 8-18 hr |
| Clostridia (all) are: | Gram (+), spore-forming, obligate anaerobic rods |
| Where is GABA and glycine secreted from? | Renshaw cell in Spinal cord |
| What is trismus? | Lockjaw |
| What is sardonicus? | Raised eyebrows and open grin |
| What is Opisthotonos? | Spasms of spinal extensors |
| What condition is seen with Trismus, Sardonicus, and Opisthotonos? | Tetanus |
| Heat-labile toxin that inhibits ACh release at the NMJ causing botulism. Organism? | C. botulinum |
| What is the a common mode of ingestion of Botulinum toxin in babies? | Ingestion of spores in honey |
| What are the 4 D's of Botulism? | Diplopia, Dysarthria Dysphagia Dyspnea |
| What specific symptoms of Botulism are treated with local botox injections? | Dystonia, achalasia, and muscle spasms. |
| What is a better description of the alpha toxin produced by C. perfringens? | Lecithinase, a phospholipase |
| What are the clinical manifestations of C. perfringens? | 1. Myonecrosis (gas gangrene) which presents with tissue crepitus and hemolysis |
| How many toxins are produced by C. difficile? | 2 toxins |
| What is Toxin A of C. difficile? | An enterotoxin, which binds to brush border of gut and alters fluid secretion. |
| What is the action of Toxin B of C. difficile? | Cytotoxin, which disrupts cytoskeleton via actin depolymerization |
| How does Toxin B of C. difficile causes disruption of the cytoskeleton? | Via actin depolymerization |
| What organism causes Pseudomembranous colitis? | C. difficile |
| What is the MCC of Pseudomembranous colitis? | Secondary use of antibiotic, especially clindamycin or ampicilin |
| Which are often the most associated antibiotics that cause Pseudomembranous colitis? | Clindamycin and Ampicillin |
| What is the treatment of C. difficile infection? | Metronidazole or oral vancomycin |
| Treatment for recurrent cases of Pseudomembranous colitis (C. diff infection)? | Fidaxomicin, or fecal microbiota transplant |
| What encodes for the diphtheria exotoxin? | B-prophage |
| Coryne = | Club shaped |
| Color of Corynebacterium diphtheriae colonies on cysteine-tellurite agar? | Black |
| What are the clinical manifestations of C. bacterium? | 1. Pseudomembranous pharyngitis (grayish-white membrane) 2. Lymphadenopathy, myocarditis, and arrhythmias |
| Common test for Corynebacterium diphtheriae toxin | (+) Elek test |
| What type of vaccine is made from Corynebacterium diphtheria? | Toxoid |
| What are the ABCDEFG of Corynebacterium diphtheria? | A. ADP-ribosylation B. Beta-prophage C. Corynebacterium D.- Diphtheriae E. Elongation Factor 2 G. Granules (blue and red) |
| What color are granules found in C. diphtheriae? | Blue and red |
| What biochemical process causes the elongation of factor 2 by C. diphtheriae exotoxin? | ADP-ribosylation |
| Listeria is an __________________________________. | Gram (+), facultative intracellular rod |
| What are the MC modes of acquiring Listeria monocytogenes? | 1. Ingestion of unpasteurized dairy products and cold deli meats 2. Transplacental transmission 3. Vaginal transmission during birth |
| Which bacteria grows well at refrigerator temperatures 4-10 C ? | Listeria monocytogenes |
| How are the "rocket tails" in Listeria made? | Via actin polymerization that allow intracellular movement and cell-to-cell spread across cell membranes, thereby avoiding antibody |
| Tumbling motility | Listeria monocytogenes |
| "Cold enrichment" | Listeria monocytogenes |
| What is caused by L. monocytogenes infection? | 1. Amnionitis, septicemia, and spontaneous abortion in pregnant women 2. Granulomatosis infantiseptica 3. Neonatal meningitis, 4. Meningitis in immunocompromised |
| What is the treatment for Listeria monocytogenes infection? | Ampicillin |
| Nocardia and Actinomyces both are: | Gram (+) and form long, branching filaments resembling fungi |
| Nocardia is: | Anaerobe, acid fast (weak), and is found in soil |
| Where is Nocardia often or most commonly found? | Soil |
| What is caused by a Nocardia infection? | - Immunocompromised --> Pulmonary infections (mimic TB) - Immunocompetent --> Cutaneous infections after trauma |
| Common spread of Nocardia infection is to the _______. | CNS |
| What is the treatment for Nocardia infections? | TMP-SMX (sulfonamides) |
| Where is Actinomyces often found? | Normal oral, reproductive, and GI flora |
| Actinomyces is _______________________ and not __________________. | ANAerobe ; acid fast |
| What are some clinical manifestation of Actinomyces infection? | 1. Oral/facial abscesses that drain through sinus tracts 2. Yellow "sulfur granules" 3. PID with IUDs |
| What organism is associated with dental caries/extraction ian dother maxillofacial trauma, along with oral abscesses? | Actinomyces |
| Yellow "sulfur granules" | Actinomyces |
| SNAP | Sulfonamides --------Nocardia Actinomyces ------- Penicillin |
| Common subtypes of Mycobacterium? | 1. M. tuberculosis 2. M. avium-intracellulare 3. M. scrofulaceum 4. M. marinum |
| Which mycobacteria is often resistant to multiple drugs? | M. tuberculosis |
| Which mycobacteria specie causes disseminated non-TB disease in AIDS? | M. avium-intracellulare |
| What antibiotic is used in prophylaxis of M. avium intracellulare infection in AIDS patients? | Azithromycin |
| M. scrofulaceum causes: | Cervical lymphadenitis in children |
| Hand infection in aquarium handlers is often due to __________________ infection. | M. marinum |
| All mycobacteria are _____________________ organisms. | Acid-fast |
| What are the most significant TB symptoms? | Fever, night sweats, weight loss, cougu (non productive or productive), and hemoptysis |
| Shape of the Cord factor in Mycobacteria? | Serpentine cord |
| "Serpentine cord" indicates: | M. Tuberculosis infections |
| What is the role of the Cord factor of M. tuberculosis? | 1. Activates macrophages (promote granuloma formation) 2. Induces release of TNF-alpha |
| What are the components of the Ghon complex? | Hilar nodes and Ghon focus |
| Where in the lung are Ghon focus most commonly located? | Mid/lower lobes |
| Which lung lobes usually develop secondary tuberculosis cavitary lesions? | Upper lobes |
| What does a PPD (+) indicate? | Current infection or past exposure |
| What does a negative PPD test indicate? | NO infection and in sarcoidosis or HIV infection |
| Which pathological conditions can produce a negative PPD test? | 1. Sarcoidosis 2. HIV infection (especially with low CD4+ count) |
| What is an important characteristic of Secondary TB? | Caseating granulomas with central necrosis and Langerhans giant cell |
| Caseating granulomas with central necrosis are key sign of ___________. | Secondary Tuberculosis |
| Secondary TB that is disseminated into the vertebrae. Dx? | Pott Disease |
| Another name for Leprosy? | Hansen disease |
| Why bacteria causes Leprosy? | Mycobacterium leprae |
| What are some features of M. leprae? | 1. Acid-fast bacillus 2. Likes cool temperatures 3. Produces a "glove and stocking" loss of sensation 4. Cannot be grown in vitro |
| Which two lab techniques are used to Dx Leprosy? | Skin biopsy and PCR |
| What is the MC reservoir of M. leprae in the U.S.A? | Armadillos |
| What are the 2 forms of Hansen disease? | 1. Lepromatous 2. Tuberculoid |
| Lepromatous leprosy: | Presents diffusely over skin, with leonine facies, and is communicable. It can be lethal Low cell-mediated immunity with a humoral Th2 response |
| What are the characteristics of Tuberculoid leprosy? | Few hypoesthetic, hairless skin plaques; High cell-mediated immunity with Th1 immune response and low bacterial load |
| What is the treatment for Leprosy? | Tuberculoid form: Dapsone and Rifampin Lepromatous form : Dapsone and Rifampin + CLOFAZIMINE |
| Gram negatives are stained _________________. (color) | Pink |
| What characteristic have all gram (-) comma-shaped rods? | Oxidase (+) |
| What are the 3 comma shaped gram negative organisms? | 1. Campylobacter jejuni 2. Vibrio cholerae 3. Helicobacter pylori |
| Grown in 42 C. | C. jejuni |
| C. jejuni features: | Gram negative, Comma shaped Oxidase (+) Grows in 42 Celsius |
| What is a key characteristic of V. cholera growth? | Grows in alkaline media |
| What organism, gram negative, grown in basic media? | Vibrio cholerae |
| H. pylori is ___________-shaped, oxidase _________, and produces ________________. | Comma-shaped; Oxidase (+); Urease |
| Which gram negative comma-shaped rod produces urease? | H. pylori |
| What are the 4 MC shpates of gram negative bacteria? | Diplococci, Coccobacilli, Bacilli, and Comma-shaped |
| WHich are the gram (-) diplococci? | N. gonorrhoeae and N. meningitidis |
| N. meningitis is: | Gram negative, diplococci, Aerobic, and (+) Maltose fermentation |
| N. gonorrhoeae does not ferment _________________. | Maltose |
| Which a lesser known Maltose negative gram (-) diplococci? | Moraxella |
| N. gonorrhoeae shares most laboratory characteristics with? | Moraxella |
| Which are the 2 MC gram negative coccobacilli? | 1. H. influenzae 2. Bordetella pertussis |
| Which are 3 not so common gram negative coccobacilli? | Pasteurella, Brucella, and Francisella tularensis |
| What is the first test done to different gram negative bacilli? | Lactose fermentation |
| Lactose (+) fermenters then are divided into: | Fast and slow fermenters |
| Which are the most common gram negative fast lactose fermenters? | E. coli and Klebsiella |
| What is a key distinguish features of Citrobacter and Serratia? | Slow lactose fermenters |
| If bacilli are Lactose negative (non-fermenters), which is the next applied test to differentiate bacteria? | Oxidase |
| Which bacteria is a lactose non fermenter, oxidase positive, gram negative bacilli? | Pseudomonas |
| Oxidase positive lactose fermenter bacilli, are finally categorized as: | H2S producers or non produces |
| Salmonella is a H2S __________________. | Producers |
| Which are the 2 H2S non-production? | Shigella and Yersinia |
| According to the Gram (-) algorithm, E. coli is: | Gram negative bacilli, Fast Lactose fermenter |
| What characteristics are shared by all Neisseria species? | Metabolize glucose and produce IgA proteases. 2. Contain lipooligosaccharides (LOS) with strong endotoxin activity |
| N. gonorrhoeae is often intracellular, as it is found within ___________________. | Neutrophils |
| N. meningitidis ferments _______________ and _______________. | Glucose and Maltose |
| Which Neisseria species has a polysaccharide capsule? | Meningococci |
| Which features are present in N. meningococci and not in N. gonorrhoeae? | Polysaccharide capsule, maltose fermentation, and Vaccine |
| Mode of transmission of N. meningitidis? | Respiratory and oral secretions |
| What are conditions caused by N. meningococci? | 1. Meningococcemia with petechial hemorrhages and gangrene of toes 2. Meningitis 3. Waterhouse-Friderichsen syndrome |
| What is the prevention or prophylaxis of N. meningococcal infection? | Rifampin, ciprofloxacin, or ceftriaxone |
| Most commonly used treatment of N. meningococci infection? | Ceftriaxone or penicillin G |
| What penicillin is used to treat N. meningitidis? | Penicillin G |
| What are the most common complications due to N. gonorrhoeae infection? | Gonorrhea, septic arthritis, neonatal conjunctivitis, PID, and Fitz-Hugh-Curtis syndrome |
| N. gonococci causes which important syndrome? | Fitz-Hugh-Curtis syndrome |
| N. meningococci causes with important syndrome? | Waterhouse-Friderichsen syndrome |
| What is seen in Waterhouse-Friderichsen syndrome? | Adrenal insufficiency, fever, DIC, and shock |
| What measures are taken to prevent or reduce N. gonorrhoeae infections? | Condoms in sexual transmission, and erythromycin eye ointment prevent neonatal blindness |
| What is the treatment of N. gonorrhoeae infection? | Ceftriaxone |
| Which antibiotic is often co-adiminter with Ceftriaxone in N. gonorrhea infections? | Azithromycin or doxycycline |
| Why is azithromycin added to treatment of N. gonorrhoeae? | Due to possible chlamydia coinfection |
| Which a common small gram negative coccobacillary rod? | Haemophilus influenzae |
| Which type or form of H. influenzae is most common to cause disease? | Nontypeable (unencapsulated) |
| Which type of H. influenzae has a vaccine developed? | Type b |
| What type of virulence factor is produced by H. influenzae? | IgA protease |
| Which common gram positive bacteria can be co-cultured with H. influenzae to promote its growth? | S. aureus |
| Why is Staph aureus co-cultured with H. influenzae? | Provides factor V via RBC hemolysis |
| What factors are needed for culture growth of H. influenzae? | Factors V (NAD+) and X (hematin) |
| What are some common conditions caused by H. influenzae infection? | EMOP: E - epiglottitis M - Meningitis O - Otitis media P - pneumonia |
| What signs are seen in Epiglottitis? | 1. Epiglottis appears "cherry red" 2. Lateral neck X-ray shows the "thumb sign" |
| What is the treatment for H. influenzae mucosal infections? | Amoxicillin +/- clavulanic acid |
| H. influenzae meningitis is treated with ______. | Ceftriaxone |
| What is H. influenzae vaccine conjugated with: | Diphtheria toxin or other protein |
| At what age is H. influenzae type b vaccine applied? | Between 2-18 months of age |
| What are the virulence factors of Bordetella pertussis? | 1. Pertussis toxin 2. Adenylate cyclase toxin 3. Tracheal cytotoxin |
| What is the function of Pertussis toxin? | Disables Gi |
| Why is Bordetella pertussis infection often confused by a viral infection? | Due to lymphocytic infiltrate results in form immune response |
| Which vaccines prevent Bordetella pertussis infection? | Tdap and DTaP |
| What is the 1st stage of Bordetella pertussis infection? | Catarrhal -- low-grade fever, and Coryza |
| The "whooping cough" in B. pertussis infection is seen in which stage of the infection? | Paroxysmal (2nd) |
| Describe the Paroxysmal stage of B. pertussis infection: | Paroxysms of intense cough followed by inspiratory "whoop", posttussive vomiting |
| What stain is used for Legionella? | SIlver stain. Grow on charcoal yeast extract medium with iron and cysteine. |
| What is the most common way to detect legionella? | Antigen in the urine |
| What important electron imbalance is seen in Legionella pneumophila? | Hyponatremia |
| What is the MC mode of transmission of Legionella? | Aerosol transmission from environmental water source habitat (AC systems, hot water tanks) |
| Legionella pneumophila treatment? | Macrolide or quinolone |
| What is Legionnaires' disease? | Severe pneumonia (often unilateral na lobar), fever, GI, an CNS symptoms. |
| Mild flu-like syndrome due to Legionella pneumophila infection? | Pontiac disease |
| Low sodium levels in the blood is a key characteristic of ____________________________ infection. | Legionella pneumophila |
| What gram negative oxidase (+) organism is often described to produce a grape-like odor? | Pseudomonas aeruginosa |
| What is Ecthyma gangrenosum? | Rapidly progressive, necrotic cutaneous lesion caused by Pseudomonas bacteremia. Most likely seen in immunocompromised |
| What does the mnemonic PSEUDOMONAS describe? | Condition and features caused by Pseudomonas aeruginosa: P- Pnuemonia S- Sepsis E- Ecthyma grangrenosum U- UTIs D - Diabetes O- Osteomyelitis M- Mucoid polysaccharide capsule O - Otitis externa N - Nosocomial infections A - Addicts to drugs S - Skin infections |
| What is a common skin infection due to Pseudomonas aeruginosa? | Hot tub folliculitis |
| Common skin condition in which hair follicles become inflamed? | Folliculitis |
| What time of Otitis is associated with Pseudomonas infection? | Externa |
| Which patients are at higher risk of pseudomonas pneumonia? | Cystic fibrosis patients due to Mucoid polysaccharide capsule and biofilm production |
| What are some features produced by Pseudomonas aeruginosa? | 1. Phospholipase C 2. Exotoxin A 3. Endotoxin 4. Pigments |
| What pigments are produced by Pseudomonas aeruginosa? | Pyoverdin and Pyocyanin (blue-green pigment) |
| Swimmers ear is: | Otitis externa caused by P. aeruginosa |
| What are some common treatments for Pseudomonas? | 1. Carbapenems 2. Aminoglycosides 3. Monobactams 4. Polymyxins 5. Fluoroquinolones 6. Third and Fourth generation cephalosporins 7. Extended-spectrum penicillins |
| How do Shigella and Salmonella invade the GI tract? | Via the M cells of Peyer patches |
| How is the spread of all Salmonella types? | Hematogenously |
| How does Shigella spread? | Cell to cell |
| Salmonella has a _______________, and Shigella does not. | Flagella |
| Salmonella has an ________________ and Shigella has an ____________. | Salmonella ---- endotoxin Shigella ----- Exotoxin (Shiga toxin) |
| Which is more infectious, Salmonella or Shigella? | Shigella; requires a very small inoculum |
| What is the GI manifestation of Shigella infection? | Bloody diarrhea (or bacillary dysentery) |
| What is the pathogenesis of Salmonella infection affecting the GI tract? | Constipation, followed by diarrhea |
| What is the vaccine of Salmonella typhi? | Oral vaccine contains live attenuated S. typhi IM vaccine contains Vi capsular polysaccharide |
| Typhoid fever is caused by: | Salmonella typhi |
| What are the clinical features of Typhoid fever? | Rose spots on abdomen, constipation, abdominal pain, fever |
| What is the normal treatment of Typhoid fever? | Ceftriaxone or fluoroquinolone |
| What are the 4 F's associated with Shigella? | Fingers, Flies, Food, and Feces |
| Which the most severe subtype of Shigella? | Shigella dysenteriae |
| What defines the severity of Shigella species? | The amount of toxin produced |
| Order of Shigella species severity: | S. dysenteriae > S. flexneri > S. boydii > S. sonnei |
| What are possible developments of Yersinia enterocolitica infection? | Acute diarrhea or Pseudoappendicitis |
| What is Pseudoappendicitis? | Right lower abdominal pain due to mesenteric adenitis and/or terminal ileitis. |
| Lactose fermenting enteric bacteria have pink colonies when cultured in _________________. | MacConkey agar |
| What enzyme is produce by E. coli that breaks down Lactose? | B-galactosidase |
| Lactose is broken down by E. coli's beta galactosidase into: | Glucose and Galactose |
| What color do all lactose fermenters, except E. coli, when cultured in EMB agar? | Purple/black colonies |
| E. coli on EMB agar produces: | Colonies with a green sheen |
| What are E. coli virulence factors? | 1. Fimbriae 2. K capsule 3. LPS endotoxin |
| What is caused by fimbriae of E. coli? | Cystitis and Pyelonephritis |
| K-capsule in E. coli causes: | Pneumonia and Neonatal meningitis |
| What Virulence factor of E. coli is responsible for septic shock development? | LPS endotoxin |
| Which E. coli strain is a microbe that invades intestinal mucosa an causes necrosis and inflammation? | Enteroinvasive E. coli |
| EIEC ahs similar clinical presentation to: | Shigella |
| Enterotoxigenic E. coli: | Produces heat labile and heat-stable enterotoxins No inflammation or invasion |
| Whe E. coli strain is responsible for Traveler's diarrhea? | ETEC |
| What is the toxin and mechanism of Enteropathogenic E.coli? | NO toxin produced Adheres to apical surface, flattened villi, prevents absorption |
| What E. coli strain causes diarrhea in children? | EPEC |
| What is the most common E. coli strain in the United States? | Enterohemorrhagic E. Coli (O157:H7) |
| How is EHEC transmitted? | Via undercooked meat, raw leafy vegetables |
| What is the toxin name of EHEC? | Shiga-like toxin |
| Shiga-like toxin in EHEC cause? | Hemolytic-uremic syndrome (HUS) |
| What is HUS? | Triad of anemia, thrombocytopenia, and acute renal failure due to microthrombi forming on damaged endothelium |
| What kind of RBCs are seen in HUS? | Schistocytes |
| Dysentery toxin ca cause: | Necrosis and inflammation |
| What fermentation features is different in strain EHEC than other E. coli presentations? | EHEC does NOT ferment sorbitol |
| What are the 5 Ks of Klebsiella? | Aspiration pneumonia Abscess in lungs and liver Alcoholics diAbetes "currAnt jelly" sputum |
| Found in intestinal flora that causes lobar pneumonia in alcoholics and diabetics when aspirated. What is the most likely bacteria? | Klebsiella |
| Why Klebsiella produces very mucoid colonies? | Due to abundant polysaccharide capsules |
| What is the description of sputum in a Klebsiella patient? | Dark red "currant jelly" |
| What organism is the MCC of bloody diarrhea in children? | Campylobacter jejuni |
| C. jejuni infection is a common antecedent to: | Guillain-Barre syndrome and reactive arthritis |
| Which animal contact may cause a C. jejuni infection? | Dogs, cats, pigs |
| Gram (-) , comma or "S" shaped, oxidase (+), grown at 42 Celsius | Campylobacter jejuni |
| What is the most common mode of transmission of vibrio cholerae? | Contaminated water or undercooked food (raw shellfish) |
| What is the mechanism of action of V. cholerae toxin? | Permanently activates Gs, leading to increase in cAMP. |
| Grows in alkaline media? | V. cholerae |
| How is it possible for H. pylori to survive in gastric acidic mucosa? | It is Urease positive which produces ammonia, creating an alkaline environment |
| What part of the stomach is most likely colonized by H. pylori? | Antrum of stomach |
| What are the most common type of peptic ulcers caused by H. pylori infection? | Duodenal ulcers |
| H. pylori is a risk factor for: | Peptic ulcer disease, gastric adenocarcinoma, and MALT lymphoma |
| What lymphoma is associated with H. pylori infection? | MALT |
| What is the term or therapy denomination for H. pylori infection? | Triple therapy |
| What is the composition or parts of the Triple therapy in treatment of H. pylori? | Amoxicillin (metronidazole if penicillin allergy), + Clarithromycin + Proton pump inhibitor (PPI) |
| Category of bacteria of spiral-shaped and with axial filaments? | Spirochetes |
| What are common spirochetes? | Borrelia, Leptospira, and Treponema |
| How can treponema be visualized? | Dark-field microscopy or direct fluorescent antibody (DFA) microscopy |
| What organism causes Lyme disease? | Borrelia burgdorferi |
| What transmits BOrrelia burgdorferi? | Ixodes deer tick |
| The Ixodes deer tick is a vector for: | 1. Borrelia burgdorferi 2. Anaplasma spp. 3. Protozoa Babesia |
| Which area of the USA is Borrelia burgdorferi commonly found? | Northeastern United States |
| Description of Stage 1 of Lyme Disease: | Early localized; erythema migrans and flu-like symptoms |
| What is the description of Erythema migrans? | "Bulls-eye" configuration |
| Stage 2 Lyme disease is seen with: | Early disseminated; Secondary lesions, carditis, AV block (3), facial nerve (Bell) palsy, and migratory myalgias/transient arthritis |
| 3 AVB and Bell palsy are part of the ________________ stage of Lyme disease. | Second |
| What are the symptoms seen in the Third and last stage of Lyme disease? | Encephalopathy and chronic arthritis |
| What is the 1st line of treatment in Lyme disease? | Doxycycline |
| What are secondary treatment options of Lyme disease? | Amoxicillin and cefuroxime in pregnant women and children |
| Leptospira interrogans is: | Spirochete with hook-shaped ends found in water contaminated with animal urine |
| Animals urinating in bodies of water. Which is a common bacteria to be found? | Leptospira interrogans |
| What are the two conditions due to Leptospira interrogans infection? | 1. Leptospirosis 2. Weil Disease |
| What is Weil disease? | Icterohemorrhagic leptospirosis; Severe form with jaundice and azotemia from liver and kidney dysfunction, fever, hemorrhage, and anemia |
| What is a key clinical finding of Leptospirosis? | Photophobia with conjunctival suffusion (erythema without exudate) |
| What condition is common or prevalent among surfers ? | Leptospirosis |
| What organism causes syphilis? | Treponema pallidum |
| What is the main characteristic of Primary syphilis? | Genital painless chancre |
| Is the chancre in Primary syphilis painful? | NO |
| Which stage of syphilis is seen with condylomata lata? | Secondary |
| What are the key features of Secondary syphilis? | Maculopapular rash, condylomata lata, lymphadenopathy, and patchy hair loss |
| What is Condylomata lata? | Smooth, painless, wart-like white lesions on genitals |
| Gummas are found in? | Tertiary syphilis |
| What are "gummas"? | Chronic granulomas in tertiary syphilis |
| What are some key features of Tertiary syphilis? | Gummas, aortitis, neurosyphilis, Argyll Robertson pupil, broad-based ataxia, and positive Romberg, Charcot joint, stroke without hypertension |
| What is seen with aortitis in syphilis? | Vasa vasorum destruction |
| Tabes dorsalis and "general paresis" are part of _________________ | Neurosyphilis in Tertiary stage |
| What fluid is tested to Dx for Neurosyphilis? | Spinal fluid |
| What are some key features of Congenital syphilis? | Facial abnormalities such as rhagades, snuffles, saddle nose, notched (Hutchinson) teeth, mulberry molars, and short maxilla |
| What Cranial Nerve cause deafness in congenital syphilis? | CN VIII |
| What are rhagades? | Linear scars at angle of mouth |
| What are conditions that can produce VDRL false positives? | Pregnancy, Viral (EBV) infection, Drugs, Rheumatic fever, and Lupus and Leprosy |
| What is detected by VDRL? | Nonspecific antibody atha reacts with beef cardiolipin |
| Flu-like syndrome after antibiotics are started. MC Dx? | Jarisch-Herxheimer reaction |
| What does a Jarisch-Herxheimer reaction occurs? | Due to killed bacteria (usually spirochetes) releasing toxins |
| A pleomorphic, gram-variable rod involved in bacterial vaginosis. | Gardnerella vaginalis |
| What is the most common presentation of Gardnerella vaginalis? | Gray vaginal discharge with a fishy smell; nonpainful |
| What histoloigical finding is key for Gardenela vaginosis? | Clue cells |
| What are Clue cells? | Vaginal epithelial cells covered with Gardnerella |
| What is the best treatment option of Gardnerella vaginalis? | Metronidazole or clindamycin |
| What is the Amine whiff test? | Mixing vaginal discharge with 10% KOH enhances fishy odor |
| When is the Amine whiff test often used? | To diagnose bacterial vaginosis by Gardnerella vaginalis |
| What are the 2 forms of Chlamydiae? | 1. Elementary body 2. Reticulate body |
| What of Chlamydiae is infectious? | Elementary body |
| Reticulate body of Chlamydiae serves to: | Replicate in cell by fission |
| Chlamydia psittaci causes: | Atypical pneumonia |
| What is the preferred treatment for chlamydia infection? | Azithromycin or doxycycline |
| Why does chlamydia lack the classic peptidoglycan wall? | Due to reduced muramic acid rendering B-lactam antibiotics ineffective. |
| What are the cytoplasmic inclusions seen with Chlamydia? | Reticulate bodies |
| Chlamydia trachomatis causes: | Reactive arthritis (Reiter's syndrome), neonatal and follicular adult conjunctivitis, nongonococcal urethritis, and PID |
| Chlamydia pneumoniae and Chlamydophila psittaci cause: | Atypical pneumonia |
| Which species of chlamydia is the most important? | Chlamydia trachomatis |
| What is caused by C. trachomatis Types A, B, and C? | Chronic infection, cause blindness due to follicular conjunctivitis in Africa |
| What conditions are associated to C. trachomatis types D-K? | Urethritis/PID, ectopic pregnancy, neonatal pneumonia (staccato cough) with eosinophilia, neonatal conjunctivitis (1-2 weeks after birth) |
| What condition is associated to C. trachomatis types L1, L2, and L3? | Lymphogranuloma venereum |
| What is Lymphogranuloma venereum? | Small, painless ulcers on genitals --> swollen, painful ighilan lymph nodes atha ulcerate (boubous). |
| What is the treatment for Lymphogranuloma venereum? | Doxycycline |
| Ulcer due to C. trachomatis type L1-L3 are ___________________. | Painless |
| Bartonella spp causes? | Cat scratch disease and Bacillary angiomatosis |
| Relapsing fever is caused by: | Borrelia recurrentis |
| What condition is due to a Borrelia recurrentis infecion? | Relapsing fever |
| What conditions are due to Brucella infection? | Brucellosis and Undulant fever |
| Q fever is due to _____________________ infection. | Coxiella burnetii |
| What condition is due to Francisella tularensis? | Tularemia |
| What is the source animal of Francisella tularensis? | Ticks, rabbits, and deer flies |
| Dog bites often cause a _____________ infection. | Pasteurella multocida |
| What some associated condition to Pasteurella multocida infection? | Cellulitis and Osteomyelitis |
| Rickettsia rickettsii infection causes | Rocky Mountain spotted fever |
| Dermacentor is: | Source of Rickettsia rickettsii |
| What is the name of a dog tick? | Dermacentor |
| What are the common sources of Salmonella species, except for Salmonella typhi? | Reptiles and poultry |
| The plague is due to _________________ infection. | Yersinia pestis |
| What is the main treatment Rickettsial diseases and vector-borne illnesses? | Doxycycline |
| Description of rash of RMSF? | Rash starts at wrist and ankles and then spreads to trunk, palms, and soles |
| RMSF rash is similar in spread to: | Secondary syphilis, Coxsackievirus A infection |
| Typhus rash: | Start centrally and spreads out, sparing palms and soles |
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rakomi
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