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Path Micro Exam 4
| Question | Answer |
|---|---|
| Pyogenic | pus generating |
| characteristics of S. Aureus | G+ cocci cluster Catalase and Coagulase + beta hemolytic |
| When is S. auerus pneumonia typically seen | secondary infection to influenza |
| What separates S. aureus pneumonia from other pneumonias | typically is a necrotizing infection |
| What does a necrotizing infection lead to with S. aureus pneumonia | pleural empyema |
| pleural empyema | lung lining cavity fills with pus |
| Symptoms of necrotizing pneumonia | severe respiratory symptoms, coughing up blood/blood stained mucous, high fever, leukopenia, high c-reactive protein levels, hypotension |
| What will a chest radiograph show for necrotizing pneumonia | multi-lobar cavitating alveolar infiltrates |
| 19 y.o with C.F. is admitted to hospital with a 3 day history of worsening cough, increasing shortness of breath. She had 5 hospital stays in the past year for similar things. chest x-ray shows infiltrates. sputum culture G- bacillus mucoid colonies | Pseudomonas aeruginosa |
| characteristic of P. aeruginosa | G- bacillus Encapsulated makes a biofilm |
| pyocyanin | nonfluorescent blue |
| pyoverdin | fluorescent green |
| Who produces pyocyanin and pyoverdin | P. aeruginosa |
| Where is P. aeruginosa typically seen | water sources |
| What types of patients typically get P. aeruginosa infections | CF (cystic fibrosis) patients, mechanically ventilates patients |
| What are the clinical manifestations of P. aeruginosa | febrile, leukocytosis, purulent sputum, systemic toxicity, chest radiographs with new infiltrates or increase in pre-existing ones, |
| How to diagnose a P. aeruginosa infection | growth on culture of expectorated sputum or bronchoscopically obtained samples |
| Who typically gets chronic pneumonia | CF patients |
| Is chronic pneumonia rare? | no |
| What does CF patients with P. aeruginosa infections begin to produce | large amounts of an extracellular mucoid polysaccharide |
| What does motile P. aeruginosa become in CF patient infections | nonmotile, anaerobically respiring, mucoid variants growing in a biofilm |
| Characteristics of B. anthracis | Medusa head/comet tail Endospore producer G+ bacilli |
| What virulence factors does B. anthracis have | anthrax toxin polypeptide capsule |
| What microbe causes pulmonary anthrax | B. anthracis |
| When is the only time you can treat pulmonary anthrax | early phase (4-5 days into infection) |
| What is a classic finding of pulmonary anthrax in a radiograph | widening of the mediastinum secondary to mediastinitis |
| 7 year old boy developed a sore throat and fever 2 days ago. Today he developed a rash | Streptococcal pharyngitis |
| What microbe typically causes streptococcal pharyngitis | S. pyogens (Group A strep) |
| Who typically gets streptococcal pharyngitis | 5-15 year old |
| What can streptococcal pharyngitis turn into | scarlet fever |
| Where is epidemics of streptococcal pharyngitis common | military training facilities |
| What are the symptoms of streptococcal pharyngitis | edema, lymphoid hyperplasia of the posterior portion of the pharynx. enlarged hyperemic tonsils, patchy discrete tonsillopharyngeal exudates |
| What labs can be run to determine if S. pyogens caused the infection | throat culture (beta-hemolytic) Total WBC count exceeding 12000 with increased PMNS C-reactive + |
| What toxin does S. pyogenes produce that causes Scarlet fever from pharyngitis | erythrogenic toxin |
| What does the erythrogenic toxin cause during scarlet fever | delayed-type skin reactivity |
| Symptoms of scarlet fever | Diffuse erythema that blanches with pressure with numerous small papular elevations Strawberry tongue Paleness of skin around mouth Pastia's lines (rash is marked in skin folds) |
| Where does scarlet fever typically start | armpits or groin |
| 70 yo sudden shaking chill followed by fever and cough producing rusty colored sputum. rales in right chest. x-ray shows dense infiltrate in R mid lobe. G stain of sputum shows TNTC PMNs and G+ cocci (more football shaped) | Streptococcus pneumonia |
| Characteristics of Strep. pneumoniae | G+ lancet shaped diplococci Encapsulated |
| Who is at risk of severe strep. pneumoniae diseases? | Asplenics |
| What can strep. pneumoniae cause | sinusitis and pneumonia rust-colored sputum present |
| What are the virulence factors for Strep. pneumoniae | IgA protease Catalase- Pneumolysin (alpha-hemolytic) |
| What agar is typically needed to determine if Strep. pneumoniae is present | bile salt agar |
| clinical manifestations of pneumococcal pneumonia | grayish, anxious appearance splinting on affected side (favoring 1 lung over another) cracking heard in lungs increased fremitus |
| How to diagnose pneumococcal pneumonia | seeing fluid/pus in lungs on radiographs sputum G stain and culture |
| Woman from Arkansas present to doctor with fever and small black ulcer on right arm. Area around ulcer is red and tender. Right axillary lymph nodes are enlarged and tender. Ulcer is at site of tick bite from 4 days ago | Francisella tularensis (Tularemia) |
| Characteristics of Francisella tularensis | aerobic G- coccobaccilli weakly catalase + Oxidase- pale-staining (doesnt stain well) Facultative intracellular organism capsulated and catalase protect from phagosome |
| What is required for the growth of Francisella tularensis | Cysteine |
| What is the ID of Francisella tularensis | 10-50 intradermal or inhaled |
| What do intracellular organisms do | live inside of your cells |
| How is Francisella tularensis transmitted | rabbits, ticks, deer flies |
| What are symptoms/signs of Francisella tularensis (tularemia) | ulceroglandular oculoglandular pneumonia typhoidal |
| Where is Francisella tularensis most commonly seen | Arkansas and Missouri |
| What months is Francisella tularensis most common in | June-August and December |
| How to diagnose Tuleremia | Serology ***Culture is dangerous |
| Characteristics of Burkholderia pseudomallei | G- bacillus Oxidase+ Aerobic and motile Safety pin staining |
| Where is Burkholderia pseudomallei commonly found | soil and surface water in endemic regions |
| What regions are endemic to Burkholderia pseudomallei | Thailand and Northern Territory Australia |
| What are the clinical manifestations of Melioidosis | Pneumonia (most common) Acute presentation- pneumonia signs Subacute or chronic- purulent sputum, hemoptysis, night sweats (suggest TB) |
| How to diagnose Melioidosis | G stain and culture |
| What media is required when culturing to test for Melioidosis | Ashdown's agar |
| 6 yo develops runny nose with fever and malaise. Week later, begins to have violent coughing which occurs 15-20x per day sometimes accompanied by vomiting. Xray clear. blood smear 70% lymphocytes | Bordetella pertussis |
| Characteristics of Bordetella pertussis | small G- coccobacillus |
| What media(s) is/are required to grow Bordetella pertussis | Bordet-Gengou or Regan-Lowe |
| How is bordetella pertussis spread | airborne droplets |
| What toxins does Bordetella pertussis have | tracheal cytotoxin Pertussis toxin |
| What does Tracheal cytotoxin do | damages ciliated cells |
| What does Pertussis toxin do | subunit toxin increases intracellular cAMP produces marked lymphocytes inhibits phagocytosis |
| Does bordetella pertussis have a vaccine? | yes acellular vaccine boost every 4-5 years |
| Whooping cough clinical signs- phase 1 | Catarrhal phase 1-2 weeks malaise rhinorrheae mild cough excessive lacrimation |
| Whooping cough clinical signs- phase 2 | Paroxysmal Phase paroxysmal cough |
| Whooping cough clinical signs- phase 3 | Convalescent phase gradual reduction in frequency/severity of coughs lasts 2 weeks |
| When is the best time to run diagnostic tests for whooping cough | catarrhal phase |
| How to diagnose whooping cough | bacterial culture and PCR of specimens collect from posterior nasopharynx |
| 60 yo alcoholic man seen in ER 4 day history of fever, cough, right sided chest pain. cough produces thick, bloody sputum. chest xray shows dense R lower infiltrate with bulging fissures and cavitation. G stain of sputum shows TNTC G- bacilli | Klebsiella pneumoniae |
| characteristics of Klebsiella pneumoniae | g- bacillus Urease+ Capsule Ferments lactose |
| What do colonies of Klebsiella pneumoniae look like | mucoid colonies (basically buoyant from capsule) |
| What agar does Klebsiella pneumoniae turn pink on | MacConkey |
| What toxin does Klebsiella pneumoniae and whats it do | Endotoxin fever and shock, eventually sepsis |
| 2 types of Klebsiella pneumoniae infections | HAP/VAP CAP |
| HAP/VAP- Klebsiella pneumoniae symptoms | new pulmonary infiltrate with Fever, Cough, increased sputum production, leukocytosis |
| CAP- Klebsiella pneumoniae | coughing , fever, pleuritic chest pain, labored breathing, sputum production, crackle noises in chest, leukocytosis |
| What leads to the thick, mucoid, blood-tinged sputum | marked inflammation and necrosis |
| What can Klebsiella pneumoniae cause | necrotizing pneumonia |
| Who is most susceptible of turning Klebsiella pneumoniae into necrotizing pneumonia | alcoholic, diabetic, or chronic lung patients |
| How to diagnose Klebsiella pneumoniae infection | Gram stain culture chest xray |
| 69 yo woman history of chronic emphysema and bronchitis is seen at ER with 2 day history of worsening shortness of breath and C. noticed sputum has chnages from clear-white to yellow-brown. G stain of sputum shows +++ WBC and very small G- coccobacilli | Haemophilus influenza |
| characteristics of Haemophilus influenza | very small G- bacillis Oxidase+ facultative anaerobe nonmotile IgA proteases capsule |
| What agar is required to grow Haemophilus influenza | chocolate agar |
| What are the two types of Haemophilus influenza | typeable and nontypeable |
| Typeable Haemophilus influenza | encapsulated |
| What can typeable Haemophilus influenza cause | meningitis, sinus infectinos, ear infections (in children) |
| Nontypeable Haemophilus influenza | unencapsulated form |
| What can Nontypeable Haemophilus influenza cause | pneumonia in adults |
| Who is most likely to get Nontypeable Haemophilus influenza | adults with lung cancer |
| What type of Haemophilus influenza has a vaccine | Typeable |
| How to diagnose Haemophilus influenza | clinical appearances labs |
| Moraxella catarrhalis characteristics | G- diplococcus dozen+ adhesins Oxidase+ Catalse+ DNase+ hockey puck sign |
| How is Moraxella catarrhalis distinguishable from Neisseria | Gram stain |
| What agar is used for Moraxella catarrhalis | blood agar (turns it pink) |
| What is Moraxella catarrhalis known to cause | otitis media and sinusitis in adults (3rd most common) |
| What patient population commonly gets pneumonia from Moraxella catarrhalis | older adults COPD, CHF, or diabetes |
| Clinical manifestations of Moraxella catarrhalis | increased cough and sputum production increased sputum purulence increased labor breathing |
| How to diagnose Moraxella catarrhalis | sputum G stain showing intra and extracellular G- diplococci |
| Characteristics of Mycoplasma pneumonia | no cell wall short rod with organelle at one end aerobic ferments glucose to acid |
| What media is Mycoplasma pneumonia able to grow on | cell-free defined media (supplemented with serum) |
| How is Mycoplasma pneumonia spread | respiratory droplets |
| Who is likely to get Mycoplasma pneumonia and what will it cause | Children younger than 3: URT 5-20: bronchitis and pneumonia older adults: pneumonia |
| When is Mycoplasma pneumonia typically seen to spread | among family members or among those in close quarters |
| Clinical manifestations of Mycoplasma pneumonia | mostly asymptomatic some cough, some sputum production |
| Diagnosis of Mycoplasma pneumonia | Mostly not necessary PCR test when needed |
| Chlamydophila pneumoniae characteristics | obligate intracellular pathogen G- (doesnt Gram stain) |
| What can Chlamydophila pneumoniae cause | pharyngitis, bronchitis, pneumonia, otitis media, laryngitis |
| How is Chlamydophila pneumoniae transmitted | respiratory droplets, small particle aerosolization and fomites |
| Clinical manifestations of Chlamydophila pneumoniae | resembles M. pneumonia, typically asymptomatic |
| Chlamydophila pneumoniae diagnosis | PCR test if necessary |
| Legionella pneumophila | G- aerobic bacillus catalase+ Urease- |
| Where is Legionella pneumophila found | aquatic bodies (lakes or streams), water distribution systems, etc |
| What media is required to grow Legionella pneumophila | buffered charcoal yeast extract agar |
| What does Legionella pneumophila require to grow | Cysteine |
| What can Legionella pneumophila cause | Legionnaires' disease or Pontiac fevere |
| Clinical manifestations of Legionella pneumophila- Legionnaire's disease | URI symptoms with GI symptoms lethargy and confusion |
| Diagnosis of Legionella pneumophila | fever, rales with consolidation labs: hyponatremia, hematuria, proteinuria |
| Coxiella burnetii characteristics | Pleomorphic coccobacillus with G- cell wall survives phagolysosome |
| Reservoirs of Coxiella burnetii | cattle, sheep, goats |
| How is Coxiella burnetii shed | urine, feces, milk, birth products aerosolized |
| Q fever symptoms | more likely in adult men compared to women and children |
| clinical manifestations of Q fever | flu-like pneumonia severe headache |
| Diagnosis of Q fever | risk factors (contacts with animals or downwind from farm) Serologic testing (blood and sputum cultures will be negative) |
| 10 yo boy on a club swim team is seen for left ear pain which has been worsening for the past 2 days. On examination, there is erythema and swelling of the external auditory canal with a small amount of clear drainage | Otitis externa "Swimmer's ear" |
| What is otitis externa | superficial infection of the external auditory canal |
| Where does otitis externa typically occur | hot, humid enviornments |
| What (microbes) typically cause otitis externa | P. aeruginosa, S. epidermis, S. aureus |
| What are the symptoms of otitis externa | itchy and pain in ear swelling and redness seen in external auditory canal |
| What are the two microbes that can cause otitis externa to have pus | S. aureus and P. aeruginosa |
| How to determine if otitis externa is caused by S. aureus or P. aeruginosa if pus is seen | green pus is P. aeruginosa clear and less pus looking is S. aureus |
| 73 yo man with history of hypertension and type 2 diabetes mellitus comes in with 3 day history of excruciating left ear pain. Speech seems slurred and wife says left side of face is droopy. left ear is swollen, tender, with purulent drainage | Necrotizing malignant otitis externa |
| What is Necrotizing malignant otitis externa | spreads from squamous epithelium of ear canal to adjacent areas of soft tissue, BV, cartilage and bone |
| Who typically gets Necrotizing malignant otitis externa | diabetics |
| What microbe typically causes Necrotizing malignant otitis externa | P. aeruginosa |
| Symptoms of Necrotizing malignant otitis externa | Granulation tissue in floor of external canal at cartilaginous-osseus junction |
| What can Necrotizing malignant otitis externa cause | osteomyelitis of temporal bone, sigmoid sinus thrombosis, septic thrombophlebitis of jugular vein, permanent facial paralysis |
| How to diagnose Necrotizing malignant otitis externa | CT or MRI of ear |
| 15 month old brought for fever, irritability, runny nose and drooling. Tugging at right ear. Red bulging right tympanic membrane with obvious fluid in middle ear | Acute Otitis media (AOM) |
| What is Acute Otitis media (AOM) | fluid in middle ear impaired function of Eustachian tube |
| Who is most likely to get Acute Otitis media (AOM) | children |
| Does viruses or bacteria typically cause Acute Otitis media (AOM) | Bacteria |
| What bacteria can cause Acute Otitis media (AOM) | S. pneumoniae H. influenzae M. catarrhalis |
| What viruses can cause Acute Otitis media (AOM) | Rhinovirus RSV Influenza |
| What type of H. influenzae causes Acute Otitis media (AOM) and why | nontypeable because of vax for typeable |
| symptoms of Acute Otitis media (AOM) | pain, fever, drooling, irritability, red bulging tympanic membrane, fluid in middle ear |
| What is Otitis media with effusion (OME) | middle ear fluid without acute signs of bacteria infection or illness |
| What are the predisposing factors of Otitis media with effusion (OME) | Viral infection Barotrauma Allergy Eustachian tube dysfunction |
| Symptoms of Otitis media with effusion (OME) | temporary conductive hearing loss sense of aural fullness visible fluid behind tympanic membrane |
| What is chronic otitis media (COM) | subacute or chronic tympanic membrane perforation |
| What bacteria cause chronic otitis media (COM) | P. aeruginosa or S. aureus |
| What can chronic otitis media (COM) cause | chronic draining ear hearing impairment spread to adjacent tissue |
| What are the complications of chronic otitis media (COM) | Mastoiditis |
| What is Mastoiditis | infection of mastoid (bone) which usually follows AOM or COM infection spreads from middle ear to mastoid |
| Who is most likely to get Mastoiditis | elderly and immunocompromised |
| What bacteria causes Mastoiditis | P. aeruginosa S. aureus S. pneumoniae H. influenzae |
| How to diagnose Mastoiditis | CT scan or MRI |
| What is Labyrinthitis (otitis interna) | potentially a viral or post-viral inflammatory disorder |
| What are the symptoms of Labyrinthitis (otitis interna) | Vertigo, Nausea, vomiting, gait impairment |
| How to diagnose Labyrinthitis (otitis interna) | clinical presentation |
| 64 yo history of smoking and alcohol abuse. 3 months fever, drenching night sweats and cough with blood tinged sputum. 35lbs weight loss and appears wasted. Patient is homeless and spends some time in shelter. xray shows upper lobe disease | TB |
| Who is most likely to get TB | immunocompromised patients in close quarters |
| What does an xray of TB look like | upper lobe disease with loss of normal aerated lung and cavities |
| What bacteria causes TB | Mycobacterium tuberculosis |
| What is the physiology of mycobacteria | poorly staining rods acid-fast obligate aerobes non-spore forming motile |
| Do mycobacteria replicate quickly or slowly? | slowly up to 8 weeks |
| What is unique about mycobacteria's cell walls | lipid-rich cell wall with outer layer of mycolic acid |
| What are the pathogenesis of mycobacteria | facultative intracellular pathogens replicate in vesicles within macrophages |
| How does mycobacteria prevent fusion of phagocytic vesicles | lysosomes due to sulfolipids in envelope |
| Virulence factors of mycobacteria | High lipid content in cell wall Cord factor Aerosol spreading cell entry mechanisms intracellular growth slow generation time inhibits phagosome-lysosome function reduce production of IL-12 can survive and multiply in inactive alveolar macrophages |
| What is the immune response to TB | Granulomatous inflammation Effective response depends on cell-mediated immunity |
| Who is most likely to get TB | People with HIV, debilitated or immunocompromised |
| People with HIV and TB is most likely to progress to what disease | TB disease |
| Where is TB most commonly seen | 3rd world countries |
| What are the risk factors of TB | homelessness, urban poverty, malnutrition, crowding, alcoholism |
| Where are rates of TB increased | prisons, healthcare workers, immigrants from regions with high rates of endemic TB |
| How is TB spread | aerosolized droplets |
| What are the two ways TB is seen | Latent TB infection TB disease |
| What is a latent TB infection | bacteria lives in body but doesnt cause symptoms not sick and cannot spread organism "dormant" |
| What is TB disease | bacteria multiplies and destroys body tissue. Sick and have symptoms can spread the disease "active" |
| Where do TB infections start | in the upper lobes (most oxygen there) |
| Will TB infection or TB disease test positive on a skin or blood test | Both |
| What will be seen on an xray with TB infection | normal |
| What will be seen on an xray with TB disease | abnormal |
| Will sputum test + or - with TB infection | neg |
| Will sputum test + or - with TB disease | pos |
| Will patients have symptoms with TB infection | no |
| Will patients have symptoms with TB disease | yes |
| Are people with TB infection, infectious? | no |
| Are people with TB disease, infectious? | yes |
| What are other forms of TB | pulmonary TB Progressive TB pneumonia Military TB Extrapulmonary TB |
| What is pulmonary TB | reactivation of TB in the apex of lung |
| What can pulmonary TB cause | caseous necrosis and formation of cavities |
| What are the symptoms of pulmonary TB | local pulmonary symptoms (coughing up blood and sputum production) Prominent systemic symptoms (fever, chills, night sweats, fatigue, weight loss) |
| Primary progressive TB pneumonia | most contagious high fever, productive cough, very infectious |
| Who is most likely to get Primary progressive TB pneumonia | very young and elderly |
| Military TB | progressive, disseminated hematogenous TB disseminations resembles millet seed |
| What are the two types Extrapulmonary TB | GI TB Laryngeal TB |
| What can Extrapulmonary TB cause through lymphohematogenous spread | meningitis, lymphadenitis, renal TB, skeletal TB |
| How to diagnose TB | radiographs of chest lab diagnostics staining (acid-fast and Auramine-rhodamine) Culture PCR |
| What is the best way to test for TB | skin testing (Mantoux method) |
| What are the limits to tuberculin skin testing | False positive TST reactions (test isnt exclusive to TB) False negative TST reactions |
| When doing a skin test, what is one way a false positive would occur | getting the vaccine for TB |
| What do cultures of TB look like | thin, flat, spreading, friable with rough appearance Slow growing (8-10) Not photoreactive |
| What mycobacterium makes up the TB vaccine | M. bovis |
| What pigment does M. marinum make when exposed to light | yellow-orange |
| What pigment does M. avium make when exposed to light | No pigment |
| What pigment does M. fortuitum make when exposed to light | No pigment |
| What are Nontuberculous mycobacteria (NTM) found | soil, water, plant material Hot tubs milk fresh and salt water |
| What bacteria is found in hot tubs and milk | M. avium |
| What bacteria is found in fresh and salt water | M. marinum |
| Who typically gets Nontuberculous mycobacteria (NTM) | immunocompromised patients |
| How fast does M. tuberculosis grow | slow |
| How fast does M. fortuitum grow | fast |
| How fast does M. Bovis grow | slow |
| How fast does M. avium grow | slow |
| How fast does M. marinum grow | slow |
| How fast does M. leprae grow | none (cannot be grown in lab) |
| What is the reservoir for M. tuberculosis | Humans |
| What is the reservoir for M. fortuitum | environment |
| What is the reservoir for M. Bovis | animals |
| What is the reservoir for M. avium | environment and birds |
| What is the reservoir for M. marinum | water and fish |
| What is the reservoir for M. leprae | wild armadillos and humans |
| What is the main disease caused by M. tuberculosis | TB |
| What is the main disease caused by M. fortuitum | skin abscesses |
| What is the main disease caused by M. bovis | TB |
| What is the main disease caused by M. avium | pulmonary disease or disseminated disease or cervical lymphadenitis |
| What is the main disease caused by M. marinum | skin granuloma |
| What is the main disease caused by M. leprae | leprosy |
Created by:
Kayla_K