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Micro First Aid
| Hint | Answer |
|---|---|
| what does teichoic acid from cell membranes (gram pos) induce? | TNF and IL-1 |
| where in bacs is endotoxin/LPS? | in outer membrane of gram negs |
| What does Lipid A induce? | TNF and IL-1; polysaccharide in outer membrane of gram negs is the antigen |
| where in the cell are beta lactamases found? | in periplasm (site between inner and outer membrane in gram negs) |
| What are bacterial capsules made out of? What is the exception? | Polysaccharides, except Bacillus anthracis which is made of D-glutamate. |
| what are pili/fimbria made from? | glycoprotein |
| what are flagella made of? | protein |
| what are spores made of? | dipicolinic acid |
| 4 organisms which have IgA proteases and their purpose | S. pneumoniae, N. meningitidis, N. gonorrheae, H. influenzae. Allows them to colonize mucosal surfaces. |
| 6 bugs which do not Gram stain well | "These Bugs May Microscopically Lack Color": Treponema (too thin), Rickettsia (intracellular parasite), Mycobacteria (acid fast), Mycoplasma (no cell wall), Legionella (primarily intracellular), and Chlamydia (intracellular and lacks muramic acid in wall) |
| how to visualize treponema | dark field microscopy and fluorescent antibody staining |
| how to ID Legionella | silver stain |
| where does exotoxin come from? | certain species of some gram pos and gram neg bacs |
| is exotoxin secreted from cell? | yes (not endotoxin) |
| what is exotoxin made of? endotoxin? | exotoxin: peptide. endotoxin: lipopolysaccharide. |
| where are the genes for exotoxin located? endotoxin? | exotoxin: on plasmid or bacteriophage. endotoxin: chromosome. |
| toxicity of endotoxin vs exotoxin | endo: low, exo: high |
| clinical effects of exotoxin vs endotoxin | exotoxin: various. endotoxin: fever, shock |
| antigenicity of exotoxin vs endotoxin | exo: induces high titer antibodies (antitoxins). endotoxins are poorly antigenic. |
| vaccines for exotoxins vs endotoxins | exotoxins: toxoids used as vaccines. endotoxins: no vaccines. |
| heat stability of exotoxin vs endotoxin | exo: rapidly destroyed at 60C except for staph exotoxin. Endotoxin: stable at 100C for 1h |
| how do superantigens work? | bind MHC II and T cell receptor directly, activating loads of T cells to stimulate release of IFN-gamma and IL-2 |
| how does S. aureus superantigen work? | TSST-1 causes toxic shock syndrome. Enterotoxins cause food poisoning. |
| How does Strep pyogenes superantigen work? | Scarlet fever-erythrogenic toxin --> toxic shock-like syndrome |
| How do ADP-ribosylating toxins work? | B (binding) component binds to a receptor on the surface of the host cell, enabling endocytosis. A (active) component then attaches an ADP-ribosyl to a host cell protein --> alter function. |
| 4 examples of ADP-ribosylating A-B toxins | Corynebacterium diptheriae, Vibrio cholerae, E. coli, Bordetella pertussis |
| what is the Corynebacterium diptheriae toxin? | an A-B toxin which inactivates elongation factor (EF-2) similar to Pseudomonas exotoxin A. Causes pharyngitis and throat pseudomembrane. |
| How does the Vibrio cholerae toxin work? | an ADP-ribosylating A-B toxin which ribosylates a G protein --> stimulate adenylyl cyclase --> pump out Cl and H20 |
| How does E. coli heat stable toxin work? | stimulates guanylate cyclase |
| How does E. coli heat labile toxin work? | stimulates adenylyl cyclase via a cholera-like mechanism, causing watery diarrhea |
| Mnemonic for the E. coli toxins | Labile like the AIR (Adenylyl cyclase), stable like the Ground (guanylate cyclase) |
| mechanism of Bordetella pertussis toxin | an ADP-ribosylating AB toxin that stimulates adenylyl cyclase --> causes whooping cough. Inhibits chemokine receptor, causing lymphocytosis. |
| What is the toxin of Clostridium perfringens? | alpha toxin causes gas gangrene |
| agar sign of Clostridium perfringens | double zone of hemolysis on blood agar |
| how does C. tetani toxin work? | An exotoxin that blocks the release of glycine as a neurotransmitter --> lockjaw |
| How does the C. botulinum toxin work? | an exotoxin that blocks the release of ACh, causing anticholinergic symptoms and CNS paralysis esp. cranial nerves. |
| describe Bacillus anthracis toxin | big complex, but 1 exotoxin stimulates adenylyl cyclase |
| how does Shiga toxin work> | an exotoxin that cleaves host cell rRNA and enhances cytokine release. |
| What is Streptolysin O? | An exotoxin found in S. pyogenes. The antigen for ASO antibody in rheumatic fever. |
| 3 things that Endotoxin does, in general | 1) Activates macrophages, 2)activates alternate pathway of complement 3)Activates Hageman factor |
| 3 things that macrophages secrete | IL-1, TNF, and NO |
| what does IL-1 cause in host? | fever |
| what does TNF cause in host | Fever, hemorrhagic tissue necrosis |
| what does NO cause in host | hypotension, shock (in big doses) |
| What does C3a cause in host | hypotension and edema |
| what does C5a cause in host | neutrophil chemotaxis |
| what does Hageman factor cause | activation of coagulation cascade --> can cause DIC |
| fermentation patterns of Neisseria | MeninGococci ferment Maltose and Glucose. Gonococci just ferment Glucose. |
| what color pigment does S. aureus produce | yellow pigment |
| what color pigment does Pseudomonas aeruginosa produce | blue-green |
| what color pigment does Serratia marcescens produce | red |
| 4 types of gram pos rods | Clostridium (anaerobe), Corynebacterium, Listeria, and Bacillus |
| What are catalase positive clusters of gram pos cocci? | staphylococcus |
| what are catalase neg chains of gram pos cocci | streptococci |
| What are coagulase positive, catalase positive, gram pos cocci | S. aureus |
| How do you distinguish the coagulase negative staphylococci? | If novobiocin sensitive, S. epidermidis. If resistant, S. saprophyticus |
| what is alpha hemolysis? Beta? gamma? | alpha is green (partial), beta is clear, gamma is no hemolysis |
| how to distinguish between the alpha hemolytic strep? | S. pneumoniae has a cpsule, is optochin sensitive, bile soluble. Viridans strep (eg S. mutans) has no capsule, is optochin resistant, and not bile soluble. |
| How to distinguish the Beta hemolytic strep | Group A is S. pyogenes and bacitracin sensitive. Group B strep is S. agalactiae and is bacitracin resistant. |
| 2 gamma hemolytic strep | Enterococcus (either alpha or gamma hemolytic) and peptostreptococcus (an anaerobe) |
| 4 "coccoid" gram neg rods | H. influenzae, Pasteurella, Brucella, and Bordetella pertussis |
| what does H. influenzae require to grow | factors V and X |
| how do you get pasteurella | animal bites |
| Describe Klebsiella | a fast lactose fermenting gram neg rod |
| describe E. coli | a fast lactose fermenting gram neg rod |
| describe enterobacter | a fast lactose fermenting gram neg rod |
| describe citrobacter | a slow lactose fermenting gram neg rod |
| describe serratia | a slow lactose fermenting gram neg rod |
| describe pseudomonas | an oxidase positive lactose nonfermenting gram neg rod |
| describe shigella, salmonella, and proteus | an oxidase negative lactose nonfermenting gram neg rod |
| H. influenzae media | chocolate agar w/ factor V (NAD) and X (hematin) |
| N. gonorrheae media | Thayer-Martin media |
| B. pertussis media | Bordet-Gengou (potato) agar |
| C. diptheria agar | Tellurite plate, Loffler's medium, blood agar |
| M. tuberculosis media | Lowenstein-Jensen agar |
| media for lactose-fermenting bacteria | pink coloniees on MacConkey's agar |
| Legionella media | charcoal yeast extract agar w/ iron and cysteine |
| fungi media | Sabouraud's agar |
| what do you use Giemsa's stain for? | Borrelia, Plasmodium, trypanosomes, Chlamydia |
| what do you use PAS stain for? | To stain glycogen and mucopolysaccharides. Used to dx Whipple's dz |
| what is the silver stain for? | Fungi, PCP, Legionella |
| what is conjugation? | direct cell-cell DNA transfer in prokaryotic cells only. Chrosomal or plasmid DNA |
| what is transduction | phage-mediated cell-cell DNA transfer in prokaryotes. In generalized transduction can be any gene. In specialized, only certain ones. |
| what is lysogeny? | the genetic code for a bacterial toxin encoded in a lysogenic phage. Ie, Botulinum, cholera, diptheria, and erythrogenic toxin of Strep pyogenes |
| Mnemonic for 4 obligate aerobes | Nagging Pests Must Breathe (Nocardia, Pseudomonas aeruginosa, Mycobacterium tuberculosis, Bacillus) |
| 3 examples of obligate anaerobes | Clostridium, Bacteroides, and Actinomyces |
| why are aminoglycosides useless in anaerobes? | because aminOglycosides require O2 to get into cell |
| mnemonic for 2 obligate intracellular parasites | stay inside when it's Really Cold (Rickettsia, Chlamydia) |
| 8 facultative intracellular bugs | Some Nasty Bugs May Live FacultativeLY (Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella, Yersinia) |
| what is a positive "quellung" reaction? | if an encapsulated bacterium is present, that capsule swells when anticapsular antisera are added. |
| what beta hemolytic bacterium has tumbling motility | Listeria |
| what is the purpose of catalase? | degrades H202 made by PMNs. H202 is a substrate for myeloperoxidase. |
| what is "Protein A" | a virulence factor found in S. aureus that binds Fc-IgG, inhibiting complement fixation and phagocytosis. |
| is S. pyogenes bacitracin sensitive or resistant? | sensitive |
| Antibody to "M protein" enhances host defenses against what? | S. pyogenes |
| Mnemonic for diseases caused by S.pneumoniae | MOPS: Meningitis, Otitis media, Pneumonia, Sinusitis. Also, Most OPtochin Sensitive |
| is S. pneumoniae sensitive to optochin or resistant. | Sensitive, remember MOPS: Most OPtochin Sensitive. |
| are Group B strep bacitracin sensitive or resistant? | Bacitracin resistant and Beta-hemolytic (2 Bs of group B strep) |
| what diseases do group B strep cause? | pneumonia, meningitis, and sepsis, primarily in babies |
| what do enterococci cause? | UTIs and subacute endocarditis |
| are enterococci sensitive or resistant to penicillin G? | resistant |
| What does the Lancefield group D include? | the enterococci and the nonenterococcal group D strep |
| what is Lancefiel grouping based on? | differences in the C carbohydrate on the bacterial cell wall. |
| how do you distinguish enterococci from nonenterococcal group D streps? | they are hardier and can grow in 6.5% NaCl |
| which viridans group strep causes subacute endocarditis? | S, sanguis |
| which viridans group strep causes caries | S. mutans |
| what two antibiotics are particularly prone to causing C. difficile pseudomembranous colitis | Clindamycin or ampicillin |
| What does the "coryne" in "corynebacterium" mean? | club shaped |
| what agar does corynebacterium diptheriae grow on? | tellurite agar |
| ABCDEFG of diphtheria | Adp ribosylation, Beta-prophage, Corynebacterium, Diphtheriae,Elongation Factor2, Granules |
| lab dx of diptheria | gram + rods w/ metachromatic granules |
| what happens in inhalation anthrax? | flulike symptoms that rapidly progress to fever, pulmonary hemorrhage, and death. "Woolsorter's disease." |
| symptoms of contact anthrax | malignant pustule (painless ulcer) which can progress for bacteremia and death. They are black vesicular papules covered by a black eschar. |
| what does Actinomyces israelii cause? | oral-facial abscesses with "sulfur granules" that may drain through sinus tracts in skin. However they are normal oral flora |
| gram stain and o2 req of actinomyces israelii | gram pos anaerobe |
| what does nocardia asteroides cause? | pulmonary infection in the immunocompromised. |
| gram stain and o2 requirements of nocardia asteroides | gram + and weakly acid fast aerobe in soil |
| how to remember treatments for Actinomyces israelii vs Nocardia? | SNAP: Sulfa for Nocardia, Actinomyces for Penicillin |
| penicillin and gram negative bugs | Gram negs are resistant to benzyl penicillin G but may be susceptible to penicillin derivatives like ampicillin. The gram negative outer membrane inhibits entry of penicillin G and vancomycin. |
| capsule in Neisseria gonococci vs meningococci | Meningococci have a polysaccharide capsule, gonococci don't |
| mnemonic for remembering what diseases Haemophilus causes | haEMOPhilus causes Epiglottitis, Meningitis, Otitis Media, and Pneumonia. |
| transmission of H. influenzae | aerosol |
| what is the Hib vaccine | contains type B capsular polysaccharide conjugated to diptheria toxoid or other protein |
| how to treat Hib infections | treat meningitis w/ ceftriaxone. Rifampin prophylaxis in close contacts/ |
| what is the K antigen of enterbacteriaceae? | capsular antigen related to the virulence of the bug |
| what is the H antigen of enterobacteriaceae? | flagellar anitgen |
| fermentation of enterobacteriaceae | all ferment glucose and are oxidase negative |
| mnemonic for characteristics of enterobacteriaceae | COFFEe: Capsular, O antigen, Flagellar antigen, Ferment glucose, Enterobacteriaceae |
| 3 As of klebsiella | Aspiration pneumonia, Abscess in lungs, Alcoholics |
| which are the the lactose fermenting enteric bacteria and how do you tell? | Klebsiella, E. coli, Enterobacter, Citrobacter, etc. Grow Pink colonies on MacConkey's agar. |
| Salmonella vs Shigella | Only salMonella is Motile and can invade further to disseminate hematogenously. Shigella is more virulent than Salmonella |
| How is Shigella transmitted? | 4Fs: Food, Fingers, Feces, and Flies |
| where do you get Yersinia enterocolitica from? | Pet poop (puppies) or contaminated milk, or pork, or day care. Can mimic Crohn's or appendicitis. |
| findings in Campylobacter | Comma or S-shaped organisms. Growth at 42C, oxidase positive |
| findings in salmonella | motile, lactose negative |
| how do vibrio cholera and pertussis toxins works? | cholera toxin permanently activates Gs, pertussis toxin permanently disables Gi and promotes lymphocytosis by inhibiting chemokine receptors. |
| what is bacillus anthracis toxin? | edema factor, a bacterial adenylate cyclase |
| tx of legionella | erythromycin |
| how to grow legionella | charcoal yeast extract w/ iron and cysteine. A french legionnaire sitting by the charcoal campfire with his silver helment and an iron dagger -- not a CYSsy. |
| mnemonic for diseases associated with PSEUDOmonas | Pneumonia, Sepsis, External otitis, UTIs, Drug Use/Diabetic OsteoMyelitis (+ hot tub folliculitis + wound and burn infections) |
| how to treat pseudomonas aeruginosa | aminoglycoside + extended spectrum penicillin |
| toxins made by pseudomonas aeruginosa | endotoxn (fever, shock), and exotoxin A (inactivates EF-2) |
| treatment of H. pylori | triple therapy: metronidazole, bismuth, and either tetracycline or amoxicilln. OR, more expensive, metronidazole, omeprazole, and clindamycin. |
| what does Brucella cause and how transmitted? | brucellosis/undulant fever, transmitted by dairy or contact w/ animals |
| how do you get francisella? | aka tularemia. tick bite, rabbits, deer |
| what does Pasteurella multicoda cause and how transmitted? | causes cellulitis, from dog and cat animal bites. |
| what bacs cause bacterial vaginosis | Gardnerella vaginalis is a pleomorphic, variable gram rod that causes green-discharge, fishy, nonsmelly vaginosis. Mobiluncus is an anaerobe that is also involved. |
| how to treat bacterial vaginosis | metronidazole |
| how to dx bacterial vaginosis microscopically | clue cll (vag epithelial cells covered w/ bacs) |
| does Ghon complex occur in primary or secondary TB? | primary. consists of hilar nodes + Ghon focus (usually in the lower lobes) |
| what is Pott's dz? | vertebral dz |
| what does Mycobacterium kansasii cause | pulmonary TB like symptoms |
| what does Mycobacteria scrofulaceum cause? | cervical lymphadenitis in kids |
| tx of leprosy | long term oral dapsone. toxicity is hemolysis and methemoglobinemia. alternate treatments include rifampin and combination of clofazimine and dapsone. |
| what do rickettsiae need to live? | obigate intracellular parasites that need CoA and NAD to survive. |
| how are Rickettsiae transmitted? | All except Coxiella are transmitted by an arthropod vector. Coxiella is transmitted by aerosol and causes pneumonia. |
| classic Rickettsia trias | headache, fever, rash (vasculitis). Coxiella causes pneumonia |
| tx of Rickettsiae | tetracycline |
| what organism causes Rocky Mountain Spotted Fever? | Rickettsia rickettsii from a tick. |
| symptoms of Rocky Mountain Spotted Fever | Fever, headache, centripetal rash (sPotted=centriPetal) |
| what organism causes endemic typhus and how spread? | Rickettsia typhi, from fleas. |
| symptoms of endemic typhus | headache, fever, centriPHugal rash. |
| what organism causes Q fever and how transmitted | Coxiella, from aerosol. Q fever is "queer" because it has no vector and has a negative Weil-Felix rxn, and can survive outside the organism for a long time |
| what is the Weil-Felix reaction | assays for antirickettsial antibodies. Cross-react w/ Proteus antigen. usually pos for typhus and rocky mountain spotted fever, neg for Q fever |
| what organism causes epidemic typhus | Rickettsia prowazekii, from human body louse. |
| what agar does Mycoplasma pneumonia grow on | Eaton's agar |
| does Mycoplasma pneumonia have a cell wall? | no cell wall |
| what is the only bacterial cell membrane w/ cholesterol? | Mycoplasma |
| treatment of Mycoplasma | tetracycline or erythromycin |
| what is odd about the Chlamydia cell wall? | lacks muramic acid |
| treatment of chlamydia | erythromycin or tetracycline |
| lab dx of chlamydia | cytoplasmic inclusions seen on Giemsa or fluorescent antibody-stained smear |
| which subtypes of Chlamydia trachomatis cause blindness in Africa | A,B, and C (Africa, Blindness, Chronic Infection) |
| what subtypes of Chlamydia trachomatis cause urethritis/PID, ectopic pregnancy, neonatal pneumonia, or neonatal conjunctivitis? | Types D-K. |
| which chlamydia serotypes cause lymphogranuloma venereum? | Types L1,L2,L3 (Ls -lympho) |
| what is lymphogranuloma venereum? | acute lymphadenitis -- positive Frei tests |
| mnemonic for spirochetes | Borrelia, Leptospira, Treponema: BLT is Big (borrelia is big) |
| which spirochete can be visualized by light microscopy? | Only Borrelia, using Wright or Giemsa stain. |
| treatment of Lyme dz | tetracycline |
| 3 stages of Lyme dz | 1)erythema chronic migrans, flulike symptoms. 2) neuro and cardiac manifestations 3)autoimmune migratory polyarthritis |
| mnemonic for Lyme dz symptoms | BAKE a key LYME pie: Bells palsy, Arthritis, Kardiac block, Erythema chronicum migrans |
| what organism causes yaws | Treponema pertenue |
| treatment of syphilis | penicillin G |
| What is the Argyll Robertson pupil? | constricts w/ accomodation but is not reactive to light. pathognomic for 3' syphilis. "prostitute's pupil" -- accomodates but doesn't react |
| what are conidia? | asexual fungal spores |
| how to distinguish Candida albicans | budding yeast w/ pseudohyphae in culture at 20C, germ tube formation at 37C |
| what is the form of coccidiodomycosis and what is the dz called? | a spherule filled w/ endospores. called San Joaquin valley or desert or valley fever |
| where is histoplasmosis found? | Mississippi and Ohio river valleys. |
| where do you get histoplasmosis from? | bird or bat droppings. |
| micro appearance of histoplasmosis | intracellular (tiny yeasr inside macrophages). |
| where is paracoccidiodomycosis | Rural Latin America. "captain's wheel appearance" |
| where is blastomycosis found? | states east of the mississippi, and in central america |
| micro appearance of blastomycosis | Big, Broad Based Budding |
| how to treat dimorphic fungi | fluconazole or ketoconazole for local infection. Ampho B for systemic infection. |
| how to culture dimorphic fungi | on Sabouraud's agar. |
| what causes tinea versicolor? | Malassezia furfur |
| symptoms of tinea versicolor | hypopigmented skin lesions. Occurs in hot, humid weather |
| Treatment of tinea versicolor | topical miconazole, selenium sulfide (selsun) |
| what causes tinea nigra | Cladosporidium weneckii, an infection of the keratinized layer of the skin. Appears as a brown spot |
| tx of tinea nigra | topical salicylic acid |
| what causes tinea pedis, cruris, corporis, capitis? | Pruritic lesions w/ central ring clearing. Caused by dermatophytes. Microsporidium, Trichophyton, Epidermophyton. See mold hyphae in KOH prep, not dimorphic. |
| what is a reservoir for Microsporidium | pets |
| how to treat dermatophytes | topical azoles |
| form of aspergillosis. | Not dimorphic. A mold w/ septate hyphae branching at 45 degrees |
| is Cryptococcus dimorphic? | no |
| culture for Cryptococcus neoformans | Sabaroud's agar |
| what does latex agglutination test detect | polysaccharide capsular antigen in Cryptococcus |
| form of mucor and rhizopus | mold w/ irregular nonseptate hyphae branching at wide angles (>90 degrees). |
| who tends to get mucor and rhizopus infections | ketoacidotic diabetics and leukemia patients. |
| what diseases do mucor and rhizopus cause? | They tend to proliferate in the walls of blood vessels and cause infarction of distal tissue. Rhinocerebra, frontal lobe abscesses. |
| how to dx PCP pneumonia | lung biopsy or lavage. Identified by methenamine silver stain of tissue |
| tx of PCP pneumonia | TMP-SMX, pentamidine, dapsone |
| when should you start prophylaxis for PCP pneumonia in HIV | when CD4 drops <200 |
| form of sporothrix schenckii | dimorphic fungus that lives on vegetation. sporotrichosis = rose gardener's dz |
| symptoms of sporotrichosis | causes local pustule or ulcer w/ nodules along draining lymphatics (ascending lymphangitis). little systemic illness. a cigar-shaped budding yeast is visible in the pus |
| tx of sporotrichosis | itraconazole or potassium iodide. |
| symptoms of entamoebiasis | bloody diarrhea (dysentery), liver abscess, RUQ pain |
| transmission of amoebiasis | cysts in water |
| dx of amoebiasis | serology, or trophozoites or cysts in stool |
| tx of amoebiasis | metronidazole and iodoquinol |
| tx of Giardia lamblia | metronidazole |
| how to dx cryptosporidium | cysts on acid fast stain |
| tx of cryptosporidium | none |
| what does toxoplasma cause? | in HIV, brain abscess. Birth defects (ring-enhancing brain lesions). |
| transmission of toxoplasma | cysts in meat or in cat poops |
| dx of toxoplama | serology or biopsy |
| tx of toxoplasma | sulfadiazine + pyrimethamine |
| what tx for relapse caused by P. vivax or P. ovale | primaquine |
| how to dx trichomonas vaginalis | motile trophozoites on wet mount |
| tx of trichomonas vaginalis | metronidazole |
| what does Trypanosoma cruzii cause | Chagas' disease: dilated cardiomyopathy, megacolon, megaesophagus |
| transmission of T. cruzii | reduviid bug |
| dx of chagas | blood smear |
| tx of chagas | Nifurtimox |
| what do Trypanosoma gambiense and rhodiense cause? | African sleeping sickness |
| how is african sleeping sickness transmitted? | tsetse fly |
| how to dx african sleeping sickness | blood smear |
| how to tx african sleeping sickness | suramin for blood-borne dz or melarsoprol for CNS penetration |
| What does Leishmania donovani cause? | Kala-azar: visceral leishmaniasis |
| how s Leishmania donovani transmitted | sandfly |
| dz of kala azar | macrophages contain amastigotes |
| tx of kala azar | sodium stibogluconate |
| what does the Babesia genus of protozoa cause | Babesiosis: fever and anemia |
| how is Babesiosis transmitted | Ixodes tick |
| how to dx babesiosis | blood smear. No RBC pigment. Appears as "maltese cross" |
| tx babesiosis | quinine, clindamycin |
| tx of taenia solium | Praziquantel/niclosamide, or albendazole for cysticercosis |
| what is Echinococcus granulosus | tapeworm (cestode) in dog poop that when ingested can cause cysts in liver and anaphylaxid iff echinococcal antigens are released from cysts |
| tx of echinococcus granulosus | albendazole |
| host of schistosoma and disease | snails. cercariae penetrate human skin and cause granulomas, fibrosis, and inflammation of spleen and liver. |
| tx of schistosoma | praziquantel |
| what is clonorchis sinensis | a trematode (fluke) found in undercooked fish. causes inflammation of the biliary tract. |
| tx of all flukes | praziquantel |
| what are ancyclostoma duodenale? | aka hookworm. larvae penetrate foot skin --> intestinal infection --> anemia. |
| tx of ancyclostoma duodenale | mebendazole/pyrantel pamoate |
| tx of ascaris lumbricoides | mebendazole/pyrantel pamoate |
| what is ascaris lumbricoides | giant roundworm. eggs are visible in poops |
| what is Enterobius vermicularis (pinworm)? | food contaminated w/ eggs; intestinal infection --> anal pruritis |
| how to dx pinworm | scotch tape test |
| tx of pinworm | mebendazole/pyrante pamoate |
| what is Strongyloides stercoralis | a roundworm whose larvae in soil penetrate the skin and infect intestines. |
| tx of Strongyloides stercoralis | Ivermectin/thiabendazole |
| What is Trichinella spiralis | a nematode in undercooked meat, usually pork. causes inflammation of muscle and periorbital edema |
| tx of trichinella | thiabendazole |
| what is Dranunculus medinensis | a nematode in drinking water that causes skin inflammation and ulceration. "Guinea worm" |
| tx of dranunculus medinensis | niridazole |
| what is Loa loa | a nematode transmitted by deer fly. causes swelling in skin. can see it crawling in conjunctiva. |
| tx of loa loa | diethylcarbamazine |
| what is Onchocerca volvulus | a roundworm transmitted by female blackflies that causes river blindness |
| tx of onchocerca volvulus | Ivermectin |
| what is Toxocara canis | eggs in food --> granulomas. if in retina, get blindness. Visceral larva migrans. |
| tx of Toxocara canis | Diethylcarbamazine |
| what is Wuchereria bancrofti | a roundworm transmitted by female mosquito. causes elephantiasis |
| tx of elephantiasis | diethylcarbamazine |
| what parasite causes liver cysts | Echinococcus granulosus |
| what parasite causes B12 deficiency | Diphylloobothrium latum |
| what parasite causes biliary tract dz | Clonorchis sinensis |
| What parasite causes hemoptysis | Paragonimus westermanii |
| what parasite causes portal hypertension | Schistosoma mansonii |
| What parasite causes hematuria and bladder cancer | Schistosoma haematobium |
| What parasite causes microcytic anemia | Ancyclostoma, Necator |
| What parasite causes perianal pruritis | Enterobius |
| what is the only DNA virus that is not dsDNA | parvovirus (remember "part-of-a-virus" |
| what is the only family of RNA viruses that is not ssRNA | Reoviridae "remember "repeat-o-virus" |
| which DNA virus families are nonlinear? | papovaviruses and hepadnaviruses |
| naked viral genome infectivity | naked nucleic acids of most dsDNA and +ssRNA viruses are infectious, naked -ssRNA and dsRNA are not. Viral nucleic acids with the same structure as host are infective alone; others require special enzymes. |
| What are 3 naked RNA virus families? | remember "naked CPR": caliciviridae, picornavirus, reovirus. |
| where do enveloped viruses get their envelope? exception? | from host plasma membrane, except herpesviruses which get it from the nuclear membrane. |
| virus ploidy | all viruses are haploid except retroviruses which have 2 identical ssRNA molecules. |
| where do DNA viruses replicate? what is the exception? | in the nucleus, except poxvirus |
| where do RNA viruses replicate? exceptions? | cytoplasm, except influenza and retroviruses |
| naked DNA virus families | PAP = Parvo, Adeno, Papova. "you need to be naked for a pap smear" |
| enveloped DNA virus families | HPH: Herpes,Pox, Hepadna |
| mnemonic for remembering DNA virus families | they are HHAPPPy viruses: hepadna, herpes, adeno, pox, papova, parvo |
| what is the usual shape of DNA viruses? exception? | icosahedral, except Pox which is complex. |
| medically important hepadnavirus | HBV -- not a retrovirus but has reverse transcriptase anyhow |
| what family does EBV belong to? | herpesvirus (DNA) |
| what family does CMV belong to | herpesvirus (DNA) |
| what does HHV8 cause? | kaposi's sarcoma. |
| what does adenovirus cause | febrile pharyngitis, conjunctivitis, and pneumonia |
| what does parvovirus B19 cause? | aplastic crises in sickle cell pts, 5th disease, and hydrops fetalis |
| what family does JC virus belong to and what does it cause? | Papovavirus (circular dsDNA). causes progressive multifocal leukoencephalopathy |
| what is the largest DNA virus | pox |
| mnemonic for the picornaviruses | PERCH: Polio, Echo, Rhino, Coxsackie, HAV |
| what does echovirus cause | aseptic meningitis |
| what does coxsackievirus cause | aseptic meningitis, herpangina -- febrile pharyngitis, hand, foot, and mouth disease, myocarditis |
| structure, shape, and envelope? of picornavirus | icosahedral,SS+linear, no envelope |
| 2 important caliciviruses | HEV, Norwalk virus -- viral gastroenteritis |
| structure, shape, and envelope? of calicivirus | SS+ linear icosahedral, no envelope |
| structure, shape, and envelope? of reoviruses | double icosahedral, ds linear segmented, no envelope |
| medically important reoviridae | Reovirus -- Colorado tick fever. Rotavirus too |
| medically important flaviviruses | HCV, yellow fever, dengue, St Louis encephalitis, West Nile |
| structure, shape, and envelope? of flavivirus | icosahedral, SS+ linear, enveloped |
| 3 medically important togaviruses | Rubella, EEE, WEE |
| structure, shape, and envelope? of togaviruses | icosahedral, ss+ linear, enveloped |
| 2 important retrovirusess | HIV, HTLV |
| structure, shape, and envelope? of retroviruses | icosahedral, SS+ linear, enveloped |
| medically important coronaviruses | "common cold" and SARS |
| structure, shape, and envelope? of coronaviruses | helical, SS+ linear, enveloped |
| structure, shape, and envelope? of rhabdoviruses | helical, SS- linear, enveloped |
| med. important filoviruses | ebola/marburg |
| structure, shape, and envelope? of filoviruses | helical, ss- linear, enveloped |
| medically important arenaviruses | LCV -- lymphocytic choriomeningitis, and spread by mice |
| structure, shape, and envelope? of arenaviruses | helical, ss - circular, enveloped |
| medically important bunyaviruses | California encephalitis, Sandfly/Rift Valler fevers, Crimean-Congo hemorrhagic fever, and hantavirus (hemorrhagic fever + pneumonia) |
| medically important deltavirus | HDV |
| structure, shape, and envelope? of deltavirus | helical, ss- circular, enveloped |
| what kind of immunity do live attenuated vaccines induce? killed? | live: humoral and cell-mediated. killed: humoral only. |
| is MMR live or killed | live |
| is Sabin polio vaccine live or killed | live |
| is VZV vaccine live or killed | live |
| is yellow fever vaccine live or killed | live |
| is smallpox vaccine live or killed | live |
| is adenovirus vaccine live or killed | live |
| how to remember Killed vaccines | RIP Always: Rabies, Influenza, Polio (salK= killed), hAv |
| how to remember egg-based vaccines | FRY An egg. Flu, mmR, Yellow fever |
| what is an example of a recombinant vaccine | HBV |
| how to remember negative-stranded viruses | Always Bring Polymerase or Fail Replication: Arenaviruses, Bunyaviruses, Paramyxoviruses, Filoviruses, Retroviruses |
| how to remember segmented viruses | all are RNA viruses. BOAR: Bunyaviruses, Orthomyxoviruses, Arenaviruses, Reoviruses |
| what kind of things do paramyxoviruses cause | parainfluenza (croup), mumps, measles, RSV |
| serotypes of paramyxovirus | all have only 1 serotype except for parainfluenza virus which has 4 |
| what causes diarrhea in rotavirus infection? | villous destruction w/ atrophy --> decreased absorption of Na and water |
| symptoms of mumps | makes your tests and parotids as big as POM-poms: parotitis, orchitis, meningitis |
| what kind of virus is mumps | paramyxo |
| spread of measles rash | head to toe |
| 3 C's of measles | Cough, Coryza, Conjunctivitis. And a K: Koplik spots. |
| structure of influenza | enveloped, single stranded segmented RNA |
| drugs used for influenza A | amantadine, rimantadine (especially for prophylaxis) |
| drugs used for influenza B | zanamivir and oseltamivir (neuraminidase inhibitors) |
| shape of rabies | bullet-shaped capsid |
| characteristic inclusions in rabies | Negri bodies (cytoplasmic inclusions) |
| 2 classic examples of arboviruses | dengue (aka break-bone fever), and yellow fever. variant of dengue in SE Asia: hemorrhagic shock syndrome. |
| how to remember arbovirus families | Fever Transmitted by Bites: Flavivirus, Togavirus, Bunyavirus |
| what is yellow fever | an arbovirus flavivirus transmitted by aedes mosquito. monkey and human reservoir. symptoms are high fever, black vomit, jaundice, w/ Councilman bodies (acidophilic inclusions) in liver. |
| What is mononucleosis? | Infects B cells. fever, hepatosplenomegaly, pharyngitis, LAD esp of posterior auricular nodes. Peak incidence in teens, atypical circulating T cells |
| how to test for mono | monospot test -- heterophil antibodies detected by agglutination of sheep RBCs |
| incubation of HAV. carriers? | 3 wks, no carriers |
| incubation of HBV | 3 months. |
| what kind of virus is HCV | flavivirus |
| what does HDV require? | HBsAg as its envelope. |
| are there carriers of HDV? | no |
| 3 Es of Hep E | Enteric, Expectant mothers, and Epidemics |
| how are HAV and HEV transmitted? | fecal-oral: the vowels hit your bowels |
| how to detect active HAV? | IgM HAVAb |
| what serologic marker indicates low HBV transmissibility | HBcAb |
| What serologic marker indicates high HBV transmissibility | HBeAg |
| genome of HIV | diploihttp://www.studystack.com/AddCards.jsp?studyStackId=61956d; 2 molecules of RNA |
| what is p24? | rectangular nucleocaspid protein in HIV |
| what is gp41 and gp120? | envelope proteins in HIV? |
| what is CCR5 mutation? | a mutation which when homozygous gives you immunity to HIV, and in heterozygotes gives a slower course of HIV. 1% of US whites. |
| what is CCR5 mutation? | mutation which causes rapid progression of HIV to AIDS. 20% of US whites. |
| micro signs of HIV encephalitis | microglial nodules w/ multinucleated giant cells |
| how does HIV gain access to CNS in HIV encephalitis | infected macrophages |
| what are normal form of prions? pathologic form? | normal: alpha helix. pathologic: beta sheets. |
| 4 what are dominant normal flora in colon? | Bacteroides fragilis> E. Coli |
| what are normal flora in vagina? | Lactobacillus. Colonized by E. coli and group B strep. |
| common causes of pneumonia for kids 6 wks --18 yrs | Viruses (RSV), Mycoplasma, Chlamydia pneumoniae, S. pneumonia |
| common causes of pneumonia for adults 18-40 | Mycoplasma, Chlamydia pneumoniae, S. pneumoniae |
| common causes of pneumonia for adults 40-65 | S. pneumoniae, H. influenzae, Anaerobes, Viruses, Mycoplasma |
| Common causes of pneumonia in the elderly | S. pneumoniae, viruses, anaerobes,H. influenzae, gram neg rods |
| what are common causes of pneumonia in neonates? | Group B strep, E coli |
| What are the atypical pneumonias | Mycoplasma, Legionella, Chlamydia |
| what are common postviral pneumonias | Staph, Hib |
| what tends to cause meningitis in newborns | Group B strep, E. coli, Listeria |
| what tends to cause meningitis in kids 6mo-6yrs | S. pneumoniae, Neisseria, Hib, enteroviruses |
| what tends to cause meningitis in people 6-60years | Neisseria, enteroviruses, S. pneumoniae, HSV |
| What tends to cause meningitis in the elderly? | S. pneumoniae, Gram neg rods, Listeria |
| CSF finding in bacterial meningitis | Pressure up, increased PMNs, increased protein, decreased sugar |
| CSF findings in fungal and TB meningitis | increased pressure, increased lymphocytes, increased protein, decreased sugar |
| CSF findings in viral meningitis | normal or elevated pressure, increased lymphocytes, normal protein, normal sugar |
| what organism usually causes osteomyelitis | S.aureus |
| what are sexually transmitted causes of osteomyelitis | gonorrhea. septic arthritis more common than osteo thoug |
| what tends to cause osteomyelitis in sickle cell | Salmonella |
| what tends to cause osteomyelitis w/ prosthetics | S. epidermidis, S. aureus |
| what causes vertebral osteomyelitis | TB (Pott's dz) |
| in whom does most osteomyelitis occur? | kids |
| lab sign of osteomyelitis | elevated ESR |
| 2nd most common cause of UTI in young woman | S. saprophyticus |
| what kind of findings w/ Proteus mirabilis | swarming on agar due to motility.produces urease, associated w/ struvite stones. |
| diagnostic markers of UTIs | Leukocyte esterase -positive = bacterial. Nitrite test -- positive = gram neg |
| what is condylomata acuminata | genital warts, koilocytes, HPV 6, 11 |
| Chlamydia vs gonorrheal PID | Chlamydial: subacute, often undiagnosed. gonorrheal; acute, high fever |
| most common STD in US | chlamydia |
| 2 most common causes of nosocomial infection | E. coli (UTI) and S. aureus (wound infections) |
| nosocomial pathogens from catheterization | E. coli, Proteus mirabilis |
| nosocomial pathogen from respiratory therapy equipment | Pseudomonas aeruginosA |
| nosocomial pathogens from working in dialysis unit | HBV |
| nosocomial pathogen from hyperalimentation | Candida albicans |
| ToRCHeS diseases | Toxoplasma, Rubella, CMV, HSV/HIV, Syphilis |
| branching rods in oral infections -- | Actinomyces israelii |
| surgical wound infections --> | S. aureus |
| traumatic wound infections --> | C. perfringens |
| dog or cat bite --> | Pasteurella multocida |
| which antibiotics block cell wall synthesis by inhibiting peptidoglycan crosslinking | beta-lactams. penicillin, ampicillin, ticarcillin, piperacillin, imipenem, aztreonam, cephalosporins |
| what antibiotics block peptidoglycan synthesis | Bacitracin, vancomycin, cyclosrine |
| what antibiotics disrupt the cell membrane | polymixins |
| what antibiotics block nucleotide synthesis | sulfa, trimethoprim |
| what antibiotics block DNA topoisomerases | quinolones |
| what antibiotics block mRNA synthesis | Rifampin |
| What antibiotics block 50S | Chloramphenicol, erythromycin/macrolides, lincomycin, clindamycin, streptogramins, linezolid |
| what antibiotics block 30S | aminoglycosides, tetracyclines |
| which are the bactericidal antibiotics | Penicillin, cephalosporins, vancomycin, aminoglycosides, fluoroquinoones, metronidazole |
| what is IV form of penicillin? oral? | IV: penicillin G. Penicillin V = oral |
| toxicity of penicillin | hypersensitivity, hemolytic anemia |
| what is a toxicity of methicillin | interstitial nephritis |
| what are the aminopenicillins | Ampicillin, amoxicillin |
| are amoxicillin and ampicillin penicillinase sensitive or resistant | sensitive |
| amoxicillin vs ampicillin | amOX has greater Oral bioavailability |
| clinical use of ampicillin and amoxicillin | extended spectrum -- certain gram pos bacs and gram neg rods (HELPS kill enterococci: Haemophilus, E. coli, Listeria, Proteus, Salmonella, enterococci) |
| toxicity of ampicillin and amoxicillin | hypersensitivity, ampicillin rash, pseudomembranous colitis |
| what are the anti-pseudomonals | Ticarcillin, carbenecillin, piperacillin. Remember "TCP takes care of pseudomonas." |
| mechanism of antipseudomonals | same as penicillin but extended spectrum |
| clinical use of antipseudomonals | Pseudomonas and gram neg rods |
| penicillinase sensitivity of antipseudomonals | sensitive, so use w/ clavulanic acid |
| toxicity of antipseudomonals | hypersensitivity |
| what are 1st generation cephalosporins active against | Cefazolin, cephalexin. Gram pos cocci, Proteus, E. coli, Klebsiella. "PEcK" |
| 2nd generation cephalosporins are active against | cefoxitin, cefaclor, cefuroxime. Gram pos cocci, Haemophilus, Enterobacter aerogenes, Neisseria, Proteus, E. coli, Klebsiella, Serratia. "HEN PEcKS." |
| what are 3rd generation cephalosporins and what are they active against | Ceftriaxone, Cefotaxime, Ceftazidime. Against serious gram neg, resistant infections and meningitis (penetrate CNS). Ex: ceftazidine for Pseudomonas, ceftriaxone for gonorrhea |
| what are 4th generation cephalosporins for? | cefepime, cefpiramide. increased activity against Pseudomonas and gram pos |
| Toxicity of cephalosporins | hypersensitivity (cross sensitivity w/ penicillins). increases the nephrotoxicity of aminoglycosides and has a disulfiram-like reaction w/ ethanol if have a methylthiotetrazole group |
| what is aztreonam | a monobactam resistant to Beta-lactamases that binds to PBP3, inhibiting cell wall synthesis |
| interactions of aztreonam w/ other antibiotics | Synergy w/aminoglycosides, no cross-sensitivity w/ penicillins. |
| cilincial use of aztreonam | gram negative rods like Klebsiella, Pseudomonas, Serratia. No activity against gram positive or anaerobes. Used for penicillin-allergic patients and those whose renal insufficiency prevents use of aminoglycosides. |
| toxicity of aztreonam | usually none, occasional GI upset |
| Mechanism of imipenem/cilastatin, meropenem | broad-spectrum, Beta-lactamase resistant carbapenem. Always administered w/ cilistatin which is an inhibitor of renal dihydropeptidase to decrease its inactivation in renal tibules |
| clinical use of imipenem, meropenem | gram pos cocci, gram neg rods, anaerobes. drug of choice for enterobacter. |
| toxicity of imipenem,meropenem | Gi distress, skin rash, CNS toxicity |
| mechanism of vancomycin | inhibits cell wall mucopeptide formation by binding D-Ala-D-Ala portion of cell wall precursors. Bactericidal |
| how do bacs become resistant to vancomycin | aa change of d-ala-d-ala to d-ala-d-lac |
| clinical use of vancomycin | serious, gram positive multidrug resistant organisms like MRSA and Clostridium difficile colitis |
| toxicity of vancomycin. | well tolerated in general -- does "NOT" have many problems. Nephrotoxicity, Ototoxicity, Thrombophlebitis, + "red man syndrome" (diffuse flushing, which can be prevented w/ antihistamines and slow infusion rate) |
| How to remember the 30S inhibitors and 50S inhibitors | buy AT 30, CELL at 50: 30S = Aminoglycosides (cidal), Tetracyclines (static). 50S: Chloramphenicol (cidal), Erythromycin (static), Lincomycin (static), cLindamycin (static) |
| how to remember the aminoglycosides | "Mean" GNATS canNOT kill anaerobes. GNATS = Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin. NOT = toxicities: Nephrotoxic, Ototoxic, Teratogen. |
| mechanism of aminoglycosides | bactericidal; inhibits formation of initiation complex and causes misreading of mRNA. Requires O2 for uptake, so doesn't work w/ anaerobes. |
| clinical use of aminoglycosides | severe gram neg rod infections. Synergy w/ beta-lactams. Neomycin for bowel surgery. |
| mechanism of tetracyclines | bacteriostatic, bind to 30S and prevent attachment of aatRNA |
| CNS penetration of tetracyclines | limited |
| which is the only tetracycline that can be used in renal failure | doxycycline |
| what foods do tetracyclines conflict with? | things w/ divalent cations |
| what is a special property of demeclocycline | it is an ADH antagonist and is used as a diuretic in SIADH |
| how to remember clinical uses of tetracycline | "VACUUM THe BedRoom": V. cholerae, Acne, Chlamydia, Ureaplasma Urealyticum, Mycoplasma, Tularemia, H. pylori, Borrelia, Rickettsial |
| toxicity of tetracyclines | GI distress, teeth discoloration, inhibition of bone growth in kids, photosensitivity. Contraindicated in pregnancy. |
| which are the macrolides | erythromycin, clarithomycin, azithromycin |
| mechanism of macrolides | bind 23S rRNA of 50S ribosomal subunit. Bacteriostatic. |
| Clinical use of macrolides. | URIs, pneumonias, STDs --- gram pos cocci (strep in ppl w/ penicilin allergies), Mycoplasma, Legionella, Chlamydia, Neisseria |
| toxicity of macrolides | GI discomfort, acute cholestatic jaundice, eosinophilia, skin rashes. Increases serum conc of theophyllines and anticoagulants. |
| mechanism of chloramphenicol | inhibits 50S peptidyltransferase. Bacteriostatic |
| Clinical use of chloramphenicol | Meningitis (Haemophilus, Neisseria m, S. pneumoniae). Use conservatively b/c of toxicities |
| toxicities of choramphenicol | Anemia (dose dependent), aplastic anemia (dose independent), gray baby syndrome in preemies b/c lack liver UDP-glucuronyl transferase |
| mechanism of clindamycin | blocks peptide bond formation at 50S. bacteriostatic. |
| clinical use of clindamycin | to treat anaerobic infections esp above the diaphragm (C. fragilis, C. perfringens) |
| toxicities of clindamycin | Pseudomembranous colitis, fever, diarrhea |
| are sulfas bacteriocidal or static? | static |
| clinical use of sulfas | Gram pos, gram neg, Nocardia, Chlamydia. Can use triple sulfas or SMX for simple UTI. |
| toxicity of sulfas | hypersensitivity, hemolysis in G6PD deficiency, nephrotoxicity (interstitial nephritis), kernicterus in infants. Displaces other drugs like warfarin from albumin. |
| mechanism of sulfas | PABA analog,inhibits dihydropterate synthase |
| MOA of trimethoprim | inhibits dihydrofolate reductase. bacteriostatic. |
| How to remember toxicity of trimethoprim | TMP: Treats Marrow Poorly. megaloblastic anemia, leukopenia, granulocytopenia. Alleviate w/ supplemental folinic acid. |
| Clinical use of trimethoprim | Use w/ sulfa as TMP-SMX for recurrent UTIs, Shigella, Salmonella, Pneumocystis |
| mechanism of quinolones | inhibits DNA gyrase. Bactericidal |
| Clinical use of quinolones | Gram neg rods of urinary and GI tracts including Pseudomonas, Neisseria, some gram positives |
| Toxicities of quinolones | GI upset, superinfection, skin rashes, headache, dizziness. Cartilage toxicity (bad for fetus and kids). Tendonitis and tendon rupture in adults, leg cramps and myalgias in kids. |
| how to remember quinolone toxicities | "quinoLONES hurt attachments to your BONES" |
| mechanism of metronidazole | forms toxic metabolites in the bacterial cell wall. Bactericidal |
| Clinical uses of metronidazole | GET GAP on the Metro: Giardia, Entamoeba, Trichomonas, Gardnerella, Antiprotozoal, h Pylori (triple therapy) |
| metronidazole toxicity | Disulfiram-like reaction, headache, metallic taste, etc |
| Mechanism of polymixins | Binds to cell membranes of bacteria and disrupt their osmotic properties. Cationic and act like detergents. "Mixins mix up membranes" |
| clinical use of polymixins | resistant gram neg infections |
| toxicity of polymixins | neurotoxicity, acute tubular necrosis. |
| how to remember the TB drugs | INH-SPIRE (INH, Streptomycin, Pyrazinamide, (i) - Rifampin, Ethambutol |
| what is used for TB prophylaxis | INH alone |
| what is main toxicity of TB drugs | hepatotoxicity |
| mechanism of INH | decreased synthesis of mycolic acids. |
| clinical use of INH | TB including as sole prophylaxis |
| toxicity of INH | Hemolysis if G6PD deficient, hepatotoxic, neurotoxic. SLE-like syndrome. Administer w/ B6 to prevent neurotoxicity. Remember INH Injures Neurons and Hepatocytes. |
| Mechanism of Rifampin | inhibits DNA dependent RNA polymerase. |
| Clinical use of Rifampin | TB. Also delays resistance to dapsone when used in leprosy. Meningococcal prophylaxis and chemoprophylaxis in contacts of kids w/ Hib. |
| Toxicity of Rifampin | Minor hepatotoxicity and drug interactions (increases P450) |
| Rifampin 4 R's | Rna polymerase inhibitor, Revs up microsomal P450, Red/orange body fluids, Rapid resistance if used alone |
| mechanism of resistance to aminoglycosides | modification via acetylation, adenylation, or phosphorylation |
| mechanism of resistance to vancomycin | terminal D-ala-D-ala of cell wall component replaced w/ D-lac. Decreases affinity. |
| mechanism of resistance to chloramphenicol | modification via acetylation |
| mechanisms of resistance to macrolides | methylation of rRNA near erythromycin binding site |
| mechanisms of resistance to tetracycline | altered uptake and efflux |
| mechanism of resistance to sulfas | altered enzyme, decreased uptake, or increased PABA synthesis |
| Meningococcal prophylaxis | Rifampin (drug of choice), minocycline. |
| Gonorrhea prophylaxis | ceftriaxone |
| syphilis prophylaxis | Benzathine penicillin G |
| prophylaxis for history of recurrent UTIs | TMP-SMX. |
| Pneumocystic pneumonia prophylaxis | TMP-SMX (drug of choice), aerosol pentaminidine |
| endocarditis prophylaxis w/ dental or surgical procedures | penicillins |
| mechanism of ampho B | binds ergosterol (unique to fungi), forming pores in membrane |
| clinical use | wide spectrum of systemic mycoses and intrathecally for fungal meningitis |
| toxicity of ampho B | fever/chills, hypotension, nephrotoxic, arrhythmias, anemia, IV phlebitis. |
| mechanism of nystatin | binds ergosterol |
| clinical use of nystatin | topical only, for oral thrush, diaper rash, vaginal yeast |
| mechanism of azoles | inhibit fungal steroid (ergosterol) synthesis |
| Clinical use of azoles | systemic mycoses. Fluconazole for cryptococcal meningitis in AIDS. Candidal infections. Ketoconazole for Blastomyces, Cocidioides, Histo, Candida albicans, hypercortisolism |
| toxicity of azoles | hormone synthesis inhibition --> gynecomastia, liver dysfunction, fever, chills |
| mechanism of flucytosine | inhibits DNA synthesis by conversion to 5-FU which competes w/ uracil |
| clinical use of flucytosine | systemic fungal infections |
| toxicity of flucytosine | nausea, vomiting, diarrhea, bone marrow suppression |
| mechanism of caspofungin | inhibits cell wall synthesis |
| clinical use of caspofungin | invasive aspergillosis |
| toxicity of caspofungin | GI upset, flushing |
| mechanism of terbanifine | inhibits fungal squalene epoxidase |
| clinical use of terbanifine | to treat dermatophytoses especially onychomycosis |
| mechanism of griseofulvin | interferes w/ microtubule function. disrupts mitosis. deposits in keratin-containing tissues like nails |
| clinical use of griseofulvin | oral treatment of superficial infections. Inhibits growth of dermatophytes like tinea, ringworm |
| toxicity of griseofulvin | teratogenic, carcinogenic. Confusion, headaches. Increases P450 and warfarin metabolism |
| mechanism of amantadine | blocks viral penetration and uncoating via M2 protein. May buffer endosome pH. Also causes dopamine release from nerve terminals. Remember: "A man to dine takes off his coat" |
| clinical use of amantadine | influenza A, parkinson's, rubella? |
| toxicity of amantadine | ataxia, dizziness, slurred speech.Remember Amantadine blocks flu A and rubellA and causes problems with the cerebellA |
| mechanism of resistance to amantadine | mutated M2 protein. 90% of flu A is resistant to amantadine |
| why is rimantadine better than amantadine? | fewer CNS effects. Does not cross BBB |
| mechanism of zanamivir, oseltamivir | inhibits flu neuraminidase, decreasing release of progeny virus |
| clinical use of zanamivir, oseltamivir | both flu A and B |
| mechanism of ribavirin | inhibits guaniine nucleotides by inhibiting IMP dehydrogenase |
| clinical use of ribavirin | RSV and chronic hep C |
| toxicity of ribavirin | hemolytic anemia. Severe teratogen. |
| mechanism of acyclovir | preferentially inhibits viral DNA polymerase when it's phosphorylated by viral thymidine kinase |
| clinical use of acyclovir | HSV, VZV,EBV. Mucocutaneous and genital herpes lesions. prophylaxis in the immunosuppressed |
| toxicity of acyclovir | delirium, tremor, nephrotoxicity |
| mechanism of resistance to acyclovir | lack of thymidine kinase |
| mechanism of gancyclovir | phosphorylation by viral kinase. Preferentially inhibits CMV DNA polymerase. |
| toxicities of ganciclovir | leukopenia, neutropenia, thrombocytopenia, renal toxicity. More toxic to host enzymes than acyclovir. |
| clinical use of ganciclovir | CMV esp in immunocompromised |
| MOA of resistance to ganciclovir | mutated CMV DNA pol or lack of thymidine kinase |
| mechanism of foscarnet | inhibits viral DNA polymerase that binds to pyrophosphate binding site of enzyme. Does not need to be activated by viral kinase. remember "FOScarnet = pyroPHOSphate analog" |
| clinical use of foscarnet | CMV retinitis in immunocompromised pts when ganciclovir fails and for acyclovir-resistant HSV |
| toxicity of foscarnet | nephrotoxic |
| mechanism of foscarnet | mutated DNA pol |
| how to remember protease inhibitors | -Navir tease a pro- protease inhibitors |
| toxicity of protease inhibitors | GI intolerance, hyperglycemia, lipodystrophy, thrombocytopenia (indinavir) |
| how to remember the non-nucleoside reverse transcriptase inhibitors | Never Ever Deliver nucleosides: Nevirapine, efavirenz, delavirdine |
| toxicity of reverse transcriptase inhibitors | bone marrow suppression, peripheral neuropathy, lactic acidosis (nucleosides), rash (non-nucleosides), megaloblastic anemia (AZT) |
| clinical use of reverse transcriptase inhibitors | HAART generally entails combo therapy w/ protease inhibitors and reverse transcriptase inhibitors. |
| when to initiate HAART | when have CD4 <500 or high viral load. AZT is used during pregnancy to reduce risk of fetal transmission |
| Mechanism of interferons | they are glycoproteins from human leukocytes that block various stages of viral RNA synthesis by induces a ribonuclease that degrades viral mRNA |
| clinical use of IFN-alpha | chronic hep B and C, Kaposi's sarcoma |
| clinical use of IFN-gama | NADPH oxidase deficiency |
| toxicity of interferon | neutropenia |
| how to treat onchocerciasis | Ivermectin (rIVER blindness --.IVERmectin |
| what do you treat w/ mebendazole/thiabendazole | nematode/roundworm (pinworm, whipworm) infections |
| what do you treat with pyrantel pamoate | giant roundworm (Ascaris), hookworm (Necator/Ancyclostoma), pinworm (Enterobius) |
| what do you treat flukes with? | praziquantel |
| treating cysticercosis | praziquantel |
| treating tapeworm infections (except cysticercosis) | niclosamide |
| treating leishmaniasis | Pentavalent antimony |
| how to treat malaria hypnozoites | primaquine |
| treating giardia, amoebiasis, bacterial vaginitis, Trichomonas | metronidazole |
| treatment of PCP | TMP-SMX, pentamidine |
| treating Chagas' disease, American trypanosomiasis | Nifurtimox |
| treating African trypanosomiasis (sleeping sickness) | Suramin |
| How to remember antimicrobials to avoid during pregnancy | SAFE Moms Take Really Good Care. S=sulfa, A=aminoglycosides, F=fluoroquinolones, E=erythromycin, M=metronidazole, T=tetracyclines, R=Ribavirin, Griseofulvin, Chloramphenicol |
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saral