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HY Micro Systems

Day 7

Normal flora: skin Staph epidermidis
Normal flora: nose Staph epidermidis; colonized by Staph aureus
Normal flora: oropharynx Viridans group sterptococci
Normal flora: dental plaque Stre mutans
Normal flora: colon Bacteroides fragilis > E coli
Normal flora: vagina Lactobacillus, colonized by E coli and group B strep
In which situation would a neonate have no flora? Neonates delivered by C-section; they get rapidly colonized after birth
Bug assoc'd with contaminated seafood (shellfish, ocean water) Vibrio parahaemolyticus and V vulnificus
Wound infections from contact with infected ocean water or shellfish Vibrio vulnificus
Preformed toxin in meats, mayonnaise, and custard S aureus (food poisoning happens and ends quickly)
Bug assoc'd with reheated rice Bacillus cereus (food poisoning happens and ends quickly)
Bug assoc'd with reheated meat dishes Clostridium perfringens
Bug assoc'd with undercooked meat E coli O157:H7
Bug assoc'd with eating poultry, meat, and eggs, and touching reptiles or turtles b/f eating with unwashed hands Salmonella
Lactose negative flagellar motility oranism causing bloody diarrhea Salmonella (salmon swim)
Bug causing bloody diarrhea and pseudoappendicitis Yersinia enterocolitica
Bug causing watery traveler's diarrhea ETEC (T for Traveler's diarrhea)
Protozoan causing watery diarrhea Giardia and Cryptosporidium (immunocompromised)
Which viruses are associated with watery diarrhea? Rotavirus, adenovirus, and Norwalk virus (norovirus)
What are the MCC of pneumonia in neonates? Group B strep and E coli (colonize vagina)
What are the MCC of pneumonia in children (4wks-18yo)? RSV (viral), Mycoplasma, Chlamydia pneumoniae, Strep pneumo (Runts May Cough Sputum)
What are the MCC of pneumonia in adults 18-40yo? Mycoplasma, Chlamydia pneumoniae, and Strep pneumo
What are the MCC of pneumonia in adults 40-65yo? Strep pneumo, H flu, Anaerobes, viruses, mycoplasma
What are the MCC of pneumonia in the elderly? Strep pneumo, influenza virus, anaerobes, H flu, gram negative rods (fecal matter due to poor hygiene)
What is the treatment for neonatal pneumonia? Ampicillin and gentamycin
What is the treatment for pneumonia in adults 18-40yo? Macrolides for Mycoplasma and Chlamydia pneumo, and penicillin or cefriaxone (3rd gen cephalosporin) for Strep pneumo
What is the treatment for pneumonia in adults 40-65yo? Ceftriaxone (3rd gen ceph) for Strep pneumo, 2nd gen ceph for H flu, clindamycin for anaerobes, and Macrolides for Mycoplasma, Clindamycin for anaerobes,
What is the treatment for pneumonia in the elderly? Ceftriaxone (3rd gen ceph) for strep pneumo, clindamycin for anaerobes, 2nd gen cephalosporin for H flu, and aminoglycosides (gentamycin) for gram neg rods; can also just use a big gun like imipenem/cilastatin or meropenem to cover everything
Cause of nosocomial pneumonia Staph, enteric gram neg rods
Cause of penumonia in HIV Pneumoncystis jiroveci
Cause of aspiration pneumonia (general) Anaerobes
Cause of pneumonia in an alcoholic or IV drug user Strep pneumo, Klebsiella, Staph
Pneumonia in CF patient Pseudomonas
Post viral pneumonia Staph, H flu
Cause of atypical pneumonia; what's the treatment? Mycoplasma, Legionella, Chlamydia (pneumo and psittaci); treat with macrolides (azithromycin)
What is the MCC of meningitis in newborns? Group B strep, E coli, and Listeria
What can be used to treat meningitis in neonates? Ceftriaxone for Group B strep and E coli, and ampicillin for Listeria
What is the MCC of meningitis in children 6mos-6yo? Strep pneumo, Neisseria meningitidis (life threatening purpura), H flu type B, Enteroviruses
What is the MCC of meningitis in people 6-60yo? Enteroviruses, Strep pneumo, N meningitidis, and HSV (temporal lobe encephalitis)
What is the MCC of meningitis in people over 60yo? Strep pneumo, gram neg rods, and Listeria
What should be administered prior to a dose of ceftriaxone to reduce neural sequelae in children and to decrease morbidity/mortality in adults during treatment for meningitis? Dexamethasone (steroid)
What is used to treat meningitis caused by toxoplasmosis? Pyrimethamine and sulfadiazine
Which viruses can cause meningitis? enteroviruses (esp coxsackievirus and echovirus), HSV, HIV, West Nile virus, and VZV
AIDS patient with radiographic finding of ring-enhancing lesions in both cerebral hemispheres Toxoplasmosis (brain abscess)
What are the CSF findings in bacterial meningitis? Increased presure, increased neutrophils/PMNs, increased protein, decreased sugar (bacteria like to eat sugar)
What are the CSF findings in fungal or TB meningitis? Increased pressure, increased lymphocytes, increased protein, decreased sugar (fungi like to eat sugar)
What are the CSF findings in viral meningitis? Normal or slightly increased pressure, increased lymphocytes, normal or slightly increased protein, normal sugar
What is the treatment for staph aureus osteomyelitis? Vancomycin (just assume that it's MRSA)
Osteomyelitis preferentially infects which part of the bone? Metaphysis of the long bone
Osteomyelitis in sexually active Neisseria gonorrhea (rare) or septic arthritis
Osteomyelitis in diabetics and drug addicts Pseudomonas aeruginosa
Osteomyelitis in sickle cell patients Salmonella
Osteomyelitis in prosthetic replacement Staph aureus and Staph epidermidis
Osteomyelitis in vertebral bodies Mycobacterium TB (Pott's disease)
Osteomyelitis after a dog or cat bite or scratch Pasturella multocida
What test can rule out osteomyelitis? Negative CRP
What tool is used to diagnose osteomyelitis? Bone scan or MRI (X-rays are NOT sufficient to rule out osteomyelitis)
Osteomyelitis occurs most commonly in which population? Children
Dysuria, frequency, urgency, suprpubic pain, and WBCs (no casts) in urine UTI
Fever, chills, flank pain, CVA tenderness, hematuria,and WBC casts Pyelonephritis (UTI that ascended to kidney)
Positive leukocyte esterase test bacterial UTI; basically just means inflammation is somewhere in the urinary tract
Positive nitrite test gram negative bacterial UTI; more specific than the positive leukocyte esterase test
Leading cause of UTI; shows metallic sheen on EMB (eosin methylene blue) agar E coli
2nd leading cause of community-acquired UTI in sexually active women Staph saprophyticus
3rd leading cause of UTI. Large mucoid capsule and viscous colonies Klebsiella penumoniae
Motility causes swarming on agar; produces urease; associated with struvite stones; cause of UTI Proteus mirabilis
Blue-green pigment and fruity odor; causes drug-resistant nosocomial UTIs Pseudomonas aeruginosa
What is the treatment for UTIs? TMP-SMX (treatment of choice), or fluoroquinolones or nitrofurantoin
What is the treatment for UTIs in pregnant women? 1st or 2nd generation cephalosporins, aminopenicillin, or nitrofurantoin
Neonate with cotton-like yellow-white scars on retina visible by fundoscopy (chorioretinitis), hydrocephalus, and intracranial calcifications Toxoplasma gondii (TORCH infection)
How is toxoplasma gondii transmitted? Via aerosolized cat feces or ingestion of undercooked meat; transplacental transmission in first 6mos gestation
Neonate with PDA, cataracts, deafness, and bluberry muffin rash (I'm hungry already!) Rubella (TORCH infection); in children causes mild illness called German measles; a togavirus
How is rubella transmitted? Via respiratory droplets
Newborn with unilateral hearing loss, seizures, and petechial rash CMV (TORCH infection); CMV is MCC of TORCH infections
How is CMV transmitted? Sexual contact, organ transplant
Neonate with recurrent infections and chronic diarrhea HIV (TORCH infection)
Name 3 ways to prevent HIV transmission to a neonate/fetus. 1. Prophylax mom with zidovudine 2. Prophylax mom with HAART 3. Deliver infant via C-section
Neonate with vaginal deliver presents with temporal encephalitis and vesicular lesions; mother had vaginal vesicular lesions HSV; vesicular lesions in mother are a contraindication for vaginal delivery due to easy transmissability through skin or mucous membrane contact intrapartum (during delivery)
Stillbirth or hydrops fetalis; if infant survives, presents with facial abnormalities (notched teeth, saddle nose, short maxilla) and saber shins Syphilis
What other viral infection can cause hydrops fetalis? Parvovirus (DNA virus)
What is the MCC of saddle nose deformity? Wegener's granulomatosis! Gotcha!
Rash begins on trunk, spreads to face with lesions of differnt age Chicken pox caused by VZV
Erythematous, sandpaper-like rash with fever and sore throat Scarlet fever caused by Strep pyogenes
Vesicular rash on palms and soles; ulcers in oral mucosa Hand-foot-mouth disease caused by Coxsackievirus type A
Urethritis, cervicitis, creamy purulent discharge Gonorrhea caused by Neisseria gonorrhea
Painful genital ulcer, inguinal adenopathy Chancroid caused by Haemophilus ducreyi
Ulcers, lymphadenopathy, rectal strictures (may be mistaken for IBD) Lymphogranuloma venereum (Chlamydia trachomatis serotypes L1-L3)
Vaginitis, strawberry cervix, corkscrew motility on wet prep Trichomoniasis caused by Trichomonas vaginalis
Noninflammatory, malodorous discharge (fishy smell), positive whiff test, clue cells Bacterial vaginosis caused by Gardnerella vaginalis (also mobiluncus and various anaerobes)
What are the top 2 bugs that produce the infamous chandelier sign? PID: Chlamydia trachomatis (subacute, often undiagnosed) and Neisseria gonorrhea (acute, fever); C trachomatis is the MC STD in the US
Infection of the liver capsule and violin string adhesions of parietal peritoneum to liver Fitz-Hugh-Curtis syndrome; complication of PID
Nosocomial infection assoc'd with hyperalimentation (e.g, TPN feeding) Candida albicans
Nosocomial infection assoc'd with urinary catheterization E coli, proteus mirabilis
Nosocomial infection assoc'd with respiratory therapy equipment Pseudomonas aeruginosa
Nosocomial infection assoc'd with work in a renal dialysis unit HepB (also assoc'd with needle sticks)
What are the 2 most common causes of nosocomial infections? E coli (UTI) and Staph aureus (wound infection)
HIV + adult: Low grade fevers, cough, and hepatosplenomegaly; oval yeast cells within macrophages Histoplasma capsulatum (Histo hides in macrophages)
HIV + adult: Superficial vascular proliferation; biopsy of skin reveals neutrophilic infiltrate Bacillary angiomatosis caused by Bartonella henselae
HIV + adult: Superficial neoplastic proliferation of vasculature; biopsy reveals lymphocytic inflammation Kaposi's sarcoma caused by HHV8
HIV + adult: Chronic watery diarrhea; acid fast cysts seen in stool Cryptosporidium
HIV + adult: Encephalopathy due to reactivation of a latent virus; results in demyelination Progressive Multifocal Leukoencephalopathy (PML) caused by JC virus
HIV + adult: Abscesses in brain; many ring-enhancing lesions on imaging Toxoplasmosis gondii
HIV + adult: Cotton wool spots on fundoscopic exam CMV retinitis
HIV + adult: Intersitial pneumonia; biopsy reveals cells with intranuclear Owl's eye inclusion bodies CMV
HIV + adult: Pleuritic pain, hemoptysis, infiltrates on imaging Invasive aspergillosis caused by Aspergillus fumigatus
HIV + adult: TB-like disease of the lungs, especially with CD4 counts <50 MAC (Mycobacterium avium-intracellulare)
A microbe that colonizes the nasopharynx and can lead to meningitis in children H flu type B
Bug hints: Postive PAS stain Tropheryma whippelii (Whipple's disease)
Bug hints: Chronic granulomatous disease Catalase + organisms: staph aureus, nocardia, and aspergillus
Bug hints: Bilateral Bell's palsy Borrelia burgdorferi (Lyme disease)
What is the correct tx for a woman who presents with purulent urethritis? 3rd generation cephalosporin (ceftriaxone) to treat N gonorrhea and azithromycin or doxycycline to treat Chlamydia. Must alway treat for Chlamydia with a gonococcal PID b/c Chlamydia often co-infects with N gonorrhea.
Created by: sarah3148



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