CCOM Micro Exam 3 helps – Flashcards
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| 23 serotypes account for _______% of __________ infection |
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| 90% of Pneumococcal |
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| Gr+ lancet-shaped diplococci |
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| Strep pneumo |
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| Single bout of rigors |
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| Strep Pneumo |
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| Strep Pneumo virulence factors |
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| Capsule - Pneumolysin |
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| Strep Pneumo CXR |
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| Atypical: generally patchy |
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| Optochin Sensitive? |
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| Strep Pneumo |
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| Positive Quelling |
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| Strep Pneumo |
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| Bile (or deoxycholate) soluble |
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| Strep Pneumo |
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| When does Strep pneumo become invasive? |
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| A: In children <5 with severe illness such as -Cancer -Renal Disease -Splenectomy -Transplant |
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| Catalase Positive |
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| Staph (NOT Strep) |
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| Coagulase + |
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| Staph aureus |
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| What is Staph aureus' aerotolerence? |
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| Facultative Anaerobe |
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| Q: Agent of most soft tissue infections? |
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| A: Staph aureus |
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| Infection of Staph aureus is due to ________ |
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| contact |
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| If 2 BCX are + for _________, PT has a ___% risk of _______ (with ___% mortality if present). |
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| If 2 BCX are + for Staph aureus, PT has a 50% risk of ACUTE INFECTIOUS ENDOCARDITIS (with 100% mortality if present). |
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| Best prevention for SA transmission? |
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| Chlorhexadine soap |
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| Pneumonia presentation with Staph aureus? |
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| Necrotizing |
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| blue-green pigment |
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| Pseudomonas aeruginosa (Ps. aeruginosa) |
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| Fruity odor |
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| Pseudomonas aeruginosa (Ps. aeruginosa) |
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| How typical is pneumonia from fruity organism? |
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| Unlikely. |
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| Normal reservoir for Pseudomonas aeruginosa (Ps. aeruginosa)? |
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| Ubiquitous |
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| **Mortality of Pseudomonas aeruginosa (Ps. aeruginosa) pneumonia? |
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| Highest mortality (just of necrotizing pneumonias?) |
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| Pseudomonas aeruginosa (Ps. aeruginosa) morphology |
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| GNR, motile, capsule possible, |
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| Pseudomonas aeruginosa (Ps. aeruginosa) respiration |
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| fermentor, facultative anaerobe |
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| What is Pyoverdin? |
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| Green pigment from Pseudomonas aeruginosa (Ps. aeruginosa) |
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| What is Pyocyanin? |
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| Blue pigment from Pseudomonas aeruginosa (Ps. aeruginosa) |
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| Function of Pyoverdin and Pyocyanin? (incl. sp.) |
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| Iron sequestration for Pseudomonas aeruginosa (Ps. aeruginosa) |
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| Produced by Pseudomonas aeruginosa (Ps. aeruginosa): |
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1) Pyoverdin - Iron (fluorescent) 2) Pyocyanin - Iron 3) Exotoxin A (AKA Exoenzyme A) - ADP-Ribosyltransferase action 4) Proteases/Elastases 5) Slime Layer |
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| ADP-Ribosyltransferase is present in which 2 compounds? |
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| Diphtheria Toxin, & Exotoxin A (Pseudomonas aeruginosa) |
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| Biofilm formers include: |
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| 1) Pseudomonas aeruginosa (Ps. aeruginosa) 2) ? |
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| Presentation of P. aeruginosa pneumonia? |
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| Rapidly fulminant consolidation - high mortality |
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| Describe Pseudomonas aeruginosa resistance patterns |
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| Ceftazidine-resistance common (MDR) Resistance includes: -Ceftazidime & Cefepime -cipro -imipenem -piperacillin Susceptibility: TOBRA (Aminoglycosides) |
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| K. pneumoniae lab diagnosis |
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| GNR, Fac. Anaerobe with capsule, Oxidase negative, Mucoid colony morpholgy |
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| K. pneumoniae risk factors? |
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| Usually HAP - 50% immunocompromised PTs Comorbidities include: -Diabetics with UTI -Bacteremia/Meningitis in neonates -Liver abscesses + meningitis or ophthalmitis |
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| Does Kleb pneumoniae have a capsule? |
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| Yes - Polysaccharide (causes mucoid appearance of colonies) |
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| Opportunistic pathogens |
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| 1) K. pneumoniae 2) MTB 3) Nocardia |
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| Most virulent K. pneumoniae capsules? |
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| K1 & K2 |
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| # of different K. pneumoniae capsules? |
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| 72 |
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| Current jelly appearance? |
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| K. pneumoniae |
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| Abscess formers: |
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| 1) K. pneumoniae |
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| Agents of Chronic Pneumonia |
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| 1) K. pneumoniae |
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| Respiratory Isolation recommended |
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| 1) P. aeruginosa 2) K. pneumoniae |
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| ** Describe K. pneumoniae resistance patterns |
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| Panresistant (CRKP) -Cefepime & Imipenem? |
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| K. pneumoniae mortality |
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| Pneumonia: 50% Bacteremia: 100% |
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| Acinetobacter (A. baumanii) Lab diagnosis |
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| GNCB (appear diplococci), non-motile, aerobic, Oxidase negative, Fermentation negative |
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| Pneumonia presentation of Acinetobacter (A. baumanii) |
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| CAP & HAP (VAP!) Infections also include Endocarditis, Meningitis, Peridontitis, Osteomyelitis, Endophthalmitis, UTIs, Skin infections, wound infections. |
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| Describe resistance patterns of Acinetobacter (A. baumanii) |
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| Easily acquire resistance genes. --------- >1/3 are resistant Carbapenems are the effective Tx |
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| H. influenzae (Type B) lab diagnosis |
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| Small GNR, fastidious (CO2 on chocolate), oxidase positive(+), |
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| Typical presentation with Hib? |
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| Tracheitis, AECB, AECOPD Pneumonia after viral infection |
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| H. influenzae (Type B) is where? |
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| Initially on mucosal surfaces, but may become invasive. |
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| Treatment of HiB |
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| Cephalosporins or Bactrim |
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| Vaccine-preventable Bugs |
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HiB Strep Pneumo |
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| L. pneumophilia laboratory diagnosis |
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| AEROBIC, GNR |
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| Facultative intracellular organisms: |
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| 1) L. pneumophilia |
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| Predisposing factors for L. pneumophilia |
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| 1) Age 2) alcohol abuse 3) Heart disease 4) smoker 5) chronic disease 6) Age 7) Immunosuppression |
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| Reservoir for L. pneumophilia |
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| Water systems |
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| Walking pneumonia can be caused by |
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| M. pneumoniae, U. urealyticum, |
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| Smallest cellular organism? |
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| M. pneumoniae |
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| M. pneumoniae lab diagnosis |
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| fastidious, requiring long incubation |
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| Transmission of M. pneumoniae |
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| Direct contact and inhalation of aerosols |
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| How infectious is M. pneumoniae? |
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| Not very. Usually only infecting closed populations under stress. |
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| Predominance of Mono/Macroph indicates what? |
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| M. pneumoniae |
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| Lab incubation of M. pneumoniae takes ____. |
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| 2 weeks |
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| Dx of M. pneumoniae based on _____? |
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| 1) CXR 2) Cx (special medium) 3) Serology (DFA/IFA/"Cold aggultinins") |
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| What should M. pneumoniae be treated with? |
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| 1) Macrolides ("-mycin") 2) Tetracycline 3) Quinolones |
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| __-__% of sexually mature women are colonized with ____________. |
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| 40-80%, with U. urealyticum&parvum |
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| Children typically infected with U. urealyticum&parvum by which means? |
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| Vertical transmission |
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| What disease process results in children infected with U. urealyticum&parvum |
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| Bronchiolitis ARDS |
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| How does U. urealyticum&parvum typically present? |
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| Coughing and wheezing child of infected mother |
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| Cx site for U. urealyticum&parvum? |
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| Mom: Vaginal (or from urine) Child: Throat |
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| Tx for U. urealyticum&parvum? |
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| Clarithromycin |
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| Lab diagnosis of Chlamydia pneumoniae? |
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| (small GNR) - slow growing in cell Cx. |
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| How does Chlamydia normally present? |
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| Cervicitis |
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| What is an Elementary body? |
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| The infectious particle of a Chlamydia infection |
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| What is a reticulate body? |
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| The Replicative particle of a Chlamydia infection. Obligate intracellular particle. |
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| How long is the incubation period for Chlamydia? |
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| 4 weeks |
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| Chlamydia trachomatis by vertical infection causes: |
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| Pneumonia and Conjunctivitis (or just one) |
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| TWAR |
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| Taiwan associated Respiratory Disease (Chlamydia pneumoniae) |
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| What is MIF? |
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| Micro-Immuno-Fluorescence |
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| Systems that can be complicated by Chlamydia |
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| CNS Joints Asthma Heart |
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| Tx of Chlamydia? |
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| Macrolides (-mycin) |
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| Chronic necrotizing pneumonia is most often from which type of respiratory organism? |
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| facultative anaerobes |
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| Most common neoplastic pneumonia? |
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| Primary squamous carcinoma |
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| Signs of Chronic necrotizing pneumonia? |
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| Prolonged onset, fever, chills, night sweats, Anorexia, weight loss, pleuritic chest pain Solitary cavitating lesion on CXR |
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| MTB organism |
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| Fac intracellular pathogen Obligate AEROBE |
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| MTB Transmission |
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| Human to human (only host/reservoir) |
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| Virulence factors of MTB |
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| 1) Mycolic acids 2) Cord factor (Trehalose dimycolate) |
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| What causes TB from MTB? |
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| Immunosuppression is commonly the trigger to activate latent infections. |
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| Where will MTB replicate after inhalation (as dusts/aerosols)? |
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| Often lungs, but anywhere where oxygen is present (usually within the macrophages) |
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| What causes the lesion in pulmonary TB? |
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| CMI response |
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| How is latent TB diagnosed? |
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| Dx by ppd or quantiferon test. |
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| What response is a positive PPD? |
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| DTH w/ induration |
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| Will quantiferon be positive with BCG vaccine? Why or why not? |
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| No. Quantiferon tests for proteins only made by MTB, not by BCG. |
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| Fastest way to conclusively detect MTB in lab? |
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| PCR |
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| Tx for TB? |
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| Isoniazid Rifampin Pyrazinamide Ethambutol |
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| reservoir of Actinomyces israelii? |
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| Human mouth & GI Female repro |
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| Lab diagnosis of Actinomyces israelii |
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| Branching, filamentous Gram Positive or variable, Facultative Anaerobe (ANACx) |
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| Risk for Actinomyces israelii pneumonia? |
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| Male, Tobacco and alcohol use, Poor oral hygiene, oral trauma |
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| How does Actinomyces israelii get to pathogenic sites? |
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| hematogenous spread |
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| How does Actinomyces israelii pneumonia present? |
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| Abscesses with sinus tracts and sulfur crystals. (Can also infect skin, bones, lower GI, brain, other organs) |
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| Tx of Actinomyces israelii? |
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| Penicillin |
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| How does Nocardia asteroides stain? |
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| Filamentous appearance, variable AFB/Gram positive |
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| Life cycle of Nocardia asteroides |
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| Opportunistic, facultative intracellular bacteria. |
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| How is Nocardia asteroides transmitted? |
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| NOT person to person Environmental source + CMI supression |
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| Which factors increase risk of Nocardia asteroides infections? |
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| CMI Suppression Lymphoma Other pulmonary problems Males affected most |
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| How is Nocardia asteroides spread? |
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| First by environment Second by hematogenous spread |
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| How does Nocardia asteroides present? |
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| Purulent lesions WITHOUT GRANULOMA formation Nodular masses Can be acute to chronic Can infect other tissues (ie skin) |
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| Tx of Nocardia asteroides? |
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| Bactrim or Cephalosporins |
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| Reservoir of Non-TB Mycobacteria? |
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| Environment & Animals (NF to some degree) |
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| Common strains of Non-TB Mycobacteria? |
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| M. kansasii M. fortuitum MAC |
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| Length of latency of Non-TB Mycobacteria |
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| No latency or reactivation |
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| diagnosing PT's Non-TB Mycobacteria |
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| weak PPD test positive. |
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| Tx of Non-TB Mycobacteria? |
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| Depends on senstivities |
