Microbiology

Break down “Staph aureas”

-is it gram positive or negative? Is this different from strep infections?

-is it catalase positive or negative? How is this different from strep infections?

-coagulase positive or negative?

-is it hemolytic?

-is this a mannitol fermenter? What does this do to agar?

-what is the main virulence factor of Staph. a? What does it do?

-what conditions are common from staph aureus?

-for cases of MRSA, how do we treat?

-for cases of MSSA, how do we treat?

-“staph” meaning grape-like granule(cocci)

-“aureas” meaning golden brown on stain

-gram positive; no, all strep infections are also gram positive

-catalase positive; all strep infections are catalase negative

-coagulase positive

-yes, beta-hemolytic

-yes; turns agar yellow

-protein A(think A for aureus!); prevent compliment binding

-pneumonia(patchy infiltrates, and follows a previous infection); septic arthritis(most common cause of this); acute endocarditis(look for IV drug users); osteomyelitis(most common cause of this); scalded skin syndrome; toxic shock syndrome

-vancomycin

-nafcillin(a penicillin)

Break down: “Staph epidermitis”

-is it gram positive or negative? Is this different from strep infections?

-is it catalase positive or negative? How is this different from strep infections?

-coagulase positive or negative? What does this differentiate from?

-What does it mainly cause issues for?

-why is it so good at the above?

-how to treat?

-this bug is very similar to staph saprophyticus, how do you differentiate?

-“staph” meaning grape-like granule(cocci)

-“epidermitis” meaning inflammation on the skin(its normal skin flora)

-gram positive; no, all strep infections are also gram positive

-catalase positive; all strep infections are catalase negative

-coagulase negative; differentiates from staph aureus

-prosthetic joint infections; Foley catheter infections; endocarditis from artificially implanted heart valve

-secretes a sticky biofilm to stick to metals and plastics

-vancomycin

-this is novobiocin sensitive

Break down: “Staph saprophyticus”

-is it gram positive or negative? Is this different from strep infections?

-is it catalase positive or negative? How is this different from strep infections?

-coagulase positive or negative? What does this differentiate from?

-What does it mainly cause issues for?

-this bug is very similar to staph epidermitis, how do you differentiate?

-“staph” meaning grape-like granule(cocci)

-gram positive; no, all strep infections are also gram positive

-catalase positive; all strep infections are catalase negative

-coagulase negative; differentiates from staph aureus

-UTIs in sexually active females

-this is novobiocin resistant

Break down: “Strep pyogenes”

-also called __

-is it gram positive or negative? Is this different from staph infections?

-is it catalase positive or negative? How is this different from staph infections?

-this has a capsule made up of __(think Hot Apple pie)

-is it hemolytic? What virulence factor allows this?

-another important virulence factor? Why?

-What issues does it mainly cause?

-2 very serious complications of strep pyogenes? State symptoms

-how to treat strep?

-“strep” meaning grape-like(cocci) chains

-“pyogenes” meaning pus-producing

-group A strep

-gram positive; no, all staph infections are also gram positive

-catalase negative; all staph infections are catalase positive

-hyaluronic acid

-beta hemolytic; streptolysin O

-streptokinase; lyses clots

-impetigo; pharyngitis/strep throat; cellulitis(most common cause of this!); scarlet fever(strawberry tongue with pharyngitis and widespread rash affecting everywhere but the face); toxic shock syndrome; necrotizing fasciitis

-rheumatic fever(JONES criteria) and glomerulonephritis(cola-colored urine and puffy cheeks)

-penicillin

What protein/virulence factor causes rheumatic fever?

-M protein

What heart condition primarily comes from rheumatic fever?

-mitral stenosis

Name the 2 severe conditions that stem from strep pyogenes; state which hypersensitivity comes from each

-rheumatic fever(type II) and glomerulonephritis(type III)

When can glomerulonephritis occur from strep pyogenes?

-2 weeks post-strep infection

How to differentiate group A strep from group B strep?

-group A is bacitracin sensitive; group B is bacitracin resistant

Break down: “Strep agalactiae”

-also called __

-is it gram positive or negative? Is this different from staph infections?

-is it catalase positive or negative? How is this different from staph infections?

-what 2 tests are positive in group B strep, and diagnostic for it?

-is it hemolytic?

-what conditions does this cause?

-if mom tests positive for group B strep, how do you prevent the baby from catching it?

--“strep” meaning grape-like(cocci) chains

-“agalactiae” meaning without milk

-group B strep

-gram positive; no, all staph infections are also gram positive

-catalase negative; all staph infections are catalase positive

-hippurate and CAMP

-beta hemolytic

-neonatal meningitis(most common cause of this!); sepsis; pneumonia

-intrapartum penicillin

Break down: “Strep pneumoniae”

-is it gram positive or negative? Is this different from staph infections?

-is it catalase positive or negative? How is this different from staph infections?

-is it hemolytic?

-what is it major virulence factor?

-bile soluble?

-virulence factor?

-what are the 4 conditions that pneumoniae is responsible for?(MOPS)

-patients with what condition are particularly susceptible to this?

-treatment is __

-“strep” meaning grape-like(cocci) chains

-gram positive; no, all staph infections are also gram positive

-catalase negative; all staph infections are catalase positive

-alpha hemolytic

-polysaccharide capsule

-yes

-IgA protease

-meningitis, otitis media; pneumonia, and sinusitis(most common cause of all of these!)

-sickle cell disease

-macrolide(azithro) or 3rd gen cef(ceftriaxone)

What 2 strep infections are alpha-hemolytic?

-strep viridans and strep pneumoniae

Break down: “Strep viridans”

-is it gram positive or negative? Is this different from staph infections?

-is it catalase positive or negative? How is this different from staph infections?

-is it hemolytic?

-lack of what virulence factor differentiates it from strep pneumoniae?

-why else differentiates from strep pneumoniae?

-bile soluble?

-causes what conditions?

-“strep” meaning grape-like(cocci) chains

-gram positive; no, all staph infections are also gram positive

-catalase negative; all staph infections are catalase positive

-alpha hemolytic

-no capsule

-optochin resistant

-no, bile resistant(strep pneumoniae is bile soluble)

-dental caries; mitral valve endocarditis of those with previously damaged heart valves

What bug has a characteristic “lancet shaped diplococci”?

-strep pneumoniae

What bug causes a classic “rust-colored” sputum in a lobar pneumonia?

-strep pneumoniae

Break down: “Enterococcus”

-bile resistant?

-3 main infections caused by this?

-one type of enterococcus, __, is vancomycin resistant; so what do you treat with?

-“entero” meaning intestine

-“coccus” meaning grape-like granule

-bile resistant

-UTIs; endocarditis; biliary tree infections

-faecium; lenozolid or tigecycline

Break down “bacillus anthracis”

-they have a unique capsule made of __, instead of the normal __

-obligate (aerobe/anaerobe)?

-how does it spread?

-this has 2 important toxins, __ and __(generally explain each)

-a special condition off of this is called wool sorter’s disease(explain); what can this lead to if not treated?

-drug of choice for treatment is __, with a close second being __

-“bacillus” means small rods in chains, and “anthracis” means black, coal-like lesions(hinting at the eschar lesions they cause)

-poly D protein; polysaccharide

-obligate aerobe

-it is spore-forming

-lethal factor(LF; functions as a protease that cleaves MAP kinase, causing tissue necrosis, and the textbook black eschar) and edema factor(EF; increases cAMP which pushes fluid into the intercellular space)

-because the spores can survive a long time dormant, it sometimes gets mixed into sheep wool, then eventually this gets shaved by humans who get the anthrax on them, which travels into their lungs and caused a pulmonary anthrax; pulmonary hemorrhagic mediastinitis

-fluoroquinolone; doxycycline

Bacillus cereus

-all similar attributes to __

-associated with? Trick?

-bacillus anthracis

-reheating rice; think cereus is like cereal, which is close to rice

Break down “Clostridium tetani”

-classically causes?

-obligate (aerobe/anaerobe)?

-how does it spread?

-cause of infection?

-presentation? A textbook description of one symptom?

-toxin moves (anterograde/retrograde) along neuron? Why? What does the toxin do?

-treatment?

-tetanus

-“clostridium” means spindle/rod-shaped, and “tetani” means causing spasms

-obligate anaerobe

-through spores

-through a penetrating trauma from rusty metal

-as name implies, muscle spasms and rigidity, with overly arching back; “risus sardonicus“, meaning evil smile, which is lock-jaw

-retrograde; normal movement is spinal cord to muscle, so this toxin moves from the periphery to the spinal cord; cleaves SNARE proteins which inhibits exocytosis of GABA and Glycine from Renshaw cells, into the synapse

-immediate immunoglobulins and metronidazole

Clostridium botulinum

-classically causes? Presents as?

-traditionally caused by…, which might be too obvious in a question stem, so maybe keep an eye out if multiple family members present similarly, implying they may have eaten the same food from the same cans

-spreads by?

-because of the direction of the paralysis, states above, initial symptoms are likely to be of the __, such as __ or __

-pathophysiology?

-has a special name in babies, called __, where babies generally get it from consuming __

-treatment?

-botulism; a DESCENDING paralysis

-improperly canning of foods

-spores

-eye; ptosis or diplopia

-cleaves SNARE proteins which inhibits exocytosis of Ach into the synapse, inhibiting contraction

-floppy baby syndrome; honey

-immediate antitoxin

If we’re talking spore-forming, what are the 2 big genus? And how do we differentiate these 2?

-bacillus and clostridium; bacillus is aerobic, and clostridium is anaerobic

Clostridium tetani, which causes __, has a toxin that cleaves SNARE proteins, stopping them from releasing the NTs __ and __(if you can’t release (excitatory/inhibitory) NTs, this causes (spastic/flaccid) paralysis)

Clostridium botulinum, which causes __, has a toxin that cleaves SNARE proteins, stopping them from releasing the NT __(if you can’t release (excitatory/inhibitory) NTs, this causes (spastic/flaccid) paralysis)

tetanus; GABA and Glycine; inhibitory; spastic paralysis

-botulism; Ach; excitatory; flaccid paralysis

What is your first thought of babies consuming honey?

-clostridium botulinum/floppy baby syndrome

Brain break! Quick trick for knowing all the gram positive bacteria

Clostridium difficile

-gram positive/negative?

-aerobe/anaerobe?

-spores?

-present as normal flora, or not?

-2 ways someone may develop this infection are toxogenic, such as through __, and the other way is through antibiotic use, such as with __

So what classically causes it to cause symptoms?

-symptoms? Worst case?

-classic prevention?

-it has 2 toxins, easily named __ and __, which both work by targeting __ and __(doing what?)

-this infection can lead to a __

-first-line treatment? For severe cases? If a patient cannot take medications, period?

-gram positive

-anaerobe

-yes

-present as normal flora

-nosocomial/hospital-acquired infection; clindamycin and PPIs

-high-volume foul-smelling diarrhea; toxic megacolon

-hand washing hygiene

-toxin A and toxin B; colonic mucosal cells; disrupting cytoskeleton and tight junctions

-pseudomembranous colitis

-vancomycin; metronidazole; fecal transplant from someone with a healthy gut microbiome

Clostridium perfringes

-gram positive/negative?

-aerobe/anaerobe?

-spores?

-2 classic vignettes?

-2 main conditions caused?

-for the first, what are the 2 toxins involved? What do they do?

-Treatment?

-gram positive

-anaerobe

-yes

-motorcycle accidents and deep penetrating wounds from combat

-gas gangrene and late-onset food poisoning

-alpha toxin(breaks through cell membranes) and gas toxin(causes the gas, leads to crepitus)

-penicillin

Corynebacterium diphtheriae

-gram positive/negative?

-rod/cocci? Special case with this bug Special granules?

-toxin process?

-the above causes what to occur? Where?

-other symptoms?

-can potentially lead to complications of the __

-texted on 2 special agar…

-because this is preventable with vaccination, the classic vignette will likely include a child who is __

-treatment? When is this given?

-positive

-rod; but it’s especially described as a club-shaped y- or v-formation with metachromatic granules

-A subunit(active) and B subunit(binding), causing ribosylation of EF2 to inhibit protein synthesis

-formation of a pseudomembrane of the throat and tonsils

-bull’s neck due to lymphadenopathy and pharyngeal paralysis

-heart

-telurite and loefler’s agar

-foreign or immigrated

-diphtheria antitoxin(neutralizes toxin) and antibiotics; immediately, as soon as this pathogen is suspected(prevent as much myocardial cell death as possible)

Listeria monocytogenes

-gram positive/negative?

-rod/cocci?

-commonly passed along by what?

-hemolytic?

-how does it move when outside the cell? Textbook description?

-how does it move inside the cell? Textbook description?

-how does it handle temperature?

-what group is this more common in? What could it cause?

-treatment?

-gram positive

-rod

-meat and soft cheeses

-beta hemolytic

-using flagella; “tumbling motility”

-rapidly depolymerizes actin against the bacterial wall, propelling in the opposite direction; “actin rockets”

-can multiply in near-freezing temperatures

-pregnant women; early termination or meningitis of the baby

-ampicillin

Actinomyces israelii

-gram positive/negative?

-rod/cocci? More specific?

-aerobe/anaerobe? Differentiates from what other gram positive branching rod?

-this bacteria normally inhabits where? So infection is normally associated with what? Such as?

-when an infection, actinomyces causes formation of what? And these drain pus with what characteristic feature?

-treatment?

-gram positive

-rod; branching rod

-anaerobe; nocardia

-the oral cavity; jaw trauma; recent dental work

-sinus tracts; yellow sulfur granules

-penicillin G

Abbreviation for gram positive cocci? Rods? Branching rods?

-SSE; BCCL; AN

Between the 2 spore forming gram positive rods, which is aerobic? Which is anaerobic?

-bacillus; clostridium

Nocardia sp.

-gram positive/negative?

-rod/cocci? More specific?

-aerobe/anaerobe? Differentiates from what other gram positive branching rod?

-why does the show up on an acid fast stain?

-targeted groups?

-3 main sites of infection in the body? What they cause at these sites?

-treatment?

-gram positive

-rod; branching rod

-aerobe; actinomyces israelii

-it contains mycolic acid

-immunocompromised

-pulmonary(pneumonia with cavitary lung lesions), CNS(brain abscesses), and cutaneous(pyogenic indurated lesions)

-sulfonamides

What major pathogens stain acid fast/have mycolic acid?

-Nocardia and Mycobacterium species

Neisseria sp.

-gram positive/negative?

-cocci/rod? More specifically?

-what 2 agars can this grow on?

-deficiency of what can allow for more frequent infections from this bacteria?

-what virulence factors does this bacteria have? Include their purpose

-2 important species of Neisseria?

-gram negative

-cocci; diplococci

-chocolate agar and VPN/thayer Martin agar

-C5-C9/MAC complex deficiency

-pili with antigenic variation(to avoid immune response); IgA protease(to survive along mucosal surfaces)

-meningitidis and gonorrheae

What is chocolate agar?

-blood agar that has been heated, de-activating lipids and other elements

Neisseria meningitidis

-review the Neisseria sp. card for info that covers both Neisseria species

-what is a differentiating factor about this species over the other? What is the other?

-important virulence factors? Include their function

-there are 4 types of this species that cause infection(A, B, C, and D), which most commonly causes infection in the US? Why?

-most concerning in what group?

-there is initial inflammation, which causes the capillaries to be? Leading to __(Which presents when there’s?) and __(which can lead to?)

-this can lead to hemorrhaging of the adrenals, all called?

-treatment? And due to this infection being spread by close contact, what is recommended for those who came into contact? Using what?

-this ferments maltose and glucose; gonorrheae ONLY ferments glucose

-capsule(anti-phagocytic); LOS(cause inflammatory response)

-type B; it is tue only form not covered by vaccination of N. meningitidis

-those with sickle cell

-leaky; petechial rashes; thrombocytopenia; hypovolemia; shock

-Waterhouse-Friderichsen syndrome

-ceftriaxone; prophylaxis; rifampin

A petechial rash indicates what lab value? Indicating they’re on their way to developing what?

-thrombocytopenia; DIC

What is Waterhouse-Friderichsen syndrome? What bacterial infection does it present in?

-hemorrhage of the adrenals; Neisseria meningitidis

Neisseria gonorrheae

-review the Neisseria sp. card for info that covers both Neisseria species

-what is a differentiating factor about this species over the other? What is the other?

-how is it transmitted?

-what cells does this bacteria invade?

-capsule? This is as opposed to the other Neisseria species, __

-in men, this infection moves from the urethra, __, and can potentially cause __ or __

-in women, this infection also moves from the urethra, __, but can cause __, leading to __

-following the above condition in women, a complication of PID is the infection moving into the peritoneum, causing __(explain)

-what is the consistency of the discharge present in both men and women, with gonorrhea?

-what joint issue is common in gonorrhea? What joint is most common?

-if a woman with gonorrhea delivers a baby, this can commonly lead to a congenital __ within the first __ days of birth(timing is important, because chlamydia also causes this, but it normally occurs at least __ after birth

-treatment?

-what is the most common co-infection with gonorrhea? How does this change treatment?

-this ferments ONLY glucose; meningitidis ferments maltose AND glucose

-sexually

-polymorphonuclear neutrophils(PMNs)

-NO!; meningitidis

-up; prostatitis or orchitis

-up; PID(pelvic inflammatory disease); infertility

-Fitz-Hugh-Curtis syndrome; adhesions form along the liver, described as “violin string adhesions”

-white and purulent

-asymmetric polyarthritis; most commonly of the knee

-purulent conjunctivitis; 5; 1 week

-ceftriaxone

-chlamydia; add doxycycline to treatment

Moraxella catarrhalis

-gram positive/negative?

-rod/cocci? More specific?

-aerobe/anaerobe?

-typically targets what body region?

-virulence factors? State its function

-conditions caused?

-treatment?

-gram negative

-cocci; diplococci

-aerobe

-nasopharynx

-biofilm(resists antibiotics); beta-lactamase(create resistance within the culture)

-otitis media; bacterial sinusitis; COPD exacerbations

-cephalosporins or amoxicillin-clavulonate

What “sign” is exclusive to Moraxella catarrhalis?

-hockey-puck sign

Enterobacter, Serratia, and Klebsiella

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-2 most common conditions caused by these bacteria?

-nosocomial/hospital acquired? Why is this important?

-what do they all ferment?

-what agar do these grow on? And due to fermenting the above, what color do they grow on this agar?

DIFFERENTIATING THE THREE…

-enterobacter’s only differentiating factor is that it is __

-serratia’s differentiating factors are __ and __

-for Klebsiella, remember the 3 As: __; it also has a __

-contrasting the first 2, Klebsiella is the only one that is __, and is positive for __

-Klebsiella can have the patient producing a __

-gram negative

-rod

-enteric

-pneumonia and UTIs

-yes; multi-drug resistance of bacteria

-lactose

-MacConkey agar; pink colonies

-motile

-motile and production of a red pigment

-abscesses(causes), alcoholics(seen in), and aspiration(get started by); capsule

-immotile; urease

-currant jelly sputum

What gram negative ferments maltose?

What gram negatives ferment lactose?

-Neisseria meningitidis

-Enterobacter, Serratia, Klebsiella, and E. coli

Salmonella sp.

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-the 2 main species are __ and __

-motile/immotile?

-capsule?

-what does it produce on Hektoen agar? Why?

-if it spreads into the lymphatics, what cell type does it occupy?

more on the species Salmonella enteritidis:

-acquired from __

-symptoms?

-has a type __ secretion system

more on the species Salmonella typhi:

-harbors in what organ?

-symptoms?

-number 1 cause of osteomyelitis in patients with __

-treatment?

-vaccine option?

-gram negative

-rod

-enteric

-typhi and enteritidis

-motile

-yes

-black colonies; its H2S positive

-macrophages

-undercooked chicken

-inflammatory diarrhea

-3

-gallbladder

-rose-colored macules, pea-soup diarrhea

-sickle cell disease

-fluoroquinolone

-yes!

Someone with sickle cell disease gets osteomyelitis?

-salmonella typhi

Shigella

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-acquired from?

-the 2 main species are __ and __

-which of the 2 are most common in the US?

-which of the 2 can precipitate hemolytic uremic syndrome(HUS)? What is the vignette of this?

-what is the MOA of the shiga toxin that allows it to cause HUS?

-what agar does this grow on? What is the appearance of its growth?

-motile/immotile?

-how does shigella transport itself through the body? What cells does it invade?

-symptoms?

-diarrhea caused by a type __ secretion system; just like?

-gram negative

-rod

-enteric

-contaminated food/water in daycares/nursing homes

-sonnei and dysenteriae

-sonnei

-dysenteriae; patient has inflammatory bloody diarrhea, then a week later, they have signs of acute renal failure

-binds/inhibits 60S subunit of ribosomes to inhibit translation

-hektoen agar; green colonies

-immotile

-propels itself with actin filaments; invades M cells

-inflammatory and blood diarrhea

-3; salmonella

What 3 enteric gram negative rods have a type 3 secretion system causing diarrhea?

-Salmonella, Shigella, and Yersinia

E. coli

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-the 2 main species are __ and __

-ferments __, which grows the color __ and __ agar

-it also grows on EMB agar, giving a __ color

-capsule?

-number 1 cause of __; what virulence factor assists in doing this?

-also causes neonatal __, but ONLY if it’s positive for what antigen?

more on EHEC…

-most commonly caused by eating __

-symptoms?

-how is EHEC unique from its sister subspecies?

-it has a toxin that has the same MOA as the shiga toxin, which is __; for this reason, it’s name is __

-also like shigella, this subspecies can cause __ in children under 10

-what EHEC serotype is associated with outbreaks?

More of STEC…

-also known as __

-passed by __

-classic vignette?

-has 2 toxins, a heat labile(which increases __) and heat stable(which increases __)

-symptoms?

-gram negative

-rod

-enteric

-EHEC and ETEC

-lactose; pink; MacConkey

-green

-yes

-UTIs; fimbriae

-meningitis; K antigen(polysaccharide capsule similar to sialic acid, so the body doesn’t recognize it as foreign)

-undercooked meat

-bloody diarrhea

-the only E. coli that doesn’t ferment sorbitol

-binding/inhibiting 60S subunit of ribosomes to inhibit translation; shiga-LIKE toxin

-HUS

-O157:H7

-traveler’s diarrhea

-infected water

-patient went to Mexico and drank water

-cAMP; cGMP

-watery diarrhea

Number 1 cause of UTIs?

-E. coli

Leading cause of gram negative sepsis?

-E. coli

Which E. coli subspecies is the only one that doesn’t ferment sorbitol?

-EHEC

What is the cause of “traveler’s diarrhea”?

-ETEC

Diarrhea differences between EHEC and ETEC?

-EHEC is bloody diarrhea, ETEC is watery diarrhea

Yersinia sp.

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-the 2 main species are __ and __

-capsule?

-treatment for both?

More on yersinia enterocolitica…

-mainly transmitted by __

-this bacteria is resistant to (warm/cold) temps, similarly to __

-special aspect of staining? Textbook description of stain pattern?

-symptoms? Very unique symptom is that it mimics __

More on yersinia pestis…

-cause behind the famous __

-the main reservoir isn’t humans, but __, and __ transfer it from them to us

-As the name bubonic plague implies, it forms __, which are __

-toxins of this bacteria use a type __ secretion system

-gram negative

-rods

-enteric

-pestis and enterocolitica

-yes

-streptomycin with tetracycline

-puppy feces or contaminated milk

-cold; listeria

-bipolar staining; safety pin

-bloody diarrhea with systemic symptoms; appendicitis

-black death/bubonic plague

-rodents/prairie dogs; fleas

-buboes; swollen lymph nodes

-3

What bacteria has a bipolar staining that appears like a safety pin?

-yersinia enterocolitica

Campylobacter jejuni

-gram positive/negative?

-rod/cocci? Special aspect about the rods?

-enteric, respiratory, or zoonotic?

-how it is transmitted to humans?

-prefers (warm/cold) temps

-symptoms? What special condition can arise from this bacteria?

-self-limiting? If severe?

-gram negative

-rod; curved rods(the 3 are HCV)

-enteric

-poultry

-warm temps(42 Celsius)

-bloody diarrhea, reactive arthritis; Guillaine-Barre syndrome

-YES!; macrolide(azithromycin)

What are the 2 cold-loving rods? Meaning they can be transmitted through?

Which is gram negative and which is gram positive?

-Listeria and Yersinia enterocolitica; milk products

-Yersinia; Listeria

What are the 3 curved gram negative rods?

-Helicobacter, Campylobacter, Vibrio

What condition has an ascending paralysis? What bacteria is it secondary to?

What condition has a descending paralysis? What bacteria is it secondary to?

-Guillain-Barre syndrome; Campylobacter

-Botulism; Clostridium

Vibrio sp.

-gram positive/negative?

-rod/cocci? Special aspect about the rods?

-enteric, respiratory, or zoonotic?

-symptoms?

-common vignette?

-does vibrio cholera invade the mucosa? What does it do?

-how does the cholera toxin work?

-treatment?

-there are 2 other species of Vibrio, vulnificus and parahemolyticus, and the only important note on these is that they are transmitted through __

-gram negative

-rod; curved rod(the 3 are HVC)

-enteric

-PROFUSE watery diarrhea, with a consistency of rice water

-underdeveloped country with poor water sanitation

-NO!; it uses fimbriae to attach

-activates Gs pathway(adenylyl cyclase) which increases cAMP

-rehydration therapy with electrolytes

-contaminated seafood like oysters

If someone reports with profuse watery diarrhea, with the consistency of rice-water, what bacterial infection do they have?

-Vibrio

-Break down “Helicobacter pylori”

-gram positive/negative?

-rod/cocci? Special aspect about the rods?

-enteric, respiratory, or zoonotic?

-motile/immotile?

-urease? What 2 screening tests does this allow to test positive for?

-infection causes?

-complications if untreated?

-treatment?

-“Helicobacter” meaning helically shaped, and “pylori” telling us it occurs around the pylorus

-gram negative

-rod; curved rod(the 3 are HCV)

-enteric

-motile

-urease positive; urea breath test and biopsy

-ulcers in the duodenum or stomach

-gastric adenocarcinoma and MALT lymphoma

-PPI, amoxicillin, macrolide(clarithromycin)

Proteus mirabilis

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-when plated, what textbook description is used?

-causes renal stones with what textbook description? What attribute does it have that allows it to form these?

-the odor of this infection may be described as?

-treatment?

-gram negative

-rod

-enteric

-swarming motility

-staghorn calculi(struvite stones); its urease positive

-fishy

-sulfonamides

If you have a bacterial infection of a gram negative rod with “swarming motility”, what bacteria caused this?

-Proteus mirabilis

Pseudomonas

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-prefers what type of environment?

-when plated, produces a blue-green pigment from what 2 components?

-produces an odor described as __

-aerobe/anaerobe? Why is this important?

-the number 1 cause of __ and __

-IV drug users and diabetics are most likely to develop what from this bacteria?

-also a fatal complication in patients suffering from severe __

-also associated with __

-causes 2 skin infections…

-the last association is with the ear…

-pseudomonas has a key toxin…; what also shares this same toxin?

-treatment?

-gram negative

-rod

-enteric

-aquatic

-pyoverdin and pyocyanin

-fruity and grape-like

-aerobe; it’s the only one of the enteric gram negative bacteria that is

gram negative nosocomial pneumonia; respiratory failure in CF patients

-osteomyelitis

-burns

-nosocomial UTIs

-hot tub folliculitis and ecthyma gangrenosum

-otitis externa(“swimmer’s ear”)

-toxin A(inactivated EF-2); diphtheriae

-piperacillin

What is the only gram negative bacteria that’s an aerobe?

-Pseudomonas

Bordetella pertussis

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-classically causes __

-so these cells invade?

-toxins in these bacteria?

-symptoms? And what stage of the infection does this symptom occur in?

-treatment?

-prevention?

-gram negative

-rod

-respiratory

-whooping cough

-no, they use ‘filamentous hemagglutinin’ to attach to the cells

-bordetella toxin(acts by inhibiting G(i), which increases cAMP); adenylate cyclase toxin(directly increases adenylate cyclase to increase cAMP); tracheal toxin(damages ciliated epithelium of respiratory tract)

-bouts of coughing that result in a whooping when the child breathes in; paroxysmal stage

-macrolides

-Dtap

Haemophilus influenzae

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-grown on what type of agar? What 2 things does this require?

-major conditions caused by this bacteria?

-vaccine? Does it cover all subtypes?

-treatment?

-Anything for people who had close contact with the ground zero patient, as prophylactic?

-gram negative

-coccobacillary shape

-respiratory

-chocolate; factor 5 and 10

-epiglottitis(inflamed epiglottis, inspiratory stridor, and drooling), otitis media, meningitis(only type B haemophilus)

-haemophilus vaccine; it only covers type B haemophilus

-ceftriaxone

-rifampin

If you hear epiglottitis, what infection should be at the top of your differential?

-haemophilus influenzae

Legionella

-gram positive/negative? What is a special added topic on staining this bacteria?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-what agar is needed for this bacteria to grow?

-what 2 conditions does this cause?

-for the more serious condition listed above, what group is it more common in?

-what will x-ray show with the above condition?

-symptoms of above condition?

-treatment?

-gram negative; it doesn’t stain well, so you need a silver stain

-rod

-respiratory

-BCYE(charcoal yeast) agar, with iron and cysteine

-Pontiac fever(self-limited fever and malaise) and Legonnaires’ disease

-smokers

-patchy infiltrates with consolidation of one lobe

-hyponatremia, neuro symptoms(headache and confusion), diarrhea

-fluoroquinolones(-floxacin drugs), then macrolides if it doesn’t work

If you hear pneumonia with diarrhea and hyponatremia, think what?

-Legionella

Bartonella henselae

-gram positive/negative? What special stain is needed to visualize this bacteria?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-2 main conditions caused by this bacteria? Both caused by what?

-for cat scratch fever, an extra symptoms that’s important is __(comment on its movement)

-how do you majorly differentiate the 2, if you have a patient, recently got a new cat, and is presenting with rash and redness?

-treatment of bacillary angiomatosis?

-treatment of cat scratch fever?

-gram negative; warthin-starry stain

-bacilli

-zoonotic

-cat scratch fever and bacillary angiomatosis; cat scratches!

-lymphadenopathy; travels up the single arm and affects the axilla

-cat scratch fever occurs in immunocompetent individuals; bacillary angiomatosis occurs in immunocompromised individuals

-doxycycline

-macrolides

Brucella

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-passed on by direct contact with what? Or indirect contact with what?

-special aspect of the fever this bacteria causes?

-other symptoms?

-treatment?

-gram negative

-rod

-zoonotic

-farm animals; milk and cheese product

-undulating(goes up and down)

-hepatosplenomegaly and osteomyelitis

-doxycycline paired with rifampin

Francisella tularensis

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-what animal is the main reservoir for this bacteria? Passed on by what kind of tick?

-symptoms?

-treatment?

-gram negative

-coccobacilli

-zoonotic

-rabbit; dermacentor

-painful ulcer at bite site, causing movement through lymph nodes and development of granulomas with caseating necrosis within the lymph nodes

-streptomycin(aminoglycoside)

Pasteurella multocida

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-where is this bacteria commonly found? So how it is commonly spread to humans?

-symptoms?

-so classic vignette?

-virulence factor?

-what is a special agar that this bacteria grows on?

-on microscopy, it gives a textbook __ appearance, because it __(what other bacteria gives this appearance?)

-treatment?

-gram negative

-rod

-zoonotic

-dog and cat respiratory tracts; dog and cat bites

-cellulitis, osteomyelitis

-someone develops cellulitis and osteomyelitis after a dog or cat bite

-capsule

-5% sheep’s blood agar

-safety pin; stains most readily at its 2 ends; Yersinia

-penicillin

What 2 bacteria, on microscopy, give a textbook “safety pin” appearance, because of how it stains most readily on its 2 ends

-Yersinia and Pasteurella

Anaplasma phagocytophilum and Erlichia chaffeensis

-gram positive/negative?

-rod/cocci?

-enteric, respiratory, or zoonotic?

-anaplasma is passed on by what tick? And the common reservoirs of this bacteria are?

-erlichia is passed on by what tick? And what is the common reservoir?

-symptoms?

-lab value?

-on blood smear, you will see leukocytes with __

-treatment?

-gram negative

-rod

-zoonotic

-ixodes; mice and deer

-lonestar tick; deer

-mostly systemic(fever, chills, myalgia), and GI(nausea, vomiting)

-pancytopenia

-morulae

-doxycycline

If someone presents with GI and systemic symptoms, and a peripheral blood smear is taken that shows leukocytes with morulae, what 2 bacteria could it be?

-anaplasma or erlichia

Mycobacterium tuberculosis

-acid fast? Why?

-what special agar does this grow on?

-aerobe/anaerobe?

-virulence factors? Explain what they do

-3 possible paths of progression following primary TB infection?

-following primary infection in the lungs, it heals and causes what? What is this called?

-explain miliary TB

-when will patients who have latent TH experience a re-activation? How does it cause it?

-when there is re-activation of TB, does it still target the middle and lower lines of the lungs? What 2 other regions of the body does re-activation TB affect?

-treatment course? What is prophylaxis for those with latent TB?

-yes; due to mycolic acid

-lowenstein-jensen agar

-aerobe

-cord factor(clump of glycolipids that creates a granuloma, walling it off and protecting it from getting destroyed); sulfatides(prevent phagolysosomal fusion, allowing them to exist inside of macrophages without being destroyed by lysosomal hydrolases)

-healed latent infection; systemic infection(miliary TB); reactivation TB

-fibrosis and calcification or the area, and hilar lymph nodes; Ghon complex

-bacteremia occurs, spreading the infection to multiple sites in the body, causing multi-organ failure

-in states of immunosuppression(AIDS, cancer, old age); down-regulation of TNF-alpha

-NO, it targets the upper lobes; skeletal vertebrae(causes Pott’s disease) and CNS(tuberculoma or meningitis)

-RIPE(rifampin, isoniazid, pyrazinamide, ethambutol); rifampin and isoniazid

3 paths of progression following a TB infection?

1. healed latent infection

2. systemic infection(miliary TB)

3. reactivation TB

Primary TB infection primarily affects what portions of the lungs?

-middle and lower lobes

What is a Ghon complex? What is it seen in?

-following primary infection pf TB, fibrosis and calcification of the affected lung parenchyma and hilar lymph nodes

Do TB tests only show positive for active TB?

-NO!, active and latent TB, as well as those who have received the TB vaccine

If you want to put a patient on a TNF-alpha inhibitor, what must you first screen them for? Why?

-TB; re-activation can occur when TNF-alpha is inhibited

Mycobacterium leprae

-bacteria, virus, fungi?

-what main disease does this cause?

-acid fast? Why?

-prefers warm or cold temps?

-main reservoir?

-there’s 2 main presentations, depending on its pathophysiology inside the body, causing the reaction. One type is the tuberculin response, which is caused by __ response(explain), which gives symptoms of __, and will test positive on a __ skin test

-the other type of presentation is the lepromatous response, which is caused by __ response(explain), which gives symptoms of __

-explain what Leonine facies is

-treatment depends on the type of leprosy, with the tuberculin type receiving __, while the lepromatous type receives __

-bacteria

-leprosy(aka: hansen’s disease)

-yes; due to mycolic acid staining

-cold

-armadillos

-Th1; disease contained by macrophages; hairless, well-demarcated pigmented skin plaque; lepromin

-Th2; these people have a very weak Th1 response, so the bacteria cannot be contained by the macrophages, thus break out; symmetric neuropathy with a glove and stocking pattern, as well as Leonine facies

-facial deformities including skin thickening, loss of eyebrows and eye lashes, collapse of the nose, and formation of nodular earlobes

-dapsone and rifampin; the same drugs, plus clofazimine

Borrelia burgdorferi

-main condition this causes?

-special shape? Other 2?

-caused by what tick?

-what 2 stains can pick this bacteria up?

-symptoms occur in levels(Lyme has levels): stage 1 has __, stage 2 has __, stage 3 has __

-treatment? If you’re under 8 years old?

-Lyme disease

-spirochete; leptospirosis and syphilis

-ixodes tick

-wright and giemsa

-bullseye rash; myocarditis-heart block and Bell’s palsy; arthritis and meningitis

-doxycycline; amoxicillin

How ixodes tick, what is the reservoir of larvae? What is the reservoir of adults?

-mice; deer

Leptospira interrogans

-main condition this causes?

-special shape? Other 2?

-caused by?

-symptoms?

-leptospirosis(aka: Weil’s disease)

-spirochete; borrelia and syphilis

-water contaminated by animal urine

-conjunctival suffusion(redness around eyes), renal and liver damage

What are spirochetes commonly described as?

-question-mark shaped

Histoplasma capsulatum

-what is it?

-exposure from?

-histology?

-presentation of fungus depends on? Explain?

-symptoms?

-particularly targets what group?

-treatment?

-systemic fungus

-bat dropping, cave diving, chicken dropping, so caves or farms

-macrophages with oval bodies

-temperature; mold in cold, yeast in heat

-largely asymptomatic, but can appear like TB with lung granulomas and a pneumonia, as well as hepatosplenomegaly

-immunocompromised

-azoles for local infection, and amphotericin B for disseminated infection

Blastomycosis dermatitidis

-what is it?

-exposure from?

-histology?

-X-ray?

-presentation of fungus depends on? Explain?

-symptoms?

-particularly targets what group?

-treatment?

-systemic fungus

-aerosolized spores from dirt

-broad-based budding

-patchy alveolar infiltrate with lesions or cavities

-temperature; mold in cold, yeast in heat

-osteomyelitis and pneumonia

-immunocompromised

-azoles for local infection, and amphotericin B for disseminated infection

Coccidioides immitis

-what is it?

-exposure from?

-histology?

-presentation of fungus depends on? Explain?

-symptoms?

-particularly targets what group?

-treatment?

-systemic fungus

-aerosolized spores from dust, like earthquakes

-spherules

-temperature; mold in cold, BUT spherules in heat(not yeast, line the others)

-largely asymptomatic, but pneumonia with lesions and cavities, arthralgia, and meningitis

-immunocompromised

-azoles for local infection, and amphotericin B for disseminated infection

Paracoccidioides brasiliensis

-what is it?

-exposure from?

-histology?

-presentation of fungus depends on? Explain?

-symptoms?

-particularly targets what group?

-treatment?

-systemic fungus

-a

-“captain’s wheel” yeast in the body

-temperature; mold in cold, BUT yeast in heat

-cervical lymphadenopathy, pneumonia with granulomas, mucocutaneous lesions

-immunocompromised

-azoles for local infection, and amphotericin B for disseminated infection

All systemic fungi are __, meaning?

What are the systemic fungi?

-dimorphic; they change appearance based on temperature

-histoplasma, blastomycosis, coccidiomycosis, and paracoccidiomycosis

What systemic fungus creates spherules in the body?

-coccidioides

Paracoccidioides brasiliensis

-what is it?

-exposure from?

-histology?

-presentation of fungus depends on? Explain?

-symptoms?

-particularly targets what group?

-treatment?

-systemic fungus

-a

-“captain’s wheel” yeast in the body

-temperature; mold in cold, BUT yeast in heat

-cervical lymphadenopathy, pneumonia with granulomas, mucocutaneous lesions

-immunocompromised

-azoles for local infection, and amphotericin B for disseminated infection

Malassezia furfur

-what is it?

-appearance?

-it causes? Appearance on skin?

-fungus targets what skin layer?

-high yield individuals at risk?

-treatment?

-cutaneous fungus

-spaghetti and meatballs

-Pityriasis versicolor; hyper-/hypo-pigmented patches

-stratum corneum

-neonates receiving TPN(total parenteral nutrition)

-selenium sulfide

Dermatophytes

-what is it?

-it causes what infection on skin? It causes what infection on nails?

-pruritis?

-3 main types of dermatophytes? Trick?

-appearance?

-at-risk?

-treatment for tinea? Treatment for onychomycosis?

-cutaneous fungus

-tinea; onychomycosis

-yes!

-EMT(epidermophyton, microsporum, and trichophyton)

-ring-shaped lesions with a rust-color

-athletes

-azoles; terbinafine

Sporothrix schenckii

-what is it?

-it causes?

-classically found on?

-dimorphic?

-histology?

-treatment?

-cutaneous fungus

-sporotrichosis(rose gardeners disease)

-rose bushes, tree bark, and plants

-yes!

-cigar-shaped yeast

-azole

Candida albicans

-what is it?

-it causes?

-dimorphic? Appearance in heat? Appearance at body temp?

-causes a white plaque that can scrape off, why is this important?

-histology?

-treatment? Specifically for oral candidiasis?

-opportunistic fungus

-oral candidiasis, vaginal candidiasis, diaper rash, esophagitis(AIDS-defining illness), and endocarditis

-differentiates from leukoplakia, which cannot scrape off, and is pre-cancerous

-yes! Germ tubes; pseudo-hyphae with budding yeast

-azoles; nystatin