Clinical Microbiology and Infections (session 3)

Clinical Pearl: infections can cause altered _________, especially in what population

mental status; elderly

Clinical Pearl: for unexplained tachycardia get a _____________, other wise may miss fever and consideration of infection

rectal temperature

Clinical Pearl: if “everything hurts”

think myalgias, muscle and body pain due to fever/infection

Common Cold common microbe

rhinovirus

most common colds don’t need

antibiotics

symptoms of common cold

cough, congestion, sore throat, fever

RSV

respiratory syncytial virus

common cause of rsv

bronchiolitis (inflammation of the bronchioles)

rhinorrhea

lots of snot

symptoms of rsv

rhinorrhea, coughing, congestion, fever, wheezing

under age _is common but also worrisome

2

risks that are concerning with RSV

premies, low birth weight, immunocompromised, maternal smoking, low SPO2tr

treatment for RSV

suction, O2, saline (if hostpitalized)

Influenza

sudden onset cough, fever, congestion, headache- “can’t get out of bed”

influenza looks like

meningitis

influenza has two glycoproteins

1. hemagluttinin

   1. neuraminidase

tamiflu is generic for___; and its mechanism is?

oseltamivir; inhibits neuraminidase glycoprotein, thereby prevent new virions from entering the host cell this drug shortens flu by less than a day if given less than 48 hours of onset

if influenza is superimposed by bacteria think

staph aureus

Covid-19 (SARS-CoV-2) symptoms

same as common cold, some may have GI symptoms

Covid-19 (SARS-CoV-2) attaches to what

type 2 pneumocytes of lungs and other organs

Covid-19 (SARS-CoV-2) relevance

radiographically, abnormal findings at distal airways

Covid-19 (SARS-CoV-2) complication

ARDS (big killer in covid): acute respiratory distress syndrome

Covid-19 (SARS-CoV-2)  treatment

use steroid hormone if hypoxic , paxlovid prevent severity of disease

Vomitting and Diarrhea- many are ___

viral (norovirus)- recall Na, K

Vomitting and Diarrhea microbial associations: clostridium difficile

recent antibiotics

Vomitting and Diarrhea microbial associations: blood in stool (consider if abx present)

shigella, salmonella, yesenia, E. Coli

Vomitting and Diarrhea microbial associations: potato/egg salad

staph aureus

Vomitting and Diarrhea microbial associations: reheated fried rice

Bacillus cereus

Vomitting and Diarrhea microbial associations: uncooked poultry 

clostridium perferengens

Vomitting and Diarrhea microbial associations: wheeze or hives

scomboid poisoning (tuna)

Vomitting and Diarrhea microbial associations: contaminated seafood or shellfish

vibrio cholerae

Vomitting and Diarrhea microbial associations: tingling 

ciguatera toxin (sea bass)

HSV

herpes Simplex Virus

Type 1 HSV

oral (mouth)

Type 2 HSV

genitals

HSV symptoms

painful ulcerations

HSV herpetic whitlow

fingertip infection

HSV encephalitis or meningitis

fever, headache, seizure, altered mental status

VZV

varicella zoster virus

VZV do what?

skin exam

VZV : zoster oticus

involves ears

VZV:disseminated shingles

crossing multiple dermatomes and/or immuncompromised

VZV: chicken pox/shingles

chicken pox: blistering rash

shingles: painful blisters

VZV: zoster opthalmicus

shingles of eyes- watch for tip of nose blister- if present may involve eyes

Clostridium Tetani

tetanus

Tetanus

muscle contraction

masseter

risus sardonicus- smile muscles

tetanus mechanism

toxin prevents GABA from release at the preseynaptic terminal at spinal cor

opisthotonus

arching of the back

source of tetanus

dirty soil, nail, wounds

Clostridium Botulinum

botulism

Botulism Key:

descending paralysis 

Botulism mechanism

at neuromuscular junction toxin prevents release of ACh from presynaptic terminal

Types of botulism

1. infant

2. wound

3. food

infant botulism source

from honey to babys alkaline stomach

infant botulism symptoms

“floppy baby” 

starting with more mild symptoms like constipation

wound botulism

contamination gets through skin

food botulism

improperly canned foods

Vulvovaginitis key

excess vaginal discharge

Vulvovaginitis types

1. bacterial vaginosis

2. trichomonas vaginitis

3. candida albicans

Bacterial vaginosis

maldistribution of bacterial flora

Gardnerella vaginitis

1. clue cells=eptihelial cells studded with bacteria

2. pH is more alkaline

3. fishy odor with KOH treatment 

gardenerella vaginits is it an sti

no

treatment for gardnerella vaginosis

metronidozole (Flagyl) or vaginal cream

trichomonas vaginitis- trichomoniasis

parasite

is trichomonas vaginitis an sti

yes so treat partner too

trichomoniasis distinctions

1. strawberry cervix

2. pH of vagina is more alkaline

3. mobile trichomads under microscope

trichomoniasis complications

preterm labor, other STI associated

trichomoniasis treatment

antimicrobials

is Candida albicans an STI

no; fungal

Candida Albicans risks

diabetes, abx use, etc

Candida Albicans distinctions

1. pH is more acidic

2. hyphae under microsope

3. cottage cheese discharge

Candida Albicans treatment

antifungals

hepatits= 

liver inflammation (recall AST and ALT)

Hepatitis symptoms

fever, jaundice, vomitting, abdominal pain

Hep A

oral/fecal transmission

Hep B

sex, needles (e.g. tattoos, IV drug use, and vertical transmission from mom

Hep C

sex, needles