Microbiology final exam uncw

diagnosis and treatment

differential symptoms (differentiation that points out how it is different)

specimen analysis

patient history & risk factors

potential sources of exposure

epidemiologic investigation of outbreak

for each disease

name the disease

name the microbe(s)

identify type of microbe (e.g., prokaryote, virus, yeast, etc.)

recognize noteworthy symptom(s) for diagnosis

identify mode(s) of transmission

describe prevention and/or treatment

compare & contrast to similar disease(s)

Place the tissue layers in order from superficial to deep.

Dermis

muscle

Epidermis

subcutaneous layer

Dermis

muscle

subcutaneous layer

epidermis

Staphylococcus aureus and Streptococcus

pyogenes (group A strep) cause pyogenic

infections (e.g., abscesses)

Mostly found on dermis due to how close it is blood vessels

Pyogenic means pus. A lot of neutrophils are in pus!

staph or strep?

carriers are common (upper respiratory

tract and skin)

both are non-motile, gram-positive

cocci

differentiated by arrangements and

catalase test (H2O2 H2O + O2).

antibiotic resistance more common in

Straph. aureus (e.g., MRSA)

Another way you can tell a difference is that Streptococcus is round cells that are found in chains! And staph is grape clusters.

impetigo

superficial skin infection (epidermis) caused by staph or strep and characterized by pustules (pyogenic), skin peeling, and yellowish

crusts.

spread by direct and indirect contact

treatment with topical mupirocin

Why is it important to determine that an invasive skin infection is caused by S. aureus (staph) rather than S. pyogenes (strep)?

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a

Staph produces toxins and strep does not

b

Staph is usually more resistant to antibiotics

c

Staph is not carried by humans so finding the source is important

d

Staph infection can lead to scarlet and rheumatic fevers

Staph is usually more resistant to antibiotics

cellulitis

Cellulitis is an infection of the dermis &

subcutaneous tissue caused by staph or

strep (also other bacteria)

results from parenteral (through the skin)

implantation

Lymphangitis (initial redness of the site) and bacteremia (infection in or of the blood) can result

oral antibiotics for uncomplicated

infections or i.v. antibiotics &

debridement for serious infections or

immunocompromised

Necrotizing fasciitis comes from cellulitis

also called the flesh-eating disease, characterized by massive, rapid tissue digestion caused by staph

or strep (superantigens, toxins that overstimulate your immune system)

bacteria introduced through the skin injuries

treat aggressively with i.v.

antibiotics, debridement,

amputation (only 24-48 hours to diagnosis)

staphylococcal scalded skin

syndrome (SSSS)

a staph infection characterized by widespread desquamation (all over the body) of epidermis (looks like a burn)

typically in newborns

5% of S. aureus strains

produce exfoliative toxins

Which superficial, bacterial skin infection is characterized by pustules that erupt and form yellowish crusts?

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a

cellulitis

b

impetigo

c

necrotizing fasciitis

d

scalded-skin syndrome

impetigo

viral rash

macules-a macular rash is a red-spotted rash, but flat spots

papules- red bumps

vesicles-a vesicle is a bump filled with fluid, a red bump filled with fluid.

pustule- a pustule, which is filled, as the name suggests, with pus.

measles is maculopapapular rash, With chicken pox, vesicular rash.

measles

measles (rubeola) is a viral infection that

begins with non-specific symptoms (fever,

sore throat, headache)

Koplik's spots appear in oral cavity

red maculopapular exanthem (rash) spreads

from head to trunk and extremities

natural active immunity

1 million children die annually from measles

pneumonia or encephalitis

subacute sclerosing panencephalitis (SSPE)

measles part two

humans are the only reservoir for measles virus

virus is transmitted via respiratory route

(extremely contagious)

measles vaccine was introduced in 1964

Which of the following is a differential symptom only associated with measles?

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a

maculopapular skin rash

b

pustules with yellowish crusts

c

Kopliks spots

d

epidermal desquamation

Kopliks spots

conjunctivitis (various)

"pink eye" is caused by so many things, but it can be washed away or perhaps treated with antibiotics

trachoma (bacterial)

The leading cause of infectious blindness worldwide. Caused by Chlamydia and causes scaring.

keratitis (viral)

leading cause of infectious blindness U.S., nothing to treat it, and caused by. herpes targets the corneas.

neonatal conjunctivitis

vertical transmission mother infected with Neisseria gonorrheae or Chlamydia trachomatis (STIs)

newborns <28 days

erythromycin drops given at

birth

Match the barrier defense with its example.

physical barrier- grab salt and acid in secretions such as sweat and sebum

chemical barrier- shedding of dead cells from the stratum corneum

mechanical barrier- competition by normal flora skin bacteria

biological barrier

physical barrier- keratinized cells of the stratum corneum

chemical barrier- salt and acid in secretions such as sweat and sebum

mechanical barrier- shedding of dead cells from the stratum corneum

biological barrier- competition by normal flora skin bacteria

Staphylococcus aureus and Streptococcus pyogenes have all the following in common except:

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a

asymptomatically carried by humans

b

cause skin infections in humans

c

are gram-positive cocci

d

are highly resistant to many antibiotics

e

produce exotoxins, exoenzymes and superantigens

are highly resistant to many antibiotics

All of the following are associated with scalded-skin syndrome except:

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a

exfoliative toxin

b

skin redness and peeling

c

Streptococcus pyogenes

d

newborns and infants

Streptococcus pyogenes

About 10-20% of those infected with chickenpox will develop a latent infection of the nerves called

blank1 - Word Answer - Type your answer and submit

, which is characterized by a localized rash and painful inflammatory response.

shingles

Match the virus with its description.

varicella zoster- centripetal vesicular rash;usually mild

variola major-centrifugal pustular rash; high mortality rate

variola minor- centrifugal pustular rash; low mortality rate

Vaccinia- localized pustular rash; usually mild

Measles, chickenpox, and smallpox have all of the following in common EXCEPT:

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a

respiratory transmission

b

widespread vaccination creates herd immunity

c

natural active immunity

d

zoonotic infection

zoonotic infection

If a newborn develops neonatal conjunctivitis, it was most likely transmitted from a mother who:

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a

has impetigo caused by Streptococcus pyogenes

b

has a latent infection caused by the varicella-zoster virus

c

has a sexually transmitted infection, such as gonorrhea

d

has staphylococcal scalded skin syndrome

has a sexually transmitted infection, such as gonorrhea

The most common cause of infectious blindness is an infection of the cornea, called , which is caused by herpes simplex virus.

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a

cellulitis

b

conjunctivitis

c

keratitis

d

trachoma

e

glaucoma

keratitis

POLIOMYELITIS

• Acid-stable enterovirus

- Fecal-oral transmission

• Contaminated water

- Neurotropic

attacks the central nervous system

• Typically asymptomatic

• 1% paralytic disease

• Vaccines 1950s

- Salk IPV (injectable; killed

- Sabin OPV (oral)

• Eradication by 2005?

The rash associated with smallpox is described as "centrifugal," which means the rash:

spreads from the trunk to the arms and legs

Early meningitis symptoms can be mistaken for other diseases like influenza. Two differential symptoms include neck stiffness and light sensitivity, also know as:

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a

encephalopathy

b

encephalitis

c

hydrophobia

d

photophobia

e

night blindness

photophobia

Meningicoccal meningitis is characterized by a skin rash (see image) called:

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a

Koplik's spots

b

erythema migrans

c

postherpetic neuralgia

d

centrifugal rash

e

petichiae

petichiae

The three major causes of bacterial meninigitis can be prevented with conjugate vaccines. By linking the bacterial to a protein antigen, the conjugate vaccine creates a T-dependent response and opsonizing antibodies to aid in bacterial phagocytosis.

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a

capsule

b

capsid

c

envelope

d

sex pilus

e

flagella

capsule

Because it can be transmitted by

blank1 - Word Answer - Type your answer and submit

, West Nile virus is classified as an arthropod-borne virus, or arbovirus.

Mosquito

Tetanus and botulism have all of the following in common except:

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a

bacterial neurotoxins

b

foodborne transmission

c

paralysis

d

passive immunization

e

endospores

foodborne transmission

Pregnant women are tested for before they deliver. Women testing positive can be prophylactically treated with antibiotic so that they do not spread this pathogen to the newborn during delivery.

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a

Staphylococcus aureus

b

Streptococcus pyogenes

c

Streptococcus agalactiae

d

Clostridium botulinum

e

Toxoplasma gondii

Streptococcus agalactiae

Match the disease to its description.

botulism- bacterial neurotoxin causes flaccid paralysis

tetanus- virus spread by fecal-oral route causes paralysis in 1% of those infected

poliomyelitis- intracellular bacterium spread by contaminated food causes meningitis

listeriosis- prion causes brain damage or spongiform encephalopathy

Creutzfeldt-Jakob disease- bacterial neurotoxin causes spastic paralysis

botulism-bacterial neurotoxin causes spastic paralysis

tetanus- bacterial neurotoxin causes flaccid paralysis.

poliomyelitis- virus spread by fecal-oral route causes paralysis in 1% of those infected

listeriosis- intracellular bacterium spread by contaminated food causes meningitis

Creutzfeldt-Jakob disease- prion causes brain damage or spongiform encephalopathy

For non-immune individuals exposed to botulism or tetanus, antibodies against the respective neurotoxins can be administered to the patient to prevent paralytic effects. This type of immunotherapy provides to protect the patient.

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a

passive immunity

b

active immunity

c

autoimmunity

d

herd immunity

e

immune tolerance

passive immunity

chickenpox

a viral infection that begins with non-specific symptoms

(sore throat, headache), but fever accompanies rash. Typically transmitted through the respiratory route

centripetal vesicular rash-confined to scalp, face, trunk - does not spread to extremities. The bumps are vesicular, meaning filled with fluid

Chickenpox (Varicella)

humans are the only reservoir of varicella-zoster

virus (HHV-3)

natural active immunity, mild self-resolving infection.

It is similar to herpes because it has a dormant phase

Although chickenpox is a mild, self-resolving infection, a vaccine was introduced in 1995. The vaccine not only protects against chickenpox, but it is hoped to also protect against a latent infection called:

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a

cowpox

b

smallpox

c

impetigo

d

necrotizing fasciitis

e

shingles

shingles

shingles

about 1/3 develop shingles, a latent infection of cranial/spinal nerves

10-18% of those develop postherpetic neuralgia

1.1 million cases per year in U.S.

7x more cases in people 65 years and older

Shingrix vaccine for 50+ year old

The rash that emerges from the major nerve root and then extends along the whole nerve.

risk from chickenpox

n the first 12 years of vaccine, 88% drop in chickenpox-

related deaths

other risks of chickenpox:

staph & strep infections

pneumonia

immunocompromised (20% mortality)

some non-immune adults and adolescents

encephalopathy (0.1%)

vertical transmission (mom to child)

Reye's syndrome (nerve pain)

smallpox

smallpox is a viral infection that begins with non-specific symptoms- (sore throat, headache) with fever first and rash last

centrifugal pustular (pus filled) rash

begins at the head and trunk but spreads to the extremities

can be mistaken for chickenpox early on

smallpox pt 2

humans only reservoir for variola viruses

transmitted via respiratory route (mildly contagious)

also fomites or direct contact

natural active immunity but scars/organ damage

20-30% mortality (no treatment)

"cowpox" vaccine (Edward Jenner 1798)

worldwide vaccination program

last natural case in Somalia 1977 (eradication)

The rash associated with smallpox is described as "centrifugal," which means the rash:

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a

is red and bumpy

b

is contagious

c

appears mainly on head and trunk of body

d

spreads from the trunk to the arms and legs

spreads from the trunk to the arms and legs

meningitis

meningitis is an infection of the meninges characterized by fever, headache, nausea, vomiting, stiff

neck, photophobia

transmitted via respiratory route

bacteria that can give you meningitis-

Neisseria meningitidis

Streptococcus pneumoniae

Haemophilus influenzae

viruses

fungi

typically opportunistic, e.g., AIDS

Diagnosis of meningitis

lumbar puncture, CSF

Gram stain and/or culture

A lumbar puncture is performed on a patient with a suspected case of meningitis. Analysis of the CSF reveals the presence of a fungus called Cryptococcus. What do you expect to discover about the patient's risk for infection?

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a

the patient is a college student

b

the patient recently traveled overseas

c

the patient is immune compromised

d

the patient works at a zoo

the patient is immune compromised

meningococcal meningitis

Neisseria meningitidis

encapsulated G- diplococcus

3-30% carriers

It's hard to get rid of. And that's because it's encapsulated. It would stain pink! It affects college students more. because it is a respiratory bacterium, and it can be spread through secretions.

pneumococcal meningitis

Streptococcus pneumoniae

encapsulated G+ diplococcus

70% carriers

It stains purple and is also encapsulated, making it harder to kill.

Haemophilus meningitis

Haemophilus influenzae

encapsulated G- pleomorphic

bacillus

carriers common

effects newborns!

meningococcal meningitis pt 2

meningococcal meningitis is the most serious form

convulsions, shock, coma, clotting, cardiac failure

petechiae (disease is you start to see this splotchy purple-red rash develop on the skin.)

15% mortality with antibiotic treatment

Haemophilus meningitis vaccination

Haemophilus meningitis was the most common type in young children before 1992 when the Hib vaccine was introduced

3 types of bacterial meningitis

3 types of bacterial meningitis can be prevented with

conjugate vaccines (one of the things they have in common that protects them during infection is the capsular polysaccharide, the capsule, the protective coating of sugars.) use opsonization

capsule (T-independent) linked to protein antigen (T-dependent)

ActHIB 1992

Prevnar 2000

Menactra 2004

The three major bacterial causes of meningitis are encapsulated. Why is capsule an important virulence factor for these infectious bacteria?

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a

capsule helps the bacteria invade host cells

b

capsule is toxic to the host

c

capsule prevents phagocytosis of the bacteria

d

capsule helps with bacterial motility

capsule prevents phagocytosis of the bacteria (maybe on the final idk)

neonatal meningitis

neonatal meningitis can be caused by

Streptococcus agalactiae (group B strep)

10-30% women colonized in vagina

vertical transmission during delivery

meningitis, septicemia, & pneumoni

but it also can cause septicemia. Or bloodstream infection.

prophylactic treatment

prophylactic treatment

pregnant women routinely screened at 35-37 weeks

i.v. beta-lactam administered before delivery

Prevents transmission of neonatal meningitis

Neonatal conjunctivitis and neonatal meningitis have all of the following features in common EXCEPT:

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a

Antibiotics are used prophylactically

b

Vertical transmission of pathogen

c

Infection is caused by viruses

d

Microbes are present in the birth canal of mothers

Infection is caused by viruses

west nile encephalitis

An unexplained disease emerged in NYC, 1999

patients had high fever, headache, brain swelling,

impaired function, paralysis

At the Bronx Zoo, a similar problem emerged in wild and exotic birds

CDC confirmed same virus in CNS tissue specimens from

humans and birds

WNV

West Nile fever and encephalitis is caused by an

arthropod-borne virus (arbovirus)

West Nile virus

mosquito vector

bird reservoir

What is the primary reservoir of West Nile Virus?

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a

birds

b

ticks

c

mosquitoes

d

cats

e

fleas

birds

toxoplasmosis

an infection of the brain of humans

(and animal reservoirs)

caused by a protozoan parasite called Toxoplasma gondii.

Affects pregnant women, comes from an animal reservoir

neurotoxin

tetanus and botulism are paralytic diseases

caused by exposure to bacterial neurotoxins

Clostridium sp. (produces endospores)

G+ bacilli that reside in soil

endospores aid in survival in the environment

germination under anaerobic conditions

vegetative cells produce neurotoxins

tetanus

tetanus is caused by Clostridium tetani

puncture wounds (anaerobic environment)

neurotoxin = tetanospasmin

spastic paralysis

Lockjaw is the hallmark symptom

Tetanus is usually associated with deep tissue wounds (e.g. punctures) because these provide an environment that is ideal for germination of Clostridium tetani endospores and growth of the bacteria. A deep tissue wound is characterized as:

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a

anaerobic

b

aerobic

c

acidic

d

alkaline

e

hypertonic

anaerobic

how to get better with tetanus

wound cleaning

toxoid vaccine (DTaP)

10 yr boosters

passive immunization

botulism

botulism is caused by Clostridium botulinum

foodborne transmission

"sausage"

honey & infants

neurotoxin = botulin (this is what the toxins is called)

flaccid paralysis (what this toxin does is it prevents the release of that neurotoxin, so signal from brain goes down the nerve, contracts, but then it stops there. It never reaches the muscle, the muscle doesn't know the signal has been given, and it doesn't contract.)

botulism pt 2

food processing techniques & monitoring

passive immunization (given antibodies against neurotoxins

bioweapon? (could be, but they use military people's blood as antibodies)

Botox (this is the neurotoxin lol)

Tetanus and botulism are both paralytic diseases. These diseases differ, however, because tetanus is characterized by

blank1 - Word Answer - Type your answer and submit

paralysis, whereas botulism is characterized by

blank2 - Word Answer - Type your answer and submit

paralysis.

spastic and flaccid

endocarditis

endocarditis = infection & inflammation of heart valves

septicemia (bacteremia) = blood infection

acute endocarditis

acute endocarditis is typically caused by S. aureus

(sometimes S. pyogenes or S. pneumoniae)

The s for those two stand for streptococcus

bacteria enter bloodstream via parenteral route

bacteria colonize healthy heart valves and form

fibrin-platelet vegetations (biofilm)

A bacterial blood infection is called

blank1 - Word Answer - Type your answer and submit

bacteremia

Symptoms of acute endocarditis

acute onset of symptoms- fever and abnormal heartbeat

high fatality rate- bacteremia and embolism (clot)

treatment

high-level i.v. antibiotics in bloodstream

surgical debridement of valves in extreme cases

subacute endocarditis

subacute endocarditis is caused by oral streptococci

minor mucosal injuries, e.g., dental procedures

risk factors for colonization

prior heart valve damage

congenital malformations

administer prophylactic amoxicillin

before procedure

Which example would not be an appropriate use of antibiotic prophylaxis?

Select an answer and submit.

a

Prevent subacute endocarditis by giving antibiotics to person with heart valve defect before undergoing dental procedure

b

Prevent neonatal conjunctivitis by giving antibiotic eye drops to a newborn whose mother might have chlamydia

c

Prevent neonatal meningitis by giving antibiotics to a mother who carries group B strep so she will not pass it on to her newborn

d

Prevent infant botulism by giving antibiotics to a 6 month old child before eating raw honey

Prevent infant botulism by giving antibiotics to a 6 month old child before eating raw honey

vector disease

Vector transmitted, again, means spread by an arthropod vector during blood feeding.

lyme disease

1970s Old Lyme, Connecticut

fever, headache, fatigue, arthritis

Lyme disease is caused by

Borrelia burgdorferi

(G- spirochete)

tick vector (nymph)

deer & mice reservoirs

Lyme disease symptoms

70% of cases present with erythema migrans

bull's eye rash

secondary stage:

joints

cardiovascular

nervous

Rocky Mountain spotted fever

Rocky Mountain spotted fever (RMSF)

is characterized by an early measles- like rash and fever

disease attacks cardiovascular and nervous systems

Rickettsia rickettsia bacteria

tick vector

rodent & small mammal

reservoirs

Abscess (furuncle/carbuncle)

Cause: Staphylococcus aureus

Symptom: pus-filled lump

Spread: skin breaks

Tx: drainage + antibiotics

monkeypox

Pox-like lesions

Close contact

Ehrlichiosis

bacterial infection transmitted by ticks

Like cellulitis but raised, sharply bordered

Rubella (German Measles)

A highly contagious viral disease, especially affecting children, that causes swelling of the lymph glands and a reddish pink rash; may be harmful to the unborn baby of a pregnant woman who contracts it

Trachoma

chronic, contagious form of conjunctivitis that typically leads to blindness

Fifth disease

- Slapped cheek rash, fever, runny nose, headache

- Secondary rash may appear on body especially soles of feet.

- Weakened immune system = anemia, infections.

Keratitis

an inflammation of the cornea

Listeriosis

A disease of the nervous system of humans that can cause fever, meningitis, miscarriage, or premature birth and is spread by eating food contaminated with listeria

Which one of the following is a differential symptom for Lyme disease?

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a

measles-like rash

b

bull's-eye rash

c

petichiae

d

Koplik's spots

e

arthritis

bull's-eye rash

If a patient came to the hospital with a fever and a red-spotted rash, all the following questions would be useful to ask as you collect background information for diagnosis EXCEPT:

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a

Did you recently spend time in the wooded areas of western North Carolina?

b

Did you receive the MMR vaccine as a child?

c

Do you have a cat and regularly clean the kitty litter box?

d

Have you discovered any ticks on your skin recently?

e

Have you recently traveled to a state (e.g., Utah, Texas, South Carolina) experiencing a measles outbreak?

Do you have a cat and regularly clean the kitty litter box?

(before it was) AIDS

Pneumocystis Pneumonia - Los Angeles"

aids

extreme weight loss

Kaposi sarcoma (opportunistic infection)

Gay Cancer"

GRID (gay-related immune disorder)

4H disease (homosexual, heroin user, hemophiliac, Haitian)

the disease got an official name in July 1982

acquired immune deficiency syndrome (AIDS)

This weight loss product, called AYDS,

with the unfortunate catch phrase,

was discontinued after the new

naming of AIDS

Ryan White

hemophiliac

contracted HIV via blood transfusion in

1984 (age 13)

was refused admittance to Indiana

school in 1985

readmitted in 1986 under protest

died 1990 of respiratory infection

before graduating high school

Which statement about HIV/AIDS is true?

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a

HIV is transmitted by an arthropod vector

b

Only homosexual males develop AIDS following exposure to HIV

c

AIDS is characterized by a susceptibility to opportunistic infections

d

HIV cannot be transmitted vertically

e

AIDS is characterized by extreme weight gain

AIDS is characterized by a susceptibility to opportunistic infections

AIDS spread

AIDS was transmitted via a similar pattern to hepatitis B (viral)

sex, shared needles, transfusions

therefore, must be carried in blood & body fluids

the cause of AIDS was identified in 1983 by Luc Montagnier

(Nobel Prize 2008)

human immunodeficiency virus (HIV)

HIV is an enveloped virus with spikes

gp120 binds to CD4 (TH cells)

gp41- initiates entry by fusion

HIV in an RNA retrovirus

reverse transcriptase

RNA- DNA

integrase- viral latency

protease- assembly/maturation

CD4 is the host receptor for HIV. Therefore, the virus specifically infects and destroys , which leads to immune deficiency (AIDS).

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a

B lymphocytes

b

helper T lymphocytes

c

cytotoxic T lymphocytes

d

dendritic cells

e

natural killer cells

helper T lymphocytes

AIDS-defining illnesses (ADIs)

AIDS-defining illnesses (ADIs) are opportunistic infections

associated with defective immune system

pneumocystis pneumonia

Kaposi sarcoma

candidiasis

CMV

What can be done to deal with the AIDS pandemic?

limit contact

test blood

PrEP

pre-exposure prophylaxis

drug therapy

fusion inhibitors

RT inhibitors

integrase inhibitors

protease inhibitors