Term
| Neutrophilia and the "Left Shift" |
|
Definition
-Neutrophils (WBCs) are the body's primary defense.
-segmented neutrophils=mature form
-banded neutrophils=immature form
-Obtained from CBC with differential
-Left Shift=an increase in the relative number of immature forms of neutrophils (>10%)
-clinical marker of acute inflammatory/infection
-inc. b/c bone marrow keeps pumping out as others are being eaten
-Neutrophilia (leukocytosis) (condition of raised WBC count) w/o left shift may occur when the body is stressed (ex exercise, anxiety, "fight or flight") |
|
|
Term
|
Definition
-Skin
-Respiratory Tract
-GI tract
-Genitourinary Tract
-Blood |
|
|
Term
|
Definition
-Acid pH from normal flora and sebaceous gland secretion
-Mucous membranes
-Mucus (moistens and protects)
-Lysozymes
-Secretory antibodies (IgA) |
|
|
Term
|
Definition
-Ciliary action move particles out of the lung (move in one direction)
-Cough Reflex
-Mucous membranes protective factors |
|
|
Term
|
Definition
-Flushing and peristalsis
-releases a lot of water
-Saliva-digest food
-Stomach acid
Proteolytic digestive enzymes
-something the breaks down protenatious substance)
-Lysozymes and Secretory IgA |
|
|
Term
|
Definition
-Urine production provides flushing of microbes
-alter when put a catheter to measure how much is coming out
-can cause infection (E. Coli)
-Vaginal pH (acidic)
-Mucous membranes |
|
|
Term
|
Definition
-WBC's, antibodies (IgG,IgM), complement (activated by bacteria in bloodstream)
-Reticuloendothelial system
-Migrating RES (monocytes and macrophages)
-Sessile RES (Kupffer cells-liver and spleen-filter out bacteria and remnants) |
|
|
Term
| Most useful nomenclature for classification of bacteria |
|
Definition
-Gram Stain
-gram positive, gram negative
-Shape and configuration
-Cocci (chains, pairs and clusters), Bacilli (rod)
-Growth requirements
-aerobic and anaerobic |
|
|
Term
|
Definition
-Gram positive, aerobic
-Gram positive, anaerobic
-Gram negative, aerobic
-Gram negative, anaerobic
-Other |
|
|
Term
| Others (atypical bacteria) |
|
Definition
-Mycobacteria
-Mycoplasmas (ex. M. pneumoniae)
-Fungi (Candida albicans)
-Rickettsias (Rickettsia rickettsii-rocky mtn spotted fever)
-Spirochetes (Treponema pallidum)
-Viruses (HIV, Coronavirus-SARS) |
|
|
Term
| Bacterial Cell Wall Structure |
|
Definition
-Peptidoglycan layer
-Lipopolysaccharride layer
-Porin channels
-Periplasmic Space
-Penicillin binding proteins (PCB's)
-Drug altering/destroying enzymes
-plasmids
-chromosomes
-Nucleus (30s and 50s ribosome, DNA)
-areas to attack microorganism |
|
|
Term
|
Definition
-trick antibiotics to bind here instead
-run interference against antibiotics
-important form of resistance
-"tie up penicillins" |
|
|
Term
| PBP's (penicillin binding proteins) |
|
Definition
-enzymes that congregate around cell walls
-responsible for cross linking peptidoglycan strands
-when anitbiotic binds with PBP's it causes strands to be loose, cell wall looses structure, cell wall degraded in both + and - |
|
|
Term
|
Definition
| going after cell walls w/o affecting human cells |
|
|
Term
|
Definition
-peptidoglycan
-PBPs
-beta lactamases |
|
|
Term
|
Definition
-peptidoglycan
-lipopolysaccharide
-porin channel
-periplasmic space
-PBPs
-beta lactamses |
|
|
Term
|
Definition
-prod. exotoxins, just leak out b/c pourous
-peptidoglycan lattice work of protein and complex sugars..very pourous
-much more peptidoglycan than gram - |
|
|
Term
|
Definition
-less peptidoglycan-lots of lipopolysaccarhide (endotoxin)
-released when cell is broken down
-bacteria encased in intertube b/c lipid
-doesn't let anything in with a charge
-antibiotics tend to be lipophobic |
|
|
Term
|
Definition
| water filled, thought to be for releasing debris from metabolic processes |
|
|
Term
|
Definition
| structural intergrity of cell wall |
|
|
Term
|
Definition
gram (-), beta lactamase hang out here
-antibiotic comes into pourin channel to where high conc. of b. lactamase is |
|
|
Term
| drugs altering/destorying enzymes |
|
Definition
plasmids-pick up from organism
chromosomes-from "parent"
both are from genes |
|
|
Term
| peptidoglycan in gram (+) |
|
Definition
| gram + has a high amount of pressure, so peptido. helps keep everything inside cell |
|
|
Term
| Major mechanisms of bacterial antimicrobial resistance |
|
Definition
1) enzymatic inactivation or modification of drug
2) decreased drug uptake or accumulation
3) altered or lack of target receptor site
4) circumvention of drug action consequences |
|
|
Term
| 1) enzymatic inactivation or modification of drug |
|
Definition
-b. lactamase hydrolysis of b.lactam ring
-modification of aminoglycosides by acetylating, adenylating, or phosphorolating enzymes
-causes it to look completely different
-can't get through the cell wall, or if it does, the affinity for ribosomes is gone and no longer interacts |
|
|
Term
| 1) enzymatic inactivation or modification of drug |
|
Definition
-b. lactamase hydrolysis of b.lactam ring
-modification of aminoglycosides by acetylating, adenylating, or phosphorolating enzymes
-causes it to look completely different
-can't get through the cell wall, or if it does, the affinity for ribosomes is gone and no longer interacts |
|
|
Term
| 2) decreased drug uptake or accumulation |
|
Definition
-lack of outer membrane permeability (intrinsic or acquired)
-faulty or lacking antibiotic uptake and transport system
-antibiotic efflux system (ex, tetracycline resistance)
-outer membrane of microorganism changes and antibiotics can't get through
-common in drugs that are highly charged
-efflux system-drugs get in fine, but a pump inside cell drives drug out, conc. in cell too low |
|
|
Term
| 3)altered of lack or target receptor site |
|
Definition
-altered PBP's (b-lactam resistance)
-altered ribosomal target (aminoglycosides, macrolide, etc)
-altered enzymatic target (sulfas, trimethoprim, rifampin, and quinolone resistance)
-change chemical structure so "key" (antibiotic) doesn't fit
-some bacteria quit producing PBPs altogether |
|
|
Term
| 4) circumvention of drug action consequences |
|
Definition
| -hyperproduction of drug targets or competitive substrates (bactrim resistance) |
|
|
Term
|
Definition
-innformative (stain and morphology)
-rapid
-cheap |
|
|
Term
|
Definition
| SPECIFIC IDENTIFICATION of microorganism |
|
|
Term
|
Definition
| -determination of antibiotics susceptibility |
|
|
Term
| susceptibility testing techniques |
|
Definition
1) disk diffusion
2) dilution suseptibility testing
3) the E-test |
|
|
Term
|
Definition
Kirby-Bauer susceptibility test
-zone of inhibition (S, I, R) |
|
|
Term
| Dilution Susceptibility Testing |
|
Definition
-more quantitative
-determination of the MIC, MBC
-macro dilution by hand, micro dilution by machine |
|
|
Term
| Dilution Susceptibility Testing |
|
Definition
-more quantitative
-determination of the MIC, MBC
-macro dilution by hand, micro dilution by machine |
|
|
Term
|
Definition
-diffusion method allows determination of MIC
-give quantitative value
-strip impregnated with anibiotic, use diffusion to determine MIC |
|
|
Term
|
Definition
minimum inhibitory concentration
-when looses turbitiy, that value is MIC
-turbidity means it is growing |
|
|
Term
|
Definition
minimum bacteriocidal concentration
-kill off 99.9% most of the time |
|
|
Term
| Kirby-Bauer Disk Diffusion |
|
Definition
-zone of inhibition interpretive standard
-tetracycline
-National Committee on Clinical Laboratory Standards (NCCLS)
-standardizes
-Clinical and Laboratory Standards Institute (CLSI) |
|
|
Term
| Kirby-Bauer Disk Diffusion, Tetracycline values |
|
Definition
Resistant= Intermediate= 15-18mm
Susceptible= >/= 19mm
Disk Potency 30mcg of TCN |
|
|
Term
|
Definition
| MBC=MIC most of the time, or off by 1 or 2 |
|
|
Term
|
Definition
| anitbiotic conc. v. time, first order decay |
|
|
Term
| Killing Properties of Antibiotics |
|
Definition
-interval dependent killing
-concentration dependent killing |
|
|
Term
| interval dependent killing |
|
Definition
the antibiotic exerts its killing effect as long as the concentration remains above the MIC
-ex, b-lactams and vancomycin |
|
|
Term
| concentration dependent killing |
|
Definition
the antibiotic continues to exert its killing effect after the concentration has fallen below the bacteria's MIC (post antibiotic effect). The HIGHER the PEAK, the GREATER THE KILLING EFFECT.
-ex, aminoglycosides and fluoroquinolones |
|
|
Term
| Things to keep in mind about MIC |
|
Definition
-hard data, readily reproducible
-clinical application can be tricky
-in vivo vs. in vitro
-MIC does not automatically translate into a successful clinical outcome
-should MIC's be reported? |
|
|
Term
|
Definition
| easy to find MIC, but hard to find MBC |
|
|
Term
| bacteriocidal v bacteriostatic |
|
Definition
bacteriocidal-however antibiotic interacts with organism, it has the ability to kill
bacteriostatic-drugs inhibit protein sysnthesis, slow down but do not kill, slow down and then have immune system kick in |
|
|
Term
|
Definition
may find need to take into consideration, numbers may be misleading
-the general practice=don't report it |
|
|
Term
| factors that can change the MIC |
|
Definition
-innoculum of bacteria used
-MIC increases as number of bacteria goes up in a sample
-composition of broth or agar
-needs to be consistent
-temperature, pH, osmolarity
-clinical examples where in-vitro activity does no predict clinical efficacy
-MRSA (methylcillin resistant Staph. Aureus)-gained activity by blocking b.-lactamase then receptor changed so cephalosporins could no longer have any effects
-Enterococcus-cephalosporins
-Meningococcus-cephalosporins
-often causes meningitis, need to get adequate amts of drug to get into brain, cephalosporins don't really get into brain well |
|
|
Term
| other information to go along with the MIC |
|
Definition
-does the antibiotic get to the site of infection in adequate amounts
-what concentrations are necessary to kill bacteria tolerable to the anitbiotic
-does the antibiotic penetrate inside cells where bacteria often proliferate (ex, intracellular infections) |
|
|
Term
|
Definition
-generally useful when the antibiotic has a "narrow therapeutic window"
-the effective level is close to level that produces toxicity
-aminoglycosides-elimination solely by kidneys so if kidney failure occurs, dosing must also (nephrotoxicity/ototoxicity)
-vancomycin (same) |
|
|
Term
| Antibiotic elimination from the body |
|
Definition
many antibiotics are cleared from the body through the kidneys
-correlation b/n rate of elimination of the drug expressed as the half-life and kidney function
-kidney function is estimate by the creatinine clearance |
|
|
Term
|
Definition
breakdown product of skeletal muscle
-eliminated through the kidney
-if creatinine is not being eliminated as if normal than serum creatinine goes up=way to tell if abnormal kidney function |
|
|
Term
| to collect creatinine clearance |
|
Definition
-must collect urine for 24 hours, must collect at certain time and stop at certain time
-estimate may be inaccurate |
|
|
Term
|
Definition
-cocci
-Staphylcoccal species
-Streptococcal species
-Enterococcal species |
|
|
Term
-gram + aerobe
-MOST VIRULENT of the Staph species
-most produce penicillinase (b-lactamase) mediated by plasmids (or chromosome itself)
-penicillinase-resistant penicillin (methicillin) and cephalosporins are effective against this type of resistance |
|
Definition
Staphylcoccus aureus
-"aureus"=golden color on agar plates |
|
|
Term
-gram + aerobe
-part of normal skin flora
-coagulase negative
-"S. albus" white pigmentation on agar
-usually a colonizer
-diseases assoc. w./immunocompromised, vilolation of natural barriers, implantation of foreign devices |
|
Definition
| Staphylococcus epidermidis |
|
|
Term
|
Definition
only for staph
-distinguish b/n s. aureus and other staph organisms
-s. aureus is the only coagulase organism out of staph organisms |
|
|
Term
-free living in nature
-may colonize the skin
-coagulase negative, rarely causes infection in healthy individuals
-most noted as a cause of urinary tract infection in women |
|
Definition
| Staphylococcus saprphyticus |
|
|
Term
| s. epidermidis in the urine |
|
Definition
| usually a sign of contamination |
|
|
Term
-furunculosis ("boil")
-carbuncle
-bullous impetigo
-paronychia
-deep lesions |
|
Definition
|
|
Term
-pyrogenic supprative lesions-produce pus and absecesses
-infection of the hair follicle or sweat gland
-acne vulgaris
-stye (infection of the base of the eyelash) |
|
Definition
|
|
Term
-spreading of lesions to subq tissue, very serious, can lead to bloodstreams infection
-expanding furuncle, may have furuncul growing together-leave scars |
|
Definition
|
|
Term
| important characteristic of a staph infection |
|
Definition
production of pus and absecesses
-imp. to lance, drain, and then clean it out
-must do b/c antibiotic alone have a hard time getting to and also have extreme pHs to inhibit antibiotics |
|
|
Term
-highly communicable, superficial skin infection
-lg blisters containing viable staph
-seen mostly in infacts and children under conditions where infections can easily be spread through touch contamination |
|
Definition
|
|
Term
infection of soft tissue around the nails
-brought on by banging the nail, damage under the nail, blood under nail, good growth medium, usually fungus, breaks down skin even more, s. ep. colonizes, cephalitis |
|
Definition
|
|
Term
tissue destruction with abscess formation of deep tissues
-high rate of mortality
-40-45% resistant
-increased risk in diabetes, alcoholism, malignancy, old age, steroid or cytotoxic therapy, etc. |
|
Definition
| deep lesions (staphylococcal infections) |
|
|
Term
| examples of deep tissue infections |
|
Definition
-osteomyelitis-bone infections, us. from breaking bone
-septic arthritis-joint infection
-cerebral, pulmonary and renal abscesses
-breast abscesses
-bacterial pneumonia
-endocarditis
-eterocolitis |
|
|
Term
|
Definition
staph septicemia (gets into bloodstream)
-death of soft tissue |
|
|
Term
| diseases caused by staphyloccal toxins |
|
Definition
-scalded skin syndrome (Ritter's disease)
-toxic shock syndrome
-staphylococcal food poisoning |
|
|
Term
|
Definition
-gram +
-spherical or oval shaped
-chains or pairs
-comprise significant portion of the indigenous microflora of humans and animals (mostly GI tract; some respiratory tract)
-rarely cause disease (commensual->opportunistic) |
|
|
Term
| 3 very important human pathogens (streptococcus) |
|
Definition
-streptococcus pyrogenes
-streptococcus pneumoniae
-streptococcus agalactiae |
|
|
Term
| Further classification of streptococcus |
|
Definition
-Lancefield groups
-Brown groups |
|
|
Term
|
Definition
| based on the antigenic characteristics of the outer membrane. 14 common groups designated by letters of the alphabet (groups A through R-no I) |
|
|
Term
|
Definition
-streptococci are grown on sheep's blood agar producing 3 patterns of hemolysis around the colonies
alpha, beta, gamma |
|
|
Term
|
Definition
| green zone indicative of "incomplete hemolysis"-S. pneumoniae, S. viridians |
|
|
Term
|
Definition
| clear zone indicative of "complete hemolysis"-S. pyogenes, most S. agalactiae |
|
|
Term
|
Definition
"non hemolytic", most group D streptococci
-no zone around colony |
|
|
Term
| clinical classification of streptoccocus |
|
Definition
-combines the lancefield and brown groupings and disease producing characteristics
-s. pyogenes-group A, beta hemolytic Strep |
|
|
Term
|
Definition
| enterococcal and non-enterococcal |
|
|
Term
Accounts for 40 million MD office visits yearly
-Pathogens:
-Group A streptococcus (15%)
-other hemolytic streptococci
-arcanobacterium hemolyticum
-neisseria gonorrhea
-chlamydia pneumoniae
-epstein-barr virus (mononucleosis)
-other |
|
Definition
Pharyngitis
-viruses cause more sore throat than bacterial |
|
|
Term
| diagnostic focus with pharyngitis |
|
Definition
-rule in or rule out Group A streptococci
-Rapid Strep Test
-Gold Standard (culture and susceptibility of throat swab) |
|
|
Term
| rapid strep test-good sensitivity |
|
Definition
| (90%)-means if test is positive, 90% chance that a streptococcal infection is occuring |
|
|
Term
| rapid strep test-fair sensitivity |
|
Definition
(60%)
-means if test is negative, there is a 40% chance that you missed a strep infection |
|
|
Term
| Steps for diagnosing pharyngitis |
|
Definition
1) Rapid Group A streptococcus screen
-if positive:
-treat for strep. pharyngitis
-if negative:
-perform throat culture
-if positive, treat for streptococcal pharyngitis
-if negative, symptomatic treatment |
|
|
Term
| concerns with pharyngitis |
|
Definition
-condition is usually indistinguishable from viral infections
-if group A, beta hemolytic strep, concern arises over immunological sequella (consequence of disease)
-Rheumatic fever (heart valve disease)
-more common w/strep pharyngitis
-Acute glomerulnephritis (chronic renal failure)
-more common w/strep impetigo
-attack and cause kidney damage |
|
|
Term
|
Definition
(heart valve disease), v. rare now
-usually happens to children
-may end up with a heart murmur
-antigens bind to valve
-may want to put on prophylaxis penicillin for a lifetime so never get strep again |
|
|
Term
streptococcal disease
-localized infection of healthy skin
-usually affects kids 2-5 yrs
-vesicles are contagious, but lesions do not usually result in scarring
-staph aureus sometimes a secondary invader
-nephritogenic strains
-first acute, the |
|
Definition
|
|
Term
-streptococcal disease
-streptococcal infection of the skin and subcutaneous tissues (dermis)
-spreading areas of erythema and pain w/systemic manifestations of fever and lymphadenopathy
-usually a recent history of a sore throat |
|
Definition
erysipelas
-gets into dermis |
|
|
Term
|
Definition
usually on the face, serious infection requiring antibiotics (PCN, iv)
-butterfly shape may be a result of sun damage |
|
|
Term
| Other streptococcal diseases |
|
Definition
-necrotizing fasciitis (skin eating strep)
-wound and burn infections
-puerperal infection
-scarlet fever
-immunologic sequella
-rheumatic fever
-acute glomerulonephritis |
|
|
Term
-streptococcal disease
-strep gets into tissue and goes in all directions
-v. warm lesion
-may be a result fr sm cut |
|
Definition
|
|
Term
Streptococcus agalactiae (group b)
and treatment |
|
Definition
-a leading cause of pneumonia, sepsis, and meningitis during first 2 mo. of life
-incidence 1-3 cases per 1000 births
-mortality ~30-60%
-immediate perinatal period infections caused by contamination of infant w/birth canal
-women may harbor group b strep, if child is born and has a traumatic birth, put on immediately if mom is +
-late onset disease (3-8 weeks post-partum lower mortality rate-not enough maternal IgG)
treatment:penicillin and aminoglycoside |
|
|
Term
Streptococcus pneumoniae
-pneumococcal pneumoniae and treatment |
|
Definition
-most common cause of bacterial pneumonia
-alph step
-mortality increases sharply after 50 yrs
-co-morbidities increases mortality rates:
-alcoholism
-diabetes mellitus
-chronic renal disease
-some malignancies
-transplantation
Treatment: getting more complicated |
|
|
Term
streptoccus pneumoniae
-pneumococcal meningitis |
|
Definition
| -one of the big three causes of bacterial meningitis and the most common |
|
|
Term
| Big 3 causes of bacterial meningitis |
|
Definition
1) Pneumococcal meningitis (step pneumoniae) most common
2) H. flu
3) N. meningiditis
all also have capsules |
|
|
Term
streptococcus pneumoniae
URI |
|
Definition
| -common cause of sinusitis and otitis media |
|
|
Term
| other infections of streptococcus pneumoniae |
|
Definition
endocarditis
arthritis
peritonitis (inflammation of intestines) usually following bloodstream infections |
|
|
Term
| NCCLS Guidelines of Strep pneumoniae to penicillin G |
|
Definition
-drug suseptible strep pnuem. (DSSP)
-penicillin G
-drug intermediate sus. strep pnuem.
-MIC >/= .1<1.0, high dose Pen G or amoxicillin or ceftriaxone for non-meningeal sites
-drug resistant strep pneumoniae
-MIC >/=2.0 |
|
|
Term
| Prevention of Streptococcus pneumoniae |
|
Definition
-Prevention
-vaccine developed against most common disease producing capsular antigens
-high risk patients:elderly >65 yr, underlying diseases affecting immune status |
|
|
Term
| Two vaccines developed for streptococcus pneumoniae |
|
Definition
-Pneumococcal conjugate vaccine, 7 valent (7 distinct strains it will protect you against)
-strictly a pediatric vaccine
-Pneumococcal Polysaccharide Vaccine, 23 valent
-covers 98% of disease causing strains
-pneumovax 23, pneu-imune 23-for children >2 yr of age and high risk adults
-does not stimulate antibody titers like 7 valent does |
|
|
Term
|
Definition
alpha streptococci
-large group of streptococci with no lancefield degination but with an alpha hemolytic characteristic
-are major constituents of the mouth and pharynx
-subacute bacterial endocarditis
-v. rare, taking antibiotics before dental procedures helps to protect |
|
|
Term
|
Definition
E.faecalis (85%) (most prevalent)
E. faecium (15%)
others
-gamma hemolysis
-normal inhabitants of GI tract and able to survive harsh conditions (spread by touch contamination)
-can be very resistant
-many times must treat with combinations of antibiotics (synergy)
-2 antib. help out better
-opportunistic organisms capable of causing UTIs, wound infections, endocarditis in damaged heart valves |
|
|
Term
| enterococcus and resistance |
|
Definition
-one of the most highly resistant organisms today
-synergistic combinations are losing effectiveness
-vancomycin resistant enterococcus (VRE)
-enterococcus faecium
-some evidence that the resistance factors can be passed on to more virulent organisms (staph aureus)
-this is the reason we try to limit our use of vancomycin, why we closely follow resistant patterns and why we try to implement infection control |
|
|
Term
| first to break through vancomycin |
|
Definition
|
|
Term
| importance of oxygen for aerobes and anaerobes |
|
Definition
-molecular oxygen is very reactive and toxic
-H2O2-hydrogen peroxide
-O2 super oxide radicals
-OH- hydroxyl radicals
-Macrophages pour oxygen radicals over bacteria
-three enzymes break down radicals
-if bacteria has it, they will be resistant |
|
|
Term
| oxygen radical enzymes, more enzymes present, more aerobic |
|
Definition
-catalase
-peroxidase
-superoxide dismutase |
|
|
Term
|
Definition
absolutely require oxygen
-energy derived from glycolysis, Krebs Cycle
-oxygen is final electron acceptor in ETC
-have all the enzymes, oxygen not toxic |
|
|
Term
|
Definition
-aerobic
-oxygen is electron acceptor
-positive for catalase and peroxidase (2 of 3 enzymes)
-can grow in the absence of oxygen through fermentation derived energy
-prefer oxygen but have the "faculty" to grow in anaerobic conditions |
|
|
Term
|
Definition
| facultative anaerobes or microaerophilic bacteria (aerotolerant anaerobes) |
|
|
Term
microaerophilic bacteria
(aerotolerant anaerobes) |
|
Definition
-use fermentation for energy
-no electron transport system
-can "tolerate" low amounts of oxygen b/c they have superoxide dismutase (only 1 of 3 enzymes)
-no catalase or peroxidase |
|
|
Term
|
Definition
-cannot thrive in the presence of oxygen (no enzymes available to defend against it)
-blood cultures for these anaerobes are put into special bottles that are oxygen free (anaerobic culture bottles) |
|
|
Term
|
Definition
|
|
Term
staph
corynebacteria
listeria
B. anthracis |
|
Definition
| gram +, facultative anaerobes |
|
|
Term
|
Definition
|
|
Term
|
Definition
| gram +, obligate anaerobes |
|
|
Term
neisseria
pseudomonas
legionella |
|
Definition
|
|
Term
| most other gram negative rods |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| gram -, obligate anaerobes |
|
|
Term
|
Definition
| acid fast, obligate aerobes |
|
|
Term
|
Definition
| no cell wall, facultative anaerobe |
|
|
Term
|
Definition
|
|
Term
|
Definition
has any ability to survive in presence of oxygen
-obligate aerobe, facultative aerobe, and microaerophilic |
|
|
Term
|
Definition
-clostridia
-streptococcus-related gram positive cocci (SRGPC) |
|
|
Term
|
Definition
-all are spore forming organisms
-gram + anaerobes
C. botulinum
C. tetani
C. perferingens
C. difficile |
|
|
Term
|
Definition
-botulism
-neurotoxins cause "flaccid" paralysis
-babies and honey, spores in honey-toxin released, babies paralyzed |
|
|
Term
|
Definition
tetanus
neurotoxins cause rigid paralysis
-lock jaw, put on high doses of benzodiazepines to relax, w/o treatment, eventually quit breathing |
|
|
Term
|
Definition
gas gangrene
-exotoxins destroy skin, softr tissue and musscles
-once necrotic, no blood or oxygen to tissue, irreversible
-traumatic wounds, symptoms w/in 24-48 hr |
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Term
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Definition
-pseudomembranous enterocolitis
-exotoxin A causes diarrhea
-no pseudomembrane
-exotoxin B is cytotoxic-dehydration from diarrhea
-interacts with membrane of GI-creates a pseudomembrane (not permeable) over it-stops colon from doing its work (reclaiming water from feces)
-superinfection of the intestines caused by antibiotics which wipe out the normal GI flora
-clindamycin wipes out normal flora
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Term
| Streptococcus related gram positive cocci (SRGPC) |
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Definition
aka anaerobic strep, peptostreptococcus
-many species but few are important pathogens in humans
-peptostreptococcus is the most significant pathogen recovered in clinical specimens and recovered as often as bacteriodes fragilis
-recovered in abscessed cavities of the body (harbor anaerobes) |
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Term
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Definition
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Term
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Definition
-most abundant bacteria of the lower GI tract (colon). Outnumbers E. Coli 1000 to 1.
-Beta lactamase producer
-is instrumental in the development of intraabdominal abscesses
-has been a target organism in the development of broad spectrum antibiotics |
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Term
| Bacteroides melaningogenicus |
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Definition
-found in oral cavity and upper respiratory tract
-dental, sinus, pulmonary infections, abscesses, HUMAN BITES
-some are beta-lactamase producers
-grow in mouth, esp under plaque-inflammation, gingivitis, infection forms |
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Term
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Definition
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Term
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Definition
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Term
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Definition
Neisseria Sp.
moraxella catarrhalis |
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Term
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Definition
| gram - diplococci, two pathogenic strains and many commensals |
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Term
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Definition
(meningococcus)
-major cause of meningitis, exclusively affecting humans
-can be a harmless member of the normal flora (10-30% of healthy adults are carriers)
-serogroups A,B,C,Y, and W135 are most commonly assoc with clinical disease
-serogroups B & C account for 75% of outbreaks
-peak incidence occurs b/n 6mo and 5 yrs but also occurs in pop. living closely together (military)
-tansmission by droplet nuclei (sneezing, coughing)
-last epidemic:Brazil (1971), last USA epidemic 1946
-encapsulated bacteria resists phagocytosis, contributes to virulence, need for vaccine protection
-mortality 100 % if untreated, 15% if treated appropriately |
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Term
| Neisseria meningiditis and sepsis |
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Definition
-coagulopathy destroys major organs
-adrenal gland destruction: waterhouse-frederickson syndrome |
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Term
| Treatment of neisseria meningiditis |
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Definition
| high dose penicillin G, alternative 3rd generation cephalosporins, chloramphenicol |
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Term
| prophylaxis of neisseria meningiditis |
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Definition
-rifampin 600mg bid x 2 days for adults
-controversial
-diff drug b/c treating person trying to get to brain
-rifampin gets into saliva in high conc, can knock out there |
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Term
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Definition
-1 mill new cases ev yr, prob a severe underestimate
-transmission by sexual contact, maj reservoir in asymptomatic infected persons
-highest incidence among 20-24yrs of age
-50% of women are infected after sigle exposure
-50% of women are asymptomatic, 15% may develop PID, fallopian scarring, sterility, ectopic pregnancy
-20% of men are infected after single exposure
-10% are asymptomatic, <1% developing complications:prostatitis, uretheral stricture, epidimitis
-Chlamydia trachomatis is oftentime a co-infection and should also be treated |
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Term
| treatment for neisseria gonorrhea |
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Definition
-b-lactamase production has complicated treatment
-ideal treatment involves >95% erradication rate with a single dose
-regimen depends on site of infection and whether infections is complicated or uncomplicated
-selected 2nd or 3rd generation cephalosporins, fluoroquinolones, spectinomycin are all effective |
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Term
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Definition
aka branhamella catarrhalis
-aerobic, gram -, diplococci, resembles neisseria sp
-low pathogenicity, but increasing concern in URIs snf pneumonias, esp in patients with chronic bronchitis
-nasal cavity is its natural reservoir
-COPD,CAP, acute otitis media, sinusitis, urethritis, invasive diseases in immunosuppressed patients
-usually localized but can be invasive
-lipo-polysaccharide contributes to virulence but is diff in structure from the lipopolysaccharide of the enteric gram - bacilli (enerobacteriaceae) |
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Term
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Definition
-blindness,
-prophylaxis with silver nitrate solution 1%
-treatment ceftriaxone 25-50 mg/ky single dose neisseria gonorrhea
-90% neisseria gonorrhea effective in one dose |
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Term
| treatment for moraxella catarrhalis |
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Definition
-used to be exquisitively sensitive to penicillin
-1980s beta lactamase producers (chromosomally anad plasmid mediated)
-most remain sensitive to erythromycin, tetracyline, amoxicillin/clavulanic acid (augmentin), and cephalosporins (none are more superior over others)
-most infections involve oral mucosa, oral antibiotics are usually OK. pneumonia/bacteremia-parenteral AB's (intravenously) |
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Term
| gram negative bacilli (enterobacteriaceae) |
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Definition
enteric bacilli, aerobes
-large, diverse group ofgram neg rods found in nature and as part ofthe nromal flora of man and animals
-most are upportunistic pathogens but some strains are highly and specifically pathogenic (E coli)
-colonization of the human GI tract but can cause disease
-colonization of human GI tract but can rarely cause disease
-do not colonize the GI tract but do cause disease when present
-Salmonella, shigella, some E. coli, and yersinia species are truely pathogenic
-causative organisms of gram - species
-lipo-polysaccharide (endotoxin) contained in cell wall and is the initiating (virulence) factor in development of gram - sepsis
-enteric common antigen
-chromosomal and plasmid mediated resistance to antibiotics is common and treatment is guided by results of cultures and sesitivities (susceptibility) |
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Term
| enteric common antigen (enteric bacilli) |
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Definition
antibodies can bind to antigens that were released when organism were broken down
-only worked for gram - enterobacteriacae
-very expensive-FDA said too hard to id, and when you had it was too late |
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Term
| Escherichia coli (non-diarrheagenic) |
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Definition
-typical or common EC
-normal flora
-most common cause of UTI
-causes opportunistic infections (breach of natural barriers pathologically or iatrogenically)
-some quite severe (septic shock-trigger is lipopolysaccharide) |
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Term
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Definition
| the most abundant organism found in normal flora followed by klebsiella species, proteus species, and enterobacter sp |
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Term
| E. coli causing enteric infections (diarrheagenic) |
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Definition
-Entrotoxogenic-ETEC
-Enteropathogenic-EPEC
-Enteroinvasive-EIEC
-Enterohemorrhagic-EHEC, EC O157:H7
-Enteroaggregtive-EAggEC |
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Term
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Definition
-tainited water supply
-travellers diarrhea, foreign travel, profuse, watery diarrhea |
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Term
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Definition
| watery diarrhea, N & V, fever, children <2 yrs, adults |
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Term
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Definition
| -foreign travel, watery diarrhea, rarely dysentery (scant stool, blood, mucus, leukocytes in stool, fever and cramps) |
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Term
| Enterohemorrhagic (EHEC,EC O1575:H7) |
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Definition
-common in cows, esp ground beef
-diarrhea, hemorrhagic colitis, undercooked ground beef, potentially fatal in very young, elderly, immunosuppresed
-causes RBCs to break down
-when rapid breakdown, free hemoglobin from massive RBC breakdown gets into kidneys, can't filter, clogs kidney, renal failure |
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Term
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Definition
| chronic and acute diarrhea, vomiting, affects all ages, source unknow |
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Term
| Klebsiella-enterobacter serratia group |
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Definition
-enteric bacilli
-gram - rods
-enterobacter cloacae
-seratia marcescens |
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Term
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Definition
gram -
-kelbsiella enterobacter serratia group
-virulence
-endotoxin
-multiple antibiotic resistance mechanisms including beta lactamase
diseases: UTIs=pyelonephritis (kidney inf) and cystitis (infl of bladder)
-nonsocomial pneumonias (ventricular assoc) and bacteremia |
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Term
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Definition
klebsiella-enterobacter serratia group
-virulence
-endotoxin
-red pigment strains may be more virulent
-multiple mechanisms of antibiotic resistance including beta lactamase production
-diseases: UTIs-pyelonephritis and cystitis, nosocomial pneumonia and bacteremia, infective arthritis-from intra-auricular injections |
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Term
| Proteus mirabilis (indole positive) |
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Definition
-gram neg, enteric bacilli
-virulence: endotoxin, flagella produce "swarming appearance", urease prod.
-some b lactamase prod
disease:
-UTIs-cystitis and pyelonephritis
-Urolithiasis-all proteus sp. prod urease which split urea, generates ammonia, alkalinizes the urine, precipitation of magnesium and ammonium phosphate, staghorn calculi
-kidney stones, only way to treat is to open up kidney and get out
-proteus vulgaris, morganella morganii, providentia rettgeri, and providentia stuartii (indole neg) |
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Term
| gram neg aerobic enterobacteriaceae, true pathogens |
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Definition
-salmonella typhi
-salmonella enteriditis
-shigella dysenteriae
-yersinia pestis |
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Term
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Definition
-not in GI naturally, must be put there
-Virulence:
-endotoxin
-capsule-resists antibodies and complement
-survives within macrophages but not neutrophils
-mult mechanisms of drug resistance
-invasion of mucus layer and epithelial cells of intestines
Disease:
-enteric fever (Typhoid fever)- steady invasion of GI tract to lymphatic system to bacteremia
-untreated cases-highly fatal
-"carrier state" (typhoid mary)
-shed bacteria through bile |
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Term
| how many antibiotics prod are used in humans |
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Definition
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Term
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Definition
eneterobacteriaceae-gram - rods
-virulence:
-endotoxin
-invasion
-survives macrophages but not neutraphils
-multiple drug resistance
-Disease:
-water diarrhea with fever, N & V, usually self-limiting
-bactermia occaisionally
Transmission:
-fecal/oral, contaminated food-eggs, milk, poultry, kitchen sponges/towels/untensils |
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Term
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Definition
gram - enterobacteriacae rods
Virulence:
-enterotoxins-Shiga A and B
-endotoxins
-invasion
-resists stomach acid (extremely contagious)
Disease:
-dysentery (shigellosis)-watery diarrhea, fever, N&V,
-can be fatal to sm children
-Transmission: fecal/oral-exteremely contagious requiring v. sm amts of bacteria |
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Term
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Definition
-coccobacilli (pleomorphic)
-virulence:
-exotoxin
-endotoxin
-capsule (resists phagocytosis)
-enzymes-coagulase and fibrinolysin
Disease:
-bubonic plague (black plague, pneumonic plague)
-rapidly fatal disease, fever, chills, sudden onset, bacteremia and sepsis, vasculitis and gangrene (black death)
Tansmission:
-infected fleas |
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Term
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Definition
-gram - coccobacilli, non-enterobacteriaceae
Virulence:
-endotoxin
-capsule-only on type B strain-vaccine
-surface enzymes
-Beta lactamase producer
Disease:
-young children and the elderly
-alcoholism, smoking and COPD
-meningitis-#1 cause in children 6mo to 6 yr (mostly assoc w/type B strain)
-epiglotittis-#1 cause in young children
-swells so much it can cause death
-sinusitis and otitis media
-purulent conjunctivitis
Vaccine: against type B strain, polysaccharide with conjugated protein carrier |
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Term
| pseudomonas aeruginosa and burkholderia |
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Definition
gram neg
Virulence:
-exotoxins
-endotoxins
-proteolytic enzymes, elastase
-Mult anitbiotic resistance mech-extremely challenging organism to kill
-most ways to create resistance
-Harbored in moist environments-hot tubs, swimming pools (swimmers ear)
-cystic fibrosis |
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Term
| pseudomonas aeruginosa and burkholderia disease and treatment |
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Definition
disease:
-pneumonia (necrotizing and bronchopneumonia)
-burn wound infections-black or green discolorizing
-endocarditis-IV drug abusers
-UTIs-cystitis and pyelonephritis
-bacteremia-esp in immunocompromised patients
-external otitis
-corneal kerartitis
-hot tub folliculitis-pseudomonas inf in hairs
-osteomyelitis-inf of bone
Treatment:
-usually requires mult antibiotic b/c no single agent covers more than 80% of isolates |
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