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Microbiology 2010
Medical Microbiology 2010
1360
Microbiology
03/25/2010
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Term
Most protozoa are facultative intracellular pathogens. Name one that must be extracellular.
 Definition
Giardia spp.
1-7
Term
Name the five general types of infectious etiologies.
 Definition
Bacteria
Viruses
Fungi
Parasites (Protozoa, Helminths, Ectoparasites)
Prions
CC 1-2
Term
A bacteria that is found somewhere on the human body can be placed into one (or more) of 3 general roles. What are they?
 Definition
Colonizer
Opportunist
Pathogen
CC 1-2
Term
What are 5 general ways that we can identify bacteria, viruses, fungi and parasites?
 Definition
Appearance
Culture
Antigen recognition
Biochemical properties
Genetic detection
CC 1-3
Term
What are 4 processes that cause disease during an infection that are caused directly by the pathogen (and 1 additional one by the host)?
 Definition
The pathogen: Uses our energy Produces waste products and toxins Destroys human tissue Obstructs vital organs (Our immune response causes side effects) CC 1-3
Term
How should a blood culture be collected?
 Definition
At two different sites at two different times.
CC 1-4
Term
when you culture, how can you prevent contamination?
 Definition
  1. Blood should be collected at two different sites at two different times

CC1-4

 
Term
Name the 4 Koch's postulates.
 Definition
Organism found in disease animal but not healthy
Organism can be grown in pure culture
Organism causes same disease when inoculated into healthy animals
The organism can be recovered again from these animals
1-3
Term
Name 4 limitations of Koch's postulates.
 Definition
You can't culture all organisms away from the host
There are not animal models for every infectious human disease
Some diseases have multiple infectious etiologies
Humans can be normal carriers of organisms that are pathogens
1-3
Term
What is the focus of molecular Koch's postulates?
 Definition
To find factors that are important in the pathogenesis of infectious disease, such as toxins, adhesins, etc.
1-3
Term
Define virulence with reference to molecular Koch's postulates.
 Definition
The number of organisms required to start an infection.
1-4
Term
What are the 3 requirements to fulfill molecular Koch's postulates?
 Definition
The phenotype associated with the gene associated with virulent strains
Inactivation of gene leads to loss of virulence
Restoration of gene should restore virulence
1-4
Term
How can you inactivate a gene experimentally when trying to fulfill molecular Koch's postulates?
 Definition
Use of transposons that implant into the middle of a gene.
Term
What are the two kinds of infectious disease?
 Definition
Infection and intoxication.
1-5
Term
Which 6 steps may be included in the infectious cycle?
 Definition
Pathogen entry into the body
Pathogen adherence and colonization
Pathogen invasion through epithelium (sometimes)
Pathogen evasion of host defenses
Cell/tissue damage
Dissemination of pathogen
1-6
Term
Name 3 advantages that a bacterium may have if it is an intracellular pathogen.
 Definition
Nutrients available in host cytosol
Protected from immune system (initially)
Protected from some antibiotics
1-6
Term
Name the major disadvantage for a bacterium if it is an intracellular pathogen.
 Definition
It requires a lot of energy and factors taking up a lot of the bacterium's DNA to evade mammalian defense mechanisms against intracellular pathogens (CTL, NK, apoptosis, etc)
1-6
Term
Name 3 bacteria that are obligate intracellular pathogens.
 Definition
Mycobacterium leprae
Chlamydiae spp
Rickettsia spp
1-7
Term
Name 5 bacteria that are facultative intracellular pathogens.
 Definition
Salmonella spp
Shigella spp
Listeria monocytogenes
Legionella spp
Mycobacterium tuberculosis
1-7
Term
Name three bacteria (or groups of bacteria) that are obligated to be extracellular pathogens.
 Definition
Gram positive (except Listeria monocytogenes)
Vibrio cholerae
Treponema pallidum
1-7
Term
Most fungi are facultative intracellular pathogens. Name one that must be extracellular.
 Definition
Cryptococcus spp.
1-7
Term
 Definition
Term
T/F. Bacteria are universally larger than viruses.
 Definition
False. The pox virus is larger than Mycoplasma pneumoniae.
2-3
Term
Which bacterium does not have peptidoglycan in its cell wall?
 Definition
Mycoplasma spp. And probably Chlamydiae spp.
2-3
Term
Name 3 bacteria that have sterols in their cell membrane.
 Definition
Mycoplasma, Helicobacter pylori, and Borrelia burgdorferi.
2-3
Term
Name 2 bacteria that are incapable of making their own energy.
 Definition
Rickettsiae and Chlamydiae.
2-3
Term
Name the basic bacterial morphology and arrangements.
 Definition
Rods
Spirochtes
Cocci: Diplococci, chains, clusters
2-4
Term
Name 4 structures that lie external to the cell envelope in a typical bacterium.
 Definition
Sex pilus
Capsule
Common pili
Flagella
2-4
Term
Name the components of the cell envelope.
 Definition
Plasma membrane
Cell wall
Outer membrane (if present)
2-4
Term
What is the function of the common pili on the external surface of a bacterium?
 Definition
Attachment to tissue
2-4
Term
What is the function of a capsule of a bacterium?
 Definition
Antiphagocytic
Possibly biofilm formation
2-5
Term
Name the two alternating units that form the peptidoglycan layer in bacteria.
 Definition
N-acetylglutaime (NAG or GlcNAc)
N-acetylmurein (NAM or MurNAc)
The cross links form on the murein units
2-6
Term
Name the enzyme responsible for crosslinking the pentapeptide bridges in peptidoglycan cell walls of bacteria.
 Definition
Transpeptidase (or penicillin binding proteins PBPs)
2-6
Term
After the mordant step of the gram stain, a G neg cell will appear the color...
 Definition
Purple. It will lose the purple color after the subsequent decolorizing step.
2-7
Term
Name the four steps of the gram stain procedure.
 Definition
Stain (Crystal violet)
Mordant (Iodine)
Decolorize (Ethanol or Acetone)
Counterstain (Safranin)
2-7
Term
Name the 2 most relevant portions of the outer membrane of G neg bacteria that make them unique.
 Definition
Lipopolysaccharide (lipid A, core, and O antigen)
Porin proteins
2-7
Term
What is the significance of LPS in G neg, and what portion of this molecule provides for this function?
 Definition
The O antigen provides bile and complement resistance.
2-8
Term
In a bacterial serotype O,H, and K stand for ...
 Definition
O: LPS antigen
H: flagella antigen
K: capsular antigen
2-9
Term
If in the lab you were to determine that a G neg lacked the O antigen on its Lipid A, what could rule out about the areas this pathogen could infect?
 Definition
It could not infect the GI tract. It would not have bile resistance. If pathogenic it would more likely cause respiratory or GU infections.
2-9
Term
Name a disadvantage a G neg cell has as a result of the outer layer.
 Definition
Difficult to secret proteins through two membranes.
2-9
Term
What is the function of the waxy layer of mycobacteria?
 Definition
Resistance to dessication and phagocytosis.
2-10
Term
How would you detect spirochetes in a laboratory specimen?
 Definition
Dark-field microscopy.
2-10
Term
Name two important spirochetes.
 Definition
Borrelia burgdorferi
Treponema pallidum
Also, Leptospira
2-11
Term
Rocky mountain spotted fever is caused by the organism...
 Definition
Rickettsia rickettsi
2-11
Term
Endemic typhi is caused by the organism...
 Definition
Rickettsiae typhi
2-11
Term
Name the two forms of Chlamydiae bacteria in their life cycle.
 Definition
Reticulate bodies
Elementary bodies
2-11
Term
What molecular component of a cell envelope does Chlamydiae lack?
 Definition
Peptidoglycan.
2-11
Term
What agent can cause blindness, nongonococcal urethritis, and pneumoniae?
 Definition
Chlamydiae trachomatis
2-11
Term
What agent causes psittacosis?
 Definition
Chlamydophila psittaci
2-11
Term
What is too small to be gram stained and causes pneumonia?
 Definition
Chlamydophila pneumoniae
2-11
Term
Which bacterium lacks a cell wall altogether?
 Definition
Mycoplasma
2-12
Term
Name four genera of bacteria that stain as gram positive rods.
 Definition
Clostridium Corynebacterium Listeria Bacillus Charts after lecture 2
Term
Name the species that is a gram positive coccus in clusters, produces catalase and is sensitive to novobiocin.
 Definition
Staphylococcus epidermidis.
Charts after lecture 2
Term
Name the bacterium that is a gram positive cocci in clusters and produces both catalase and coagulase.
 Definition
Staphylocuccus aureus.
Charts after lecture 2
Term
Name the organism that is a gram positive cocci in clusters, produces catalase, and is resistant to novobiocin.
 Definition
Staphyloccus saprophyticus
Charts after lecture 2
Term
Name the gram negative diplococci that ferments maltose.
 Definition
Neiserria meningitidis
Charts after lecture 2
Term
Name the gram negative diplococci that cannot ferment maltose.
 Definition
Neiserriae gonorrheae
Charts after lecture 2
Term
Name four gram negative coccobacillus
 Definition
Hemophilus
Bordetella
Pasteurella
Brucella
Charts after lecture 2
Term
Name two unusually shaped anaerobic rods.
 Definition
Bacteroides
Fusubacterium
Charts after lecture 2
Term
What is the result of an oxidase test that is common to all coliform gram negative rods?
 Definition
Negative for oxidase.
Term
T/F bacteria posses the 80S ribosomal subunit.
 Definition
False. Eukaryotes do. Bacteria contain the 70S subunit. 2-3
Term
Which bacteria contain sterols in their plasma membrane?
 Definition
H. pylori, B. Burgdorferi and Mycoplasma spp. 2-3
Term
What is the sex pilus for?
 Definition
Conjugation. 2-5
Term
What is the function of a mordant? What mordant do we use in lab?
 Definition
A mordant is a substance used to sequester dyes--in our case, within bacterial cell walls. The mordant we use in lab is iodine. 2-7
Term
What region of LPS has endotoxic activity?
 Definition
Lipid A. 2-8
Term
What are lipoteichoic acid and teichoic acid specific to?
 Definition
Gram positive, cell membrane and cell wall components. 2-8
Term
What is LPS specific to?
 Definition
Gram negative bacteria.
Term
What shape are spirochetes?
 Definition
SPIRAL! Yey. You get a cookie.
Term
Are Rickettsiae spp. intra or extracellular pathogens?
 Definition
Obligate intracellular pathogens.
Term
From where do chlamydiae and chlamydophila spp. get their energy?
 Definition
Host cells. 2-11
Term
Are Chalmydiae and Chlamydophila spp. intra or extracellular pathogens?
 Definition
Obligate intracellular pathogens. 2-11
Term
What conditions does Chlamydiae trachomatis cause?
 Definition
Blindness, nongonococcal urethritis, pneumonia. 2-11
Term
What is the major pathogenic Mycoplasma spp.?
 Definition
M. pneumoniae. 2-12
Term
Name five important factors to consider when trying to grow bacteria in culture.
 Definition
Temperature
pH
oxygen (redox)
Nutrients (e.g. iron)
Osmolarity
3-2
Term
What are two ways bacteria acquire iron in vivo when the body tries to keep it from them?
 Definition
Produce iron binding molecules(siderophores)
Bind to human transferrin and lactoferrin (Neisseria)
3-3
Term
Name an aerobe bacterium.
 Definition
Pseudomonas aeroginosa
3-3
Term
Name a microaerophile bacterium.
 Definition
Campylobacter
3-3
Term
Give three reasons that may explain why some bacteria are obligate anaerobes.
 Definition

Lack catalase

Lack superoxide dismutase

May have redox sensitive enzymes (despite having aforementioned enzymes)

3-4
Term
Name three conditions in a patient that may lead to favorable redox conditions for anaerobic infection.
 Definition

Circulatory problems

Tight orthopaedic casts

Co-presence of facultative anaerobes

 

3-4
Term
What are the two types of anaerobic infections?
 Definition
Clostridial and non-clostridial.
3-6
Term
Clostridial or non-clostridial anaerobic infection: forms an abscess, polymicrobial infection, highly anti-biotic resistant bacteria.
 Definition
Non-clostridial anaerobic infection 3-6
Term
Which Bacteroides like bacteria have LPS that have some endotoxic properties?
 Definition
Porphyromonas and Prevotella
3-7
Term
Which Bacteroides like bacteria make a capsule?
 Definition
Bacteroides fragilis
Prevotella melaninogenica
It is probably anti-phagocytic
3-7
Term
As a group, what are the virulence factors of the Bacteroides-like bacteria?
 Definition
LPS
Capsule
Enterotoxin
Proteases
3-7
Term
Bacteroides like bacteria that is normal flora in the colon.
 Definition
Bacteroides fragilis
3-7
Term
Bacteroides like bacterium that is found in female genital tract and can cause PID and infertility.
 Definition
Prevotella bivia.
3-7
Term
Bacteroides like bacteria that are found the mouth, can cause URI.
 Definition
Prevotella melaninogenica and Porphyromonas gingivalis
3-7
Term
This organism is involved in 90% of spore forming anaerobe infections.
 Definition
Clostridium perfringens
3-8
Term
This spore forming anaerobe is associated with infections in patients with cancer of the GI tract.
 Definition
Clostridium septicum
3-8
Term
Name the virulence factor of clostridia perfringens. What does it do?
 Definition
Alpha toxin. It is a lecithinase/phospholipase C. It disrupts mammalian cell membranes.
3-9
Term
What is a requirement for growth of clostridia in the tissue?
 Definition
Low tissue redox.
3-9
Term
Do Clostridia cause endogenous infections, exogenous infections, or both.
 Definition
Both. They come from vegetative cells or spores that get into wounds, ruptures, tumors, etc.
3-9
Term
What diseases are caused by histotoxic claustridia. (There are six)?
 Definition
Gas gangrene (Clostridial myonecrosis). Anaerobic cellulitis. Simple wound infection. Organ infections. Septiciemia/bacteremia, C perfringens type A food poisoning.
3-9
Term
How do you treat or control clostridial infections?
 Definition
Remove affected tissue by surgery. Often involves amputation. Hyperbaric oxygen (controversial). Prevention is better than treatment.
3-9,10
Term
What two genera form spores and are associated with human infections?
 Definition
Bacillus and Clostridium
3-10
Term
What are the phases of bacterial growth?
 Definition

lag, exponential (log), stationary

 

 

 

 

 

 

 

 

3-2
Term

Match the terms with definitions

1.aerobe  2. microaerophile  3. facultative anaerobe  4.aerotolerant  5.strict anaerobe


A. Prefer to grow via fermentation but can respire

B.Only grow without oxygen

C. always ferment but can grow w/ or w/o oxygen

D.Grown only in presence of oxygen

E.require oxygen at lower concentrations than found in normal air

 

 

 

 Definition

facultative anaerobe: Prefer to grow via fermentation but can respire

Strict anaerobe: Only grow without oxygen

Aerotolerant: always ferment but can grow w/ or w/o oxygen

Aerobe: Grown only in presence of oxygen

Microaerophile: require oxygen at lower concentrations than found in normal air

 

3-3 and 3-4
Term
Where are anaerobes normally found in the body?
 Definition

Skin, mouth, vagina, colon

 

 

3-4
Term
 Definition
Term
What are the resistance properties of spores?
 Definition

Resistant to:

Heat

Radiation

Chemicals (including some disinfectants)

Drying

 

Why? Low internal water and rich in DNA stabilizing proteins

 

3-10
Term
What important diseases can be transmitted by spores?
 Definition

Anthrax (Bacillus anthracis)

Tetanus (Clostridium tetani)

Clostridium difficile

Infections caused by histotoxic clostridia

 

 

3-11
Term
What are the 5 desirable pharmacologic properties of an ideal antibacterial drug?
 Definition
Stable in acid, soluble in water, diffuses across membranes, slow excretion, selective (large therapeutic index) 4-2
Term
Name four concerns a clinician should consider when using a pharmacologic agent?
 Definition
Selective toxicity: Does it only affect the bug?
Effects on non-pathogenic flora.
Allergy
Toxicity
4-2
Term
Bacteriostatic or bactericidal:
Sulfonamides
 Definition
Bacteriostatic
4-2
Term
Bacteriostatic or bactericidal:
Trimethoprim
 Definition
Bacteriostatic
4-2
Term
Bacteriostatic or bactericidal:
Sulfonamide w/ trimethoprim
 Definition
Bacteriocidal
4-2
Term
Bacteriostatic or bactericidal:
Tetracyclines
 Definition
Bacteriostatic
4-2
Term
Bacteriostatic or bactericidal:
Erythromycin
 Definition
Bacteriostatic
4-2
Term
Bacteriostatic or bactericidal:
Vancomycin
 Definition
BOTH!!! This is because many bacteria may be resistant to vancomycin. In this case it is only bacteriostatic in its action.
4-2
Term
Bacteriostatic or bactericidal:
Quinolones
 Definition
Bacteriocidal
4-2
Term
Bacteriostatic or bactericidal:
Penicillins
 Definition
Bacteriocidal
4-2
Term
Bacteriostatic or bactericidal: Cephalosporins
 Definition

Bactericidal 4-2

 

P.S. Thanks Brady
Term
Bacteriostatic or bactericidal:
Aminoglycosides
 Definition
Bacteriocidal
4-2
Term
What proportion of antibacterial drug use is for prophylaxis?
 Definition
1/4 to 1/2
4-3
Term
For what situations would prophylactic antibacterial use be appropriate?
 Definition
Prevent epidemic menigitis, or endocarditis. When using prosthetics, such as artificial valves/arteries. Transplants. Surgery of gunshot wounds, burns, colon, etc. 4-3
Term
ADMET is an acronym for these terms.
 Definition

Absorption/administration

Distribution

Metabolism

Excretion

Toxicity

 

4-4
Term
Name some common toxic side effects of antibacterial drugs.
 Definition
Nephrotoxicity, ototoxicity, and hypersensitivity.
Term
Give three situations in which you would use multiple antibiotics in combination.
 Definition
Empiric therapy for serious infections. (Multiple broad)
Mixed infections. (Multiple narrow if agents are known)
Synergism
4-5
Term
Name the 5 mechanisms of action of the main antibacterial drugs.
 Definition
Inhibition of nucleic acid synthesis
DNA damage
Inhibition of cell wall synthesis
Inhibition of cell membrane function
Inhibition of protein synthesis
4-30
Term
Name the antibacterial agents that inhibit nucleic acid synthesis (3)
 Definition
Sulfonamides
Trimethoprim
Rifampin
4-5, 4-30
Term
Name the antibacterial agents that damage DNA (4)
 Definition
Quinolones
Nitrofurantoin
Metronidazole
Methenamine
4-5, 4-30
Term
Name the antibacterial agents that inhibit cell wall synthesis (6)
 Definition
Beta lactams: Penicillins, Cephalosporins, Monobactams, Carbapenems
Vancomycin
Bacitracin
4-5, 4-30
Term
Name the antibacterial agents that inhibit cell membrane function (2)
 Definition
Polymixin
Daptomycin
4-5, 4-30
Term
Name the antibacterial agents that inhibit protein synthesis (6)
 Definition

Tetracyclines/Tigecycline

Aminoglycosides

Chloramphenicol

Macrolides: Erythro/Azithro/Clarithromycin

Quinupristin/Dalfopristin

Linezolid

 4-5, 4-30
Term
Name 4 clinical uses of sulfonamides.
 Definition
Uncomplicated UTIs
Toxoplasmosis (in combination)
Malaria
Prophylaxis for burn patients (topical) and AIDS patients (prevent Pneumocystis jirovecii)
4-6
Term
The name of the enzyme that is inhibited by sulfonamides is...
 Definition
Dihydropteroate synthetase.
4-7
Term
The enzyme that is inhibited by trimethoprim is...
 Definition
Dihydrofolate reductase
4-7
Term
True or false. The selectivity of trimethoprim as an antibacterial is due to bacteria synthesizing their own folate but humans get folate from their diet.
 Definition
False. This is true for sulfonamides, but not trimethoprim. Both humans and bacteria have dihydrofolate reductase (trimethoprim target), but the selectivity is due to the much lower concentration needed to inhibit that bacterial enzyme.
4-7
Term
What toxicities are caused by trimethoprim?
 Definition
Slight blood dyscrasias (usually associated with sulfa combination). Anemia if patient is already folate deficient.
4-8
Term
What organism was rifampin used to treat primarily? (Not used alone anymore).
 Definition
Mycobacterium tuberculosis. Both intra and extracellularly. It also has some activity against staphylococci. 4-8
Term
What is rifampin used for now?
 Definition
Combination with other first-line anti-tubercular drugs. Combination for treatment of prosthetic valve endocarditis (staphylococcal), resistant staph infections, prophylaxis against meningococcal disease and meningitis.
4-8
Term
What is the spectrum of quinolones?
 Definition
As a general class it can be effective for G pos or G neg.
4-9
Term
Name the class of the following drug as well as the generation: Nalidixic acid.
 Definition
1st generation quinolone. DNA damaging agent. It is no longer used.
Term
Name the class of the following drug as well as the generation: Ciprofloxacin.
 Definition
2nd generation quinolone. DNA damaging agent. Used in UTIs and against pseudomonal infections. No longer used against G pos because of resistance.
4-9
Term
Name the class of the following drug as well as the generation: Ofloxacin
 Definition
2nd generation quinolone. DNA damaging agent.
4-9
Term
Name the class of the following drug as well as the generation: Norfloxacin
 Definition
2nd generation quinolone. DNA damaging agent.
Term
Name the class of the following drug as well as the generation: Levofloxacin.
 Definition
3rd generation quinolone. DNA damaging agent.
Term
Name the class of the following drug as well as the generation: Moxifloxacin
 Definition
4th generation quinolone. DNA damaging agent. Treatment of RTI. Better G pos coverage than cipro. effective against PCN-resistant S. pneumoniae.
4-9
Term
Where in the body would an organism that is otherwise susceptible to penicillin be unaffected by IV penicillin?
 Definition
CSF because it does not cross the BBB. And kidney because the osmotic pressure is high.
4-11
Term
Name the 5 classes of beta lactams.
 Definition
Penicillins, Cephalosporins, Monobactams, Carbapenems, and Beta lactamase inhibitors.
4-13
Term
Time or concentration dependent: Penicillin.
 Definition
Time dependent. Should be administered continuously.
4-16
Term
Give the generation and spectrum of the following cephalosporin: Cefazolin
 Definition
1st generation. G pos w/ added activity against E coli.
4-16
Term
Give the generation and spectrum of the following cephalosporin: Cephalexin
 Definition
1st generation. G pos.
4-16
Term
Give the generation and spectrum of the following cephalosporin: cephadroxil
 Definition
1st generation. G pos
4-16
Term
Give the generation and spectrum of the following cephalosporin: Cefaclor
 Definition
1st generation. G pos (given orally)
4-16
Term
Give the generation and spectrum of the following cephalosporin: Cefoxotin
 Definition
2nd generation. G pos. Increased G neg activity.
4-16
Term
Give the generation and spectrum of the following cephalosporin: Cefuroxime
 Definition
2nd generation. G pos. Increased G neg activity.
4-16
Term
Give the generation and spectrum of the following cephalosporin: Cefotaxime
 Definition
3rd generation. Even greater against G neg. G pos.
4-16
Term
Give the generation and spectrum of the following cephalosporin: Ceftazidime
 Definition
3rd generation. Only anti-pseudomonal 3rd gen. G pos. Even greater G neg than 2nd gen.
4-16
Term
Give the generation and spectrum of the following cephalosporin: Ceftriaxone
 Definition
3rd generation. G pos. Even greater anti G neg. IM or IV. Longer half life (8h)
4-16
Term
Give the generation and spectrum of the following cephalosporin: Cefpodoxime
 Definition
3rd generation. G pos. Even greater anti G neg.
4-16
Term
Give the generation and spectrum of the following cephalosporin: cefdinir
 Definition
3rd generation. G pos. Even greater anti G neg.
4-16
Term
Give the generation and spectrum of the following cephalosporin: Cefepime
 Definition
4th generation. anti-pseudomonal. More resistant to beta lactamase. Only IV
4-16
Term
Give the names of 4 carbapenems.
 Definition
Imipenem, meropenem, ertapenem, and doripenem.
4-17
Term
Which carbapenem is not effective against pseudomonas?
 Definition
Ertapenem.
4-17
Term
What agent is administered with carbapenems to increase their half life?
 Definition
Cilastatin. It inhibits renal dehydropeptidase and blocks hydrolysis.
4-17
Term
Name the beta lactamase inhibitors (3).
 Definition
Clavulanic acid, sulbactam, and tazobactam.
4-17
Term
What enzyme does vancomycin inhibit?
 Definition
Peptidoglycan synthase. It is responsible for polymerizing the peptidoglycan.
4-19
Term
What might a bacteria convert its terminal D-ala residue to in order to become resistant to vancomycin?
 Definition
D-Ser or L-Lac.
4-19
Term
Why isn't vancomycin effective against G neg?
 Definition
Too big. Won't traverse the porin channel.
4-19
Term
Why can't bacitracin be given IV?
 Definition
It causes severe renal damage.
4-20
Term
What is the spectrum of polimixin? Explain why.
 Definition
It is only effective against G neg because it acts as a cationic detergent and disrupts the cell membrane. G pos bacteria have too thick of a cell wall and are not susceptible.
4-21
Term
What is the most common use of colistin?
 Definition
IV for resistant G neg infections. Very useful against pseudomonal infections. BTW it is a polimixin mixture of B and E.
4-21
Term
Name the aminoglycosides (6).
 Definition
Streptomycin, kanamycin, gentamicin, tobramycin, amikacin, and neomycin.
4-24
Term
Name the 2 cephalosporins that have activity against pseudomonas and their generation.
 Definition
Ceftazidime (3rd gen)
Cefepime (4th gen)
4-16
Term
Which of the following classes of antibacterials is NOT bacteriostatic:
Trimethoprim
Aminoglycosides
Tetracyclines
Sulfonamides
Erythromycin
 Definition
Aminoglycosides are bactericidal 4-2
Term
The MIC of drug A is 0.2 mM. The MIC of drug B is 5.6 mM. Based on this information alone, which drug would you prescribe a patient?
 Definition
Drug A. A low MIC is good, as it means less is needed to inhibit bacterial growth.
4-4
Term
What is Kernicterus? What antibacterial drug causes it?
 Definition
CNS deposition of bilirubin in newborns leading to encephalopathy. Caused by sulfonamides - sulfa drug displaces the albumin bound bilirubin.
4-6
Term
Which of the following antibacterial classes is NOT appropriately matched to it's mechanism of action:
Vancomycin - inhibition of cell wall synthesis
Tigecycline - inhibition of protein synthesis
Rifampin - DNA damaging agent
Carbapenems - inhibition of cell wall synthesis
 Definition
Rifampin is NOT a DNA damaging agent. It inhibits RNA synthesis.
Term
Name the 4(5) major mechanisms of antibiotic resistance in bacteria.
 Definition
Enzymes that destroy antibiotic
Target modification
Change membrane permeability to antibiotic
Efflux pump expels antibiotic
(Biofilm formation)
7-2
Term
Give the classic example of enzyme breakdown of antibiotic resistance.
 Definition
Beta-lactamase.
7-3
Term
What type of resistance is involved in S. aureus resistance to oxacillin?
 Definition
Change of PBP (Target modification). This is in MRSA.
7-3
Term
The alteration of which proteins would bring about resistance to fluoroquinolones.
 Definition
Topoisomerase IV
DNA gyrase
7-3
Term
The alteration of which cellular component would elicit macrolide resistance?
 Definition
Ribosome
7-3
Term
Antimicrobial resistance to beta-lactams by the production of altered PBPs occurs in which 3 organisms?
 Definition
Staphylococcus aureus Enterococcus faecium Streptococcus pneumoniae 7-4
Term
What is a resistance mechanism that commonly co-exists synergistically with target modification?
 Definition
Decreased cell permeability by loss of porin. It favors the enzyme by decreasing the rate antibiotic can enter the cell.
7-4
Term
This is a porin that Pseudomonas aeruginosa may down regulate to resist quinolones.
 Definition
What is OprD?
7-4
Term
What are two mechanisms Pseudomonas uses to resist quinolones?
 Definition
Decreased porin and cell permeability
Efflux pump
7-4
Term
Enterococcus is most often susceptible to these 2 antibiotics, although resistance is on the rise.
 Definition
Ampicillin
Vancomycin
7-5
Term
What antibiotic must you use to treat MRSA?
 Definition
Vancomycin
7-5
Term
What are 2 components do CA-MRSA have that HA-MRSA do not?
 Definition
SCCMec IV
Panton-Valentine Leukocidin
7-5
Term
From where is it thought that S. aureus acquires vancomycin resistance?
 Definition
Enterococcus transposon. 7-5
Term
Which of the following is NOT an example of currently emerging resistance: a. Carbepenemase enzyme in Acinetobacter b. Quinolone-carbapenem resistance in Klebsiella c. Beta-lactamase expression in Streptococcus pyogenes d. Enterococcus resistance to vancomycin
 Definition
c. Beta-lactamase expression in Streptococcus pyogenes GAS remains susceptible to penicillins 7-6
Term
When considering conjugation, what is the requirement for a bacterium to be a male cell?
 Definition
It must contain a conjugative plasmid. A conjugative plasmid is a mobile piece of extrachromosomal DNA that has genes that allow it to transfer itself to other bacterial cells via a sex pilus.
8-3
Term
What is the name of the site of initiation of replication of a piece of DNA?
 Definition
Origin
8-4
Term
What gene encodes an initiator protein that is required for plasmid replication?
 Definition
rep
8-4
Term
What gene is involved in controlling the replication and copy number of a plasmid?
 Definition
Cop
8-4
Term
Do large plasmids tend to have a large or small copy number?
 Definition
Small. 1-2 per chromosome.
8-5
Term
Do small plasmids tend to have a large or small copy number?
 Definition
Large. 10 or more per chromosome.
8-5
Term
What is the name of the site where the transfer of the plasmid is initiated?
 Definition
oriT. It is nicked by a nickase during the initiation of DNA transfer.
8-5
Term
What are the two types of transposable elements?
 Definition
Insertion sequences and transposons.
8-9
Term
What are insertion sequences?
 Definition
Transposable elements that only contain genes required for their movement.
8-9
Term
What are transposons?
 Definition
Transposable elements that carry genes required for their movement as well as additional genes that specify a phenotype such as antibiotic resistance, toxin production, etc.
8-9
Term
What are composite transposons?
 Definition
They are transposons that carry insertion sequences at their ends.
8-9
Term
Contrast replicative from conservative transposition.
 Definition
Replicative occurs when the transposon is replicated and inserted someplace new.
Conservative occurs when the transposon breaks off and inserts at a target site.
8-9
Term
Name the 5 different types of antibiotic prescribing.
 Definition
Prophylaxis, Pre-emptive therapy, empiric therapy, pathogen-directed therapy, susceptibility-guided therapy.
CC 2-2
Term
Name four reasons you would use prophylactic antibiotics.
 Definition
Perioperative antibiotics to prevent surgical infection.
Endocarditis prophylaxis to prevent endocarditis.
Travel prophylaxis by travelers to malaria endemic areas.
Opportunistic infection prophylaxis by immunocompromised patients to prevent infections like Pneumocytis jarovceci.
CC 2-2
Term
When would you use pre-emptive therapy?
 Definition
If CMV load tested via PCR indicates that CMV levels are rising then a physician may administer valganiclovir in cases of immunosuppression like in transplant patients.
CC 2-2
Term
What are situations that would indicate empiric use of antibiotics?
 Definition
Fever in neutropenic patients. Community-acquired pneumonia. Ventilator-associated pneumonia.
CC 2-2
Term
What is the difference between pathogen-directed therapy and susceptibility-guided therapy?
 Definition
In pathogen-directed therapy the infectious agent is known, but no information about the specific strain's susceptibility is known so the clinician must use local epidemiological data about the agent to determine therapy. In susceptibility guided therapy the susceptibility is known and the narrowest effective therapy should be used.
CC 2-3
Term
When susceptibility and pathogen are known, what should guide the clinician's decision when prescribing an antibiotic?
 Definition
Narrowest spectrum. Most effective. Least toxic. Cheapest (not to rob the first three).
CC 2-3
Term
When susceptibility and pathogen are known, what should guide the clinician's decision when prescribing an antibiotic?
 Definition
Narrowest spectrum. Most effective. Least toxic. Cheapest (not to rob the first three).
CC 2-3
Term
Name four situations that would not require antibiotics.
 Definition
Viral infection with no good antiviral medications indicated.
Contamination in a sample like CNS in blood culture.
Colonization of a resistant strain without evidence of infection like VRE on an anal swab. This would indicate isolating the patient from other patients, but not antibiotic therapy.
Treatment will not hasten the resolution of infection, even if bacteria are involved.
Adequate drainage of an abscess.
CC 2-3
Term
Define MIC.
 Definition
The lowest concentration of antibiotic at which there is no visible growth in a test tube with growth media.
CC 2-4
Term
Name the 4 methods used to test antibiotic susceptibility.
 Definition
Disk diffusion/Kirby Bauer method
Broth macro/microdilution or liquid agar dilution
E test
Commercial semi-automated methods. Like the microscan or vitek automated instruments.
CC 2-4
Term
What ratio is a predictor of efficacy in concentration dependent antibiotics like aminoglycosides?
 Definition
Peak concentration/MIC
CC 2-4
Term
Give two examples of concentration dependent antibiotic classes.
 Definition
Aminoglycosides and quinolones.
CC 2-4
Term
Give two examples of time dependent antibiotics.
 Definition
Beta lactams and vancomycin.
CC 2-4
Term
What is the best way to administer time dependent antibiotics?
 Definition
Continuous infusion or multiple daily doses. This may optimize the time above the MIC.
CC 2-4
Term
What are four things you should consider when you are going to administer an antibiotic (other than the organisms susceptibility)?
 Definition
Route of administration. IV or oral.
Anatomic site. Will it achieve high levels in serum?
Costs.
Toxicity.
CC 2-5
Term
What are the important constituents of fungal cell walls?
 Definition
Glucans, chitin, and mannan.
9-3
Term
What are the important constituents of fungal cell membranes?
 Definition
Ergosterol and zymosterol.
9-2
Term
T/F. Fungi's motility varies by species and in dimorphic fungi it may vary depending upon the environment in which the organism is found.
 Definition
False. Fungi are nonmotile.
9-2
Term
What genus of fungus will stain with a gram stain, while all others do not?
 Definition
Candida.
9-2
Term
Name the stains that will stain fungi in general.
 Definition
Calcofluor. Silver stains. Periodic-acid schiff (PAS)
9-2
Term
What molecule is most abundant in chitin?
 Definition
N-acetylglucosamine. (NAG)
9-2
Term
Is the following a characteristic of yeast or mold: pseudohyphae?
 Definition
Yeast
9-2
Term
Is the following a characteristic of yeast or mold: Include Cryptococcus neoformans?
 Definition
Yeast.
9-2
Term
Is the following a characteristic of yeast or mold: produce multicellular forms?
 Definition
Mold
9-2
Term
Is the following a characteristic of yeast or mold: have fuzzy colonies?
 Definition
Mold
9-2
Term
Is the following a characteristic of yeast or mold: reproduce by budding?
 Definition
yeast
9-2
Term
Is the following a characteristic of yeast or mold: are speciated by biochemical tests?
 Definition
Yeast
9-2
Term
Is the following a characteristic of yeast or mold: are speciated by colony morphology, color, and microscopic appearance?
 Definition
Mold.
9-3
Term
Is the following a characteristic of yeast or mold: reproduce by branching.
 Definition
Mold
9-3
Term
Name the four types of antifungals.
 Definition
Amphotericin, azoles, echinocandins, and flucytosine.
9-4
Term
Which drug binds to ergosterol and causes membrane permeability to increase?
 Definition
Amphotericin.
9-4
Term
What is the major toxicity of amphotericin?
 Definition
Nephrotoxicity
9-4
Term
What is the target for azole drugs?
 Definition
They bind to one of the cytochrome P-450 enzymes and inhibit the c-14 alpha demethylation of lanosterol. This leads to less ergosterol and increased methylsterols in the membrane.
9-4
Term
Name the 6 azoles.
 Definition
Imidazole, Triazole, Fluconazole, Voriconazole, Itraconazole, and posaconazole.
9-4
Term
What do echinocanidins inhibit?
 Definition
Synthesis of 1,3-beta-D-glucan. It is against the cell wall synthesis.
9-4
Term
Which agents target the 1,3-beta-D-glucan?
 Definition
Echinocandins.
9-4
Term
Name the 3 enchinocandins.
 Definition
Caspofungin, micafungin, and anidulafungin.
9-4
Term
What are the most common side affects of echinocandins?
 Definition
Headache and elevation of liver enzymes.
9-4
Term
What is the target of flucytosine?
 Definition
Noncompetitive inhibition of thymidylate synthase. It is a fluorine analogue of cytosine.
9-4
Term
What is the most common use of flucytosine?
 Definition
Used with amphotericin against cryptococcal meningitis.
9-4
Term
Name risk factors for candidal infection.
 Definition
Antibiotics that destroy flora of GI or vagina.
Steroid and anti-metabolites that impair cell mediated immunity or induce neutropenia.
Chemotherapeutic agents that cause mucosal injury and ulceration of GI tract.
GI surgery.
9-5
Term
Which organism is identified by india ink stain?
 Definition
Cryptococcus neoformans.
9-6
Term
Name the yeast for which there is an antigen test.
 Definition
Cryptococcus neoformans.
9-6
Term
What is the treatment for Cryptococcus neoformans?
 Definition
Amphotericin and flucytosine. Followed by fluconazole.
9-7
Term
What is the main site of entry for Aspergillus?
 Definition
Respiratory tract. From there it can enter the lungs, and proceed into the blood vessels.
9-7
Term
Name the 5 manifestations of aspergillus in the lungs.
 Definition
Airway colonization Allergic bronchopulmonary aspergillosis (ABPA) Aspergilloma Invasive pulmonary aspergillosis Disseminated aspergillosis 9-7
Term
What is the antigen that can be detected with aspergillosis?
 Definition
Galactomannan
9-7
Term
The presence of galactomannan antigen indicates which pathogen may be present?
 Definition
Aspergillus.
9-8
Term
Aspergillus is susceptible to...
 Definition
Amphotericin formulations
Voriconazole, posaconazole, or itraconazole
Echinocandins
9-9
Term
Which fungal infection may go from the sinuses to the brain?
 Definition
Zygomycetes.
9-9
Term
Most molds enter the body through inhalation, but this one enters through puncture wounds in the skin.
 Definition
What is Sporothrix schenckii?
9-9
Term
Rose gardeners disease is caused by...
 Definition
Sporothrix schenckii.
9-9
Term
Which fungus causes a string of red, nodular lesions?
 Definition
Sporothrix schenckii.
9-9
Term
Name the other molds we should know, but don't have any other information about.
 Definition
Dematiaceous molds
Penicillium marneffei
Fusarium
Scedosporium
9-10
Term
Two dimorphic fungi are commonly found in the Ohio and Mississippi River area. Which are they?
 Definition
Histoplasma capsulatum, and Blastomyces dermatitidis.
9-10,11
Term
Where is Coccidioides immitis found in the US?
 Definition
Southwestern states.
9-10
Term
Name the clinical presentations of histoplasma capsulatum.
 Definition
Acute primary respiratory infection. >90%
Mediastinal granuloma and fibrosis
Chronic pulmonary histoplasmosis or cavitary pulmonary histoplasmosis
Disseminated histoplasmosis
9-10
Term
Name the fungus that lacks ergosterol.
 Definition
Pneumocystis jiroveci.
9-10
Term
Which course of antibiotics is given to T cell impaired individuals to prevent Pneumocystis jiroveci infection?
 Definition
Trimethoprim/sulfamethoxazole. (or Bactrim)
9-12
Term
Are dermatophytes molds or yeasts?
 Definition
Molds.
9-12
Term
Name the zoophilic dermatophytes.
 Definition
Microsporum canis. It is the only one.
9-12
Term
Name the anthropophilic dermatophyte.
 Definition
Trichophyton rubrum
9-12
Term
Which fungus will fluoresce green under ultraviolet light (Wood's light)?
 Definition
Microsporum
9-12
Term
What is the treatment for dermatophytes?
 Definition
Imidazoles topically. Or griseofulvin (obsolete) terbinafine or the azoles orally.
9-12
Term
How do parasites try to avoid a vigorous immune response against them?
 Definition
They use molecular mimicry. They try to make their antigens close to self antigens of the host.
10-1
Term
Name the 3 types of parasites.
 Definition
Protozoa, helminths, and ectoparasites.
10-2
Term
Define definitive and intermediate host.
 Definition
Definitive: where the parasite reproduces sexually.
Intermediate: where it reproduces asexually.
10-2
Term
What is the host for schistomiasis before humans?
 Definition
Snail.
10-6
Term
Where does a human get schistomiasis from?
 Definition
Infested slow moving water with infected snails.
10-6
Term
Katayama fever is...
 Definition
acute schistomiasis.
10-7
Term
Which drug is used to treat schistomiasis?
 Definition
Preziquantel.
10-7
Term
The pork tapeworm's name is...
 Definition
Taenia solium.
10-7
Term
Cysticercosis is caused by...
 Definition
Taenia solium. 10-7
Term
Hydatid disease is caused by which organism?
 Definition
Echinococcus granulosus.
10-7
Term
Which tapeworm is carried by dogs?
 Definition
Echinococcus granulosus.
10-7
Term
What ectoparasite causes scabies?
 Definition
Sarcoptes scabei
10-7
Term
This is an infestation of the skin by larvae of flies (maggots).
 Definition
What is myiasis?
10-7
Term
Name the six anti-malarial drugs.
 Definition
Chloroquine, quinine, primaquine, artemisinin derivatives, mefloquine, and atovaquone/proguanil.
10-8
Term
This drug is active against the erythrocytic stages of Plasmodium spp.
 Definition
Chloroquine.
10-8
Term
This drug is active against the asexual erythrocytic stages of Plasmodium.
 Definition
Quinine
10-8
Term
This drug is the only effective anti-malarial that is active against exo-erythrocytic forms of P vivax and P ovale that reside in the liver.
 Definition
Primaquine.
10-8
Term
Anti-malarial that is active against chloroquine resistant forms, but should only be used in combination therapy to prevent emergence of resistance.
 Definition
Artemisinin derivatives.
10-8
Term
Herpes simplex virus
 Definition
Herpesviridae
dsDNA
Enveloped
11-6
Term
Epstein-Barr virus
 Definition
Herpesviridae
dsDNA
Enveloped
11-9
Term
Cytomegalovirus
 Definition
Herpesviridae
dsDNA
Enveloped
Term
Kaposi Sarcoma Herpes Virus
 Definition
Herpesviridae
dsDNA
Enveloped
11-9
Term
Hepatitis B Virus
 Definition
Hepadnaviridae
dsDNA (incomplete)
Contains reverse transcriptase
Enveloped
11-9
Term
Human papillomavirus
 Definition
Papovaviridae
dsDNA
Naked
Circular DNA
11-9
Term
Adenovirus
 Definition
Adenoviridae
dsDNA
Naked
Linear genome
11-6
Term
Smallpox
 Definition
Pox viridae
Complex genome
Enveloped
11-6
Term
What are 4 tools used in the diagnosis of viruses?
 Definition
Tissue cultures
Immunocytochemical staining
Antigen detection
PCR
11-2
Term
What are the two kinds of symmetry that viral capsules exhibit?
 Definition
Helical or rod shaped
Spherical with icosahedral symmetry
11-3
Term
T/F. All capsids are composed of capsomeres.
 Definition
F. They may or may not be composed of capsomeres
11-3
Term
Viral genome + capsid = ???
 Definition
nucleocapsid
11-3
Term
The herpes virus has a special layer in between the capsid and the envelope. What is it?
 Definition
The tegument.
11-3
Term
The name of an intact infectious viral particle is this.
 Definition
What is a virion?
11-3
Term
What happens if an enveloped virus loses its envelope?
 Definition
It will no longer be capable of infecting its host.
11-4
Term
Which type of capsid structure requires that the virus have an envelope?
 Definition
Helical symmetrical structure
11-4
Term
What are the axes of rotational symmetry in an icosahedral capsid?
 Definition
2,3, and 5 fold axes.
11-5
Term
What are the six classes of viruses?
 Definition
ssDNA, dsDNA, dsRNA, (-)ssRNA, (+)ssRNA, and retroviruses (also contain (+)ssRNA)
11-5
Term
What are the seven families of DNA viruses?
 Definition
Hepadnavirus, herpesvirus, adenovirus, poxvirus, papovavirus, parvovirus, and iridovirus. HHAPPPI "happy' 11-6
Term
What is the only family of ssDNA virus?
 Definition
Parvovirus.
11-6
Term
Which are the only circular DNA virus families?
 Definition
Papovavirus, and hepadnavirus.
11-6
Term
Which DNA virus family does not have an icosahedral capsid?
 Definition
Poxvirus.
11-6
Term
Which is the only DNA virus that does not replicate in the nucleus?
 Definition
Poxvirus.
11-6
Term
Enveloped or naked: Hepadnavirus.
 Definition
Enveloped.
11-6
Term
Enveloped or naked Poxvirus.
 Definition
Enveloped
11-6
Term
Enveloped or naked: Herpesvirus.
 Definition
Enveloped.
11-6
Term
Enveloped or naked: Iridovirus
 Definition
Enveloped
11-6
Term
Enveloped or naked: Parvovirus.
 Definition
Naked
11-6
Term
Enveloped or naked: Adenovirus.
 Definition
Naked
11-6
Term
Enveloped or naked: Papovavirus.
 Definition
Naked.
11-6
Term
What are the four classes of RNA viruses?
 Definition
(+)ssRNA,(-)ssRNA, segmented (-)ssRNA, and segmented dsRNA.
11-7
Term
What are the 7 steps in the viral life cycle?
 Definition
Attachment, penetration, uncoating, gene expression, replication, assembly, and release.
11-8
Term
What molecule on influenza virus binds to sialic acid?
 Definition
Hemagglutinin
11-8
Term
What does the hemagglutinin on influenza virus bind to on the host?
 Definition
Sialic acid.
11-8
Term
What is the requirement for a virus to fuse with the cell plasma membrane?
 Definition
It must have an envelope. The envelope fuses with the plasma membrane and allows the nucleocapsid to enter the cell.
11-8
Term
T/F. Only unenveloped viruses enter the cell via receptor-mediated endocytosis.
 Definition
F. Both enveloped and unenveloped can enter this way.
11-9
Term
What are the two ways that newly synthesized enveloped viruses can exit the cell?
 Definition
Budding through the plasma membrane.
Fusion of secretory vesicles containing the virions with the plasma membrane.
11-10
Term
T/F. All enveloped viruses gain their envelop from the plasma membrane of the host.
 Definition
T.
Term
What is the only virus that uses host polymerase to replicate their DNA?
 Definition
Parvovirus (the only ssDNA family).
11-10
Term
Where in the cell do most DNA viruses replicate their nucleic acid and assemble the nucleocapsid? What is the exception to this?
 Definition
The nucleus. Poxviruses replicate in the cytoplasm. They encode all the machinery they need in their genome and do not need nuclear enzymes in the host.
11-10
Term
Where in the cell do most RNA viruses replicate and assemble? What is the exception?
 Definition
In the cytoplasm. Influenza viruses are negative sense and make mRNAs in the nucleus.
11-10
Term
Which virus's replication is most error prone?
 Definition
RNA viruses utilizing RNA-dependent RNA polymerases.
11-10
Term
What two forms of viral replication violate the central dogma of biology?
 Definition
RNA dependent RNA polymerase
RNA dependent DNA polymerase
11-11
Term
This is an important target for virus therapy (in general).
 Definition
Viral polymerase.
11-12
Term
Large viruses like herpesvirus exhibit gene expression that is divided into three classes. What are they?
 Definition
Immediate early (alpha), early (beta), and late (gamma)
11-13
Term
(-)ssRNA virion particles must bring what with them into the cell in order to complete their infectious cycle?
 Definition
RNA polymerase. It must be already present in the virus to turn (-)RNA into (+)RNA that can be transcribed.
11-15
Term
What three components (other than the genome) must be present in the virion of a retrovirus?
 Definition
Reverse trancriptase, integrase, and protease.
11-17
Term
What is unique about the hepadnavirus genome?
 Definition
Incompletely double stranded DNA. Uses reverse transcriptase for replication.
11-17
Term

Hantavirus is a member of the following family:

 

a. Togaviridae

b. Bunyaviridae

c. Filoviridae

d. Papovaviridae

 Definition

b. Bunyaviridae

 

17-3, 11-7
Term
How does the following virus generally enter its human host: coronavirus?
 Definition
Fecal-oral route through the GI tract. It is a localized disease. Also, through the respiratory tract.
12-3
Term
How does the following virus generally enter its human host: enterovirus?
 Definition
Fecal-oral through the GI tract, or contact with the eyes. It is systemic.
12-3
Term
How does the following virus generally enter its human host: reovirus?
 Definition
Fecal-oral through the GI tract. It is systemic.
12-3
Term
How does the following virus generally enter its human host: adenovirus?
 Definition
Fecal-oral through the GI tract, or contact with the eyes. It is systemic.
12-3
Term
How does the following virus generally enter its human host: rhinovirus?
 Definition
Upper respiratory tract. Causes local infection.
12-3
Term
How does the following virus generally enter its human host: hantavirus?
 Definition
Respiratory tract. Causes infection in URT, LRT, or systemically.
12-3
Term
How does the following virus generally enter its human host: RSV?
 Definition
Respiratory tract. Causes infection in URT, or LRT.
12-3
Term
How does the following virus generally enter its human host: coxsackievirus?
 Definition
Respiratory tract. Causes infection in URT.
12-3
Term
How does the following virus generally enter its human host: arenavirus?
 Definition
Respiratory tract. Causes infection in URT.
12-3
Term
How does the following virus generally enter its human host: parainfluenza?
 Definition
Respiratory tract. Causes infection in URT or LRT.
12-3
Term
How does the following virus generally enter its human host: influenza?
 Definition
Respiratory tract. Causes infection in URT, and LRT.
12-3
Term
How does the following virus generally enter its human host: rubella?
 Definition
Respiratory tract. Causes a systemic infection.
12-3
Term
How does the following virus generally enter its human host: mumps?
 Definition
Respiratory tract. Causes a systemic infection.
12-3
Term
How does the following virus generally enter its human host: foot and mouth disease virus?
 Definition
Respiratory tract. Causes a systemic infection.
12-3
Term
How does the following virus generally enter its human host: VZV?
 Definition
Respiratory tract. Causes a systemic infection.
12-3
Term
How does the following virus generally enter its human host: pox virus?
 Definition
Respiratory tract. Causes a systemic infection.
12-3
Term
How does the following virus generally enter its human host: HPV?
 Definition
Sexual contact. Causes a localized infection.
12-3
Term
How does the following virus generally enter its human host: HIV?
 Definition
Sexual contact, or other bodily fluid via needle, etc. Causes a systemic infection.
12-3
Term
How does the following virus generally enter its human host: HSV?
 Definition
Sexual contact, or contact with eyes or mucous membranes. Can cause a systemic infection.
12-3
Term
How does the following virus generally enter its human host: HBV?
 Definition
Sexual contact, or blood or other body fluid contact. Causes a systemic infection.
12-3
Term
How does the following virus generally enter its human host: rabies?
 Definition
Animal bite.
12-3
Term
How does the following virus generally enter its human host: bunyavirus?
 Definition
Insect vector or animal bite.
12-3
Term
How does the following virus generally enter its human host: togavirus?
 Definition
Insect vector or animal bite.
12-3
Term
How does the following virus generally enter its human host: flavivirus?
 Definition
Insect vector or animal bite.
12-3
Term
Name three factors that affect dissemination of a virus.
 Definition
Portal of entry.
Host immunity.
Cell-specific virus receptors.
12-4
Term
Name four viruses that can spread through the nervous system.
 Definition
Rabies, HSV, VZV, and arbovirus.
12-4
Term
What are 4 possible general things that may occur to a virally infected host cell?
 Definition
Lysis
There may be no change at all
Cell dysfunction or morphological changes (there are various types)
Transformation to cancer
12-5
Term
More specifically, what morphologic or dysfunctional changes may occur to a host cell infected with a virus?
 Definition
Hyperplasia
Excessive mucous secretion
Syncytia formation (fusion of cells)
Inclusion body formation
12-5
Term
Name six ways to detect the presence of virus particles or virion components to diagnose viral infections. (Directly without culture).
 Definition
Light microscopy for host cell morphology
Immunofluorescence
Electron microscopy
Hemagglutination
ELISA
Specific stains such as Tzank smear for giant multinucleated cells and ground glass for inclusion bodies
12-6
Term
Name the four general techniques for diagnosing viral infection.
 Definition
Tissue culture
Direct detection of viral particles or components
Direct detection of viral genome
Detection of anti-viral host antibodies
12-6
Term
Name four patterns of infections caused by viruses.
 Definition
Acute infection progressing to death (Ebola, Hantavirus)
Acute infection followed by clearance
Persistent chronic infection (HBV, HCV, HIV)
Latent infection and reactivation
(HIV, HSV, EBV, CMV, other herpes)
12-7
Term
Name the genus and family of poliovirus.
 Definition
Enterovirus genus and Picornavirus family.
12-8
Term
If an antibody response is mounted against poliovirus, what proportion of CNS infections will be prevented relative to no antibody response?
 Definition
99%
12-8
Term
Name the 3 rare nervous system manifestations of poliovirus infection.
 Definition
Meningitis/encephalitis
Paralytic poliomyelitis: Acute flaccid paralysis
Post polio syndrome: Additional progressive muscle wasting due to anterior horn damage
12-9
Term
Name the drug that has activity against picornaviruses (like polio)?
 Definition
Pleconaril.
12-9
Term
What must happen for a latent virus to begin to produce viral particles?
 Definition
Reactivation due to stress, cellular injury, or the availability of a cell-type permissive for replication.
12-10
Term
Name the family and subfamily of HIV.
 Definition
Family is retrovirus, and subfamily is lentivirus.
12-10
Term
How does the switch from early to late proteins in HIV production occur?
 Definition
The early proteins include rev which influences the splicing of mRNA to make late proteins which lead to capsid assembly. 12-11
Term
Viral polymerases have higher error rates. But why would DNA viruses that also use some host machinery have a higher mutation rate?
 Definition
Proofreading may be less accurate in virus infected cells (kind of like a bus driver not driving as well if they're being held up with a gun).
The rate at which viruses replicate lends itself to high mutation errors.
12-12
Term
What causes antigenic shift?
 Definition
Reassortment of genomic material of multiple viruses.
12-12
Term
What causes antigenic drift?
 Definition
Point mutations acquired from one virus over time.
12-13
Term
Name six mechanisms viruses may use to escape the immune system.
 Definition
Undergo a latent period
Infect sites protected from immune system (CNS)
Rapidly evolve to change important antigenic epitopes
Reassortment of viral genes to undergo antigenic shift
Produce defense molecules that interfere with immune function (i.e. antigen presentation)
Infect and destroy immune cells (HIV)
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: acyclovir?
 Definition
Nucleoside analogue. Indicated for HSV, and VZV.
13-2
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: valacyclovir?
 Definition
Nucleoside analogue. Indicated for HSV, and VZV
13-2
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: famciclovir?
 Definition
Nucleoside analogue. Indicated for HSV, and VZV.
13-2
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: penciclovir?
 Definition
Nucleoside analogue. Indicated for HSV.
13-2
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: trifluorothymidine?
 Definition
Nucleoside analogue. Indicated for HSV.
13-2
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: gancyclovir?
 Definition
Nucleoside analogue. Indicated for CMV.
13-2
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: valganciclovir?
 Definition
Nucleoside analogue. Indicated for CMV.
13-2
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: cidofovir?
 Definition
Nucleoside analogue. Indicated for resistant CMV.
13-2
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: foscarnet?
 Definition
Polymerase inhibitor. Indicated for nucleoside analogue resistant HSV and CMV.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: fomivirsen?
 Definition
Anti-sense mRNA. Indicated for CMV-retinitis.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: amantidine?
 Definition
Ion channel blocker (HA). Indicated for Influenza A.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated:rimantidine?
 Definition
Ion channel blocker (HA). Indicated for Influenza A.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: oseltamivir?
 Definition
Sialic acid analogue (NA). Indicated for Influenza A and B.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: zanamivir?
 Definition
Sialic acid homologue (NA). Indicated for Influenza A and B.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: peramivir?
 Definition
Sialic acid homologue (NA). Indicated for Influenza A and B.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: ribavirin?
 Definition
Nucleotide analogue. Indicated for RSV, HCV, and Lassa.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: palivizumab?
 Definition
Monoclonal antibody. Indicated for RSV.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: interferon alpha?
 Definition
Immunomodulator. Indicated for HCV, HBV, and HPV. 13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: imiquimod?
 Definition
Cytokine inducer. Indicated for HPV.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: lamivudine?
 Definition
Nucleoside analogue. Indicated for HBV, and HIV.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: adefovir?
 Definition
Nucleoside analogue. Indicated for HBV.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated:entacavir?
 Definition
Nucleoside analogue. indicated for HBV.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: telbivudine?
 Definition
Nucleoside analogue. Indicated for HBV.
13-3
Term
For the following anti-viral, name its drug class, and viruses for which it is indicated: pleconaril?
 Definition
Class??? Indicated for enterovirus.
13-3
Term
Name eight organisms for which the vaccines are attenuated virus and may not be safe for immunocompromised patients.
 Definition
Measles, mumps, rubella, yellow fever, smallpox, polio (OPV), influenza (flumist), varicella. Note IM influenza and IPV polio are dead virus. 13-4
Term
Name eight organisms for which the vaccines are inactivated (dead) viruses.
 Definition
HAV, HBV, (HEV coming soon), Influenza (not mist), HPV, Polio (IPV), Rabies, and rotavirus.
13-3
Term
Name 6 viruses for which passive immunization is available.
 Definition
HAV, HBV, VZV, Rabies, CMV, and RSV.
13-5
Term
Name the 4 anti-viral actions of cytokine (interferon) and cytokine inducer (imiquimod).
 Definition
Induce viral mRNA degradation
Inhibit viral protein synthesis
Enhance CTL activity
Enhance NK cell activity
13-5
Term
Name the four principles of antiviral drugs and their use.
 Definition
They should target virus specific proteins, and not host.
They only act on actively replicating viruses
They must be used very early in infection to be effective
Drug resistance develops rapidly
13-5
Term
What is the target for the nucleoside analogue class of anti-virals?
 Definition
Viral polymerase
13-6
Term
For the anti-viral drugs ending in "-clovir", what must happen in the cell for them to be active?
 Definition
They must gain an initial phosphate from viral enzymes thymidine kinase or UL97, and two additional phosphates from host enzymes. 13-6
Term
What are two mechanisms of resistance that happen against the anti-virals acyclovir and penciclovir?
 Definition
Reduced or absent viral thymidine kinase Decreased viral polymerase affinity for ACV-TP/PCV-TP. 13-7
Term
What drug should be used in viruses with induced acyclovir resistance (who would otherwise be susceptible)?
 Definition
Foscarnet.
13-7
Term
T/F. Genital herpes is transmissible if the affected patient is undergoing viral suppressive therapy.
 Definition
True. Suppressive therapy only reduces sexual transmission by 50%.
13-7
Term
Which virus requires the higher dose of acyclovier: HSV, or VZV?
 Definition
VZV requires the larger dose.
13-7
Term
T/F. Acyclovir therapy is indicated to reduce the symptoms of VZV causes shingles.
 Definition
False. No anti-viral therapy is indicated for shingles.
13-7
Term
What is the window to treat chicken pox with anti-virals and which should you use?
 Definition
<3 days in adults. Use acyclovir/valacyclovir.
13-7
Term
What is different between acyclovir and valacyclovir?
 Definition
Bioavailibility. Valacyclovir is 3 to 5 times greater, but it is also more expensive.
13-8
Term
What viral enzyme is ganciclovir phosphorylated by?
 Definition
UL97.
13-8
Term
What is the unique toxicity of ganciclovir (compared to other similar anti-viral nucleoside analogues)?
 Definition
Bone marrow suppression.
The other anti-virals may cause nephrotoxicity, but not bone marrow suppression.
13-8
Term
What is the main drawback to fascarnet anti-viral therapy? When is it indicated?
 Definition
It is directly toxic to renal tubules.
Causes renal insufficiency.
Used in viruses resistant to acyclovir and ganciclovir.
13-8
Term
Name the 2 ion channel blockers.
 Definition
Amantidine and rimantadine.
13-8
Term
Name the 3 sialic acid analogues.
 Definition
Zanamivir, Oseltamivir, and Peramivir.
13-9
Term
Which of the following acquisitions of HBV infection is more likely to produce a chronic carrier state: perinatal transmission from mother to newborn, or adult acquisition via sex or body fluid?
 Definition
Perinatal transmission causes chronic active hepatitis in majority of cases (80%). Adult infection is mainly self limited (80%)
13-10
Term
What treatment is indicated in HCV infection?
 Definition
Pegylated interferon and ribavirin for 6-12 months.
13-10
Term
What is the mechanism of action of ribavirin?
 Definition
It decreases the nucleotide pool and inhibits viral mRNA. It is active against many RNA viruses, and available as PO, IV and inhaled.
13-11
Term
Name the 5 nucleoside/nucleotide analogues that are used for chronic HBV infection.
 Definition
Lamivudine Adefovir Entecavir Telbivudine Tenofovir 13-12
Term
What is the name of the monoclonal antibody specific for RSV?
 Definition
Palivizumab.
13-13
Term
What is palivizumab?
 Definition
It is a monoclonal antibody specific for RSV and available only IV. It is used prophylactically for infants at risk (immunocompromised).
13-13
Term
Name the two second line nucleoside analogue antiviral drugs.
 Definition
Foscarnet
Cidofovir
13-8
Term
Ribavirin is used for HCV infections, but not HBV. What is a likely reason for this?
 Definition
Ribavirin is active against RNA viruses (HCV) by inhibiting viral mRNA.
HBV is a DNA virus so would not be susceptible.
13-11
Term
When you initially start to suspect an outbreak?
 Definition
When there are 2 or mores cases of an illness with similar characteristics linked by time, location or contacts.
14-2
Term
When collecting epidemiological data about an outbreak, what are 4 things that you are trying to determine?
 Definition
Reservoir
Transmission route
Incubation time
Value of Ro (limited outbreak vs epidemic vs endemic)
14-2
Term
What is the viral family to while West Nile Virus belongs to?
 Definition
Flavivirus.
14-4
Term
Which avian flu strain has been predominant since 2004? What is the mortality rate in humans?
 Definition
H5N1 strain. Approximately a 60% mortality rate. 467 cases and 282 deaths as of December 2009.
14-4
Term
Name the 5 spongiform encephalopathies in humans (genetic and transmissible).
 Definition
Sporadic Creutzfeldt-Jakob disease (sCJD)
New variant Creutzfeldt-Jakob disease (vCJD)
Kuru
Gerstmann-Straussler-Scheinker disease (GSS)
Fatal familial insomnia (FFI)
14-5
Term
Name the 3 spongiform encephalopathies in animals.
 Definition
Scrapie (sheep)
Bovine spongiform encephalopathy (BSE)
Chronic wasting disease (CWD) in elk and deer.
14-5
Term
T/F. When PrP is introduced into the brain of humans it causes spongiform encephalopathy.
 Definition
False. PrP is a protein called prion that is present in all brains without any harmful effect, but when the protein takes on an abnormal shape it accumulates unless destroyed by normal pathways.
14-5
Term
What does Nipah virus cause?
 Definition
Encephalitis. It is an emerging disease that was associated with an outbreak in 1999 in Malaysia.
14-6
Term
What virus was discovered in 2000 by fishing with PCR primers in children with undiagnosed pneumonias?
 Definition
Metapneumovirus.
14-6
Term
What is chikungunya?
 Definition
It causes a Dengue-like illness (fever, bone pain and rash). It has a mosquito vector.
14-6
Term
Name 5 important factors in emerging infections.
 Definition
Frequent interspecies crossing
Adaptation of virus to human host
International travel
Global warming
Improved diagnostic tests
14-6
Term
What is the definition of an epidemic?
 Definition
Cases of illness in excess of expectancy.
14-7
Term
What is the definition of endemic?
 Definition
An epidemic whose incidence remains stable for a long period. (So an increase to epidemic proportions, and then stabilizing at that level to become endemic).
14-7
Term
Define attack rate.
 Definition
Proportion of individuals exposed that become ill.
14-7
Term
Define virulence with regards to epidemiology.
 Definition
The speed with which a pathogen kills its host.
14-7
Term
Define the variables in the equation: Ro = b x k x D
 Definition
Ro: Basic reproductive rate. It is the number of secondary cases following a single introduction into a fully susceptible population.
b is the attack rate
k is the number of potentially infectious contacts per unit time
D is the duration of infectivity of an infected person
14-7
Term
Name the 4 most common anatomical divisions of respiratory infections.
 Definition
Rhinitis Sinusitis

Pharyngitis

Bronchitis

CC 3-2
Term
The most common infectious etiology of rhinitis in general is due to...
 Definition
Respiratory viruses.
CC 3-2
Term
Most common bacteria that causes sinusitis is...
 Definition
Streptococcus pneumoniae CC 3-2
Term
The 2 most common bacteria that cause otitis media are...
 Definition
Streptococcus pneumoniae Haemophilus influenzae CC 3-2
Term
The 2 most common bacteria that cause bronchitis are ...
 Definition
Streptococcus pneumoniae Haemophilus influenzae CC 3-2
Term
What are the 4 cardinal symptoms of community acquired pneumonia?
 Definition
Cough productive of sputum
Pleuritic chest pain
Shortness of breath
Fever
CC 3-2
Term
What are the 3 most common bacteria that cause community acquired pneumonia?
 Definition
Streptococcus pneumoniae (40% of cases)

Haemophilus influenzae

Moraxella catarrhalis CC 3-2
Term
Name 3 atypical organisms that can also cause community acquired pneumonia.
 Definition
Chlamydophila pneumoniae Legionella pneumophila (unproductive cough) Mycoplasma pneumoniae CC 3-2
Term
Name the 5 bacteria that most commonly cause ventilator-associated pneumonia.
 Definition
Pseudomonas aeruginosa Staphylococcus aureus Acinetobacter spp Enterobacter cloacae Klebsiella pneumoniae CC 3-3
Term
What 2 bacteria are the most common causes of cystitis?
 Definition
Escherichia coli Staphylococcus saprophyticus CC 3-3
Term
What are the 2 symptoms associated with cystitis?
 Definition
Dysuria (burning or stinging on passing urine)
Increased frequency of passing of urine
CC 3-3
Term
What 2 symptoms distinguish acute pyelonephritis from cystitis?
 Definition
Fever
Flank pain
CC 3-3
Term
Community acquired pyelonephritis is almost always caused by ...
 Definition
Escherichia coli CC 3-3
Term
What 4 bacteria are associated with UTI's from a urinary catheter?
 Definition
Escherichia coli (GNR) Enterococcus faecalis (GPC) Proteus mirabilis (GNR) Candida albicans (Yeast) CC 3-3
Term
Name 5 manifestations that occur with severe sepsis.
 Definition
Hypotension (low blood pressure)
Tachycardia (high heart rate)
Cold mottled extremities
Confusion
Oligouria (decreased urine output)
CC 3-3
Term
Name two infections that may likely proceed to bacteremia.
 Definition
Pneumonia
Urinary tract infection
CC 3-3
Term
Vascular line related bacteremia is usually due to ...
 Definition
Staphylococcus aureus Coagulase negative staphylococci CC 3-3
Term
Name three common sources of endovascular bacteria that produce prolonged bacteremia.
 Definition
Intravascular catheter Intravascular pacemaker lead

Infected heart valve (endocarditis)

CC 3-3
Term
Name 2 pathogens associated with prolonged bacteremia due to an intravascular source.
 Definition
Staphylococcus aureus Streptococci

CC 3-3
Term
Name 2 important and common causes of encephalitis.
 Definition
Herpes simplex virus
Vector borne viruses (e.g. West Nile Virus)
CC 3-4
Term
Name 4 important and common infectious causes of meningitis.
 Definition
Neisseria meningitidis Streptococcus pneumoniae Listeria monocytogenes Enteroviruses CC 3-4
Term
What are 3 symptomatic divisions of STD causing infectious agents?
 Definition
Cause urethritis
Cause genital ulcers
Cause genital warts
CC 3-4
Term
What are the 2 most important bacteria that cause urethritis?
 Definition
Neisseria gonorrhoeae Chlamydia trachomatis CC 3-4
Term
What are the 2 most important causes of genital ulcers? State if the ulcer is painful or not.
 Definition

Herpes simplex virus (painful ulcer)

Treponema pallidum or syphilis (painless ulcer)

CC 3-4
Term
What is the most common infectious cause of genital warts?
 Definition

Human papillomavirus

CC 3-4
Term
Name 6 examples of pathogens that cause diarrhea outside of a hospital.
 Definition

Salmonella (GNR)

Campylobacter (GNR)

Giardia lamblia (Protozoan)

Cryptosporidium (Protozoan)

Noroviruses

Rotavirus

CC 3-4
Term
Name an important nosocomial, or hospital acquired, infectious cause of diarrhea.
 Definition

Clostridium difficile (GPR)

CC 3-4
Term
Name two important infectious causes of dermatitis.
 Definition

Tinea spp

Candida spp

CC 3-4
Term
Name an important cause of superficial cellulitis.
 Definition

Streptococcus spp

CC 3-4
Term
Deeper skin infections such as abscesses are most commonly caused by ...
 Definition

Staphylococcus aureus

CC 3-4
Term
Name 2 examples of systemic infections that have manifestations in the skin.
 Definition

Pseudomonas aeruginosa bacteremia

Disseminated fungal infections

CC 3-4
Term
Give a definition of immunodeficiency.
 Definition

"A state in which the response of the host to a foreign antigen is not normal."

CC 3-5
Term
Give 4 examples of immunodeficiency.
 Definition

Splenectomy

Neutropenia

T-cell depletion (HIV, transplant)

Hypogammaglobulinemia

CC 3-5
Term
What disorder would cause a complement deficiency?
 Definition

Lupus

CC 3-5
Term
Name three situations that would lead to asplenia and immunodeficiency.
 Definition

Liver cirrhosis

Splenectomy

Sickle cell disease

CC 3-5
Term
If a patient has a defect in opsonization and/or reticuloendothelial system, what 3 pathogens would be better able to cause infection? What component do these 3 have in common?
 Definition

Streptococcus pneumoniae

Haemophilus influenzae

Neisseria meningitidis

They all have capsules

CC 3-5
Term
Name 2 granulocyte or neutrophil abnormalities that would cause immunodeficiency.
 Definition

Chronic granulomatous disease

Neutropenia

CC 3-5
Term
If a patient has a granulocyte or neutrophil abnormality, which 3 organisms would be better able to cause an infection? What do they have in common?
 Definition

Aspergillus

Pseudomonas aeruginosa

Staphylococcus aureus

They produce catalase

CC 3-5
Term
If a patient has an IgA deficiency, what organism would be better able to cause an infection?
 Definition

Giardia lamblia

CC 3-6
Term
What are two conditions that would cause IgG deficiency?
 Definition

Multiple myeloma

Common variable immunodeficiency (CVID)

CC 3-6
Term
If a patient has an IgG deficiency, which 3 organisms would be better able to cause infection? What component do these organisms have in common?
 Definition

Streptococcus pneumoniae

Haemophilus influenzae

Neisseria meningitidis

The have a capsule

CC 3-5
Term
Name 5 medications that would suppress T-cell function.
 Definition

Glucocorticoids

Tumor necrosis factor antagonists

Anti-lymphocytic antibodies

Cytokine inhibitors (cyclosporine)

Anti-metabolites (azathioprine)

CC 3-6
Term
Name 3 fungi that commonly cause opportunistic infections.
 Definition

Pneumocystis jarovecii

Candida spp

Cryptococcus spp

CC 3-6
Term
Name a species of bacteria that commonly causes opportunistic infection.
 Definition

Mycobacteria

(I'm sure there are many others)

CC 3-6
Term
Name 6 viruses that commonly cause opportunistic infection.
 Definition

HSV

VZV

CMV

KSHV

HPV

JC (don't know what this one is)

CC 3-6
Term
Name a parasite that commonly causes opportunistic infection.
 Definition

Toxoplasma

CC 3-6
Term
After transmission of an exogenous pathogen, name 4 events in the cycle of exogenous infections.
Definition
Gain Access
Colonization
Pathology
Dissemination
 
15-2
Term
Name the pathogen that can enter the body via insect bites, cuts, ingestion, and inhalation. In other words it enters by multiple routes.
 Definition
Francisella tularensis   15-3
Term
Infection or intoxication: Symptoms develop within hours.
 Definition
Intoxication
 
15-3
Term
Infection or intoxication: elevated fecal leukocytes
 Definition
Infection
 
15-3
Term
Infection or intoxication: symptoms develop within days of exposure
 Definition
Infection
 
15-3
Term
Which of the following pathogens disseminates from the GI tract to cause infection elsewhere? a. Shigella spp b. Salmonella typhi c. Salmonella enterica d. Proteus vulgaris
 Definition
b. Salmonella typhi   15-3
Term
Which food-borne intoxication causes neurologic manifestations but no GI toxicity?
 Definition
Botulism toxin
 
15-3
Term
What organism produces a shiga toxin that can damage kidney function? a. Shigella dysenteriae b. Enterotoxigenic E. coli c. Enteropathogenic E. coli d. Enterohemorrhagic E. coli e. a & d
 Definition
e. Shigella dysenteriae (some strains) Enterohemorrhagic E. coli   15-4
Term
Given the following three types of infectious pathology:
Infection without toxin Exogenous bacterial toxin intoxication Infection with in vivo toxin production
List them from slowest to fastest in presentation of symptoms
 Definition
Exogenous bacterial toxin intoxication Infection with in vivo toxin production Infection without toxin   15-4
Term
A patient comes to you complaining of symptoms that suggest a GI infection. Upon culture you find Shigella. But the patient is confident they didn't eat any bad food, where could it have come from?
 Definition
Water supply
 
15-4
Term
Name the 3 symptoms common to most GI infections/intoxications.
 Definition
Diarrhea
Cramping
Vomiting
(Sometimes fever)
 
15-4
Term
Name the gram positive coccus that produces an exogenous heat stable enterotoxin.
 Definition
Staphylococcus aureus   15-5
Term
Name the gram positive rod that produces an exogenous heat-stable enterotoxin.
 Definition
Bacillus cereus   15-5
Term
Name the gram positive rod that produces an exogenous heat-labile neurotoxin.
 Definition
Clostridium botulinum   15-5
Term
Name the 2 gram positive rods that produce heat-labile enterotoxins in vivo.
 Definition
Clostridium perfringens Bacillus cereus   15-5
Term
You culture stool from a patient with diarrhea, and culture it on several culture plates and place it in different conditions. All plates grow flora. However, one MacKonkey Agar plate that was incubated with low O2 at 42*C also grows an organism that you think is responsible for the infection. What is it?
a. Campylobacter jejuni b. Enteropathogenic E. coli c. Vibrioe cholerae d. Shigella dysenteriae
Definition
a. Campylobacter jejuni   It is a microaerophile that grows at 42*C.
Term
What is the one gram positive rod that is able to invade intestinal epithelium? It also is able to cause actin to polymerize.
 Definition
Listeria monocytogenes   15-5
Term
What group of viruses may account for 42% of GI infections?
 Definition
Noroviruses
 
15-5
Term
Name the six most common food poisoning bacteria in the USA.
 Definition
Nontyphoid Salmonella Clostridium perfringens Shigella spp Campylobacter jejuni E. coli Staphylococcus aureus   15-6
Term
What should you do if you doubt the safety of your water?
 Definition
Boil it.
 
Or, don't drink it I guess. But you can only do that for so long.
 
15-6
Term
What waterborne gram negative rod causes diarrhea so bad that you may have to put a hole in your bed with a bucket underneath?
 Definition
Vibrio cholerae   15-7
Term
"I'll take GI pathogens for 200"
 
The trophozoite of this protozoan has been said to look like a monkey face. It may be acquired by drinking from contaminated streams and may cause worse infection in IgA deficient individuals.
 Definition
What is Giardia lamblia?     15-7
Term
Name the four viruses that are associated with waterborne enteritis.
 Definition
Hepatitis A Virus
Noroviruses
Rotavirus
Enterovirus
 
15-7
Term
Which virus causes diarrhea, cramps and dehydration in children?
 Definition
Rotavirus
 
15-7
Term
Name 5 physical and chemical defenses the GI tract has to avoid infection.
 Definition
Gastric acid
Bile
Intestinal Proteases
Mucus
Intestinal motility
 
15-8
Term
Name 6 ways that pathogens get around GI tract defenses.
 Definition
Ingested in large numbers
Acid/bile resistance (e.g. O antigen)
Protected in food when ingested
Produce urease to raise pH
Seek shelter under mucus
Adherence
15-8
Term
What immune defenses does the GI tract have to prevent infection (2)?
 Definition
IgA
GALT (Peyer's patches): M cells, B cells, T cells
 
15-8
Term
Name the virulence factors associated with Campylobacter jejuni (3).
 Definition
Adhesins
LPS
Enterotoxin (questionable importance)
 
15-9
Term
What autoimmune disorder can be sequelae to Campylobacter jejuni infection?
 Definition
Guillain-Barre syndrome
 
15-9
Term
The infectious form of Giardia spp. is ...   a. Oocysts b. Sporozoites c. Trophozoites d. Cysts
 Definition
d. Cysts
 
They are secreted in large numbers in the stool. Takes ~10 to start an infection.
 
15-10
Term
 Definition
Giardia trophozoite   15-10
Term
Giardia is treated with a DNA damaging agent. What is it?
 Definition
Metronidazole
 
15-12
Term
"Enteric pathogens for 500"   This organism's life cycle proceeds as follows:  

Sporozoites->Trophozoites->Merozoites->Oocysts

 Definition
What is Cryptosporidium parvum   15-12
Term
What form of Cryptosporidium is transmissible?   a. Cyst b. Oocyst c. Merozoite d. Reticulate body
 Definition
b. Oocyst
 
It will develop into sporozoites in the intestine.
 
15-12
Term
Where histologically/anatomically in the GI tract does Cryptosporidium mature from sporozoites into trophozoites?   a. Under brush border membrane b. Partway into the submucosa c. Outer epithelial layer d. Intestinal lumen    
 Definition
a. Under the brush border membrane
 
15-13
 
 
Term
Cryptosporidium in the stool can be stained with ...
 Definition
acid fast stain.
 
15-13
Term
For immunocompetent, you can treat Cryptosporidium, with the approval of the FDA, with a. Ciprofloxacin b. Azole c. Penicillin d. Nitazoxanide    
 Definition
d. Ntazoxanide
 
15-14
Term
Rotavirus is a member of the family...
 
a. Parvoviridae
b. Picornaviridae
c. Bunyaviridae
d. Reoviridae
 
 Definition
d. Reoviridae
 
It is the only dsRNA family.
 
15-14
Term
T/F. Rotavirus has an envelope.
 Definition
F. It does not. Enteric pathogens generally do not have envelopes, because envelops may cause them to be susceptible to acid.
 
15-14
Term
The name of the enterotoxin-like protein produced by Rotavirus is:
 
a. HSP50
b. NFkB
c. NSP4
 Definition
c. NSP4
 
Unsure if this is important for pathogenesis
 
15-14
Term
Prevention of rotavirus involves...
 Definition
vaccination.
 
There is a new vaccine recently released. Administered to children at 2, 4, and 6 months.
 
15-15
Term
Hepatitis A Virus belongs to the family:
 
a. Papovavirus
b. Coronavirus
c. Picornavirus
d. Reovirus
 Definition
c. Picornavirus
 
15-16
Term
The genome of hepatitis A virus is...
 Definition
(+) ssRNA
 
15-16
Term
T/F Hepatitis A Virus has an envelope.
 Definition
F. It does not. Most enteric viruses don't
 
15-16
Term
How many HAV serotypes are known?
 
a. 3
b. 1
c. 5
d. 9
 Definition
b, 1
 
15-16
Term
What failure leads to HAV that has infected enterocytes spreading to the blood and further to the liver?
 Definition
Failure to make sufficient levels of neutralizing antibodies against HAV.
 
15-16
Term
Laboratory data most definitively used to aid in HAV diagnosis is...
 Definition
IgM anti-HAV antibodies in serum
 
15-17
Term
Antiviral medication that is used for Hepatitis A Viral infection:
a. Acyclovir
b. Adefovir
c. Zanamivir
d. Nothing
 Definition
d. Nothing
 
"Specific antiviral chemotherapy not available"
 
15-17
Term
What proportion of new STD cases occur in teenagers?
a. 1/4
b. 1/5
c. 1/8
d. 1/10
 Definition
b. 1/5
 
16-2
Term
Name the two most common pathogens associated with urethritis.
 Definition
Chlamydiae trachomatis Neiserria gonorrhoeae    16-2
Term
Five major principles of prevention and control of STDs are...
 Definition
1. Education and counseling of persons at risk 2 Identification of infected persons unlikely to seek diagnostic and treatment services 3. Effective diagnosis and treatment of infected persons 4. Evaluate, treat and counsel sex partners of infected persons 5. Vaccinate persons at risk for vaccine preventable STDs.  

16-4
Term
What molecular component of the cell envelope is Chlamydiae missing that most other bacteria have?
 Definition
Peptidoglycan
 
16-5
Term
What protein is the major serological determinant of Chlamydiae trachomatis? a. Major outer membrane protein b. O antigen c. Pilus B d. Ergosterol
 Definition
a. Major outer membrane protein (MOMP)
 
16-5
Term
The infectious form of Chlamydiae is called _____________, while the form that is capable of producing more organisms is called ______________.
 Definition
Elementary body is infectious Reticulate body is replicative   One way to remember is Elementery is Extracellular. And the extracellular must be the infectious form because it gets around. Reticulate is Replicative and intracellular. 16-5
Term
Intracellular Chlamydiae forms visible specks in an epithelial cell that are called ...
 Definition
inclusions.
 
16-5
Term
Name 3 manifestations caused by different serovars of Chlamydiae trachomatis.
 Definition
Trachoma: A, B, Ba, C
Oculogenital disease: B, Da, Ia, D-K
Lymphogranuloma venereum: L1, L2, L2a, L3
 
16-6
Term
Which immune cells will be present in large number on a histological preparation in ocular and genital Chlamydiae trachomatis infection?
a. Eosinophils b. Basophils c. Plasma cells
 Definition
c. Plasma cells
 
16-7
Term
Which immune cells will be present in large numbers in infant pneumoniae caused by Chlamydiae trachomatis?   a. Plasma cells b. Neutrophils c. Eosinophils d. a and c e. b and c
 Definition
e. Neutrophils and Eosinophils
 
16-7
Term
Which cell's function is most critical in recovery from Chlamydiae trachomatis?   a. Th1 cells b. Th2 cells c. Basophils d. NK cells
 Definition
a. Th1 cells
 
16-7
Term

There are 7 epidemiological characteristics that are correlates of having or acquiring Chlamydiae genital infection. Name as many as you can.

 Definition
Young age Black race Home-of-record from the south More than one sex partner A new sex partner Lack of condom use History of having a sexual disease   16-7
Term
T/F Urethral discharge the morning after a sexual encounter indicates that a Chlamydial infection may have been acquired the previous evening.
 Definition
F. The manifestations of urethritis and dysuria with discharge happen 7 to 14 days after contact with an infected partner.
 
16-7
Term
What are the 3 symptom's of Reiter's syndrome?
 Definition
Nonbacterial urethritis
Conjunctivitis
Arthritis
 
"You can't see, can't pee, and can't climb a tree."
16-8
Term
What antigen is commonly expressed on patients cells that acquire Reiter's syndrome?
 Definition
HLA-B27
 
16-8
Term
What are the 3 primary complications of Chlamydial urethritis in men?
 Definition
Epididymitis
Reiter's syndrome
Transmission to women
 
16-7
Term
What are the 5 symptoms of Chlamydial urethritis/cervicitis in females.
 Definition
Dysuria-pyuria syndrome
Cervicovaginal discharge
Mild abdominal pain
Intermittent bleeding
Dyspareunia (painful coitus)
 
16-8
Term
What condition leads commonly to infertility and ectopic pregnancy and is associated with Chlamydial infection?
 Definition
Pelvic inflammatory disease
 
16-8
Term
Fitz-Hugh-Curtis syndrome
 Definition
PID w/
Perihepatitis
Ascites
 
16-8
Term
What are 2 pediatric conditions associated with Chlamydiae trachomatis?
 Definition
Conjunctivitis - ophtalmia neonatorum
Pneumonia - afebrile
 
16-8
Term
Treponema pallidum lacks LPS, but does have structures on the outer membrane the resemble structures on host cells called...
 Definition
glycosaminoglycans (GAG)
 
16-9
Term
Mononuclear and plasma cells surrounding vessels in a lesion is typical of the condition...
 Definition
syphilis.
 
16-10
Term
In tertiary syphilis, granulomatous lesions from with a central necrotic mass surrounded by plasma cells, lymphocytes, and monocytes. These lesions are called _______.
 Definition
gummas.
 
16-10
Term
T/F A syphilis outbreak in the early 90s occurred that was associated with poverty, crack, HIV, minority background, and homosexuality.
 Definition
F. It was seen in heterosexuals, but all of the other characteristics are accurate.
 
16-10
Term
Genital infection with Chlamydia trachomatis in adolescent girls and young women most commonly causes: a. cervicitis b. dyspareumia c. ectopic pregnancy d. asymptomatic infection e. chronic abdominal pain
 Definition
D. asymptomatic infection
 
16-15
Term
T/F Zoonoses are not infectious from human to human via contact.
 Definition
F. Some are not infectious, but some are (e.g. plague, influenzae)
 
17-2
Term
What are three important elements of controlling/preventing zoonotic infections?
 Definition
Veterinary medicine
Sanitary engineering
Entomologic management
 
17-3
Term
This term refers to the transmission of infectious diseases from animal tissue transplantation.
 Definition
Xenozoonosis
 
17-3
Term
Which of the following is NOT a characteristic of hantavirus?   a. RNA genome b. Spherical virus c. (+) sense RNA d. Enveloped
 Definition
c. It is a negative sense RNA virus. 
It has a viral specific transcriptase and multiple copies of a viral-encoded RNA binding protein.
 
17-3
Term
Hantavirus is transmitted to the human host by...
 Definition
breathing in aerosols containing infectious material.
 
17-3
Term
The hantavirus envelope is made up of ...
 Definition
2 glycoproteins.
 
17-4
Term
Name the 3 diseases that may be caused by different hantavirus strains:
 Definition
Hemorrhagic Fever (HF)
Hemorrhagic Fever with Renal Syndrome (HFRS)
Hantavirus Pulmonary Syndrome (HPS)
 
17-4
Term
Hantavirus is a member of the following family:

 

a. Togaviridae

b. Bunyaviridae

c. Filoviridae

d. Papovaviridae

 Definition
b. Bunyaviridae
 
17-3, 11-7
Term
Treatment of hantavirus involves...
 Definition
Replacement of fluid and electrolytes
Kidney dialysis of indicated
 
17-4
Term
What family does Rabies virus belong to:
 
a. Rhabdoviridae
b. Flaviviridae
c. Caliciviridae
d. Poxviridae
 Definition
a. Rhabdoviridae
 
17-5, 11-7
Term
Which of the following is NOT a characteristic of Rabies virus:   a. Bullet shaped virions (due to the envelope) b. (-) ssRNA c. One segment of genomic material d. Nucleocapsid is icosahedral
 Definition
d. Nucleocapsid is icosahedral
 
It is actually helical.
 
17-5
Term
T/F Raccoons make good pets.
 Definition
F. Unless you want to go crazy with rabid encephalitis. Then knock yourself out.
 
17-5
Term
Which receptor is the target for rabies?
 Definition
Acetylcholine receptor
 
17-5
Term
Rabies incubation period can last up to:
a. 1 week
b. 24 hours
c. 3 years
d. 12 months
 Definition
d. 12 months
 
17-5
Term
A characteristic symptom of advanced rabies includes ______phobia.
 Definition
hydrophobia
 
Aversion to swallowing water because of painful spasms of the throat and neck
 
17-6
Term
Ultimate outomes of rabies after the onset of symptoms include...
 Definition
death.
 
17-6
Term
What is the genus of ticks that harbors Rickettsiae rickettsii?
 Definition
Dermacentor
 
17-7
Term
T/F Rickettsiae usually infects its arthropod host when that arthropod feeds on an infected mammal.
 Definition
F. Transovarial transmission from infected female ticks to offspring is the principal transmission method.
 
17-7
Term
How does Rickettsia induce the formation of filipodia in host cells?
 Definition
It can direct actin polymerization.
 
17-8
Term
Name 3 substances that Rickettsia produces that cause damage to the host cell.
 Definition
Phospholipases
Proteases
Membrane peroxidases
 
17-8
Term
Rickettsiae readily invade many mammalian cells yet are mainly seen in the... a. Glomerulus b. Meninges c. Alveoli d. Vascular endothelium e. Cardiomyocytes
 Definition
d. Vascular endothelium
 
It is thought that lysis of endothelial cells leads to rupture of capillaries and small vessels (spots that go with the fever).
 
17-8
Term
T/F Rickettsiae is only transmitted well via tick to human contact.
 Definition
F. Laboratory personnel should be cautious as Rickettsiae are very infectious and difficult to culture.   17-8
Term
_______ test uses antigens derived from an unrelated organism. a. Weil-Felix b. Ricketsial mimicry c. That one d. Proteus mimicry
 Definition
a. Weil-Felix
 
17-8
Term
Which drug should be used to treat Rickettsiae? a. Ciprofloxacin b. Amoxicillin c. Doxycycline d. Metronidazole  
 Definition
c. Doxycycline
 
17-9
Term
What genus of tick transmits Borrelia?
 Definition
Ixodes
 
17-10
Term
The ixodes ticks exhibit three seasonal stages in their life cycle....
 Definition
Larva
Nymph
Adult
 
17-10
Term
"Zoonoses for 400"   Borrelia expresses these surface proteins which demonstrate antigenic variability, and may allow it to escape the immune system of the host.
 Definition
What are Osps (outer surface proteins)?
 
17-11
Term
"Zoonoses for 200"   This surface molecule on Borrelia is thought to be important for tissue attachment, and may be associated with plasmid transmission.
 Definition
What are Osps (outer surface proteins)?
 
17-11
Term
How long must a tick feed on a human to transfer Borrelia organisms?
 Definition
>48 hours
 
17-12
Term
Borrelia cell morphology is...
 Definition
spirochete.
 
17-10
Term
What are the two steps in the tiered approach to laboratory diagnosis of infection with Borrelia?
 Definition
EIA or IFA for anti-flagellar antigen, and if positive
Western immunoblot procedure
 
17-12
Term
Name the two elements of a medical response to a bioterrorist attack.
 Definition
Protect those who are not affected (prophylactic vaccines and antibiotics)
Treat the ill
18-2
Term
In what patient population would an outbreak of virulent and fatal infection most strongly indicate a possible biological warfare agent?
 Definition
Healthy populations
18-2
Term
Name 4 agents whose outbreak would be managed very much like bioterrorism.
 Definition
Pandemic influenza
SARS
Monkeypox
West Nile Virus
18-2
Term
Name the 5 characteristics of category A agents.
 Definition
Easily spread from person to person
High mortality rates
Major public health impact
Public panic and social disruption
Special action required for public health awareness
18-3
Term
Name 2 reasons why a terrorist may use a Category B agent over a Category A agent.
 Definition
May be easier to obtain
Fairly easy to disseminate

18-3
Term
What are the 3 infections caused by Bacillus anthracis?
 Definition
Cutaneous (95%)
Inhalation (5%)
GI (sporadic)

18-3
Term
Bacillus anthracis has a capsule that is made out of a. Polysaccharides b. N-acetylglucosamine c. Polyglutamyl d. N-acetylmurein
 Definition
c. Polyglutamyl

18-4
Term
Which of the following is NOT a function of lethal factor made by Bacillus anthracis? a. Rapidly kills macrophages b. Impairs neutrophil chemotaxis c. Triggers fluid loss in alveolar endothelium d. Induces apoptosis in endothelial cells
 Definition
c. Triggers fluid loss in alveolar endothelium

18-4
Term
Name the two components of the lethal toxin made by Bacillus anthracis.
 Definition
Lethal factor
Protective antigen

18-4
Term
Name the two toxins made by Bacillus anthracis.
 Definition
Lethal toxin
Edema toxin

18-4
Term
What are the two components of edema toxin?
 Definition
Edema factor
Protective antigen

18-5
Term
Which enzyme is activated by edema factor?
a. Protein kinase A
b. Phospholipase C
c. Adenyl cyclase
d. Phosphofructokinase
 Definition
c. Adenyl cyclase

18-4
Term
Which of the following is NOT a way that Bacillus antrhacis can be transmitted and cause pulmonary disease? a. Person to person contact b. Close contact with infected animals c. Spores in soil d. Spores spread by engineered aerosols.
 Definition
a. Person to person contact

18-5
Term
A patient with anthrax should be handled according to:
a. Contact Precautions
b. Airborne precautions
c. Standard precautions
 Definition
c. Standard precautions

18-5
Term
Biodefense for 800. This is the component of Bacillus anthracis produced toxin that vaccinated individuals make antibodies against.
 Definition
What is protective antigen?

18-5
Term
Give two options for treatment of cutaneous anthrax.
 Definition
Doxycycline for 60 days
Ciprofloxacin for 60 days

18-5
Term
In addition to the antibiotic given in cutaneous anthrax, 2 additional antibiotics should be given for inhalation or GI anthrax. Name 7 from which these two could be chosen.
 Definition
Rifampin
Vancomycin
Penicillin/ampicillin
Chloramphenicol
Imipenem
Clindamycin
Clarithromycin

18-6
Term
Which of the following is an antibiotic that would NOT be used for inhalation anthrax?
a. Doxycycline
b. Rifampin
c. Imipenem
d. Moxifloxacin
e. Chloramphenicol
 Definition
d. Moxifloxacin

18-6
Term
The monoclonal antibody being developed against anthrax is:
a. Daclizumab
b. Raxibacumab
c. Ranibizumab
d. Cetuximab
 Definition
b. Raxibucamab

18-6
Term
What are the 3 types of infection caused by Francisella tularensis?
 Definition
Skin infection at site of bit or abrasion
GI infection after ingestion of contaminated meat
Inhalation (only requires 10 to 50 organisms)

18-7
Term
Give 2 possible preferred antibiotics for tularemia.
 Definition
Streptomycin
Gentamicin
18-8
Term
These two antibiotics can be used for cutaneous anthrax or as prophylaxis for tularemia.
 Definition
Doxycycline
Ciprofloxacin
18-8
Term
Name the three infections caused by Yersinia pestis.
 Definition
Acute febrile lymphadenitis (bubonic plague)
Pulmonary infection (pneumonic plague)
Septiciemia
18-8
Term
What are the 4 virulence factors of Yersinia pestis?
 Definition
Lipopolysaccharide endotoxin
Capsular envelope
Enzymes: Coagulase and fibrinolysin
Plasminogen activator
18-8
Term
What type of precautions should be used with a patient with Yersinia pestis pulmonary infection?
 Definition
Droplet precautions.
18-9
Term
What type of precautions should be taken with patients with Variola major infection?
 Definition
Immediate isolation
Negative pressure room
N95 respirators
Gowns and gloves
Surveillance and vaccination of household and close contacts
18-10
Term
Variola or Varicella: Rash most dense on face.
 Definition
Variola 18-10
Term
Variola or Varicella: Itchy lesions.
 Definition
Varicalla 18-10
Term
Variola or Varicella: Rash on palms and soles of feet.
 Definition
Variola 18-10
Term
Name 3 hemorrhagic fevers.
 Definition
Ebola hemorrhagic fever
Lassa fever
Marburg hemorrhagic fever
18-11
Term
Define Category A Agents.
 Definition

High priority agents of bioterrorism. 

 

-easily spread from one person to another

-high mortality

-major public health impact

-cause public panic and social disruption

-special action required for public health preparedness

 

18-3
Term
How does bioterrorism differ from expolsions/bombs? (aside from the obvious microbes vs schrapnel)
 Definition

-Causes widespread illness and death instead of a one time event

-difficult to know if exposed, so can lead to severe biological stress

-can persist over several months, causing more casualties
Term
Name 5 Category A agents
 Definition

Anthrax

Tularemia

Plague

Smallpox

Viral hemorrhagic fever

Botulism

 

 

 

 
Term
Name 2 category B agents
 Definition

Salmonella

O157:H7
Term
how is anthrax spread? What kind of precuations should be taken if you suspect your patient has anthrax?
 Definition

It is NOT spread person to person, but via exposure through an open cut.

 

Standard precautions
Term
Describe an anthrax cutaneous lesion/ulcer
 Definition
Painless ulcer, with a black center
Term
50% of people with inhalation anthrax develop
 Definition
meningitis
Term
Describe the capsule of anthrax
 Definition
It is a polyglutamyl capsule
Term
What are the 2 anthrax exotoxins and what factors comprise them?
 Definition

Lethal toxin is made up of two components:

1. Lethal factor (LF) 

-Rapidly kills macrophages

-Induces apoptosis in endothelial cells

-Impairs neutrophil chemotaxis

2. Protective antigen (PA)

-mediates the cellular toxin uptake

 

Edema toxin is also made up of two components

1. Edema factor (EF)

-High Adenyl cyclase acitivity, cAMP

-->Tissue edema

2. Protective Antigen (PA)

 
Term
What's the treatment for cutaneous anthrax?
 Definition
Doxycycline or cipro x60 days
Term
What is Raxibacumab? 
Definition
A monoclonal antibody that targets protective antigen of anthrax
Term

F. tuleremia:

1. Morphology

2. Intracellular/Extracellular?

3. More common in N or S hemisphere?

4. Seasonal peak? Why?

 Definition

1. coccobacillus

2. Facultative intracellular

3. N hemisphere

3. Summer because spread by ticks, often
Term

F. tuleremia:

Transmission

 Definition

Insect bite

Feces or saliva of an animal

Contact (like skinning) with a contaminated animal

Inhalation (rare)
Term
Tularemia clinical symptoms
 Definition

ulceroglandular (representing 75% of all forms)

pneumonic

blood clots
Term
Tularemia treatment
 Definition

Streptomycin or gentimycin (preferred)

Alternatives: Oral Doxycycline, ciprofloxacin, or chloramphenicol
Term
Yersinia pestis is most common in what part of the US?
 Definition
Southwest
Term
Which Gram negative bacterium has characteristic bipolar staining?
 Definition
Yersinia pestis
Term
Describe the transmission of Y. pestis
 Definition

A flea ingests blood from an infected rodent. Coagulase prevents blood from clotting and flea can’t swallow/digest it. The Y .pestis multiplies in the

clotted blood
Term
Y. pestis treatment
 Definition

Preferred antibiotics  (10 days): streptomycin or gentamicin (IV)

Alternatives (10 days): doxycycline, ciprofloxacin or chloramphenicol

Term
What are Guarnieri bodies?
 Definition
B-type inclusions in the cytoplasm of smallpox infected host cells
Term
T/F There are as many as 12 countries that could possibly have weaponized smallpox.
 Definition
True. There are 12 countries that are working with biological weapons, but we don't know who has smallpox. Soviet scientists left to work in different places but we don't know who, or if anyone, took smallpox with them
CC-2
Term
From what source did polio infections come from in 2000 in Hispanola and Egypt?
 Definition
From vaccine that had reverted to wild type.
CC-3
Term
What is the primary reason field work is not possible in areas of certain countries like Sudan and Somalia.
 Definition
These are strife torn areas where the influence of the government does not reach certain areas. This makes them unsafe for public health workers.
CC-4
Term
What are some differences between smallpox and polio infections that make a difference in the ease of the eradication efforts?
 Definition
1. Surveillance
Surveillance was simpler in smallpox because of distinctive rash. Polio has asymptomatic patients and chronic carriers which contrasts with smallpox that does not.
2. Efficacy of vaccination
Polio requires at least 3 doses.
CC-5
Term
T/F IPV takes a longer time to protect vaccinated patients than OPV
 Definition
True. IPV takes 6 to 8 weeks to make an antibody response. OPV provides immunity within days.
CC-6
Term
T/F. Polio escaping from laboratories and causing an epidemic is not a significant concern.
 Definition
False. Between 1941 and 1976 there were 12 instances where laboratory-associated polio infections occurred.
CC-7
Term
Considering that eradication of polio seems impractical given the complications, what is the stated goal in measurable terms?
 Definition
Stopping the virus transmission in man.
(How that differs exactly, I'm not sure. It was just in the syllabus and seems important)
CC-8
Term
Which vaccine can be stored longer: OPV or smallpox?
 Definition
Smallpox. It can be stored for decades. OPV can only be kept for a few years.
CC-9
Term
T/F It will likely be necessary to continue polio vaccination even if human transmission is successfully stopped.
 Definition
True.
CC-9
Term
 Definition
Term
Which of the following is NOT a risk for transmission of blood-borne illness:
a. Tattooing
b. Hemodialysis
c. Sexual exposure
d. Exposure to clear urine of infected individual
 Definition
d. Exposure to clear urine of an infected individual
(Assuming there is no blood in it, which is what was meant by clear)
19-2
Term
Blood is screened for presence of these 6 infectious agents.
 Definition
HIV-1
HIV-2
HBV
HCV
HTLV 1
Syphilis
19-2
Term
Give an example of a surrogate marker for HBV infection.
 Definition
Serum liver enzymes (ALT)
19-2
Term
What 4 viruses may cause hepatitis, but are not named as "hepatitis viruses?"
 Definition
Cytomegalovirus
Epstein-Barr virus
Yellow fever virus
Dengue virus
19-3
Term
What two hepatitis viruses belong to the family Flavivirus?
 Definition
HCV
HGV
19-3
Term
"Hepatitis for 500."

This is the only Hepatitis virus that does not have an RNA genome.
 Definition
What is HBV? It is Incomplete dsDNA
19-3
Term
What is the only hepatitis with an RNA genome that is anti-sense?
 Definition
HDV.
19-3
Term
These two drugs are used as therapy for HBV infection.
 Definition
Interferon
Lamivudine
19-3
Term
These two drugs are used as therapy for HCV infection.
 Definition
Interferon
Ribavirin
19-3
Term
What causes most of the damage in HBV infection?
 Definition
The immune system. (Immunopathogenesis)
19-5
Term
Which DNA virus uses reverse transcriptase?
 Definition
Hepatitis B virus
19-4
Term
What are the 4 important genes in Hepatitis B virus?
 Definition
Surface Ag (S)
Core (C)
pol (P)
X
19-4
Term
HBsAG may be found...
a. As free particles in serum
b. On the surface of HBV
c. Within the nucleocapsid of HBV
d. As polymers in serum
e. b and c
f. a,b, and d
g. all of the above
 Definition
f
As free particles in the serum
As polymers in the serum
On the surface of HBV
19-4
Term
If you do not clear HBV after infection, what is the probability of you presenting with chronic hepatitis?
 Definition
~30%
19-5
Term
What proportion of people with persistent HBsAG positive results will continue to be asymptomatic?
 Definition
>90%
19-5
Term
"Hepatitis for 400"

This molecule may be associated with infectivity of HBV.
 Definition
What is HBeAg?
It is a sign of ongoing HBV replication and higher viral load.
19-7
Term
Name the antibody the provides immunity to HBV.
 Definition
Anti-HBs
19-7
Term
Name the first antibody to appear in a person with HBV infection.
 Definition
Anti-HBcAg
19-7
Term
X protein in HBV:
a. Increases attachment to cells
b. Inhibits the action of interferon gamma
c. Transcriptional activator
d. Associated with lower hepatocellular carcinoma risk
 Definition
c. Transcriptional activator
It is associated with higher hepatocellular carcinoma risk
19-7
Term
Name the general situation where you would use HBIG.
 Definition
Unvaccinated exposed individuals (along with vaccine)
This includes newborns to affected mothers.
19-8
Term
Name 4 drugs used for chronic HBV infection.
 Definition
Alpha interferon
Lamivudine
Adefovir dipivoxil
Entecavir
19-8
Term
Which of the following drugs has problems with resistance in HBV:
a. alpha interferon
b. Lamivudine
c. Adefovir
d. Entecavir
 Definition
b. Lamivudine
Resistance is a problem due to mutations in viral polymerase (reverse transcriptase)
19-8
Term
Name two groups who are at higher risk for HDV co-infection with HBV.
 Definition
Hemophiliacs
IV drug users
19-8
Term
What lab test can diagnose HDV infection?
 Definition
Serology for Anti-delta Ag
19-8
Term
What 2 agents are used to HCV?
 Definition
alpha-interferon
Ribivirin
19-9
Term
If a patient may be in the window period of HCV, having just stuck themselves with a needle from an affected person, how could you test them to know without waiting for serology to become positive?
 Definition
RT-PCR for presence of circulating virus
19-9
Term
What proportion of transplants for chronic HBV or HCV infections are associated with re-infection of new liver due to the same agents (patient manifesting same virus as indicated the transplant)?
 Definition
Virtually all of them
19-10
Term
Reactivation of these 4 pathogens is a concern in transplants.
 Definition
HSV HBV HCV Trypanosoma cruzi 19-10
Term
Which is more severe:
a. Primary HSV infection in transplant patient
b. Reactivation of latent HSV infection in transplant patient
 Definition
a. First time infection of HSV
19-10
Term
EBV infects B cells via the receptor:
a. BCR
b. CD19
c. CD21
d. zeta chain
 Definition
c. CD21 or complement receptor CR2
19-11
Term
Name 4 cancer's that EBV is associated with
 Definition
Burkitt's lymphoma
Nasopharyngeal carcinoma
non-Hodgkin's lymphoma (most)
Hodgkin's lymphoma (some)
19-11
Term
What is the largest risk in EBV infection in patients with a transplant under immunosuppression?
a. Hodgkin's lymphoma
b. PTLD
c. Autoimmune disease
 Definition
b. PTLD
19-11
Term
Name the one antigen made by EBV that cannot be processed and presented by MHC-I.
 Definition
EBNA-1
19-11
Term
Two agents that are effective against EBV during the replicative cycle.
 Definition
Acyclovir
Gancyclovir
19-12
Term

You are treating a patient with Hepatitis B, Hepatitis C, and HIV. You use a needle to inject him with some drugs. Then, as you turn around to place the needle in the sharps container, an evil ninja emerges from the shadows! Years of medical school training have honed your reflexes, and you fling the needle like a dart; it sticks him in the arm.

Frightened, he flees like the coward he is, but you take comfort in the fact that he might catch all those diseases. What are the ninja's chances of catching Hep B, Hep C, and/or HIV from the needlestick injury?

 Definition

Hep B: ~30%

Hep C: ~3%

HIV: ~0.3%

 

(Syllabus: 19-2)
Term

Hepatitis comes in six delicious flavors: A, B, C, D, E, and G. Which of them can be transmitted parenterally?

 

FOR ONE BONUS POINT: How are the others transmitted?

 Definition

Hep B, C, D, and G can be transmitted parenterally.

 

Hep A and E use the fecal-oral route.

 

(Syllabus: 19-3)
Term
Which hepatitis viruses can cause chronic liver infection?
 Definition
Hepatitis B, C, and D can cause chronic liver infection (which, by the way, can progress to liver cancer).
Term
Ugh, I don't want hepatitis! I'll get every vaccine available. Doing so will protect me against which types of Hepatitis?
 Definition

A, B, and D.

 

(Syllabus: 19-3)
Term

Hepatitis B is a member of the Hepadnavirus family. What else is true about it?

 

A) It has single-stranded DNA.

B) It has double-stranded DNA.

C) It has single-stranded RNA.

D) It has double-stranded RNA.

 Definition

B. It has double-stranded DNA.

 

(Syllabus: 19-4)
Term

TRUE OR FALSE:

 

Hepatitis B has reverse transcriptase.

 Definition

TRUE

 

(Syllabus: 19-4)
Term

An evil ninja comes to see you in your office, wondering if he has Hepatitis B. You request a serology test and get the following results:

 

HBV DNA: Positive

HBeAg: Positive

HBsAg: Positive

Anti-HBcAg: Negative

Anti-HBsAg: Negative

 

What do you tell the ninja?

 Definition

You can tell him whatever you want, but the fact is that he has acute Hepatitis B (currently in its "window period," though that doesn't matter with modern tests).

 

(Syllabus 19-7)
Term

"I'll take Hepatitis for 300, Alex."

 

"And the answer is:

THIS virus exacerbates Hepatitis B infections."

 Definition

"What is Hepatitis D?"

 

(Syllabus: 19-8)
Term
To what family of viruses does Hepatitis C belong, and what kind of nucleic acid does it have?
 Definition

It is in the flavivirus family, and it has positive-sense RNA.

 

(Mnemonic: You get a child to try a food and she likes it. You say, "SEE, you like the FLAVor! Wasn't this a POSITIVE experience?")

 

(Syllabus: 19-9)

 

 
Term
What unpleasant results might you experience if you have a chronic infection with Epstein-Barr virus?
 Definition

Some cancers: Nasopharyngeal carcinoma and various lymphomas ("Burkitt's," as well as both Hodgkin's and non-Hodgkin's).

 

Also, if you need a transplant, you might get post-transplant lymphoproliferative disease (PTLD).

 

(Syllabus: 19-11)
Term

Epstein-Barr virus is a:

 

A) DNA virus

B) RNA virus

C) Computer virus

D) All of the above

E) None of the above

F) Some of the above

 Definition

A. It's a DNA virus.

 

(Syllabus: 19-11)
Term
Your transplant patient gets PTLD from an Epstein-Barr infection that was latent in his donated organ. He asks, "Medical Student, what the heck is PTLD? And what can you do to treat me?"
 Definition

PTLD is post-transplant lymphoproliferative disease. The virus was latent in the organ's B cells, but when he became immunocompromised, it triggered a proliferative growth program in those B cells. It could progress to lymphoma.

 

The best thing to do is reduce the immunosuppressive therapy. You might also give him IV immunoglobulins. There aren't a lot of other options.

 

Ideally, you wouldn't have put an EBV-positive organ into an EBV-negative recipient in the first place.

 

(Syllabus: 19-12)
Term
What are 5 general types of defenses that respiratory tract has to prevent infection?
 Definition
Microbial/flora
Mechanical
Innate
Humoral
Cellular
20-3
Term
What are 3 components of mechanical protection against respiratory infection?
 Definition
Airflow (normal and cough/sneeze)
Mucociliary elevator
Epiglottis
20-3
Term
What are 5 components of innate protection against respiratory infection?
 Definition
Airway fluid
Antimicrobial peptides
Mucin
Lactoferrin
SLIP1
20-3
Term
What are 2 components of humoral protection against respiratory infection?
 Definition
sIgA
Capsule/virion neutralizing IgG
20-3
Term
What are 3 components of cellular protection against respiratory infection?
 Definition
Neutrophils
Macrophages
T cells (CD4,CD8,CD17)
20-3
Term
What type of condition would predispose to aspiration pneumoniae, and abscesses with endogenous flora (anaerobic streptococci, Fusobacterium)?
 Definition
CNS injury (traumatic brain injury, cerebral palsy)
This would inhibit mechanical protection
20-3
Term
Common pathogens (pneumococcus) may be more able to cause respiratory infections in this condition.
 Definition
What is humoral deficiency.
20-3
Term
Where in the respiratory tract of a normal healthy person are bacteria responsible for more infections than viruses:
a. Nasal cavity
b. Middle ear
c. Pharyx
d. Bronchioles
e. Viral infections more common than bacteria in the respiratory tract in general
 Definition
e. Viral infections are more common than bacteria in the respiratory tract in general
20-4
Term
3 endogenous flora of the upper respiratory tract that commonly cause disease.
 Definition
Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis 20-4
Term
Where in the respiratory tract will infection more likely lead to bacteremia?
a. Pharynx
b. Trachea
c. Alveoli
d. Nasal passage
 Definition
c. Alveoli
20-4
Term
What are the 6 common respiratory viruses?
 Definition
Adenovirus
Influenza
Parainfluenza
Rhinovirus
Human metapneumovirus
Coronavirus
20-4
Term
It is thought that many upper and lower bacterial respiratory tract infections are preceded by ____________ that "pave the way."
 Definition
viral infection
20-4
Term
Few pathogens are primarily inhaled. Name 5.
 Definition
Legionella M. tuberculosis Pulmonary anthrax Histoplasma Tularemia 20-4
Term
The specificity and serotype of adenovirus are specified by:
a. Attachment protein 2
b. Penton
c. hemagglutinin
d. Fiber protein
 Definition
d. Fiber protein
20-5
Term
What percent of respiratory infections can be attributed to adenovirus?
 Definition
~5-10%
20-6
Term
Other than viral culture, what can be used to diagnose adenovirus infection?
 Definition
Shell vial: Incubate with cell layer, immunostain
Serum antibodies
Antigen detection
PCR
20-7
Term
What two factors inside of erythrocytes are required for the growth of H. influenzae?
 Definition
Factor X (hematin)
Factor V (NAD)
20-8
Term
Which Haemophilus influenzae serotype is most associated with meningitis and bacteremia?
 Definition
Type B. Hib stands for Haemophilus influenzae type B 20-9
Term
What ENT emergency may be caused by Haemophilus influenzae?
 Definition
Epiglottitis
20-9
Term
Which serotype of H. influenzae causes most adult disease?
 Definition
Non-typeable strains (non a-f).
20-9
Term
The molecule that makes H. influenzae a type B is...
 Definition
Polyribose ribosyl phosphate (PRP)
20-10
Term
Name 6 virulence factors of H. influenzae.
 Definition
Polysaccharide capsule (often B)
Endotoxin (LOS)
IgA protease
Pili and afimbrial adhesions
Ability to get iron from heme and transferrin
Genetic transformation
20-10
Term
A neonate presents with high fever, and a spinal tap shows neutophils and a gram negative coccobacillus which is oxidase positive. What is the most likely organism?
 Definition
Haemophilus influenzae It would most likely be E. coli if it were oxidase positive. 20-10
Term
Cold agglutinins is an old school diagnostic test for...
 Definition
Mycoplasma pneumoniae 20-13
Term
Which of the following is NOT a diagnostic test commonly used to diagnose M. pneumoniae infection? a. Culture b. PCR c. Serology d. Cold agglutinin
 Definition
a. Culture Not commonly used with fastidious organisms that take very long to grow such as M. pneumoniae. 20-13
Term
What are the three model pathogens described in detail as model pathogens for inhalation acquired infections?
 Definition
Adenovirus, Haemophilus influenza, Mycoplasma pneumoniae
Term

T or F:

Sneezes and coughs have up to 10 million microbes per sneeze?

 Definition
True: they also have 10 uM particles which dry quickly to even smaller size, travel up to 6 feet with speeds up to 60 mph
Term
What are the two reasons microbiologist feel that breathing is a terribly risky activity? (hint: they both involve breathing)
 Definition

  1. Breathing in exogenous flora (from sneezes, coughs, etc)= inhalation
  2. Breathing in endogenous flora= aspiration
Term

Which of the following is not true:

  1. Commensal flora inhibit growth of pathogens in upper airways
  2. Mechanical mechanisms for respiratory include all of the following:, air flow, mucociliary elevator, and epiglottis
  3. Innate immunity involves all of the following: fluid, antimicrobial peptides, Mucin, Lactoferrin, SLIP1, sIgA, IgM, and Specific IgG
  4. Cellular immunity involves all of the following: PMNs, Macrophages, CD4, CD8, and Th14

 Definition
3:  While most of what is said is true, there is no IgM in the upper respiratory tract: the remainder of the info is correct (20-3)
Term
Ryan a medical student had a traumatic brain injury: soon after he developed pneumonia, what do you suspect is the cause?
 Definition

Muscle/nerve dysfunction prevents airway protection: aspiration of endogenous flora (anaerobic strep, Fusobacterium)

(20-3)
Term
A bone marrow transplant patient is at risk for developing respiratory tract infection.  What type of infection would you be most concerned about?
 Definition
Opportunistic pathogens: fungal and viral pneumonia with exogenous pathogens (P. jiroveci, CMV)
Term
A 78 year old woman presents to your office with persistent cough, what type of pathogens do you suspect caused her pneumonia?
 Definition

Because age (and other immune deficiencies) can cause a lack of Humoral defense, you would expect common pathogens to be associated (pneumococcus)

(20-3)
Term
Cystic fibrosis is a downward spiral of progressively worsening infections.  What part of the defense mechanism is insufficient?
 Definition

Normal cellular and humoral immunity but compromised mechanical and innate

(20-3)
Term

T or F:

Viruses are the leading cause of LRT infections, but in URT it is about equal between viruses and bacteria

 Definition

False: viral is leading cause of both

(20-4)
Term

Which of the following is false:

  1. URT infections are caused by endogenous flora taking advantage (S. pneumonia, M. catarhalis)
  2. URT infections are usually confined to the areas of the pharynx, nares, and mouth
  3. Aspiration of endongenous flora is much more likely then inhalation of exogenous flora, even if you don't drink
  4.  LRT infections can be seeded from the bloodstream

 Definition
3: Local spread is common to the sinuses and ears
Term

T or F:

RTI are caused by a VERY narrow group of viral pathogens

 Definition

False: Very broad group including: adenovirus, influenza, parainfluenza, rhinovirus, human metapneumovirus, and coronavirus

(20-4)
Term

Which of the following isn't primarily inhaled:

  1. Strep Pneumonia
  2. Legionella
  3. TB
  4. anthrax
  5. Histoplasma
  6. Tularemia

 Definition

Answer: 1

Strep is commonly aspirated, not inhaled because it is endogenous flora

(20-4)
Term
The adenovirus have specific serotypes based on what?
 Definition

Antibody to fiber protein

(20-5)
Term
Adenovirus serotypes are important to infectivity why?
 Definition

Because they find a specific cellular receptor (Coxsackievirus/adenoviurs receptor (CAR) is used by serogroups A, C-F)

20-5
Term

Which of the following is incorrect about adenovirus:

  1. Children infected with 1 and 2 serotypes 
  2. Adults infected with 4, 7, and 14
  3. Military relatively uninfected because of continued use of immunization
  4. Causes a vast array of infections including conjunctivitis 
  5. Infections can be endemic or epidemic

 Definition

Answer: 3

Military discontinued vaccination for 14
Term
What are the three main forms of infections (under virulence factors):
 Definition

Lytic virus in human epithelial cells, chronic/latent infection in lymphoid tissue, oncogenic transformation

(20-6)
Term

Adenovirus virulence properties include which of the following:

  1. a capsule for inducing phagocytosis
  2. An E3 gene that enhances cell signaling (ie induce apoptosis)
  3. Chuck Norris 
  4. "early" genes that hijack cell machinery
  5. Polyribose ribosyl phosphate 

 Definition

Answer: 4

While it is tempting to go with Chuck Norris, he has nothing to do Adenovirus.  The E3 gene BLOCKS cell signalling.  PRP is Haemophilus. Andenvirus is naked.

20-6
Term
How is adenovirus diagnosed?
 Definition
Culture of virus (expensive), Serum antibodies (false positives), Antigen detection, PCR
Term

T or F:

Primary treatment for Adenovirus is supportive care

 Definition
T: although and investigational agent (cidofovir) is being used in immunosuppressed
Term
Lack of immunizations + toddlers = 
 Definition
Haemophilus influenza
Term

Which of the following is not a characteristic of Haemophilus?

 

  1. Member of family Pasteurelleaceae
  2. Small, pleomorphic gram- cocobacilli 
  3. Fastidious growth requiring factor X and factor V
  4. fully encapsulated family

 Definition

Answer: 4 this is half truth: there are both encapsulated and naked strains

20-8
Term
Polysaccharide capsules are the basis for typing Haemophilus T or F
 Definition
T: with type b being especially important
Term
Besides humans, what else serves as a reservoir for H. influenza?
 Definition
YOUR MOM!!!! Because only humans serve as reservoirs
Term
Transmission of H. influenza occurs primarily through what?
 Definition
Respiratory droplets
Term

T or F:

Immunization has a dramatic effect on reducing nasal carriage of Hib strains and protecting communities against spread

 Definition
T
Term

All of the following are true of H. influenza in children except:

  1. Ottis media/sinusitis (type b)
  2. Epiglottitis (type b)
  3. Pneumonia (type b)
  4. Miningitis/bactererimia (type b)
  5. Epiglottitis, pneumonia, miningitis are all rare in US kids because of Hib Vaccine.  But H. influenza in number 1 cause of OM.

 Definition

1: It would have been fairly easy to narrow this down between 5 and 1.  OM is caused by the non-typeable, and is therefore not reduced by Hib Vaccination.  

20-9
Term

T or F:

Most adults are immune to nontypeable strains

 Definition
False: they are immune to most TYPEABLE strains
Term
A 35 year old patient with chronic bronchitis and positive culture for H. influenza likely has what type of H. influenza?
 Definition

60% of the time patients with COPD have nontypeable H. influenza, especially with exacerbations and chronic bronchitis

(20-9)
Term
What are the virulence factors I associated with H. influenza?
 Definition

Polsaccharid capsules (Resistant to phagocytosis, complement; promotes invasion and bacteremic disease). PRP (polyribose ribosyl phosphate) are classified as type b. Hib is most common capsular strain. 

Confused? 20-10

 
Term
H. influenza: virulence factors II
 Definition

Endotoxin (LOS): adhesion to resp. epithelim

Promotes inflammation and sepsis in invasive disease

IgA Protease

Pili and afimbiral adhesions

Ability to obtain iron from heme and trasnferrin

Genetic transormation
Term

Which of the following isn't associated with the pathogenesis of H. influenza?

  1. Transmission
  2. Increased immune response
  3. virulence factors
  4. environment
  5. all of the above are involved

 Definition
2: actually a decrease in the immune response allows colonization
Term
The single most important factor for H. influenza to cause invasive diseases is what?
 Definition

Capsule association with Hib

20-10
Term
Morphology of H. influenza
 Definition
gram- coccobacilli
Term

T or F:

H. influenza can grow on chocolate agar, but not on blood agar.  Why or why not?

 Definition

True: H. influenza requires two factors that are found in RBCs, therefore they must be lysed in order for growth

20-10
Term
What are two ways to detect Hib?
 Definition

Serotyping and Latex particle agglutination in CSF

20-11
Term
Treatment for H. influenza can be resistant to B-lacatams, and depends on the sight of infection.  However, prevention is a much better option.  How is H. influenza prevented?
 Definition
Conjugated PRP vaccine for Hib
Term
Persistant cough + erythema multiforme + Anemia =
 Definition
Mycoplasma pneumoniae
Term
Why is M. pneumoniae such a weirdo?
 Definition
No cell wall, sterols in membrane, itty bitty genome and size.
Term
In addition to erythema multiforme and hemolytic anemia what other clinical manifestations are associated with Mycoplasma infection generated autoantibodies? 
 Definition
Bell's palsy, thrombocytopenic purpura
Term

T or F: 

Mycoplasma will colonize the whole respiratory tract down to and including the alveoli

 Definition
F: there is no receptor in the alveoli
Term
WHat does mycoplasma use to attach to epithelium?
 Definition
Adhesins
Term
How does mycoplasma cause damage?
 Definition
Once attached to epithelium peroxides are produced.  They also cause an inflammatory response.  
Term

Diagnosis of Mycoplasma pneumoniae is true of all of the following except:

  1. Clinical Symptoms are unremarkable
  2. Serology, but there are many false positives
  3. PCR from LRT specimens
  4. Cold Agglutinins (blood on ice will agglutinate b/c of anitbody)
  5. Culture is time consuming and not usefull clinically

 Definition
1: Clinical symptoms are important: anemia, atypical pneumonia, erythema multiforme, etc 
Term

Mycoplasma treatment involves all of the following except:

  1. B-lactams
  2. tetracyclines and macrolides
  3. fluoroquinolones
  4. questionable use of antibiotics because of lack of evidence/study supporting their efficacy
  5. All of the above are true of treatment

 Definition

1. B-lactams target cell wall, there is no cell wall to target.  Also immunization in the 60's seemed to worsen infection 1/2 of cases. 

20-14
Term
What two events usually occur during colonization of a host?
 Definition
Adherence to tissue
Multiplication
21-2
Term
How are pathogens able to colonize host tissue, when it's already crowded by normal flora?
 Definition
Novel pili that allow it to attach to sites where the flora is not attaching.
21-2
Term
Contrast pili from nonfrimbrial adhesions.
 Definition
Pili: Long-range
Nonfimbrial adhesions: Short-range
21-2
Term
What are the 4 characteristics of Enterobacteriaceae?
 Definition
Facultative anaerobes
Oxidase negative
Can grow on media w/ only glucose
Bile resistant
21-4
Term
You culture an enteric on a MacConkey agar plate. It grows clear colonies at 24 hours. Which of the following could NOT be this organism: a. Shigella dysenteriae b. E. coli c. Proteus mirabilis d. Morganella morganii
 Definition
E. coli. It is lactose positive and would not form clear colonies. It would be red. 21-5
Term
What are 3 general virulence factors for E. coli?
 Definition
Fimbrial and afimbrial adhesions
Iron acquisition
Toxins
21-7
Term
Name the most common manifestation of this organism: ETEC.
 Definition
Traveller's diarrhea.
21-8
Term
Name the most common manifestation of this organism: EPEC.
 Definition
Infant diarrhea in developing countries
21-8
Term
This strain of E. coli forms a "pedestal" with the proteins intimin, and TIR, but not Stx.
 Definition
EPEC.
21-9
Term
This strain of E. coli forms a biofilm that colonizes the gut under the mucus layer.
 Definition
EAEC.
21-9
Term
This strain of E. coli forms a type III secretion system and invades the cytoplasm of host cells.
 Definition
EIEC
21-9
Term
Does S. saprophyticus cause CA UTI's or nosocomial UTI's?
 Definition
CA UTI's
21-11
Term
Which adhesin protein is associated with pyelonephritis?
 Definition
P-pili or Pap pili
2-11
Term
What is the important antigen in E. coli that causes neonatal meningitis? a. E44 b. K1 c. O42 d. K7
 Definition
b. K1
21-12
Term
For what E. coli infection are antibiotics actually contraindicated?
 Definition
Hemolytic uremic syndrome (HUS)
21-12
Term
T/F More people are colonized with H. pylori outside of the US than within.
 Definition
T
21-13
Term
Name 5 virulence factors for H. pylori.
 Definition
Urease
Flagella
VacA: cytotoxin that can damage stomach cells
Type IV secretion system
CagA: the last to referred to as cag pathogenicity island
21-14
Term
Colonization involves TWO (fairly obvious) aspects. What are they?
 Definition

Adherence and multiplication.

 

(Syllabus: 21-2)
Term

What do bacteria use for

a) long-range attachment, and

b) short-range attachment

?

 

 Definition

a) Pili

b) Non-fimbrial adhesins

 

(Syllabus: 21-2)
Term
Tell me about enterobacteriaceae. How do they Gram stain and what shape are they? Where are they found? Are they anaerobes or aerobes or what? Are they oxidase positive or negative? On what media do you grow/isolate them?
 Definition

Enterobacteriaceae are Gram negative rods that are often part of the normal GI flora. They are facultative anaerobes but are oxidase-negative (they have some other enzyme that they use in place of cytochrome C). They grow well on simple media using just glucose as an energy source, but you can use MacConkey agar to isolate them. (That's because MacConkey has bile salts, which the enterbacteriaceae can tolerate, but many other bacteria cannot.) Some enterbacteriaceae eat the lactose in the MacConkey agar; they produce lactic acid, which turns the pH-sensitive media PINK.

 

(Syllabus: 21-4)
Term
Name six important members of the enterobacteriacea.
 Definition

Shigella

Salmonella

Escherichia

Klebsiella

Proteus

Yersinia

 

(Mnemonic: SEKSY P. Mmm, that is one sexy pea that I'll eat and send to my GI tract.)

 

(Syllabus: 21-5)
Term
You have some enterbacteriaceae on a nice plate of MacConkey agar. How can you determine if they are Escherichia, Salmonella, or Shigella?
 Definition

Eschericia eat lactose; the others don't. (Escheria turn MacConkey agar pink.)

 

Salmonella makes hydrogen sulfide (H2S); the others don't.

 

(Syllabus: 21-5)
Term
Some members of enterobacteriaceae cause opportunistic infections. What is the most common type of infection that they cause?
 Definition

Urinary tract infections.

 

(Syllabus: 21-5)
Term
What are the three antigens used to distinguish different strains of E. coli?
 Definition

O (surface--LPS), H (flagella), and K (capsule).

 

(Syllabus: 21-6)
Term
What is a siderophore?
 Definition

Molecules with a high affinity for iron. E. coli produce them to steal our iron. Jerks!

 

(Syllabus: 21-7)
Term
E. coli can produce up to five toxins. What are they, and what do they do?
 Definition

Endotoxin (LPS): Summons a powerful immune response.

Hemolysin (Hly): Can damage kidney cells (possibly leading to pyelonephritis).

Heat-stable enterotoxin (STa): Increases cGMP levels in enterocytes; this somehow causes diarrhea.

Heat-labile enterotoxin (LT): Increases cAMP levels in enterocytes; again, diarrhea.

Shiga toxin (STX): Inactivates ribosomes, preventing protein synthesis--especially in kidney cells.

 

(Syllabus: 21-7)
Term
E. coli can produce five kinds of infection. What are they (and what do the acronyms mean?)
 Definition

ETEC: Enterotoxigenic E. coli

EPEC: Enteropathogenic E. coli

EAEC: Enteroaggregative E. coli

EIEC: Enteroinvasive E. coli

EHEC: Enterohemorrhagic E. coli

 

(Syllabus: 21-8)
Term
I really want to get ETEC. How would I go about getting it, and what would I enjoy as my symptoms?
 Definition

It's transmitted by contaminated food and water. It causes watery diarrhea.

 

(Syllabus: 21-8)
Term
What's a Type III secretion system?
 Definition

It's a way for Gram-negative bacteria to excrete proteins directly from their cytoplasm to the external environment. It's like a tube or syringe.

 

(Syllabus: 21-9)
Term
Which E. coli infections use a Type III secretion system?
 Definition

EPEC, EIEC, and EHEC.

 

(Syllabus: 21-8 and 9)
Term
Hello. I'm an E. coli bacterium. I like to cruise down the epithelium with my bundle-forming pilus (bfp) dangling, until it grabs onto a nice, juicy cell. Then I get down to business. What kind of infection do I cause, and what are the symptoms?
 Definition

I am EPEC. After grabbing the cell, I use my Type III secretion system to create a close attachment to my host cell and I rise up on a pedestal. I like to cause diarrhea in infants.

 

(Syllabus: 21-8 and 9)
Term
A biofilm is characteristic of which E. coli infection?
 Definition

EAEC (enteroaggregative E. coli).

 

(Syllabus: 21-9)
Term
THIS E. coli infection resembles Shigella, both in pathogenesis and disease symptoms.
 Definition

What is EIEC (enteroinvasive E. coli)?

It doesn't produce enterotoxins, though it does cause diarrhea.

 

(Syllabus: 21-9 and 10)
Term
THIS E. coli infection is like EPEC, but with Shiga toxin.
 Definition

What is EHEC (enterohemorrhagic E. coli)?

 

(Syllabus: 21-10)
Term
What is hemolytic uremic syndrom (HUS), and how do you get it?
 Definition

It's acute kidney failure, usually as a result of EHEC. (Shiga toxin can affect the kidneys.)

 

(Syllabus: 21-10)
Term
What bacterium is the most common cause of community-acquired urinary tract infections?
 Definition

E. coli.

 

(Syllabus: 21-11)
Term
What are the two leading causes of neonatal meningitis?
 Definition

E. coli and Group B strep.

 

(Syllabus: 21-11)
Term

TRUE OR FALSE:

 

I should treat HUS with antibiotics.

 Definition

FALSE. (Unless you don't like your patient.)

 

(Syllabus: 21-12)
Term
Compare and contrast the morphology and biological properties of H. pylori and C. jejuni.
 Definition

They are both curved, Gram-negative rods that are motile and microaerophilic. H. pylori grows well at 37°C, while C. jejuni prefers a tropical 42°C.

 

(Syllabus: 21-12)
Term

H. pylori is a Sith lord, fighting a jedi neutrophil above the bubbling, acidic pit of the stomach. The neutrophil force-pushes the H. pylori into the stomach acid--surely it's curtains for the dark lord!

 

But no... Darth Pylori manages to survive in that acidic cesspool. HOW????

 Definition

H. pylori produces urease, which raises the pH in its immediate vicinity. It also uses its flagellum to move into the mucus layer, where the pH is much higher than in the acid.

 

(Syllabus: 21-14)
Term
Most stomach and duodenal ulcers stem from what bacterium?
 Definition

H. pylori.

 

(Syllabus: 21-15)
Term
The 5 ways nosocomial infections are spread from person to person.
 Definition
Healthcare workers hands
Contact of patient with contaminated environment
Poorly cleaned equipment
Airborne transmission
Blood administered at hospital
22-2
Term
Name the 4 most common nosocomial infections.
 Definition
Bloodstream infections from lines
Urinary tract infections from catheters
Pneumonia; many from ventilators
Surgical wound infections
22-2
Term
This organism is the most common cause of hospital acquired diarrhea.
 Definition
Clostridium difficile 22-2
Term
Name the 3 toxins of C. difficile
 Definition
Toxin A
Toxin B
Binary toxin
22-3
Term
An enterotoxin made by C. difficile that disrupts signal transduction, and can provoke intense inflammation: a. alpha toxin b. toxin A c. toxin B d. Binary toxin
 Definition
b. Toxin A
Term
A toxin made by C. difficile that induces cytopathic effect on tissue culture cells, enabling diagnosis: a. alpha toxin b. toxin A c. toxin B d. Binary toxin
 Definition
c. toxin B
22-3
Term
A toxin made by C. difficile that acts upon actin by adding ADP-ribose. It is associated with more severe disease: a. alpha toxin b. toxin A c. toxin B d. Binary toxin
 Definition
d. Binary toxin
22-3
Term
What 2 drugs are used to treat C. difficile infection?
 Definition
Metronidazole (oral or IV)
Vancomycin (oral only, not IV)
22-4
Term
Name 2 antibiotics that retain activity against VRE.
 Definition
Linezolid
Daptomycin
22-4
Term
Contact with non-visually contaminated skin of a patient could transfer this GNR that colonizes patients skin, and colonize our hands for about 15 minutes.
 Definition
K. pneumoniae 22-5
Term
Name 4 (of the 8) components of an effective strategy for preventing nosocomial infections.
 Definition
Hand hygiene before and after contact
Isolation for patients with transmissible disease
Cleaning of hospital rooms
Adequate cleaning of equipment
Perioperative antibiotics
Rational antibiotic use
Screen blood supply
Vaccinate healthcare workers
22-6
22-5
Term
This precaution requires private negative pressured rooms, and N-95 mask worn by providers.
 Definition
Airborne precautions
22-6
Term
This precaution requires that the patient have a private room and visitors wear a surgical mask.
 Definition
Droplet precautions
22-6
Term
This precaution requires a private room, and visitors use gloves, gowns, and dedicated stethoscopes.
 Definition
Contact precautions
22-6
Term
Which of the following does NOT describe the pathogen that is the most common cause of bacteria in the hospital?
a) It is gram-negative
b) It forms spores
c) It is anaerobic
d) It causes diarrhea due to toxin formation.
 Definition
a) Clostridium difficile is the most common cause of diarrhea in the hospital. It is gram-positive. All other facts listed are true.
22-2
Term
Which of the following is the LEAST effective way to prevent C. difficile from spreading in hospitals?
a) Contact precausions
b) Restricting the use of antibiotics
c) Designating thermometers and stethoscopes to infected patients
d) Using antibacterial gels.
 Definition
d) Antibacterial gels will not kill C. diff spores, which is why handwashing must be enforced.
22-3. Not explicitly stated, but emphasized in slides and lecture.
Term
What is the gold standard for diagnosing C. difficile?
 Definition
Detection of toxins using cell culture cytotoxicity assay or a toxin ELISA
22-4
Term
What is Toxin A? How does it compare to Toxin B?
 Definition
Toxin A is an enterotoxin of C. difficile. Disturbs actin cytoskeleton of intestinal epithelial cells, rendering htem leaky. Can provoke inflammation. Toxin B is nearly identical.
22-3
Term
What would you expect to see on microscopy of stool in a patient with C. difficile?
 Definition
Elevated fecal leukocytes (due to proinflammatory effects of toxin A and B).
22-3
Term
What is the spectrum of clinical manifestations of C. difficile?
 Definition
Asymptomatic carriage --> acute diarrhea --> pseudomembranous colitis --> toxic megacolon and colon perforation --> relapsing diarrhea
22-3 and slides
Term
How do you treat C. difficile?
Definition
oral or IV metronidazole or oral vancomycin (NOT IV)
Term
What can Enterococcus faecalis and faecium cause?
 Definition
Line-related bloodstream infections, endocarditis, and catheter related UTIs.
22-4
Term
How are Enterococci transmitted?
 Definition
They are natural colonizers of the lower GI tract. In hospital setting, can colonize the skin of sick people and be transferred from person-to-person via hand carriage.
22-4
Term
What is used to treat vancomycin resistant Enterococci?
 Definition
Linezolid and daptomycin
22-4
Term
Fill in the blanks: MRSA is Gram ______, catalase _______, and coagulase ________.
 Definition
All positive.
22-4
Term
What does MRSA commonly cause?
 Definition
Wound infections, abscesses, and blood stream infections.
22-4
Term
Which pathogen is particularly problematic in ICUs?
 Definition
Klebsiella
22-5
Term
What do you need to consider in determining treatment for Klebsiella?
 Definition
Whether the strain has extended-spectrum beta-lactamase. All Klebsiella pneumoniae isolates are resistant to ampicillin, but those with ESBL are resistant to all beta-lactams except carbapenems.
22-5 and slide
Term
What are universal precautions?
Definition
Gloves worn when touching body fluids, secretions (except sweat), nonintact skin, mucous membranes.
Wash hands between patients and after glove use.
Eye protection when danger of body fluid splashing.
Do NOT recap needles - dispose in containers.
22-6
Term
What does contact isolation require?
 Definition
Patient is put in private room.
Healthcare workers use gloves and gown
Patient-dedicated stethoscopes
22-6
Term
What are airborne precautions?
Definition
Private room with monitored negative pressure.
All visitors must wear N-95 mask.
22-6
Term
What are droplet precautions?
Definition
Private room
All visitors must wear a surgical mask. (Different from airborne precautions because droplets are larger particles)
22-6
Term
Which disease require contact precautions?
 Definition
MRSA, C. difficile, VRE, eteritis, rotavirus, HAV, RSV, lice and scabies
22-6
Term
Which diseases require droplet precautions?
 Definition
Meningococcus, influenza, pertussis, mumps, and rubella
22-6
Term
Which disease require airborne precautions?
Definition
Tuberculosis, measles, and varicella
22-6
Term
Give two examples of pathogens that invade through the epithelium and then stop in the respiratory tract.
 Definition
Influenza virus
Rhinovirus
23-2
Term
Give two examples of pathogens that invade through the epithelium and then stop in the urogenital tract.
 Definition
Human papillomavirus 6 Chlamydia spp 23-2
Term
Give an example of pathogen that invades through the epithelium and then stops in the skin.
 Definition
Human papillomavirus 1, 2, and 4
23-2
Term
Give two examples of pathogens that invade through the epithelium and then stop in the GI tract.
 Definition
Shigella spp Rotavirus 23-2
Term
Why is the Rhinovirus limited in its invasion?
 Definition
It replicates better at lower temperatures of the superficial tissue.
23-2
Term
Why is influenza limited in its invasiveness?
 Definition
The virions only bud off the apical surface of infected cells.
23-2
Term
Give 2 examples of pathogens that invade through the epithelium and continue to invade in the GI tract
 Definition
Salmonella typhi 23-3
Term
Give 2 examples of pathogens that invade through the epithelium and continue to invade in the urogenital tract.
 Definition
HSV 1 and 2,  Treponema pallidum 23-3
Term
Give 3 examples of pathogens that invade through the epithelium and continue to invade in the respiratory tract.
 Definition
Measles virus VZV M tuberculosis 23-3
Term
Give an example of a pathogen that invades through the epithelium and continues to invade in the skin
 Definition
Staphylococcus aureus (also S pyogenes) 23-3
Term
This organism is an enteric that mimics appendicitis.
 Definition
What is Yersinia enterocolitica? 23-3
Term
What proteins do Yersinia use to resist phagocytosis?
 Definition
YOPS (Yersinia outer proteins) 23-3
Term
Yersinia makes invasin: a. in the colon b. before entry into the host c. when they reach the subepithelium d. inside the cytoplasm of M cells
 Definition
b. before entry into the host
It is not made well at 37*C, so it is made before infection.
23-4
Term
The protein that is transfered via TTSS in Shigella.
 Definition
Ipa
23-4
Term
The protein that is transferred via TTSS in Salmonella.
 Definition
Sip
23-4
Term
Which of the following is FALSE about Shigella? a. It enters epithelium at M cells b. It invades primarily at the colon c. It exists intracellularly primarily in the endosome d. It's invasion genes are plasmid encoded
 Definition
c. It exists intracellularly primarily in the endosome It actually is in the cytoplasm. Salmonella exists intracellularly in the endosome. 23-4
Term
Which of the following is FALSE about Salmonella? a. It exists intracellularly in the endosome b. It enters the epithelium through M cells and enterocytes c. It primarily invades through the colon epithelium d. Its invasion genes are encoded in a chromosome
 Definition
c. It primarily invades through the colon epithelium Salmonella invades through the ileum. Shigella invade through the colon. 23-4
Term
Name two bacteria that invade the cell using a zipper method.
 Definition
Yersinia Listeria 23-5
Term
Name two bacteria that invade the cell using a membrane ruffling method.
 Definition
Salmonella Shigella 23-5
Term
What may be present in microscopic examination of stool in infection with invasive bacteria?
 Definition
Leukocytes
23-7
Term
T/F There can be person to person spread of Shigella infection.
 Definition
True.
23-8
Term
Name the 5 virulence factors for Shigella.
 Definition
LPS (endotoxin) Ipa protein (mediate invasion) Mxi-Spa proteins (translocon) needle of TTSS IcsA and IcsB (involved in intercellular spread) Shiga toxin (S. dysenteriae) 23-8
Term
Name the molecule that Shigella has to polymerize actin and propel it into adjacent cells.
 Definition
IcsA
23-11
Term
Is the change of T cell epitopes of microbial proteins systematic or random?
 Definition
Random
Term
Is the change of antigens the induce antibody response systematic or random?
 Definition
Systematic
Term
Name 3 pathogens that use antigen variation.
 Definition
Influenza virus Neisseria gonnorrhoeae Trypanosoma brucei
Term
What family does influenza virus belong to?
 Definition
Orthomyxoviridae
Term
The main target on influenza for antigenic drift is...
 Definition
Hemagglutinin
Slide 22
Term
What must happen to bird flu for it to be able to infect humans?
 Definition
It must acquire the ability to bind receptors in humans.
Slide 23
Term
Which is random and which is systematic: antigenic variation, or T cell epitope change?
 Definition
Antigenic variation is more systematic.
T cell epitope change is more random.
24-2
Term
What is the principle determinant of whether flu outbreaks occur?
a. How drastic the antigenic change from the previous year
b. If the virus underwent reassortment
c. Match in specificity of population antibodies to viral antigens
d. The type of neuraminidase
 Definition
c. Match in specificity of population antibodies to viral antigens
24-4
Term
What are three complications of influenza?
 Definition
Primary influenza viral pneumonia
Secondary bacterial pneumonia
Croup or exacerbation of chronic condition
24-4
Term
The genome of the influenzae virus is made up of...
 Definition
8 segments of (-)ssRNA
24-2
Term
Does Neisseria gonorrhoeae produce oxidase?
 Definition
Yes
24-5
Term
Name the protein on Neisseria gonnorhoeae that undergoes phase and antigenic variation and increases adherence to host cells.
 Definition
Opa
24-6
Term
Name the 3 molecules on the surface of Neisseria gonorrhoeae that are important virulence factors.
 Definition
Pili
Opa proteins
LOS
24-6
Term
What do pilE and pilS refer to in N. gonorrhoeae?
 Definition
pilE: the expressed pilin gene locus
pilS: the silent pilin gene locus
Term
What is phase variation?
 Definition
It involves turning off and on the expression of a molecule that serves as an antigen for immune recognition in the host.
24-2
Term
This agent causes African sleeping sickness
 Definition
Trypanosoma brucei 24-7
Term
What is VSG?
 Definition
It is variable surface glycoprotein. It is the major protein on Trypanosoma brucei that is changed by the organism to evade the immune response of the host. 24-7
Term
What are three ways that Trypanosoma brucei varies its expression to change its surface antigens?
 Definition
Gene conversion: moving a silent gene to an site where it is expressed
Telomere exchange
Differential transcription of two genes w/ promotors.
Slide 38/24-8
Term
Name the organism that causes Chagas disease.
 Definition
Trypanosoma cruzi. 24-8
Term
Which of the following organisms do NOT undergo antigen variation? a. Trypanosoma cruzi b. Borrelia burgdorferi c. Campylobacter d. Bordetella pertussis e. Plasmodium falciparum
 Definition
a. Trypanosoma cruzi Brucei does. Cruzi does not 24-8
Term
Which of the following organisms do NOT undergo antigen variation? a. Neisseria meningitidis b. Streptococcus pneumoniae c. Haemophilus influenzae d. Escherichia coli e. Salmonella f. Streptococcus pyogenes g. None of the above
 Definition
g. None of the above.
They all undergo antigenic variation.
24-9
Term
Which influenza strains have been included in the seasonal vaccine since 1977?
 Definition
Influenza B, AH1N1, AH3N2
Term
Which serotypes of influenza cause seasonal influenza?
 Definition
A and B
Term
Which serotype of influenza causes cold symptoms and is present year-round?
 Definition
C
Term
The influenza virus is from the _____ family, and its genome is _____.
Definition
Orthomyxoviridae, segmented.
Term
The _____ RNA of influenza virus is replicated in the ______. (In the first blank describe the RNA)
 Definition
negative sense single-stranded, nucleus
Term
True or False. Influenza serotypes B and C can be hosted in a variety of animals, while serotype A can only be hosted in humans.
 Definition
False. Other way around.
Term
Describe the interaction of the glycoprotein hemagglutinin (HA) with the host epithelial cells.
 Definition
HA is cleaved by proteses on the host cell into HA1 and HA2 moieties. HA2 is important for viral entry and fusion with host cells.
Term
Describe the interaction of the enzyme neuraminidase (NA) with the host cellepithelial cells.
 Definition
NA cleaves sialic acid residues from the host cell receptor for the virus, freeing virus particles and enabling them to spread through secretions. Also important for viral neutralization.
Term
Antigenic _____ is thought to occur through reassortment processing of the segmented genome of influenza.
 Definition
Shift (NOT DRIFT!)
Term
The ______ protein is only found on the surface of Influenza A.
 Definition
M2
Term
Influenza A _______ occur when a virus with a new HA subtype emerges. This is caused by antigenic ______. Influenza A _______ occur when there are minor changes to the HA or NA antigen. This is due to antigenic _____.
 Definition
Pandemic, Shift. Epidemic, Drift
Term
Influenza A has at least ___ HA subtypes and ___ NA subtypes.
 Definition
15,9
Term
It is hypothesized that mutations in HA that switch the ______ specificity are partially responsible for adaptation in a new host.
 Definition
Binding
Term
Human influenza receptor molecules possess __________________ linkage with respiratory cells, whereas avian influenza viruses utilize a ________________ linkage with the intestinal epithelial cells in birds.
 Definition
alpha2,6 sialic acid-galactose
alpha2,3 sialic acid galactose
Term
How does the distribution of cases by age group differ between seasonal influenza and pandemic influenza (i.e. H1N1)?
 Definition
Seasonal flu seems to get the older population, while pandemic flu is associated more with young populations.
Term
Contrast pandemic vs. seasonal influenza symptoms
 Definition
seasonal: ***fever***, myalgia
pandemic: ***GI sickness***, cough, sore throat
Term
Contrast antiviral treatment for seasonal and pandemic influenza.
 Definition
Pandemic: Antivirals for all hospitalized patients.
Seasonal: Antivirals not effective after 48 hrs.
Term
True or False. Most individuals with pandemic influenze present with severe symptoms.
 Definition
False.
Term
How many cases of pandemic H1N1 have occurred in the USA this year?
 Definition
Don't know!
Term
What is the original antigenic sin with respect to influenza?
 Definition
First influenza infection leaves a lifelong imprint as far as antibody response.
Term
True or False. Immunity among pandemic H1N1 is greatest among the elderly.
Definition
False. Immunity is greatest among school age children (50% pre-vaccine)
Term
The following factors could contribute to a 3rd wave of novel H1N1 except:
a) "seasonal forcing" in immunocompromised population
b) Coinfections
c)Immunodeficiency
d)mutations in the virus
e)increased half-life of virus
 Definition
(e)
Term
What strain of influenza is expected to circulate as the seasonal strain in the Fall of 2010?
 Definition
Pandemic H1N1
Term
What are the two main strategies for immune invasion utilizing molecular mimicry?
 Definition
1) Disguised antigens (bind host antigens or make similar surface antigens)
2) Production of antigens which induce cross-reactivity with host tissues
Term
What is the result of a microbe using disguised antigens?
 Definition
inadequate immune response to pathogen
Term
What are two pathogenic strains of Neisseria?
 Definition
N. meningitidis, N. gonorrhoeae
Term
Which type of molecular mimicry does N. mieningitidis demonstrate?
 Definition
disguise
Term
Classify N. meningitidis according to the following:
Gram
oxidase test
motility
morphology
 Definition
gram-negative
oxidase-positive
non-motile
diplococci
Term
Virulence factors of Neisseria meningitidis:
 Definition
Capsule (branched carbohydrates)
Pili (Attachment)
Opa (Attachment)
IgA Protease (cleaves at the hinge region)
Iron Acquisition (bind human transferrin)
Lipooligosaccharide (inflammatory)
Term
N. miningitidis generally colonize in the ________ , wherease N. gonorrhoeae generally colonizes in the _________.
 Definition
Respiratory tract
Genital tract
Term
True or false. Genetically, meningococci are 80% identical to gonococci, yet they cause very different diseases.
 Definition
True
Term
How can one differentiate between pathogenic and non-pathogenic strains of Neisseria?
 Definition
Pathogenic strains grow on Thayer-Martin media
Term
True or false. There are few carriers of N. meningitidis that are asymptomatic.
 Definition
False. Most common outcome of invasion - colonize the nasopharynx without disease. Lots of carriage. Little disease.
Term
Risk factors for being a carrier of meningitidis?
 Definition
young adults
geographic regions
social setting
Term
Risk factors for disease contraction from N. meningitidis?
 Definition
Recent colonization
New strain to region/patient
immune deficiency
Term
IgA Protease is present in what microbes?
 Definition
N. meningitidis, N. gonorrhoeae, Streptococcus pneumoniae, Haemophilus influenzae, Ureaplasma urealyticum
Term
Provide a general description of N. meningitidis pathogenesis.
 Definition
Pili and Opa provide for epithelial attachment. Rapidly multiply to form plaque. Invade epithelial cells and vasculature. In vasculature, they multiply rapidly and lose their capsule (releasing LOS). Spread to brain (meningitis), skin (purpura), joints (arthritis), and bones (osteomyelitis).
Term
A strong correlation exists between ___________________ and meningococcal infection.
 Definition
terminal complement-deficiencies (C5-9)
Term
Clinical signs and symptoms for meningococcal infection.
 Definition
High fever
Low blood pressure
Headache
Stiff neck
Petechiae or purpura
Characteristic rash
Meningitis
Fulminant (death can occur in hours)
Term
Is there a vaccine for N. meningitidis?
 Definition
Yes. It is effective in reducing carriage for serotypes A, C, Y and W135. However, there is no capsular vaccine for serotype B (problem for infants).
Term
True or false. N. meningitidis is susceptible to many types of antibiotics.
 Definition
True! Penicillins, cephalosporins, fluoroquinolones all work.
Term
What test is sufficient for laboratory diagnosis of N. meningitidis?
 Definition
CSF containing gram negative diplococci
Term
Why wouldn't a capsular vaccine for serotype B of N. meningitidis be effective?
 Definition
It cross-reacts with host sialic acid.
Term
Classify Streptococcus pyogenes according to the following:
Gram
Spore forming capability
Catalase test
motility
morphology
 Definition
Gram positive
non-motile
non-spore forming
catalase negative
cocci arranged in pairs or chains
Term
What types of hemolysis do the following Streptococcal species exhibit?
a) S. pyogenes
b) S. agalactiae
c) Enterococcus faecalis
d) Viridans streptococci
e) S. pneumoniae
 Definition
a) B hemolytic
b) B hemolytic
c) alpha hemolytic
d) alpha or gamma hemolytic
e) alpha hemolytic
Term
What tropism do the following Streptococcal species exhibit?
a) Enterococcus faecalis
b) Viridans streptococci
c) S. pyogenes
d) S. agalactiae
e) S. pneumoniae
 Definition
a) colon
b) upper resp. tract, colon, female genital tract
c) Throat, skin
d) female genital tract
e) upper respiratory tract
Term
How can bacitracin sensitivity and PYR testing help defferentiate streptococci?
 Definition
S. pyogenes is inhibited in the presence of Bacitracin, whereas other species are resistant.
PYR testing - only S. pyogenes and enterococci are PYR positive
Term
S. pyogenes isolates can be further subdivided into ________ type.
 Definition
M protein.
Term
What are the virulence factors of S. pyogenes?
 Definition
Cell wall:
M protein
lipotechoic acid
Hyaluronic acid capsule
C5a peptidase
Exotoxins:
Hemolysins
Streptokinase
Hyluronidase
Erythrogenic toxins
Term
How does the M protein on S. pyogenes contribute to immune evasion?
 Definition
complexes with Factor H to coat bacteria and avoid alternate complement pathway and phagocytosis
Term
The _______ domains of the M protein are highly variable and contribute to antigenic variability.
 Definition
distal
Term
T or F. S. pyogenes bacteria without M protein are not virulent.
 Definition
true
Term
LTA on S. pyogenes is important. Why?
 Definition
complexes with M protein.
attaches to fibronectin on oropharygeal epithelial cells. (ADHESION)
Term
What does Streptokinase do?
 Definition
promotes clot dissolution and bacterial spreading
Term
Describe the erythrogenic exotoxin released by S. pyogenes.
 Definition
Mediated by bacteriophage
Superantigen effects, activates T cells in TCR independent manner, small vessel damage and leak.
Term
S. pyogenes infection can manifest in several ways, for example:
 Definition
pharyngitis
impetigo (skin infection)
Abscess formation
Toxic Shock Syndrome
Rhematic fever
Glomerulonephritis
Term
Which S. pyogenes constituent is mostly responsible for molecular mimicry, avoiding immune recognition?
 Definition
Hyaluronic capsule
Term
Describe the pathogenesis of a suppurative infection by S. pyogenes.
 Definition
Attachment by M protein and LTA
Hyaluronidase digests tissue matrix
Hemolysisns lyse RBCs
Streptokinase prevents clotting and thereby keeps immune system from walling off the infection.
Spread to adjacent tissue.
Term
Manifestations of toxogenic infection by S. pyogenes are:
 Definition
Scarlett fever (Strawberry tongue)
Erythroderma (toxic shock, this version is not by tampon use)
Term
True or false. A gram stain of throat/rectal/vaginal swab can help identify strep infection.
 Definition
False. There are too many other strep!
Term
How is strep infection identified in the laboratory?
 Definition
B-hemolysis on blood agar
Positive PYR test
bacitracin sensitivity
Term
Treatment and control of infection with S. pyogenes.
 Definition
early detection and treatment with antibiotics (penicillin and beta-lactams are effective thus far). No vaccine available.
Term
Extracellular pathogens have to find different ways to escape...
 Definition
phagocytosis.
26a-2
Term
Name 4 (5) organisms that produce IgA protease.
 Definition
Neisseria gonorrhea Neisseria meningitidis Hemophilus influenzae Streptococcus pneumoniae (Ureaplasma urealytica) 26a-2, 25-4
Term
What is fabulation?
 Definition
After opsonizing antibodies are cleaved by IgA protease, the Fab portion will still remain on the pathogen. This will disguise the pathogen.
26a-2
Term
GAS makes a capsule made of _______________.
 Definition
hyaluronic acid
26a-3
Term
Name 2 effects on immune evasion of M protein binding of factor H.
 Definition
Molecular mimicry: The immune system does not see M protein as immunogenic when bound to factor H.
Prevent activation of alternative complement cascade
26a-4
Term
Name 4 important function of M protein on GAS.
 Definition
Antigenically variable
Adherence w/ lipotechoic acid
Binds host factors such as factor H
Induce autoimmunity
26a-4
Term
Most capsules are polysaccharide. Name two pathogens that make proteinaceous capsules.
 Definition
Bacillus anthracis Yersinia pestis 26a-4
Term
Which of the following organisms does NOT make a capsule: a. Streptococcus pneumoniae b. Streptococcus pyogenes c. Bacillus anthracis d. Staphylococcus aureus
 Definition
d. Staphylococcus aureus 26a-6
Term
Which of the following organisms does NOT make a capsule: a. Hemophilus influenzae b b. Neisseria meningitidis c. Proteus vulgaris d. Salmonella typhi
 Definition
c. Proteus vulgaris 26a-6
Term
Which of the following organisms does NOT make a capsule: a. Vibrio cholerae b. Klebsialla pneumoniae c. Pseudomonas aeruginosa d. Cryptococcus neoformans e. E. coli K1
 Definition
a. Vibrio cholerae 26a-6
Term
T/F Group B Strep bind factor H with its capsule.
 Definition
T. However, Group A Strep binds factor H with its M protein.
26a-6
Term
T/F Neisseria gonorrhoeae has a polysaccharide capsule.
 Definition
False. N. meningitidis has a polysaccharide capsule, but N. gonorrhoeae does not. 26a-8
Term
T/F Streptococcus pneumoniae is only found in humans.
 Definition
True.
26a-8
Term
What are some ways that extracellular mibrobes avoid being phagocytosed?
 Definition
Release of exotoxins to damage phagocytes
Slippery capsules
Antiphagocytic surface proteins.
Term
What are some ways that intracellular pathogens avoid being destroyed post-phagocytosis?
 Definition
Molecules that inhibit phagosome:lysosome fusion (M tuberculosis)
Escape phagosomes (Shigella, Listeria)
Resist being killed inside phagocytes (M. tuberculosis, Salmonella)
Term
IgA protease producers include
 Definition
Pathogenic Neisseria spp.
Hemophilus influenzae
S. pneumoniae
Term
T or F. Children have a hard time mounting immune responses against pathogens encapsulated in polysaccharide.
 Definition
True
Term
What is fabulation?
 Definition
Fab coating of bacteria so that they look like host cell. Proteases aimed at antibodies can result in fabulation.
Term
IgA proteases can promote all of the following except:
a) binding of factor H
b) colonization
c) molecular mimicry
d) prevention of opsonization
 Definition
a) - b,c,d are 3 important things that proteases can lead to.
Term
What are the functions of protein A and protein G? Which one is associated with Staphylococcus aureus?
 Definition
These are surface proteins that bind the Fc region of antibody, thereby preventing phagocytosis and producing molecular mimickry. Protein A is associated with staph, G is with Strep pyogenes.
Term
A major action of many bacterial toxins is to inhibit ___________.
 Definition
phagocytosis (This can be done by killing phagocytes or hindering chemotaxis)
Term
The 2 most important anti-phagocytic factors for Group A strep.
 Definition
M protein
Hyaluronic capsule
Term
What are important functions of the
M protein for pathogenesis of S. pyogenes?
 Definition
Antigenically variable (multiple infections)
Adherence (w/LTA)
Binds factor H (inhibits activation of complement)
Binds other host factors and "hides"
Crossreactivity with cardiac tissue.
Term
Most capsules are made of _________. Exceptions are the capsules of _______ and _______ that are polypeptide capsules.
 Definition
polysaccharides. Bacillus anthracis. Yersinia pestis
Term
Why is the anthrax vaccine aimed at protective antigen (PA)?
 Definition
Because this antigen then binds lethal factor or edema factor which gives B. anthricis its virulence.
Term
What is the one fungus that possesses a capsule?
 Definition
Cryptococcus neoformans
Term
Random question: E. coli is the number one cause of what?
 Definition
neonatal meningits.
Term
True or false. Some pathogens produce soluble capsule that acts as a decoy to mop up antibody.
 Definition
True
Term
What is one way vaccines targeted against capsules have become more effective in children?
 Definition
Coupling capsule antigen to carrier proteins (conjugation)
Term
What is the first test you would do on gram positive diplococci to differentiate staph from strep?
 Definition
Catalase test.
Negative - strep
Positive - staph
Term
How do you differentiate between different types of strep in the laboratory (broadly speaking)?
 Definition
Hemolysis test on blood agar.
Gamma hemolysis (no hemolysis) - enterococci
Beta (complete) hemolysis - A and B
alpha (partial) hemolysis - pneumoniae, viridins
Term
polysaccharide capsules are important in all of the following except:
S. pneumoniae
S. pyogenes
B. anthracis
H influenzae b
N. meningitidis
S. typhi
K. pneumoniae
P. aeruginosa
Cryptococcus neoformans
E. coli
 Definition
S. pyogenes - hyaluronic acid
B. anthracis - protein (poly D-glutamic acid)
H. influenzae b - PRP
E. coli - sialic acid
Term
Which molecule does Streptococcus pneumoniae use to expose a site where it can adhere?
 Definition
Neuraminidase
Slide 6
Term
Name 3 virulence factors for Streptococcus pneumoniae.
 Definition
Pneumolysin
IgA protease
Polysaccharide capsule
Slide 11
Term
What infections can S. pneumoniae cause?
 Definition
Otitis media
Meningitis
Spontaneous bacterial peritonitis
Primary bacteremia (in Ig deficient or splenectomy)
Pneumonia
Slide 16
Term
What are 5 virulence factors (MSCRAMMs) of S. aureus?
 Definition
Protein A
Clumping factors A and B
Collagen binding protein
Fibronectin binding proteins A and B
Plasmin-sensitive protein
Term
Name 6 soft tissue infections that are caused by S. aureus.
 Definition
Impetigo
Folliculitis
Furuncles (boils)
Wound infection
Cellulitis
Fasciitis
Slide 32
Term
What is the function of neuraminidase in Streptococcus pneumoniae?
 Definition
It cleaves sialic acid from host cell glycans, and exposes cell membrane surface uncovering sites for attachment.
26b-2
Term
This toxin decreases ciliary function of bronchial epithelium, decreases capillary integrity in lung and meninges, and stimulates pro-inflammatory TNF-alpha and IL-1 production.
 Definition
What is pneumolysin?
26B-2
Term
Name 3 virulence factors of Streptococcus pneumoniae.
 Definition
IgA protease
Pneumolysin
Capsule
26B-2
Term
What is one way that viral infection predisposes to secondary bacterial pneumonia?
 Definition
Causes death of tracheal ciliated epithelium
26b-3
Term
T/F Infants are susceptible to Streptococcus pneumoniae infection because their ciliated cells are not completely functional yet.
 Definition
False. They are susceptible because they have Ig deficiency.
26b-3
Term
Name 2 components of S. pneumoniae that induce inflammatory response when they reach alveoli.
 Definition
Pneumolysin
Peptidoglycan
26b-3
Term
Name the staphylococcal exotoxin that is associated with community acquired MRSA.
 Definition
Panton-Valentin Leukocidin
26b-4
Term
Which of the following organisms is NOT associated with pneumonia: a. Staphylococcus aureus b. Streptococcus pneumoniae c. Hemophilus influenzae d. Klebsiella pneumoniae e. Staphylococcus saprophyticus
 Definition
e. Staphylococcus saprophyticus
Term
What is the #1 cause of community acquired pneumonia?
 Definition
S. pneumoniae
Term
What is the #1 cause of skin and soft tissue infections?
 Definition
S. aureus
Term
Who or what are carriers of S. pneumoniae? What is the primary site of carriage?
 Definition
Humans only. Nasopharynx
Term
How is S. pneumoniae transmitted between persons?
 Definition
Respiratory droplet, close contact
Term
S. pneumoniae inhibits opsonization by producing _________ and ________, and it exposes cell membrane surfaces by producing _________ which cleave ______.
 Definition
IgA protease, capsule, nueraminidase, sialic acid
Term
True or false. Unencapsulated strains of S. pneumoniae are avirulent.
 Definition
True! Capsule is the most important virulence factor.
Term
What is S. pneumoniae's capsule made of?
 Definition
polysaccharide
Term
3 things that cause increased risk for S. pneumoniae infection.
 Definition
Ig deficiency
Splenectomy - decreased clearance from blood
Decreased ciliary response (smoking, etc)
Term
Pneumolysin is a cytotoxin released by ___________ that does all of the following except:
a) Decreases capillary integrity in lung or meninges
b) Decrease saliva production
c) Decrease ciliary function of bronchial eptihelium
d) Stimulate inflammation
 Definition
Streptococcus pneumoniae
b)
Term
T or false. Peptidoclycan stimulates inflammation.
Definition
True!
Term
Virulence factors of S. pneumoniae
 Definition
Capsule
IgA protease
Pneumolysin
Term
The inflammatory response seen in a pneumococcal infection is due to ________ and _______.
 Definition
pneumolysin
peptidoglycan
Term
Two host factors contributing to pneumonia:
 Definition
Defective ciliary clearance
Defective antibody response
Term
Typical clinical manifestations of pneumonia include:
 Definition
Fever
Cough
Dyspnea
Chest pain (if pleurisy develops)
Term
S. pneumoniae can cause the following infections:
 Definition
Otitis media
Meningitis
Spontaneous bacterial peritonitis
Primary bacteremia
Term
Laboratory identifiers of Staph. aureus
 Definition
Gram + cocci, typically clustered
Beta hemolytic
Catalase +
Coagulase positive
Term
The _______ is the major reservoir of S. aureus.
 Definition
Nose
Term
What are the MSCRAMMs of Staph?
 Definition
Microbial Surface Component Reacting with Adherence Matrix Molecules.
Protein A
Clumping factors (fibrinogen)
Collagen Binding Proteins
Fibronectin binding proteins
Plasma-sensitive protein (nasal epithelial cells)
Term
What are some important surface components of S. aureus?
 Definition
Lipoteichoic acid - trigger cytokine release
Pepetidoglycan - Anchor for MSCRAMMs, cytokine trigger
Term
T or F. Staph aureus doesn't secrete exotoxins.
 Definition
False. Exotoxins are important to the pathogenesis of Staph infections
Term
What are some of the exotoxins of S.aureus.
 Definition
Hemolysins (gamma hemolysin - leukocidin that is toxic to neutrophils)
Panton-Valentin Leukocidin (MRSA)
Exfoliative toxins (toxic to skin cells)
Term
What is responsible for the massive release of cytokines seen in many Staph infections?
 Definition
Superantigens that directly stimulate T cells. Stimulates up to 20% of T cells. Leads to secretion of lymphokines by macrophages (IL-2 and TNF)
Term
What are two clinical syndromes caused by S. aureus?
 Definition
Toxic shock syndrome
Staph food poisoning
Term
T or F. Food contaminated with S.aureus may still be harmful even when thoroughly cooked.
 Definition
T. Toxins are heat stable.
Term
Clinical features of toxic shock syndrome.
 Definition
Fever
Diffuse rash
Hyptension
Mutliorgan system disfunction (GI, renal)
Term
S. aureus is the #1 cause of what?
 Definition
skin and soft tissue infections
Term
Different clinical categories of skin or soft tissue infections caused by Staph aureus.
 Definition
Impetigo (superficial skin)
Folliculitis
Furuncles (boils)
Wound infection
Cellulites (dermis + subdermal tissue)
Fascitis
Term
What are common types of deep infection caused by S. aureus?
 Definition
Endocarditis
Osteomyelitis
Pneumonia *Hospital Acq.
IV Catheter-Related Bacteremia *Hospital acq.
Term
Groups at risk for CA-MRSA
 Definition
Children
Military
Athletic teams
Prisoners
Men who have sex with men
Term
T or F. Most strains of S. aureus are Panton-Valentin Leukocidin (PVL) positive
 Definition
True
Term
What are 3 agents that commonly cause neonatal meningitis?
 Definition
E. coli Streptococcus agalactiae Listeria monocytogenes Slide 23
Term
What are 5 bactericidal components of the phagolysosome?
 Definition
Acidification
Defensins
Iron-poor environment
Antibacterial enzymes
Reactive O2 and N2 intermediates
27-2
Term
What are 5 ways a bacteria can resist phagosome killing?
 Definition
Prevent fusion w/ lysosome
Modify vacuole
Escape vacuole
Tolerate environment in phagosome
Reduce acidification
27-3
Term
What are 2 signals that help macrophage killing be induced or enhanced?
 Definition
Cytokines from T cells: IFN-gamma and TNF
TLR activation by pattern recognition
27-3
Term
What are 4 consequences of macrophage activation?
 Definition
ROI
RNI
Increased phagosome lysosome fusion
Increased MHC class II
27-3
Term
Many viruses downregulate MHC class II expression. Name one bacterium that does.
 Definition
Mycobacterium tuberculosis 27-3
Term
What are 3 common causes of meningitis in neonates?
 Definition
E. coli Listeria monocytogenes Streptococcus agalactiae Also less common, Neisseria meningitidis serotype b Hemophilus influenzae type b but vaccination has decreased prevelance 27-6
Term
Listeria has a protein encoded in the gene ________ that allows it to break through the phagosome membrane, and a protein encoded by gene ______ that nucleates host actin.
 Definition
hlyA (listeriolysin O)
actA
27-6
Term
Name for microbes that escape the phagosome and live in the cytoplasm.
 Definition
Listeria monocytogenes Trypanosoma cruzi Shigella Rickettsia 27-6
Term
In neonatal meningitis where the agent is unknown, what two antimicrobials should be included in empiric therapy to cover Listeria infection?
 Definition
Ampicillin
Trimethoprim-Sulfamethaxole
27-7
Term
What strategy is employed by Legionella to avoid being killed by phagocytes?
 Definition
Prevent phago-lysosome fusion
27-7
Term
What gram positive rod can grow at 4*C?
 Definition
Listeria monocytogenes 27-5
Term
What mechanism in Legionella is encoded by the genes dot/icm?
 Definition
Type IV secretion system.
It prevents fusion of phagosome and lysosome
27-8
Term
If you observe the ring form of plasmodium trophozoite in a peripheral blood smear, which species is most likely the cause of malaria?
 Definition
Plasmodium falciparum
27-10
Term
The infectious form of Plasmodium that is transfered from the anopheles mosquito is the ____________.
 Definition
sporozoite
27-10
Term
The form of Plasmodium that invades the RBCs is the ______________ form.
 Definition
merozoite
27-10
Term
What are the three groups of people that malaria is most severe in?
 Definition
Travelers (previously unexposed)
Children (previously unexposed)
Pregnant women
27-12
Term
This protein causes knobs to form on RBCs and allows for their sequestration into various places of the body.
 Definition
PfEMP made by Plasmodium species.
27-12
Term
What is the protein that allows Plasmodium to bind to and invade hepatocytes?
 Definition
Circumsporozoite
27-12
Term
This form of Plasmodium can infect only reticulocytes.
 Definition
Plasmodium vivax (and ovale)
27-10
Term
Bonus (Daily Double): This blood group antigen is missing epitopes in >60% of African Americans and is also known to be required for Plasmodium vivax entry into red cells.
 Definition
What is the Duffy antigen?
27-12
Term
What are some ways that intracellular bacteria get inside cells?
 Definition
Direct phagocytosis
Invasins
Membrane ruffling
Receptor mediated phagocytosis
Term
What do phagolysosomes possess that are bad for bacteria?
 Definition
Acidic environment
Defensins (antibacterial peptides)
Antibacterial enzymes
Reactive oxygen species
Iron-poor environment
Term
What are a few approaches that some bacteria take to avoid the deleterious effects of phagolysosome fusion?
 Definition
Prevent fusion
Modify the vacuole
Escape the vacuole
Tolerate the environment
Term
What are four bacteria that prevent phagolysosome fusion?
 Definition
Mycobacteria
Leishmania
Salmonella
Legionella
Term
What are four bacteria that escape the phagosome?
 Definition
Shigella
Trypanosoma
Listeria
Rickettsieae
Term
What are two bacteria that tolerate the environment in a phagolysosome?
 Definition
Salmonella
Coxiella
Term
What are three bacteria that modify the phagolysosome vacuole?
 Definition
Salmonella
Toxoplasma gondii
Legionella
Mycobacteria (reduce acidification)
Term
All of the following are ways that bacteria prevent macrophage activation except:
a) Prevent Mphages and CD4 cells from coming into contact
b) Releasing toxins that bind to promoter regions
c) Downregulate MHC class II
d) Induce TH2 response instead of TH1
 Definition
B. The rest are true.
Term
3 effects of Macrophage activation
 Definition
Reactive oxygen and nitrogen species
Increased phagosome-lysosome fusion
Upregulation of MHC class II expression
Term
How does cytomegalovirus avoid detection by CD4 cells?
 Definition
One degrades MHC class II
One blocks interaction between MHC class II molecules and the invariant chain
Term
4 examples of viruses that avoid detection by CD8 cells
 Definition
Adenovirus - prevents transport of MHC I
HIV - sequesters MHC proteins in trans-Golgi
Herpes and CMV - inhibit TAP
Term
What factors does Listeria use to break out of the double phagosome in a second cell?
 Definition
listeriolysin O
Phospholipase C
Term
3 priniciples causes of neonatal meningitis
 Definition
Listeria, E. coli, Group B Strep
Term
Reservoir for Listeria monocytogenes.
 Definition
Food borne. Normally found in soil, decay. Intestines of animals. Contamination of processed foods (meat, soft cheese). Can be spread by humans.
Term
Biological characteristics of Listeria monocytogenes
 Definition
Gram Positive, Rod, facultative anaerobe, catalase positive, oxidase negative. INcomplete beta hemolysis.
Term
Virulence factors of listeria
 Definition
listeriolysin O, actA (nucleation of actin to provide for microbe travel)
Term
What classical form of trophozoite will you see with Plasmodium falciparum?
 Definition
a classical ring
Term
________ are the motile infective state of malaria that are injected into the host by a mosquito.
 Definition
sporozoites.
Term
True or False. Plasmodium falciparum has a dormant liver stage, which allows relaps to occur.
 Definition
False. falciparum has no dormant stage. vivax and ovale do. relapse can't occur in falciparum
Term
What is the vector for malaria?
 Definition
Anopheles female mosquito
Term
T or F. Plasmodium falciparum is found in tropical regions, while vivax and ovale are found in more temperate regions.
 Definition
T
Term
T or F. Legionella and Listeria can be transferred from human to human.
 Definition
F. Only Listeria can.
Term
Does more severe malaria occur in previously exposed individuals or those who have never previously been exposed?
 Definition
Those who have never previously been exposed. Partial immunity builds up. *Heterozygote sickle cell individuals have some resistance.
Term
T or F. Legionella is primarily a human pathogen.
 Definition
F
Term
Virulence factors for P. falciparum
 Definition
ability to bind endothelial cells in capillaries and cause microvascular disease.
PfEMP causes binding of RBC to many different host proteins.
Term
T or F. All plasmodium spp. can infect all RBCs.
 Definition
F. falciparum can, but vivax can only get into reticulocytes.
Term
PfEMP expression leads to formation of ______ on the surface of RBCs, reducing RBC clearance from the ______.
 Definition
knobs, spleen
Term
_________ variation allows for P. falciparum to bind to various host cell proteins.
 Definition
Antigenic
Term
How to diagnose malaria?
 Definition
Blood smear.
Only falciparum will present in ring form.
Term
What are the two most common endotoxins?
 Definition
LPS
LOS
28-2
Term
Why are exotoxins usually heat labile?
 Definition
They are secreted proteins, and their 3D structure is affected by heat, pH, osmotic strength, etc.
28-2
Term
Which of the following is NOT an enterotoxin producer? a. Streptococcus pneumoniae b. Bacillus cereus c. Staphylococcus aureus d. Clostridium difficile e. Vibrio cholerae
 Definition
a. Streptococcus pneumoniae. It makes pneumolysin, but that is not an enterotoxin 28-2
Term
Which of the following is NOT an enterotoxin producer? a. E coli b. Shigella c. Clostridium botulinum d. Clostridium perfringens
 Definition
c. Clostridium bolulinum Botulin toxin is a neurotoxin 28-2
Term
Tetanus toxin blocks the release of the neurotransmitter ___________ from inhibitory neurons.
 Definition
glycine (probably among others)
28-3
Term
Botulin toxin blocks the release of _________ from excitatory neurons.
 Definition
acetylcholine
28-5
Term
T/F Botulin toxin is heat stable.
 Definition
False. It is heat sensitive. The bacterial spores are heat stable, however.
Term
Which of the following manifestations is NOT associated with botulin poisoning?
a. Vomiting
b. Constipation
c. Flaccid paralysis
d. Respiratory failure
e. Irregular pulse
 Definition
e. Irregular pulse
28-6,7
Term
Name 5 bacteria that produce hemolysins.
 Definition
Streptococcus pyogenes Listeria monocytogenes Staphylococcus aureus Uropathogenic E coli Clostridium perfringens 28-7,8
Term
Name 2 toxins that inhibit protein synthesis by adding ADP-ribose to elongation factor 2.
 Definition
Pseudomonas exotoxin A Diphtheria toxin 28-8
Term
This toxin removes one base from an rRNA subunit to block protein synthesis.
 Definition
Shiga toxin
28-9
Term
Which of the following is NOT a virulence factor of Pseudomonase? a. Exotoxin A b. Phospholipase C c. Endotoxin d. Capsule e. Adhesive pili f. Superantigen g. Proteases/elastases h. Leukocidin
 Definition
f. Superantigen
28-10
Term
Name 7 drugs (or groups) that have some activity against Pseudomonas
 Definition
Penicillins: Piperacillin, ticarcillin with beta lactamase inhibitor
Cephalosporins: Cefepime, ceftazidime
Carbepenems: Imipenem, meropenem (not erta)
Monobactam: Aztreonam (restricted use)
Aminoglycosides
Quinolones
Colistin
28-11
Term
What virus makes an exotoxin?
 Definition
rotavirus
Term
How do the different toxins of ETEC work? What other toxin shares this mechanism?
 Definition
LT, cholera toxin ADP-ribosylate adenylate cyclase in intestinal epithelial cells, resulting in constitutive cAMP production. ST results in constitutive cGMP production
Term
What are the toxins of C. Difficile and how do they work?
 Definition
Exotoxin A and B - both have the same mechanism - decrease tight junction premeability (see 28-3 and Nosocomial infections lecture)
Term
Tetanus is ___________ paralysis. Botulism is ___________ paralysis
 Definition
Tetanus - spastic. Botulism - flaccid
Term
How do botulinum toxin and tetanus toxin work, and why do they cause different effects?
 Definition
They inhibit vesicle docking, preventing neurotransmitter release. Tetanus toxin works on the inhibitory neurons on the CNS, preventing them from releasing glycine (inhibitory) on motor neurons. Botulinum toxins prevents the release of Ach into the NMJ
Term
Clostridium botulinum:

Gram:?
Shape:?
Oxygen usage:?
Spore-forming:?
 Definition
Gram + rod, anaerobic, sporeforming
Term
What are the ways the botulinum toxin can get into your body?
 Definition
- ingested (food, bioterrorism)
- C. botulinum spores are ingested and the germ colonizes the GI tract (occurs mainly in infants who lack normal flora)
- C. botulinum spores get in a wound
Term
Treatment of botulism:
 Definition
antitoxin is available
Term
Pseudomonas aeruginosa:

Gram:?
Shape:?
Oxygen usage:?
Motile?
Fastidious?
Oxidase:?
Extracellular/Intracellular?
 Definition
Gram - aerobic, motile, oxidase + rod. Very hardy and not fastidious. Primarily extracellular
Term
Why does Pseudomonas Aerugonisa not cause serious problems outside of hospitals?
 Definition
It has no way to cross epithelium - has to get in through wounds, burns, IV lines, etc.
Term
Name 5 factors that contribute to susceptibility to M. tuberculosis infection.
 Definition
Poor living conditions, crowding
Malnourishment
Compromised immune system
Exposure potential (more is worse)
Genetic components
29-3
Term
This is the red dye that stains Mycobacteria species.
 Definition
Carbolfuschin
29-4
Term
Which of the following is NOT a virulence factor for M. tuberculosis: a. Galactomannan b. Mycolic acid c. Lipids d. Lipoarabinomannan e. Cytolysin f. Adhesin/invasin genes g. Potential secretion systems (ESX loci)
 Definition
a. Galactomannan It is associated with Aspergillus 29-4, 9-8
Term
Name 4 measures for preventing M. tuberculosis infection.
 Definition
Effective treatment
Improving social conditions
Screening
Isolation of infected patients
29-9
Term
What are the 4 frontline drugs for TB?
 Definition
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
29-9
Term
Name 6 second line drugs for TB.
 Definition
Streptomycin (injected)
Fluoroquinolones
Capreomycin
Ethionamide
Cycloserine
P-aminosalicylic acid (PAS)
29-9
Term
Which type of leprosy has worse nerve damage?
 Definition
Tuberculoid leprosy.
29-11
Term
Which type of leprosy has a higher bacterial count?
 Definition
Lepromatous leprosy.
29-11
Term
Which type of leprosy is most infectious?
 Definition
Lepromatous leprosy
29-12
Term
What skin test antigen is used to differentiate the type of leprosy one may have and what does the result indicate?
 Definition
Lepromin - positive indicates tuberculoid, negative indicates lepromatous 29-12
Term
Give important characteristics of tuberculoid leprosy.
 Definition
Th1 response
Lepromin DTH positive on skin test
CD4>CD8 at lesion site
Low bacteria
Granuloma formation and nerve damage
29-12
Term
Give important characteristics of lepromatous leprosy.
 Definition
Th2 response
Negative for lepromin skin test
Bacteria not well controlled, high count
Invade Schwann cells and macrophages near nerves
Substantial nerve damage
29-13
Term
High bacteria count and "foamy" macrophages indicate which type of leprosy?
 Definition
Lepromatous leprosy.
29-13
Term
Low bacteria count and many lymphocytes indicates which type of leprosy?
 Definition
Tuberculoid leprosy. 29-13
Term
Do M. tuberculosis and M. leprae grow in culture?
 Definition
M. Tuberculosis does, but very slowly - it takes 3 weeks to grow on the plate. M. Leprae does not.
Term
What cells do M. tuberculosis bacteria typically inhabit in the host, and how do they survive there?
 Definition
Primarily in macrophages.
- prevent phagosome fusion with lysosome
- KatG gene = catalase/peroxidase activity -> ROS ineffective
- Downregulation of MHC-II
Term
Which cytokine is crucial in the immune response to TB?
 Definition
TNF alpha
Term
What are 5 essential questions in a travel history?
 Definition
Where did you go? Major cities vs rural areas
What did you do there?
Where did you go?
When did you go?
What precautions did you take?
Immunization history.
CC 6-6
Term
Which of the following is NOT an etiology you would consider for fever in a returning traveller?
a. Dengue fever
b. Malaria
c. Leptospirosis
d. Cryptococcus
e. Acute schistosomiasis
f. Typhoid fever
g. Meningococcal meningitis
 Definition
d. Cryptococcus
CC 6-6
Term
Which of the following would you NOT consider as an etiology of diarrhea in a returning traveler? a. Typhoid fever b.E coli c. Entamoeba histolytica d. Norovirus
 Definition
a. Typhoid fever
CC 6-8
Term
What are the 4 most urgent traveler's illnesses?
 Definition
Malaria
Typhoid
Amebic liver abscess
Viral hemorrhagic fever
CC 6-8
Term
What 4 symptoms do returning traveler's most often seek medical care for?
 Definition
Diarrhea 13%
Respiratory infections 10%
Skin disorders 3%
Febrile illness 2%
CC 6-2
Term
What are 3 things that you can do to avoid mosquito bites?
 Definition
Use DEET repellant
Protective clothing
Permethrin impregnated bednetting
CC 6-2
Term
Name an infection that you should be concerned about if bitten by a monkey.
 Definition
Herpes B
(Probably Rabies also?)
CC 6-2
Term
What are 5 components of an emergency medical travel kit (assuming you do not have a chronic medical condition)?
 Definition
NSAIDS
Antihistamines
Anti-diarrheal
Oral Rehydration Salts (ORS)
Antibiotics
(If you have a chronic condition, you will need to bring your medication and letters of necessity for injectable medications)
CC 6-2
Term
Which of the following places would present the LEAST RISK of altitude sickness?
a. La Paz, Bolivia
b. Lhasa, Tibet
c. Antwerp, Belgium
d. Lima, Peru
e. Mt. Kilimanjaro, Africa
 Definition
c. Antwerp, Belgium
CC 6-2
Term
Swimming and fishing in fresh water lakes and rivers puts people at risk for which two infections?
 Definition
Schistosomiasis
Leptospirosis
CC 6-2
Term
What are 6 things you should know about the patient in order to give adequate travel advice?
 Definition
Age
Pregnancy status
Underlying health conditions
Immunosuppressed state
Medications
Immunizations
CC 6-3
Term
What 4 things should you know about the trip the traveler is taking in order to give adequate travel advice?
 Definition
Destination
Season of travel
Duration
Itinerary (planned and possible activities)
CC 6-3
Term
Which of the following is the most expensive vaccination?
a. TDaP
b. Typhoid
c. Hep A/B (twinrix)
d. Yellow fever
 Definition
c. Hep A/B (twinrix) $300
Yellow fever $80
TDaP $10
Typhoid $40
CC 6-4
Term
Which vaccine costs a total of $400?
 Definition
Rabies (given in 4 doses)
CC 6-4
Term
If you are a traveler, and you have 3 loose stools per 24 hours but no fever or blood in stool, what should you do?
 Definition
Take Loperamide and ORS for hydration
CC 6-4
Term
If you are a traveller and have about 8 loose stools a day accompanied by fever and/or bloody stools, what should you do?
 Definition
Take antibiotics and ORS.
CC 6-4
Term
What is the name for the group of travelers that are at highest risk for malaria?
 Definition
Travelers visiting friends and relatives (VFR's)
CC 6-4
Term
This drug is taken prophylactically every day to prevent malaria infection. It is cheap, but causes sun sensitivity and candida vaginitis. Should be taken 4 weeks after returning.
 Definition
What is doxycycline?
CC 6-5
Term
This drug is taken weekly for malaria prophylaxis. It is cheapest if the traveler will be in the area for more than a week. It has neuropsychiatric symptoms associated with its use. Should be taken 4 weeks after returning.
 Definition
What is Mefloquine?
CC 6-5
Term
This drug is taken daily for malaria prophylaxis. It is cheapest if the person will be in the endemic area for less than a week. After returning, this drug should be taken an additional week.
 Definition
What is Atovaq/Prog?
Term
Name 4 antibiotics that are usually effective in treating Salmonella typhi.
 Definition
Bactrim
Amoxicillin
Ceftriaxone
Fluoroquinolone
CC 6-5
Term
Where is typhoid most commonly acquired?
a. Central/South America
b. Asia/Africa
c. Australia
d. India
 Definition
d. India
CC 6-5
Term
What infection is only endemic in areas that are 15 degrees away from the equator on either side?
 Definition
Yellow fever
CC 6-5
Term
A patient comes to you with symptoms that are likely associated with infection they received while traveling. They returned 2 days ago, and were away for 6 days. What are 6 possible causes?
 Definition
Dengue
Rickettsia
Legionella
Malaria
Typhoid fever
Hemorrhagic fever
CC 6-6,7
Term
If a patient returned from working as a health care worker in an endemic area for viral hemorrhagic fever and presents with fever within 21 days of returning, what should you do?
 Definition
Isolate and treat the patient
CC 6-7
Term
Why would you expect an ELISA HIV test to be negative in an early acute HIV-1 infection?
 Definition
Acute infection is symptomatic at 2-4 weeks post exposure. But the antibodies for the ELISA test don't appear until week 12. The test will likely be negative even if they do have an acute infection.
30-5
Term
What proportion of untreated people who are infected with HIV will progress to AIDS and death?
 Definition
Close to 100%.
30-3
Term
What are 4 causes of organ dysfunction in a person with HIV infection?
 Definition
Direct effect of HIV (AIDS dementia complex) Immune reaction (thombocytopenia) Secondary infection by OI (Pneumocystis) Malignancies (Non-Hodgkin's lymphoma) 30-3
Term
Give the generic names for the 7 nucleoside analog reverse transcriptase inhibitors (NRTIs).
 Definition
Zidovudine
Didanosine
Stavudine
Lamivudine
Emtricitabine
Abacavir
Tenofovir
30-4
Term
Give the generic names of 3 non-nucleoside reverse transcriptase inhibitors.
 Definition
Nevirapine
Efavirenz
Etravirine
30-4
Term
Give the generic names for 8 protease inhibitors (PIs).
 Definition
Squinavir
Ritonavir
Indinavir
Nelfinavir
Fos-Amprenavir
Lopinavir/ritonavir
Tipranavir
Darunavir
30-4
Term
Give the function of the following HIV drug: zidovudine.
 Definition
Nucleoside analog reverse transcriptase inhibitor (NRTI). Bogus substrate for RT.
30-4
Term
Give the function of the following HIV drug: didanosine.
 Definition
Nucleoside analog reverse transcriptase inhibitor (NRTI). Bogus substrate for RT.
30-4
Term
Give the function of the following HIV drug: stavudine.
 Definition
Nucleoside analog reverse transcriptase inhibitor (NRTI). Bogus substrate for RT.
30-4
Term
Give the function of the following HIV drug: lamivudine.
 Definition
Nucleoside analog reverse transcriptase inhibitor (NRTI). Bogus substrate for RT. Also used for HBV.
30-4, 13-12
Term
Give the function of the following HIV drug: emtricitabine.
 Definition
Nucleoside analog reverse transcriptase inhibitor (NRTI). Bogus substrate for RT. May also be used for HBV infection.
30-4, 13-6
Term
Give the function of the following HIV drug: abacavir.
 Definition
Nucleoside analog reverse transcriptase inhibitor (NRTI). Bogus substrate for RT.
30-4
Term
Give the function of the following HIV drug: tenofovir.
 Definition
Nucleoside analog reverse transcriptase inhibitor (NRTI). Bogus substrate for RT. Also used for HBV.
30-4, 13-12
Term
Give the function of the following HIV drug: Nevirapine.
 Definition
Non-nucleoside reverse transcriptase inhibitor (NNRTI). "Freezes" RT by binding to hydrophobic pocket.
30-4
Term
Give the function of the following HIV drug: Efavirenz.
 Definition
Non-nucleoside reverse transcriptase inhibitor (NNRTI). "Freezes" RT by binding to hydrophobic pocket.
30-5
Term
Give the function of the following HIV drug: Etravirine.
 Definition
Non-nucleoside reverse transcriptase inhibitor (NNRTI). "Freezes" RT by binding to hydrophobic pocket.
30-4
Term
Give the function of the following HIV drug: Saquinavir.
 Definition
Protease inhibitor (PI). Substrate mimic that cannot be cleaved by protease.
30-4
Term
Give the function of the following HIV drug: ritonavir.
 Definition
Protease inhibitor. Substrate mimic that cannot be cleaved by protease.
30-4
Term
Give the function of the following HIV drug: indinavir.
 Definition
Protease inhibitor. Substrate mimic that cannot be cleaved by protease.
30-4
Term
Give the function of the following HIV drug: nelfinavir.
 Definition
Protease inhibitor. Substrate mimic that cannot be cleaved by protease.
30-4
Term
Give the function of the following HIV drug: Fos-amprenavir.
 Definition
Protease inhibitor. Substrate mimic that cannot be cleaved by protease.
30-4
Term
Give the function of the following HIV drug: lopinavir/ritonavir.
 Definition
Protease inhibitor. Substrate mimic that cannot be cleaved by protease.
30-4
Term
Give the function of the following HIV drug: Tipranavir.
 Definition
Protease inhibitor. Substrate mimic that cannot be cleaved by protease.
30-4
Term
Give the function of the following HIV drug: Darunavir.
 Definition
Protease inhibitor. Substrate mimic that cannot be cleaved by protease.
30-4
Term
Give the function of the following HIV drug: Enfuvirtide.
 Definition
Fusion inhibitor. Binds gp41 and blocks normal coil-coil interaction required for fusion with host membrane. Should not be used initially when other good options for treatment are available.
30-4
Term
Give the function of the following HIV drug: Maraviroc.
 Definition
Entry inhibitor. Occupies CCR5 HIV-1 co-receptor to block virus entry.
30-5
Term
Give the function of the following HIV drug: Raltegravir.
 Definition
Integrase inhibitor. Very potent in combination with 2 NRTIs.
30-5
Term
What are 4 toxicities (acute and chronic) of anti-retroviral therapy.
 Definition
Hyperlipidemia
Insulin resistance (& Diabetes)
Lipodystrophy
Neuropathy
30-5
Term
What are the 4 beneficial effects of anti-retroviral therapy?
 Definition
Increased CD4 T cell count
Delay in progression to AIDS
Prevent CV disease from chronic inflammation
Prolong survival
30-5
Term
What are 3 versions of drug combinations used in anti-retroviral therapy?
 Definition
2 NRTI + 1 PI
2 NRTI + 1 NNRTI
2 NRTI + Integrase inhibitor
30-5
Term
Which of the following manifestations is NOT associated with acute HIV-1 infection:
a. Nuchal lucency
b. Oral ulcer
c. Myalgias
d. Headaches
e. Photophobia
 Definition
a. Nuchal lucency
30-5
Term
Which of the following manifestations is NOT associated with acute HIV-1 infection?
a. Lymphadenopathy
b. Rash
c. Sore throat
d. Hoarseness
 Definition
d. Hoarseness
30-5
Term
Which of the following manifestations is NOT associated with acute HIV-1 infection?
a. Fever
b. Lethargy
c. Malaise
d. Retro-orbital pain
e. Neutrophilia
f. Rash
 Definition
e. Neutrophilia
Patients will have neutropenia.
30-5
Term
What type of regimen is this: Atazanavir, Ritonavir, Lamivudine, Zidovudine?
 Definition
PI-based regimen. Contains 2 PI, and 2 NRTIs.
Slide 34
Term
What type of regimen is this: Efavirenz, Tenofovir, Emtricitabine?
 Definition
NNRTI based regimen. Contains 1 NNRTI and 2 NRTIs.
Slide 34
Term
If candida is causing an infection of the skin of an HIV patient, how may you treat it?
 Definition
Topical clotrimazole, or other azole.
30-6, 9-4
Term
What drug may be used to treat zoster, or HSV lesion? Would would differ in the treatment of these?
 Definition
Acyclovir. Higher dose necessary for VZV.
30-6, 13-7
Term
Other than being dermatomal, what is another important differentiating characteristic of a zoster rash?
 Definition
Pustules at varying stages along the dermatome.
Slide 51
Term
What drug is used to both treat and prevent Pneumocystis jarovecii infection in HIV patients?
 Definition
Sulfamethoxazole/Trimethoprim
Slide 52
Term
Where anatomically does a Mycobacterium Avian Complex infection in an AIDS patient manifest?
 Definition
Presents as infiltrates in portal triad and liver parenchyma.
30-7
Term
Which of the following combinations would be appropriate therapy for MAC infection in AIDS?
a. Cefepime, Tetracycline, Ethambutol
b. Vancomycin, Clindamycin, Amikacin
c. Rifabutin, Azithromycin, Ethambutol
d. Aztreonam, Refabutin, Ciprofloxacin
 Definition
c. Rifabutin, Azithromycin, Ethambutol
(or Clarithromycin, amikacin may be substituted)
30-7
Term
Which of the following would NOT be used on an AIDS patient with Pneumocystis jarovecii infection? a. TMP/SMZ b. Pentamidine c. Dapsone/TMP d. Amikacin e. Atovaquone f. Corticosteroids
 Definition
d. Amikacin
30-7
Term
A multiple ring enhancing lesion in a CT is a manifestation in what co-infection in AIDS patients?
 Definition
Toxoplasma encephalitis
30-9
Term
Which parasite is dependent upon cats for part of its lifecyle?
 Definition
Toxoplasma gondii
Term
What are 3 changes in the immune system that happen after a splenectomy?
 Definition
Changes in complement components
Changes in antibodies
Loss of phagocytic function (as a result)
31-2
Term
Disorders in which 2 cell lines would result in a decrease in effective antibody production?
 Definition
Helper T cells
B cells
31-3
Term
Decrease in useful antibody would predispose someone to infection with which 2 groups of bacteria?
 Definition
Pyogenic bacteria
Encapsulated bacteria
31-3
Term
Name the pyogenic bacteria.
 Definition
Staphylococci Streptococci Pneumococci (more specifically) Meningococci Hemophilus influenzae Stedman's 7.0
Term
Which pathogens form capsules?
 Definition
S. pneumoniae N. meningitidis H. influenzae Cryptococccus neoformans
Term
Interestingly, deficiency in any of the components of the membrane attack complex in complement (C5-C9) only predisposes a person to _____________ infection.
 Definition
Neiserria 31-3
Term
Name 4 ways that a current infection (or its treatment) may lead to immunosuppression and a subsequent infection.
 Definition
Mild transient immunosuppression by primary infection (e.g. Measles)
Antibiotic treatment reduces flora
Physical changes like sores or openings (chancres)
HIV causes widespread immunosuppression
(Also, respiratory viruses predispose to pneumonia)
31-4
Term
Give 4 examples of latent infections that may reactivate when a host becomes immunocompromised.
 Definition
Herpes simplex virus Mycobacterium tuberculosis Toxoplasma gondii Varicella zoster virus 31-6
Term
What 2 patient populations are at risk for acquiring toxoplasmosis?
 Definition
AIDS patients
Fetus/newborn
31-7
Term
What form of Toxoplasma lives in macrophages?
 Definition
Tachyzoites
31-8
Term
Name the infectious form of Coccidiodes immitis.
 Definition
Arthroconidia (the mycelial form)
31-13
Term
T/F Coccidioides immitis causes a contagious infection.
 Definition
False. The spherules in the lungs of affected people are not infectious.
31-13
Term
A person with disseminated Candida infection most likely... a. Inhaled Candida blastoconidia b. has another condition that affects the immune system c. has an indwelling catheter d. will be diagnosed and treated quickly e. b and c f. b and d
 Definition
e. Has another condition that affects the immune system (like AIDS), and an indwelling catheter
31-15
Term
Pathogenic fungi are typically:
a. Yeasts
b. Molds
c. Dimorphic
 Definition
c. Dimorphic
Able to thrive outside and inside of a host
Molds and yeasts most often cause OIs.
Term
What infection does cystic fibrosis predispose you to?
 Definition
Pseudomonas aeruginosa (31-2)
Term
Which virus causes oral hairy leukoplakia in HIV patients?
 Definition
Term
Name the two ways you can acquire Toxoplasma gondii, and in which way specify what form of the life cycle you are ingesting.
 Definition
Term
How is Toxoplasma Gondii diagnosed?
 Definition
Term
Coccidioides immitis closely resembles what disease?
 Definition
TB
Term
 Definition
Term
Name 3 mobile genetic elements that are relevant for the mobility of virulence factors.
 Definition
Transposons
Plasmids
Bacteriophages
Slide 2
Term
Give 2 examples of bacteria that acquire virulence via bacteriophages.
 Definition
Corynebacterium diphtheriae Vibrio cholerae 33-3,7
Term
Low concentration of what substance induces the production of diphtheria toxin?
 Definition
Iron
33-3
Term
How does iron affect transcription of diphtheria toxin?
 Definition
When available it binds to a dimer of DTXR that represses transcription of diphtheria toxin.
When it is low the repressor will not attach to the promoter and diphtheria toxin is made.
33-4
Term
What is/are the reservoir(s) for Corynebacterium diphtheriae?
 Definition
Humans only
33-5
Term
How does the diphtheria toxin perform its action?
 Definition
It ADP-ribosylates elongation factor 2, halting host protein synthesis. It can be lethal if it gets to cardiac tissue.
33-5
Term
What are 2 components of effective treatment of Corynebacterium diphtheriae infection?
 Definition
Antitoxin
Antimicrobials
33-6
Term
Which bacterium can obtain a pathogenicity island from a phage? Name the phage.
 Definition
Vibrio cholerae CTXo 33-6
Term
What is the receptor for the phage that infects Vibrio cholerae?
 Definition
Toxin-coregulated pilus (TCP)
33-7
Term
Name the 2 most important serotypes of Vibrio cholerae that cause infection.
 Definition
O1
O139
33-7
Term
What is the action of Cholera toxin?
 Definition
It ADP-ribosylates a Gs protein and constitutively activates it. This G protein activates adenylate cyclase. cAMP levels rise and electrolytes and fluid are lost.
33-8
Term
Which of the following toxins is NOT associated with Vibrio cholerae? a. accessory enterotoxin b. cholera toxin c. zonula occludens toxin d. alpha toxin
 Definition
d. alpha toxin
33-8
Term
This toxin affects tight junctions and is made by Vibrio cholerae.
 Definition
What is zonula occludens toxin (ZOT)?
33-8
Term
Which 3 factors activate the transcription of the ToxT gene in Vibrio cholerae?
 Definition
TcpP
ToxR
ToxS
33-8
Term
This is the name for the most severe form of cholera.
 Definition
What is cholera gravis?
33-10
Term
What is the difference between lysogeny and lysis?
 Definition
Lysis - phage infects cell and multiplies rapidly, killing the cell
Lysogeny - phage infects cell but does not replicate. The DNA is simply inserted into the bacterial genome and is present in all of the cell's daughters.
Term
Where does diphtheriae toxin come from?
 Definition
Beta phage
Term
Corynebacterium diptheriae

Shape:?
Gram:?
Oxygen Usage:?
How do you isolate it?
 Definition
Gram positive club shaped aerobe, isolated on tellurite salts
Term
How does C. diptheriae infect the body?
 Definition
Colonizes the nasopharynx or an open wound. Does not invade epithelium - rather toxin production results in necrosis of local tissue and pseudomembrane formation
Term
Describe the two ways you can die from diptheria
 Definition
The pseudomembrane (composed of necrotic tissue and dead RBCs, PMNs, etc.) enlarges and closes off the child's throat.

The toxin can get into the blood and damage internal organs
Term
V. cholerae:

Shape:?
Gram:?
Motile:?
Oxidase:?
Oxygen usage:?
 Definition
Gram - comma-shaped rod, oxidase +, flagellar, facultative anaerobe
Term
V. cholerae reservoir
 Definition
Estuary waters
Term
T or F: Fecal leukocyctes are found in the diarrhea of a person infected with cholera
 Definition
F - the bacteria does no real damage to the epithelium, it just makes the cells secrete a lot of water.
Term
Name 2 two component regulatory systems in Salmonella.
 Definition
PhoP/PhoQ
PrmA/PrmB
32-3,4
Term
Name 2 type III secretion systems found in Salmonella.
 Definition
Inv/Spa
Spi/Ssa
32-7
Term
What is the skin manifestation that presents in Salmonella typhi infection?
 Definition
Abdominal rose colored spots
32-10
Term
A colony is taken from a culture plate in a stool culture, and tested for the Vi antigen. A positive result is obtained. What is the organism?
 Definition
Salmonella typhi 32-12
Term
A _____________ is a single regulatory element that independently mediates coordinate regulation and turns on/off virulence genes in bacteria.
 Definition
global regulator
32-2
Term
What are 2 types of systems that bacteria use to sense environmental changes?
 Definition
Two sensing mechanisms
Quorum sensing
32-2
Term
T/F Two component regulatory systems regulate only virulence factor expression.
 Definition
False. They regulate many bacterial function, including virulence factor expression. 32-2
Term
A sensor protein in a two component regulatory system is stimulated by the environment, undergoes a conformation change, and activates a ___________ kinase domain.
 Definition
histidine
32-2
Term
Define pag in Salmonella.
 Definition
pag stands for PhoP/PhoQ activated genes. 32-3
Term
Define prg in Salmonella.
 Definition
prg stands for PhoP/PhoQ repressed genes. 32-3
Term
This two component regulator in Salmonella causes production of enzymes that modify LPS so it no longer binds antimicrobial peptides.
 Definition
What is PrmA/PrmB?
32-4
Term
Quorum sensing involves production/secretion of a small molecule called a _______.
 Definition
autoinducer. (A peptide or homoserine lactone)
32-4
Term
T/F An autoinducer may stimulate quorum sensing as well as a two component regulatory system.
 Definition
True 32-5
Term
What is the reservoir different between Salmonella typhi and nontyphoid Salmonella?
 Definition
Nontyphoid Salmonella has a zoonotic reservoir, but S. typhi has only a human reservoir. 32-7
Term
The Inv/Spa type III secretion system triggers ___________ of enterocytes.
 Definition
membrane ruffling
32-8
Term
Which culture tests positive for Salmonella typhi first? a. Stool b. Blood c. Urine d. Abscess
 Definition
b. Blood
32-10
Term
An immune response that completely eliminates the infection.
 Definition
What is sterilizing immunity?
34-2
Term
What do live attenuated vaccines generally produce in the host?
 Definition
Active T cells
Antibodies
34-3
Term
What do killed vaccines generally produce in the host?
 Definition
Antibodies
34-3
Term
What do subunit vaccines generally produce in the host?
 Definition
Antibodies
34-3
Term
What phenomenon accounts for the fact that unvaccinated individuals may be protected from infection although they do not have immunity.
 Definition
Herd immunity. They are surrounded by people who are immune.
34-4
Term
Which of the following is NOT an organism that a 8 year old child will be vaccinated against? a. Adenovirus b. Rotavirus c. Corynebacterium d. Streptococcus pneumoniae
 Definition
a. Adenovirus
34-6
Term
Which of the following is NOT an organism that a 8 year old child will be vaccinated against? a. Poliovirus b. Hepatitis C virus c. Influenza d. Hemophilus influenzae e. None of the above
 Definition
b. Hepatitis C virus
34-6
Term
Which of the following is NOT an organism that a 8 year old child will be vaccinated against? a. Hepatitis A virus b. Hepatitis B virus c. Bordetella d. Clostridium botulinum e. None of the above
 Definition
d. Clostridium botulinum 34-6
Term
Which of the following is NOT an organism that a 8 year old child will be vaccinated against? a. Neisseria meningitidis b. Varicella zoster virus c. Clostridium tetanus d. Mumps e. None of the above
 Definition
e. None of the above.
Meaning that an 8 year old should have had all of these vaccinations
34-6
Term
When is the most infectious time of a Bordetella pertussis infection?
 Definition
Early infection. When symptoms look like a cold.
34-15
Term
______________ is a surface molecule on Bordetella pertussis that binds glycolipids.
 Definition
Filamentous hemagglutinin
34-15
Term
What is the other function of pertussis toxin?
 Definition
It functions as an adhesin, in addition to being a toxin.
23-15
Term
Which leukocyte can Bordetella pertussis bind to?
 Definition
Neutrophils
34-15
Term
What are the 2 components of pertussis toxin?
 Definition
A (active) and B (binding)
34-16
Term
What does the pertussis toxin do in host cells?
 Definition
The A subunit ADP-ribosylates the Gq protein and inactivates. This allows adenylate cyclase to remain active and produce cAMP.
Term
What is secreted by Bordetella pertussis into host cells that is activated by calmodulin?
 Definition
Adenylate cyclase
34-16
Term
What is the two component system in Bordetella pertussis?
 Definition
bvgA/bvgS
34-16
Term
Name two bacteria that establish a persistent or latent infection.
 Definition
Mycobacteria Treponema 35-2
Term
Name 3 protozoa that establish a persistent or latent infection.
 Definition
Plasmodium Toxoplasma Trypanosomes 35-2
Term
For the following pathogen, name the immune cell that it infects and destroys: HIV.
 Definition
CD4 T cells
35-2
Term
For the following pathogen, name the immune cell that it infects and destroys: Mycobacteria
 Definition
Macrophages
35-2
Term
For the following pathogen, name the immune cell that it infects and destroys: EBV.
 Definition
B cells
35-2
Term
For the following pathogen, name the immune cell that it infects and destroys: Trypanosomes.
 Definition
Macrophages
35-2
Term
For the following pathogen, name the immune cell that it infects and destroys: CMV
 Definition
T-cells and macrophages
35-2
Term
For the following pathogens, name the anatomical area they commonly establish latency: EBV
 Definition
B-cells
35-2
Term
For the following pathogen, name the immune cell that it infects and destroys: HSV-1
 Definition
Trigeminal ganglion neurons
35-2
Term
For the following pathogen, name the immune cell that it infects and destroys: HSV-2
 Definition
Dorsal root ganglion neurons
35-2
Term
For the following pathogen, name the immune cell that it infects and destroys: VZV.
 Definition
Neurons and glia
35-2
Term
For the following pathogen, name the immune cell that it infects and destroys: CMV.
 Definition
Monocytes.
35-2
Term
For the following pathogen, name the immune cell that it infects and destroys: HPV.
 Definition
Keratinocytes
35-2
Term
For the following pathogen, name the immune cell that it infects and destroys: HIV.
 Definition
Resting T cells.
35-2
Term
Name the reservoir(s) for HSV.
 Definition
Humans only. They are capable of infecting other species, but there is no known reservoir.
35-3
Term
What host cell molecules do HSV bind to?
 Definition
Heparan sulfate
Hve4 (HVEM or TNFR14)
HveC (nectin-1 or CD115)
35-4
Term
While latent in the neuron, HSV genes may encode a protein called ____________.
 Definition
Latency-Associated Transcript (LAT)
35-5
Term
Which of the following is NOT an HSV virulence factor?
a. UL41
b. ICP0
c. p24
d. ICP47
 Definition
c. p24
35-7
Term
Name 2 HSV factors that shut off protein synthesis and block apoptosis.
 Definition
UL41
gamma 34.5
35-7
Term
Name the HSV factors (3?) that block complement, antibody, and Ag recognition.
 Definition
gE/gI
gC
ICP47
35-7
Term
Is primary or secondary HSV lesion associated the more severity and longer duration?
 Definition
Primary
35-7
Term
This condition occurs due to frequent recurrences of HSV infection, and manifests as corneal opacity caused by CMI response.
 Definition
What is Herpetic Stromal Keratitis (HSK)
35-7
Term
This stain will show inclusion bodies in Giant Multinucleate cell.
 Definition
Tzanck smear stain
35-8
Term
Chocolate agar.

What is it and what grows on it?
 Definition
TSAYE + lysed red blood cells - good for cultivating fastidious bacteria, including H. influenzae and Neisseria spp, which require factors V and X, only present INSIDE the RBCS.
Term
TSAYE
 Definition
General non-specific medium
Term
Blood agar plates.

What is it? Explain how it is a differential medium.
 Definition
TSAYE + sheep RBCs. Differential based on hemolysis

- alpha: partial (greenish zone around)
- beta: complete
- gamma: non-hemolytic
Term
MacConkey Agar

 Definition
Contains bile salts, crystal violet, lactose.

Bile salts and crystal violet select against gram (+)s, select only Enterobacteriaceae

Lactose + turns pink (E. Coli, Klebsiella)
Lactose - colorless (Shigella, Salmonella)
Term
Sorbitol MacConkey Agar (SMAC)
 Definition
Contains sorbitol, differentiates EHEC (0157:H7) from other E. Coli strains
Term
Gram strain procedure
 Definition
1. Smear on plate
2. Air dry
3. Fix by passing through flame 3 times
4. Crystal violet, 30-60 seconds, rinse
5. Iodine, 30-60 seconds, rinse
6. Decolorize with alcohol, rine
7. Safranin counterstain 30 seconds, rinse, blot dry
Term
Oxidase test - what is it used to differentiate?
 Definition
Enterobacteriaceae from other gram negatives (like Neisseria)
Term
Indole test - what is it testing?
 Definition
Ability to change tryptophan into indole
Term
 Definition
Term
What is the formula for sensitivity and how can it be interpreted?
 Definition

The formula for sensitivity is

Sn = TP / (TP + FN)

 

The percentage that tested positive that should have if the test was perfect
Term

What is the formula for specificity?

Describe this formula in words

 Definition

Specificity

The formula for sensitivity is

Sp = TN / (TN + FP)*100%

 

The likelihood that the test will be negative is outcome is negative (pathogen absent, person not affected by disease) 

OR

the percent that tested negative and should have among all that tested negative

 
Term
What is the Positive Predictive Value?
 Definition
PPV = TP / (TP + FP)*100%
The probability that positive test results are correctly positive
Term
What is negative predictive value?
 Definition

NPV = TN / (TN + FN)*100%

The proportion of negative results that are correctly determined to be negative
Term
What is nonselective media? Name 3 types
 Definition

Media that supports the growth of many types of bacteria

  1. Blood agar
  2. Chocolate Agar
  3. TSAYE
Term
Why is sodium azide added to growth media?
 Definition
It selects for Gram positive bacteria over gram negatives
Term
Why are Bile salts and Crystal Violet aded to growth media?
 Definition

Bile salts select for Gram negative enteric over Gram negative mucosal and Gram positive bacteria

 

Enteric bacteria have hydrophilic repeated sugars on their LPS (O antigens) that repel hydrophobic growth inhibitors (Bile Salts and Crystal Violet)
Term

What is Colistin? Why is it added to growth media?

What types of Growth Medium characteristically include Colistin?

 Definition

1. It is a polymixin that inhibits the growth of many gram negative bacteria.

2. Adding it to media selects for Gram positives.

3. MacConkey Agar and CNA blood agar

 
Term

What is the basis for selective media?

What is the basis for differential media?

 Definition

1. Selective media include an inhibitory agent(s) to prevent unwanted organisms from growing

 

2. DIfferential media distinguish between bacterial species by incorporating chemicals that lead to a specific type of growth or change in the medium
Term

1. Describe hemolysis activity (Greek letters)

2. What type of medium enables one to derermine hemolysis activity?

 Definition

β-hemolytic: Complete hemolysis

α-hemolytic: Partial hemolysis

γ-hemolytic: No hemolysis

 

2. Blood agar plates
Term
Which species grow well on chocolate agar and why?
 Definition

It contains red blood cells that  have been lysed by heating to 56 °C.

 

H. influenzae and Neisseria require both factor X (hematin) and factor V (NAD), present inside
erythrocytes
Term

Name 2 enteric bacteria that ferment lactose and 2 that don't

What type of Agar would be useful to test this and what does a positive test look like?

 Definition

- Do ferment lactose: E. Coli. Klebsiela, Enterobacteria

- Do NOT: Salmonella, Shigella, Pseudomonas, Proteus, Yersinia)

 

-MacConkey agar

 

-Positive (lactose fermenting): Pink/red colonies vs transparent colonies

 

*Remember that fermentation of lactose also causes bile salt precipiation, so the colonies have zones of cloudiness around them
Term
What is Sorbitol MacConkey agar used to isolate?
 Definition
E. Coli O157 from other E. Coli
Term
Name the steps in a Gram Stain
 Definition

1. Put culture on a slide


2. Add a tiny bit of water and fix the culture to the slide


3. Floor the slide with crystal violet (CV) for 30-60 s. Rinsewith tap H20


4. Cover the slide with Gram's Iodine and let it set for 30-60 s.

Iodine (trapping agent/mordant) interacts with CV+ and forms large complexes of crystal violet and iodine within the inner and outer layers of the cell. This prevents  removal of the CV-I complex and therefore the stain color

 

5. Decolorize with Alcohol. Then, rinse with water

This drains the color out of Gram Negatives, which lack the thick membrane of Gram positives. Leave it on too long and any bacterium will lose its color

 

6. Counter Stain with Safranin. Rinse with water.

Safranin will adhere to the decolorized GN bacteria and turn them pink

 
Term
What's the Kirby Bauer Method?
 Definition

Also know as the Standardized Disc Susceptibility Test

 

Paper disc are impregnated with different antibiotics and placed onto agar plates containing an organism.

Zones of inhibition will form where bacteria can't grow. The size of the zone reflects its susceptibility (resistance) to the antibiotic
Term

What is the oxidase test? How is it performed?

What organisms is it useful for differentiating?

 Definition

The oxidase test differentiates bacteria on their posession of a particular cytochrome oxidase. Not all faculative or aerobic organisms have the particular cyt oxidase, so this test is used for taxonomic purposes.

 

one adds oxidase reagent to a colony on filter paper/Q-tip and waits to see if it turns from clear to dark blue (a positive result)

 

Enterobacteriaceae (oxidase -) are often distinguished from oxidase + gram negatives

 

Neisseria is oxidase +
Term
What is the indole test? What is the procedure?
 Definition

It tests an organisms's ability to break down Tryptophan, forming indole

 

Procedure:

1. Inoculate tryptone broth with bacterial isolate overnight at 35 degrees

2. Add Kovac's reagent and shake (to split off the idole)

3. A positive test is formation of a red ring at the top of the medium

 
Term
 Definition
Term

Gram -

Bacillus

Lactose fermenting

Indole +

 Definition
E. Coli
Term

2 species that are:

Gram -

Bacillus

Lactose Non-fermenting

Oxidase +

 Definition

P. aeruginosa

V. cholerae
Term
 Definition
Term

Gram negative

Bacillus

Lactose non-fermenter

Oxidase negative

Produces H2S and is motile

 Definition
Salmonella spp
Term

Gram neg

Bacilli

Lactose non-fermenting

Oxidase negative

Does not produce H2S

Is not motile

 Definition
Shigella
Term

Gram Positive

Coccus

Catalase +

Coagulase +

 Definition
Staph aureus
Term

Gram +

Coccus

Catalase -

Beta hemolytic

Bacitracin sensitive

 Definition
Strep pyogenes
Term

Gram +

Coccus

Catalase -

Beta hemolytic

Bacitracin insensitive

 Definition
S. agalactiae
Term

Gram +

Coccus

Catalase -

Alpha hemolytic

Optochin sensitive

 Definition
Strep. pneumoniae
Term

Gram +

Coccus

Catalase -

Alpha hemolytic

Optochin resistant

 Definition
Strep. viridans
Term

Gram +

Coccus

Catalase -

Gamma hemolytic

 

 Definition
E. faecalis
Term
Require X and V factors
 Definition

H. influenzae

 
Term

Genus that is:

Gram positive

Bacillus

Spore-forming

Aerobic

 Definition
Bacillus
Term

Gram positive

Bacillus

Spore-forming

Obligate anaerobe

Motile

 Definition
C. perfringens
Term

Gram +

Bacillus

Non-spore forming

Motile

 Definition
Listeria (monocytohenes)
Term
Non spore-forming Clostridium
 Definition
diptheriae
Term
These two species make spores
 Definition

Clostridia

Bacillus
Term

Gram negative

diplococci

Oxidize maltose

 Definition
N. meningiditis
Term

Gram neg

Bacillus

Lactose non-fermenter

Strict anaerobe

 Definition
B. fragilis
Term
Name the gram reaction and morphology of Staphylococcus aureus.
 Definition
Gram positive cocci in clusters
Term
Name the gram reaction and morphology of Staphylococcus epidermidis.
 Definition
Gram positive cocci in clusters
Term
Name the gram reaction and morphology of Streptococcus pyogenes or group A strep.
 Definition
Gram positive cocci in chains
Term
Name the gram reaction and morphology of beta hemolytic streptococci.
 Definition
Gram positive cocci in chains
Term
Name the gram reaction and morphology of alpha hemolytic streptococci
 Definition
Gram positive cocci (chains?)
Term
Name the gram reaction and morphology of Streptococcus pneumoniae
 Definition
Gram positive cocci in pairs (Diplococci)
Term
Name the gram reaction and morphology of Neisseria meningitidis.
 Definition
Gram negative cocci in pairs (Diplococci). Look like hamburger buns.
Term
Name the gram reaction and morphology of Neisseria gonorrhoeae.
 Definition
Gram negative cocci in pairs (Diplococci). Look like hamburger buns.
Term
Name the gram reaction and morphology of Hemophilus influenzae.
 Definition
Gram negative coccobacillus. Small and pleomorphic.
Term
Name the gram reaction and morphology of Bacteroides.
 Definition
Anaerobic gram negative rod.
Term
Name the gram reaction and morphology of Escherichia coli.
 Definition
Pleomorphic gram negative rod
Term
Name the gram reaction and morphology of Shigella spp
 Definition
Gram negative rod
Term
Name the gram reaction and morphology of Klebsiella pneumoniae .
 Definition
Gram negative rod
Term
Name the gram reaction and morphology of Proteus sp
 Definition
Gram negative rod
Term
Name the gram reaction and morphology of Vibrio cholerae.
 Definition
Comma shaped gram negative rod
Term
Name the gram reaction and morphology of Salmonella sp.
 Definition
Gram negative rod
Term
Name the gram reaction and morphology of Pseudomonas aeruginosa.
 Definition
Gram negative rod. Obligate aerobe.
Term
Name the gram reaction and morphology of Bordetella pertussis.
 Definition
Gram negative rod
Term
Name the gram reaction and morphology of Enterobacter.
 Definition
Gram negative rod.
Term
Name the gram reaction and morphology of Citrobacter sp
 Definition
Gram negative rod
Term
Name the gram reaction and morphology of Serratia.
 Definition
Gram negative rod
Term
Name the gram reaction and morphology of Campylobacter.
 Definition
Gram negative rod. Microaerophillic. Grow best at 42*C.
Term
Name the gram reaction and morphology of Yersina sp.
 Definition
Gram negative rod. Bipolar stain. May appear like a safety pin.
Term
Name the gram reaction and morphology of Helicobacter pylori.
 Definition
Gram negative rod.
Term
Name the gram reaction and morphology of Clostridium difficile.
 Definition
Gram positive rod.
Term
Name the gram reaction and morphology of Clostridium botulinum
 Definition
Gram positive rod
Term
Name the gram reaction and morphology of Clostridium tetani.
 Definition
Gram positive rod
Term
Name the gram reaction and morphology of Clostridium perfringens
 Definition
Gram positive rod. Appear like box cars.
Term
Name the gram reaction and morphology of Legionella pneumophilus
 Definition
Gram negative rod
Term
Name the gram reaction and morphology of Mycobacterium tuberculosis
 Definition
Acid fast bacillus
Term
Name the gram reaction and morphology of Mycobacterium leprae
 Definition
Acid fast bacillus
Term
Name the gram reaction and morphology of Trponema pallidum
 Definition
Spirochete. Visualize with dark field microscopy.
Term
Name the gram reaction and morphology of Borrelia burgdorferi
 Definition
Spirochete.
Term
Name the gram reaction and morphology of Chlamydia trachomatis
 Definition
Not-stainable. Gram negative structure. Intracellular parasite.
Term
Name the gram reaction and morphology of Rickettsia sp
 Definition
Not-stainable. Gram negative structure. Intracellular parasite
Term
Name the gram reaction and morphology of Mycoplasma sp
 Definition
Not-stainable. No cell wall.
Term
Name the gram reaction and morphology of Bartonella
 Definition
Gram negative rod
Term
Name the gram reaction and morphology of Francisella tularensis
 Definition
Gram negative rod. Class A agent.
Term
Name the gram reaction and morphology of Listeria monocytogenes
 Definition
Gram positive rod