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microbio 2 2


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What are the different bugs of clostridia?
tetani- tetanus
botulinum- botulism
perfringens- alpha toxin- myonecrosis, gas gangrene, hemolysis
Dificile- cytotoxin, kills enterocytes- pseudomembronous colitis. (metronidazole)
what are the buzz words in tetanus?
rusty nail
tetanus toxi prevents Gaba and glycine- inhibition of inhibitors
risus sardonicus- grotesque grinning
Formalin inactivated toxin is prophylaxis
What happens with anthrax infection?
Contact- malignant pustule (painless ulcer) can cause bacteremia and death
Inhalation- flu symps that progress to fever, pulm hemorrhage and shock
Black skin lesions- vesicular papules covered by black eschar
Woolsorter's disease- inhalation of spores from contaminated wool
What is Edema Factor, Protective Antigen, and Lethal Factor?
Proteins in the toxin of anthrax
Edema factor - A subunit of the exotoxin. Calmodulin-dependant. Increase cAMP, impairs neutrophils- massive edema
Protective Antigen- promotes entry of EF into phagocytic cells
Lethal Factor- Zn MMP that inactivates protein kinase. simms TNF alpha
What are the ABCDEFG of Diphtheria?
ADP ribosylation
Beta Prophage
Elongation Factor 2
Granules (metachromatic)/Grows on Tellurite
What must be done on first suspicion of Diptheria?
Antitoxin- only works on circulating toxin
Penicillin or Erythromycin- kill the bacteria, prevent more toxin
Vaccinate- immunity does not develop w/o vaccine
What's special about Listeria?
Only G+rod with endotoxin
meningitis in neonates and immunosuppressed
ampicillin and trimethoprim-sulfamethoxazole kill.
What is the difference between Actinomyces and Nocardia
Sufa for Nocardia Actinomyces give Penicillin
Actinomyces forms sulfur granules
Nocardia is acid-fast
Actino- facial abcess (normal oral flora)
Nocardia- pulmonary infection in the immunocomprimised
What are the virulence factors of Neisseria Meningitidis?
Capsule- surrounds the bacterium and is antiphagocytic. A,B,C cause meningitis
Endotoxin- can release endotoxin, cause blood vessel destruction and sepsis.
IgA1 protease- Only found in pathogenic, cleaves IgA
Can extract Iron from transferrin
What are the symptomes of Meningococcemia?
spiking fevers, chills, arthralgia, muscle pain, rash
What are the symptoms of fulminant meningococcemia?
septic shock, bilateral hemmorage into adrenals. Hypotension, tachy
DIC, Coma
What are the symptoms of Meningitis?
neonates- bulging ant fontanelle
older infants- stiff neck, Kernig's, bruzinski's
What is thayer-martin VCN?
chocolate agar (heated blood) with vancomycin, colistin and nystatin to kill G+, G-, and fungi
Which can ferment maltose gonorrhea or meningococcus?
What is the treatment for neisseria?
penicillin G, ceftriaxone
close contacts- rifampin
What is the Rx for clostridium perfringens?
Hyperbaric O2, abtics-penicillin, and removal of nectrotic tissue
What are the virulence factors of N. gonorrhoeae?
Pili- changes like crazy. adhere to host, prevent phagocytosis by holding bacteria very close to host cells

Protein II- also involved in adherance to host
What are the differences between meningo and gonococcus?
no polysaccharide
no maltose
no vaccine
What are the symps of gonococcal disease?
Men- penetrates mucous membranes of the urethra- inflamm, painful urination. discharge
Women- PID, endometritis, salpingitis, oophoritis. fever, pain, abnl bleeding, cervical motion tenderness
What are the complications of PID?
Scarring of the fallopian tube
ectopic pregnancy
peri-hepatitis- infection of the capsule around the liver RUQ pain and tenderness
What is Fitz-Hugh-Curtis Syndrome?
peri-hepatitis- chlamydia or gonococcal infection of the capsule of the liver
What are the symptoms of septic arthritis?
Acute fever with swelling of the joints. Can have rapid destruction of the joint.
What are the symptoms of Gonococcal bacteremia?
fever, joint pain, skin lesions (extremities)
Pericarditis, endocarditis, meningitis.
What is ophthalmia neonatorum?
eye infection from delivery transmission to newborn. can damage the cornea
Rx- erythromycin eye drops
What is the Rx of choice for Gonorhea?
Which capsule in H. Influenza is bad?
Capsule= a-f, B is Bad
How long does mom immunity for H. Influenza last in kids?
kids develop their own at 3yrs
What does H. Influenza cause?
haEMOPhilus Influenza
E-epligottitis- rapid swelling, blocks resp and esophagus. exam of airway can cause laryngospasm. drool
Meningitis- Nonspecific signs- fever, vomit, altered mental status
Otitis Media
Septic Arthritis- single joint- fever, pain swelling, most common arthritis in kids
sepsis- fever, lthargy, loss of appetite, no localized disease
What is the treatment for H. flu?
cefotoxime, ceftriaxone for serious
ampicillin or amoxicillin for less serious
What is the vaccine of H. Flu contain?
B capusle attached to diptheria toxin to activate t-cells.
What bug causes achancroid, unilaterally painful, swollen lymphnoses that can rupture?
What's the DDx and what can differentiate?
Haemophilus ducreyi

Syphilis and chlamydia are painless
Herpes has systemic symps
What are clue cells?
Diagnostic of Gardnerella/Haemophilus vaginalis.

Rx- metronidazole
How does the exotoxin of bordatella pertussis function?
activates cell-membrane bound G regulatory proteins. Turns off the inhibition. Increase in cAMP.
Histamine sensitization
Insulin synthesis
inhibition of phagocytosis
What are the virulence factors of pertussis?
extracytoplasmic Adenylate cyclase- swallowed by neutrophils, lymphocytes, and monotcytes. Impaired chemotaxis, increase in H2O2
Filamentous hemagglutinin- attaches to ciliated epi cells.
Tracheal cytotoxin- destroys the ciliated epi cells
What are the stages of pertussis?
Catarrhal- 1-2 wks, liek a URI
Paroxysmal- the cough, can cause vomiting, cyanosis. Large increase in lymphocytes
Convalescent- no longer contagious, attacks die down.
What organism do you need a calcium alginate swab for?
What type of medium must be used for b. pertussis?
Bordet-Gengou medium- potato, blood and glycerol
How do you treat pertussis?
Erythromycin in the catarrhal stage may prevent disease.
Didn't you ever see the movie Legionairre?
what's the low-down
Jean Claude Van Damme
aerosolized contaminated water
Pontiac fever- muscle aches, fatigue, fever and chills. quick
legionnaires- high fever and severe pneumonia. Older, smoker, Gram stain with neutrophils and no organisms.
What culture must be used for Legionaire's?
silver stain,
Charcoal Yeast
what does H2S give bacteria the ability to do?
liquify gelatin, hydrolize urea, and decarboxylate
What's so special about Eosine Methylene Blue and MacConkey Agar?
for lactose fermenters
EMB- become blue, and G+ are inhibbed
MacConkey- bile salts, inhibit G+, lactose fermenters become pink
What are the O, K and H antigens in the enterics?
O- LPS, O is outer
K- capsule
H- flagella, antigenic.
What bugs can get all up and in them lymph nodes?
Salmonella typhi, Yersinia enterocolitica, campylobacter
What bugs are enteroinvasive?
Salmonella, Shigella, E. Coli
Which bugs ferment lactose?
Lactose is KEE
Klebsiella, E. Coli, Enterobacter, Citrobacter
What are the virulence factors of E. Coli?
adhereance with pili
Can invade
Heat-labile and Stable
Shiga like
Libid A
Fe binding siderophore
What is the mechanism of the heat labile and stable toxin?
Prevent resorbstion of Na and Cl, and stim secretion of Cl and HCO3
What is the mechanism of shiga-like toxin?
Inhibit protein synthesis by the 60s Ribosome
What is Hemolytic Uremic Syndrome?
anemia, thrombocytopenia, infection of O157:H7
What is EIEC?
same disease as Shigella, can invade epithelial cells. Fever, WBCs in stool.
What virulence factor allows E. coli to cause UTIs?
What does Klebsiella cause?
Hospitals, sepsis
UTI in foley catheters. Hospitalized patients and alcoholics. Bloody sputum, 50% of cases. Produces cavities. red currant jelly. O antigen capsule.
Breakdown Proteus mirabilis:
What happens on agar?
what's it's relationship with urea?
What disease? How do you Dx?
Moves around on agar
splits urea
causes UTI, Dx- alkaline urine.
What are the similarities and differences between Salmonella and Shigella?
Both non-lactose fermenters
Invade Intestine and cause bloody diarrhea
SalMonella is Motile and can disseminate further. Symptoms can be prolonged with abtics. has an animal reservoir
Shigella does not have a reservoir and is transmitted by Food, Fingers, Feces, and Flies. Shigella is more virulent
What are the four disease states of salmonella?
1. typhoind
2. carrier state
3. sepsis
4. gastroenteritis
What is typhoid Fever?
enteric fever
can invade regional lymph nodes. seeds in multiple organ systems. Bacteria are pahgocytosed by monos and can survive intracellularly, !!!How facultative!!!
tenderness over Right lower quadrant. rose spots on abdomen.

Can be a carrier if it just hangs in the gallbladder.

treat with cipro or ceftriaxone

encapsulated, so no spleen = more likely to be infected
What are the sources of Yersinia enteroliticus infection?
puppie poo
contaminated milk

Outbreaks in daycare
How does Yersinia enteroliticus cause disease?
Invades -> notes and bloodstream
Enterotoxin- secrete enterotoxin similar to heat -stable toxin to cause diarrhea

survives in the cold
What would microscopic examination of the stool of a cholera patient show?
no WBCs, but some curved, darting rods.
What bug gives the japanese fits, with their sushi habits?
Vibrio parahaemolyticus
Campylobacter jejuni:
What's the reservoir?
what are the symptoms?
How does it cause disease?
Reservoir- chickens, domestic animals
Sx- fever, headache, bloody, loose diarrhea
Invades the intestine and secretes a toxin that destroys mucosal cells.
What bug will make you wish you never ate rice?
Bacillus cereus
What bug will make you wish you never ate reheated meat?
C. perfringens
What bugs cause bloody diarrhea?
Every Year Eighty-Eight Commoners Can Shit Something
Entamoeba histolytica
Yersinia enterocolitica
C. Difficile
What bugs cause watery diarrhea?
Even Very Common People Are Normally Runny
C. perfringens
What are some fun facts about H. pylori:
What type of bug?
How can you test for it?
How do you treate?
G- rod
Urease + breath test (alkaline environment)
Rx- bismuth, metronidazole, and amoxicillin/tetracycline
Rx2- costs more: metronidazole, omeprazole, and clarithromycin
What does Psuedomonas Aeruginosa cause?
Pneumonia- Cystic fibrosis
Sepsis- Black lesions on skin
External otitis- swimmer's ear
Drug Use and Diabetic Osteomyelitis
Hot Tub folliculitis
Wound and burn infections
Can cause endocarditis in IV drug users
When you think blue-green what do you think?
Pseudomonas- pyocyanin
What are some virulence factors for Pseudomonas?
exotoxin A- inactivates EF-2
Endotoxin- fever, shock
How do you treat Psuedomonas?
aminoglycoside and extended spectrum pnicillin- piperacillin, ticarcillin
What bug has a grape-like scent?
When does Bacteroides fragilis become a problem?
seat belt laceration
abdominal surgery
bowel rupture

forms abscesses
What are the virulence factors in Yersinia pestis?
F1- capsular antigen, anti phagocytic
V and W
What is the host of the bubonic plague now adays?
squirrels and prairie dogs in SW U.S.
How does yersinia pestis manifest itself as a disease?
bacteria invade, gobbled up by macrophages. Reproduce intracelularly. to the inguinal nodes Hot red and painful. Fever and headache. Bacilli invade the bloodstream, liver, lungs, and other discoloration.

In an outbreak, can be pneumonic and spread person to person

treat with gentamicin
What is the reservoir for francisella tularensis?
Rabbits, ticks, flea
What is ulceroglandular tularemia?
Bite is with a black base, skin ulcer (Different from Yersinia)
swollen lymph nodes
What is pneumonic tularemia?
lung infection during skinning of the rabbit.
What diesease does franciscella tularensis cause?
typhoidal (GI)
only a few bacteria are needed.
How do you get brucellosis?
unpasteurized milk
someone who works in meat, or meat packing, a vet

causes undulant fever- can last montsh to years.
What are Chlamydia and Rickettsia uncapable of ?
making their own ATP
They have an ATP/ADP translocator
What can rickettsia do that chlamydia can't?
it can oxidize and make ATP.
What are the two phases of chlamydia?
Elementary body- does not divide. has bonds to stabalize for extracellular existance. enters cell with endocytosis
Initial/Reticulate body- larger, more RNA binary fission

Starts off as EB, some EB remain to be released and infect other cells
What is the treatment for chlamydia?
tetracycline, erythromycin
What is the disease of chlamydia trachomatis?
What is the reservoir?
eyes and genitals
trachoma- chronic conjunctivitis- preventable blindness.
Kids are the reservoir
What is diagnostic of inclusion conjunctivitis by Chlamydia?
intracytoplasmic inclusion bodies
Urethritis, with a gram stain w/ mad neutrophils, but no G-diplococci is more likely Gonorrhea or Chlamydia?
What is tricky about Chlamydia and PID?
can be asymptomatic and lead to infertility
What is teh Rx for PID?
ceftriaxone and doxycycline
What is Reiters?
Inflamm of large joints by chlamydia, inflam of eyes- uveitis can also occur.
What is lymphogranuloma Venereum?
STD caused by Chlamydia, spontaneously healing sore, enlarged nodes that explode
Why should you think that parrots are filthy?
they have chlamydia psittaci- if you inhale chlamydia dust, you can get pneumonia, psittacosis
What are the roles of the tick, louse, and flea in Rickettsia?
tick- Rocky Mountain
louse- epidemic typhus - prowazekii
flea- endemic typhus - typhi
What are the difference between chlamydia and rickettsia:
where do they replicate?
what cells do they attack?
chlamydia- endosomes, columnar
rickettsia- cytoplasm, endothelium
What is the Weil-Felix reaction?
test using Proteus vulgaris Ags to look for Rickettsia
OxK=scrub typhus
What is unusual about the chlamydia peptidoglycan wall?
does not have muramic acid
What is the Rx for Rickettsia?
doxycycline and chloramphenicol
What is the difference between the rash in RMSF and Typhus?
typhus- spares palms, face
What is trench fever?
Caused by Bartonella. Not an obligate intracellular.
high fevers rash, headache, severe back and leg pains. 5 day interval between episodes
What is cat scratch disease?
Bartonella- lymph node or nodes will enlarge, low grade fever.
What causes Q fever?
Coxiella burnetti
has an endospore
mild pneumonia- fever 2-3 weeks after infection. no rash
What would cause something similar to RMSF with a dog bite?
Breakdown 1ry, 2ry, and 3ry syphilis.
1ry- painless chancre
2ry- rash on plams and soles, condyloma latum, CNS, eyes, bones, joints
3ry- Gummas of skin and bone, CV- AA, Neurosyphilis (tabes dorsalis)

latent- 25% relapse into 2ry again
What are gummas?
localized granulomatous lesions that necrose and become fibrotic. Skin and bones. skin are painless, bone are crazy painful.
How does CV syphilis come about?
inflam destruction of the vasa vasorum-> necrosis of the media layer of the aorta.
How does neurosyphillis present?
asymptomatic- syphilis in the CSF
subacute meningitis- fever, stiff neck, and headache. SCF high lymphocyte count, high protein, low glucose, and + syphilis (most bacteria have high glucose, low protein)
Meningovascular syphilis- spirochetes attack blood vessels in the brain and meninges- CV occlusions
Tabes dorsalis- disruption of the posterior columns- disruption of vibratory and proprioceptive sensations, ataxia.
General Paresis- mental deterioration
What is the Argyll-Roberston pupil?
Prostitute pupil- accomodates but does not react. Constricts with near vision, but no reaction to light.
midbrain lesion
What happens in congenital syphilis?
Early- 2 yrs. rash and condyloma latum, snuffles (runny nose)

Late- like 3ry- deafness is common. Bone and teeth. saddle nose

Rx for mom before 4th month.
How do you Dx syphilis?
FTA-ABS- positive early in disease, stays positiver for a while.
VDRL- nonsecific ab that reacts with cariolipin. can have false positives.
Viruses, Drugs, Rheumatic fever and arthritis, and Lupus can give false +.

+VDRL +FTA= infection
+VDRL -FTA=false +
-VDRL +FTA=treated syphilis
-VDRL -FTA=-unless aids or recent infection
What is the Jarisch-Herxheimer phenomenon?
most spirochetes- worse symps right after Abtic use.
What are the 3 subspecies of syphilis and what do they cause?
enemicum- endemic
pertenue- yaws
carateum- pinta
What are the stages of lyme disease infection?
Early localized stage- Erythema chronicum migrans, flulike
Early disseminated stage- multiple smaller ECM
Neurologic- meningitis, Bell's palsy, peripheral neuropathy
Cardiac- heart block or myocarditis

Stage 3 Chronic arthritis
How do you Dx and Rx lyme disease?
ELISA for Abs
culture the edge of a bite

Rx- doxycycline or penicillin
What does Ixodes mean?
the tick that carries lyme disease.
What are the phases of Leptospira infection?
first - leptospiremic phase, blood and CSF- high temps. red conjunctiva, photophobia
2nd phase- IgM

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