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202 Cards in this Set
- Front
- Back
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neutrophils defend against which organisms?
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extracellular bacteria (*staph aureus**pseudomonas*, GAS, flu, e. coli, fungi
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macrophages defent against which organism?
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intracellular bacteria, fungi
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complement defends against which organism?
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capsulated- neiserria meningitis, strep pneumo
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what host defense is against fungi?
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neutrophils and macrophages
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cancer chemo causes what lapses in host defense?
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neutropenia, mucositis (physical barriers)
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solid organ transplantation causes lapses in what host defense?
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cell mediated immunity against intracellular bacteria (physical barriers in 1st month)
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bone marrow transplant causes lapses in what host defiencse?
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neutropenia, mucositis, cell mediated and humoral immunity
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Cell mediated immunity against which pathogens?
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intracellular
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empiric antibiotics for neutropenic fever/cancer?
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antiseudomonal betalactams w/ gram negative coverage- cefepime or carbapenems
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which transplant type has greatest risk?
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lung (or heart lung combo)
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which protozoan is common in 1-6 month of solid organ transplant due to immunosupression?
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toxoplasmosis
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which fungi are common in 1-6 month of solid organ transplant due to immunosupression?
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endemic mycosis +aspergillus
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describe pre, early-post, and late-post immune system defects?
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neutropenia, graft vs. host t-cells and b cells, chronic t cell/b cell problems
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endemic mycoses are seen more in solid organ transplant or bone marrow transplant?
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solid organ
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Common culture negative organisms for Endocarditis
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HACEK (hard to grow)- Haemophilus aphrophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)+ Bartonella, Coxiella
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azithromycin is used against?
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gram negatives only
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how long to treat complicated catheter infection
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4-6 weeks
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name worst to least catheters for infection?
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non-tunnel> tunnel> picc> port
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after femoral, worst site for catheter infection?
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internal jugular>subclavian
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alternatives for vancomycin w/ MRSA?
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daptomycin, linezolid
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most common organisms in native valve endocarditis?
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Strep viridans, staph aureus (acute)
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most common organisms in early prosthetic endocarditis?
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Coag neg staph
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late prosthetic endocarditis?
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coag neg staph, strep viridans, staph aureus
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nosocomial endocarditis organisms?
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staph aureus, gram negative, candida
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IVDU endocarditis organisms?
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staph aureus, polymicrobial (enterococci/pseudomonas)
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Causes of culture negative endocarditis?
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HACEK, Bartionella, Coxiella
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what are oslar nodes?
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tender nodules in digits seen in endocarditis
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what are janeway lesions?
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non-tdner pustular lesions on palms and soles seen in endocarditis
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What are roth spots?
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retinal lesions seen in endocarditis
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major criteria of Endocarditis (dukes); how many needed?
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2/2 or persistently positive blood cultures OR Endocardial environment; need 2
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minor criteria for endocarditis (dukes); how many needed
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predispositon, fever, peripheral phenomena, less convincing microbiology; need 5 or 1 major + 3 minor
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tx of endocarditis: MSSSA, strep, culture negative
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cetriaxone
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tx of endocarditis: MRSA, Coag Neg Staph
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Vancomycin
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Tx of endocarditis: strep and enterococci
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gentimicin/penacillin; substitute vanc if gentamicin resistant
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t/f use endocarditis prophylaxis for Mitral valve prolapse? For prosthetic valve?- in procedures
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No; Yes
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which normal skin flora is anerobic?
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propionibacterium
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organisms that cause impetigo?
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Group A strep, staph aureus
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organisms that cuase folliculitis?
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staph aureus, pseudomonas
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what organisms causes a skin infection via swimming pools and hot tubs?
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pseudomonas
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what organisms cause furnucles/carbuncles?
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just staph aureus
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what is inflammation of the dermis called?
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ersipelas
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what causes erlyipsea?
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Group A strep, other group streps
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how to differentiate erlypsia from cellulitis?
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it is well demarcated! Also raised
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risk factors for erlypsia?
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venous stasis, alcohol abuse, lymphatic obstruction
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where is cellulitis?
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in dermal and superficial fascia layers- deeper than erysipelas
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common organisms in cellulitis?
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gram positives; In DM/diabetes ulcer- gram negatives and anerobes
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tx of cellulitis?
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vancomycin
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which post-op cellulitis has a high risk of necrotizing fasciatis? When does it occur?
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Group A strep; w/ in 2 days
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what is fourneir's gangrene?
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necrotizing fascitis in the scrotum
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pathogenesis of necrotizing fascitis?
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Strep pyogenesis exotoxins/superatigens A-C over produce cytokines
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cause of pyomyositis?>
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staph aureus
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necrotizing fasciaties is in what part of skin?
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subcutaneous fatt and tissue
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inmates/football teams/postpartum women all get what?
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CA-MRSA
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tx for CA-MRSA?
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Clinda, vanc, bactrim, doxy
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presentation and organism from ingesting raw shell fish?
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hemorrhagic bullae; vibrio vulnificus
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tx for hemorrhagic bullae of vibriovulnificus
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doxycycline
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presentation and organism for people who handle saltwater fish, shellfish, poutry, and meat?
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indollent cellulitis/seal finger= erysipelothrix rhusiopathie
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Tx for erysipelothrix rhusipathiae for handling saltwater fish and meat?
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vancomycin
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tx of anthranx
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doxycycline or ciprofloxacin
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cat bites cause what dz w/ which organism?
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acute lymphangitis; pasturella
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getting in fresh or salt water w/ minor trauma causes what? Organism?
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chronic granulomatous lymphangitis; mycobacterium marinum
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tx of mycobacterium marinum chronic granulomatous lypmhangitis?
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clarithro, doxy, or bactrum; or rifampin
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2 organisms that can cause TSS
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staph aureus (super antigen); Group A strep (exotoxins)
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differences between how GAS and staph aureus TSS look?
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GAS- necrotizing facitis; Staph- desquamization
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what organism causes scalded skin syndrome? Tx?
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staph aureus superantigen; vanc
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describe SRIS? Temp, HR, RR, WBC
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Temp:36 or 38, HR>90, RR>20 or PaCO2<32, WBC> 12k or < 4 k or 10% immature
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sepsis?severe sepsis?
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SIRS + infection + 1 organ failed
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septic shock?
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SIRS + infection + hypotension
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sepsis rate increasing or descreasing? Mortality rate?
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increasing; declining but still high (absolute numbers continue to rise)
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who gets sepsis?
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6th decade, non-white males, w/ alcohol dependence or genetics
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pathogens that cuase the most sepsis?
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gram positives; increasing candida but still rare
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pathogenesis of spesis?
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cytokines influence hypothalamus, endothelial cells, and vessel wall causing fever, depletion of IV volume and vasodilation leading to lactic acidosis and death
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in sepsis, which organism causes ecthyma gangrenosum?
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pseudomonas- burn/open wound patients
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component responsible for shock in gram negative sepsis? Host cell components?
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LPS (lipid A + O antigen); Host cell-TLR4, CD14, and cytokines
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component responsible for gram positive staph?
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lipoteichoic acid activated by TLR2, peptidoglycan activates cytokines, superantigens/exotoxins
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empiric abx for sepsis?
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carbapenem, 3/4 cephalsopron, piperacillin +/- vanc
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when to use hrAPC? Risk?
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sepsis w/ acute organ dysfunction; risk= bleeding
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when to use steroids in sepsis? Insulin?
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when hypotensive after a week; when glc above 150
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name some characteristics of atypical pneumonia
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more mild, insterstitial cxr, no response to pcn
|
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organisms of atypical pneumonia?
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mycoplasma, chlamydophila, legionella (coxsiella, franciella, pcp, endemic fungi, respirtaory viruses)
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what viruses cause atypical pneumonia?
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influenza A, rsv, metapneumovirus, rhinovirus, coronavirus
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how to differentiate viral from bacterial pneumonia?
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URI manifestations, normal WBC, winter/kids/nursing home
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most common cause of atypical pneumonia?
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mycoplasma
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pathophysiology of mycoplasma pneumonia
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attach w/ P1, damage cilia and elaborate gas-H202/superoxides
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complications of mycoplasma pneumoia?
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bullous myrigintis, steven johnson target syndrome, hemolytic anemia (agglutins), meningoenchephalitis, myopericarditis, arthritis
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which atypical pneumonia organism is an obligate intracellular bacteria>
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chlamydiae pneumoniae
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pathogenesis of chlayminia pneumonia
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elementary bodies phagocytosed, into vesicules, become reticulate bodies, back to elementary bodies that are released
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biological characteristics of legionalla pneumophilia?
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aerobic, gram positive, non-spore forming
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where is legionella pneumophila found and how is it infective?
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bulding water supplies, it is inhaled into lower respiratory tract and then consumed by macrophages
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which atypical pneumonia cannot go from person to person
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legionella
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clinical manifestions of legionella pneumonia?
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sudden pontiac fever (flu like) or Legionairre's dz (non-productive cough ans systemic signs)
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differences and similarities of tx of atypical pneumonias?
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All- macrolides, floroquinolones Mycoplasma and chlamydia- Tetracyclines
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What Ig is in the upper airways and antibacterial?
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IgA
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symptoms and signs of CA- pneumonia?
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fever, cough, chest pain, rales, lobar infiltrate
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history of LOC puts one at risk for what?
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aspiration pneumonia w/ polymicrobial anerobes
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what causes pneumonia in birth to 3 weeks?
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GBS, e. coli, Listeria
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what causes pneumonia in 3 weeks to 3 months
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strep pneumo, chlamydia, bordatella, s. aureus
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What cuases pneumonia in 3 months up to 5 years?
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strep pneumo, h. flu, mycoplasma
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what causes pneumonia in young adults?
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strep pneumo, atypicals
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what causes pneumonia in adults?
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Strep pneumo, H. flu, moraxella, s. aureus
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which pneumonia will not last a long time?
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strep pneumo
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tx of strep pneumo pneumonia?
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ceftriaxone or quinolones
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morphology of h. flu?
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gram negative bacillus
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tx of h. influenza pneumonia?
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ceftriaxone
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morphology of moraxella?
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gram negative diploccocus
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t/f moraxella colonizes?
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true- nasopharyngeal mucosa mostly of infants
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tx of moraxella pneumonia
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ceftriaxone
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which organism causes necrotizing pneumonia, pleural effusion, and empyema?
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staph aureus
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tx of staph aureus pneumonia
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vancomycin
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what determines when a pneumonia patients should be hospitalized?
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CURB-65 of 2/3: confsion, uremia, respiratory rate, blood pressure low, 65 or older
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empiric tx for healthy outpatient pneumonia>
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macrolides or doxy
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empiric tx for outpatient w/ comorbid illness or use of abx
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macrolide + betalactam or enhanced floroquinolone
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empiric tx for hospitalized pneumonia patient
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macrolide + betalactam or enhanced floroquinolone
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empiric tx for ICU pneumonia
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beta lactam + macrolide or enhanced floroquinolone; suspect MRSA add vanc
|
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how does host commensal flora change when in hospital?
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goes from gram positive to gram negative
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Hospital acquired pneumonia organisms?
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Enterobacteria, pseudomonas, staph aureus, actinobacter (PASE)
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what medicine can predispose to hospital acquired pneumonia?
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PPI
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which cancer is most likely to give fever?
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non-hodkins lymphoma
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with IV acess what nosocomial cause of FUO do you consider?
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phlebitis
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with intubation, ng what nosocomail cause of FUO do you consider?
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nosocomial sinusitis
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treatment of toxoplasmosis?
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pyrimethamine/sufadiazine
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which gastroenteritis are caused by cytotoxins, destroying cells?
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shiga toxin, c. diff toxins
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how do gram negatives and viruses cause gastroenteritis?
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invasion
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which gastroenteritis are caused by neurotoxin? What do you see?
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staph, b. cereus= vomiting
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how does norovirus present?
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vomiting w/ little diarrhea
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which parts of epithelial cell are affected by cholera toxin?
|
GM1 ganglioside bound to, ADP-ribolyasylated
|
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antibiotics for cholrea?
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doxycycline, flouroquinolone
|
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antibiotiscs for ETEC?
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rifaximin
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what type of ecoli produces shiga toxin?
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enteroinvasive e. coli
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which e. coli causes chronic diarrhea?
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enteroaggreative
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where do you get E.colia O157: H7
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water, meat, veggies, anything not staerillized/pasturierzed
|
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virulence factors of E. coli O157: H7?
|
shiga-like toxin
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how to grow e. coli o157.h7?
|
sorbitol maccokeny agar
|
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which parasite diarrhea is most common in US?source?
|
giardia; water
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tx of giardia?
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metronidazole
|
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how to diagnose parasite diarrhea?
|
microscopy; can do ag test for giardia and cryptosporidia
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presentation of entamoeba histolygica?
|
chronic bloody diarhea
|
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tx of parasite diarrhea?
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metronidazole; nitrazoxanide for cryptosporidium parvum
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presentation of cryptosporidium parvum?
|
nonbloody chronic diarrhea
|
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how to test for C. diff?
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test for toxins w/ ag- cannot culture
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which agenst of gastroenteritis are nonfermenters of lactose?
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salmonella and shigella
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for which gastroenteritis are abx contraindicated?
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EHEC, salmonella
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tx of salmonella?
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cirpfloxaxin or ceftriaxone
|
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rose spots on abdomen seen in what disease?
|
salmonella typhi
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what gastroenteritis do you get from pork or milk?
|
yersina entercolitia
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most common cause of bacterial diarrhea in US?
|
campylobacter jejuni
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which bacteria gives you Guillian barre? What other symptoms?
|
campylobacter jejuni; bloody diarrhea
|
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tx of camplyobacter jejuni?
|
macrolides or doxy
|
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subacute bacterial endocarditis on native valve?
|
strep viridans
|
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subacute bacterial endocarditis on prosthetic valve?
|
coag negative staph
|
|
acute native valve endocarditis?
|
staph aureus
|
|
IVDU endocarditis organisms?
|
staph aureus
|
|
drug for coccidio?
|
intraconazole
|
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what disease do filipinos get?
|
coccidio
|
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how to diagnoses HSV encephalitis?
|
CSF pcr
|
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which encephaltisis is accompanined by problems to heart, eye, muscle, and hand foot and mouth dz?
|
enterovirus
|
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transmission of enterovirus? Who gets it?
|
fecal-oral; kids in daycare
|
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what gives you a polio-like ilnness w/ encephalitis?
|
WNV
|
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how to diagnose WNV?
|
Ab in CSF and serum
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who gets nocardia?
|
transplant or steroid immunosuppressed, rarely seen in HIV infected
|
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which lung disease has intracellular very small organisms?
|
histo
|
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what disease is likely to cause fever and seizures in advanced HIV?
|
toxoplasmosis
|
|
name organisms likely to cause fever in advanced HIV
|
cryptococal, disseminated MAC or histo, reactivation CMV, lymphoma, toxo
|
|
how to daignose mycobacteria?
|
blood cultures
|
|
how to diagnose cryptococal?
|
serum/csf ag
|
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how to diagnose histo
|
urine histo
|
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how to daiganose cmv?
|
serum cmv pcr
|
|
gram positive branching fillamentous organisms that are weakly acid fast
|
nocardia
|
|
tx of nocardia
|
bactrim
|
|
gram positive branching fillamentous organisms that are not acid fast
|
actinomyces
|
|
treatment for MAC?
|
clarithromycin, rifampin, ethambutol
|
|
how to differentiate MAC from mTb?
|
amplification
|
|
where do you get leishmaniasis? How is it transmitted?
|
tropics; sandfly
|
|
what causes cutaneous larvae migrans?
|
ancysolostoma BRAZILense (dog and cat hook work)
|
|
what causes skin lesion and infiltrate on CXR?
|
endemic mycoses- blasto, histo
|
|
t/f or false you colonize blasto?
|
FALSE
|
|
where do endemic mycoses go most?
|
lung> skin> bone
|
|
nocardia goes where?
|
lung, brain, skin
|
|
tender painful axillary nodes makes you think of what dz? w/ necrotizing granulomas
|
cat scrat dz
|
|
in summer in mo, very sick, thromboctyopenia, elevated liver enzymes?
|
erhlichiosis
|
|
tx for erhlichia?
|
doxycycline
|
|
granulocytoc vs. monocytic eehrlichiosis?
|
anaplasmosis= granulocytic; chaffenis= monolocytic
|
|
morphology of ehrlichia?
|
gram negative, onligate intracellular
|
|
vecttor for granulomcytic ehrlichiosis? Monocytic?
|
granulocytic= ixodes tick; monocytic= lone star tick
|
|
hospitalized UTI organisms?
|
klebsiella, other enterobecter, staph saprophytics, enterococci
|
|
what to use for UTI when pregnant?
|
beta lactam antibiotics
|
|
tx pyelonephritis or high resistance UTI?
|
fluroquinolones
|
|
what to use in hospitalized pyelonephritis?
|
ceftriaxone
|
|
bacteria that cover the gut?
|
carbanemens, pip/tip, metronidazole + 3rd/4th cephalosporin
|
|
virulence factors of bacteriodes fragilis?
|
beta-lactam production; capsule
|
|
pneumonia + erythema nodosum?
|
blasto
|
|
which abx is a weak MAOI inhibitor and causes thrombocytopenia and optic neuropathy?
|
linezolid
|
|
which atbx rapidly depolarizes membranes?
|
daptomycin, linezolid
|
|
when can daptomycin not be used?
|
pneumonia
|
|
which abx you have to measure trough levels?
|
vancomycin
|
|
which anx is active agaist b fragilis?
|
ticarcillin, pieracillin
|
|
which cephalosporins cover pseudomonas?
|
cefepime, ceftazidime
|
|
1st generation cephalopsorin?
|
cefazoli
|
|
side efects of carbapenems?
|
seizures, less w/ meropenem
|
|
monobactams/atrezonam work against what?
|
gram negatives and pseudomonas
|
|
mechanism fo action of vanc?
|
inhibits cell wall synthesis by binding to d alanine
|
|
adverse effects vancomycin?
|
red man, ototoxicity, hematologic
|
