Microbiololgy - Normal Flora

8/9/2019 Microbiololgy - Normal Flora

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Compartment Syndrom

5 P’s

Pain (occurs 1st)

Palor

Poikliothermia

Parathesia

Pulselessness (occurs l

How did a bacteria pick up nasty trait

- Tranduction Phage

NORMAL FLORA

Gram + or Gram - ??

o If the part of the body that is affected is EXPOSED TO O2 → Gram + Aerobe But if Hiding from O2 → Gram + Anaerobe

o If part of the body that is affected is NOT EXPOSED TO O2 → Gram – Anaerobe

If in both locations with or without O2 → Facultative

Facultative Anaerobe prefers no O2 Facultative Aerobe prefers O2

Anaerobe Clues

o Air fluid levels

o Bad breath, body odor, Farts

o Bleach works by introducing oxygen to the bacteria!!!

SKIN

Staphlococcus aureus o MCC of skin infections

Cellulitis → Flat red area; + blanching

Oomphalitis → cellulitis around umbilicus of a newborn Mastitis → cellulitis around breast Panniculitis → cellulitis as a ring around abdomen Folliculitis → infection of a hair follicle

Pus at the base of the hair shaft Carbuncle → small nodular indurated area with infection Furuncle → hari follicle in the middle of carbuncle – no pus Ballintitis → infection of the head of the penis Fascitis → Compartment syndrome

Strep pyogenes

o

S. aureus is the MCC for skin infections except for these 5 cases where it is Strep pyogenes whis responsible

“LINES”

Lymphangitis → infection follows lymphatic channels = “red streak”

I mpetigo → honey crusted lesions ( if bullous d/t Staph aureus’s elastaseactivity)

N ecrotizing fascitis → “flesh eating strep” → Compartment Syndrome

E rysepelas → raised edges; do not blanche (vs. cellulitis)

S carlet Fever

o “sand paper rash”

o Strawberry tongue

o

Rash on PALMS & SOLES

Staph epidermi dis

o Action is under the epidermis where it is the most abundant

o Primarily due to:

Shunt Infection

Central Lines

These both penetrate the skin underneath the epidermis


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Have IgA Protease → allows bacteria to live in the mouth

without IgA killing them

#1 way to paralyze cilia → VIRUS o Virus paralyzes cilia making the lung susceptible to

infection!!!

o Cilia no longer has ability to sweep them up and out

o S. pyogenes has no capsule so type I pneumocytescan eat them u or cause infection

MCC of Sinusitis → S. pneumo, H . inf lu , Neisseri a – in that order

Propr iobacteri um Acne

o Exposed to oxygen but hiding under skin = Gram + ANAEROBE

o Affinity for Propionic Acid found in sebaceous glands

o Affinity for Progesterone

+ Females > Males

Caused by birth control pills/shots → acne 2 weeks prior to menses

More common in pregnancy

o HATES O2

Therefore, acne treatment is based on exposure to O2 (Oxy 10)

o Acne Medications Start with Oxy 5/10 → Abrasive pads (open pores to O2 ) → ABX treatment:

Clindymycin, Erythromycin, Minocycline (T4)

If these don’t work need the BIG GUNS

Retin-A = previtamin A → Stimulates skin to grow thereby pushing the “bug” ofor oxygen exposure

SE:

o Photosensitivity (because forming new immature skin cells that are

susceptible to damage o Absorbed in the ileum → Hyperlipidemia

o Fat soluble → teratogenic

MOUTH/THROAT/ESOPHAGUS

Strep pyogenes o Resides in the back of the throat

o Rheumatic Fever

Jones Criteria = SPECC

Subcutaneous nodules

Polyarthritis (MC)

Erythema marginatum = little red dots with margins

Chorea (Syderham)

Carditis – MS >> AS/MS >> AS >> TS → MC

o Strep is swallowed → lungs → returns via pulmonary vessels → MV

o Fish mouth appearance (MS) Pt. most likely had a prior strep infection in last 2 weeks

o Post Strep GN Strain 12

Strep. Pneumonia

H. infl uenza

Neisseria

o Catarrhalis

o Meningitis

o Gonorrhea


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GUMS = Facultative anaerobes

Peptococcus

Peptostreptococcus

Fusobacterium

o Fused at the edges and tapered at the end Vincent Angina = painful ulcers in the back of the throat

Trench mouth = pus oozing from the gums

Actinomyces

o Sulfur granules

o Fistula tracts

Strep vir idans – MCC of subacute bacterial endocarditis (SBE) o Mutans → responsible for dental caries → ferments glucose → produces lactic acid

o Sanguis

o Salivarius

Cold agglutins

STOMACH

Heli cobacter pylor i

o Urease +

o Duodenal gastritis is highly associated

o Dx: H2 Breath Test

o Treatment

Amoxicillin

Tetracycline/Metronidazole

Bismuth → suffocates bacteria

H2 Blocker/Pump Blocker

o

Infections most likely due to bad sewage systems

SMALL INTESTINE – 95% are oxygenated → facultative aerobes

E. coli

o Anything to do with S. int. think E. Coli

o Vitamins produced by E. Coli

Vitamin K

Cofactor for Clotting factors 2,7,9,10, protein C & S → Measure PT

o This is why broad spectrum drugs can cause bleeding

Folate

Biotin

Panthotenic acid

Helps absorb Vitamin B12 in the ileum

COLON – 95% of gas is CO2 also not exposed to oxygen → GRAM –„s

Proteus

o 2nd

in line for UTI

Klebsiella

o Currant jelly sputem

Big Mama Anaerobes:

Clostridium melangosepticus

Strep bovis

Bacteriodes fragilis

Rx: Clindymycin, Cefoxitin, Metronidazole


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All 3 are main causes of sepsis in

the newborn

o MC in alcoholics and homeless

o 3rd

in line for UTI

o Likes to hang out in the fissures of the lungs → pneumoniae

Enterobacter

Citrobacter

o Multiple cerebral abcesses in the newborn 0-2 mos.

Clostri dium diff icil e

o

Pseudomembranous colitis d/t chronic antibiotic use o Gastroenteritis after antibiotic use

Clostr idium perf ingens

o Gastroenteritis associated with holiday ham

RECTUM

Group B Strep

E. coli

Lysteria

STAPH Species: β lactam ring

Staphlococcus aureus:

Gram + cocci in clusters; gold pigment

Enzymes:o Catalase + → breaksdown hydrogen peroxide

o β-lactamase → breaks through β lactam containing drugs

o coagulase & staphlokinase Allows for the ability to eat through clots MCC of Acute Endocarditis → has ability to eat through the valves

MCC of death for burn unit patients in the first week β lactamase cuts

here

o Lipase → breaksdown fat Panniculitis Folliculitis Mastitis

o Elastase Bullous Emphysema/pneumatocelle

o Collagenase → affects skin and bones

MCC of Osteomyolitis (Salmonella is the 2nd

MCC of bone infection)

Type IV (basement membrane) → Scalded Skin, Kidney, Lung also affected

Type III (endothelium – arteries affected) → Vasculitis Type II (connective tissue) → MCC Fascitis and Septic Arthritis (gonorrhea #2) and

Folliculitis

Toxins:

o Exfoliatin/SSSS-T: Staph Scalded Skin Syndrome

Red rash all over the body → sloughs off = Nikolsky sign (recall it‟s also seen with

Penphiguis vulgaris) Involves the PALMS & SOLES

o Erythrodermic Toxin


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Causes Scarlet Fever

o Lecithinase Causes skin infections → Subcutaneous fat

o TSST: Toxic Shock Syndrome

Triad:

High Fever

Hypotension → shock

Bright red rash all over the body especially…PALMS & SOLES Associated with retained tampon in a female

If you see just MENSES….CLICK AND MOVE!!!

o Enterotoxin

Causes food poisoning associated with dairy products → Gastritis

Custard Pie

Staph infections usually arrive after flu-like symptoms

Treatment for Staph:

o Vancomycin – best treatment but expensive

o

Macrolides

o Chloramphenicol

o 1st Generation Cephalosporins

o Quinolones

Staph epidermidi s:

Enzymes:

o Catalase +

Resides underneath skin

White pigment

MCC Shunt infections and Central line infectionsTreatment

o Vancomycin → however, there are now vanco. Resistance

o Linezolid This is a lorefin drug and not fully tested but is an alternative to vanco. Resistentance

Staph Saphr ophyticus

NO PIGMENT

Enzymeso Catalase +

Symptoms

o

Frequent cause of UTI: Ages:

5-10 because they tend to play with themselves more at this age

18-24 → post coital UTI, especially with no circumcision

o Recall that E. Coli is the MOST COMMON CAUSE OF UTI!!!

STREPTOCOCCUS SPECIES:

General Characteristics

o Gram + cocci in CHAINS


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o Groups A, B, C, D

o Types of hemolysis α-hemolysis → partial hemolysis → Green Zone

β-hemolysis → complete hemolysis → Clear Zone

γ-hemolysis → no hemolysis → Red Zone Streptokinase is responsible for β-hemolysis → it is used for breaking up clots and

binds up fibrinogen in acute MI, but if patients had recent Strep infection, the patient ha

built antibodies to streptokinase and it will not work → This is the reason that theydoctors use tPA instead!!!

Dosing: 75,000 units IV bolus and 75,000 units drip

Works by converting plasminogen → plasmin → breaks up the clot

Binds up fibrinogen → wont’t allow for anymore clotso Allows 1-3% to bleed to death

o tPA causes < 3% to bleed to death

o APSAC can induce tPA reversal

Strep Strains:

Immunity is type specific, that is why you can get recurrent strep infections

Strep pneumoniae aka Pneumococcus

o Gram + diplococci

o α – hemolysis

o 80 Strains

o Pneumococcal vaccine (pneumovax) Covers 23 strains that account for 98% of infections by Strep pneumo. Who needs it?

Everybody > 65 y.o.

> 2 y.o. with Sickel Cell

o Functional asplenic after age 2

o

Recall that the spleen is the organ that can rid the body of encapsulatedorganisms

End Organ Failure o It is most likely that encapsulated cause that will kill DM and CF patient

PSGN o Skin or throat strep can cause PSGN

o Associated with Strain 12

Group A: Strep pyogenes

o β – hemolytic


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8/31

Likes immunocompromised patients

Nitrite Negative UTI

Treatment

o Vancomycin

Vancomycin

MOA:

o Cell wall inhibitor

o Inhibits phospholipids carrier (Nam-Nag)

o Irreversible (non-competitive inhibitor)

Treatment for all Gram +

Toxicityo Ototoxicity

o Nephrotoxicity

o Red Man Syndrome

d/t intense histamine release

This is not an allergic reaction

Causes of Meningitis

0-2 mos

o 1 - Group B Strep

o 2 – E.coli

o 3 – Lysteria

2 mos. – 10 yrs.

o 1- Strep. Pneumoniae o 2 - Neisseria

10 – 21 years

o 1 – Neiserria

> 21 years

o Strep. pneumoniae

SPORE FORMERS

Spores:

o Composed of Ca2+

- dicholinate

o Contain a poly D – glutamate membrane

The “D” gives the spore the ability to create a bad reaction in the body because we

don‟t have D-amino acids, we have L-amino acids!!!

o Spores hate HEAT!!! That is why sterilization is useful against spores

Vancomycin Treatment:

MRSA

Staph epidermidis

Enterococcus

Bugs with Preformed

toxins:

-

Bacillius anthrax- B. cerus


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Bacillis o Anthrax

2 Types:

Skin → necroses of the skin o Form a Malignant pustule

Pulmonary → Woolsorters Disease

o Induces necrosis of the lung → end up drowning in your own blood

o

Most commonly used in germ warfare Toxin has 3 Factors:

Edema Factor

Protector Factor

Lethal Factor → the one that causes death

o B. Cereus

Associated with Gastroenteritis after eating fried/reheated rice + Preformed toxin → symptoms within 8 hours of ingestion

Clostridium

o C. Perfr ingens

Causes Gas Gangrene (strict anaerobe)

Known to attack the extremities of Diabetics

Dry Gangrene

Necrotic Skin

Wet Gangrene

What we fear since blood tried to go back to necrotic area it will bring gas embo

back into the circulation which can lodge in the Right Ventricle → Gas

Embolus!!!

Treatment

o Lay person in the L side and tap on the right side

Requires immediate amputation Causes gastroenteritis associated with holiday ham/turkey → reheated

Immediate symptoms → DIARRHEA

o C. diff icil e

Pseudomembranous colitis associated with ↑ abx. Intake

Lives in the GI but when the abx. Clears E.coli it grows rampantly Pseudomembrane appears as a gray membrane Treatment

1st stop abx.

ABX:

o

Vancomycino Metronidazole

MOA: promotes production of free radical

Contraindicated in G-6PD patients SE → dysguzia, disulfiram reaction

o C. tetani

Associated with Dirty Wounds

Give anti-immunoglobulin to bind up toxin → inject it right into the wound Toxin


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11/31

Looks like eye ball is being pushed out

Neisseria

N. meningiti des

o Gram negative diplococci

o Largest encapsulated bacteria

Requires MAC complex to fight it Only encapsulated organism that can release it’s toxin without dying at the same time

o Ferments maltose

o Use a Thayer Martin Agar (chocolate agar) to plate

o Has more endotoxin than anyone else Lipid A will cause

Early vasculitis → (present with DIC)

o Purpura

o Petechiae

o Ecchymoses

If bleed into the adrenal glands = Waterhouse-Fredriechson Syndrome

o

DIC will cause adrenal hemorrhage o Look for ↓ Na/↑ K = electrolyte imbalance

o Treatment → Start Prednisone/Cortisol

o Associated with people in close quarters → college students

o Treatment Prophylaxis for close contact → Rifampin

N. gonor rhea

o MCC of STD → Chlamydia But 90% are asymptomatic

o MCC of symptomatic/purulent STD → Gonorrhea Called the drips

Men → 90% symptomatic Women → 50 % asymptomatic

+ perihepatitis → Fitz-Hugh-Curtis Syndrome

o Fallopian tube affected and pus drops next to the liver

o Disseminated gonococcal infection Can become disseminated due to it’s pili The pilli allows it to walk up the epithelium and into the bladder and into the blood

stream

o Tenosynovitis N. gononrrhea loves to attack the tendons and ligaments

Joints of the wrist and ankles

Present wi th dysur ia and painfu l wr ist 3 days later

o Gonococcal Arthritis Comon in teenagers

o Treatment

Cef triaxone – 250 mg IM x 1 Cefixeme – 400 mg IM x 1 Cefoxitin – 250 mg IM x 1

Ciprofloxacin Oflaxacin

Present like this no matter the age →

always assume Neisseria as the culprit

Must also treat for

Chlamydia:

- Azithromycin 1 g x 1


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Gatofloxicin

Recall that Neisseria is Catalase + and contains IgA protease

N. cattarrhalis → formally known as Morexella

o Normal throat flora

o “Cattar” = mucous → therefore this bug likes mucous membranes Engaging in oral sex ↑ chances for this bug

E. coli

Gram negative ROD

Vitamins produced by E. Coli

o Vitamin K

o Folate

o Biotin

o Panthotenic acid

o Helps absorb Vitamin B12 in the ileum

Illness

o MCC of UTI in all Ages

o

All small intestine infection → iliocystitis, ascending cholangitis (↑alk. Phos), appendicitis

etc…

o MCC of traveler‟s diarrhea

o #2 in neonatal sepsis

Families

o EIEC = Enterinvasive E. Coli Regular traveler’s diarrhea Loose stools

o ETEC =enterotoxigenic E. Coli

ADP-ribosylates Gs → Turns the On, On → ↑ cAMP Looks like rice water stool

Same toxin as Vibrio cholera Most often due to poor sanitation

o EHEC – Enterohemorrhageic E. Coli Endemic HUS

0157:H7 → Epidemic HUS

HUS

o Occurs 2 weeks after E. coli infection

o Likes medium sized arteries (GI/Renal) MCC of renal failure in children

Most commonly associated with RAW HAMBURGER Lives in the anus of cows

Proteus mir abili s

#2 cause of UTI

Urease + (PPUNCH ) o + struvite stones

UTI infections

1. E.coli

2. Proteus3. Klebsiella


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Treatment:o Norfloxacin

Klebseil la pneumonia

#3 cause of UTI

Encapsulated

Associated with pneumonia in alcoholics and homeless

“currant jelly sputem” → suputem + blood

Loves fissures of lungs

GRAM NEGATIVES THAT ATTACK IMMUNOCOMPROMISED PATIENTS

Serratia mascecents

o Red pigment

Acenetobacter

Citrobacter o Encapsulated

o + Multiple Cerebral Abcess

Pseudomonas aeruginosa o Contains the same enzymes as Staph → green pigment

Can cause same sickness Same populations affeceted

CF

Diabetic

Burn patients

Neutropenic

o Treatment: If Staph → 1 abx

If Pseudo → 2 abx Next treat for fungus

o Can become “normal flora” after 48 hrs. in the hospital (need to cover for it!!!), because it love

plastic Catheters Intubation

o Infections Malignant otitis externa

Red, swollen →Very tender when ear is lifted

Can kill patient quickly

Tx: Hospitalize → ICU → IV abx

NOT SWIMMERS EAR Most commonly associated with Burn patients in the 2

nd week

Whirlpool folliculitis

Loves to live in the water

Butt crack and soles of feet meet water first → INFECTION

o Treatment:

Quinolones (ciprofloxacin) can cover pseudo and staph together


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HOUSE OF “ella”

General Characteristics:

o Gram negatives that like to get into the cell

o The symptoms don’t start until late but lasts only a few days

o Granulomatous change Involves T-Cells and MФ

Involves tissues that are invaded by MФ

Brain, Bone, Liver, Lung, Skin, etc…. Bordatell a pertussis = Whooping cough

o Gram –

o NO ENDOTOXIN

o Exotoxin

ADP riboslyate Gi → Turns the Off, Off → Gs remains on o 3 stages of Whooping cough

Prodromal – little fever/rhinorrhea → not a big deal

Catarrhal – production of mucous in lungs Paroxysmal – staccato coughing

Cough so much that can’t catch breath so the suck in a whole bunch of air that

creates a WHOOP soundo DTaP vaccine available

o ELISA Test and nasal pharyngeal washing used to test for antigens in the back of the throat o Treatments:

Erythromycin (macrolides)

Also, give this to those in close contact

o CBC ↑↑↑ WBC → lymphocytosis

Brucella o Undulating fever (fever spikes 7x/day)

o

Risk Veterinarian Can be found in the placenta of an aborted aninmal

o B. abortus → cows

o B. suis → pig

o B. militensis → goats

Pastur ell a multocida

o Dog/cat bites

Bacteria is in the saliva Treatment: Amoxicillin


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16/31

01-29-04

Miscellaneous Gram Negatives

Vibr io cholera

o “Rice water diarrhea” Similar to ETEC → Turns the On, On ADP ribosylates Gs → ↑ cAMP

o Etiology = Sanitation

Vibr io parahemolyticus o Raw Fish – sushi

o

GastroenteritisVibrio vulnif icus

o Gastroenteritis associated with Oysters

Yersina entercoli tica o Gastroenteritis that mimics appendicitis → actually acute ileitis

o Mesenteric adenitis = swollen lymph nodes

o Seen in daycares

o Associated with Reiter’s Syndrome Post infectious arthritis → immune complex disease (+) HLA B27

Ankylosing spondylitis (scarring/fusion of the spine)

o

Most commonly in a middle age maleo Begins in the lumbar area → Bilateral scaro-iltis (@sacro-iliac joint)

o Ankylosing of lumbar spine → fusion ↓ height Schoeber test – spine does not move when asl to bend over

o Die of aortic dilatation → AR

Reiter’s Syndrome

o Post infectious arthrititis

o MC infectious associations Chlamydia Shigella

Yersina IBD

o Most treat unrderlying problem 1st

Psoriasis

o Oval, silvery plaques on extensor surfaces → usually the back of the

forearm

o Recall that this relates to rapidly dividing cells (skin) possible uric acidstones

Yersina pestis

HLA B27 (+)

Ankylosing

spondylitis

Reiter’s

Syndrome

Psoriasis


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o Bubonic plague/Pneumonic Plague

o Rat carries it, rat bitten by fly → used as a VECTOR

o Bubbo = infected crop of lymph nodes → fluctuant mass

o Used in germ warfare

o Presentation: A guy still alive walking in Mexico or Arizona → Likes dry heat

Camoylobacter j ejuni i o Gastroenteritis associated with ingestion of raw eggs

o

Comma/Curved shapedo Tx:

Macrolide → Erythromycin

ATYPICALS

General characteristics

o Don’t have a cell wall Therefore, can’t use PCN Rx:

Tetracycline

Macrolide Quinolone

o They are not real bacteria therefore, a cell mediated reaction will take place

o organs that are invaded by macrophages will be affected

Chlamydia

Chlamydia Trachomatis

o Most common cause of STD (cervicitis, PID)

o Most common cause of infertility in women

o Most common cause for ectopic pregnancy Chlamydia tested with pap smear.

90% are asymptomatic

#1 cause of neonatal blindness in the worldo “trachoma”

Deep ulceration of cornea Transmitted via birth

o treated with erythromycin ointment/sulfacitomide drugs

Treatment: Azythromycin: 1 gm

o Don’t confuse with CMV which causes congenital blindness (not of the newborn)

Chlamydia Pneumonia

o Symptoms:

stacatto coughing Due to irritation of the interstituim

o 0-2 months- atypical pneumonia MCC of Interstitial pneumonia Present severely short of breath

Non-productive cough

o On X-ray

Reticulonodular Ground glass appearance

4 Bugs that are comma/curved

shaped:- Vibrio cholera

- H. pylori

- Campylobacter

- Lysteria

Congunctivitis in Newborn:0-24 hrs.- chemical caused by silver

nitrate24hrs – 7 days = Gonnorhea

After day 7 = Chlamydia


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o Parasite: On blood smear can see T –cells and MФ

Cause eosinophilia

This can help separate it from the other atypicals

o Only one with DNA and RNA Inranuclear and enteronuclear cyto inclusion bodies

o 2 phases:

Elementary – infectious phase Reticulate – resting phase

Dormant activity because it is invading your cell for ATP

o Associated with:

Alzheimer‟s – Ag in neurofibrillary tangles in the hippocampus

Coronary artery disease – find in atherosclerotic plaque

Chlamydia Psittacii

o Associated with parquets and parrots.

o

Cause pneumonia in the lungs Intersitial Pneumonia

Ureaplasma

Urease positive (pseudomonas, cryptoccocus, proteus, ureaplasma, H. pylori)

No cell wall = plasma only → no epithelial lining at all

Non gonnococal urethritis

Mycoplasma Pneumonia

Most common cause of atypical pneumonia age 10-30

“Walking pneumonia”

o

In the interstitium of the lungs

o CXR findings: Interstitial pattern Ground glass appearance Reticulonodular pattern

Has Mycolic acid in membrane (not true bacteria)

Has no cell wall

Spends too much time in blood, so body forced to make antibodies to them

o Cryoglobulinemia = cold agglutinins IgM

Acute infection only Detect by using an antigen from Strep Salivarius

o Ex. Patient positive for Strep salivarius antigen which is the same as cold agglutinins.

Bullous myringitiso Located on tympanic membrane

Mycoplasma Hominis

Cause vaginitis

RARE

Opthalmia Neonatorum (gonnorhea)

Treated with silver nitrate

5 infections that cause

Cryoglobulinemia“I AM HE”

1. Influenza2. Adenovirus

3. Mycoplasma

4. Hep B

5. EBV

Cold Agglutinins Warm Agglutinins

IgM IgG

Acute Inflammation Chronic Inflammation


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Legionell a pneumophila

Most common atypical pneumonia after age 40

Loves standing water found in heating and air-conditioning ducts

“High rise building syndrome”

Pontiac fever = get just fever due to IL-1 + non-specific symptoms

Legionnair‟s disease = full blown pneumonia

Will silver stain in the lung (along with pneumocyctis corinii)

Charcoal yeast agar extract (CYAE) will grow it.

(+) Heart Block

Mycobacteri um:

Mycolic acid with peptidoglycan wall

o But not typical bacteria T-cells and macrophages affecting tissues that macs invade

Rx:

o INH

o MOA: Inhibit peptidoglycan wall

o SE: Pull Vitamin B6 out of system (used by transaminases) Myositis Hepatitis (fat soluble)

Inhibits p450 (macrolides, inh, quinilones) Drug induced lupus

TUBERCULOSIS

TB1st. Contact Bacteris inhaled → tubercule sticks to respiratory epithelium and develops into Ghon focu

Wont even know got it = Asymptommatic

o Ghon focus

o Ghon complex - MФ ingest bacteria and bring them to the lymph node → MФ tries to fuses

with a lysosome but can’t

Cord factor inhibits lysosomal fusion

o IL-1 – fever, recruit T - helper celss = Granuloma formation

o IL-2 to release more response

o IL-12 promote cell mediated immunity

o Macs and T-cells start secreting interferons Interefere with protein synthesis and cells start dying around it granuloma in he right

lower lobe As cells die they calcify =dystrophic calcification

o Macs and T-cells start secreting TNF:

Atypical pneumonia

0-2 months - chlamydia

10-30 years - Mycoplasma

>40 years - Legionella


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Wt. Loss

o When T lymphocytes are knocked out by prednisone or decreased immunity, the tubercule will

come out and cause a cavitary lesion. TB po ps out into the airway and begins to rip up the vasculature → Cough up blood Can stay dormant → waits for opportune time

2nd

Contact

Lesion symptomatic causing cavitary lesions in the upper lobe

o

Cough b/c the bacteria needs to get up the the upper lobe because it has the most O2 = 20 Upperlobe cavitary lesion

o Bacteria Explodes out of it’s cavitary lesion again hoping to get back to GI tract. Cough and swallow Causing obstruction in ileum (bacteria gets absorbed because it’s fat soluble) where all

lymphoid tissue exists and tries to stop infection

But it cannot → Ileum swells up = Obstruction 3

rd Contact

Milliary TB:

o When gets into blood stream and goes all over body

o Arrives everywhere MФ go

Meningitis: MC affected nerve = CN III – posterior fossa → (+) hydrocephalus

CN 9, 10, 11 12

Pott’s disease = TB of spinal cord → (+) compression fracture

Sterile Pyuria (in Kidney)

White cells in urine that won’t go away

Skin – rash = eythema nodosum

Hepatosplenomegaly

Bone Adrenal failure = ↓ Na/↑K

Pericarditis

Diffuse ST elevation

PPD Test

Most people don’t know they have TB until PPD test

o Intadermal injection 1 (strength) – used when just want to prove a symptomtic case of TB 5 – used for screening 250 – used only in AIDS patients b/c have no CD4 cells → Hypersensitive skin

o watch a granuloma create

Positive test:

o 15mm induration with no risk factors

o

10 mm induration with 1+ risk factors: all health care workers 3

rd world countries (Africa, Asia, South America, Philippines, inner city projects, nursin

homes, jail) → Overcrowding

o 5mm for Aids patients

o 10% risk of getting TB if come in contact with someone who had it ( + 1 risk factor)

o After one year treatment with INH the risk will go down to 1% (general population)

o AIDS patients= 10%/year risk of getting TB Tend to get multiple drug resistant TB


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+PPD

Sx No Sx

4 drugs for 4 months for

everybody, if Tb is

sensitive to INH and

Rifampin can finish the

year with just Rifampin

and INH otherwise cont.

with all four.

Treatment CXR

treatment NegativeCXR

35yo

INH, Vit. B6 Yearly

CXR

Tend to get infected with new strains

MANAGEMENT

Positive ppd

o Symptomatic

Treat

o

Asymptomatic CXR

Treatment:

Everyone must be given 4 drugs for 4 mos.

INH

Rifampin

o (-) β subunit of RNA Poly

Pyrizinamide

o Unknown

o SE – Liver Failure

Ethambutal

o

Unknown

o SE – Impairs Red-Green discrimination

Streptomycino Aminoglycoside

D Cycloserine

Mycobacteri um L eprae

Leprosy

Hansen’s Disease

Neuropathy

o d/t granuloma formation around nerves

Lion – Like Facies

Treatment:o Dapsone

o SE → inhibits p450, Autoimmune hemolytic anemia

Mycobacteri um Kansasii

swollen lymph nodes

Mycobacteri um Avium Intracell ulare CD4< 100

Experience gastroenteritis before it hits the lung

Drug of choice = Clarithromycin & Azithromycin

Mycobacteri um Scrofulaceum

Supraclavicular adenopathy in children

Remove lymph nodes

Mycobacteri um ulcerans

Show up as ulcers

Granuloma Formation

Granulomas secrete

o INF-α → Made by MФ (+) Protein Syn.

o INF-γ → Made by T-cells

Mediate MФ

transformation intoGiant cells,


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(+) Caseating granulomas

Mycobacteri um mar inum

Cleaning fish tanks

Caseating granulomas

Spirochetes → spiral shaped, flipping motility, (+) cell mediated response

Treponema Pall idum

Rule of 6’s

o Classic painless chancre (disappear in 6 wks)

o 6 wks later a rash will develop involving the palms and soles (scarlet fever, TSS)

o Will appear 6 yrs. Later with neuropathy neurosyhpyllis

Lancinating shooting stabbing

“like a pin” cutting the skin

Will attack dorsal columns tabes dorsalis = wide gait

Attack Edinger – Westphal nucleus part of reactive vision (coordination between CN III-VI) syphilic eye accommodates but not reacts = Argyll-Robertson Pupil

Loves bone – that is how to differentiate neonatal syphilis

o

Flat forehead

o Snuffles- nasal bone gone

o Hutchinson’s teeth – teeth look razor sharp Saber tooth shins with anterior bowing of the legs → Tibia eaten away Long fissure along corner of the mouth = Rhagades

Testing for Syphilis:

Dark field microscopy (most specific test)

Blood Test :

o FTA – ABS (IgM antibody test)

IgM will bind if it is present

o TPI (Trep. Pallidum Immobilize)

Screening

VDRL (CNS for tertiary syphilis) sensitive but not specific can remain postive for 1 yr aftertreatment

RPR – blood sensitive but not specific, used for screening can be positive for life

Treatment:

1° syphilis: Penicillin (procaine) 1.2 million unit x1

2° syphilis: Penicillin 2.4 million units x1 → each buttock

3° syphilis: Penicillin 2.4 million units 1/wk for 3 wks.

Neonatal: 50,000 units/kg/day for 10 days

TORCH → Neonatal Infections

Toxoplasmosis → multiple ring enhanced lesions in the parietal lobe – Catexposure

Other

R ubella → cataracts, hearing loss, autism, “blueberry muffin” rash, PDA CMV → Central calcifications, #1 Cause of congenital blindness

Herpes → temporal lobe encephalitis

Specific blood test


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Syphilic aortitis = obliterative endarteritis (tree bark appearance of blood vessels) proximal aort

only.

Treponema Palli dum Variant Bi jel

Tr eponema Pertenve Yaws

Treponema Carateum Pinta

Borrellia Borgdorfori:

Lyme disease: EAST COAST

o 1° stage: Bitten by tick (Ixodes tick ) (only 60% report bite)

tick also carries babesiosis

stage: rash

Erythema chronicum migrans

o 2° stage: arthritis, heart block,

o 3° stage: neuropathy (non-specific)

o Dx: Lyme titers

Check antibodies to Lyme (IgM < 2 mos. and IgG > 2 mos.)o Treatment:

Penicillin

Tetracyclin

Borr ell ia Recur rentis

Relapsing fever – get fever once a wk for 5-6 wks → Check the history

o Brill Zinsser disease = pathogen hides in lymph nodes and comes out once a wk slightly

mutated

Leptospir osis I nterogens

Sewege worker, because it is in rat urine Likes to attack liver and kidney

o Weils disease = infectious nephritis and hepatitis

o “Fort Brag fever”

Treatment: Penicillin

SULFA Drugs

MOA

o Replaces PABA → competitive inhibition

o Inhibits Folate

SE: Megaloblastic anemia

Coverageo Gram (+)

No S. aureus

o Simple Gram (-)

E. coli

H. influenza

SE:o Photosensitivity

All come in with rash → disappear with no

consequence

Bulls eye lesion

that enlarges

over time

Ixodes Tick VectorLyme Disease

Babesiosis

Erlichiosis


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o Allergic reaction

o G6 – PD

o Hemolytic anemia

o Intersitial nephritis


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Fungi:

Like warmth and moisture

o B/w skin folds, groin, axilla, vagina

o Prevention = Keep Cool and Dry

Loves sugar → think about Diabete

Contains Ergosterol- target for drugs

Topical → do not get absorbed = NO SE

o

Nystatino Tinactin

o Micatin

o Myconazole

MOA: Bind to ergesterol, make hole in membrane and cells swell up and die

Amphoteracin B (IM/IV) – also binds to ergesterol, but gets confused with cholesterol and pokes holes incells of body:

o SE: Hyperkalemia – systemic toxicity

Hypokalemia – renal toxicity → K will leak out in urine Renal failure

Inhibit synthesis of ergosterol – can’t use with amphoteracin B because it will have nothing to bind to = ↑SE

o Hraconazole

o Ketoconazole – inhibits p450, inhibits 5α-reductase

o Fluconazole – has best CNS penatration, x bbb, 1 dose PO treatment against candidisis (diflucan)

o Griseofulvin Fat soluble drug that inhibits microtubles = (-) Mitosis

Superficial fungi:

Piedre

o Little black balls on the hair shaft → like dead cells on hair

o Tx. Cut hair off.

Cutaneous Fungi:

Give Tinea name

Location will give last name:

o Tinea Capitus – thick flaky crusty lesions of the scalp MC in children

Kerion = complication caused by bacterial infection (S. aureus) of flaky lesion,swollen lesion underneath

o Need to treat fungi, bacteria, and inflammation

o Tinea Babae – on chin

o Tinea Intertrigo – skin touches skin (armpits, underneath breasts)

Red macerated area

o

Tinea Corporis – on body, most commonly on the face Ring worm

o Tinea Manis – on hand (webs between fingers)

o Tinea Nigra – flaking on the palms causing darkening of the life lines

o Tinea Cruris – on the groin (jock itch)

o Tinea Pedis – between toes (athlete foot)

o Tinea Versicolor – on the back, in the shape of a upside down x-mass tree Likes pigment Common in blacks and Hispanics see pigment changes.


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Treatment: Gresiofulvan (best for capitus and versicolor) or Selsin blue (5% selenium)

Deep fungi:

Tinea Unguum (underneath nail)

o Need to remove the nail → the nail turns black

o

Seen in a Diabetic foot

Systemic fingi:

Candidiasis

o Most common cause of vaginitis (#2 Gardenella – fishy odor, #3 Trichomonas – frothy

green discharge) in females and thrush in neonates (Beware of DiGeorge) – white curdy

discharge

Mucocutaneous Candidiasis

o T-cell defect involving only candidiasis

Histo → Midwest

o Pigeons, bats

o

Lives within macrophages Blasto → Northeast

o Pigeons

o Big Broad Based Budding hyphae → cavitary lesions

Coccidio → Southwest

o Broad based cavity

o Thin wall cavity

Paracoccidio → South America

o Looks like a ship wheel

Aspergillus → Moldy hay/basement

o Fungus ball

o

Bad vasculitis (invades blood vessels)

o Severe allergic reaction in the lungs due to fibers. (mimics asthma) PIE syndrome

PIE = Pulmonary infiltrate with eosinophilia

Most common cause is ABPA (allergic bronchopulmonary aspergillosis)

Loeffler (worms) → invades the lung

Churg-Strauss – necrotizing vasculitis, idiopathic

o Treatment: Steroids

Cryptococcus AIDS pt. With headache/meningitis

o Encapsulated

o Stains with Indian Ink

o

Urease positive Rhizo/Mucor

o Diabetic with something growing out of nostrils

Sporothrix – rose busho Treat with Potasium Iodide on skin and treat like any other fungus if it is systemic.

Enterococcus will cause nitrite negative UTI


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Parasites → GASTRITIS T cells, macrophages and eosinophils

How did you get it

L iver fl ukes:

o Schistosomiasis –walking bear foot in a swamp → snails carry it

Mansoni → affect the liver → Risk for CA Hematobium- squamous cell bladder cancer (chonic irritation)

o Toxacara : Carti – cat larvae

Cani- dog larvae

Cutaneous larva migrans – can see larva burrowing under the skin → Itchy Visceral – larva migrates to organs (liver)

o Echnococcus – from eating raw lamb/sheep/dogs

o Clinorchis Sinensis/Opthorchis – likes biliary tract Clue for biliary involvement is Alkaline Phosphatase Causes gastroenteritis

Treatment of Liver flukes with Praziquantel

Hook worms

Hook into the intestinal/bowel wall

Cause sever cramps and diarrhea

Pneumonic = NEAT ASs:

o Necator americanus

o Enterobius Vermiculris- pin worm Symptoms: pruritis ani (ass itching) (caused by eggs) Scotch tape test: only female comes out at night to anus to lay eggs

Worm lives in the cecum

o Anclystoma Duodenale Duodenal obstruction

o Trichuris Trichurium – Whip worm Anchors into rectum causing tenesmus (feel the nee to poop!!!) And rectal prolapse b/c the worm will get bigger and push it back farther

o

Ascaris lumbricoideso Strongyloides

Treatment:

o Mobendazole – (vermox) give 1 tablet and then repeat in a week = DOC

Paralyzes microtubules → can‟t hook on

o Pyrantel Pamaoate – specific treatment for pin worm

o Thiobendazole – treatment for Strongyloides


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NASA = parasites associated with loffler syndrome = endocarditis & pneumonitis

Part of their life cycles occur in the heart and lungs Necator americanus Anclystoma duodenale Schistosomiasis Strongyloides Ascaris lumbricoides

(Pulmonary infiltrate and severe eosinophilia)

Flat Worms:

Will curl around the intestine D. Latum

o Likes to eat B12 (homocystiene methyl transferase, methyl malonyl mutase)

Tanea Saginatum

o Associated with raw beef

Tanea Solium → larvae from Cystericerosiso Raw pork

o Likes to swim in the aqueous humor of the eye

Trichinella Spiralis

o Raw bear meat

o Tunnels under muscles causing myoisitis Treatment:

o Hyclosamine

o Niclosamide These inhibit oxidative phosphorylation = ↓ ATP

Protozoa: Brain:

o Naeglaria Fowleri

“swimming through swamp” → penetrates through cribiform plate fulminant meningo encephalitis – eat through meninges and brain

o Toxoplasmosis Associated with cat litter

Parietal lobe ring enhanced lesion Treatment = Pyremethamine/ Sulfadiazine

o Trypanosomaa Rhodienses Carried by Tsetse fly → GABA connection

African sleeping disease Cornea:

o Acanthomoeba Associated with contact lenses Will eat through cornea

o Erlichiosis Dog licking face Picked up via saliva

Penetrates side of the eye (puncture wound next to eye)


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Heart:

o Trypanasoma Cruzi

Chagas disease

Eats ganglia and causes heart block Get it from South America

Reduuvid bug

Lung: o

Pneumocystis Corinii Silver stains (along with Legionella)

CD4 count below 200 Treatment: Bactrim (SMX-TMP)

GI: o Giardia → gastroenteritis

Loves fresh water/ well water → hiking in the moutains Treatment- IV metronidazole

o E. histolyticum

Multiple liver abscesses

Never do surgery Treatment: metronidazole (8wks)

o Microsporidium Most common cause of diarrhea in AIDS patients

o Cryptosporidium Most common cause of VERY WATERY diarrhea → dehydration Partially acid fast Treatment → Cipro

o Isospora Belli

GU:

o Trichimonas

# 3 cause of Vaginitis Treatment:

Metronidazole 2g x 1

Also treat partner

Skin: o Leschmaniasis

“Gulf war syndrome” Transmitted by sand flies

o Leschmania Donivini Attacks skin and nostrils

o Leschmania Rhodiensis

Likes to be systemic (in the blood) → Attacks organs Caled Kala-Azar if systemic Treatment → Stibogluconate

Lymphatics:

o Wucheria Bacrofti Elephantitis No treatment

Blood:

o Babesiosis

Common causes of vaginitis in order of

incidence:

1.

Candida- white cheesy curdy

discharge

2.

Gardnerella – fishy odor, clue

cells

3. Trich- frothy green discharge


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o Petichial rash involving “palms and soles”

o Centripital rash = From periphery to torso

Rickettsia Typhi

o Endemic typhs

o Flea born

o Rash starts in axilla and going outward

Rickettsia Prowzeki i

o

Epidemic typhuso Louse born

Rickettsia Akar i

o Rickettsial pox – fleshy papules/ vesicles

o Mites

Rickettsia Tsutsugamushi

o Scrub typhus

o Caused by mite (mighty mite)

Coxiell a Burnetti (long lost relative)

o Q fever

o Find in dusty barn

o

Doesn’t behave like rest of rickettsia family → NO vasculitis Just get lung disease

Documents

Microbiololgy - Normal Flora