1
Q
Does the blood contain a normal biota?
A
○ No because it’s a closed system. Unless you’re actually puncturing something to get in, there’s no real normal or natural biota in there.
2
Q
How might organisms get into your bloodstream?
A
○ Brushing too hard and your gums bleed
○ IVDU
○ Colonization of mucous membranes
○ Hangnail
3
Q
Infective endocarditis
A
Endocarditis=Inflammation of the endocardium, specifically mitral and aortic valves
4
Q
Where is the endocardium in the heart?
A
□ Inside lining of the heart. Although we primarily see changes in lining of the valves with endocarditis, we can see changes in lining of the heart anywhere. Most frequently in valves d/t stress/turbulence. At any point in the heart when endocardium is exposed to stress/injury/turbulence is where you can have focus of endocarditis.
5
Q
2 types of infective endocarditis:
A
Acute or subacute
6
Q
Acute endocarditis
- cause
- virulence factors
A
® You can get it from IV Drug Use
® The vegetations can break off. A lot of these organisms are forming colonies (biofilms). This is important as a virulence factor b/c it’s protective against the host defense mechanisms.
- When you talk endocarditis, you think more microbial.
7
Q
Subacute endocarditis
- what does it affect?
- timeline
- causes
- reason for infection
- signs and sxs
- mimics
A
- infects already previously damaged valves.
- more slowly than acute endocarditis because you’re dealing with damages over time. Less pronounced.
- damage from Rheumatic fever, Calcified bicuspid aortic valve, Turbulent flow from HTN, Congenital malformations
- Anytime you have irregularities in the valves, that encourages bacteria to come in and attach there.
- Low-grade fever, anorexia, fatigue, abnormal heart beat, anemia, hx of previous valvular issues
- A lot of times mimics MI sx
8
Q
What is a biofilm?
A
◊ Biofilms are usually a mixed group of organisms (some fungal, some bacterial, etc), but for endocarditis, fungal cases are rare.
9
Q
What are different ways that endocarditis can develop?
A
□ Native valves
□ Prosthetic valves
□ IVDU- Staph aureus
□ Rheumatic heart disease
10
Q
differential of bacteria for native valve infection
A
- Strep Mutans– part of viridans streptococci
- Strep bovis
- Strep pyo
- Enterococcus faecalis
- Staph aureus
11
Q
differential of bacteria for prosthetic valve infection
A
□ Staph epidermis □ Staph aureus □ Gram negative bacilli □ C. albicans (unit 7--candida, just be aware now) □ Streptococci
12
Q
differential of bacteria for IV drug use
A
□ Staph Aureus □ E. faecalis □ Streptococci □ P. aeruginosa □ C. albicans
13
Q
Streptococcus mutans
- group
- location?
- how do they grow?
- oxidase?
A
- viridans streptococcus: group of organisms with similar characteristics but same treatment. You can’t truly differentiate them unless you do PCR.
- oral
- green on agar so easy to identify
- oxidase + –> aerobic
14
Q
Streptococcus bovis
- indicates
A
- colon CA or IBS
15
Q
Streptococcus pyogenes
- antigen
- other issues it can cause
- PYR test
- catalase
A
- there is a group A antigen you can test for
- Glomerulonephritis
- Skin infections that can lead to toxic shock syndrome, can cause scarlet fever, Pharyngitis, Cellulitis, Sinusitis
- positive
- catalase -
16
Q
Enterococcus faecalis
- what does it cause?
- associated w/
- PYR test
- enterobacteriaceae group
- virulence factor
- lives with
- tx
- VDE strains
A
- Causes endocarditis and UTI
- hospital-acquired infections
- PYR + (group a strep or coagulase - staph and entero
- Klebsiella, Proteus, Serratia
- Resistance
- eskape pathogens
- Vancomycin- ampicillin or vancomycin with aminoglycosides.
◊ VDE strains: need vancomycin to grow can’t grow without vancomycin would instead use linezolid or daptomycin.
17
Q
ESKAPE pathogens
A
◊ E for e.coli or Enterococcus faecium ◊ S for staph aureus ◊ K for Klebsiella pneumoniae ◊ A for Acinetobacter baumannii ◊ P for Pseudomonas aeruginosa ◊ E for enterobacter
18
Q
Vancomycin MOA
A
binds to cell wall precursor (things that build the cell wall)–>inhibits cell wall synthesis
19
Q
Staph epi
- found?
- forms?
- what should you do?
A
- Lives on the skin; found on catheters
- Form clusters b/c they have adhesin molecules to cluster themselves and to other surfaces
- quickly remove catheter
20
Q
HACEK organisms
- found with?
- live?
A
- prosthetic valves
- oral-pharyngeal region)
- Haemophilus, Aggregatibacter (previously Actinobacillus), Cardiobacterium, Eikenella, Kingella.
21
Q
Rheumatic disease
- what is it?
- damage caused
- what level does it damaged?
- gross features
- clinical features
- Type III hypersensivity
- skin manifestations
- explain progression to chronic rheumatic heart disease
- mitral valve effects and clinical manifestations
- histological findings in acute
- histo findings in chronic
- test for diagnosis
A
- Prior infection of group a beta hemolytic strep and antibodies made against M protein but then cross react with self cardiac antigens.
- Inflammation causes damage to the tissues, and damage to the endothelium circulating immune complexes, cytokines, and inflammatory cells cause fibrinoid necrosis creating foci of necrosis
- Acute rheumatic fever can damage any of the three levels of the heart: endocardium, myocardium, pericardium
- Vegetations and Subendocardial fibrous plaques
- Fever, Fatigue, Chest pain from pericardial rub, Heart murmurs, Sydenham’s chorea
- This is a type III hypersensitivity.
- subcutaneous nodules, Erythema marginatum
- damage to the heart causes damage to the valves with chronic inflammatory process that is in recurrent episodes; not getting treated and they are getting rheumatic fever over and over
- Mitral stenosis is seen and when there is reduced frequency of rheumatic heart disease,start seeing secondary cause of mitral stenosis–atherosclerosis; • Opening snap with decrescendo murmur, pulmonary hypertension, Left atrial dilation
- leukocytes and other inflammatory cells in the conective tissue with Aschoff nodule/body
- organization, neovascularization, and then fibrosis (collagen deposition)
- Serology for Antibodies against streptomycin O and anti-DNAse B.
22
Q
Sydenham’s chorea
A
involuntary movement that tends to occur with rheumatic fever
23
Q
3 characteristic gross changes seen in chronic rheumatic heart disease
A
- Commissural fusion of mitral valve
- Leaflet thickening
- Thickening and fusion of the tendinous chords
24
Q
For the continuous acute attacks, is there instances where we have rheumatic disease and go into states of remission or is it newly infective tissue or continuous attacks?
A
-This is not an infectious process. It starts with a bug, but continues with the immune system. Those repeated episodes occur in response to seeing the bug again, but perhaps not. There could be other reasons why our body becomes hyper immune reactive.
25
Types of Hemolysis
• A- partial hemolysis
• B- complete hemolysis
- Gamma- none
26
Beta hemolytic bugs
| - how to differentiate
• Strep Pyogenes and
A galaciae
- bacitracin; S. pyogenes is sensitive. A galaciae is not
27
What can cause myocarditis?
- Coxsackie B
- Trypanosoma Cruzi
- B. burgdorferi
- C. Diphtheriae
- Staph aureus
- E. faecalis.
28
What is myocarditis
- inflammaion of the heart muscle
29
Diptheria
- clinical fx
- vaccine
- toxin
- staining
- similar to? differentiate by?
- Bullsneck from lymphadenopathy, thick pseudomembrane when you look in throat that bleeds when moves and increase spread of toxins.
- tDAP, Dtap
- intracellular AB toxin- not able to synthesize proteins because it targets elongation
- gram +, and will look like chinese letters
- listeria, listeria is motile
30
5 classifications of pneumonia
- hospital acquired, health care associated, community acquired, atypical, HIV associated
31
Hospital-Acquired
| - where is it acquired?
- obtained during hospital visit
32
Health Care-Associated
- what is it?
- approach
- It includes healthcare contact or hospitalization within three months.
- will be approached differently because you want to think about different bugs/drug resistance.
33
Community-Acquired
- how?
- isnt associated with?
- presentation?
- difference from atypical
- pattern
- PE
- Someone who visits a friend/somebody else who is sick and they acquire it from them.
- isn't associated with a hospital or anything health-care related.
- no previous serious illness/risk factor like HIV or immune compromised state.
- They will have an acute, typical presentation of pneumonia with high fever, more of a cough productive with sputum, maybe some rust colored sputum.
- These patients are more sick as compare to atypical pneumonia where the patients don't present sick as much).
- The pneumonia will have a distinct lobar pattern so abnormal lung sounds will be heard in the lower lobes of the lung and may be more on one side versus the other.
- On physical exam, bronchophony/egophony are going to be positive and very clear in this particular area. When you percuss, it will be dull.
34
Atypical
- presentation
- rales
- broncophony
- percussion
- fever might be a little over 100.
- Rales might be a little more scattered.
- Bronchophony/egophony may or may not be present depending on how severe the consolidation is on one area.
- Percussion may not have a clear dullness in any one particular area.
35
HIV-associated
- HIV or immunodeficient- associated pneumonia makes you think about different bug classifications and treatment.
36
specifics of the case that would point you towards community acquired vs atypical?
- healthy, regularly acute disease not a super short course, severity of symptoms not too severe
- fever isnt that high
37
atypical pneumonia course of development
- typical bug
- other bugs (bacterial, viral, fungus)
- low grade fever, patchy infiltrates, small bullae, no organisms from gram stain → typically microplasma pneumonia
- Bacterial: Microplasma pneumiae, Chlamydia Psittaci, Chlamydia pneumoniae, Coxiella burnetii, Francisella tularensis, Legionella pneumophila
- Viral: Influenza, Parainfluenza, Adenovirus, RSV, CMV
- Fungus--something in California--not on her list
38
Legionella
- presentation
- gram stain, why?
- grow wear?
- quick test
- where did came come from
- presents with lobar pneumonia and diarrhea
- It gram stains negative but poorly bc they're so thin,
- charcoal yeast agar,
- Yes, urine antigen test
- Legionalla's story is that it affected a lot of men at a legionnaires conference in Philadelphia in 1976. That's where its name came from
39
Viruses
| - test
- RT-PCR: Real time PCR would be quick for everyone, so you can look & start ruling those out.
40
Francisella
- grown on
- important Q
- states
- gram
- vaccine
- charcoal yeast extract
- Ask the patient if they've been bitten by ticks, or around rabbits, deer, squirrels
- Misourri, Arkansas, Oklahoma
- Gram (-)
- Usually only available to laboratory personel working with this bacteria. It's very experimental, so not passing out often, but if you're working with it it's very infectious so you will be getting that very experimental vaccine
41
Coxiella aka Q Fever
- Epidemiology
- exposure
- gram
- can you culture?
- Common in Australia--has she been there
- exposure to cattle or livestock placental tissue
- Gram (-)
- Intracellular--so more difficult to grow; But mainly bc it's a severe biohazard so you have to have a special biohazard facility
42
Chlamydia psittaci
- how to rule this out quickly
- other name
- carried in?
□ Birds, Parrots specifically.
- parrot fever
- bird feces
43
Microplasma pneumoniae
- sxs
- gram stain
- acid fast
- culture
- Bullae, Bullus laryngitis, Scratchy throat
- No gram stain; Bc no cell wall
- Acid fast stain:No
- Growth looks more like a fried egg appearance
44
Types of chlamydia
- key differentiating factor that separates chlamydia trachomatis from the other two?
- what do you look for in cultures
- psittaci, pneumoniae, & trachomatis
- Neonates: Largely STD specifically those that pass through the birth canal; also iodine (+) whereas the other 2 are iodine (-)
- Elementary bodies = infectious form and Reticular bodies = reproductive form
45
Chlamydia pneumoniae
- Giemsa stain (+)
46
Strep pneumoniae
- defining feature
- location in lungs
- gram
- shape
- catalase
- hemolysis
- Quellung reaction
- culture
- Rusty colored sputum
- lobar consolidation without effusion
- Gram positive
- Lancet shaped diplococci
- catalase negative
- alpha hemolytic
- Quellung reaction positive
- colony, it was sunken in in the middle
47
Nocardia
- acid fast
- xray findings
- gram
- growth
- Weakly acid fast
- cavitation
- gram +
- filamentous beaded hyphae
48
Define UTI
- Urinary Tract Infection
49
Bugs that can cause UTI
- E. Coli
- Staph saprophyticus
- Proteus Mirabilis
- Enterococcus
- Klebsiella Pneumoniae
50
How frequent is this
- 1 in 3 women will have UTI by time 24
| - 50% by age of 32
51
If young man comes in with painful urination (16-24) what is first thing you think of?
- Niseria gonnorrhea
52
Risk factors for UTI
- Female: Short urethra
- Poor sanitation
- Poor hygiene practices: Wiping back to front
- Indwelling cath
- Diabetic
- Stones
53
Where does e coli come from?
| - How do they get into kidney?
- GI tract, from poo
| - Lymph/hemotogenous spread; Motile- flagella (sometimes multiple), fimbriae, pilli
54
Why would indwelling cath make nervous to get UTI
| - other name
- It is foreign body and human body doesn’t like unknown things hanging aroung in it
○ Nidus of infection: foreign body stuck in body
55
How do you get hematogenous spread of e coli?
- sepsis
| - bowel perforation
56
Honeymoon cystitis
| - Most likely bug
Increased sexual activity -> increased bacteria driven up into the urethra
- Staph saprophyticus
57
What is azo?
- side effect
- What does it do?
- Azo pyridine
- Turns urine red/orange
- It is urinary tract anesthetic
- Does NOT fix problem but masks the pain
58
- When differentiating between Staph saprophyticus and epidermidis
○ Novobiocin: Saprophyticus - Resistant; Epidermidis-Sensitive
Everything else they share in common; catalase +, coagulase -, urease +
59
When would I need culture and sensitivity?
§ Recent travel
§ Pregnant
§ If she had rheumatoid dx
- If it doesn’t work after 3 or 4 days
60
Cipro
depends on where you're at because could be resistant, FDA decided that it needs black box warning (as well as other fluoroquinolones) and should only be used if there is no other choice
61
If this pt has severe nausea and vomiting, would this be an indication to put her in the hospital?
Yes, bc if the antibiotics are in the emesis vs in the blood stream
62
How can you have pyelonephritis and have completely clean urine?
There could be an obstruction of the infected kidney because of a stone
63
Delirium tremens
most severe form of ethanol withdrawal, manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse.
64
case of someone is relatively fragile medically, whose been hospitalized with multiple trauma, whose possibly gotten instrumentation-associated pyelonephritis or possible hematogenous spread pyelonephritis.
- tx?
- Vancomycin and a carbapenem (beta lactam)
65
What if everything you tried on klesiella isn't working and sepsis is setting in? What do you do now?
- Trial-med
| - contact CDC
Unit 6: LGS
flashcards
Decks in class (10)
# Cards
