Micro Cheat Sheet #2

(PASS Videos)

Spore Formers Bacillus and Clostridium SPORES o o o o Made of Ca-dipocholinate Dormant form of the bacteria CANNOT replicate but CAN release toxin especially when exposed to heat (GET MAD!) It is destroyed ONLY by sterilization process 121 degrees C vaporized

Bacillus o Has poly D-Glutamate membrane (humans have L-amino acids) o B. anthracis Has a toxin with three factors: lethal factor (kills cells), edema factor, and protective factor (mediates entry) Two types of Anthrax: Cutaneous Anthrax: malignant pustule (skin necrosis) o Will not kill pt unless inhales cutaneous form Pulmonary Anthrax: Wool Sorters Disease; (hot desert) mediastinal hemorrhagic lymphadenitis o B. cereus Fried/reheated rice (hot wok) Two toxins: Emetic toxin: from the rice fast (1-6hrs) diarrhea, vomiting Diarrheal toxin: meats, sauces increases cAMP - 18hrs watery diarrhea

Clostridium o C. difficile Gastroenteritis associated with antibiotic use ALL Antibiotics destroy E.coli Clindamycin is notorious

Pseudomembranous colitis grey membrane with yellow plaques on colon Tx: DOC is metronidazole (promotes production of free radical) Side Effects: dysguzia (alteration in taste), disulfiram reaction Most Effective Drug is Vancomycin C. perfringens Gas Gangrene Known to attack extremities in diabetics o Dry gangrene necrotic skin o Wet gangrene blood to the area (risk of gas emboli) o Tx: Immediate amputation (hyperbaric chamber) Food poisioning Gastroenteritis associated with holiday ham or turkey o Enterotoxin o Immediate symptoms diarrhea almost instantaneously C. melanogosepticus Associated with colon cancer (along with S. bovis) Produces a black pigment C. tetani Associated with a dirty wound Give anti-Ig to bind toxin (into the wound) Toxin: Inhibits release of glycine (inhibitory) in the spinal cord increasing contraction respiratory failure Lock jaw Tetanus Immunizations: Td = toxoid; TIG = immunoglobulin Clean, Minor: Td NO YES Clean Minor: TIG NO NO Other: Td CLAUSE below YES Other: TIG NO YES

Hx Td dose 3 known doses < 3 or >10years since last booster

Clean is considered anywhere inside your house. Dirty is when you step outside. Knife cut in house = clean. Knife cut outside = dirty If more than 3 tetanus shots, you dont do anything. EXCEPT: when it is a dirty wound and it has been greater than 5 years then give Td

C. botulinum Toxin inhibits presynaptic release of Ach flaccid paralysis (floppy baby) Muscle will not work die of respiratory failure Worse in kids (especially infants) because of excess brown fat inceased heat spores hate heat Children Honey, molasses

Do NOT give children honey until 6mo of age (normal flora will appear) Adults ingest spores via canned foods Tx: antitoxin first, antibiotic second

Propionobacterium Acne o Progesterone stimulates propionic acid or sebum o Acne more severe in women and adolescent boys o Refer to a dermatologist when its nodular or nodulocystic o Gram (+) anaerobe; hides in the hair follicles o White comedones: clear vesicles o Black comedones: sebum has been oxidized; turns black o Tx: oxy-5 or oxy-10; benzoyl peroxide or abrasive pads; antibiotics (minocycline, clindamycin, or erythromycin); retinoic acid

Retinoic Acid o Pre-Vitamin A o Cause proliferation of skin cells, pushing the pathogen to the surface (hypersensitivity) o Main Side effects: Hyperlipidemia (fat soluble) Hyperparathyroidism Retinoic acid is a cofactor Vit A and Mg are cofactors for PTH Pseudotumor cerebri Vit A needed to make CSF Teratogenic (must do pregnancy test)

Lysteria o L. monocytogenes The ONLY gram + with endotoxin (kills quickly) Causes monocytosis granulomatous inflammation Syphilis TB EBV Epstein-barr virus STELS Lysteria Monocytogenes Salmonella typhi Attack placenta causing abortions Requires iron to grow; high incidence in pt with hemochromatosis

Causes: Neonatal sepsis Gastroenteritis associated with migrant workers, raw cabbage, spoiled milk, hot dogs Curved rod, tumbling motility Intracellular, cold growth Tx: Ampicillin, macrolide, vancomycin L. meningitis MCC of meningitis in Renal Transplant pt and Adults with cancer

Gram Negatives

Hemophilus o o o o o o Gram (-) pleomorphic rod Has IgA protease Part of normal flora for the posterior pharynx 80% are NOT encapsulated and therefore cause noninvasive respiratory diseases (nontypeable) 20% are encapsulated (poly D-glutamic acid) causes the systemic form (H. influenza B) H. Influenza 2nd MCC of sinusitis, otitis media, bronchitis, and pneumonia S. pneumonia is #1 H. Influenza type B MCC for epiglottitis Symptoms: Thumb print sign, drooling, fever, stridor (upper airway; both inspiration and expiration) Tx: intubate immediately H. aegyptus Pink eye (not viral conjunctivitis which is a little redness in the eye) H. ducreyi MCC of chancroid Most common painful genital lesion (unilateral lymph node) Tx: ceftriaxone

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Painful genital Lesions o Chancroid (H. ducreyi) most common ulceration with central necrotic area Tx: Ceftriaxone

Herpes (Herpes Simplex II) small vesicular rash Acyclovir 5x day Pancyclovir 3x day Valcyclovir (valtrex) 2x day (more compliant) ***Remember: does NOT sure decreases symptomatic days, viral shedding and recurrence Pregnancy symptomatic within 2 weeks of planned deliver must do a C section Lymphogranuloma venereum Chlamydia trachomatis ulcerative LN drain (bilateral) Tx: Doxycycline Granuloma Inguinale Calymmatobacterium donovini donovini bodies (macrophages with the bug in it) Tx: Arithromycin, tetracycline

HiB Vaccine o Has cut HiB infections down by 90% o Given at 2m, 4m, 6m, 18m o Last dose at 5y; no longer needed after that

Nisseriae o The ONLY gram negative diplococcic o Has IgA protease o Part of throat flora o Encapsulated (has the largest capsule) o The ONLY gram (-) that releases endotoxin during the log phase o N. meningitis Ferments maltose and glucose Presents with DIC (uses up clotting factors) D-dimer and fibrin split products Waterhouse-Fredrickson syndrome hemorrhage into adrenal gland Increased ACTH levels MCC of meningitis from 10-21y/o Tx: dexamethasone BEFORE antibiotic to prevent hearing loss from inflammatory neurological damage ; give rifampin to close contacts (>25hrs/wk) o N. gonorrhea Ferments glucose Has pili that naturally transform each year (phase variation)

MCC for purulent STDs #2 cause of STDs (Chlamydia is #1) In men: 90% of cases are symptomatic In women: 50% are symptomatic Uses pili to walk up the uroepithelium to gain access to the blood Fitz-Hugh-Curtis Syndrome: Abscess right underneath the liver Gonococcal arthritis: ligaments (i.e. tenosynovitis) Starts at Wrist and ankles When cultures positive, cover for Chlamydia as well (but not vice-versa) Azithromycin: 1gm or 2gm for both GC and Chlamydia Ceftriaxone: 250mg IM Cefixime: 400mg PO Cefoxitin: 250mg IM Ciprofloxacin: 500mg PO for just N. gonorrhea Gatifloxacin: 400mg PO Ofloxacin: 400mg PO N. caterrhalis Does NOT ferment sugar Most common strain in the back of the throat Loves mucus #3 for respiratory tract infections (sinusitis, otitis media, bronchitis, pneumonia)

Helicobacter o H. pylori Curved rod, urease positive Silver stain GI tissue 1 of 3 with silver stain CLO test Associated with duodenal ulcers (95%) and gastric ulcers (70%) Treat ALL positive gastric cultures Hydrogen breath test is most diagnostic, if available, for eradication Tx: Amoxicillin, Bismuth, H-2 blocker or PPI Need to have a PPI and an antibiotic combo Bismuth suffocates 3 drugs for 2 weeks (98% eradication) MCC bad water (sewer system)

E. coli

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Makes up 95% of small intestinal flora Small Intestinal infections: Acute cholecystitis - +Murphy sign, colic pain Ascending cholangitis increased alkaline phosphatase Common bile duct is affected Acute appendicitis Most common cause is fecal matter stuck there Abdominal abscess Acute spontaneous bacterial peritonitis Makes: 90% of vitamin K Clotting factors 2,7, 9, 10 Biotin Folate Cofactor for rapidly dividing cells Panthotenic acid Helps absorb: Vit. B12 Dorsal column o How do we know have dorsal column problems? Vibration and position sense Cortical spinal tract o Responsible for motor function USA pernicious anemia o Knocks out intrinsic factor, therefore cannot absorb b12 Antiparietal cell Ab ETEC (enterotoxogenic) Major cause of diarrhea in developing areas Travelers Diarrhea (rice water) Severe watery diarrhea (>20L per day) EPEC (enteropathogenic) Young children and infants Causes loss of microvilli E/A Diarrhea from malabsorption Results in calcium oxalate stones in kidney o Malabsorption no calcium absorption by calcium binding proteins calcium binds to fat (saponification). Oxalate breaking down from proteins in stomach is now going to get reabsorbed bind with Ca in the blood gets filtered into the kidney

To check if microvili problem, give D-xylose EIEC (enteroinvasive) Plasmid shared by shigella Invades intestinal mucosa Provides shiga-like toxins (verotoxin) Can cause seizures Bloody, purulent diarrhea EHEC (enterohemorrhagic) O157:H7 (outbreak epidemic) Cattle, sheep, goats Ingestion of contaminated food Bloody diarrhea, endemic HUS renal failure Anemia, thrombocytopenia, renal failure

Proteus o P. mirabilis #2 MCC for UTIs #1 is E.coli Urease positive Associated with high urine pH, struvite stones (must be surgically removed), staghorn calculus, high ammonia in the urine Tx: Quinolones

Klebsiella o K. pneumoniae #3 for UTIs Likes to attack alcoholics and homeless people In lungs: currant (blood mixed with mucus) jelly sputum; likes to attack fissures Encapsulated

Likes Immunocompromised people o Serratia marscesens Produces a red pigment o Citrobacter Produces citric acid Encapsulated Likes to attack 0-2mo babies Causes multiple cerebral abscesses

Pseudonomas auregenosa Same enzymes as S.aureus Likes to attack diabetics, burn pt (2nd week; 1st week is S.aureus), neutropenics, and cystic fibrosis Gold pigment like S.aureus Also produces a green pigment Has a fruity grape smell when plated Likes plastic (endotracheal tubes, bladder catheters) Causes: Whirlpool folliculitis Tennis Shoe folliculitis nail through shoe Malignant otitis externa mastoid (coagulase) MCC of death in 2nd week after burn Recurrent pulmonary infections in CF Ichthyma gangrenosum blood form (black bulla on the skin)