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What does IDSA stand for, what is their website and what type of info would you find there?
- Infectious Disease Society of America
- Information on guidelines
What does CDC stand for, and why would you look them up?
- Center for Disease Control and PREVENTION
- A-Z directory to look for specific topic, and has the most updated info.
- Great source to get info on current outbreaks. (You wouldn't go to PubMed for that shit)
What does SIDP stand for and why would you look them up?
- Society of Infectious Diseases Pharmacists.
- Good educational resources.
What does WHO stand for, what is their website?
- World Health Organization
What is the purpose of WHO?
- WHO is the directing and coordinating authority for health within the UNITED NATIONS system.
- It is responsible for providing leadership on global health matters, etc…
What is the best site to for fungal information, according to Dr. Jeffres?
What is the MD consult book by Mandell?
"Principles and Practice of INFECTIOUS Disease."
What is the MD consult book by Long?
"Principles and Practice of PEDIATRIC Diseases."
What are the 4 types of human pathogens?
What are the 2 examples of Fungi and how are they different?
- Yeast (CANdida albicans) - BUDS
- Mold (aSPERrgillus sp.) - Dandelion w/SPORes
- "YEAST is used to brew a CAN of BUDlight"
- Think "SPER" AND "SPORE."
Examples of DNA virus:
Hint: These have 3 letters (not counting numbers)
5 types of bacteria:
- Gram neg
- Gram pos
- Acid fast bacteria
T/F: Malaria is caused by an RNA virus.
- It's cause by a protozoan PARASITE.
T/F: Echinococcus is a classified as a gram neg bacteria.
- It is a parasitic worm.
HSV1 and HSV2 is classified as what?
T/F: SARS is cause an RNA virus.
T/F: CMV is a type of fungus:
T/F: EBV is an RNA virus.
- It is a DNA virus.
What is VZV classified as?
Hep C is classified as what?
T/F: Influenza is a type of RNA virus.
T/F: Asperigillus sp. is a yeast and reproduces by budding.
T/F: E. coli is the most common anaerobic bacteria, and you usually only get sick from it when your immune system is down.
- It's NOT an ANArobe.
- It's an AERobe! (The rest of the statement is TRUE)
Put in these in order from biggest to smallest: Hair, Human RBC , coarse sand and bacteria.
- Coarse sand (870 micrometers)
- Hair (43 micrometers)
- Human RBC (7.5 micrometers)
- Bacteria (1-2 micrometers)
What is a host?
An organism which provides nutrients to another organism.
What are the TWO definitions of a PARASITE, and which will we use for the purpose of this test?
- A worm. (Use this definition to classify on the test)
- An organism which lives at the expense of its host.
An upset in the homeostasis of the host resulting in signs/symptoms.
Define INFECTIOUS disease.
- Detrimental changes in health as a result of a PARASITE.
- (NOT just worms. In this case, use 2nd definition of parasite)
Explain the difference between signs and symptoms. Provide examples.
- SIGN - Objective evidence that CAN be proven (temp, rash, vomiting).
- SYMPTOM - Subjective evidence that CAN'T be proven (headache, nausea).
- A microbe with the CAPACITY to cause disease.
- Microbe = bacteria, virus, fungus and parasite.
- The measure of the pathogenicity (likelihood of causing disease)
- VIRULENCE and PATHOGENICITY can be USED INTERCHANGEABLY.
How is virulence measured?
- Virulent: Readily cause disease. (Only small #'s required to initiate and sustain infection)
- Attenuated: Reduced ability to cause disease.
- Avirulent: Doesn't cause disease.
- Opportunistic: Normally doesn't cause disease in NORMAL host, but will in immunocompromised host.
Define virulence factors.
Pathogen properties that enable the microorganism to ESTABLISH itself within a host.
List and explain the 4 virulence factors.
- Adhesion: Ability to ATTACH to host.
- Invasins: Ability to ENTER host.
- Evasins: Ability to ESCAPE host defense.
- Toxin production: The best way to destroy tissue.
What are some examples of evasins properties?
- Abscess formation
- Capsule formation
- Biofilm production
- Doubling time: E. coli (17 min), replicates faster than treponema palladium (1980 min).
Explain the difference between a JOCK and a NERD.
- NERD: High Resistance
- JOCK: High Virulence
Examples of gram-POSITIVE NERDS:
- Enterococcus sp. (Vanco resistant)
- Staphylococcus epidermidis
Examples of gram-POSITIVE JOCKS:
- Streptococcus pyogenes (Toxin production, adhesion, fast doubling time)
- Streptococcus pneumoniae (Encapsulated)
Examples of gram-NEGATIVE NERDS:
Acinetobacter sp. (Can be sensitive ONLY to COLISTIN)
Examples of gram-NEGATIVE JOCKS
- Legionella pneumonoPHILA (Pleomorphic, grows in water)
- Neissearia sp.
- H. influenzae
Examples of JOCKS AND NERDS.
- Gram-POSITIVE: Staphylococcus aureus - MRSA, CA-MRSA
- Gram-NEGATIVE: Pseudomonas aeruginosa (Can be sensitive ONLY to colistin) - MDR-pseudomonas
Modes of transition of infection - Examples of DIRECT contact:
Modes of transition of infection - Examples of INdirect contact:
- Not direct contact (No shit...this is stupid)
- Occurs when pathogen can withstand the environment OUTSIDE its host for a long period of time before infecting another.
Explain normal flora and colonization.
- Means the same thing as colonization: Microbes living on surface or within a host and are NOT producing disease.
- The organism may be multiplying within site.
- Usually doesn't NOT cause tissue damage.
- The family of organisms COEXISTING with human host are called "normal flora."
- Normal flora can be changed by disease, antibiotics, etc…
T/F: Normal flora can never cause disease because it's normal to have them in our bodies.
- Most strains of normal flora have LOW pathogenicity, but damage of normal host defenses can allow almost any normal flora to produce infection or disease.
How does normal flora protect us from non-indigenous species?
- COMPETITION for binging (colonization) sites.
- SPECIFIC antagonism - Produce BACTERIOCINS to kill/inhibit other species of bacteria (usually closely-related)
- NONSPECIFIC antagonism - Produce a VARIETY of metabolites and end products that inhibit other microorganisms. These include fatty acids (lactate, propionate, etc.), peroxides, and antibiotics.
Where does normal flora colonize at?
- Lower urethra
- Lower intestine
- LARGE intestine
- Upper throat
What part of the body is typically sterile?
The 6 natural physical barriers are:
- Genitourinary tract
- Respiratory tract
- Intestinal tract
- Mucous membranes
How does the skin protect from microorganisms?
- A mechanical barrier, if intact.
- It's dry, therefore inhospitable for growth.
- Slightly acidic pH of 5-6. (acid mantle)
- Continual desquamation (shedding) of skin scales.
Since few organisms can penetrate the skin, how to they gain access to human host?
- Catheters (intravenous)
- Arthoropod vectors
- Surgical incision
T/F: Skin membranes supports a broader spectrum and larger number of microorganism than mucous membranes because of more surface area.
- Because of its moisture, mucous membranes support a broader and larger spectrum.
What are some examples of mucous membranes?
- Mouth - saliva
- Vagina - cervical mucus
- Urethra - prostatic fluid
- Eye - tears
- Nose - snot
- Pretty much any openings and its fluid.
T/F: Mucous membrane secretion contains IgA, and no other immunoglobulins.
- It contains IgA and IgG.
- Protects by agglutination (clumping) of microorganism, preventing them from attaching to receptors on host.
How does the respiratory tract act as a barrier?
- Turbulent airflow will cause large particles to come in contact with mucosal surfaces and be destroyed.
- Then it's expelled by coughing. (90% cleared in one hour)
T/F: If particles reach the alveoli, expulsion becomes less effective.
- Can't cough it out when it reaches the alveoli. Alveolar macrophages and tissues histiocytes will do most of the work.
What factors can decrease effectiveness of the RESPIRATORY tract's role as a barrier?
- Mechanical respirators
- Air pollutants (cigarette smoke)
- Genetic defects (cystic fibrosis)
- Concomitant infection
- Allergic agents
How does the intestinal tract act as a barrier against microorganisms?
- The 1st line defense: Acidic pH of stomach (caution with PPI's), antibacterial effects of pancreatic enzymes, bile and intestinal secretion.
- Peristalsis and normal loss of epithelial can purge the intestinal tract of harmful microorganisms.
- Normal bowel microbial flora competes with outside microbes for nutrients.
Altering symbiotic intestinal normal flora can result in what?
Overgrowth of potentially pathogenic organisms.
T/F: One of the reasons why the genitourinary tract can act as a barrier is because urine's low pH is bacteriostatic for some strains.
- It's bacteriCIDAL…not static!(Everything else in that statement is true)
The lower unrinary tract is flushed with urine 4 - 8 times a day, eliminating potential pathogenic organisms except:
Neisseria gonorrhoeae, and some strains of E. coli, because they are able to attach to epithelial cells of he urinary tract.
T/F: Regarding the genitourinary tract, UTI's are 14 times more common in women because they have a shorter urethra (20 cm) which provides more passive protection than men (5 cm)
- Longer a urethra does provide more passive protection…5 cm in females and 20 cm in men.
T/F: With regard to the genitourinary tract, the vagina's normal flora metabolizes GLYCOGEN into LACTIC ACID, which creates an UNfavorably low pH environment for most pathogenic microorganisms.
- That is why NONspecific vaginitis or vaginosis is characterized by an elevated pH.
Explain how the eye provides a protective barrier against microorganisms.
- It is constantly bathed by tears, which dilutes and washes away foreign substances via the tear ducts into the nasal cavity.
- Tears also contains large LYSOZYME, IgA and other antimicrobial substances.
What are the steps in the mechanism of infection?
- 1. Pathogen and host are in close proximity.
- 2. Pathogen enters host and spreads via blood or lymph system.
- 3. Pathogen multiplies within host.
- 4. Results in tissue damage by pathogen directly, or by host's own immune system.
- 5. End result: Either pathogen destroys hose, or vice versa…or they just coexist.
T/F: Diagnosis of infection requires S/S and CC.
- Positive culture not needed. Signs and symptoms is enough for diagnosis.
Universal signs of infection:
- Leukocytosis: WBC > 10,000 or 12,000 (from CBC…differential determines %)
- Left shift: Increase in immature neutrophils (bands)
- Fever: Occurs as a result of "resetting" of normal temp range, not a malfunction of the thermoregulatory mechanisms in the hypothalamus.
- Since these are non-specific, you should monitor for DECREASE to see if tx is working.
Regardless of where body temperature is measured, a fever is defined as ≥ ???
≥ 100.4 F or ≥ 38 C
T/F: With regard to sites to measure body temperature, the ear canal is no longer recommended and axillary is the "Gold standard."
- Measuring body temperature RECTALLY is the "Gold Standard," but no longer recommended. (Would you want something up your butt? No? Then don't recommend it for others!)
What are some S/S of a respiratory tract infection?
- Sputum production
What are some S/S of a urinary tract infection?
- Urinary frequency/urgency
- Dark urine
What are some S/S of meningitis?
- Nuchal rigidity (neck stiffness)
What are some S/S of a skin infection?
What monitoring parameters would you always use, regardless of sites of infections?
- Fever curve
- WBC trend
- Culture results
Monitoring parameters for pneumonia:
- Oxygen saturations and requirements
- S/S (cough, sputum production)
Monitoring parameters for meningitis:
- Range of motion
T/F: The ideal duration of tx is based on resolution of S/S PlUS 3 more days.
- It's 2 more days (everything else in that statement is true)
- Keep in mind that DOT is usually determined at diagnosis and written for random days.
DOT studies have been done in:
- COPD exacerbations
Explain the advantages/disadvantages of pre-determined DOT.
DOT guarantees a DC date, but pt may need more/extended therapy.
T/F: The GOAL of DOT is to expose pt to the least amount of antimicrobial therapy as possible.
- The longer we are exposed to antibiotics, the more likely all the bacteria in/on/around us will be come resistant.
- Opposite of what we we've been taught. (Then why the fuck was it taught to us last year?!)
T/F: A Consequence of antimicrobial exposure is that it may cause a change/mutation in normal flora or acquisition of resistant pathogens.
- Meta-analysis showed risk of acquiring MRSA increased by 1.8 folds with antibiotic use, and 3 times greater with Fluoroquinolones or glycopeptides.
How would a stewardship pharmacist, within the first 24-48 hours after the pt has been admitted, determine if antibiotic use is appropriate? (Basically, what ?'s should be asked?)
- Are they needed at all?
- Is it the right dose/freq?
- Appropriate coverage?
- Is de-escalation possible?
- Can it be give PO vs IV?
- Cheaper alternative that's as effective?
- Less toxic options?