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2013-01-27 14:44:15

Falcione Exam 2
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  1. How are Salmonella species referred to?
    Genus Serotype
  2. O antigen in Salmonella
    associated with LPS of the outermembrane
  3. H antigen of Salmonella
    associated with the flagella
  4. What are the two Salmonella phases?
    • motile/specific
    • non-motile/non-specific
  5. pathogenic strains of S. Typhi, S. Paratyphi C and S. Dublin carry what?
    Vi antigen - associated with envelope and capsule (K antigen)
  6. Which has a human reservoir?
    • S. Typhi
    • S. Paratyphi A, B, and C
  7. Where is Salmonella endemic?
    • India
    • SE Asia
    • South America
    • Central America
    • Africa
  8. Pathogenesis of Salmonela Tyhpi
    • 1. invades mucosa/epithelium of the small and large intestines
    • 2. is engulfed by macrophages
    • 3. the macrophages carry it to the liver, spleen, and bone marrow
    • 4. it multiplies inside the macrophage
    • 5. when a critical number is reached, it is released into systemic circulation
    • 6. the reticuloendothelial system tries to control the spread by taking it up
  9. What is the Salmonella carrier state?
    • sheds for a year or longer
    • asymptomatic
    • stored in gallbladder and gallstones
  10. In which infection does the fever appear to get better and then begin to get worse over the course of the first week?
    Typhoid Fever
  11. In which infection does the pt get "rose" spots?
    Typhoid fever
  12. How is Typhoid fever associated with UTIs?
    not actually a UTI, its just that the salmonella is excreted in the urine
  13. What is used to treat typhoid fever?
    • DOC: ciprofloxacin
    • 3rd gen cephs
    • azithromycin
  14. resistant to choramphenicol
  15. resistant to ampicillin
    • salmonella
    • shigella
    • klebsiella
  16. resistant to bactrim
  17. 4 Shigella subgroups
    • A - dysenteriae
    • B - fexneri (2nd most common in US)
    • C - boydii
    • D - sonnei (most common in US)
  18. Which species of bacteria are actually biogroups of E. coli
  19. highest incidence in children 6mo - 5 yrs
  20. peak incidence in late summer
  21. disease limited to humans
  22. resistant to stomach acid
  23. Shigella pathogenesis
    • 1. crosses mucosa via M cells
    • 2. macrophage engulfs
    • 3. shigella escapes macrophage
    • 4. enters mucosal cells from underneath using invasins (actin polymer rearrangement in cell's cytoskeleton that causes the bacterium to be engulfed into an endocytic vesicle)
    • 5. escape from vacuole into cytoplasm and multiply
    • 6. Move through host cell and spread to other cells by actin-based motility
    • 7. when they reach boundary of the cell, the actin filaments push the Shigella across the membrane and into the adjacent cell
  24. infection associated with seizures
    Shigella (b/c of fever)
  25. infection associated with Reiter's Syndrome (reactive arthritis)
  26. Shigella group that produces Shiga-like exotoxin
    S. dysenteriae
  27. What is used to treat Shigella?
    DOC: Cipro or Bactrim
  28. 2 categories of E. coli
    • urophathogenic/extraintestinal
    • "entero" associated/diarrheagenic
  29. virulence factors of Uropathogenic/extraintestinal E. coli
    • endotoxin (LPS)
    • exotoxin (hemolysin)
    • capsule
    • flagella
    • pili (P-fimbira and S-fimbira)
    • sideophores (steals host's iron)
  30. types of hemolysin? what infection are they associated with?
    • Alpha - secreted; disrupts lymphocytes
    • Beta - membrane bound; inhibits PMNs

    associated with uropathogenic/extraintestinal E. coli
  31. types of Pili and what they are associated with
    • P-Fimbria - UTI
    • S-Fimbria - meningitis

    associated with uropathogenic/extraintestinal E. coli
  32. source of uropathogenic E. coli
    normal flora of colon (coliform)
  33. types of transmission of uropathogenic E. coli
    • 1. Autoinoculation (fecal contamination of urethra)
    • 2. Nosocomial, Iatrogenic (urinary/IV catheter)
    • 3. Vertical (at birth bc of passage through vagina; in utero via ascending infection)
    • 4. horizontal (lack of hand washing)
  34. most common cause of UTIs
    E. coli
  35. treatment for uropathogenic E. coli
    • UTI: Bactrim
    • bacteremia: carbapenems
  36. resistant to beta-lactams (includes ESBL producing)
    • uropathogenic E. coli
    • hospital acquired klebsiella
  37. what can cause neonatal meningitis?
    uropathogenic E. coli through S-Fibriam pili
  38. treatment of neonatal meningitis
    cefotaxime or ceftriaxone
  39. groups of enteroassoicated E. coli
    • enteroadhesive (EAEC)
    • enterohemorrhagic (EHEC)
    • enteroinvasive (EIEC)
    • enteropathogenic (EPEC)
    • enterotoxigenic (ETEC)
  40. which enteroassociated E. coli are found in the small and intestines respectively?
    • small (A, P, T)
    • large (H, I)
  41. E. coli group that is pathogenetically related to Shigella
    EIEC - shigella like dysentery (invasion of intestinal epithelial cells)
  42. pathogenesis of EIEC
    invades and destroys colonic epithelium
  43. causes disease in children <2, but older children and adults are resistant
  44. which E. coli doesn't produce exotoxin
  45. pathogenesis of EPEC
    • adherence to epithelial cell membrane
    • destruction of microvilli
  46. most common of all E. coli diarrhea
  47. most common cause of traveler's diarrhea
  48. two exotoxins associated with ETEC
    • heat labile (antigenic; cholera-like toxin)
    • heat stable (non antigenic; rapid onset of action; limited to small intestine)
  49. produces highly mucoid colonies b/c of polysaccharide capsule
  50. role in CAP in alcoholics and ppl with chronic respiratory disease
  51. treatment for klebsiella
    • non-MDR: 1st gen ceph, pen/BLI, bactrim, FQ, aminolyc
    • MDR: not many options
    • ESBL producing: carbapenems, some FQs
  52. out of enterobacter, serratia, and citrobacter which one(s) inhabit the human gut?
    enterobacter and cirobacter
  53. intrinsically resistant to ampicillin and 1st and 2nd gen cephs
    enterobacter, serratia, and citrobacter
  54. associated with a "swarm" over moist agar plates
  55. 2 species of proteus
    • proteus mirabilis (indole +)
    • proteus vulgaris (indole -)
  56. the production of ____ by proteus mirabilis leads to:
    • urease
    • 1. hydrolyzes urea in urine to ammonium hydroxide
    • 2. urine pH goes up (more basic)
    • 3. Mg, Ca, and ammonium precipitate forming triple phosphate kidney stones (struvite)
    • 4. leads to renal calculi, UTIs, hydronephrosis, absecess b/c of obstruction
  57. types of infections btween proteus species
    • mirabilis: community acquired UTIs
    • vulgaris: hospital acquire infections (pneumonia, wound infections, bacteremia, septicemia)
  58. types of resistance btwn both proteus species
    • mirabilis: generally susceptible, but with increasing resistance
    • vulgaris: resistance is common
  59. infection confers long lasting type-specific immunity in this:
    vibrio cholerae
  60. What are the two enterotoxins that vibrio cholerae produces and what do they do?
    • choleratoxin, choleragen
    • 1. stimulate adenylate cyclase
    • 2. inc in intracellular cAMP
    • 3. Na and Cl absorption by microvilli inhibited
    • 4. promotes secretion of chloride and water by crypt cells of the intestines
    • 5. leads to isotonic fluid secretions from sm. intestine that go beyond the ability of the colon to absorb the excess
  61. two serotypes of vibrio cholera and their symptoms:
    • O1 - 50% symptomatic
    • O139 - 1-5% symptomatic

    watery (rice-water) diarrhea (painless, voluminous, odorless) --> severe dehydration
  62. complications of vibrio cholerae:
    • 1. metabolic acidosis
    • 2. pre-renal azotemia
    • 3. iatrogenic water intoxication (w/ overhydration; aspiration pneumonia)
    • 4. hypoglycemia
  63. treatment for vibrio cholera
    • ORT or IVF
    • DOC: doxy (single dose)
    • tetracycline, bactrim, cipro
  64. which vibrio is associated with wound infections
    vibrio parahaemolyticus adn vulnificus
  65. which species produces pigments?
    pseudomonas aeruginosa (blue, yellow-green, red-brown)

    smells like grapes
  66. which has alginate as a virulence factor and which pts are especially prone to this?
    • pseudomonas aeruginosa
    • cystic fibrosis pts
  67. dysenteric/enteroinvasive pathogens
    • Shigella
    • EHEC
    • EIEC
  68. Watery/enterotoxigenic
    • EAEC
    • V. cholerae
    • and basically all the other ones
  69. Motile
    • Salmonella
    • Shigella (in vivo)
    • E. coli
    • V. cholerae
    • P. aeruginosa
  70. Non-motile
    • Klebsiella
    • shigella (in vitro)
  71. Lactose fermenting
    • E. coli
    • Klebsiella
    • Vibrio's
  72. Non-lactose fermenting
    • P. aeuroginosa
    • Salmonella
    • Shigella
  73. Oxidase positive
    P. aeruginosa
  74. splits urea
    Proteus mirabilis
  75. doesn't split urea
    • salmonella
    • shigella
    • E. coli
    • V. cholerae
  76. produces H2S
  77. doesn't produce H2S
    E. coli
  78. positive indole
    • Klebsiella oxytoca
    • Proteus mirabilis
  79. negative indole
    • Klebsiella pneumoniae
    • Proteus vulgaris
  80. exotoxin
    • shigella dysenteriae (Shiga toxin)
    • EAEC
    • EHEC (Shiga-like toxin)
    • ETEC (heat labile and stable)
    • V. parahaemolyticus (hemolysin)
    • P. aeruginosa (exotoxin A - disrups protein sy thesis)
  81. Endotoxin
  82. Both exo and endotoxin
    • E. coli
    • V. cholerae (endo - LPS; exo - choleratoxin, choleragen)
  83. Standard media
    • Salmonella
    • shigella
  84. special media
    • v. cholerae
    • v. parahaemolyticus (salt)
    • v. vulnificus (salt)
  85. requires fresh specimen
    • Salmonella
    • Shigella
    • V. cholerae
  86. large inoculum
    • salmonella
    • ETEC
  87. low inoculum