Microbiology: Systems

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jknell
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Microbiology: Systems
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2013-04-05 17:19:43
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  1. Dominant Normal Flora of Skin
    Staph epidermidis
  2. Dominant Normal Flora of Nose
    Staph epidermidis

    Colonized by Staph aureus
  3. Dominant Normal Flora of Oropharynx
    Viridans Group Streptococci
  4. Dominant Normal Flora of Dental Plaque
    Strep mutans
  5. Dominant Normal Flora of Colon
    Bacteroides fragilis > E. coli
  6. Dominant Normal Flora of Vagina
    Lactobacillus

    Colonized by E coli and Group B Strep
  7. Bugs causing food poisoning
    • Vibrio parahaemolyticus/vulnificus
    • -Contaminated seafood

    • Bacillus cereus
    • -reheated rice
    • -"Food poisoning from reheated rice? Be serious!"

    • S. aureus (preformed toxin)
    • -meats
    • -mayo
    • -custard

    • Clostridium perfringens
    • -reheated meat dishes

    • C. botulinum
    • -improperly canned foods
    • -honey

    • E. coli O157:H7
    • -undercooked meat

    • Salmonella:
    • -poultry
    • -meat
    • -eggs
  8. Rapid Food Poisoning
    • -S aureus
    • -B cereus
  9. Bugs that can mimic appendicitis
    "mesenteric adenitis"

    Yersinia enterocolitica

    Nontyphoidal Salmonella

    Campylobacter jejuni
  10. Bugs Causing Bloody Diarrhea
    • Campylobacter
    • -Comma or S shaped
    • -growth at 42C

    • Salmonella
    • -lactose negative
    • -flagellar motility
    • -animal reservoir
    • -poultry and eggs

    • Shigella
    • -lactose negative
    • -low ID50
    • -Shiga toxin
    • -only human reservoir

    • EHEC:
    • -O157:H7
    • -can cause HUS
    • -Shiga-like toxin

    • EIEC:
    • -invades colonic mucosa

    • Yersinia enterocolitica:
    • -day-care outbreaks
    • -pseudoappendicitis

    • Entamoeba histolytica:
    • -protozoan
  11. Bugs Causing Watery Diarrhea
    • ETEC:
    • -Traveler's diarrhea
    • -ST and LT toxins

    • Vibrio cholerae:
    • -comma shaped
    • -rice water diarrhea

    • C. difficile:
    • -can also cause bloody diarrhea
    • -pseudomembranous colitis

    • C. perfringens:
    • -also causes gas gangrene

    • Protozoa:
    • -Giardia
    • -Cryptosporidium (in immunocompromised)

    • Viruses:
    • -rotavirus
    • -norovirus
  12. Common Causes of Pneumonia: Neonates (<4 weeks)
    • -Group B streptococci
    • -E coli
  13. Common Causes of Pneumonia: Children (4 weeks - 18 years)
    • -Viruses (RSV)
    • -Mycoplasma
    • -Chlamydia trachomatis (infants - 3 years)
    • -C. pneumoniae (school age)
    • -Streptococcus pneumo

    "Runts May Cough Chunky Sputum"
  14. Common Causes of Pneumonia: Adults (18-40)
    • -Mycoplasma
    • -C. pneumo
    • -S. pneumo
  15. Common Causes of Pneumonia: Adults (40-65)
    • -S. pneumo
    • -H. flu
    • -Anaerobes
    • -Viruses
    • -Mycoplasma
  16. Common Causes of Pneumonia: Elderly
    • -S. pneumo
    • -Influenza virus
    • -Anaerobes
    • -H. flu
    • -GNRs
  17. Nosocomial (Hospital Acquired) Infections
    • -Staphylococcus
    • -enteric GNRs
  18. Immunocompromised Infections
    • -Staphylococcus
    • -enteric GNRs
    • -fungi
    • -viruses
    • -PCP (HIV)
  19. Aspiration Infections
    -anaerobes
  20. Alcoholic/IV Drug User Infection
    • -S. pneumo
    • -Klebsiella
    • -Staphylococcus
  21. Cystic Fibrosis Infections
    • -Pseudomonas
    • -S. aureus
    • -S. pneumo
  22. Postviral Infections:
    • -Staphylococcus
    • -H. flu
    • -Strep pneumo
  23. Atypical Infections
    • -Mycoplasma
    • -Legionella
    • -Chlamydia
  24. Common Causes of Meningitis: Newborn (0-6 mo)
    • -Group B strep
    • -E. coli
    • -Listeria
  25. Common Causes of Meningitis: Children (6mo - 6yr)
    • -S. pneumo
    • -N. meningitidis
    • -H flu B
    • -Enterovirus
  26. Common Causes of Meningitis: 6-60yr
    • -S pneumo
    • -N. meningitidis (#1 in teens)
    • -Enterovirus
    • -HSV
  27. Common Causes of Meningitis: 60 yr +
    • -S. pneumo
    • -GNRs
    • -Listeria
  28. Viral Causes of Meningitis
    • -Enterovirus (esp Coxsackie)
    • -HSV2 (HSV causes encephalitis)
    • -HIV
    • -West Nile Virus
    • -VZV
  29. Common Causes of Meningitis in HIV
    • -Cryptococcus
    • -CMV
    • -Toxoplasmosis
    • -JC virus (PML)
  30. Treatment of Meningitis
    • -Ceftriaxone and vancomycin empirically
    • -Add ampicilin if Listeria is suspected
  31. CSF Findings in Bacterial Meningitis
    • ↑ Opening Pressure
    • ↑ PMNs
    • ↑ Protein
    • ↓ Glucose
  32. CSF Findings in Fungal/TB Meningitis
    • ↑ Opening Pressure
    • ↑ Lymphocytes
    • ↑ Protein
    • ↓ Glucose
  33. CSF Findings in Viral Meningitis
    • Normal/↑ Opening Pressure
    • ↑ Lymphocytes
    • Normal/↑ Protein
    • Normal Glucose
  34. Osteomyelitis
    • If no other info available, assume:
    • -S. aureus

    • Sexually Active:
    • -septic arthritis (more common)
    • -Neisseria gonorrhea (rare)

    • Diabetes and IV drug users:
    • -Pseudomonas
    • -Serratia

    • Sickle Cell:
    • -Salmonella

    • Prosthetic Replacement:
    • -S. aureus
    • -S. epidermidis

    • Vertebral Disease:
    • -TB (Pott's)

    • Cat and Dog bites/scratches:
    • -Pasteurella multocida
  35. UTI: Diagnostic Markers
    • ⊕ Leukocyte esterase = bacterial
    • ⊕ Nitrate test = GN
    • ⊕ Urease test = Proteus, Klebsiella
    • ⊖ Urease test = E coli, Enterococcus
  36. UTI Bugs
    • E coli
    • -leading cause
    • -green sheen on EMB

    • Staph. saprophyticus
    • -second leading cause of community-acquired UTI in sexually active women

    • Klebsiella pneumo:
    • -third leading cause
    • -large mucoid capsule

    • Serratia marcescens
    • -red pigment
    • -often nosocomial and drug resistance

    • Enterobacter cloacae
    • -often nosocomial and drug resistant

    • Proteus mirabilis:
    • -swarming motility
    • -produces  urease
    • -struvite stones

    • Pseudomonas:
    • -blue-green
    • -fruity odor
    • -nosocomial, drug resistance
  37. ToRCHeS Infections
    Microbes that pass from mother to fetus (usually transplacental)

    • Common sx:
    • -HSM
    • -jaundice
    • -thrombocytopenia
    • -growth retardation

    • Toxoplasma gondii
    • Rubella
    • CMV
    • HIV
    • Herpes simplex virus 2
    • Syphilis

    • Additional Infections (all cause meningitis)
    • -Group B strep
    • -E coli
    • -Listeria

    Parvo B19 causes hydrops fetalis
  38. Toxoplasma gondii
    • Mode of Transmission:
    • -cat feces
    • -ingestion of undercooked meat

    • Maternal Manifestations:
    • -usually asymptomatic
    • -rare lymphadenopathy

    • Neonatal Manifestations (triad):
    • -chorioretinitis
    • -hydrocephalus
    • -intracranial calcifications
  39. Rubella
    • Mode of Transmission:
    • -respiratory droplets

    • Maternal Manifestations:
    • -rash
    • -lymphadenopathy
    • -arthritis

    • Neonatal Manifestations (triad):
    • -PDA (pulmonary artery hyperplasia
    • -cataracts
    • -deafness
    • -+/- "blueberry muffin" rash
  40. CMV
    • Mode of Transmission:
    • -sexual contact
    • -organ transplants

    • Maternal Manifestations:
    • -usually asx
    • -mononucleois-like sx

    • Neonatal Manifestations:
    • -hearing loss
    • -seizures
    • -petechial rash
    • -"blueberry muffin" rash
  41. HIV
    • Mode of Transmission:
    • -sexual contact
    • -needle stick

    • Maternal Manifestations:
    • -variable depending on CD4 count

    • Neonatal Manifestations:
    • -recurrent infections
    • -chronic diarrhea
  42. Herpes Simplex Virus 2
    • Mode of Transmission:
    • -skin or mucous membrane contact

    • Maternal Manifestations:
    • -usually asx
    • -vesicular lesions

    • Neonatal Manifestations:
    • -encephalitis
    • -herpetic vesicular lesions
  43. Syphilis
    • Mode of Transmission:
    • -sexual contact

    • Maternal Manifestations:
    • -chancre (primary)
    • -disseminated rash (secondary)

    • Neonatal Manifestations:
    • -still birth
    • -hydrops fetalis
    • -facial abnormalities (dry, wrinkled skin, addle nose, short maxilla)
    • -Hutchinson's teeth (notched, widely spaced central incisors)
    • -saber shins
    • -CN VIII deafness
  44. Red Rashes of Childhood
    • Rubella
    • Measles
    • VZV
    • HHV 6
    • Parvo B19
    • S. pyogenes
    • Coxsackie virus A
  45. Red Rashes of Childhood: Rubella
    • -begins at head and moves down
    • -fine truncal rash (spares hands and feet?)
    • -postauricular lymphadenopathy
  46. Red Rashes of Childhood: Measles
    • -begins at head and moves down
    • -preceded by cough, coryza, conjunctivitis, blue-white (Koplik) spots
    • -includes hands and feet (vs. Rubella)
  47. Red Rashes of Childhood: VZV
    • Chicken pox
    • -vesicular rash
    • -begins on trunk
    • -spreads to face and extremities
    • -lesions of different age
  48. Red Rashes of Childhood: HHV6
    • Roseola
    • -macular rash over body
    • -appears after several days of high fever
    • -can present with febrile seizures
    • -usually infants
  49. Red Rashes of Childhood: Parvo B19
    • Erythema infectiosum
    • -"slapped cheek" rash on face
    • -can cause hydrops fetalis in pregnant women
  50. Red Rashes of Childhood: Strep pyogenes
    • Scarlet Fever
    • -erythematous, sandpaper-like rash
    • -spares face
    • -fever and sore throat
  51. Red Rashes of Childhood: Coxsackie Virus A
    • Hand-foot-mouth disease
    • -vesicular rash and palms and soles
    • -ulcers in oral mucosa
  52. STDs
    • -Gonorrhea
    • -Syphilis
    • -Chanroid
    • -Genital herpes
    • -Chlamydia
    • -Lymphogranuloma venereum
    • -Trichomoniasis
    • -AIDS
    • -Condylomata acuminata
    • -Hepatitis B
    • -Bacterial vaginosis
  53. Gonorrhea
    • Neisseria gonorrhea
    • -urethritis
    • -cervicitis
    • -PID
    • -prostatitis
    • -epididymitis
    • -arthritis
    • -creamy purulent discharge
  54. Syphilis
    Treponema pallidum

    • Primary syphilis
    • -painless chancre

    • Secondary syphilis
    • -fever
    • -lymphadenopathy
    • -skin rashes
    • -condylomata lata

    • Tertiary Syphilis
    • -gummas
    • -tabes dorsalis
    • -general paresis
    • -aortitis
    • -Argyll Robertson pupil
  55. Chancroid
    • Haemophilus ducreyi
    • "it's so painful, you do cry"

    • -painful genital ulcer
    • -inguinal adenopathy
  56. Genital Herpes
    • HSV2, HSV1 (less common)
    • -painful penile, vulvar or cervical vesicles and ulcers
    • -systemic sx: fever, HA, myalgia
  57. Chlamydia
    Chlamydia trachomatis (D-K)

    • -most common STD
    • -urethritis
    • -cervicitis
    • -conjunctivitis
    • -Reiter's syndrome
    • -PID
  58. Lymphogranuloma venereum
    Chlamydia trachomatis (L1-L3)

    • -infection of lymphatics
    • -genital ulcers
    • -lymphadenopathy
    • -rectal strictures
  59. Trichmoniasis
    Trichomonas vaginalis

    • -vaginitis
    • -strawberry colored mucosa
    • -motile in wet prep
  60. AIDS
    HIV

    • -opportunistic infections
    • -Kaposi's sarcoma
    • -lymphoma
  61. Condylomata acuminata
    HPV 6, 11

    • -genital warts
    • -koilocytes
  62. Hepatitis B
    HBV

    -jaundice
  63. Bacterial vaginosis
    Gardnerella vaginalis

    • -Noninflammatory, malodorous discharge (fishy)
    • -positive whiff test
    • -clue cells
    • -not exclusively an STD
  64. Pelvic Inflammatory Disease
    • Top bugs:
    • -Chlamydia trachomatis (subacute, often undiagnosed)
    • -Neisseria gonorrhea (acute)
  65. Common Nosocomial Infections
    • -CMV,RSV
    • -E coli, Proteus mirabilis
    • -Pseudomonas
    • -HBV
    • -Candida albicans
    • -Legionella
  66. Common Nosocomial Infections Risk Factors: CMV, RSV
    -new born nursery
  67. Common Nosocomial Infections Risk Factors: E coli/Proteus
    • -urinary catheterization
    • -E coli is second most common causes of nosocomial infections
  68. Common Nosocomial Infections Risk Factors: Pseudomonas
    -respiratory therapy equipment

    "Presume pseudomonas "airguinosa" when air or burns are involved"
  69. Common Nosocomial Infections Risk Factors: HBV
    -work in renal dialysis unit
  70. Common Nosocomial Infections Risk Factors: Candida albicans
    -hyperalimentation
  71. Common Nosocomial Infections Risk Factors: Legionella
    -water aerosols
  72. Bugs Affecting Unimmunized Children: Dermatologic
    Rash

    • Rubella
    • -begins at head and moves down
    • -post auricular adenopathy
    • Measles
    • -begins at head and moves down
    • -preceded by cough, coryza and conjunctivitis, Koplik spots
  73. Bugs Affecting Unimmunized Children: Neurologic
    Meningitis

    HIB: microbe colonizes nasopharynx

    Poliovirus: can also lead to myalgias and paralysis
  74. Bugs Affecting Unimmunized Children: Respiratory
    • Pharyngitis
    • -Corynebacterium diphtheriae: grayish oropharyngeal exudate, painful throat

    • Epiglottitis:
    • -HIB: fever with dysphagia, drooling and difficult breathing, Cherry red epiglottis
  75. -Pus
    -Empyema
    -Abscess
    S. aureus
  76. Pediatric Infection
    H. flu
  77. Pneumonia in CF, burn infection
    -Pseudomonas
  78. Branching rods in oral infection, sulfur granules
    Actinomyces israelii
  79. Traumatic open wound
    C. perfringens
  80. Surgical wound
    -S. aureus
  81. Dog or cat bite
    Pasteurella multocida
  82. "Currant jelly" sputum
    Klebsiella
  83. Positive PAS stain
    Tropheryma whipplei (Whipple's disease)
  84. Sepsis/meningitis in newborn
    Group B strep
  85. Health care provider
    HBV (needle stick)
  86. Fungal infection in diabetic or immunocompromised patient
    Mucor or Rhizopus
  87. Asplenic patient
    -encapsulated microbes

    • SHiN
    • -S. pneumo
    • -H. influenza type B
    • -N. meningitidis
  88. Chronic Granulomatous Disease
    • Catalase positive microbes
    • -especially S. aureus
  89. Neutropenic patients
    • Candida albicans (systemic)
    • Aspergillus
  90. Facial Nerve Palsy
    -Borrelia burgdorferi (lyme disease)

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