micro

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Author:
Tarapie
ID:
97784
Filename:
micro
Updated:
2011-08-24 08:31:30
Tags:
usmle step
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Description:
bugs
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  1. gram +
    • staph
    • strep
    • clostridium
    • corynebacterium
    • bacillus
    • listeria
    • mycobacterium
    • actinomyces & nocardia (branching)
  2. encapsulated bacteria
    • Some Killers Have Pretty Nice Capsules
    • Salmonella
    • Klebsiella
    • Haemophilus influenza B (hib)
    • Pneumococcus (strep pneumo)
    • Neisseria meningitidis (NOT gonococci)
    • Cryptococcus
  3. ID-ing staph
    • NO StRES
    • NOvobiocin: Saprophyticus is Resistant ; Epidermidis is Sensitive

    both are gamma hemolytic (non hemolytic)
  4. ID-ing Strep
    OVRPS (overpass): Optochin - Viridans is Resistant; Pneumo is Sensitive; these are alpha hemolytic

    B-BRAS: Bacitracin - group B strep (agalactiae) are Resistant; group A strep (pyogenes) are Sensitive); these are beta hemolytic
  5. cAMP inducers
    • CAEP
    • Cholera (vibrio): permanently activates Gs - rice water diarrhea
    • Anthrax (bacillus): includes edema factor (bacterial adenylate cyclase)
    • ETEC: heat labile toxin
    • Pertussis toxin: permanently disables Gi, causing whooping cough
  6. strep pneumo
    • MOPS: meningitis, otitis media, penumonia, sinusitis (mcc)
    • trigger: G+ diplo, capsule, optochin sensitive, polysaccharide vaccine, IgA protease
    • alpha hemolytic
    • tx: PCN, amoxicillin, FQ, macrolides
  7. strep pyogenes
    • GROUP A STREP
    • pyogenic: pharyngitis, cellulitis, impetigo
    • toxigenic: scarlet fever, TSS
    • immunologic: rheumatic fever (M protein), acute GN
    • trigger: bacitracin sensitive, beta hemolytic, M protein, G+ cocci in chains, streptolysin O & S, PYR+
    • lab: catalase neg, ASO titer for RFever
    • tx: PCN, cephalosporin, erythromycin
  8. Rheumatic Fever
    • develops a few weeks after GAS (pyogenes) pharyngitis
    • AB develop against GAS M proteins: cross react and cause T2HS, also CMI: T4HS
    • Sx: Polyarthritis, SubQ plaques, erythema marginatum, chorea, carditis (most serious: pericarditis, myocarditis - MCC of death, endocarditis - MV - sterile vegetations)
    • lab: ASO titers>400, increased anti-DNase B titers
    • tx: PCN, aspirin, CS for carditis and heart failure if murmur is present
  9. strep agalactiae
    • GROUP B STREP
    • Bacitracin resistant, beta hemolytic
    • pneumonia, meningitis, sepsis - mainly in babies (transmitted at birth, mainly in prolonged labor)
    • give prophylaxis at delivery
    • tx: ampicillin, aminoglycosides, cephalosporin
  10. Enterococci (e. faecalis, e. faecium)
    • UTI, subacute endocarditis
    • penicillin resistant, nosocomial
    • post GI/GU surgery - endocarditis on previously damaged heart valves
    • lab: bile-esculin test, optochin resistant
    • tx: aminoglycoside+ ampicillin/vanc. if FQ resistant, linezolid and newer abx
  11. viridans strep
    • (mutans & sanguis)
    • alpha hemolytic (green hemolysis), optochin resistant
    • dental caries, endocarditis
    • tx: PCN +/- aminoglycoside
    • produce dextrans w/sucrose as substrate - facilitate adherance to fibrin @ endothelial trauma, fibrin and platelets aggregate and become sites for adherance and colonization
  12. staph aureus
    • Protein A binds Fc-IgG, inhib complement and phagocytosis
    • coagulase & catalase + (grapelike clusters)
    • beta hemolytic
    • TSST: TSS, food poisoning, scalded skin syndrome
    • MRSA
    • Inflammatory skin disease: impetigo, carbuncle
    • tx: methicillin, nafcillin, oxacillin, vanc for MRSA

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