Micro Block 3-Pt 3

ptheodore's version from 2015-08-02 19:50

Zoonotic GNB

Question Answer
Bites of animals, cat bitesPasteurella multocida
Treatment for Pasteurella multocidaAmoxicillin-clavulanate
Facultative intracellular. Bipolar staining, “safety-pin” (Wayson stain, Giemsa). Direct Fluorescent antibody (DFA) testYersinia pestis (Plague)
IN US - desert southwest (New Mexico, Arizona, Colorado) – Wild rodents; Prairie-dogs, ground squirrels, chipmunks, other wild rodents. Transmitted through bites of infected FLEASYersinia pestis (Plague)
Infected flea bite. One/more enlarged lymph nodes – “Buboes”Yersinia pestis (Bubonic Plague)
Bite of infected flea/handling of infected animal. Septic shock. Bleeding under skin, other tissues (ecchymoses); blackening of fingers, toes, nose*Yersinia pestis (Septicemic plague)
Treatment for Yersinia pestisAminoglycosides (Gentamicin, Tobramycin)
Transmitted through rabbits, deer, rodents. Traumatic implantation – eg. While skinning rabbits`. Inhalation of aerosols – skinning animals~Francisella tularensis
Occupational hazard to Veterinarians, hunters, trappers. Ulceroglandular disease – local ulcer + swollen regional LNFrancisella tularensis
Facultative intracellular organism; Domestic livestock; cattle, goats, pigsBrucella
Treatment for Francisella tularensisStreptomycin (Aminoglycosides)
Direct contact with infected animals. Ranchers, dairy farmers. Unpasteurized dairy products (milk, cheese). Recurrent fevers (undulating pattern – rise & fall) Brucella
Treatment for BrucellaRifampicin + doxycycline
Cat scratch/bite disease. Small abcesses at site fever and localized lymphadenopathyBartonella henslae
Treatment for Bartonella henslaeAzithromycin, doxycycline
Trench feverBartonella quintana
Transmitted - human body louse (Lice). Mild, relapsing fever with maculopapular rash. Re-emergining among homeless populations.Bartonella quintana
Treatment for Bartonella quintanaTetracycline, doxycycline

Bacteroides fragilis

Question Answer
Peritonitis, intraabdominal infections (abcesses), myonecrosisBacteroides fragilis
Treatment for Bacteroides fragilismetronidazole, clindamycin

Treponema pallidum (Syphilis)

Question Answer
Stage of syphilis where the organism spreads by lymph and blood. No symptomsInoculation
Stage of syphilis present with painless hard ulcer/chancrePrimary syphilis
Stage of syphilis present with rash on Palms & Soles. Also Condyloma latum: wart-like moist papule around oral/genital/perianal region.Secondary syphilis
Stage of syphilis usually asymptomatic but with positive serology. Considered noninfectious when duration is >4yrs, except in pregnancy (can be transmitted to fetus). May last 3 to 30 yearsLatent syphilis
Stage of syphilis where the patient presents with Gumma of the skin; degeneration of nervous system and cardiovascular problems occurTertiary syphilis.
Stage of syphilis that presents with Cardiovascular disease, CNS disease and Locally destructive disease due to formation of granulomasTertiary syphilis
Interstitial keratitis with blindness. Hutchinson teeth. Eighth cranial nerve deafness. Mulberry / Moons molars. Saber shin (anterior bowing of tibia). Signs present after 2 years old.Late Congenital Syphilis
Corfirmation test for syphilisAnti-treponemal antibody
Antibodies binds to cardiolipin:VDRL: Venereal disease research laboratory. RPR: rapid plasma reagin test. ART: automated reagin testNon-treponemal antibody screening tests (for syphilis)
Fluorescent treponemal antibody-absorption (FTA-ABS) & Treponema pallidum microhemagglutination (MHA-TP) are confirmed test forSyphilis
Treatment for Treponema palladium (syphilis)Benzathine penicillin
Treatment for neurosyphilis (reponema palladium)Aqueous Penicillin G
Starts generally during the first 24 hours of antibiotic treatment for syphilis. Lysis of organisms release pyrogens that cause the systemic manifestations; Slight fever, headache, malaise, chills, muscle aches and pains, intensification of syphilitc lesions. These resolve in fewer than 12 hoursJarisch-Herxheimer reaction
Microscopy technique used to see spirochetes of syphilis under the microscopeDark field or fluorescent microscopy
Meningo-vascular syphilis. General paresis of insane. Tabes DorsalisNeurosyphilis

Borrelia & Leptospira

Question Answer
Many very narrow regular coils with hooked endSpirochetes
Virulence factor for spirochetesAntigenic variation-
Causes Lyme disease Borrelia burgdorferi
Erythema migrans (Bull's eye rash). "Flu-like" symptoms: fatigue, malaise, fever, headacheLyme disease (Stage 1)
Ixodes tick causesLyme disease
White-footed mice. White-tailed deerReservoir for ticks causing lyme disease
Bell's (facial) palsy; Loss of muscle tone on one or both sides of the face is called facial & Heart blockLyme disease stage 2
What stage of lyme disease inolves; Migratory Polyarthritis of large joints & Encephalopathy3rd stage of Lyme disease
Diagnosis test for lyme diseasePCR
Treatment for lyme diseaseDoxycycline (DOC) and Amoxicillin
Bacteria with antigenic and phase variation and causes recurrent fever (once a week)Borrelia recurrentis
Epidemic relapsing fever, caused by body louse. more severe in Africa (ethiopia & sudan)Borrelia recurrentis
Long, slender, flexible, spiral or corkscrew-shaped rodsBorrelia
Tick disease found in the Northeastern U.S (Connecticut, New Hampshire)…hiking or camping in the forestLyme disease (Borrelia recurrentis)
Treatment for Borrelia recurrentisDoxycycline
Endemic relapsing fever, caused by Soft tick’s bite or their discharge, found in western U.S, Canada, S. America. B duttoni & B hermisii
Spirochetes that are thin and have hooks at the ends. Reservoir: Wild and domestic animals esp. rodents (cats & mice). Transmission of disease via rat urine or through contaminated recreational waters (jet skiers). HawaiiLeptospira interrogans
Weil disease; High Fever +/- GIT symptoms. Progressing to hepatitis (jaundice) and renal failure plus neurological problems if not treated.Leptospira interrogans
Treatment for Leptospira interrogansDoxycycline


Question Answer
Headache, fever, myalgias + RASH (Spotted fever group), tick bitesRickettsia rickettsii
Rocky mountain spotted feverRickettsia rickettsii
Common along the East Coast (OK,TN,NC,SC). Transmitted by: dog tick(Dermacenter variabilis) & wood tick (Dermacenter andersoni)Rickettsia rickettsii
Rash, fever and history of tick bite. Macular rash develops after 3-6 days→ petechial rash; Starts on extremities (ankles and wrist and arms), spreads to trunk. Palms and soles involvedRickettsia rickettsii
Clinical symptoms and history of tick bite. Microimmunofluorescence test (test of choice). Weil-Felix test. A macular rash develops in 90% of patients after 3-5 days, initially on the wrists, arms, and ankles, and then spreads to the trunk. “Centripetal (extremities to trunk)” spread. If not treated; CNS involvement.Rickettsia prowazekii
Treatment for Rickettsia rickettsii (Rocky mountain spotted fever)Doxycycline
Fever, maculopapular rash on trunk and extremeties; face, palms and soles SPARED; mild splenomegaly. Positive Weil-Felix reaction.Epidemic typhus (Rickettsia prowazekii)
Treatment for Rickettsia prowazekii (Epidemic typhus)Doxycycline

Coxiella, Ehrlichia & Anaplasma

Question Answer
Small intracellular bacteria. Giemsa stain. Extracellular form is extremely stable, can survive in nature for prolonged duration. At risk people; Dairy farmers and vets associated with the birthing process of infected sheep, cattle and goat.Coxiella burnetii (Q fever)
Enters through aerosol form infected sheep, goats or cattle. Spreads through the blood. Causes Pneumonitis, Endocarditis, GranulomasCoxiella burnetii (Q fever)
Treatment for Coxiella burnetii (Q fever)Doxycycline
Lone star tick. Infects monocytes and macrophagesHuman monocytic ehrlichiosis:
Ixodes tick, Infects neutrophilsHuman anaplasmosis
Resembles rocky mountain spotted fever, except with Intracellular organisms called morulae (berry like inclusions)Ehrlichia and Anaplasma
Treatment for Ehrlichia and AnaplasmaDoxycycline


Question Answer
Small, Obligate intracellular pathogen (OIP). Do NOT gram stain (NO peptidoglycan, no muramic acid in cell wall). Infect mucous membranes. Infected cells – Cytoplasmic “inclusion” bodiesChlamydia
EB; Elementary body (Spore Like-Extracellular). Infectious stage – attaches to host cell – internalized. RB; Reticulate body; ReplicatesChlamydia
PAP smear, Giemsa stain & Immunofluorescent stains (better)Chlamydia
Serotype A, B, C causes Trachoma (blindness). Serotype D-K causes Urogenital infections (STD). Serotpe L1-L3 causes Lymphogranuloma venereumChlamydia trachomatis
Nonspecific urethritis (non-gonococcal). Thin watery discharge containing Numerous neutrophils but NO bacteria (on Gram staining)Chlamydia trachomatis
Urethritis and cervicitis, Pelvic inflammatory disease (PID). Potential for fallopian tube scarring and for ectopic pregnancy as a resultChlamydia trachomatis
Reiter’s Syndrome (HLA-B27) characterized by triad; Conjunctivitis (noninfectious), Urethritis (due to Chlamydia trachomatis), Reactive Arthritis (seronegative). With additional findings: Achilles tendinitis and Mucocutaneous lesionsChlamydia trachomatis
Neonatal Conjunctivitis (ophthalmia neonatorum). Infant Atypical pneumonia (interstitial pneumonia)Chlamydia trachomatis
Sexually transmitted chronic ulcerative disease. A painless papule or an ulcer develops on the genital mucosa or nearby skin causing swollen, tender lymphadenopathy “buboes” which can rupture. Groove sign due to enlargement of both the femoral and inguinal nodesChlamydia trachomatis (Lymphogranuloma venereum (LGV): Serotypes L1, L2, L3)
Nucleic acid amplification techniques (NAATs) – detect specific gene sequences in clinical specimensChlamydia trachomatis
Treatment for Chlamydia trachomatis ocular or genital infectionsDoxycycline or Azithromycin
Treatment for Chlamydia trachomatis when infected with gonorrhoeaDoxycycline & Ceftriaxone
Treatment for Chlamydia trachomatis LGVDoxycycline or erythromycin
Treatment for Chlamydia trachomatis causing newborn conjunctivitis or pneumoniaErythromycin
Atypical “walking “ pneumonia. Potential association with atherosclerosisChlamydophila pneumoniae
Treatment for Chlamydophila pneumoniae Erythromycin and tetracycline
Interstitial atypical pneumonia from Birds ie. ParrotsChlamydophila psittaci
Treatment for Chlamydophila psittaciDoxycycline

Bacterial Vaginosis

Question Answer
Normal adult vaginal flora, prevents growth of potential pathogens. Produce acid that keeps vaginal pH low (4.5)Lactobacillus
In bacterial vaginosis, the numbers of Lactobacilli are diminished, and are replaced byGardnerella (GNB) & Mobiluncus
Thin, grey, vaginal discharge with fishy smell, clue cellsBacterial vaginosis
Clue cells;Squamous epithelial cells studded with coccobacilli. pH>4.5 (Norma; below low (4.5)). Positive whiff testBacterial vaginosis
Treatment for bacterial vaginosis (oral & topical)Metronidazole or clindamycin
Yellowish, watery discharge. Itching, burning & painful urination. Sexually transmitted infection. Wet mount show motile trophozoitesTrichomoniasis
Curd-like/cottage-cheese discharge. Itching, pain. Mucocutaneous involvement (vulvovaginitis). Budding yeast-like cells. PseudohyphaeVaginal Candidiasis