Microbiology review 2
Clinical manifestations of sepsis
Drop in BP is a hallmark Fever and violent, shaking chillsAnxiety and altered mental state Rapid breathing Organs start to dysfunction Decreased urine output Cool, dusky colored extremities
Altered homeostasis of a microbiome leads to a __________ microbiome
Dysbiotic
Lateral periodontal abscess treatment
Drainage, irragation with antisceptic mouthwash(chlorhexidine) Rarely need antibiotics Assess toot(indications for extraction?)
T/F Fusobacterium necrophorum is part of the normal flora
False
T/F N. meningitidis contain LPS and have outer membrane proteins(OMP) similar to N. gonnorhoeae
False they contain LOS instead of LPS
T/F Pneumonia can be caused by bacterias only
False, Bacteria, viruses, and helminths
T/F Aggregatibacter actinomycetemcomitans may be present in oral flora of healthy patients at high levels
False, low levels
T/F gingivitis always leads to periodontal disease
False, not always
Clinical manifestations of Shigella dysenteriae
Fever Cramping Abdominal pain dysentery Nausea Vomiting Malaise Anorexia Tenesmus SHIGA TOXIN
Clinical manifestations of Shigella sonnei
Fever Malaise Anorexia Watery diarrhea(sometimes bloody with WBCs and RBCs) Tenesmus Cramping Abdominal pain
Clinical Manifestations of otitis media
Fever Pain(ear pulling) Irritability Poor sleeping
Clinical manifestations of infective endocarditis
Fever, tachycardia, extreme fatigue, breathing difficulty, murmur Most patients have obvious source of infection -Infected tooth, skin lesion, catheter, IV drug user Janeway's lesions(painless, hemorrhagic nodule on the palms and sole) Osler's nodes (small, tender nodes on the fingertips or toes) Clubbed fingers Subacute IE symptoms can take weeks to months to develop
Virulence factors of Gonococci
Fimbriae(type IV pili) LOS IgA prostease Rmp(reduction-modifiable protein): induces production of blocking antibodies
Impetigo(Pyoderma) Superficial bacteria cause infections that make the skin ______ or _______ _____________ and _____________(bacteria) Most common in __________(age group) Bacteria enter through ________ It is not serious but highly ______
Flake or peel off Staphylococcus aureus and Streptococcus pyogenes Pre-school-aged children Bacteria enter through a break in skin Contagious
Defenses of the urinary tract
Flushing action of urine Desquamation of epithelial cells lining the urinary tract Lysozyme and lactoferrin
Defenses of the eye Tear film -contain _____ and __________ Immune privilege -_________ doesn't readily occur
Lysozyme and lactoferrin
Nosocomial pneumonia Commonly associated with ___________ ventilation(e.g. ____________) Mortality rate 30-50% ______ ______- Gram negative, bacilli, oxidase + ______ ______ ______ ______-Gram negative, bacilli
Mechanical ventilation(e.g. tracheotomy) Psuedomonas aeruginosa Streptococcus pneumoniae Klebsiella pneumoniae
_______: infection of the meninges _______: infection of the brain
Meningitis Encephalitis
Treatment of bacterial vaginosis
Metronidazole(oral or vaginal gel) Clindamycin(oral or vaginal cream)
Causes of conjunctivitis Newborns -_______ ________ -_______ ________ Children and adults -_______ ________ -_______ ________
Newborns -Neisseria gonorrhoeae -Chlamydia trachomatis Children and adults -Staphylococcus aureus -Streptococcus pneumoniae
Does calculus cause periodontal disease or gingivitis?
No. The bacteria that live in and around it do
Gonococci pathogenesis Attached to ______ ______ cells and invades them The bacteria induce their own _____ and pass to the _______ ____ are recruited Gonnococci within neutrophils are released in ________ ________
Non-ciliated epithelial cells Engulfment Submucosa Neutrophils Purulent exudates
How many microbiota of the GI system are in the accessory organs
None
Sulcular and junctional epithelium mucosa lining is made up of stratified squamous _________ epithelium and lack ________ ridges
Nonkeratinized Rete ridges
Diagnosis of syphilis
Nontreponemal test; measures IgG and IgM antibodies(reagins) developed against lipids released from damaged cells -Venereal Disease Research Laboratory(VDRL) test and the rapid reagin (RPR) test Treponemal test: detects specific anti- T. Pallidum antibodies from the serum -FTA-ABS(fluorescent treponemal antibody-absorbtion) Direct visualization under dark-field microscopy -only effective during active stages of first and secondary syphilis
Clinical manifestations of Salmonella enterica
Nontyphoidal salmonella gastroenteritis -Symptoms develop 12 to 72 hours post exposure -nausea -vomiting -abdominal pain/Cramping -Diarrhea(may be bloody) -Fever(almost always) -Lasts 10 days -Short-term carriage following infection
Diagnosis of otitis media
Presence of effusion and bulging tympanic membrane with otoscope
Pre-disposing factors for sinusitis
Previous upper respiratory infection Deviated septum Enlarged lymph nodes Allergies Cystic fibrosis
Clinical Manifestations of Syphilis
Primary -painless chancre at site of inoculation filled with spirochetes -on tongue oral cavity and gingiva Secondary -untreated patients -bacteremia- 2-6 weeks after primary chancre has healed -multiple papules on trunk of patienr -Lymphadenopathy Latent -Asymptomatic -After 4 years considered non infectious Tertiary syphilis -Gummatous syphilis -Found on skin, liver, and bones - cardiovascular syphilis -destruction and necrosis of aorta Neurosyphilis syphilis -asymptomatic -pariesis -Meninghitis -Tabes doralis Congenital -After 4th month of gestation -Hutchinsons teeth(notched barrel shaped incisors)
Clinical manifestations of cholera
Profuse watery diarrhea-"rice-water stool" Vomiting Hypovolemia and hypotension Electrolyte imbalances
Transmission of leprosy
Prolonged, close contact with someone with untreated leprosy over several months Nasal secretions/droplets Incubation period is 2-7 years(average=5)
Prostatitis Inflammation of the _________ ________ prostatitis: bacteria are usually from GI tract; typically due to UTI -Reflux of infected ______ into the _______
Prostate gland Acute prostatitis Infected urine into the prostate
Clinical manifestations of ________ Fever, chills, malaise Pain in the pelvic area, lower back, or genital area Frequent urge to urinate Bloody or cloudy urine Painful urination and ejaculation
Prostatitis
Three main categories of vaginitis
Protozoan(trichomonas vaginalis) vaginitis Yeast(candida albicans) vaginitis Bacteria vaginosis(BV)
Treatment of otitis media
broad spectrum antibiotics Most common reason for prescribing antibiotics to a child Amoxicillin
Transmission of Treponema pallidum
sexual contact with an active syphilitic lesion Transplacental Less common: spread by non-genital contact or sharing of sharing of needles
Pathogenesis in upper respiratory tract
spread from another infection in upper respiratory system
Most common complication of whooping cough
Secondary bacterial pneumonia
Vibrio parahaemolyticus releases what enzyme
Secretes Beta-hemolysin
Most GI bacterial infections are _____
Self limiting
T/F late colonizers do not associate with early clononizers
True
Clinical Manifestations of bronchitis
Cough, low-grade fever, sputum production(often clear), wheezing
4 species of Shigella
1. S. dystenteriae- most virrulent, not in U.S. 2. S. flexneri- commonly isolated in U.S. 3. S. boydii- rarely isolated in U.S. 4. S. sonnei- least virulent, most common in U.S.
When are prophylactic antibiotics given?
3-7 days prior to procedure
How many antigenic types of botulinum exist and which are most common
7 antigenic types A,B, and E are most common
Otitis media is most common in (age group)
<3 YOA
Treatment of Clostridium tetani
Aggressive wound care Human tetanus immune globulin(HTIG) Metronidazole or penicillin G Drugs to control muscle spasms
Ludwigs angina treatment
Airway management -tracheostomy if needed Drainage Combinatorial antibiotic treatment(broad spectrum) -Penicillin G+ Metronidazole
Diagnosis of leprosy
Acid-fast stain Biopsies of skin lesion, nerve, nasal or ear specimens
__________ bacteria transport sugars and convert them to acid ________ bacteria survive and proliferate at low pH
Acidogenic Aciduric
Types of infective endocarditis
Acute and Subacute
Clinical manifestations of EnteroAggregative E. coli (EAEC)
Acute diarrhea in healthy patients Cause of persistent/chronic diarrhea in young children and AIDS patients(especially those that are malnourished) Persisten watery non-bloody diarrhea due to formation of thick mucus-bacteria biofilm Colonize in aggregates
Clinical manifestations of Rocky Mountain spotted fever
After 2- 14 of incubation, the patient experiences sudden onset of fever, chills, headache, myalgia, nausea, and vomiting Typical RMSF rash occurs 2-4 days after onset of symptoms, developing first on the wrists, forearms, ankles, then spreading over the body with petechial lesions short after Diagnostic feature of RMSF is the appearance of the rash on the palm and soles
There are two types of microbial succession
Allogenic:non-microbial factors alter community development Autogenic: microbial factors alter community development
Most cases of Rocky Mountain Spotted Fever are caused by
American dog tick
Fusobaterium necrophorum treatment
Ampicillin-sulbactam Piperacillin-tazobactam Ticarcillin-clavulanate
Treatment of pneumonia
Antibiotic choice determined by causative bacteria
Treatment of EHEC E coli
Antibiotics are controversial- they may shorten life of illness or may exacerbate it causing release of more LPS and SLT and may cause HUS Supportive care- rehydration For HUS include -Erythrocyte transfusion -Dialysis
Treatment of Gonococci
Antimicrobial resistance Dual treatment with I.M. Ceftriaxone and oral Azithromycin Can reinfect eye, even if successfully treated 0.5% erythromycin as ophthalmic ointment In 2006, CDC had 5 reccomended options for treating gonorrhea now there is only one
Pathogenesis of N meningitidis
Attaches to non-ciliated cells in nasopharynx and invade them The bacteria induce their own engulfment and pass to the submucosa Enter the bloodstream and/or cross the blood brain barrier and into the cerebrospinal fluid
Pathogenesis of EHEC E coli
Attachment via fibriae and injection of intimin receptor and exporting secretion proteins(Esps) Cytoskeleton modifications produce the attachment and effacing pedestals Shiga -like toxins produced
Treatment of whooping cough
Azithromycin, clarithromycin, and erythromycin - has little effect on course of disease during paroxysmal stage If patient is diagnosed late, antibiotic will not altar course of illness Patient is still contagious 5 days after start of antibiotics
Food intoxication most commonly associated with fried rice
Bacillus cereus
________ __________ (food intoxication bacteria) G+ spore forming rod, present in soil Spores germinate in food and bacteria secrete toxins depending on type of food Foods that are held at warming temperatures for a long time
Bacillus cerus
When bacteria is found in blood it is called
Bacteremia
Rare complications of clinical manifestations of Campylobacter
Bacteremia HUS Reactive arthritis Guillain-Barre Syndrome -40% of GBS cases are preceded by campylobacter infection -1/1000 cases of campylobacter infections lead to GBS
For Salmonella Typhi as the bacterial population increases, they can gain access to the bloodstream causing _______ The ______ endotoxin induces fever slowly increasing and persists Bacteria spread to the ___________ and the _____________ They renter the GI tract causing diarrhea
Bacteremia LPS Biliary tree Urinary tract
Pathogenesis of infective endocarditis
Bacteria enter the bloodstream directly(IV drug use,surgery,trauma) Pathogens adhere to cardiac enothelium, this in turn facilitates the deposition of platelets and fibrin at the site Circulating pathogens bind and form vegitations
Why won't you get O157:H7 E. coli from a steak cooked rare but you can from a hamburger
Bacteria gets on beef from rendering process and if it stays on the surface it will be easily killed but if it's mixed into a hamburger it needs to be completely cooked to be safe
Diagnosis of botulism
Based on clinical symptoms To confirm diagnosis: -test for presence of botulinum toxin in serum, stool, or food -Culture C. botulinum from stool, wound, or food
Diagnosis of Clostridium tetani
Based on clinical symptoms No laboratory tests
Clinical manifestation of Salmonella enterica typhi and complications
Begins with non-specific symptoms(low fever, headache, lethargy, malaise and constipation) Specific symptoms occur after the bacteria disseminate -High, spiking fever with low pulse, chills, flat or rose colored spot on abdomen and chest, abdominal tenderness, enlarged spleen & liver -Diarrhea occur when bacteria reinvade the GI tract Complications- intestinal perforation/bleeding, peritonitis, septic shock and meninghitis
Clinical manifestation of EnteroInvasive E. coli (EIEC)
Blood and puss in stool with fever Like Shigella, these bacteria can spread directly from cell-to-cell through actin polymerization Diarrhea results from cell death rather than any known toxin Does not produce shiga toxin
Diagnosis of infective endocarditis
Blood culture Echocardiogram
Diagnosis of sepsis
Blood cultures to detect pathogen Gram stain Antibiogram
Defenses of the nervous system
Bony casing of brain and spinal cord protect them from traumatic energy CSF serves as a cushion against impact Blood-brain barrier Microglial cells display phagocytic activity Brain macrophages
Pertussis(whooping cough) Etiology _______ ________(bacteria) G________ ______(oxygen usage) Strict _______ pathogen Fastidious
Bordetella pertussis G- coccobacillus Strict aerobe Strict human pathogen
Diagnosis of Actinomycosis
Gram stain and culture of pus or tissues in lesions -look for sulfur granules with Gram + filamentous bacteria
Treatment of botulism
Botulism antitoxin- arrests progression of paralysis Respiratory support Foodborne botulism: laxatives, enemas Wound botulism: Penicillin G after antitoxin has been administered
Treatment of Sinusitis
Broad spectrum anntibiotics Not treatment at all-50% self-resolve
Pathogenesis of Fusobacterium nucleatum
Butyric acid stimulates release of inflammatory cytokines from neutrophils Can invade oral epithelial cells, facilitating the entry of noninvasive bacteria by coaggregating with them -mediated by adhesin A(Fad A) Increases the invasive potential of P. Gingivalis
Fusobaterium necrophorum diagnosis
CT scan and blood culture
Plaque that becomes calcified is referred to as ___________
Calculus or tartar
Leading cause of bacterial-related diarrhea in the U.S.
Campylobacteriosis or campylobacter enteritis
For necrotizing ulcerative periodontitis ______ ______ can also be found in patients with HIV or AIDS
Candida albicans
Shiga toxins cause
Capillary thrombosis and inflammation of the colonic mucosa-> hemorrgagic colitis-> blood in diarhea Systemic effect-> hemolytic uremic syndrome(HUS) Toxins bind to renal tissue inducing glomerular swelling and deposition of fibrin and platelets Complement-mediated platelet, leukocyte and endothelial cell activation-> systemic hemolysis and thrombosis
Virulence factors of N meningitidis
Capsule Fimbriae(type IV pili): attachment to mucosal surfaces, resistance to neutrophil mediated killing LOS: IgA protease FHBP(factor H binding protein)
If microbes gain access to the _________ system they can go to every part of the body
Cardiovascular
Diagnosis of cystitis
Classic symptoms of cystitis: no testing is warranted to make the diagnosis Urinalysis: dipstick and/or microscopic examination Urine culture
When the microbiota reaches a point of stability it is known as the
Climax community
Pathogenesis of Fusobacterium necrophorum
Causes pharynghitis Can invade blood stream and cause serious infection Produces hemagglutinin(platelet agrregation)
Rare condition in which blood clots form within the cavernous sinus Bacteria from another facial region can spread to the cavernous sinus via facial vein
Cavernous sinus thrombosis
______________ Fever, headache, swelling of conjunctiva, muscle paralysis(eye or jaw) Fatal when a thrombus forms in the cavernous sinus
Cavernous sinus thrombosis
Treatment and prevention of salmonella enterica typhi
Ceftriaxone for severe disease Ciprofloxacin for uncomplicated enteric fever 2 vaccines -Live-attenuate oral vaccine- > 6 yoa, 4 doses -Vi Capsule vaccine- > 2 yoa, 1 dose
A. israelii is most commonly associated with __________ __________(disease) A. israelii is found in ______,_______, and _______ _______ It's colonies grow in ____________
Cervicofacial actinomycosis Human plaque, calculus, and tonsillar crypts Pus forming sulfur granules
Asymptomatic carriage of salmonella typhi
Chronic asymptomatic carriage -defined as excretion of bacteria in stool or urine >12 months after acute infection -in 1 to 6% of infections
Clinical manifestations of Aggregatibacter actinomycetemcomitans
Chronic periodontitis -Localized aggressive periodontitis(adolescents) -Destructive periodontal disease(adults) As an opportunistic pathogen -Infective endocarditis
Why is xylitol considered a good control against dental caries
Claimed to be superior to other sugar substitutes because it has a direct effect on bacterial metabolism interfering with sugar metabolism by producing a competitive inhibitor
Diagnosis of Vibrio vulnificus
Clinical manisectations Risk factors Sepsis: blood culture Isolation from stools on selective/ differential media - Thiosulfate citrate bile sucrose (TCBS) agar
Diagnosis of bacterial vaginosis
Clinically done by at least 3 of the following signs -Vaginal fluid with pH>4.5 -Homogenous adherent discharge -Fishy odor -Clue cells on a saline wet mount Gram stain of discharge can be used but it requires more time and expertise
Etiology of lockjaw ________ ___________(bacteria) G____ _____(shape) "________" like spore ______(oxygen usage) Spores present in _____ Normal flora of ______
Clostidium tetani G+ Rod Drumstick Anaerobe Spores present in soil Normal flora found in GI tract of animals
________ __________ (food intoxication bacteria) G+ forming rod, present in soil Most commonly associated canned or fermented meats(fish) and vegetables without adequate sterilization Spores survive and germinate in anaerobic environment- bacteria then produce the relative heat stable toxin(inactivated by boiling for several minutes) The toxin prevents the release of acetylcholine at the neuro-muscular junction causing flaccid paralysis Incubation period is 12 to 36 hr Symptoms include difficulty in swallowing, dizziness, descending muscular paralysis and respiratory compromise
Clostridium botulinum
Botulism Etiology ________ _________(bacteria) CDC Category ___ agent Gram ____ _____(shape) "_______" like spore _________(oxygen usage" Spores present in ______ and ______
Clostridium botulinum CDC Category A agent Gram + Rod "Drumstick" like spore Anaerobe Spores present in soil and marine sediments
Second most common food intoxication in the U.S.
Clostridium perfringens
________ __________ (food intoxication bacteria) G+ forming rod, present in soil Most commonly associated with undercooked meat, fish, gravies, legumes, and vegetables Spores are in the food and germinate in the cooked food- bacteria then produce the heat LIABLE toxin Incubation period 8 to 16 Hr Symptoms include diarrhea, nausea, and abdominal cramps Does not target CNS
Clostridium perfringens
Pathogenesis of cholera
Colonization in the small intestine - Mediated by the toxin-coregulated pilus(TCP) Secretion of the cholera toxi(CT) -Toxin stimulates cAMP production -cAMP causes active secretion of Cl-,Na+,K+ and HCO3- into the lumen Sloughed cells and mucus cause the white flecks in the stool appearing as water in which rice has been washed
Treatment of infective endocarditis
Combination of broad-spectrum antibiotics(>6 weeks) May require surgical debridement of valves
In healthy people plaque has a _______ relationship with the host, but it can become _______
Commensal Pathogenic
Transmission of Cystitis
Community acquired: Endogenously Healthcare associated: Exogenously from obstructions or catheters(Pseudomonas, Serratia, and Enterococcus species)
Clinical manifestation of Sinusitis
Congestion Discharge Sinus pressure/pain Headache
___________ Thin membrane-like tissue Covers the eye(except cornea) and lines eyelids Secretes oil and mucus-containing fluid, which lubricates and protects the eye
Conjuctiva
Inflammation of the conjuctiva
Conjunctivitis or pink eye
Transmission of Vibrio vulnificus
Consumption of undercooked or raw shellfish(especially oysters) Handling seafood, exposure to open wounds or acquiring open wounds in bacteria-contaminated water
Coaggregations of the colonizers can result in unusual formations like "______"
Corn-cobs
_______ Dome-shaped central portion of the eye Over the iris 5-6 layers of epithelial cells
Cornea
Diagnosis of Salmonella enterica typhi
Culture from blood or stool(if antibiotics haven't been given) Agglutination antibodies against O(LPS) and H(flagellar) antigens
Prevention of Clostridium tetani
DTaP vaccine- children< 7 years of age Tdap vaccine- older children and adults Td(adults)- booster every 10 years
Prevention of whooping cough
DTaP- <7yoq Tdap- older children and adults
Bacterial products can cause destruction of tissue by two pathogenic mechanisms which are
Damage from direct hit -direct action of bacterial toxins & enzymes Damage from an indirect hit -exaggerated immune response that results in tissue damage
treatment of osteomyelitis
Debridement Clindamycin 8-16 weeks
Treatment of Fusobacterium nucleatum
Debridement Metronidazole
Predisposing factors of infective endocarditis
Dental disease Recent dental procedure IV drug user Rheumatic heart disease Indwelling catheters Pacemaker Immunosuppression etc
If botulism is left untreated it can progress to cause _________ __________ of ____________,____________, and ___________
Descending paralysis of respiratory muscles, arms, and legs
Diagnosis of Fusobacterium nucleatum
Diagnosis based on symptoms and gram stain
Clinical manifestations EHEC E coli
Diarrhea starts out watery, then becomes grossly bloody Severe cramping Fever is not prominent -10% of children develop hemolytic uremic syndrome —Acute renal failure -3-5% -Most common in young children Thrombotic thrombocytopenic purpura (TPP) is a complication in adults
Most important causes of morbidity and mortality among infants and children
Diarrheal disease
Diagnosis of strep throat
Direct culture of pharyngeal specimen on blood agar(18 hours) Latex agglutination from throat swab specimen(10 min)
Diagnosis of Shigella
Direct microscopic observation of fresh stool sample -presence of RBCs and WBCs Culture of stool sample to isolate bacteria -Hektoen agar -Salmonella-Shigella agar PCR on stool sample
Transmission of conjuctivitis
Direct: fingers Vehicle: contact lenses, eye drops, lens cases, towels Newborns: from mom's birth canal
Chlorhexidine mouthwash prevents bacteria how?
Disrupts bacterial cell membrane(gram+/-)
Prevention of EHEC E coli
Don't eat undercooked hamburgers Wash raw vegetables
Clinical Manifestations of Botulism General: Additional symptoms in foodborne: Additional symptoms in infants:
Double, blurred vision Drooping eyelids Slurred speech Difficulty swallowing Dry mouth Muscle weakness Additional symptoms Additional symptoms in foodborne:Abdominal pain, nausea, vomiting, diarrhea Additional symptoms in infants: poor feeding, diminished suckling and crying ability, neck and peropheral weakness"floppy baby", constipation
As the pocket of the gingival crevice gets deeper redox potential goes ________ and GCF flow is _______
Down Increased
Treatment of Rocky Mountain Spotted Fever
Doxycycline for 7 days Empiric treatment should begin immediately upon suspicion before laboratory confirmation
Treatment of Actinomycosis
Drainage of localized abscess or surgical debridement Mild infections: oral penicillin V or amoxicillin for 2-6 months(alternatives to penicillins: tetracyclines, erythromycin, and clindamycin) Severe infections: Penicillin G for 4 to 6 weeks, followed by oral penicillin V/amoxicillin for 6 to 12 months
Hemorrhagic colitis caused by a strain of ___ _____ referred to as
E. coli EHEC
Escherichia coli strains with distinct pathogenic mechanism EHEC- ETEC- EIEC- EPEC- EAEC-
EHEC- hemorrhagic colitis ETEC- traveler's diarrhea EIEC- gastroenteritis EPEC- gastroenteritis in children EAEC- Persistent diarrhea in children
Treatment of syphilus
Early syphilis- primary, secondary, and latent -Penicillin G(IM) Late syphilis- tertiary -Gummatous and cardiovascular - penicillin G(IM) -Neurosyphilis - Penicillin G(IV)
Compare the two forms of Bacillus cerus that cause food intoxication
Emetic form- Found in rice and pasta Incubation 1-6 hr Vomiting and maybe diarrhea Enterotoxin-Heat stable Diarrheal form Found in meat and vegetables Incubation 8-16 hr Diarrhea and rarely vomiting Enterotoxin- Heat liable
Treatment of sepsis
Empiric antibiotic treatment until agent is known and susceptibilities are determined Drainage of abscesses and necrotic tissue Measure to correct shock and poor oxygenation
Infective endocarditis Inflammation of the _______ -Most of the time it is an infection of the heart valves often _______ or _______ -Most infections occur on ______ or _______ valves-PVE Can occur on ______ valves-NVS
Endocardium Mitral or aortic Damaged or prosthetic Native
Dermis vs epidermis Damage to the ______ does not usually result in bleeding but damage to ___________ does
Epidermis Dermis
Skin defenses
Epithelial cells produce antimicrobial peptides Sloughing off of epidermal cells(25-45 days) Gland secretions(sebum) has a low pH and and is oily Sweat contains lysozyme
T/F you are absolutely going to crush this exam
F-CK yea it's true you studied like an animal and put in the work(note: quizlet does not allow cursing)
Sinusitis is considered a _____ complication of an oral infection
Secondary
Furnucle(Boil) __________ when it reaches deeper in the tissue Can also occur in _____ glands or _____ glands Caused by ____________ Infection usually resolves after __________
Folliculitis Sebaceous glands or sweat glands Staphylococcus aureus Draining the pus
2 categories of food poisoning
Food infection- requires colonization by the infectious agent Food intoxication- this form is toxin-mediated and does NOT require colonization of the host by the pathogen
Transmission of Botulism
Foodborne botulism: food has botulism toxin. Canned or fermented meats without adequate sterilization Wound botulism Infant botulism: spores enter infant intestines where they germinate and release the toxin. Honey has been liked to some cases
Carbuncle A network of ________ connected by sinus tracts beneath the surface of the skin More frequent on the ___________ Painful Can result in ___________ Caused by _________ _________
Furnucles Back if the neck Bacteremia Staphylococcus aureus
____________ act as a bridge between early and late colonizers
Fusobacteria
Shigella G ______ ___(shape) ___(movement) ___(oxygen usage) H2S+______ Lactose fermentation _____ ______ susceptible to acid than other bacteria
G - Rod Non-motile Facultative anaerobe H2S+ negative Lactose fermentation negative Less susceptible to acid than other bacteria
Escherichia coli G __ __(shape) __(movement) __(oxygen usage) Lactose fermentation_____ Sorbitol formation______ H2S+______
G - Rod Some have flagella and all have fimbriae Facultative anaerobe Lactose fermentation with acid + (distinguishes from other enteric pathogens) Sorbitol fermentation with acid +(except for EHEC) H2S negative(distinguishes E coli from Salmonella)
Veillonella G_____ _____(shape) _____(oxygen usage) _____colonizer
G - cocci Anaerobic Early colonizer
Aggregatibacter actinomycetemcomitans G_____ _____(shape) _____(colony shape) _____(oxygen usage) _____ colonizer _____(transmission)
G- Cocccobacilli Star/crossed cigar-shaped colony Facultative anaerobe/Capnophile Late Person-to-person
Salmonella enterica G____ _____(shape) _____(movement) _____(oxygen usage) Glucose fermentation____ Lactose fermentation____ H2S+_____
G- Rod Flagella Facultative anaerobes Glucose fermentation+ Lactose fermentation - H2S+ positive
Capnocytophaga G_____ _____(Shape) _____(movement) _____(oxygen usage)
G- Rod Gliding motility Facultative anaerobe/Capnophile
Fusobacteria G____ ____(shape) ____(oxygen usage) ____(movement)
G- Rod - form long filaments(cigar shape) Strict anaerobe Non-motile
N. meningitidis G___ _____(shape) _____(oxygen usage) _____(capsule?)
G- diplococci, bean shaped Aerobe Polysaccharide capsule
EHEC G_____ _____(shape) Lactose fermentation___ Sorbitol fermentation___ H2S_____
G- rod + - -
Neisseria G____ ____(shape) ____(oxygen usage) ____(media)
G- Diplococci(bean shaped) Aerobes Require enriched media and CO2
Clinical manifestations of Vibrio vulnificus
Gastroenteritis Sepsis(diabetics,HIV, Liver disease, Cancer)-rapid onset Wound infection- 7 days, intense pain & swelling; cellulitis, necrotizing vasculitis and bacteremia
Vibrio parahaemolyticus clinical manifestations
Gastroenteritis Incubation: 24 to 72 hours Ranges from mild watery diarrhea to a frank, dysentery-like syndrome Also, abdominal cramps, nausea, vomiting and low-grade fever
Clinical manifestations of Gonococci
Genital infections -Purulent vaginal discharge -Dysuria -Abdominal pain -Menstrual abnormalities Pharyngeal infection -usually asymptomatic, but may cause sore throat Rectal infection Conjunctiva:severe, acute, purulent
Bacterial vaginosis is caused by a reduction in the number of "___________ bacteria" Overgrowth of certain ___________ bacteria in the vagina(part of flora in low numbers) Is the most common vaginal infection in women ages _____
Good Anaerobic 15-44
What do pioneer species all have in common
Gram + facultative anaerobes
Campylobacter G____ ___(shape) ___(movement) ___(oxygen usage) Campylobacter _____ is the most common Releases what toxin?
Gram - Curve rod Polar fkagellum Microaerophillic Cytolethal distending toxin (CDT) Campylobacter jejuni is the most common
Vibrio G_____ _____(Shape) _____(movement) _____(oxygen usage) _____(Salt tolerance) _____(ideal temperature) _____(environment)
Gram - Curved rod Highly motile(polar flagellum) Facultative anaerobe Halophillic Grows better in warmer temp(May-Oct) Commonly found in marine and brackish water
Enterobacteria G_____ _____(shape) _____(glucose fermentation) Oxidase _____ _____(Enviroment)
Gram - Rods Glucose fermentation + Oxidase - Free-living and part of human and animal flora
What do members of the red complex all have in common?
Gram - Anaerobes
O157:H7 E. Coli is a part of normal flora in the
Gut flora of cattle
Sexually transmitted infections Not nationally reportable:
HPV(most common STI inU.S.) Herpes Trichomonas vaginalis
HACEK organisms
Haemophilus Aggregatibacter Cardibacterium Eikenella Kingella
Folliculitis Superficial infection of the ______ Bacteria form _______ Caused by ________ When it occurs in eyelashes it is a ______
Hair follicle Bacteria form pus Caused by Staphylococcus aureus Stye
Clinical manifestation of Fusobacterium nucleatum
Halitosis(breath malodor) Necrotizing ulcerative gingivitis(NUG) -trench mouth
Virulence factors of Vibrio vulnificus
Hemolysins Metalloproteases- breaks down basement membrabe so bacteria can invade blood stream Mucinase- breaks down mucin DNAse Gram negative LPS Capsule
Teeth have a high or low microbial load?
High due to non-shedding surface
Savila has a high or low microbial load?
High load but cannot be maintained due to rate of swallowing
Reservoir of Shigella and routes of transmission
Humans are the only reservoir Transmission by fecal-oral route -person-to-persom, contaminated food or water, fomites, and sexual contact Outbreaks commonly occur in daycares, nusing homes, mental institutions/hospitals
Reservoir of Salmonella enterica serovar Typhi
Humans are the only resevoir Contaminated water or food via fecal-oral route
Transmission of N.meningitidis
Humans only natural host(asymptomatic carriers-nasopharynx) Person-to-person via inhilation of respiratory droplets Close, prolonged contact
Clinical manifestation of septic shock
Hypotension- Despite fluid resuscitation Organ failure Death
Diagnosis of Rocky Mountain Spotted Fever
IFA to detect antibodies in Public Health or reference labs In addition, immunohistology or PCR of biopsy from rash lesions Antibodies appear around day 7 to 10 of illness
Acute infective endocarditis is common among ________ and the most common etiologic agents are _________ and ________
IV drug users Staphylococcus aureus Streptococcus pneumoniae
Complications of Rocky Mountain Spotted Fever
If left untreated, the lesions can develop into gangrene Complications incluse thrombocytopenia, encephalitis, vascular collapse, thrombosis, renal and heart failure
Clinical manifestation of _________ Blisters become cloudy and as they fill with bacteria Blisters burst and become yellow crusts which weep pus Skin peels off
Impetigo
Defenses of Genital/Reproductive system in men and women
In males: Desquamation along urethra provides protection In females: The vaginal canal is lined with mucosal tissue and mucus -During reproductive years pH is low Exact microbiota flora compositions vary between men and women
Pathogenesis of Campylobacter
Infected cells within the ileum of the small intestine(can include the jejunum and colon) - Bacteria burrow into mucus layer - Entry facilitated by the flagellum - Entrance into cells in vacuole - Membrane ruffles formation - Secretion of CDT - arrest cell cycle of affected cells by DNA cleavage - Inflammatory response
Clinical manifestations of gingivitis
Inflamed-red gingiva Moderate bleeding Pocket depth increases
Pathogenesis of bacterial vaginosis
Inhibitors produced by Lactobacillus spp. prevent colonization or overgrowth by less desirable vaginal flora -H2O2 is produced by some strains of lactobacillus ` — most anaerobes lack catalase and peroxidase and can't eliminate H2O2 -Lactic acid production inhibits anaerobic species
Pathogenesis of Shigella
Invasion across M cell to macrophages Enterocyte invasion leading to cell-to-cell spread via actin tail Disruption of enterocyte cell-to-cell junction by transmission of polymorphonuclear neutrophils(PMNs) -PMNs effectively kill and cause more tissue damage Create ulcers, bleeding, necrosis of colonic mucosa Denuded areas of the intestines form covered with pus and blood
Diagnosis of Cholera
Isolation V. cholerae from stool culture -Thiosulfate citrate bile sucrose(TCBS) agar Immunoassays for CT or O1 and O139 LPS antigen from stool sample
Diagnosis of Salmonella enterica
Isolation from clinical specimen(feces,blood) and growth on selective agar(inhibit growth of G+ bacteria) -Hektoen agar -Salmonella-Shigella agar
Diagnosis of Campylobacter jejuni
Isolation from stool sample on CAMPY-agar -Microaerophillic environment at 42 Celsius
Diagnosis of Vibrio parahaemolyticus
Isolation from stools on selective/differential media -TCBS agae
Clinical manifestations of bacterial vaginosis
Itching and burning sensation Vaginal discharge -Homogenous, thin, grayish-white -Fishy smelling(from metabolic products of anaerobic) -Contain vaginal epithelial cells covered in bacteria(seen by microscopy)
Clinical Manifestations of Clostridium tetani
Jaw cramping, muscle spasms, painful muscle stiffness, trouble swallowing, seizures, headache, fever, sweating, changes in BP and fast HR, can lead to repiratory failure Neonatal tetanus- unhygenic practice during childbirth, unvaccinated mothers, infetion of umbelical cord, about 4 to 14 days after birth, baby becomes irritable and develops muscle spasms, infant can no longer feed, causes respiratory failure
The tongue' doral and lateral surface have specialized mucosa made up of stratified squamous ________ epithelium with hundreds of small protruding _____ of various types
Keratinized Papillae
Types of epithelium in the mouth
Keratinized: gingiva, hard palate and tongues' dorsal and lateral surface Nonkeratinizd: sulcular and junctional epithelium and lining mucosa(lips,buccal,alveolar,softpalate/tongue's ventral surface,floor of the mouth )
Pyelonephritis ________ infection Caused by same causative agents as _______ Bacteria can ascend the ______ to the ______ Sypmtoms of cystitis accompanied by ________ and _____________ Can result in permanent damage to the ________ If it is inadequately treated, it can lead to_______ ____________ __________ therapy should be initiated promptly
Kidney infection Cystitis Ureters to the kidneys Back pain and high fever kidneys Septicemia Empiric antimicrobial therapy
Pathogenesis of Aggregatibacter actinomycetemcomitans
LPS(endotoxin) -Stimulates bone reabsorbtion Leuktoxin IgG protease Collagenase Can invade gingival epithelium
Veillonella uses _____ for growth, and aquires it from nearby bacteria(_________). It then converts it to _______ acids(mainly. ______ acid). Thereby ________ the pH of dental plaque having a ______ effect on dental caries
Lactate Streptococcus weaker Propionic acid Raising Beneficial
Treponema are _____ colonizers
Late
Nesseria contain _______ instead of LPS They also have _____ and _____ membrane proteins
Lipooligosaccharide(LOS) Fimbriae and outer membrane proteins
Diagnosis of bronchitis
Listening to chest reveals bubbling bronchi Sputum samples
A lateral periodontal abscess is an infection usually next to a ________ tooth whit an established ________ ________
Live tooth(not one where pulp is infected) Periodontal pocket
Dorsum of the tongue has a high or low microbial load?
Load is high
Buccal mucosa has a high or low microbial load?
Load is low due to epithelial desquamation, inhabitants of oral epithelium require adhesins for attachment
Symptoms of a pneumonia __________- on one discrete area of the lung(one lobe) Symptoms: chest pain, blood in sputum, high grade fever, chills, and a productive cough, fast onset _________- Inflamation around bronchi or bronchioles(patchy) Symptoms: chest pain, blood in sputum, low grade fever, chills, and a productive cough, slow onset _________- Dry, non-productive cough, fever malaise
Lobar pneumonia Bronchial pneumonia Atypical pneumonia
Forms of aggressive periodontitis
Localized -Adolescents -primarily affects first molars and incisors teeth -robust serum antibody response to infecting agents Generalized -In young adults -Affects at least 3 teeth other than the first molars and incisors -Episodic nature of destruction
______ ________ Tissues of the lower face and neck become markedly swollen and tense leading to difficulty breathing Hardening of the floor of the mouth Malaise fever
Ludwig's Angina
Diagnosis of N meningitidis
Lumbar puncture to obtain CSF -Gram stain -Culture on blood agar
When the composition and size of the microbiota within the biofilm changes over time because of a series of complex interactions and becomes more diverse, it is known as a process called
Microbial succession
Clinical manifestation of EnteroPathogenic E. coli (EPEC)
More common in developing conditions than the U.S. The cause of epidemic infantile diarrhea Traveler's diarrhea No toxin production Diarrhea due to cellular invasion and cell death Produce watery diarrhea containing mucus (non-bloody) with vomiting and fever
Clinical manifestations of Shigella flexneri
More severe manifestations with dysentery(mucus, blood, pus, WBCs)
Etiology of Bacterial vaginosis Most commonly associated with _____ _________ G____ ______(oxygen usage) Not sole etological agent Includes mixed _______ flora
Most commonly associated with Gardnerella vaginalis G+(but gram variable) Facultative anaerobe Not sole etologic agent Includes mixed anaerobic flora
Treatment of Escherichia Coli
Most infections are self limiting Antibiotics are rarely given Rehydration with fluids and electrolytes
Treatment of Shigella
Most infections are self-limiting Antibiotics are rarely given Rehydration with fluids and electrolytes Ciprofloxacin for severe disease
Treatment of Salmonella enterica
Most patients recover without antibiotics Rehydration with fluids and electrolytes Antibiotics for those at risk for complications- ceftriaxone
Treatment of leprosy
Multidrug therapy Tuberculoid form- Daily dapsone and rifampicin for 6 to 12 months Lepramatous form- Daily clofazimine, dapsone, rifampicin for 12 to 24 months
Leprosey etiology _______ _______ (bacteria) Acid fast ______(shape) Cell wall with tons of ______ __________(live in) __________(growth rate) Grown on ______ and _____
Mycobacterium leprae Acid fast bacilli unique phenolic glycolipid (type of mycolic acid) Obligate intracellular pathogen Very slow growth Grown on armadillos and mouse foot pads
Clinical manifestations of __________ __________ -___________: fever, headache, painful/stiff neck, petechiae(rash), increased WBC in CSF -___________: fever, shock, widespread purpura, disseminated intravascular coagulation(DIC), thrombocytopenia and adrenal insufficiency Every 100 survivors will have long term disabilities such as loss of limb(s) deafness, nervous system problems, or brain damage
N meningitidis -Acute purulent meningitis -Meningococcemia
Choleras natural habitat and how it is spread
Natural habitat is brackish water(sea water+ fresh water) and coastal seawater Spread by contaminated food or water(mostly seafood)
Flora in which Salmonella enterica is found and most common route of transmission
Normal flora in poultry, cattle, and reptiles Most common route is contaminated foods- often prepared on contaminated surfaces Can also occur from bacteria on hands after handling pets and not washing properly
Oral spirochites normal flora and oxygen usage
Normal flora of gingival margin and crevice Strict anaerobes
Transmission of Fusobacterium necrophorum
Not exactly known, thought to be person-to-person, but animals also infected
Antigenic structures of Enterobacteria
O-LPS K-polysaccharide capsule H-flagellar protein
Most common antigenic numbers for hemorrhagic colitis
O157:H7
Clinical manifestation of Capnocytophaga
Opportunistic pathogen -Associated with gingivitis and infectios in immunocompromised patients Some sttrains produce IgA protease
Two types keratinized epithelium
Orthokeratinized: cells with keratin only Parakeratinized: cells with keratin and nuclei(found in higher levels)
Fusobacterium nucleatum _____(flora) _____(importance in oral bacteria)
Part of normal oral flora found in gingival crevice Very important to bridge early and late colonizers during plaque formation
For whooping cough the patient is contagious when?
Patient is contagious from beginning of catarrhal stage through 3rd week after onset of paroxysms
What forms as soon as a tooth is cleaned?
Pellicle
Complications of bacterial vaginosis
Pelvic inflammatory disease, infertility, adverse pregnancy outcomes
treatment of strep throat
Penicillin V or Amoxicillin Cephalosporin if allergic to penicillin
Campylobacter rectus Isolated from _______ diseases Produces _______ - Stimulates human ________ _______ to produce proinflamatory cytokines - Similar to Aggregatibacter actinomycetemcomitans
Periodontal diseases Cytotoxin Human gingival fibroblasts
____________ provides the support necessary to maintain teeth in function
Periodontium
Toxins released in whooping cough
Pertussis toxin-results in excessive mucus production Tracheal cytotoxin- destroys ciliated cells
Clinical manifestations of Fusobaterium necrophorum
Pharynghitis(adolescents & young adults) Throat or tonsil infection -Persistent fever -acute pharynghitis -Tonsillitis -Peronsillar abscess Can leave throat and enter jugular vein(about 1 week) -neck tender -sepsis symptoms Lemierres syndrome -Infectious thrombophlebitis of the internal jugular vein
_______ phase: suspended in the saliva _______ phase: attached to oral surface
Planktonic phase Sessile/biofilm phase
NUG treatment
Plaque control -debridement Metronidizale -rapid clinical improvement Oral hygiene
Infection of the lung involving the alveoli
Pneumonia
Aggressive periodontitis is rare and usually happens to patients around the age of __________ or younger and is more common in (Males/Females)
Puberty Females
Clinical manifestations of conjunctivitis
Redness of conjuctiva Pain, irritation, eyelid swelling Thick, white/yellow/green discharge(eyes "" glued shut) Sensitivity to light
Clinical manifestations of strep throat
Redness of the pharynx and tonsils White pus nodules may appear on tonsils Fever, malaise, headache
Treatment of Vibrio parahaemolyticus
Rehydration
Treatment of Cholera
Rehydration with fluids and electrolytes -Oral rehydration preffered as more efficient at providing Na+ to gut mucos Antibiotic can reduce duration and severity -Single dose of azithromycin is the preferred therapy
The cornerstone of periodontal therapy is
Removal of plaque and calculus
Most common site of pathogen entry
Respiratory tract
Complications of strep throat
Rheumatic fever Scarlet fever Acute glomerulonephritis
Etiology of Rocky Mountain Spotted Fever G_____ ______(shape) _______ ________ growth Uses a ________ to leave the phagosome
Rickettsia rickettsii G- small coccobacillus Obligate intracellular Pospholipase
The most common FATAL tick-borne infection in the U.S.
Rocky Mountain Spotted Fever
Most virulent form of shigella
S. dysenteriae- most virulent not in U.S.
Oral bacteria do not encounter naked host surface because of
Saliva
Complications of Salmonella enterica
Salmonella bacteria can penetrate into deep tissue and enter the blood stream. Once bacteria spread beyond intestines -osteomyelitis -pneumonia -UTIs -endocarditis -meninghitis
Species of Salmonella that is the only one of concern for human health
Salmonella enterica
Treatment of Aggregatibacter actinomycetemcomitans
Scaling and root planing Metronidazole and amoxicillin
Aggressive periodontitis treatment
Scaling and root planing Antibiotics to eliminate A actinomycetemcomitans -Metronidazole and amoxicillin combo
Treatment and prevention of campylobacter
Self limiting -fluid and electrolyte replacement Antibiotics should only be given for those who are immunocompromised or those with persistent diarrhea > 1 week - erythromycin or ciprofloxacin
When bacteria flourish, grow, and divide in the bloodstream it is called
Sepsis/ Septicemia
Clinical manifestations of Campylobacter
Severe abdominal cramps- CAN MIMIC APPENDICITIS Fever Diarrhea- frequently bloody with mucus(contain WBCs) Nausea and vomiting may also be present 5-10% chance of relapse
EHEC releases what toxin
Shiga toxin(SLT-I,SLT-II)
How in EHEC E. coli differentiated from other strains
Sorbitol fermentation -
Diagnosis of EHEC E coli
Sorbitol-MacConkey Agar ELISA or PCR to detect the presence of SLT-I/II in stool Blood testing to determine development of HUS
Spirochetes _____(shape) _____(movement) _____(toxin production) Cell wall similar to G ___
Spiral shape Motile by endoflagellum/axial filament Toxin production Cell wall similar to G-
Pathogenesis of Botulism
Spore germination favored by anaerobic environment Botulinum toxin released Absorbed from intestines and carried via blood to peripheral nerves synapses Then, it blocks the release of stimulatory neurotransmitter(acetylcholine) Leading to flaccid paralysis
Pathogenesis of Clostridium tetani
Spore germination is favored by necrotic tissue and poor blood supply Tetanospasmin(tetanus toxin/neurotoxin) released It is taken up by peripheral motor neurons and transported to the spinal cord then, it blocks the release of inhibitory neurotransmitters at spinal synapses Leading to spasmodic contraction of muscle
Transmission of Clostridium tetani
Spores get into the body through broken skin usually through injuries from contaminated objects
Stages of whooping cough
Stage 1: catarrhal stage, like common cold(1-2 weeks) Stage 2: paroxysmal stage—violent coughing sieges(1-6 or even 10 weeks) Stage 3: convalescence stage(2-3 weeks)
Most common food intoxication in the U.S.
Staphylococcus aureus
________ __________ (food intoxication bacteria) G+ cocci Enterotoxin is heat stable Commonly found in high lipid-content food snd processed (high salt) meats Food that has been left unrefrigerated for a few hours Incubation 1 to 6 hours Toxin stimulate nerves leading to nausea, cramping, diarrhea, and vomiting
Staphylococcus aureus
Acute infective endocarditis bacteria
Staphylococcus aureus Streptococcus pneumoniaw
Strep throat Etiology _____ _______(bacteria) G______ ________(shape and formation) ________(movement) ________(spore fomation) ________(oxygen usage) Catalase____ Coagulase____ ___-hemolytic
Steptococcus pyogenes G+ cocci arranged in chains Not motile Non-spore forming Facultative anaerobe Catalase - Coagulase- Beta-hemolytic
The oral epithelium is made of __________ _________ keratinized epithelium that contain _____ ridges and fibrous connective tissues underneath(_____ _____)
Stratified squamous epithelium Rete ridges Lamina propia
Localized alveolar ostetitis cause
Street name: Dry socket Cause: a partial or total disintegrated blood clot within the alveolar socket(not really known if bacterial are involved but there is some proof)
Pioneer species is usually ____________
Streptococcus
Lead actors/ major players of carious lesions ___________ _________ ___________ __________ - Involved in progression of deep enamel lesions(rather than initiation) Primarily, root caries: _______________ ______
Streptococcus mutans Lactobacillus spp. Actinomyces spp.
More than 60 percent of sinusitis cases are caused by _____________ and _______________
Streptococcus pneumoniae Haemophilus influenzae
Most acute cases of otitis media are caused by
Streptococcus pneumoniae Haemophilus influenzae
Bronchitis is most commonly associate with
Streptococcus pneumoniae Haemophilus influenzae, or Mycoplasma pneumoniae
Community acquired pnemonia 40%-__________ __________- Gram positive, diplococci, Alpha hemolytic 10%-__________ __________ -Aerobic, lack cell wall __________ __________ -Used to be a major cause but vaccine has reduced it __________, other bacteria and fungi 30%- __________
Streptococcus pneumoniae Mycoplasma pneumoniae Haemophilus influenzae Legionella Viruses
Pharyngitis 20-30% due to ________ 10-30% due to _________
Streptococcus pyogenes Fusobacterium necrophorum
Clinical manifestations of Cystitis
Sudden onset of symptoms Pain or burning while urinating(dysuria) Frequent urination Feeling the need to urinate despite having an empty bladder Low grade fever Cloudy or bloody urine(hematuria) Pressure or cramping in the groin or lower abdomen.
Pathogenesis of syphilis
Surface mucoid coat proteins act as adhesins for host cell Dense coat of fibronectin is thought to inhibit specific antibody attachment Slow multiplication produces endarteritis and granulomas Spreads rapidly to the bloodstream Clinical stages reflect interaction of bacteria with host and host's response
Treatment of Vibrio vulnificus
Surgical debridement or amputation Minocycline or doxycycline plus either cefotaxime or ceftriaxone
Diagnosis of Sinusitis
Symptoms or CT scan
Diagnosis of whooping cough
Symptoms(whooping) Culture(gold standard) -Regan-Lowe Agar -Samples from posterior nasopharynx(not throat) PCR ELISA to detect IgG against perstussis toxin
NUP tratment
Systemic antibiotic - Generally for patients with loss of attachment -Clindamycin, ampicillin, metronidazole, amoxicillin Dental intervention -debridement and repair
Oral spirochetes species
T denticola- more proteolytic and degrades collagen and dentine(member of red complex) T vicentii T pectinovarum T socranskii
Diagnosis of pneumonia
Tapping on chest -dull sound indicates fluid(consolidation) Chest X-ray Culture sputum sample
Pathogenesis of leprosy
Target cells: Schwann cells of nerves, macrophages, skin histiocytes Phenolic glycolipid: defense against oxidative killing Laminin-binding protein: facilitates binding to basal lamina of peripheral nerve axon unit Internalization of bacteria induces an inflammatory response by the immune system Cell injury and demyelation of peripheral nerve cells Causes local anesthesia and changes in the skin
Best defense of the eye
Tear film
Pathogenesis of Rocky mountain spotted fever
The bacteria spread via the lymphatic system and attach to vascular endothelial cells causing apoptosis Infection leads to direct systemic vascular injury Increasing vascular permeability, hypovolemia and hypotension The damage leads to the measles-like rash and petechial lesions Loss of fluid can lead to necrosis of extremities and other complications
How is the bacteria of hemorhagic colitis generally identified
Their O(LPS) and H(flagellar) antigenic numbers
Treatment of impetigo
Treated with topical mupirocin or retapamulin
Treatment and prevention of N meningitidis
Treatment: Penicillin G or ceftriaxone Prevention: Prophylaxis to those in close contact with the index case(rifampin ciprofloxacin) Vaccine: Meningococcal Conjugate VaccineChildren 11 to 12 yoa with booster at 16 yoa(recommended schedule)
Syphilis Etiology _________ ____________(bacteria) G_______ ________(shape) _______(movement) Obligate ________ pathogen Too thin for transmitted _____ microscopy
Treponema pallidum G- Spirochete Motile Obligate human pathogen Light
Treatment of cystitis
Trimethoprim-sulfamethoxaxole, fluoroquinolone, third or later generation cephalosporin
Treatment of prostatitis
Trimethoprim-sulfamethoxazole or fluoroquinolone
T/F Treponema pallidum does not have LPS in outer membrane
True
T/F Veillonella is not considered a pathogen
True
T/F both the cornea and conjunctiva are exposed to the environment
True
T/F in food intoxication there is no inflammation process and is not transmissible from person to person
True
Clinical manifestation of leprosys ____________: Less severe Hypo-pigmented plaquelike skin lesions with red edges Most common on the face, trunk, and limbs Decreased sensation in lesions(nerve damage) Thickened superficial nerves Strong cell-mediated immunity Limited bacterial growth ____________: More severe Multiple nodular skin lesions Most common on the face with thickening of the looser skin of the lips, forehead, and ears Can lead to loss of nasal bones and fingertips Loss of sensation Can lead to secondary infection Massive demyelination of nerve cells Reduced or absent cell-mediated immunity High numbers of the bacteria in the skin and superficial nerves
Tuberculoid leprosy Lepromatous leprosy
How is Typhi and nontyphoidal salmonella different in pathogenesis
Typhi -induces a mononuclear response instead of an inflammatory response and neutrophil infiltration extended multiplication in macrophages -Typhi remains within a vacuole in an extended replication cycle -Typhi can inhibit the oxidative metabolic burst
How is Typhi and nontyphoidal salmonella similar in pathogenesis
Typhi follows the same invasion and damage of M cells and epithelial cells as nontyphoidal salmonella
Pathogenesis of Cystitis
UPEC uses fimbriae(Type 1 pilli) to attach to perineal and urethra mucosa Some bacteria are lost with void of bladder Can use flagella to help reach target They can use another fimbriae(P-pilli) to achieve a strong binding in the bladder The cells multiply and the LPS induces an inflammatory reaction In some cases the bacteria can ascend the ureter to the kidneys
Diagnosis of prostatitis
Urinalysis Urine Gram stain and culture Direct rectal examination
Diagnosis of Gonococci
Urine,urethral(men),endocervical or caginal, pharyngeal or rectal specimens NAAT Culture:Thayer martin medium Gram smear: Gram - diplococci within neutrophils
Cystitis 80% caused by ________________ Other causative agents include _______ and ______ species or ___________ ___________
Uropathogenic Echerichia coli(UPEC) Klebsiella Proteus Staphyococcus saprophyticus
Virulence factors of bacterial vaginosis
Vaginolysin- adherence to vaginal epithelium Biofilm formation Symbiotic relationship with anaerobes
Treatment of Cavernous sinus thrombosis
Vancomycin plus ceftriaxone for Staph and Strep Metronidazole for anaerobic bacteria
Rickettsia rickettsii has obligate intracellular growth in ___________ ________ cells
Vascular endothelial cells
Transmission of whooping cough
Via respiratory droplets(highly infectious!) Mothers have historically been the most common reservoir of transmission
Cholera eptiology ________ _____ G____ _______(shape) _______(movement) _______(oxygen usage) _______(salt) Sucrose fermentation ____
Vibrio cholerae G- Curved rod Polar flagella Facultative anaerobe Halophillic Sucrose fermentation +
Major cause of seafood-borne illness in asia(mostly japan) The most commonly reported vibrio species in the U.S. Transmitted by consumption of undercooked or raw shellfish(especially oysters)
Vibrio parahaemolyticus
Leading cause of shellfish associated deaths in the U.S.
Vibrio vulnificus
Subacute infective endocarditis bacteria
Viridans streptococci Enterococcus spp. Staphylococcus epidermidis HACEK organisms Fungi(Candida, Aspergillus)
Major species of Vibrio
Vulnificus Parahaemolyticus Cholerae
Prevention of Cholera
Water must be boiled or chlorine/iodine treated- even for brushing teeth Bottled water only while traveling Newly approved vaccine- Vaxchora -Only for O1 serotype
Subacute endocarditis progress over______(period of time), and the main etological agents are _________ and are mainly found in the ______ _______
Weeks to months Viridans streptococci(S. Sanguinis, S oralis, S mutans, S mitis, and S salivarius) Oral cavity
UTIs are more common in ________(sex) and may involve urethra(________), bladder(______), or kidneys(________)
Women Urethritis Cystitis Pyelonephritis
For salmonella all non-typhoidal subspecies are _____ in origin
Zoonotic
Infectious dose of cholera
at least 1 million bacteria
Blister formation causes a separation of the _______ and _______
dermis and epidermis
Infection of the middle ear
otitis media
Prevention of pneumonia
pneumococcal vaccine Hib vaccine