chapter 18 smartbook

streptococcus pneumoniae

... ... which causes pneumonia and otitis media, is a small, gram-positive, lancet-shaped coccus arranged in pairs and short chains that is alpha-hemolytic on blood agar.

staphylococcal scalded skin syndrome

Children with S. aureus infection of the umbilical stump or eyes are susceptible to ... ... ... syndrome (SSSS) where extensive desquamation of the epidermis occurs.

children 5 to 15 years

The group most likely to be affected by skin or pharyngeal infections caused by S. pyogenes includes ______.

acute glomerulonephritis

The inflammation of the kidney glomerulus and tubular epithelia caused by S. pyogenes is known as ______

- reddened mucosa in throat - pain and swelling of throat - swollen tonsils

The main signs and symptoms of pharyngitis include ______

virulence

The major ... factor of S. pneumoniae is its large capsule

- erythrogenic toxin - streptolysin O - streptolysin S

The major extracellular toxins produced by S. pyogenes are ______

pyrogenic

The major extracellular toxins produced by S. pyogenes include streptolysin O, streptolysin S, and ... toxin

subacute endocarditis

The most important complication caused by viridans streptococci is

macrophages; complement

The most powerful host defenses used to combat S. aureus infection phagocytosis by neutrophils and ..., aided by the opsonic action of ...

lower

The overall incidence of CA-MRSA is ... than that of hospital MRSA

- S. aureus - S. epidermidis - S. saprophyticus

The species of staphylococci that are the most important human pathogens include

necrotizing fasciitis

The streptococcal infection ... ... begins at the skin and leads to deeper infection of the muscle, resulting in the sloughing off of tissue

pyrogenic

The toxin produced by Group A beta-hemolytic streptococci that causes the rash and severe fever in scarlet fever is called ... toxin

toxemia; intoxication

Toxin being produced in the body is known as ... whereas toxin ingested via food is known as a food ...

- fomites - direct contact - respiratory droplets

Transmission of S. pyogenes is through ______

false

True or false: Colonization with S. aureus invariably leads to clinical symptoms

true

True or false: Isolates of S. aureus can be resistant to multiple antibiotics.

false

True or false: Prevention of rheumatic fever or acute glomerulonephritis is through vaccination

true

True or false: S. aureus can be found in most environments frequented by humans.

False

True or false: Streptococci are generally resistant to environmental factors such as drying, heat, disinfection, and drugs.

false

True or false: Viridans streptococci cause disease when ingested in food or water

M; erythrogenic

Two types of antibodies can be given for long-term protection against streptococcus group A infections, a type-specific antibody produced in response to the ...-protein and a neutralizing antitoxin for the ... toxin that prevents the fever and rash of scarlet fever

magnesium; exotoxins

Ultra-absorbent tampons bind ... ions causing S. aureus to produce much greater levels of the ... involved in toxic shock syndrome

All are skin abscesses.

What do all cutaneous lesions of Staphylococcus aureus have in common?

The individual usually does not display any signs or symptoms

What happens when an individual is colonized with S. aureus?

Treat the preceding infection

What is the best method to prevent rheumatic fever or acute glomerulonephritis?

folliculitis

What is the name for a mild, superficial inflammation of the hair follicles?

streptococci; chains

When growing in liquid culture, ... generally have a spherical shape arranged in long ...

decrease; increase

When levels of magnesium ions ______, levels of toxic shock syndrome toxin produced by S. aureus ______

- Viridans streptococci usually enter tissues through surgical manipulation. - Viridans streptococci usually enter tissues through dental procedures including brushing gums and teeth.

Which are ways viridans streptococci typically enter tissues to cause disease?

- Tissue injury - Immunodeficiency states - Diabetes mellitus

Which circumstances predispose an individual to infection with S.aureus?

exfoliative toxin

Which factor associated with S. aureus gives rise to staphylococcal scalded skin syndrome?

S. aureus

Which group of staphylococci usually causes the most serious infections?

subacute endocarditis

Which is the most important complication caused by viridans streptococci?

humans

Which is the most significant reservoir for S. pyogenes?

- cells arranged in pairs or short chains - small, lancet-shaped cells - gram positive cells

Which of the following accurately describe the appearance of S. pneumoniae in a gram stain of sputum?

- gram-positive - may be encapsulated - lack spores - lack flagella - catalase positive

Which of the following are characteristics of Staphylococcus species?

- Rheumatic fever - Acute glomerulonephritis

Which of the following are long-term sequelae of S. pyogenes?

- weight loss - anemia - heart murmur - fever

Which of the following are signs and symptoms of subacute endocarditis?

- S. pyogenes - E. faecalis - S. pneumoniae - S. agalactiae

Which of the following are species of streptococci and enterococci most often associated with human disease?

- vomiting - diarrhea - nausea - cramping

Which of the following are symptoms caused by staphylococcal enterotoxin?

- vomiting - rash - liver and kidney complications - fever

Which of the following are symptoms seen in toxic shock syndrome?

- They have a focal pattern - They spread from local cutaneous infections - They spread via the bloodstream

Which of the following are true about systemic staph infections?

Streptococcus pneumoniae

Which of the following causes of pneumonia matches this description: small, gram-positive lancet-shaped cells arranged in pairs and short chains?

Osteomyelitis

Which of the following disorders is not caused by toxin production of S. aureus?

phagocytic response

Which of the following host defenses is considered the most effective in combating S. aureus infection?

scarlet fever

Which of the following is a throat infection caused by S. pyogenes that is accompanied by a bright red rash and high fever?

- Neutralizing antitoxin against the erythrogenic toxin - Antibodies against a strain-specific M-protein

Which two types of antibodies can provide long-term protection against streptococcal group A infections?

The staphylococci are notorious in their acquisition of resistance to new drugs

Why is antimicrobial susceptibility testing of Staphylococcus species essential?

blood culture

Endocarditis is diagnosed through ______.

- Arranged in long, beadlike chains - Spherical shape - Facultative anaerobes

General characteristics of streptococci include which of the following?

- Alpha-hemolytic on blood agar - Residents of the oral cavity

Identify characteristics of the viridans streptococci

pyoderma; erysipelas

Pyogenic infections of the skin caused by S. pyogenes include impetigo, which is also known as ..., as well as the more invasive skin infection called ...

- tonsillitis - pharyngitis

Pyogenic infections of the throat caused by S. pyogenes include ______

bacteremia

Repeated blood samples that are positive for ... are highly suggestive of endocarditis.

localized and systemic disease

S. aureus can cause ______.

systemic

S. aureus can cause disease ranging from localized to ...

environment

S. aureus can frequently be isolated from fomites in the ...

virulence

S. aureus exhibits more ... factors than almost any other pathogen

- hair follicles - skin glands - wounds

S. aureus invades the skin through ______.

hyaluronic

S. pyogenes does not provoke an immune response from its human host due to the presence of ... acid, which is chemically identical to that found in host tissues

hyaluronic acid

S. pyogenes does not usually provoke an immune response from the host due to the presence of ______, which is chemically indistinguishable from that found in human tissue

- skin - pharynx

S. pyogenes gains a foothold in the host, usually when defenses are lowered, through the ______.

beta; sensitive

S. pyogenes is ...-hemolytic on blood agar and bacitracin-..., characteristics used to place this organism in Lancefield Group A

skin

S. pyogenes usually invades the host through the ... , the throat, or the nasopharynx.

penicillinase

Some isolates of S. aureus show multiple resistance to antibiotics; some produce ______, which is used by the bacteria to inactivate some beta-lactam antibiotics

positive; spherical

Staphylococci are gram-______ facultative anaerobes with ______ cells arranged primarily in irregular clusters

aureus, epidermis

Staphylococcus ... , Staphylococcus ... and S. saprophyticusare human commensals and can be pathogenic

enterotoxins

Staphylococcus aureus produces ..., which can cause symptoms of cramping, nausea, vomiting, and diarrhea, appearing in 2 to 6 hours

exfoliative

Staphylococcus aureus produces an ... toxin that separates the epidermal layer from the dermis and causes the skin to peel away.

- Methicillin - Gentamicin - Cephalosporins

Strains of MRSA are generally resistant to which of the following antibiotics?

pharyngitis

Strep throat is more accurately referred to as streptococcal

Penicillin

Streptococcal pharyngitis should be treated with which drug?

Streptococcus pyogenes

Streptolysins O and S, tissue-digesting enzymes, and M proteins are all virulence factors of ... ...

focal; bloodstream

Systemic staph infections usually have a ... pattern, with a local cutaneous infection leading to systemic infection via the ...

catalase

The ... test can be used to distinguish streptococci from staphylococci

Signs and symptoms that may be caused by gonorrhea include ______.

- PID in females - urethritis in males - eye infections in newborns

pelvic inflammatory

... ... disease (PID) occurs when gonorrhea infection ascends from the vagina and cervix to the uterus and fallopian tubes.

petechiae

... are minute hemorrhagic spots in the skin that appear on the trunk and appendages as a sign of meningococcemia

lipopolysaccharide

... released from the cell wall of N. meningitidis has potent pathological effects on the host

carbuncle

A deeper lesion caused by aggregation of a cluster of furuncles into one large mass is known as ______.

silver nitrate; gonococcal

Application of antibiotics, ... ..., or other antiseptics into the conjunctival sac of newborn babies is done as a precaution to prevent ... eye infections

fallopian; ectopic

As a result of PID, scar tissue can build up in the ... tubes, leading to sterility and ... pregnancies.

meningitis

Bacterial ______ constitutes a medical emergency, and must be diagnosed as quickly as possible due to the rapidity of the disease and the potential for a fatal outcome.

fatal; meningococcal

Because the disease progresses rapidly and can have a ... outcome, diagnosis of ... meningitis must be done with great haste and accuracy

- nonmotile - gram-negative - fastidious - bean-shaped cocci - mostly strict parasites

Characteristics of the Neisseria genus of bacteria include ______.

- Pneumonia - Meningitis - Otitis media

Diseases caused by S. pneumoniae include which of the following?

- sterility - ectopic pregnancies

Due to Pelvic Inflammatory Disease (PID), scar tissue can form in the fallopian tubes and can cause ______.

meningitis; endocarditis

Extragenital gonococcal bacteremia can lead to gonococci causing damage to the joints and skin, as well as rare cases of ... in the brain and ... in the heart.

10; 50

Gonorrhea is asymptomatic in ...% of males and ...% of females, which increases the persistence and spread of N. gonorrhoeae

nasopharynx

Humans act as the reservoir for N. meningitidis because 3%-30% of the adult population carries the bacteria in their ______

mucous membranes

In animals and humans, Neisseria are found as resident microflora in the ... ...

sperm

In men, N. gonorrhoeae can cause damage to the ducts carrying ..., which can create scar tissue and blockage and possible infertility in males

- children age 2 or older - students - military recruits - people exposed during outbreaks

Individuals most at risk for meningococcal infection include

carriers

Infants born to gonococcus ... are at risk of infection with gonorrhea during the birth process.

- Safe sex education - Tracking sexual partners - Antibiotic treatment

Methods used to control and prevent gonorrhea infection include:

commensals; pathogens

Most Neisseriaceae are ... but two are primary human ....

neisseria meningitidis

Most individuals have a natural immunity to the meningococcus, ... ... which is indicated by the low infection rate of this pathogen

natural

Most people in the general population have a _______ immunity to meningococci.

pneumonia

Mucus containing a load of bacterial cells being aspirated into the lungs of susceptible patients who have lowered defenses can lead to ...

epidemic cerebrospinal meningitis

N. meningitidis is usually associated with which of the following?

gonorrhoeae; gonorrhea

Neisseria ... causes the sexually transmitted disease known as ...

- mucous membranes of animals - mucous membranes of humans

Neisseria are residents of ______.

young adults

Patient groups most susceptible to pneumococcal disease include all of the following except ______

- sputum - spinal fluid - blood - pleural fluid

Patient specimens that are useful in diagnosing pneumococcal infections include ______

meningococcemia

Petechiae, necrosis of tissues and extremities, and high fever are all signs and symptoms of ______.

pleural; spinal

Pneumococcal infections can be diagnosed using sputum, ... fluid, ... fluid and blood cultures

mucus; lungs

Pneumonia can occur when ... containing a load of bacterial cells is aspirated into the ... of susceptible patients who have lowered defenses

fallopian; anaerobic

Possible complications of PID in women include scarring in the ... tubes, ectopic pregnancies, and mixed ... infections

Screening of pregnant mothers for gonococcus

Prevention of gonorrhea in infants includes which intervention with pregnant women

streptococcus pneumoniae, neisseria meningitidis, streptococcus agalactiae

Put the following in order from most common cause of meningitis in adults to the least common:

eustachian tube

S. pneumoniae gains access to the chamber of the middle ear through the ______.

- Endogenous flora - Respiratory droplets

S. pneumoniae infection can occur through which of the following?

- Urethritis - Yellowish discharge - Painful urination

Signs and symptoms of gonorrhea in males include ______

earaches; deafness

Signs and symptoms of otitis media include painful ... and sometimes temporary ...

negative; cocci; aerobic

The Neisseria genus of bacteria includes organisms which are fastidious, nonmotile gram- ... kidney bean-shaped ... that are ... or microaerophilc.

- Moraxella - Branhamella - Neisseria

The genera found in the family Neisseriaceae include ______.

capsule

The major virulence factor of S. pneumoniae is its ______

pneumococcal

The most common type of bacterial meningitis in adults is ... meningitis

meningococcemia

The most serious complications of meningococcal infection are due to infections in the blood, known as ..., as well as brain infections

Gonorrhea

The presence of Gram-negative diplococci in neutrophils from urethral,vaginal, cervical, or eye exudates is highly diagnostic for which disease?

urethritis

The signs and symptoms of meningococcal meningitis include all of the following except ______.

neisseria gonorrhoeae

The species ... ... is responsible for causing gonococcal ophthalmia neonatorum

droplets; secretions

The transmission route of N. meningitidis is through close contact with respiratory ... or ...

- antibiotics - antiseptics - silver nitrate

The universal precaution to prevent gonococcal eye infections in neonates is the instillation of ______ into the conjunctival sac

endotoxin

The virulence factor ______ has potent pathological effects on the host when when N. meningitidis lyses and it is released

false

True or false: Methods used to control and prevent gonorrhea infection include tracking sexual partners, vaccination, and antibiotic treatment of infections.

false

True or false: N. meningitidis is a more common cause of meningitis in adults than S. pneumoniae.

urethritis; babies

Typical signs and symptoms of gonorrhea include in ... in males, eye infections in ..., and pelvic inflammatory disease in women

- ectopic pregnancies - mixed anaerobic infections - tubal infertility - scarring in the fallopian tubes

What are possible complications of PID in women?

- N. gonorrhoeae infections - Chlamydia infections

What are the leading causes of PID?

- meningococcemia - brain infection

What are the most serious complications of meningococcal infection?

- Petechiae - Hemorrhage - Vascular damage

What are the signs and symptoms of meningococcemia?

Pneumococcal meningitis

What is the most common type of meningitis in adults?

Damage to the ducts carrying sperm can create scar tissue and blockage, leading to possible infertility

What is the result of invasive gonorrhea infection in males?

when transmitted through direct contact

When is N. gonorrhoeae is most infectious?

inflammatory response

When pneumococci infect the lungs, the immune system responds with an overwhelming ______

- prisons - schools - gyms

Where is CA-MRSA most often transmitted?

fimbriae

Which are the main virulence factors of N. gonorrhoeae?

- Gonococcal infection spreading to the upper reproductive structures such as the fallopian tubes - Chlamydia infection of the female reproductive tract

Which can be causes of Pelvic Inflammatory Disease (PID)?

- protease cleaving IgA on mucosal surfaces - surface molecules attachment to other cocci and to tissue surfaces - fimbriae promoting attachment to other cocci and to tissue surfaces

Which of the following are contributing factors to the pathogenicity of N. gonorrhoeae?

- fever - headache - stiff neck

Which of the following are signs and symptoms of meningococcal meningitis?

- Proctitis - Conjunctivitis - Arthritis - Pharyngitis

Which of the following can result from extragenital gonococcal infections occurring in adults?

- Gonorrhea is among the top five sexually transmitted diseases. - Incidence of gonorrhea is probably higher than reported due to asymptomatic infections. - Gonorrhea is strictly a human pathogen

Which of the following statements about Gonorrhea are correct?

- those weakened by viral infections - young children - the elderly - the immunocompromised

Which patient groups are most susceptible to pneumococcal disease?

They must be notified of possible infection because many infections are asymptomatic

Why should sexual partners of individuals with gonococcal infection be tracked down?

nasopharynx; 3

humans harbor N. meningitidis in the ..., with carriage occurring in ...% to 30% of the adult population

inflammatory; fluids

the ... response that occurs when pneumococci infect the lungs is marked by the release of ... into the lungs

adults; sex

the individuals most at risk for gonorrhea are young ... with multiple ... partners

methicillin resistant staphylococcus aureus

what does MRSA stand for?

skin

staphylococci are common inhabitants of the ... and mucous membranes

susceptible

streptococci are generally ... to environmental factors such as drying, heat, disinfection, and drugs

coagulase

the ... test is most often used to distinguish S. aureus from other staphylococcal species

toxic shock

the symptoms seen in ... ... syndrome include fever, vomiting and rash; also potentially fatal complications involving the liver, kidneys, nervous system

50; microbiota

5% to ...% of all people carry S. pneumoniae as normal ... in the nasopharynx

osteomyelitis

A bone infection that occurs when S. aureus establishes itself in the highly vascular metaphyses of a variety of bones is known as ...

staphylococcal scalded skin syndrome

A condition seen in children with S. aureus infections of the umbilical stump or eyes showing skin blistering and extensive desquamation of the epidermis is called ______

rheumatic fever

A delayed inflammatory condition of the joints, heart, and subcutaneous tissues is known as

abscess

A local staphylococcal infection often manifests as an inflamed, fibrous lesion enclosing a core of pus called a(n) ...

folliculitis

A mild, superficial inflammation of the hair follicles is known as ...

necrotizing fasciitis

A streptococcal infection of the skin that leads to deeper infection of the muscle, resulting in the sloughing off of tissue is known as ______.

methicillin and vancomycin

Acronyms such as MRSA and VRSA indicate resistance to which two antibiotics?

gram-positive cocci

In clinical samples, Staphylococci are identified as ______

furuncle/boil

Inflammation of a single hair follicle or sebaceous gland progresses into a large, red, and extremely tender abscess or pustule that is known as a ...

hospitals

Multi-drug resistant strains of S. aureus have become common in ... and therefore strains must be checked for antimicrobial susceptibility.

Erythrogenic toxin

_______ is produced by Group A beta-hemolytic streptococci, causing the rash and severe fever characteristic of scarlet fever

coagulase, hyaluronidase, staphylokinase, lipase, penicillinase, hemolysins, leukocidins, enterotoxins, exfoliative toxins (a,b), toxic shock syndrome toxin

major virulence factors of staphylococcus aureus