microbio exam #3

parenteral prophylaxis: perenteral prophylaxis penicillin allergy: why isn't the antibiotic working?

1. IM or IV ampicillin, cefazolin, ceftriaxone 1. IV clindamycin 2. IM or IV cefazolin or ceftriaxone check pt hx, deep seated abscess, obstruction to natural drainage, foreign body at site of infection, resistant organism

gram +ve: gram -ve: of some non communicable diseases, which bacteria is seen in all of them including periodontal disease??

1 membrane, thick peptidoglycan layer 2 membranes, thin peptidoglycan layer, most antibiotics have to enter cell via PORINS P gingivalis

what is the 2nd choice drug to penicillins? how many side chains?? 1st generation spectrum? 2nd generation? 3rd generation? 4th generation? general characteristics: can patients take cephalosporin (cidal) if they have severe reaction to penicillin? __________ generation drugs preferable if susceptible (except meningiditis), & ___________ is the preferred drug adverse effects of this drug

Cephalosporins & cephamycins TWO!!!!!!! narrow spectrum, (cefazolin & cefaclor) --> intermediate spectrum (cefuroxime) --> broader spectrum (ceftazidime) --> broader spectrum, more resistanct to chromosomally mediated B lactamases (cefepime) semi synthetic, penicillin like pharmacology, MOA, bactericidal activity, older penicillins more potent against bacteria susceptible to penicillins & cephalosporins, some cross allergy bw penicillin & cephalosporins maybe life threatening reaction w/i 30 minutes, cross allergy may occur later but will not be life threatening 1st, cefazolin cross allergy with penicillins, bleeding potential, rashes, arthritis (cefaclor highest incidence)

arboviruses are spread via: acute arbovirus infection results .... typical infections with arbovirus.. common complications?? arbovirus life cycles are closely tied to....... infections show a peak incidence when arthropod is...... humans are .....

arthropod vectors (mosquitos, flea, tick, gnats) undifferentiated mild fever + rash within 4-7d (fever, headache, myalgia, joint stiffness) resolve with no long term effects, but rare secondary infections can happen viral encephalitis (brain, meninges, spinal cord, convulsion, tremor, paralysis, loss of coordination, memory, speech, personality, coma) ecology of vector!! (many in temperate, tropics, or subtropic areas),,, actively feeding & reproducing,,, dead end, accidental, maintenance hosts (control vector = control disease)

what is the most common helminthic infection worldwide? it is prevalent in areas where... transmission? example of intestinal nematode: where are these found? transmission requires... transmission?? hookworms can cause... example of tissue nematode: there is high infection rate of ______ transmission?

ascaris lumbricoides (adult female lays 200,000 eggs/day for as long as a year) human feces are used as fertilizer ingestion of food contaminated with eggs necator americanus (hookworm) tropical, subtropical areas, high rainfall & warm climate -eggs passed in feces, hatch into larvae in soil - larvae penetrate skin of ppl walking barefoot - transported to lungs, swallowed - mature into adults that lay eggs in intestine where they such blood from mucosa iron deficiency anemia, rash, abdominal pain, reduced development in children Toxocara canis DOGS, --> keep pets wormed , people are dead end hosts ingestion of eggs, most infections asymptomatic, larvae invade tissues, make granulomas

B lactam/B lactamase inhibitor combinations: B lactamase inhibitors inhibit B lactamase of which bacteria?? when are B lactamase inhibitors used? adverse effects of penicillins:

augmentin (ORAL) = amoxicillin/clavulanate timentin = ticarcillin/clavulanate unasyn = ampicillin/sulbactam zosyn = piperacillin/tazobactam Ceftolozane/tazobactam Ceftazidime/avibactam Imipenem/relebactam Meropenem/vaborbactam 1. staphylococci 2. Haemophilus 3. N gonorrhea 4. most plasmid mediated B lactamases of Enterobacteriaceae mixed infections, empiric (presumptive) therapy 1. ALLERGY 2. superinfection with high dose 3. rare: CNS toxicity, hematologic neutropenia or bleeding, elevated transaminase

antimicrobial susceptibility testing is a __________ for therapy phenotypic AST requires...... generally covers...... determins.... phenotypic methods: genotypic AST can be done... in genotypic AST, you MUST KNOW.....

guideline isolation of pathogen (pure culture), all resistance mechanisms, relative susceptibility to antibiotics (uses pharmokinetics/pharmodynamics to determine if minimum inhibitory concentration is low enough for usefulness) microdilution, gradient diffusion, disk diffusion, Vitek 2 on isolate OR sometimes directly on specific (use PCR) all or most common genetic determinants of antimicrobial resistance to antibiotics

rifampin spectrum: target of rifampin: what is it used for? side effect? examples of anti-mycobacterials:

gram +ve bacterial RNA polymerases tuberculosis, prophylaxis against meningococcal disease, severe staphylococcal infections (NOTE: resistance emerges rapidly if used alone) turns sweat, tears & urine orange 1. rifampin 2. isoniazid 3. ethambutol 4. paraminosalicylic acid (NOTE: need TWO OR MORE antibiotics to treat TB!!!)

measles virus (red measles, rubeola) is transmitted by... reservoir? where does replication happen? symptoms?? most serious complication?? tx? prevention? human parainfluenza virus causes... ___________ is common mumps causes... reservoir? incubation? symptoms?

respiratory aerosols (droplet) humans ONLY respiratory tract --> lymphatic system via monocytes & lymphocytes KOPLIK SPOTS in mouth, sore throat, maculopapular rash, dry cough, headache, conjuctivitis, lymphadenitis, otitis media, croup, pneomonia + bacterial superinfection (60% of deaths) subacute sclerosing pan encephalitis (SSPE, neurologic degeneration of cortex, white matter, brain stem) supportive, IM-IG immunoprophylaxis VACCINE!! live attenuated viral MMR mild cold like symtpoms, widespread like influenza but more benign, 4 subtypes: 1,2,3 URT infection + LRT infection + laryngotracheobronchitis (croup), 4: mild URT infection reinfection (mild URT ilness, elderly, immunocompromised), no treatment! self limiting endemic parotitis (40% subclinical) humans 2-3wks, fever, muscle pain, swelling of one or both cheeks, malaise, uncommon: epididymis & testes affected, sterility is rare

purpose of differential media it is useful when... example of differential agent: examples of differential media: selective differential media is good for.... critical factors in selecting media: atmosphere, temp & time:

makes organisms look different due to colony appearance normal flora must be differentiated from potential pathogens sugar + pH indicator 1. MacConkey agar (lactose) 2. mannitol salt agar (mannitol) STOOL specimen disease, body site, suspected pathogens, presence/absence normal flora aerobic, anaerobic & increased CO2, 35-37 degree C, 24-48hrs

penicillin G & V are active against most gram ______ bacteria, except producers of _____________ most ________________ & ______________ bacteria are susceptible it is inactive against ________________ it is active against anaerobic flora of mouth such as ______________, however ____% produce B lactamase ____________________ bacteria may have predictive value for diagnosis of oral SSC _____________ bacteria is resistant ________________ antibiotic is active against virtually ALL mouth & respiratory tract Bacteroides & prevotella, and is recommended as drug of choice for ..... of oral cavity

+ve, B lactamase (>90% Staph Aureus!!) N meningitidis, N gonorrhoeae. (moderate for H influenza) ***enterobacteriacaea*** (E coli) prevotella, 50% P melaninogenica bacteroides fragilis CLINDAMYCIN, anaerobic infections

what are biochemical tests for identification? example??? TAT? what are 2 molecular methods? tests for direct detection?

- enzyme + substrate = product that is detected by indicator - requires pure culture 1. catalase = H2O2 --> H20 & O2 2. glucose fermented to acid = decrease pH few minutes-24hrs 1. sequencing: rRNA, HSP65 (TAT=24hrs) 2. mass spectrometry = MALDI-TOF (TAT = 10-30min) 1. microscopy (low sensitivity, good specificity) tat = 15 mins 2. tests for antigen (low sensitivity, excellent specificity, require specific Ab, most EIA/ICA, TAT= 15-30 mins) 3. molecular test (excellent sensitivity & specificity, probes, single NAAT, multiplex NAAT, TAT = 4-24hrs

clostridium difficile is a gram _____, aerobic/anaerobic?, _____shaped organism with the ability to form ______ C difficile produces 2 toxins which cause _________________________??? which antibiotics?? risk factors for c difficile associated disease (CDAD)

-ve, anaerobic, motile rod, spores pseudomembranous colitis AMOXICILLIN, clindamycin, fluoroquinolone, cephalosporins antibiotics, severe underlying disease, older age, immune suppression

example of macrolides: gram +ve or -ve? what kind of infections? drugs of ______ choice to penicillin for most uses in dentistry MOA? about clarithromycin & azithromycin

1. erythromycin 2. clarithromycin 3. azithromycin (safe & well tolerated) +ve 1. streptococcal respiratory infection in penicillin allergic patients 2. mycoplasma 3. legionella 4. less severe staphylococcal infection 2nd inhibits protein synthesis via binding to 50S rRNA ..... resistance has emerged more expensive, better pharmacologically (active against H influenza, less gastric disturbance)

non enveloped DNA viruses include: adenovirus: ________ genome, ___DNA, replicates in _____, _______ virus what tissues are affected? transmission? treatment? symptoms: about papillomavirus: transmission? manifestation? treatment?

1. adenovirus 2. polyomavirus 3. papillomavirus 4. parvovirus linear, dsDNA, replicate in nucleus, lytic conjunctiva, lymphoid tissue, respiratory & intestinal epithelium respiratory & ocular secretions, fecal oral interferon, cidofovir (vaccine only for military) cold like symptom, bronchitis, pneumonia, pharyngitis, acute respiratory disease, conjuctivitis, UTI, GI disease NAKED VIRUS, circular dsDNA, small, non enveloped, icosahedral direct contact or fomite (incubation 2wks-1yr) WARTS regress over time chemicals (podophyllin, salicylic acid, topics), removal (cauterization, freezing, laser surgery)

examples of primary dimorphic fungal pathogens example of opportunistic fungal pathogens fungal pathogenesis: mycoses are classified by... example of superficial mycosis? tx?

1. blastomyces dermatitidis 2. coccidiodes immitis 3. histoplasma capsulatum 4. paracoccidiodies brasiliensis 1. candida albicans (polymorphic) 2. cryptococcus neoformans 3. aspergillus fumigatus 1. adhesion to mucosal surface 2. invasion of host tissue 3. production of extracellular products 4. evasion of immune system the tissues the infect (superficial = outside skin or in hair, cutaneous = invade skin, hair, nails, subcutaneous = localized, enter by trauma, systemic = affects multiple organs or whole body, often starts with lungs & is more virulent) Pityriasis Versicolor --> chronic superficial infection of outer skin due to Malassezia furfur, cause hypo or hyperpigmented scaly lesions Keratinolytic agents (salicylic acid), topical imidazole

classes of antifungal drugs based on MOA it is important to quickly identify which candida sp? what is a parasite? what is a host? life cycle? vector? reservoir? general characteristics of parasites: host response to parasite:

1. compound that effect fungal sterols 2. compounds that inhibit nucleic acid 3. compounds that affect fungal cell wall candida auris in hospital patient (antifungal drug resistance & multidrug resistance is increasing) organism that lives on or in host & gets its food from or at expense of host without killing host (generally only protozoa, helminths & arthropods), it is a EUKARYOTE with well defined chromosome in nuclear membrane organism that parasite lives on/in, can be more than 1 host during life cycle, which often includes larval stages & adult stages in different hosts how organism develops from immature stage --> adult animal that carries parasite to host non human host where parasite can live CHRONIC disease, no effect vaccine, no practical chemotherapy, affect young, underprivileged, vector borne 1. nonspecific immunity (macrophage endocytosis & inflammation, hyperplasia causes host cell proliferation, neoplasia (cancer) rarely seen) 2. specific immune (humoral & cell mediated)

what are the most common non polio enteroviruses: these viruses are responsible for .. herpangina is caused by ______________ coxsackievirus B causes ___________, symptoms? _____________________ are responsible for 1/3 -1/2 of acute sporadic myocarditis presentation? enteroviruses responsible for >85% of ________________ viral (aseptic) meningitis causes ___________

1. coxackieviruses A & B 2. echovirus 3. nonpolioenteroviruses - respiratory infections - herpangina - hand foot mouth disease - conjunctivitis coxsackievirus A, ages 1-7, high fever & sore throat, 2-4mm lesions pleurodynia (bornholm disease, 'devils grip'), fever, unilateral low thoracic pleuritic chest pain, abdominal pain, lasts 4 days, can relapse Coxsackieviruses B2-5 (happens in active adolescence & you adults, males more) flu like first, URT or GI symptom, cardiac symtpoms days-weeks later, cyanosis, rapid breathing, chest pain, tachycardia, myocarditis, hepatomegaly, EKG changes aseptic meningitis acute febrile illness (headache, meningeal irritation, petechiae or rash, lethargy, photophobia, exanthems, biphasic sometimes) (enterovirus also ass. with acute flaccid myelitis in children)

indications for systemically administered antibiotics examples of prophylactic need for antibiotic: conditions that previously required prophylactic antibiotic use but NO LONGER require antibiotics: questions to ask about timing: what if patient forgets to take premed?

1. cure established infection 2. localized infection 3. prevent infection major surgery, accidental trauma, minor oral surgery in immunocompromised patient, risk of endocarditis mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, congenital heart conditions (VSD, ASD, hypertrophic cardiomyopathy) how long, how often, when to acheive peak drug level can be taken after the procedure, or even up to 2hrs after to procedure

what are the cell membrane active antibiotics? which is a novel cyclic lipopeptide spectrum? what does it treat? it is INACTIVE in treating __________ due to... it is administered by _____ & cleared by the __________ MOA? Polymyxin B & colistin is used for? toxicity? last resort option for infections with ________ how is it administered? about colistin resistance: about chlorhexidine:

1. daptomycin 2. polymyxin (very last resort) 3. chlorhexidine daptomycin gram +ve (similar to vancomycin), active against VRE & VRSA skin & soft tissue, bacteremia, endocarditis PNEUMONIA, pulmonary surfactants antagonize daptomycin IV once daily, kidney calcium dependent insertion of lipid tail, depolarization of cell membrane & potassium efflux kills rapidly bactericidal for gram -ve infections, nephrotoxic & neurotoxic!!! acinetobacter, P aeruginosa, enterobacteriaceae (NOTE: found in neosporin, resistance is emerging!) polymyxin = PO, IM, IV, colistin = PO, IV plasmid encoded mrc-1 gene, modifies lipid A causing resistance potential antiplaque agent, very effective, bad taste & stains teeth

2 inhibitors of nucleic acid synthesis: examples of fluoroquinolone? spectrum? ciprofloxacin has poor activity against ______________, and is inappropriate for what age? what is the target of fluoroquinolone? function of DNA gyrase (topoisomerase II)? topoisomerase IV? chromosomal mechanisms of fluoroquinolone resistance:

1. fluoroquinolone (interferes with DNA synthesis) 2. rifampin (oral) ciprofloxacin (oral & IV), levofloxacin (oral & IV), moxifloxacin (oral) broad, poor against anaerobes streptococci, KIDS!! damage to weight bearing joints topoisomerase (regulate conformational changes in DNA by catalyzing breakage & rejoining of DNA strands during cell growth) add -ve supercoil, remove +ve remove +ve supercoil, decatenates daughter chromosomes & plasmids point mutations of QRDR of GyrA & TopoIV = decreases membrane permeability & increases efflux

new inhibitors of protein synthesis (bacteriostatic): tigecycline (IV) is active against: about ketolides about streptogramins: about oxazlidinones: antibiotics high risk for C diff low risk without use of high risk antibiotics:

1. glycylcycline (30S, minocycline, tigecycline) 2. ketolide (50S) 3. streptogramins (50S) 4. oxazolidinone (50S) MRSA, VRE, acinetobacter, enterobacteriaceae (weak vs P aeruginosa, proteus), affects calcified tissues during development, photosensitivity) - macrolide with ketone added for tighter ribosomal binding than macrolide, active vs many macrolide resistant pathogens - EX: Telithromycin (oral) - good for community acquired pneumonia, associated with liver damage & failure Quinupristin-dalfopristin (IV) - synergistic ribosomal binding - active aginst vancomycin resistant enterococcus faecium & MRSA Linezolid (oral + IV) - active vs ALL gram +ve cocci (VRE, MRSA) - skin & soft tissue infection, pneumonia - wider spectrum, oral availability, fewer side effects 3rd and 4th generation cephalosporins fluoroquinolones, lincosamides, beta-lactam/beta-lactamase inhibitor combinations , oral vancomycin, carbapenems, clindamycin first and second generation cephalosporins, macrolides, tetracyclines, metronidazole, sulfonamides

key envelope proteins of influenza: why is an annual vaccine necessary for flu?? influenza A is the most important cause of... complications of influenza A tranmission of flu? where does it bind & replicate? similarities of influenza B & C to influenza A influenza B & C are primarily ______ pathogens influenza B only undergoes _______________ influenza C only has ____ RNA segments, and is typically _____ than A or B

1. hemagglutinin = most important!!!! binding & fusion 2. neuraminidase = hydrolyzes mucus to facilitate movement of virus, assists viral budding & release (OSTELTAVIVIR) 3. M2 = ion channel to facilitate virus uncoating bc the glycoproteins frequently undergo genetic changes!!! 1. antigenic drift (gradual change in AA) 2. antigenic shift (REASSORTMENT!! produces PANDEMIC STRAINS!! when genes of RNA is substituted for a gene of a another flu virus!!) medically attended acute respiratory illness, incubation 1-5days, shedding 3-6 days starting 1 day before symptoms bacteria pneumonia (25% of mortality), exacerbation of preexisting health conditions like asthma, COPD, cystic fibrosis, CHF, high fever, otitis media, myositis airborne ciliated cells of respiratory mucosa --> massive apoptosis, shedding of cells, stripping respiratory epithelium, severe inflammation similar symptoms HUMAN antigenic DRIFT (no subtypes) 7, milder

infections caused by HSV-1 HVS-1 infection:

1. herpes labials = fever blister, cold sore, MOST COMMON, itching or tingling prior, heal in 14days) 2. herpetic gingivostomatitis = oropharynx in young children, fever, sore throat, swollen lymph nodes 3. herpetic keratitis = ocular herpes starts with malaise, anorexia, fever, bilateral swelling of groin, painful urination, cervicitis, itching, recurrent bouts usually less seere

3 settings when would you consider clindamycin before macrolide: which antibiotic can penetrate CSF & humors of eye? when do you prescribe? it will antagonize ________ drugs, & may cause _________ abnormalities adverse reactions to this drug???

1. if B fragilis present 2. CHRONIC staphyloccocal osteomyelitis 3. community acquired MRSA chloramphenicol (never used in dentistry) 1. meningiditis from H influenza 2. N meningiditis if penicillin allergy 3. S pneumonia, 4. S typhi 5. B fragilis bactericidal, hematological 1. fatal aplastic anemia 2. gray baby syndrome (vomit, green stool, gray skin, 40% die) CAN KILL PATIENTS!!!

3 genre of cutaneous mycoses (dermatophytes) common features: examples: these are the only _____________ fungal infections Tinea corporis is ______________ lesion appearance? tx? tinea pedis is the most commmon... tx?

1. microsporum 2. trichophyton 3. epidermophyton - only grow within dermis - make enzymes that degrade keratin, elastin, collagen of skin, hair, nails - mostly troublesome.... not serious Tineas or Ringworms (tinea corpis = non hairy body part, tinea capitis = scalp, tinea pedis = athletes foot, tinea barbae = beard, tinea cruris = jock itch, tinea unguium = nails) REALLY CONTAGIOUS typical ringworm clearing, scaly center with raised red edges (hyphal growth at edges) topical 2-4wks (miconazole, clotrimazole), oral as necessary (itraconazole, terbinafine) dermatophytosis in US, uncommon in children, (chronic infection of toe web, soles, fluid filled lesions dry to itch) keep area dry, mostly topical, oral may be needed (terbinafine, azoles)

examples of enveloped ssRNA NON segmented virus: paramyxovirus is a ___ve sense ssRNA with a ______ subgenomic RNA, envelop has ... where does replication happen?? it is associated with _______________ & __________ 3 genera of paramyxovirus

1. paramyxovirus (measles, mumps) 2. rhabdovirus (rabies) 3. filovirus (ebola) 3. flavivirus (dengue fever) -ve, linear, F spike that initiate cell to cell fusion --> syncytium or multinucleate giant cell formation cytoplasm respiratory transmission, syncitia formation 1. morbillivirus (measles) 2. paramyxovirus (parainfluenza, mumps virus) 3. pneumovirus (respiratory syncytial virus)

how do you do an enzyme immunoassay? what are multiplex PCR panels? how do you do serology indications for serology?

1. specific antibody bound to solid phase 2. add antigen solution, wash 3. add specific antibody+enzyme, wash 4. add substrate .... color reaction if antigen present detect common cauase of syndrome, FAST, good sensitivity & specificity, very expensive!! indirect method to detect specific antibody to infectious agent, antibodies need to be present & in high concentration >4 fold rise in titer = recent infection, <4 fold rise in titer = past infection - retrospective diagnosis if acute & convalescent sera required -most accurate & rapid method if culture is impossible - best indicator of immunity (HBV) -best indicator of population exposure - NOT useful in diagnsosis

metronidazole / tinidazole (expensive) are used as therapy for... it is bacteri______ there is NO activity against ________ bacteria it is an alternative to vancomycin for treating ___________ aminoglycosides MOA: cidal? spectrum? toxicity?? examples of aminoglycosides that are IM & IV? oral & topical?

1. trichomonas & gardnerella 2. anaerobes esp. B fragilis 2. juvenile periodontitis cidal aerobic C difficile protein synthesis inhibition by binding 30S YES!! rapidly bactericidal!! gram -ve & gram +ve OTOTOXIC! nephrotoxic gentamicin, tobramycin, amikacin, netilmicin, streptomycin, kanamycin, plazomicin neomycin

determinants of organism susceptibility amount of heat decreases as moisture level _________ critical items include .... & must be ____________ semicritical items include.... & must use at least ..... noncritical items include .... & can use... clinical contact items include: housekeeping items:

1. type of organism (prokaryotic, eukaryotic, size, lipid envelop, waxy cell wall of mycobacteria, spores = hardest to kill) 2. physiologic stage of organism = ACTIVELY GROWING ORGANISMS MORE SUSCEPTIBLE than older stagnant bc agents work by distrupting metabolism 3. properties of organisms environment (higher tmeps increase agent action, pH must be compatible, thick viscosity decrease agent action, organic material (soil, blood, pus) decrease agent action INCREASES!!! surgical instruments, implants, catheters that contact sterile tissue, STERILIZED endoscopes, endotracheal tubes that mucous membranes or nonintact skin, HIGH LEVEL disinfectant BP cuff, crutches, bedside table contact intact skin, intermediate or low level disinfectants light handle, switches, x ray, pens, intermediate level!! walls, floors, sinks, EPA degergent + water

______ of clinical isolates of prevotella produce _____________ and are resistant to ______ some prevotella produce B lactamase that hydrolyzes ____________, some produce ESBL that hydrolyze ___________ strains reported that are also resistant to ____________ bacteroides produce ______________________ & ________________ leading to ____________ resistance fusobacterium produce __________ gram -ve bacteria efflux pump: gram +ve bacteria efflux pump:

2/3, cefuroximase, 2nd generation cephalosporin cefoxitin, ceftazidime (3rd generation cephalosporin) carbapenem chromosomal cephalospirinases, metallo-B-lactamase, carbapenem resistance. (inactivate aminopenicillins, carboxypenicillins, ureidopenicillins, cefuroximime, aztreonam, 1st & 3rd generation cephalosporins, carbapenems) class D B lactamase tripartite only 1

standard antibiotic regimen for LOW to MODERATE risk bacterial endocarditis: if they can't swallow pills cuz theyre pussy: pencillin allergy: penicillin allergy and can't swallow pills cuz theyre pussy: HIGH RISK antibiotic regimen: HIGH RISK and penicillin allergy: what if patient is already on antibiotics for another condition??

2g amoxicillin orally 1hr before procedure 2g ampicillin IV or IM within 30 mins of procedure - 500mg clarithromycin orally 1hr before procedure - 2g cephalexin or cefadroxil orally 1hr before procedure - 600mg clindamycin orally 1hr before procedure - 1g cefazolin IV or IM 30. mins before procedure - 600mg clindamycin IV 30 mins before procedure - 2g ampicillin IV or IM + gentamicin @ 1.5g/kg IV or IM (do not exceed 120mg) 30 mins before procedure --> repeat 1g ampicillin IV or IM or 1g amoxicillin orally 6hrs later - 1g vanomycin IV 1-2hrs + gentamicin 1.5g/kg IV or IM 30 mins before procedure, no second dose needed!! select a DIFFERENT CLASS (EX: pt already taking amoxicillin --> select clindamycin, azithromycin or clarithromycin)

is cytomegalovirus symptomatic or asymptomatic? transmission? latent? who develops a more virulent form of disease? complications of CMV:

ASYMPTOMATIC saliva, respiratory mucous, breast milk, urine, semen YES fetus, newborn, immunodeficient adults newborns = enlarged liver & spleen, jaundice, capillary bleeding, microcephaly, ocular inflammation --> neurologic sequelae, hearing problem, vision problem, mental retardation

Zika virus is transmitted to humans primarily thru bite of infected _______ mosquito, although... many ppl infected with zika are ......... syptoms? complications? Chikungunya virus (alphavirus) symptoms: complications: tx? vaccine?

Aedes, sexual tranmission male --> female documented! asymptomatic! fever, maculopapular rash, arthralgia, conjunctivitis congenital microcephaly fever & joint pain (polyarthralgia), headache, rash (resolves 7-10days, mortality rare, life long immunity!!) hepatitis, nephritis, encephalitis

aminopenicillins include: this antibiotics are anti .... ____________ has better oral bioavailability & is less likely to.... aminopencillins are inactivated by _____________ spectrum? which bacteria is resistant???

Amoxicillin (oral + IV) & Ampicillin (oral) gram -ve activity amoxicillin, select antibiotic resistance in intestinal flora B lactamase 1. gram +ve (similar to penicillin G) 2. once very active against gram -ve N gonorrhea, H influenza, E coli, salmonella, shigella but not any more. most other anaerobic growing gram -ve are resistance B fragilis (anaerobe)

characteristics of B lactam ring advantages of penicillins G & V, ampicillin & amoxicillin which absorb poor in GI tract (better with IV)? which drugs are drugs of choice for oral therapy? distribution of B lactams: protein binding %? excretion? which penicillin is the shortest acting? next longest? next longest? next? next?

B lactam ring with B lactam bond which is essential for activity & target of B lactamases, side chain, thiazolidine ring, - selective toxicity for bacterial cell wall - all B lactase are bactericidal - most POTENT pound for pound - wide toxic-therapeutic ratio - active over broad range of pH - not inactivated by pus or tissue products - distributes well & can be forced into inaccessible areas - given by variety of routes - very inexpensive Penicillin G & ampicillin Pencillin V & amoxicillin <-BEST all tissues!! hard to penetrate CNS, humors of eye, prostate, bone 25-45% (will inactivate antibiotic) renal as unchanged drug (probenecid competes for tubular excretion and prolong time antibiotic is in body) IM Penicillin G --> Penicillin V oral --> penicillin G oral --> procaine penicillin G --> benzathine pencillin G

viral replication typically occurs where???? synthesis of viral proteins requires... issues with RNA viruses which viruses uses a segmented RNA genome? which uses polyprotein synthesis? which has nested subgenomic RNA? mechanism to hide dsRNA: types of membrane complexes:

CYTOPLASM, may involve special replication complexes that protect against innate immunity & allow for sequestration of viral components HOST machinery, with exception of orthomyxovirus - genetic capacity (RNA is labile, max genome is 30kB) - RNA viruses that do not enter nucleus cannot utilize splicing - dsRNA is a huge signal for innate immunity - RNA viruses must usurp host machinery to synthesize viral proteins - RNA structure provides specificity Flu virus, HCV, coronavirus formation of specialized replication complexes, typically associated with ER or golgi 1. invaginations 2. membrane tubules or vescicles 3. convoluted membranes 4. membranous inclusions

example of arboviruses that are also flaviviruses: other examples of arboviruses: Dengue virus is carried by _________ & _________ symptoms? complication of dengue fever: prevention: west nile virus is carried by ____________ symptoms? tx? vaccine?

Dengue virus, japanese encephalitis virus, St louis encephalitis virus, west nile virus, yellow fever virus, Zike virus Togaviruses, reoviruses, bunyavirus, aphavirus (chikungunya virus) aedes aegypti, aedes albopictus (NOT in USA) fever, headache, retro-orbital pain, joint pain, muscle/bone pain, rash, mild bleeding, neutropenia (3-10days) Dengue hemorrhagic fever (DHF) & dengue shock syndrome (DSS) due to massive cytokine release & inflammatory reaction resulting in wakening & rupture of vasculature and internal bleeding, higher risk for ppl secondarily infected with a different serotype (antibody dependent enhancement) Degvaxia vaccine = live attenuated, tetravalent vaccine Culex mosquitos acute systemic febrile illness, uncommon to have GI or maculopapular rash (70-80% asymptomatic!) <1% develop neuroinvasive disease none, none

death of microbes occurs ______________ probability of a kill is proportional to ____________ & ________________ sterilization involves killing... disinfection involves... antisepsis involves... what is microbicidal? (germicidal, biocidal) what is microbistatic? (fungistatic, bacteriostatic)

EXPONENTIALLY (not all at once) concentration of killer, % of targets still alive (wash ur hands!!) ALL viable forms of organisms EVEN bacterial spores killing MOST organisms usually from surfaces (high, intermediate or low levels) reduction of harmful microbes on animal or plant tissues KILLS microorganisms, sterilizing agents MUST BE microbicidal prevents growth of microorganism, growth can continue when agent is removed

which macrocyclic (macrolide) antibiotic is active against C difficile? MOA? better than metronidazole? systemic absorption? fecal concentration? 2 examples of lincosamides: lincosamides are primarily for _________ infections prolonged use of CLINDAMYCIN causes what??? is it an alternative to erythromycin?

Fidaxomicin inhibits RNA polymerase by binding to promoter yes, more active in vitro than vancomycin against C difficile minimal, high! limited activity in vitro and in vivo against normal gut 1. lincomycin 2. clindamycin anaerobic, sometimes gram +ve pseudomembranous colitis due to C difficile NO!

Which HSV causes encephalitis? which HSV causes whitlows? transmission of HVS ______ & ______ cells are important in establishing latency neonatal herpes is typically caused by _______ and infections infection of... herpetic whitlow and gladiatorum is due to what strains? invovles... ________ is the most common cause of sporadic form of viral encephalitis diagnosis of herpes: tx of herpes:

HSV-1 both! (HSV-1 in dental workers, HSV-2 in gynecology) direct exposure to secretions with virus, initiates at mucoepithelial cells (GENITAL HERPES CAN be transmitted in ABSENCE OF LESIONS, active lesions most significant source) CD8+ T cell, INF-y HSV-2, mouth skin eyes CNS or disseminated disease (deliver by C section!) both, infection of skin thru cut, painful & itchy, HSV-1 encephalitis vesicles & exudate are typical signs, base of lesion shows GIANT cells, PCR of lesions, CSF or blood is preferred, direct fluorescent antibody test 1. Acyclovir (inhibits viral polymerase, thymidine kinase enzyme) 2. famciclovir/penciclovir (acyclic nucleoside analog of guanosine, less potent but better uptake & half life) 3. valacyclovir 4. abreva/docosanol (block fusion of virus with host cell)

types of alpha herpesvirus types of beta herpesvirus types of gamma herpesvirus ALL MEMBERS OF HERPESVIRUS show... viral DNA of herpesvirus forms ___________ where does replication of herpesvirus occur? HSV-1 is acquired in ______________, forms lesions where? HSV-2 is acquired via...., forms lesions where? do lesions have to be visible for spread??

HSV-1, HSV-2, VZV cytomegalovirus, HHV-6, HHV-7 epstein barr virus, HHV-8 (kaposi sarcoma) LATENCY & CAUSE RECURRENT INFECTION episome NUCLEUS (large enveloped isosahedral dsDNA) childhood (close contact), lesions in oropharynx & cold sores & fever blisters (NOTE: latency in trigeminal ganglia, Ubiquitous infection) sexual contact & birth (herpes of newborn-- can occur before, during or after birth), genitalia, NO (SACRAL GANGLION)

aztreonam is a ___________ IV, oral, or IM? active against what? antibiotic resistance mechanisms which oral organism is a reservoir for B lactam resistance genes? the main mechanism of resistnace in the oral cavity is... predominant resistant subgingival isolates include:

Monobactam IV aerobic gram -ve (no activity vs strep & anaerobes) NOT USEFUL FOR DENTISTRY! 1. antibiotic inactivating enzyme (B lactamase) 2. altered target (modified PBP in gram +ve like MRSA) 3. reduced accumulation via reduced permeability of porin GRAM -VE ONLY or active effects in gram +ve & -ve 4. avoidance via biofilms Gram -ve anaerobic bacilli production of B lactamases bacteroides, veillonell, haemophilus, eikenella, capnocytophaga, streptococcus, prevotella (adult periodontitis)

animalia kingdom: about helminths: general characteristics of helminths: types: about arthropods: examples of nematodes: example of cestodes example of trematodes

Multicellular, eukaryotic, heterotrophs, can move on their own = 1. Helminths 2. arthropods elaborate attachment structure, no circulatory system - adults usually large enough to be seen by naked eye - many worms prolific - many have mouth like attachment structures, nutritional requirements met by ingestion of host tissue - many secrete enzymes to destroy host cells & neutralize immunologic & defense mechanisms - ability to alter antigenic properties Nemathelminthes (nematodes & roundworms), Platyhelminths (cestodes = tapeworm & trematodes = flukes) directly cause disease or indirectly as intermediate hosts or vectors, includes chilopoda, pentastomida, crustacea, arachnida, insecta ascaris lubmricoides, necator americanus, toxocara sp., wuchereria bancrofti taenia saginata schisosoma sp.

Do enteroviruses cause enteric disease? shedding of enteroviruses can... reservoir for poliovirus? what happened with vaccine? polio transmission: where does it enter body? it is usually short term, but if viremia persists the virus can spread to... what can happen decades later? tx? prevention?

NO! named for being transmitted fecal oral, disease varies by tissue tropism & cytolytic capcity, often asymptomatic occur for a long period before and after disease! HUMANs only (considered eradicated in US) live attenuated oral vaccine lead to vaccine derived poliovirus (VDPV) oral fecal oropharynx & intestine, multiple & shed in throat & feces lymphatic system --> spinal cord & brain (nonparalytic poliomyelitis, paralytic polio) post polio syndrome = progressive muscle deterioration supportive, VACCINE!! (inactivated polio vaccine IPV)

replication of DNA viruses typically occurs where??? DNA synthesis is most efficient during which phase? ______________ is a DNA virus that is limited to infecting mitotically active cells, while ____________ DNA virus is limited to cellular proliferating cells ___________ & _____________ inhibit cellular DNA synthesis & carry enzymes to increase dNTP pools (thymidine kinase, ribonucleotide reductase, dUTPase) genome is typically incorporated as ________ assembly for enveloped DNA virus typically occurs at site of... 3 kinds of release of DNA viruses __________ usurp the ESCRT budding pathway example of virus maturation:

NUCLEUS, may or may not use host machinery depending on whether virus carries DNA polymerase, synthesis of viral proteins may be regulated temporally S PHASE (larger dNTP pool) parvoviruses, adenoviruses herpesviruses, poxviruses Core membrane acquisition 1. lytic (accumulation of particles until critical mass is achieved, viral signals induce cell death and release of virions) 2. exocytosis 3. budding out of plasma membrane (maturation) HIV occurs during or after budding so virus doesn't affect the same cell or area = HIV, HBV, HCV, papillomavirus, flaviviruses

____________ is the most known calicivirus, and is believed to cause 1/3 of l... transmission? incubation? who gets it? symptoms? complications? example of nonenveloped segmented dsRNa viruses: unusual feature: rotavirus is the primary viral cause of... transmission? it is resistant to... effect on microvilli: vaccine? natural hosts of colorado tick virus? what cells are infected? symtpoms?

Norovirus, viral gastroenteritis oral fecal (highly infectious!!!), airborne also 12-24hrs!!! , all ages any time of year acute onset!, nausea, vomiting, cramps, diarrhea, 12-24hr duration, self limiting rapid to complete recovery! dehydration, chronic diarrhea months to years, death from aspiration of vomit Reovirus (rotavirus, colorado tick fever virus) ** 2 capsids ** mortality & morbidity from diarrhea in infants & children worldwide (incidence similar in developed & developing countries), peak bw 6 -11 months oral fecal, maybe respiratory, common disinfectants blunting, infiltration of mononuclear cells to lamina propria, prevents absorption of water --> DEHYDRATION!!, immunity to infection via IgA rotarix, RotaTeq (live attenuated) ground squirrel & chipmunk erythroid precursor cells sudden onste of fever, chills, headache, myalgia, most have biphasic illness

example of class 1 carcinogen in thailand: parasite responses: protozoa are ____ cell ______ that... nutritional requirements of protozoa are.... many protozoa can exist as ___________ form or ________ form when under adverse conditions, many also have developed elaborate.... examples of intestinal protozoa: example of urogenital protozoa: example of blood & tissue protozoa

Opisthorchis viverrini --> raw fish causing liver cancer - antigenic variation by changing surface glycoproteins regularly - poorly antigenic - hide within host cells - camouflage using bits of host cell to attach to parasite surface - depress host immune response by modulating T cell production single, eukaryotes, can invade lumen (intestinal & urogenital protozoa) or tissues (blood & tissue protozoa) (note: 2-100 um) simple & require assimilation of organic nutrients trophozoite, cyst, immuno-evasive mechanisms 1. Entamoeba histolytica (intestinal) 2. Giardia lambia 3.. crytosporidium sp. (intestinal) 4. enterocytozoon bieneusi 1. trichomonas vaginalis 1. plasmodium sp. 2, babesia sp. 3. toxoplasma gondii 4. leishmania sp. 5. trypanosoma sp,

examples of DNA viruses: examples of RNA viruses: a virus is an..... requires... it is the smallest known.. what is a virion? what is a nucleocapsid? what is a capsid? core? matrix? envelope?

Pox, Herpes, Hepadna, papilloma, parvo paramyxo, orthomyxo, parainfluenza, corona, entero, retro obligate intracellular parasite, host cell metabolic processes & protein synthesis machinery self replicating organism single virus particle nucleic acid protein assembly packaged within virion that is a discrete substructure of particle protein shell surrounding nucleic acid genome nucleic acid + surrounding protein shell viral protein layer associated with virion membrane membrane surrounding virus core

two distinct forms of prion: about PrPc: about PrPSc: how do prions replicate? prions are NOT inactivated by.... recommended sterilization procedures for prion agent:

PrPc & PrPSc (same AA sequence!!!) - high A helix content - protease sensitive - detergent soluble - non infectious - function unknown - derived from PrPc via post translational conformational change - high B sheet content - protease resistant core - detergent insoluble - infectious self propagation (different prion made sporadically, acquired, or inherited) 1. ionizing & UV radiation 2. boiling, autoclaving (121 degree C 20 min) 3. nucleases, proteases, formalin (cadavers) = VERY RESISTANT!! 1. gravity displacement autoclaving at 121 degree C for 30 mins in NaOH 2. 1M NaOH immersion followed by gravity displacement autoclaving at 121 degree C for 1hr 3. 1M NaOH immersion followed by 134 degree C porous load autoclaving 4. immersion in NaOH and boil 10min 5. porous loading autoclaving at 134 degree for 18 min

example of important cestodes: transmission? example of important trematode: lifecycle: _____________ occurs bc parasites release millions of eggs which remain trapped in tissue general characteristics of arthropods: examples of arthropods

Taenia saginata (tapeworm, beef tapeworm) eating insuffienctly cooked beef with encysted larvae Schistosome - tranmission in fresh water when cercariae released from snails - penetrates skin of people, adult worm live in veins and release eggs into water - eggs develop into micacidia which then infect snails LIVER FIBROSIS - ectoparasites - usually no vector - temporary - causes itching, scabs, rashes, redness - often carriers of bacterial infections lice, bed bugs (bite similar to mosquito bites, single or in rows), ticks (blood feeding, found in tall grass, attaches itself by chelicerae & hypostome into skin, deer ticks transmit lyme disease (NOTE: malaria pt's may be more susceptible to HIV)

Expanded spectrum penicillins include: how is it administered? there is an expanded gram ___ spectrum including organism ____________ ______ potent, inactivated by _________, ______ expensive who gets it?

Ticarcillin & piperacillin IV -ve, Pseudomonas (sink drains of office!) less, B lactamase, more serious infections in hospitalized patients, generally NOT used if pathogen is susceptible to older penicillins or 1st generation cephalosporins

what caused the plague? about this organism: incubation? 3 forms of plaque: where are the majority of cases? ___________ is likely in a bioterrorism setting plague pathogenesis: bubonic plague involves formation of .... symtpoms? treatment? characteristic sign of pneumonic plague:

Yersinia pestis from rats, ground squirrels, prairie dogs (found everywhere except australia), fleas spread infection from animal to animal, humans infected when fleas lose normal host and bite humans instead 2-4days non motile, gram -ve bacillus, bipolar (safety pin) staining, non lactose fermenting, urease negative, culture on MacConkey agar, look for capsular antigen 1. bubonic (most common, least mortality) 2. septicemic 3. pneumonic (least common, highest mortality) new mexico, arizona, colorado, califormia aerosol cutaneous lymphatic --> phagocytosed in regional lymph nodes but dont die --> multiply rapidly causing necrosis of lymph node --> bacteremia, septicemia, endotoxemia --> shock, DIC, coma, death buboes = tender lymph nodes, draining area of bite,, fever, chills, headache, exhaustion, antibiotics!! may progress to pneomonic form if untreated bloody/watery sputum!! also have cough, fever, dyspnea, nausea, pain, diarrhea, vomitting--> respiratory failure, darkened extremities from DIC, rapidly fatal

Respiratory Syncytial Virus (pneumovirus) transmission: entry? replication? _______________ spread produces ... symptoms? it is the most prevalent cause of.... tx? vaccine?

aerosols & fomites (ssRNA, segmented, envelope, helical symmetry) epithelia of nose & eye CYTOPLASM nasopharynx, URT, sometimes LRT cell to cell, giant multinucleated cells fever, rhinitis, pharyngitis, otitis, croup (<5 days), lower respiratory infection in young children (25-40% of children show signs of pneumonia or bronchitis) Synagis, Ribavirin NONE! infections in fall, winter, spring, natural immunity doesn't provide protection

test for plague: prevention? vaccine? therapy for adults? post exposure prophylaxis:

antigen detection, IgM immunoassay, immunostaining, PCR pneumonic plague HIGHLY communicable use all precautions, none for pneumonic, formaldehyde killed vaccine for bubonic only Streptomycin 1g IM twice daily for 10 days, (15mg/kg for kids) gentamicin alternative: doxycycline, ciprofloxacin, chloramphenicol Doxycycline 100mg oral twice daily for 7 days, ciprofloxacin

major steps of viral replication: majority of viral infections initiate at _____________ virus binding requires.... extracellular uptake by cell can occur via... 3 ways for virus entry into cell: fusion with plasma membrane requires... what causes conformational change in envelop protein and fusion with endosomal membrane and release into cytosol with endocytosis? uncoating of virus is initiated by... partial uncoating can be used in formation of...

binding/adhesion --> fusion & entry --> uncoating --> replication & gene expression --> assembly --> release/maturation EPITHELIA ( respiratory, conjunctiva, GI, vaginal) specific protein receptors, lipids, CHO phagocytosis, endocytosis (pinocytosis, receptor mediated endocytosis) Fusion with plasma membrane, endocytosis, penetration thru plasma membrane (known mechanism used by non enveloped viruses) receptor binding --> conformational change in envelop protein --> fusion pH change cellular signals -- receptor binding & pH change, may involve release of factors to initiate replication and/or shut off host cell defenses virus replication complex

3 examples of biological agents as toxins: what is Botulinum toxin? how does it work? where are toxins detected? symtpoms: tx: infection control?

botulinum, ricin, staphylococcal enterotoxin B nerve toxin produced by Clostridium botulinum, most lethal compound by weight, different toxicity if inhaled vs ingested blocks release of NT at NMJ and autonomic NS --> palsies & skeletal muscle weakness NOTE: NOT TRANSMITTED person to person serum, stool, GI secretions descending paralysis, floppy baby syndrome, nerve defects (blurred vision, photosensitivity, dilated pupils, drooping eyelids, difficulty speaking/swallowing breathing support, antitoxin standard precautions, 10% bleach for disinfection

genome of HBV it encodes for?????? attachment of HBV to cell is mediated by... virus is released via ________ transmission? incubation? where does replication happen do people develop immunity? latency? diagnosis?? tx? prevention?

circular partially dsDNA REVERSE TRANSCRIPTASE and replicates via RNA intermediate!!! (HBsAg outnumbers infectious virions) HBsAg where it completes to dsDNA (NOTE: HBeAg = shedding, infectious) EXOCYTOSIS!!!! NOT LYTIC!!!! --> CHRONIC INFECTION (small # of ppl, can be acute, chronic, asymptomatic) primarily blood borne, childbirth, sexually (more infectious than HIV) 90 days ONLY LIVER yes in cccDNA (minichromosome), tx of chronic infection does not eliminate cccDNA) SEROLOGICAL TEST !!!!!! - post exposure prophylaxis of anti HB immunoglobulin - acute infection = supportive - chronic = INF-a, nucleoside analogs like tenofovir, entecavir vaccine

viruses tend to have _______ structure positive sense ssRNA is ... negative sense ssRNAis... the ___________________ of a virus is viral in transmission & its mechanism of infection what is a viral envelope?? a NON ENVELOPED virus tends to be more _____________ how do most viruses acquire membrane? what is host range?? what is susceptibility?

conserved... major types = icosahedral & helical translatable RNA (same as mRNA RNA that must be copied into +ve RNA prior to protein expression OUTER SURFACE host derived lipid bilayer carrying viral glycoproteins that forms outer layer of virus particle. advatanges= protective against chemicals & enzymes, disadvantage= LESS STABLE STABLE!!! by budding thru host cell membrane (plasma membrane, ER, golgi, nuclear membrane) cells, tissues, species that a virus can infect (typically limited to host, tissue, cell type!!), range is determined by host cell receptor availability & presence of intracellular host cell factors to support viral replication), range is an absolute measurement! capacity of cell, tissue, species to support virus replication, qualitative measurement based on # of receptor molecules & ability of host cell to support viral replication

Varicella Zoster Virus (VZV) transmission? host? contagious? variecella causes... what is breakthrough varicella? is it latent? does primary infection confer life long immunity? zoster is the ...

contact / aerosolized virus / respiratory droplet, HUMANS, HIGHLY CONTAGIOUS !!!!! chickenpox & shingles VZV of vaccinated ppl, yes! yes reactivation of virus in shingles with vesicles that follow dermatomes, complication = postherpetic neuralgia,

diagnosis of HIV: majority of anti HIV therapies are..... classes? antiretroviral tx of HIV involves ... why is there no vaccine for HIV? prophylaxis? Human T-Cell Lymphotropic Virus (HTLV) transmission: 2 infection outcomes: antiviral?

detection of antibodies at 2 levels: 1. ELISA, latex agglutination, rapid antibody test 2. WESTERN BLOT ANALYSIS to rule out false negatives (blood screen by PCR also done) antiretroviral drugs 1. Nucleoside inhibitors = long elongation (AZT) 2. Non nucleoside inhibitors = inhibit reverse transcriptase (RILPIVIRINE) 3. protease inhibitors = block maturation (post translational cleavage of polypeptide) (Saquinavir) 4. integrase inhibitors = block integrase (RALTEGRAVIR) 5. entry inhibitors = fusion inhibitions & entry inhibitor (ENFUVIRTIDE, maraviroc) combination of 3 antiviral drugs ( 2NNRT + 1 NRT to reduce levels of virus in blood to UNDETECTABLE levels in blood (can still be found in tissues), can slow progression or diminish symptoms 1. bc HIV envelope is HIGHLY variable and quasispecies make it impossible 2. humoral immunity is ineffective!! esp at mucosa 3. integration of virus into chromosome low dose ART in high risk group (prostites, discordant couples) blood, sexual, vertical 1. HTLV associated myelopathy/tropical spastic paraparesis = dysregulation of immune function, neurological symptom, autoimmune like symptoms 2. ATL: adult T cell leukemia NONE!

example of filovirus: ___sense ___RNA, it is a membraned _________ virus, _______ subgenomic RNa expression _______________ receptor that allows it to... transmission? incubation? ebola is inactivated by... initial infection involves which cells? it disseminates to... initial symptom?? detection? tx?

ebola, marburg virus -ve, ssRNA, filamentous, linear (7mRNAs) CHO, bind & enter multiple cell types (macrophage, dendritic, hepatocyte, fibrobblast, adrenal cortical cells) direct contact with virus containing body fluids (eyes, mouth, airborne is rare) 5-7d, up to 21 (death within 6-9d of symptom!) γ radiation, heat, common chemicals Macrophage & dendritic cell lymph nodes, liver, other tissues --> lymphocytes not infected but necrosis of macrophage & dendritic cell in lymph node causes massive apoptosis & cytokine release multi-organ dysfunction, systemic vascular leakage, circulatory failure, anuria (kidney failure), fever, weakness, muscle pain, headache, diarrhea, nausea, vomitting, abdominal pain (mistaken for lassa fever, yellow fever, malaria, typhoid) antigen from urine or saliva (PRIMARY), ELISA, RNA, antibodies NO DRUGS! post exposure prophylaxis with serum transfusion, tx for septic shock & disseminated intravascular coagulation (anticoagulants)

flavivirus is an example of a ... ___ sense with highly structured... prototypic member? how does it enter cell? replication? HCV enveloped but also coated with..... it has a highly error prone __________ flavivirus (DENV) genome has a single ____________ 3 important genes in flavivirus: how is HCV acquired? chronic? HCV treatments:

enveloped, nonsegmented ssRNA virus +ve, 5' & 3' UTRs some vRNa are capped some uncapped HCV receptor mediated endocytosis where they produce a single polyprotein which is cleaved by viral & host proteases membranous ER structures E protein, polymerase (evolve quickly!!) polyprotein 1. NS3: serine protease for cleaving polyprotein, critical for RNA replication & virion assembly 2. NS5A: replication protein 3. NS5B: polymerase BLOOD CONTACT (transfusion, needle stick, sexual contact also documented) YES, many remain infected indefinitely, may have liver damage, cancer! target polymerase complex & protease, INSANELY EXPENSIVE!!! 1. Daclatasvir (target NS5A) 2. Elbasvir-grazoprevir (target NS5A, NS3/4A 3. Glecaprevir-Pibrentasvir (target NS5A, NS3/4A 4. ledipasvir-sofosuvir (target NS5A, NS5B) 5. Sofosbuvir (target NS5B) 6. sofosbuvir-velpatasvir (target NS5A, NS5B

HPVs only replicate in ___________, virus enters wound and attaches to ... HPV replication depends on stage of ... disease manifestion of warts: oral/laryngeal papillomas: genital warts: cervical papillomas & cancer appear within.... what types of HPV? carcinoma results from.... example of segmented single stranded RNA virus: about this virus: where does replication happen?

epithelial tissue (portal of entry, does not disseminate) basement membrane (receptor mediated endocytosis, transcription takes 1-3 days) epithelial differentiation up to 3 month incubation period, seed = painless elevated rough growth on skin, can also be flat, plantar (painful), anogenital benign epithelial tumors (HPV 6/11), pedunculate with fibrovascular stalk with rough surface, laryngeal can be life threatening if obstructing airway, occasionally in trachea or bronchi --> SSC weeks to months post infection, HPV 16/18, partial integration of HPV genome resulting in high expression of E6 & E7 genes orthomyxovirus (flu) enveloped, ssRNA, segmented NUCLEUS!!!!, enters & exits at apical side of cell (all 8 segments of virus have to enter nucleus, virus steals cap from host mRNA = decreases host RNA synthesis to increase virus RNA synthesis)

poxviruses produce..... and they are the.... where do they replicate? transmission of smallpox? _________________ is used to vaccinate against smallpox features of vaccinia virus

eruptive skin pustules called pox that leave scars, largest & most complex animal virueses (largest genome of all human viruses!) !!!!!! CYTOPLASMIC FACTORIES !!! of epidermal cells & subcutaneous CT inhalation or skin contact vaccinia virus (orthopoxvirus) localized pustular lesion at site of inoculation, swelling lymph nodes, usually no secondary lesions, large number of contraindications and complications!!

fungi is an ____________, __________ organism devoid of ____________, obtains nutrients by ___________, and reproduces by ________, are there locomotion structures? cell membrane contains __________ instead of cholesterol, and also contains _________ some species of fungi contain ______ composed of polysaccharides complexed with surface proteins the primary CHO storage produce is ____________ most fungi have _______ that be can elongated by tip growth ________________ have been derived from fungi

eukaryotic, heterotrophic, chlorophyll, absorption, spores, NO!! ergosterol, chitin (long polymer of N-acetyl glucosamine capsule (mannan & glucans-- makes them resistant to phagocytosis) glycogen hyphae pharmacological agents (penicillin, ciclosporin, statins)

HAV transmission? where does it multiply? it is characterized by... symptoms? tx? vaccine? post exposure prophylaxis? rhinovirus infects who? transmission? where does most of replication occur? they are extremely... they cause 50% of _____ infected cells release what? tx? vaccine? prevention?

fecal oral, small intestine where it enters blood --> liver (2-7wk incubation, most infectious subclinically) acute self limiting infection of liver that is NOT lytic flu like symptoms, jaundice, dark urine none, yes, <14d after infection with immune serum globulin & post exposure vaccination only humans & higher primates aerosols & fomites (hands are major vector, picking nose) --> nose, mouth, eyes NOSE!!! stable in environment!! URT infections bradykinin & histamine = runny nose (rhinorrhea), cytokines stimulate expression of virus, interferon limits progression of infection, immunity is transient over the counter, none (multipe serotypes & antigenic drift!, virus hides receptor binding site!!)., good hand hygiene

the ADA recommends NO prophylactic use of antibiotics for _________ & _____________ patients who gets CONSIDERED for prophylactic antibiotics after consultation with orthopedic surgeon?? why should we NOT prescribe prophylactic antibiotics? primary treatment of infection in dentistry is..

heart, joint replacement (in general antibiotics are NOT recommended prior to dental procedures for patients with joint implants, perceived benefit of antibiotic prophylaxis is weighed against development, selectoin & transmission of microbial resistance, stewardship applies to humans & animals) patients with hx of complications who are undergoing gingival manipulation or mucosal incision dental procedures not associated with prosthetic joint implant infections, antibiotics before oral care do NOT prevent PJII, potential hard = anaphylaxis, antibiotic resistance, opportunistic infections like C difficile, benefits may not exceed harm for most patients tracking antibiotic prescription & resistance patterns, reporting this information, education about resistance & prescription

who does toxoplasma gondii infect? transmission? prevent pregnant women from... trypanosoma brucei causes ... transmission? it multiples at.... spreads thru... trypanosoma cruzi causes... transmission?

human & domestic animals inhalation/ingestion of infective oocysts by grazing animals or from infected cat little or by ingestion of muscle tissue containing pseudocytes (steak TarTare) HANDLING CAT LITTER!! sleeping sickness (african trypanosomiasis) bloodsucking tsetse fly site of bite, bloodstream to CNS Chaga's disease = cardiomyopathy 45%, asymptomatic 41%, megaesophagus, megacolon (american trypanosomiasis) (south & central America, kills children) Reduviid bug (kissing bug)

carbapenems include: very potent which bacteria???? others? ___________ has a long half life, once daily dosing, best cabapenem for dentistry imipenem, doripenem, meropenem are used ______ daily, only ___

imipenem, doripenem, meropenem, ertapenem 1. ENTEROBACTERIACEAE 2. gram +ve (NOT MRSA) 3. P aeruginosa 4. anaerobes ertapenem twice, IV .... VERY expensive!!! last resort drug for dentistry, do not use if penicillin allergic, resistance!!!!

coronavirus is a relatively _____ RNA virus, ___ sense , with distinct..... they are common in... 3 types of human coronaviruses: early phase replication: late phase replication: where does replication occur? once virions are assembled they... ____% of adults are seropositive to common respiratory strains primary infection is of _____________ cells, typically this infection is limited to... symptoms? diagnosis? tx? vaccine?

large, +ve, spikes on envelopes, domesticated animals 1. cold causing viruses 2. enteric viruses 3. pandemic coronaviruses (SARS, MERS, COVID-19, airborne, 9% fatal) after entry, genome is translated and polymerase is synthesized which makes -ve sense copy of RNA -ve sense RNA is used to replicate new genomes & produce 5-7 nested mRNA membranous complexes (CYTOPLASM) bud into ER and are released by exocytosis 90 EPITHELIAL, URT cold like, runny nose, cough, sore throat, fever, SARS/MERS = atypical pneomonia with high fever, chills, rigors, watery diarrhea, RT-PCR of respiratory secretion, serology & isolation NOT common none, none

what is an acute viral infection? 2 types of persistent infections: examples of viruses associated with cancer: diagnosis of viral disease: tx of viral disease: vaccines & viruses

may resolve due to immunity or natural course, some produce biphasic disease , some will establish long term persistent infections that last years to a life time 1. latent infection = after lytic cycle, virus enters dormant stage & is generally not detectable, no symptoms, can reactivate (herpesvirus, HBV) 2. chronic infection = virus is detectable in tissue samples, multiplying at slow rate, symptoms mild or absent (HIV, HBV, HCV) 1. epstein bar virus 2. HBV (DNA), HCV (RNA) 3. papillomavirus 4. human T cell lymphotropic virus (HTLV) NOTE: typically promotes cell growth & survival and increased tolerance for DNA mutation 1. serological tests detect Antibodies or viral antigens = ELISA, immunoflourescence (minutes to days, Western Blot) 2. signs + symptoms 3. PCR or RT-PCR detection of viral nucleic acids in blood, mucous, excretion, tissue (1-4 days) 4. isolation/growth of virus in cell or culture, rare, (days to weeks) 1. best tx = targeting unique viral enzymes (viral polymerase & protease, proton pulp, reverse transcriptase drugs for HIV) 2. immune modulating drugs = interferones 3. Ribavirin = synthetic nucleoside analog of guanosine, broad range effectiveness against RNA & DNA viruses effective by safely inducing immune response capable of preventing or attenuating illness, do not completely block infection but prevent disease by rapid clearance, aborting infection, blocking transmission to target organs 1. prophylactic = ACTIVE (MMR, flu) 2. post exposure = ACTIVE and/or PASSIVE (antigen, immunoglobin or both) ( EX: rabies, HBV, vaccinia) 3. therapeutic = ACTIVE, boost immune response to reduce pathology (EX: VZV)

examples of viruses that affect HUMANs only what are zoonoses? what are arboviruses? routes of transmission depends on... example of asymptomatic carrier population & transmission: occupation/activities & transmission: initiation of infection happens at ????

measles, smallpox, herpes simplex virus (many viruses limited to single species diseases naturally transmitted bw humans and other vertebrates, human host may be integral part of virus life cycle or accidental host viruses transmitted via arboviral vectors = mosquitos, ticks, gnats, humans are DEAD END hosts - source of virus - stability of virus in environment (NON enveloped= more stable, enveloped viruses must remain wet) - portal of entry of virus in new host - seasonality - temperature, humidity, vector life cycle - social & economic factors - asymptomatic carrier population - age -travel - occupation 70% of ppl infected with flu are subclinical or asymptomatic, initial infection with HIV results in flu life symptoms farmers are susceptible to cowpox, wrestling & herpes gladiatorum PORTAL OF ENTRY!! activation of innate protection may result in resolution, adaptive immune response may limit or contribute to clinical disease

macroscopic morphology of actinomyces colony: bacillus anthracis? proteus alpha hemolysis beta hemolysis: gamma hemolysis

molar tooth medusa head swarming halo surrounding streptococci smaller halo (strep throat) no halo NOTE: gram +ve = blue/purple, gram -ve = red/pink,,,, spirochete = use dark field microscopy,

epstein barr virus causes: transmission? pathogenesis: latency? EBV drives ... complications from EBV cancers? diagnosis: tx?

mono (kissing disease), ultimate B cell parasite body fluids especially saliva initiates in epithelial cells in oropharynx or nasopharynx --> B cell in tonsil --> virus shed in saliva --> spreads thru lymphatics & blood YES, via B cells that formed B memory cells B cell activation & proliferation, T cells then proliferate = lymphocytosis = symptoms. (LYMPHOPROLIFIC DISEASE) CNS, splenic rupture, thrombocytopenia, agranulocytosis, hemolytic anemia, hemophagocytic syndrome, orthitis, myocardititis, Burkitt lymphoma, hodgkins/nonhodgkins lymphoma, nasopharyngeal carcinoma lymphocytosis, neutropenia, large lymphocytes, cervical lymphadenopathy Acyclovir, disseminated disease= IV gammaglobulin , interferon, antibodies

about Histoplasmosis (histoplasma capsulatum): about Blastomycosis (blastomyces dermatitidis): about coccidioidomycosis (coccidioides immitis): opportunistic mycoses are difficult to... aspergillosis is an _____________ mycoses, generally due to ____________ where is it found who gets it? tx?

most infections asymptomatic & self limiting, form localized granuloma, can disseminate, can mimic TB (ohio, mississippi river valey) disease also seen in horses & dogs, similar to histoplasmosis, mimic TB or lung cancer, symptomatic infection common (ohio, mississippi river valley, missouri, arkansas river basin) infection usually asymptomatic but mortality if untreated disseminated disease (mexico, SW US, south america) diagnose, treat, prevent, cause disease only when host is immunocompromised, >10% nosocomial infection opportunistic, inhalation of spores soil, plants (contacted frequently, rarely cause disease, infection requires profound immunosuppression) gardeners, farmers with underlying disease, cancer & transplant patients, low neutrophil count, NOT common in AIDS patients, usually cutaneous in catheter sites & wounds, can disseminate Ampho B, posaconazole, echinocandin

What is a trophozoite? what is a cyst? what is excystation ? entamoeba histolytica is an ___________ protozoa, features? it creates a typical .......... & also also leads to.... cryptosporidium is an __________ protozoa species that results in endemic... who gets it? cryptosporidia are resistant to __________

motile feeding stage non motile form that is protected by membrane or cyst wall, facilitates host to host transmission process of emergence of trophozoite from cyst intestinal, pseudopod & catches RBC flask shaped ulcer in colonic mucosa, liver abscess intestinal, contamination on municipal water - 1-3% in developed countries, 10% in developing countries, increased in AIDS patients, children, day cares (NOTE: rotavirus is #1 cause of diarrhea in young kids) - Zoonosis (found in animals) chlorination, removal of organisms from water requires filtration

______________________ is primarily an infection of children in endemic areas transmission? in US this is a common _________ how do lesions look? tx? what is monkeypox?

mulluscum contagiosum DIRECT CONTACT STD small, smooth macules in genital area and thighs (AIDS ppl get tumor like growth form) freezing, cauterize, chemicals milder form of smallpox, creates skin pockets, fever, swollen lymph nodes (NOTE: cowpox is rare in humans, usually confided to HANDS, commonly seen in agriculture workers)

entry of smallpox: incubation? when is patient infectious?? when is patient MOST infectious? transmission? secondary spread happens from oset of __________ until _________, are scabs infectious? infection control? patients should IMMEDIATELY be placed in.. major differences between chickenpox & small pox??

oropharynx or respiratory mucosa 7-17days, day 14!!! enanthem & exanthem, 2-4days is prodromal & NOT infectious 1st week of rash droplet nuclei (close face to face contact), 2 outbreaks of airborne, fomites rash, scabs disappear, yes but not highly gloves, gowns, masks, negative air pressure rooms airborne & contact precautions on admission, notify infection control of risk group chicken: -NO PRODROMAL SYMPTPOMS before rash - superficial vescicles described as "dewdrop on rose petal" - lesions appear in crops on any part of body - different stages of lesions - centripetal distribution, more on trunk, few distally MINOR criteria: - may involve face, occasionally entire body is affected - FIRST LESION on face or trunk - usually NOT extremely ill - RAPID evolution of lesions - rarely on hands & feet, no hx of vaccination, many recall exposure to chickenpox or shingles small: - prodromal symtpoms : fever ≥101 & one of the following: prostration, headache, backache, chills, vomitting, severe abdominal pain - deep seated firm hard - rounded & well circumcized - may become umbillicated or confluent - on any part of body but they are all same stage MINOR criteria: - centrifugal distribution with greatest concentration on face & distal extremities - first lesions on oral mucosa, palate, face, forearms - patients appear toxic or moribund - SLOW evoltion of lesions 2-4d - lesions present on hands & feet

what is the nearly ideal antibiotic? mechanism of action of B lactam antibiotics: what specific bond is cleaved by B lactamase? what are the B lactamase resistant penicillins? spectrum of these antibiotics includes... bacteria that are exceptions?? what hinders B lactamase of staphylococci?

penicillin G, penicillin V, ampicillin, amoxicillin inhibit terminal step in peptidoglycan (cell wall) synthesis in GROWING bacteria by binding to penicillin binding proteins (in periplasmic space if gram -ve) which are cytoplasmic membrane enzymes responsible for peptidoglycan synthesis A2pm - D-ala 1. methicillin 2. nafcillin 3. oxacillin 4. cloxacillin 5. dicloxacillin gram +ve cocci & bacilli Listeria, enterococcus, MRSA bulky side chain

examples of nonenveloped nonsegmented ssRNA viruses: kinds of picornaviruses picornavirus is a ______ ____ sense SSRNA, there is a single _________ transmission of picornavirus what is it resistant to? sensitive to? __________ is the major determinant of target tissue where does replication happen? the genome of picornaviruses can bind directly to how is it released by cell? where does virus enter body? ____________ are restricted to URT disease usually results from ????

picornavirus & calicivirus enterovirus (poliovirus, HAV), rhinovirus , cardiovirus small, +ve, polyprotein fecal oral moisture, temperature, acid, organic solvent, nonionic detergent UV, temp >56 degree C, formaldehyde, chlorination cellular receptor cytoplasm where there is polyprotein synthesis ribosomes and initiate translation, shuts off host translation machinery!! LYSIS, except HAV oropharynx, intestinal mucosa, URT, rhinovirus viral effects NOT immune response

candida albicans is a ___________ fungus, can alter.. about candida as a biofilm: key feature of mature biofilm is production of .... what happens if candida is not treated? antifungal drugs target what?

polymorphic , morphology during infection adheres to implanted medical devices growing as resilient biofilm capable of withstanding high antifungal concentration, removal of device is necessary to cure infection extracellular matrix , a polymeric material that promotes adherence and protects biofilm cells form environmental insults, material aids in retention of nutrients, water, enzymes bloodstream infection & invasive fungal infections with high risk of mortality ergosterol (fungal cell wall is composed almost exclusively of molecules that are not found in human body). (((there is a limited number of antifungal drug targets that do not also cause host toxicity!!)

what makes a patient high risk? response for high risk case? what makes patient moderate risk? response? what makes patient low risk? response? smallpox tx: vaccination?

prodrome, classic small pox lesions, all lesions same stage public health emergency!! infectious disease consult, alert health department, do not perform lab , take pictures, prodrome + 1 major criteria OR prodrome and ≥4 MINOR criteria infectious disease/derm consult, varicella testing, skin biopsy, pictures, re-eval daily no febrile prodrome OR febrile prodrome & <4 MINOR smallpox criteria if hx is suggestive of varicella do lab testing, if diagnosis is uncertain test for varicella supportive, fluid intake, pain med, hygiene, ANTIVIRALS DONT WORK primary immunity fades after 5yrs, revaccination protects against death but not minor forms, good for 30 years, post exposure vaccination within 2-3days protects against smallpox, within 4-5days protects against death

influenza diagnosis: influenza tx: flu vaccine is __________ about the inactivated vaccine (traditional): about flu mist vaccine: about flucelvax:

rapid immunofluorescence (detect antigens), serological tests (antibody titer) 1. amantadine & rimantadine (M2 ion channel blockers, 70% effective against influenza A) 2. Zanamivir & tamiflu (neuraminidase inhibitors, effective against all strains, best if taken <30hrs after infection, shorted burden of disease, combination therapy not effective) 3. Xofluza (inhibits endonuclease to block cap stealing) quadrivalent (2 influenza A subtypes, 2 influenza B strains) formalin inactivated whole virus or chemically disrupted split virus with detergent or chemicals, efficacy 60-90%, grown in egg live attenuated, temperature sensitive, grown in egg, removed from market, not for elderly virus producued in tissue culture, NO EGG!!!

SARS-CoV-2 transmission: symptoms? treatment of COVID-19 moderate illness: tx of severe COVID-19 illness: what is NOT recommended for COVID-19 tx???

respiratory secretions fever, cough, SOB, muscle ache, headache mild = above, no pneumonia or mild pneomonia moderate = evidence of lower respiratory disease, SpO2 >94 severe = dyspnea, resp frequency >30 breath/min, SpO2<93, lung infiltrates critical = respiratory failure, septic shock, organ dysfunction/failure if bacterial pneumonia or sepsis is suspected give empiric antibiotic tx, eval daily, no evidence of bacterial infection stop antibiotics place in airborne infeciton isolation room (AIIR), give oxygen therapy, Rimdesivir 5d and/or corticosteroids 10d hydroxychloroquine with or without azithromycin, HIV protease inhibitors, interferones, mesenchymal stem cell therapy, adjunctive therapy, vitamin C, D, Zinc

example of ssRNA genome, reverse transcriptase: ____ major genes, _____ virion 2 hallmarks: human pathogens: 3 major drug targets & 2 minor targets: once HIV enters cell what happens? 2 major types of error generated by reverse transcriptase: what mediates insertion of viral DNa into host chromosome? when does maturation occur? what enzyme cleaves polyproteins?

retroviruses = AIDS!! 3, enveloped 1. Reverse transcription with HIGH ERROR RATE (RT>RNA pol > DNA pol) 2. integration into host genome: insertional activation of oncogenes, markers of evolution) HIV, HTLV Reverse transcription, integration, maturation (protease) Binding & fusion virus uncoats, undergoes reverse transcription ssRNA --> dsDNA mediated by RNA dependent DNA polymerase (reverese transcriptase), DNA imported into nucleus & integrates into host chromosome, proteins made in nucleus will assemble at surface of cell & bud 1. nucleotide misincorporation = alters every aspect of replication 2. strand transfer = deletions, duplications, or insertions, addition/deletion of antigenic & glycosylation sites in envelope integrase (PERMANENT !!!!!!!!!!!!!!!!!) during/after budding, viral protease (required to make virus infectious)

HHV-6 & HHV-7 cause ______ transmission? symptom? high ___________ HHV-8 causes _________ HHV-8 is primarily spread as... what cell is attacked?

roseola (human B lymphotropic virus) = acute febrile illness of babies close contact with saliva/secretions faint maculopapular rash, fever, self limiting, classic exanthems) seroprevalence kaposi sarcoma (endemic in africa AIDS patient) STD (direct contact) B cell

selective media purpose: it is useful when.... what are some selective agents examples of selective media:

selects for certain organisms, inhibits others normal flora must be inhibited dyes, antibiotics, salt 1. MacConkey (crystal violet) 2. CNA (inhibits gram -ve) 3. mannitol salt (only staphylococci will grow)

transmission of HIV? HIV enters thru..... & travels to..... WHERE IS THE MAJOR SITE OF REPLICATION??? symptoms of HIV are directly related to... initial infection symptoms resemble.... and then the person is... when do AIDS symptoms appear? do people with AIDs die from AIDS?

sexual intercourse (butt stuff or coochie style, higher rate of transmission vagina men --> women), transfer of blood or its products, babies infected before or during birth & from breast feeding, IV drug users, DOES NOT SURVIVE LONG outside body mucous membrane or skin, dendritic phagocytes under epithelium & multiples (virus taken up and amplified by macrophages in skin, transports to lymph nodes, bone marrow) LYMPH NODES IN GUT viral blood level & level of T cells mononucleosis, asymptomatic for 2-15yrs when T4 cell <200mm^3 = fever, swollen lymph nodes, diarrhea, weight loss, neurological symptoms, opportunistic infections, cancer, destruction of immune system in gut leads to leakage of gut flora/endotoxins = chronic immune activation NO, they die from opportunistic infections commonly pneumonia

yeasts grow as _____ cells and reproduce by ______ molds are _______, have ____________ forming a mass (mycelium), and reproduce .... what are dimorphic fungi? development of human mycoses is generally related to... ________________ immunity is key determinant in protection 4 criteria of fungi that will allow it to grow in human body a primary fungal disease causes disease in..... whereas an opportunistic fungal pathogen causes... in rare cases, opportunistic fungi can cause infection in healthy individuals when...

single, budding multicellular, filamentous hyphae, sexually & asexually via spores switch bw yeast & mold form in response to environment immunological status of person (humans are naturally resistant to most fungal infections due to immune system) T cell mediated 1. ability to grow at or above 37 degree C 2. ability to reach internal strutures by penetrating or circumventing barriers 3. ability to digest & absorb human tissue 4. ability to withstand immune system any individual regardless of health, disease in immunocompromised ppl enough is inhaled (Vancouver island Cryptococcus gatii)

rhabdovirus is a ..... disease associated with... ______ sense, ______ genome, ______ shaped virions primary reservoirs? transmission? where does replication occur? from peripheral nerves, it spreads... immune response? incubation period? prodromal phase? death? what is the furious form? what is the paralytic (dumb) form? tx? prevention?

slow progressive zoonotic, wild animal bites (fatal once signs appear) -ve, ssRNA non segmented, BULLET wild mammals (also domestic) bite, scratch, inhalation of droplets 1. bite site 2. peripheral nerves, 72hr replication in dorsal root ganglion (therapeutics not effective at this point!!!!) CNS (every neuron can be infected, negri bodies seen!), --> back to periphery, highest levels of virus in salivary glands & sensory nerves of oral mucosa poor!, low or no antibody, low cell mediated immunity 1d-years, 2-10 days (fever, headache, malaise), 18 days avg 80% of patients, encephalitis, hydrophobia (pharyngeal spasm when drinking --> inability to swallow), delirium, agitation, siezures 20% of patients, flaccid paralysis clean wound!!, infuse wound with human rabies immunoglobulin (HRIG), post exposure vaccination with human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV), follow with booster vaccination for high risk (vet), domestic animal vaccination, elimination of strays, live oral vaccine into bait for wild animals

mixed culture involves multiple... it often signifies... spores & capsule stain... color of positive acid fast stain? negative?

species isolated based on colony morphology contamination with normal flora (respiratory, stool, skin, GU tract, environmental), & is NOT diagnostic, ID/AST limited or not done, reported as "mixed flora" different color or unstained (bacillus, clostridium) red (mycobacterium), blue

aminocyclitol aminoglycoside: cidal? purpose? 4 examples of bacteriostatic inhibitors of protein synthesis: tetracycline is active against... short of long acting? which are the long acting tetracyclines? problems with tetracyclines:

spectinomycin NO! bacteriostatic, used for therapy of penicillin resistant gonorrhea 1. tetracyclines (30S) 2. macrolides (50S) 3. lincosamides (50S) 4. chloramphenicol (50S) oral + IV + IM, broad spectrum 1. mycoplasma 2. rickettsia 3. chlamydia 4. good for syphilis in penicillin allergic patients short! doxycycline (oral + IV), minocycline (oral) - affect devoping calcified tissues!!! shunts skeletal development in fetus = do NOT give to pregnant women!! --> dysgenesis - tooth staining - photosensitivty

example of subcutaneous mycosis: it is due to which bacteria??? where is it found? this bacteria produces ______________ disease initial lesion is located where? tx? dimorphic systemic mycoses involve .... where is the primary site of infection for dimorphic systemic mycoses???? other dimorphic systemic mycoses:

sporotrichosis (generally by trauma) Sporothrix schenkii, soil, decaying vegitation rose handlers (thorn prick in ag workers & gardeners) extremities with multiple lesions, develop along lymphatic tract, few systemic signs of illness newer azole (itraconazole) virulent fungi capable of causing infection in healthy people, they overcome cellular defenses by changing from mold to yeast form (geographically restricted) PULMONARY 1. Histoplasmosis. (histoplasma capsulatum) 2. Blastomycosis (blastomyces dermatitidis) 3. coccidioidomycosis (coccidioides immitis) 4. paracoccidioidomycosis (paracoccidiodomycosis brasiliensis)

rubella is ____RNA with a loose _________, causes ____________, most cases reported are in _________ transmission? symptoms of postnatal rubella: symtpmos of congenital (intrauterine) rubella large percent of women and some men develop _____________ as a complication diagnsosis: tx??? vaccine?

ss, evelope, german measles, adolescence & young adults respiratory secretions ages 5-9, malaise, fever, sore throat, lymphadenopathy, rash, lasts 3 days & is mild (similar to measles except NO complex spots!!!!) infection during 1st trimester that induces miscarriage or multiple defects like cardiac abnormalities, ocular lesions, deafness, mental & physical retardation ARTHRITIS serological test NONE, isolation, highly contagious!!! attenuated viral vaccine MMR (not for preggo)

what is autoclave? dry heat oven? low temp? UV? (sunlight) ionizing radiation? (gamma, x ray) ethylene oxide? aldehydes: plasma gas sterilization: ethyl & isopropyl alcohol: chemical disinfection? iodophors: phenols: chlorination: function of spore strip alcohol based hand sanitizers need to be at least _____% alcohol

steam under pressure = 121 degree C, 15 psi, 15 minutes (volme & type of container determins time) takes long 1-16hrs, need higher temp (171 for 1hr), cheap to buy but can melt items, cant do liquid microSTATIC, used for preservation causes mutations, little penetrating power break in nucleic acid, mutations, penetrates well but dangerous GAS sterilization, substitutes alkyl groups for H+ in nucleuc acids , penetrates well, works on wrapped material, good for heat sensitive plastics, equipment, very toxic, 4-6hrs formaldehyde, glutaraldehyde, cross link DNA which stops replication, low cost, immersion for 6-10hrs, carcinogenic, hypersensitivity vaporized hydrogen peroxide, adds microwave or radiofrequency energy, produces free radicals, not toxic denature proteins, 70-95% concentration (doesn't sterilize! doesn't kill fungi & some viruses) hydrogen peroxide, high level disinfectant 3-6%, good cleansing, doesn't burn, loses potency in long term storage wound antisepsis, preoperative skin conditioning, disinfect surface & equipment toxic for skin, disrupt lipid membrane (lysol, chlorhexidine), kills fungi, mycobacterium, many viruses kills HIV, hepatitis virus, norovirus, test efficacy of autoclave, used in gas sterilizer (chemical test strips change color, place inside packaging) 60 (doesn't work on dirty hands, happy bday 2x, not effective against norovirus or C difficile (wash hands!)

core elements of antibiotic stewardship: premed for infective endocarditis prophylaxis?? when is prophylaxis needed for endocarditis? 3 primary portals for bacterial endocarditis ____________ & ______________ organisms are responsible for more than 80% of cases of bacterial endocarditis

surgical debridement, removal of infection, draining pus (ANTIBIOTICS NOT THE FIRST LINE !!! rates of prescription are underestimated, stewardship programs should address this!) risk of adverse rxn to antibiotics outweighs the benefits for many patients, premeds only used for a small subset of patients prosthetic cardiac valve, previous infective endocarditis, congenital heart disease, unrepaired cyanotic CHD (pallative shunt & conduits), completely repaired congenital heart defect with prosthetic material or device for 1st 6 mos after procedure, repaired CHD with residual defects at site, cardiac transplantation with regurgitation oral cavity, skin & URT streptococcal, staphylococcal (streptococcus viridans, staph species, HACEK organisms)

lipoglycopeptide antibiotic: how is it administered? MOA? telavancin vs vancomycin 2 antimetabolite antibiotics? function?? using these antibotics together leads to... sulfonamides treat..... trimethoprim treat...

telavancin IV, 9hr half life, once daily dose inhibits cell wall synthesis like vancomycin, also disrupts membrane depolarization more nephrotoxic & expensive! 1. Sulfonamide = oral, mimic & compete with PABA blocking folic acid synthesis --> bacteriostic 2. Trimethoprim = oral & IV, blocks reduction of dihydrofolate to tetrahydrofolate --> bactericidal/ static sequential & synergistic inhibition of folic acid synthesis ACUTE UTI, Nocardia infections (not relative to dentistry) CHRONIC UTI, Nocardia infections

example of urogenital protozoa: cyst formation? form? host? transmission? who gets it? example of blood & tissue protozoa: where is plasmodium found? transmission? life cycle?

trichomonas vaginalis NO!!! trophoziote!! HUMAN ONLY!!! (doesn't survive in environment) sexual contact, adult women (25% will get it in lifetime) Plasmodium & toxoplasma gondii & trypanosoma brucei & trypanosoma cruzi africa, mosquito (swamps) - sporrozoites in salivary gland of mosquito - goes into human blood - replication in liver & RBC - gametocytes can infection mosquito to begin lifecycle again

a glycopeptide antibiotic includes _________, MOA? vancomycin is NEVER used for gram _____ infection how is it administered? dose? spectrum??? it is an alternative to penicillin for ______________ caused by viridans streptococci & enterococci, and is a drug of... resistance has emerged in which species? about vancomycin resistance: what kind of toxicity? other? it causes __________ syndrome bc...

vancomycin, cell wall/peptidoglycan synthesis by inhibiting transglycosylase --> peptidoglycan weakened --> cell lysis, inhibits growth by binding to the 2 terminal D alanines -ve oral, IV, IM once or twice daily GRAM +VE!!!! endocarditis, LAST resort for gram +ve infections enterococci (acquired VAN gene), S aureus, reduced susceptibility in MRSA it is hard to transfer vancomycin resistant genes bc they all need to be transfered, resistances involved replacement of D alanine with D lactate nephrotoxic, ototoxic, sometimes cardiac effects, rashes, phlebitis, neutropenia redneck/redman, histamine release (slow IV infusion reduces this)

cell culture is used for cultivating ____________ & ___________ artificial culture media is a _________ system, most cultivate __________ & ___________ what are the 2 forms of artificial media? enriched media is used for cultivating ____________ enriched media includes..... utilizes what kind of agar? what organisms need enriched media??

viruses & highly fastidious bacteria (obligate intracellular parasites that need a cell to grow), cytopathic effects are observed non-living, bacteria, fungi 1. liquid broth : soup with nutrients, becomes turbid with growth, you CANNOT assess the purity 2. solid agar: liquid+agar, <=45 degreesC, colonies created, purity CAN be assessed nutritionally fastidious organisms!! vitamins, minerals, cofactors, Chocolate & blood agars 1. haemophilus 2. neisseria (gonorrhea, meningiditis)

antibiotic regimens: when are multiple antibiotics superior to a single antibiotic when are bactericidal drugs superior to bacteriostatic drugs? do bacterial infections require a complete coursE?

when infection is severe and organism is unknown only when host is immunocompromised NO, must monitor improvement of patient daily (2-7days)

cryptococcosis is caused by cryptococcus neoformans & is ALWAYS a ______________ forms __________ that have undergone huge ploidy increase it is a hallmark infection of ___________ where is it isolated from? symptoms? Tx? about cryptococcus gattii: candida is present in the _______ in 60% of healthy people, can colonize... candidiasis is the most .... infection with candidiasis is associated with...

yeast (encapsulated) titan cell AIDS patients soil, bird droppings mild infection begins in lungs, may go systemic, predilection for CNS --> slowly developing meningitis (headaches, dizziness, irritability, confusion, may mimic brain tumor, abscess or MS) mortality if untreated is 100%, amphotericin V, oral azole, found in vancouver island and spread to washington and oregon, infected healthy humans & animals, mouth/gut, almost every niche of human body and is commensal of mucosal microbiota prevalent opportunistic human fungal pathogen & the 3rd leading cause of all bloodstream infections (systemic candidiasis is deadly >40% mortality) immunosuppression, diabetes, broad spectrum antibiotics, corticosteroid use, denture use

prion diseases are .. there is _______ degeneration of ______ therapeutic agent? incubation period? immune response? example of prion disease: rapid prion replication occurs where? bodily distribution of prions: etiologic agent: high risk tissues containing prions: medium risk tissue: low risk:

zoonotic, transmissible neurodegenerative diseases (motor + cognitive) spongiform, CNS NO, inevitably fatal LONG (years to decades), NO adaptive immune response mad cow, Kuru, creutzfeldt jakob disease, scrapie spleen during subclinical phase (potentially transmitted by blood) trigeminal ganglia, salivary gland, saliva, tongue, dental pulp, gingival tissue amyloid deposition in brain contains amyloid fibrils & prion proteins brain, spinal cord, spinal/cranial ganglia, dura mater, cranial nerves, posterior eye anterior eye, cornea, olfactory epithelium, tonsil, appendix, spleen, thymus, lymphoid tissue saliva, peripheral nerve, dental pulp, gingival tissue, blood & bone marrow, CSF, placenta, urine